A student-led clerkship primer: a near-peer orientation to clerkship.

The transition between pre-clerkship and clerkship can be difficult for medical students. Near-peer teaching may fill knowledge gaps within curricular clerkship orientation, leveraging recent, relatable, and up-to-date experiences from near-peers. These benefits have not been formally evaluated in the context of a clerkship orientation. We therefore created the Clerkship Primer, a near-peer teaching initiative that aimed to introduce incoming clerks to clerkship through a curricular session facilitated exclusively by senior clerkship students. Sessions had high satisfaction among students. This pilot project suggests that curricular near-peer teaching is a valuable component of clerkship orientation.

La transition entre le pré-externat et l'externat peut être difficile pour les étudiants en médecine. Un enseignement par les pairs a le potentiel de combler des lacunes dans les connaissances dans le cadre d'une orientation à l'externat, à partir d'expériences récentes et actualisées de pairs. Ces avantages n'ont pas été formellement évalués dans le contexte d'une orientation à l'externat. Nous avons donc créé le Clerkship Primer, une démarche d'enseignement par les pairs qui vise à présenter l'externat aux nouveaux externes dans le cadre d'une séance animée exclusivement par des externes séniors. Les séances ont été très appréciées par les étudiants. Ce projet pilote porte à croire qu'un enseignement par les pairs est une composante précieuse de l'orientation à l'externat.

Not all 'impostors' are created equal: A dimensional, person-centered, and theory-based analysis of medical students.

PURPOSE: Research on the impostor phenomenon (IP) is rapidly growing in medical education due to its relationship with distress and burnout. How IP is theoretically conceptualized and analyzed has been inconsistent, however, which limits our understanding of results and how to act on them. We hypothesized that a person-centered analysis, in combination with a robust theoretical framework, would provide a more specific 'profile' of medical student IP and help to optimize supports for their well-being. MATERIALS & METHODS: We used exploratory factor analysis to assess the factor structure of the Clance Impostor Phenomenon Scale (CIPS) in medical students, followed by cluster analysis to identify distinct 'impostor' profiles, based on the identified factors. We then used self-determination theory's (SDT) framework of motivation to explore how students in each profile differed in their general causality orientation, autonomous motivation towards going to medical school, and psychological need satisfaction in the medical program - factors that SDT identifies as predictors of engagement, performance, and well-being. RESULTS: Factor analysis yielded three main IP factors - feeling like a fake, attributing success to luck, and discounting achievement - in line with Clance's original definition of IP. The cluster analysis then identified four distinct IP profiles based on individual differences in these factors, each varying in aspects of their self-determination. CONCLUSIONS: This study sheds light on the ways that medical students may experience IP, further reinforcing the notion that not all 'impostors' are created equal. Findings support the three-factor structure of the CIPS among medical students, and that most students will fall into one of four IP profiles. These profiles and their implications are discussed.

Cultivating physician empathy: a person-centered study based in self-determination theory.

While physician empathy is a vital ingredient in both physician wellness and quality of patient care, consensus on its origins, and how to cultivate it, is still lacking. The present study examines this issue in a new and innovative way, through the lens of self-determination theory. Using survey methodology, we collected data from N = 177 (44%) students at a Canadian medical school. We then used a person-centered approach (cluster analysis) to identify medical student profiles of self-determination (based on trait autonomy and perceived competence in learning) and how the learning environment impacted empathy for those in each profile. When the learning environment was more autonomy-supportive, students experienced higher satisfaction and lower frustration of their basic psychological needs in medical school, as well as greater empathy towards patients. The translation into increased empathy, however, was only evident among the students with higher self-determination at baseline. Results from this study suggest that autonomy-supportive learning environments will generally support medical students' psychological needs for optimal motivation and well-being, but whether or not they lead to empathy towards patients will depend on individual differences in self-determination. Findings and their implications are discussed in terms of developing theory-driven approaches to cultivating empathy in medical education.

Why Do We Feel Like Intellectual Frauds? A Self-Determination Theory Perspective on the Impostor Phenomenon in Medical Students.

Theory: Impostor phenomenon (IP) refers to people's feelings of intellectual fraudulence and fear of being "discovered," despite contradicting evidence of success. Due to its association with burnout and distress, it is progressively being studied in medicine. While various explanations for IP have been discussed in the literature, the role of motivation has largely been neglected. Hypotheses: Using self-determination theory (SDT) as a lens, it was hypothesized that different general causality orientations (impersonal, control, autonomy), domain-specific types of motivation (autonomous vs. controlled) toward going to medical school, and levels of satisfaction of basic psychological needs (autonomy, competence, relatedness) in the medical program, would each predict severity of IP symptoms. Method: A total of 1,450 medical students from three Canadian institutions were invited to complete a survey containing the Clance Impostor Phenomenon Scale and scales derived from SDT's mini theories: basic psychological needs theory, causality orientations theory, and organismic integration theory. We explored the prevalence of IP among the students and used regression to capture variable relationships, accounting for gender effects. Results: Data from 277 (19.1%) students were assessed, 73% of whom reported moderate or worse IP symptoms. Having an impersonal general causality orientation, more controlled motivation toward going to medical school, and lower need satisfaction in the medical program, each related to increased IP severity. Together, these motivational factors accounted for 30.3%, 13.6%, and 21.8% of the variance in students' IP severity, respectively. Conclusions: Findings from this study suggest that students who are more self-determined (both in general and in medical school), and whose basic psychological needs are more supported in their medical program, will experience less frequent and severe IP symptoms. Preliminary explanations and implications of these findings are discussed within the medical education context.

Need Fulfillment and Resilience Mediate the Relationship between Mindfulness and Coping in Medical Students.

Theory: Medical programs have turned to mindfulness-based initiatives to help reduce student distress and promote healthy coping within the learning environment. However, little attention has been paid to how fulfillment of medical students' basic psychological needs (autonomy, competence, and relatedness) impacts their capacity to be mindful and cope with stress. Self-Determination Theory (SDT) posits that mindfulness facilitates adaptive coping and wellness, in large part because of need fulfillment. Hypotheses: Using SDT as a lens, it is hypothesized that medical students' resilience and, to a greater extent, need fulfillment in medical school, will mediate the relationship between their mindfulness and coping reactions to stress. Method: One-hundred-ninety-seven medical students from the University of Saskatchewan were recruited to participate in this study: 71 first year, 58 second year, and 36 third and fourth year, each. Students completed an anonymous survey, measuring need fulfillment in medical school, mindfulness, resilience, and frequent use of various adaptive and maladaptive coping strategies. We assessed the extent that need fulfillment and resilience mediated the relationship between mindfulness and coping styles. Results: Need satisfaction and resilience fully mediated the relationship between mindfulness and adaptive coping. Conversely, need frustration and resilience partially mediated the relationship between mindfulness and maladaptive coping. Need fulfillment was a stronger mediator than resilience in both coping models. Conclusions: Findings suggest that increased supports for medical students' resilience and basic psychological needs may promote their mindfulness, and in turn, their ability to respond more adaptively and less maladaptively to stressors they face in medical school.

How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents.

BACKGROUND: Medical training can be highly stressful for students and negatively impact their mental health. Important to this matter are the types of coping strategies (and their antecedents) medical students use, which are only characterized to a limited extent. A better understanding of these phenomena can shed additional light on ways to support the health and well-being of medical students. Accordingly, we sought to determine medical students' use of various coping reactions to stress and how their gender and year of study influence those behaviours. METHODS: A total of 400 University of Saskatchewan medical students were invited to complete an online survey. Using the Brief COPE inventory, we assessed students' reported use of various adaptive and maladaptive coping strategies. Descriptive and comparative statistics were performed, including multivariate analysis of variance, to explore how gender and year influenced coping strategies. RESULTS: The participation rate was 49% (47% males and 53% females). Overall, the students' coping strategies were mostly adaptive, albeit with a few exceptions. Females used more behavioural disengagement, while males used less emotional and instrumental support. Additionally, third years used more denial to cope with stress than students in any other year. CONCLUSIONS: While few studies report significant sociodemographic effects on medical student coping, our findings raise the possibility that males and females do engage in different coping strategies in medical school, and that the clinical learning environment in third year may provoke more dysfunctional coping, compared to pre-clinical stages of training. Potential explanations and implications of these results are discussed.

Towards a better understanding of medical students' mentorship needs: a self-determination theory perspective.

INTRODUCTION: Mentorship programs are ubiquitous in medical education. However, few emphasize equal development for learners and mentors, or incorporate clinical skills, which may be important for promoting medical students' self-determination. Central to this consideration are the three basic psychological needs for autonomy, competence, and relatedness, described by Self-Determination Theory (SDT). Grounded in SDT, this study assesses the extent that meeting these needs, in a near-peer mentoring program, impacts learners' and mentors' motivation and perceived competence about learning and teaching of clinical knowledge, respectively. METHODS: Medical students from the University of Saskatchewan, who participated in its near-peer mentoring program (PULSE: Peers United in Leadership & Skills Enhancement), were invited to complete an anonymous survey. Regression was used to determine how the program's learning climate impacted learners' and mentors' psychological need satisfaction and perceived competence within their mentorship role. RESULTS: Learners and mentors both rated PULSE as highly needs-satisfying. In turn, this was associated with greater perceived competence about learning and teaching of the material. CONCLUSIONS: Findings from this study suggest that mentoring programs in medical education, which support learners' basic psychological needs, may promote their motivation and perceived competence-both about learning and also teaching of clinical skills. The implications of these results are discussed from an SDT perspective, with respect to mentoring programs in medical education.

INTRODUCTION: Les programmes de mentorat sont très répandus en éducation médicale. Ceux qui mettent l'accent sur un statut égal des apprenants et des mentors ou qui intègrent des compétences cliniques pouvant favoriser l'autodétermination des étudiants en médecine sont toutefois rares. Les trois besoins psychologiques fondamentaux décrits par la théorie de l'autodétermination (TAD), à savoir l'autonomie, la compétence et l'appartenance, sont au cœur de cette préoccupation. Fondée sur la théorie de l'autodétermination, la présente étude évalue dans quelle mesure la satisfaction de ces besoins, dans le cadre d'un programme de mentorat par les quasi-pairs, a un impact sur la motivation et la compétence perçue des apprenants et des mentors en matière d'apprentissage et d'enseignement des connaissances cliniques. MÉTHODES: Les étudiants en médecine de l'Université de Saskatchewan, qui ont participé au programme de mentorat par les quasi-pairs (PULSE: Peers United in Leadership & Skills Enhancement), ont été invités à remplir de façon anonyme un sondage. Des analyses de régression ont été réalisées pour déterminer l'impact du climat d'apprentissage dans le programme sur la satisfaction des besoins psychologiques des apprenants et des mentors et sur la compétence perçue de ces derniers dans leur rôle de mentors. RÉSULTATS: Les apprenants et les mentors ont estimé PULSE comme hautement satisfaisant pour leurs besoins. Cela a été associé à une plus grande compétence perçue en ce qui concerne l'apprentissage et l'enseignement des contenus. CONCLUSIONS: Les résultats de cette étude suggèrent que les programmes de mentorat en éducation médicale qui soutiennent les besoins psychologiques fondamentaux des apprenants peuvent renforcer leur motivation et leur compétence perçue, à la fois pour l'apprentissage et pour l'enseignement des compétences cliniques. Les incidences de ces résultats pour les programmes de mentorat par les pairs en éducation médicale sont analysées du point de vue de la TAD.

Basic psychological needs, more than mindfulness and resilience, relate to medical student stress: A case for shifting the focus of wellness curricula.

PURPOSE: Medical student distress is an increasing concern in medical education. Addressing this issue requires a comprehensive understanding of what factors influence learners' stress in medical school. Grounded in Self-Determination Theory (SDT), this study explores the relative association between medical students' mindfulness, resilience, basic psychological needs, and perceived stress. Materials and methods: Of all year 1-4 medical students at our institution, 197 (49%) completed an online survey, measuring satisfaction and frustration of their basic psychological needs (autonomy, competence, relatedness), mindfulness, resilience, and perceived stress. Variables were assessed in relation to perceived stress, controlling for students' gender and year. RESULTS: Higher mindfulness, resilience, and need satisfaction were associated with lower perceived stress. Conversely, need frustration was associated with higher perceived stress. When students' need frustration was included in the model, the association between mindfulness, resilience, and perceived stress weakened. Third years reported more autonomy frustration than all other years. Compared to males, females in second and fourth year reported higher stress, lower mindfulness and resilience, and less competence fulfilment. CONCLUSIONS: Findings of this study suggest that, while mindfulness and resilience are important qualities for medical student well-being, their stress-protective benefits may diminish when students' basic psychological needs are frustrated in medical school. Addressing potentially need-thwarting aspects of the learning environment is therefore recommended, to help reduce student stress and promote their well-being. Preliminary suggestions on how this might be achieved are discussed, from an SDT perspective.

The Clinical Ultrasonography Elective in Clerkship (CUSEC): A pilot elective for senior clerkship students at the University of Saskatchewan.

We created a clinical ultrasound (CUS) elective in clerkship, which gave medical students the opportunity to enhance their knowledge and technical skills while refining their CUS-related clinical decision making. This elective uniquely allowed medical students to integrate their CUS knowledge and skills into real patient care within the clinical environment (discipline) of their choice. As such, beyond supporting increasing technical competence, students learned to advocate for appropriate use of CUS, an important skill for trainees to develop.

Nous avons créé un stage d'externat optionnel enéchographie ciblée, laquelle offre aux étudiants en médecine l'occasion d'améliorer leurs connaissances et habiletéstechniques tout en raffinant leurs prises de décisions cliniques liées à l'échographie ciblée. Ce stage optionnel offre une occasion unique aux étudiants en médecine d'intégrer leurs connaissances et habiletésen échographie cibléeàdes soins réels aux patients dans un environnement clinique (discipline) de leur choix. Ainsi, au-delà d'un soutien au développement d'une compétence technique,les étudiants ont appris à préconiser une utilisation appropriée de l'échographie ciblée, une habiletéimportante à développer pour les apprenants.

How medical students' perceptions of instructor autonomy-support mediate their motivation and psychological well-being.

Purpose: Medical student well-being is an increasing concern in medical education. Understanding the role instructors and programs have in supporting well-being is an important puzzle piece. This study explores the relationship between medical students' perceptions of instructor autonomy-support, motivation, and well-being. Using self-determination theory, we aim to provide a practical framework through which medical instructors can support student autonomy and well-being in the learning environment.Materials and methods: Students from the University of Saskatchewan completed a survey measuring perceptions of the learning climate (LC) (instructor autonomy-support), satisfaction/frustration of basic motivational needs (autonomy, competence, relatedness), and psychological well-being. Multiple linear regression was used to determine whether age, gender, and year of study affected students' well-being, before a mediation model was tested to assess the direct effect of the LC and indirect effects of students' basic need fulfillment on their well-being.Results: The response rate was 183/400 (46%). Higher ratings of autonomy-support significantly predicted better student well-being. This was mediated completely by students' feelings of basic need fulfillment. Relatedness satisfaction contributed most to ratings of instructor autonomy-support.Conclusions: Cultivating autonomy-support for medical students is critical to their well-being. Learning environments that optimize autonomy-support will also support students' feelings of relatedness and competence.

Twelve tips to combat ill-being during the COVID-19 pandemic: A guide for health professionals & educators.

This article was migrated. The article was marked as recommended. Background: Self-determination theory (SDT) represents an organismic theory of motivation and well-being, viewing people as naturally evolving creatures with innate needs for growth, mastery, and connection. According to SDT, for these tendencies to function optimally and for people to flourish, they require support of three basic psychological needs-autonomy, competence, and relatedness. During a pandemic such as the coronavirus disease 2019 (COVID-19), which can provoke isolation, fear, and feelings of helplessness, it is more important than ever to prioritize and support each other's basic psychological needs. Aim: The concept of basic psychological need satisfaction is relevant in the health professions, but during a crisis, it is easy for these needs to get overlooked or thrown aside. Through this article, we aim to make this concept more understandable and applicable by those in the health and education professions, including students. Methods: SDT literature was foundational to creating these practical guidelines. Results: The authors present 12 SDT-derived tips for practitioners, educators, administrators, and learners, on ways to engage in need-supportive behaviour and promote well-being during the COVID-19 pandemic. Conclusion: These tips demonstrate that going back to the basics in times of emergency and stress can help optimize outcomes while fostering connection, ability, and purpose. They can be learned through practice and applied to anything, from emails and social media, to teaching, to patient care.

A comparison of teaching opportunities for rural and urban family medicine residents.

CONTEXT: Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians. Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents-as-teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences. METHODS: Year-1 and Year-2 family medicine residents at seven Canadian institutions participated in a mixed-methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi-squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed. RESULTS: Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ2 (4, n = 242) = 45.26, P < .000, Bonferroni's adjusted P < .000. Thematic analysis centred around determining factors influencing teaching opportunities and identified that the academic context, personal factors and programme factors were key dimensions. Within these dimensions, the number of medical students, a desire to be an educator and administrative support were cited as influences on teaching opportunities. CONCLUSIONS: The lack of teaching opportunities for rural trainees is attributable to a combination of practical and organisational factors revealed through thematic analysis. If rural graduates are not comfortable balancing the demands of service and teaching, this could compound the already prevalent issue of rural preceptor recruitment. It is essential to develop a rural-focused RaT curriculum to close this gap and produce competent educators who are ready to inspire generations of rural physicians.

Exploring the relationship between medical student basic psychological need satisfaction, resilience, and well-being: a quantitative study.

BACKGROUND: There is increasing acknowledgment that medical training is stressful for students and can impact their well-being. An important aspect of this is self-determination and basic psychological need satisfaction. A better understanding of how medical student perceptions of the learning environment impacts their basic psychological needs for motivation, resilience, and well-being may help to create learning environments that support the needs of medical students and help them become better healthier physicians. We aim to add to the literature on this topic by examining this relationship through the lens of Self-Determination Theory. METHODS: A total of 400 students from all 4 years of the medical program at our institution were invited to complete an anonymous online survey, measuring basic need satisfaction/frustration (autonomy, competence, relatedness) within the learning environment, resilience, and psychological well-being. We used analysis of variance to assess the effect of gender, age, and year on all variables, with t-tests to compare subgroups. Structural equation modelling was performed to test a hypothesized model in which support of medical students' basic needs would positively relate to their resilience and well-being. RESULTS: The response rate was 183/400 (46%). After data cleaning, 160 remained: 67 males (42%) and 93 females (58%). There were 67 first years (42%), 35 second years (22%), 30 third years (19%), and 28 fourth years (18%). The sample mean age was 25.8 years (SD = 4.1). A well-fitting model was confirmed to fit the data, χ2 = 3.15, df = 3, p = 0.369, RMSEA = 0.018, SRMR = 0.022, CFI = 0.999. Autonomy and relatedness satisfaction exerted direct effects on well-being. Competence satisfaction did so indirectly, through its direct effect on resilience. Female medical students had lower resilience scores compared to their male peers. CONCLUSIONS: When medical students perceived their learning environment as supportive to their basic needs, it was associated with an increase in their psychological well-being. Satisfaction of competence, but not autonomy or relatedness, predicted an increase in their resilience. Fostering medical students' basic needs for motivation, especially competence, is recommended to support their resilience and well-being. Further research is required to generalize these results further.

The Impact of a National Competency-Based Medical Education Initiative in Family Medicine.

PURPOSE: Triple C is the Canadian competency-based medical education (CBME) initiative for family medicine. The authors report on a study exploring the impacts Triple C has had across Canada. METHOD: A multi-institutional team conducted a realist study to explore the impact of Triple C implementation in different programs across Canada. Data were collected between March and June 2016 from interviews and focus groups with key medical school stakeholders. Data were analyzed using thematic and template analysis techniques. RESULTS: Data were acquired from 16 of the 17 Canadian medical schools from a combination of program leaders, educators, and trainees. Triple C was implemented in different ways and to different extents depending on context. Newer sites tended to have a more comprehensive implementation than established sites. Urban sites afforded different opportunities to implement Triple C from those afforded by rural sites. Although it was too early to assess its impact on the quality of graduating residents, Triple C was seen as having had a positive impact on identifying and remediating failing learners and on energizing and legitimizing the educational mission in family medicine. Negative impacts included greater costs and tensions in the relationships with other specialties. A principles-based approach to CBME offered flexibility to programs to incorporate variation in their interpretation and implementation of Triple C. Although there was a degree of normalization of practice, it was not standardized across sites or programs. CONCLUSIONS: Triple C has been successfully implemented across Canada but in differing ways and with different impacts.

University of Saskatchewan Radiology Courseware (USRC): an assessment of its utility for teaching diagnostic imaging in the medical school curriculum.

PROBLEM: We have found it very challenging to integrate images from our radiology digital imaging repository into the curriculum of our local medical school. Thus, it has been difficult to convey important knowledge related to viewing and interpreting diagnostic radiology images. We sought to determine if we could create a solution for this problem and evaluate whether students exposed to this solution were able to learn imaging concepts pertinent to medical practice. INTERVENTION: We developed University of Saskatchewan Radiology Courseware (USRC), a novel interactive web application that enables preclinical medical students to acquire image interpretation skills fundamental to clinical practice. This web application reformats content stored in Medical Imaging Resource Center teaching cases for BlackBoard Learn™, a popular learning management system. We have deployed this solution for 2 successive years in a 1st-year basic sciences medical school course at the College of Medicine, University of Saskatchewan. The "courseware" content covers both normal anatomy and common clinical pathologies in five distinct modules. We created two cohorts of learners consisting of an intervention cohort of students who had used USRC for their 1st academic year, whereas the nonintervention cohort was students who had not been exposed to this learning opportunity. CONTEXT: To assess the learning experience of the users we designed an online questionnaire and image review quiz delivered to both of the student groups. OUTCOME: Comparisons between the groups revealed statistically significant differences in both confidence with image interpretation and the ability to answer knowledge-based questions. Students were satisfied with the overall usability, functions, and capabilities of USRC. LESSONS LEARNED: USRC is an innovative technology that provides integration between Medical Imaging Resource Center, a teaching solution used in radiology, and a Learning Management System.

Intrinsic motivation of preclinical medical students participating in high-fidelity mannequin simulation.

Introduction: While medical schools strive to foster students' lifelong learning, motivational theories have not played an explicit role in curricular design. Self-determination Theory is a prominent motivational theory. It posits that perceived autonomy, competence and relatedness foster intrinsic motivation. This study explores the effects of autonomy on intrinsic motivation in medical students participating in high-fidelity mannequin simulation. Methods: A non-randomised crossover trial compared first-year medical students participating in (1) required simulation sessions with predetermined learning objectives and (2) extracurricular simulation sessions with student-directed learning objectives. An adapted Intrinsic Motivation Inventory (IMI) was used to assess intrinsic motivation, perceived autonomy, competence and relatedness. Each participant completed the IMI survey after each type of session. Variables were compared with signed-rank tests. Results: All 22 participants completed the IMI after both types of session. Perceived autonomy was significantly higher during extracurricular simulation (p<0.001), but intrinsic motivation, competence and relatedness were not. Intrinsic motivation correlated with autonomy (RS=0.57 and extracurricular simulation, ES=0.52), competence (RS=0.46 and ES=0.15) and relatedness (RS=0.51 and ES=0.64). The IMI subscales had good internal consistency (Cronbach's α=0.84, 0.90, 0.90 and 0.76 for intrinsic motivation, autonomy, competence and relatedness, respectively). Conclusions: Extracurricular sessions increased students' perceived autonomy, but they were highly intrinsically motivated in both settings. Further study is needed to understand the relationship between perceived autonomy and intrinsic motivation in medical education learning activities. The IMI shows promise as a measurement tool for this work.