Learning Beyond the Basics of Cadaveric Dissection: a Qualitative Analysis of Non-academic Learning in Anatomy Education.

Rapidly advancing technologies have undeniably altered how medical education is taught; the anatomy lab is no exception. With a recent shift away from traditional cadaveric dissection and towards technology-based learning methods, medical educators are left wondering what students learn beyond the basics of anatomy during their course of human dissection. Especially considering the recent dramatic changes to the way medical education is conducted in the new era of a global pandemic, we must ensure students are not missing learning experiences that are critical to their development as future physicians. What are students gaining from cadaveric dissection that they otherwise could not gain from technology-based learning alone? Thematic qualitative analysis was used to review surveys collected from four anatomy classes over a two-year period; line-by-line coding of the surveys was then arranged into themes representative of specific learning experiences gained uniquely from human dissection. These themes demonstrated evidence of professional identity formation, self-reflection, and building teamwork skills; importantly, many students demonstrated a shift in thinking about their cadaver as less of a tool and more of a patient, which allowed them to generalize their experience in lab towards their future careers in medicine. These unique learning experiences cannot be replicated with technology-based learning alone. While cadaveric dissection may play a smaller role in the future of medical education, we must ensure we continue to provide students with learning experiences that are critical to their development as medical providers, especially if these experiences go beyond the anatomy basics.

Medical Student Experiences in Operation Bushmaster 2019: "I Now See Myself as Equal Parts Physician and Leader."

INTRODUCTION: Operation Bushmaster, a 5-day high-fidelity medical practicum bringing together fourth-year medical students, graduate nursing students, international students, and physicians and other medical professionals in emergency and operational medicine from across the world, is the capstone event of the Uniformed Services University of the Health Sciences's Military Unique Curriculum. It is designed to simultaneously test students' medical knowledge, leadership skills, and grace under fire. For many students, this experience represents one of the first times that they concurrently inhabit the dual roles of military officer and (soon-to-be) physician. This is likely the most "tactical" and stressful military simulation that many students have experienced. METHODS: In this qualitative study, we analyzed a data set of 49 de-identified reflective articles written by fourth-year medical students following the completion of Bushmaster, in order to understand what students gained from the experience. Additionally, we evaluated students' responses through the lens of the threshold concept, looking for ontological shifts, integration, discursiveness, and troublesomeness during students' Bushmaster experiences. RESULTS: We identified 10 themes throughout the essays that highlighted the lessons learned during the Bushmaster experience, including its importance in guiding professional identity formation and students' deepened understanding of the unique responsibilities and pressures of the role of military physician. CONCLUSION: One of the resulting themes, "the military physician," met our criteria for a threshold concept, in that it was transformative, integrative, and troublesome. Before Bushmaster, many of the students saw themselves simply as medical students rather than as almost doctors. Following the field practicum, some identified more strongly with the role of military physician, while others continued to overestimate the amount of time remaining to complete the transformation from student to doctor or to integrate the roles of physician and military officer. Moreover, we identified the entirety of Bushmaster as a threshold experience. This work serves to further describe the liminal space in which military medical students reside on their journey to physician, as well as the moment of realization by many that becoming a military physician encompasses more than simply the sum of the roles of physician and military officer.

Threshold Concepts in a Literary Magazine Produced by Health Care Students.

This article was migrated. The article was marked as recommended. Introduction: Progress Notes is a literary magazine featuring works from health care students in the USA. It is edited by medical students at the Uniformed Services University of the Health Sciences (USUHS) to provide a space for their creative works. Since the magazine's inception in 2016, four volumes have been published, containing 130 works of poetry, fiction, reflection, and artwork. Goal: To understand the themes and perspectives of the published works. Methods: After Institutional Review Board approval, two researchers used qualitative thematic analysis to examine the texts, coding independently and resolving differences by discussion. They arranged the codes into themes which were discussed until consensus. A third researcher read the texts, codes and themes and verified that they were an accurate reflection of the published works. Artwork was assigned themes by the same two researchers who analyzed the written works, and a sample selection was verified by the third researcher. Results: Researchers identified eight themes across poetry, fiction, and reflective essays: vocation, death, failure/resilience, emotional restraint, personhood of the patient, approach to the patient, military physicians, and moments of personal realization. Four themes were identified in the artwork: death; comradeship/aloneness; vocation/quest; and competence. Discussion: Students submitted creative works in which they grapple with what it means to be a physician. Analyzed through the lens of the threshold concepts, researchers identified: "I am a healer;" "I can deal with ambiguity;" "The patient is the focus;" "As a military medical officer, I serve two masters;" and "As a physician, I have a unique and complex relationship with death." These threshold concepts represent an ontological shift in the students' professional identity. Conclusion: A literary magazine edited, and featuring works by, health care students provides a forum in which health care students wrestle with the elusive and enigmatic fundamental principles of being a physician.

"It's Okay to Say 'I Don't Know'": Medical Students Use Transformative Thinking to Cope with Ambiguity and Uncertainty.

This article was migrated. The article was marked as recommended. Uncertainty refers to the internal tension of not fully knowing or understanding a situation and is a concept that physicians must learn to deal with in order to become an effective provider. Ambiguity refers to the situation that is not fully known. Mezirow proposed that transformative learning occurs in response to a "disorienting dilemma" during which the students' frames of reference are challenged. We used his model to explain how clerkship students learn to cope with ambiguity and uncertainty. We analyzed third year medical students reflective practice essays for encounters with clinical uncertainty and ambiguity and examined how they reacted to these dilemmas. Our study is unique in its robust data set which included 273 essays.

From College Graduate to Physician: Professional Identity Formation.

This article was migrated. The article was marked as recommended. A newly matriculated medical student must transition from college student to physician in four short years. The call has been made to help students in this transition. There is little data on how this can occur and how the system of medical education can guide students. We set out to describe and understand medical students' process of professional identity formation (PIF) longitudinally from first-year to fourth-year students. Using a qualitative thematic analysis of 58 survey responses from the anatomy dissection laboratory (1st and 2nd year students), 78 clerkship reflective practice essays (3rd year students), and 26 survey responses to a realistic field exercise (4th year students) we developed a grounded theory: We found four developmental/transformational stages (Building, Becoming, Bridging, and Being) in PIF of a physician with the end result that the physician is confident, resilient, and embraces his/her identity. Additionally, there were three longitudinal supports identified that faculty provide: promoting self-reflection, promoting mastery of difficult tasks, and being available. Successful transition is tied to transformational experiences that with the faculty support propel the student toward PIF. These findings serve as a framework for medical educators to develop a curriculum that supports positive PIF in medical students.

Threshold Concepts in Medical Education.

This article was migrated. The article was marked as recommended. Background - The theory of Threshold Concepts (TC) proposes that there are ideas necessary for a student to learn which enable them to think like a professional. Studies of TC in higher education have appeared since 2003. Studies in medical education are more recent. Method - We studied TC using a qualitative analysis approach (grounded theory and constant comparison) to produce a thematic analysis of 135 de-identified reflective practice essays from students in the pediatric clerkship at our medical school. Summary of results - Seven themes met our criteria for a threshold concept; transformative (ontological shift) and troublesome (causes angst). 2 TC in our students' work were identical with those found by authors from the UK ("Medicine isn't black and white," and "Sometimes there isn't a right answer,") 4 TC were similar and 2 were distinct. Discussion - Our findings suggest that there are some TC inherent (maybe essential) in personal and professional identify formation for a student moving from layperson to physician-hood, regardless of the setting of the medical school.

Defining Medical Professionalism Across the Years of Training and Experience at the Uniformed Services University of the Health Sciences.

BACKGROUND: Many medical institutions have moved forward with curricular objectives aimed at teaching professionalism, but the question remains: are we teaching the most appropriate content at the most opportune times to maximize sustained learning? The students' point of view of professionalism is helpful in addressing this question. AIM: To describe the views of professionalism held by students and faculty at the Uniformed Services University of the Health Sciences. METHODS: In e-mailed surveys, students and faculty free-texted the three most important characteristics of a professional. Qualitative analysis was used to analyze the results. Data were compared on the basis of the percentage of each group affirming one of the characteristics. RESULTS: Fourteen characteristics of professionalism were found. There were significant differences across all participant groups in the characteristics that each indicated were most important. CONCLUSION: Differences emerge between definitions of professionalism that appear to relate to training and experience. Students' views of professionalism reflect the immediate context of their educational environment. Curricula targeted to the students' foci are relevant in teaching professionalism.

Prevalence of life-threatening conditions in children.

OBJECTIVE: We estimated the prevalence of children with life-threatening conditions (LTC) cared for in the military health system (MHS) in response to a Congressional inquiry and to inform program planning. METHODS: We developed a case definition of LTC, using the concept ''death trajectory''(1,2) to define our cases. We conducted an unduplicated count of children with LTC in the MHS database during FY 2001/FY 2002 using selected ICD-9 codes based on our case definition. We then surveyed the literature for reported prevalence of LTC among children with similar case definitions. The concept of ''death trajectory'' describes non-categorical life-threatening conditions of four types: progressive decline to death (e.g., spinal muscular atrophy); intermittent periods of intensive care to maintain quality-of-life (e.g., cystic fibrosis); curative treatment is possible but may fail (e.g., childhood cancers); and severe but non-progressive disability with extreme health vulnerability (e.g., spastic quadriplegia with tracheotomy). RESULTS: There were 3,976 children identified with LTC in a population of 2.6 million children, for a prevalence of 0.15%. CONCLUSION: A prevalence of 0.15% for children with LTC in the MHS population agrees closely with that derived for similar case definitions by other authors among populations of children in other single-payer health care systems (i.e., United Kingdom). The method used here may apply to similar health care systems with ICD 9 codes in a searchable database.

Advancing a partnership: patients, families, and medical educators.

BACKGROUND: Medical educators must impart not only an immense quantity of knowledge and technical skills but also an essential collection of values, attitudes, and ways of relating that fall under the rubric of professionalism. Along with technical skills and knowledge, becoming a physician requires caring about patients and interacting in ways that meet practical needs. SUMMARY: One way to meet the challenges of teaching about professionalism and communication is to involve experienced patients and families as partners in education. Patients and family members have participated in health care quality assessment, health care advisory groups, and efforts to implement family-centered care. Medical educators have written competencies for communication and professionalism and have begun to involve patients and families in medical education activities. CONCLUSIONS: Increased involvement of patients and families in full partnership with medical educators is a logical outgrowth of changes in relationships between patients and health care providers as described in medical literature.