Deeper look into feedback practice in an Indonesian context: exploration of factors in undergraduate clinical settings.

PURPOSE: The practice of feedback is influenced by the characteristics of students, teachers, and the clinical environment. Most studies on feedback have been conducted in Western settings with different sociocultural backgrounds to Indonesia. This study explores feedback in Indonesian clinical clerkship using a sociocultural lens and aims to provide an exemplar of adaptive practice relevant to non-Western settings. METHODS: This qualitative study was conducted using an interpretive phenomenology approach. Data were collected through focus groups with students and teachers and interviews with program coordinators. Data were transcribed verbatim and grouped according to data sources, coded, and analyzed thematically. RESULTS: Themes identified from the focus group discussions and interviews were categorized as student, teacher, and environmental factors. Student factors include dependence on feedback, tendencies to use a group approach, difficulties recognizing social rules, a perceived lack of resilience, and tendencies to doubt praise. Factors related to teachers include a high level of expertise, being extremely busy, having a strong commitment, and being unsure of students' acceptance of feedback. Clinical environment factors influence interactions between teachers and learners and include high power distance and collectivistic values. A safe environment is needed to ensure effective feedback interactions. CONCLUSION: High power distance, collectivism, and generational characteristics of students likely impact feedback practice in clinical settings. Designing a safe environment is essential for effective feedback practice.

Looking beyond the COVID-19 pandemic: the recalibration of student-teacher relationships in teaching and learning process.

BACKGROUND: Given the various novel educational approaches and online interactions following the pandemic, it is timely to identify lessons learned for post-pandemic student and teacher relationships within the 'new normal' teaching learning processes. This study aims to explore the dynamics and to what extent the disruption influences student-teacher relationships in teaching and learning process following the COVID-19 pandemic. MATERIALS AND METHODS: A qualitative descriptive approach was employed to explore individual reflections and perspectives from 28 medical teachers and 35 medical students from different institutions who participated in 10 focus groups. Data were analyzed thematically using steps for coding and theorization (SCAT) approach. The emerging themes were then further analyzed and regrouped into the relationship-centered leadership framework based on emotional intelligence. RESULTS: The identified themes described three elements representing student-teacher relationships in the teaching learning processes. The self as the center of the diagram consists of the co-existing role of the self as teachers and as students, which to some extent, is related to their personal and professional development, motivation, and struggles to maintain work-life balance. The middle layer represents the dynamic of student-teacher relationship, which showed that despite the increased number of teaching opportunities, the trust among teachers and students was compromised. These changes in the self and the dynamic relationship occurred in a broader and more complex medical education system, pictured as the outer layer. Thorough curriculum improvements, contents, and new skills were emphasized. CONCLUSIONS: Our findings emphasized the need to recalibrate student-teacher relationships, taking into account the intrapersonal, interpersonal, and the system factors. The pandemic has reemphasized the aim of teachers' roles, not only to nurture students' competencies, but also to nurture meaningful interpersonal reciprocal relationships through responding towards both teachers' and students' needs as well as supporting both personal and professional development.

Deconstructing the professional identity formation of basic science teachers in medical education.

PURPOSE: The role of basic science teachers (BSTs) in medical education has been changing dynamically. Less is known, however, about how BSTs perceive their professional identity and what factors influence its formation. This study aims to explore how the professional identity of BSTs is formed and what factors influence this professional identity formation (PIF) using the 4S ("Situation, Self, Support, Strategies") Schlossberg framework. METHOD: A qualitative descriptive study using focus groups (FGs) was conducted. Maximum variation sampling was used to purposively select BSTs. A rigorous thematic analysis was completed, including independent thematic analysis, intermittent checking and iterative discussions among researchers, and member checking. RESULTS: Nine FGs, involving 60 teachers, were conducted. The findings highlighted four major themes reflecting the 4S framework: the self as internal driver, early-career events and opportunities, individual and institutional support, and active participation in continuing professional development. Both the "Self" and the "Situation" components prompted the BSTs to utilize supports and enact strategies to become professional teachers. Although the BSTs in this study were primarily internally driven, they relied more on existing support systems rather than engaging in various strategies to support their growth. CONCLUSION: It is important to address the PIF of BSTs given their dynamic roles. Looking through the lens of the 4S framework, PIF is indeed a transition process. A structured, stepwise faculty development program, including mentorship, reflective practice, and a community of practice designed to foster BSTs' identities, should be created, taking into consideration the diverse factors influencing the PIF of BSTs.

Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture.

BACKGROUND: Professional identity formation (PIF) has been recognized as an integral part of professional development in medical education. PIF is dynamic: it occurs longitudinally and requires immersion in the socialization process. Consequently, in the medical education context, it is vital to foster a nurturing learning environment that facilitates PIF. AIM: This study assesses PIF among medical students in various stages of study and explores their perceptions of PIF, with its contributing and inhibiting factors. METHOD: This mixed-methods study uses a sequential explanatory approach with undergraduate (years 2, 4, and 6) and postgraduate medical students in Indonesia. We examine the subjects by administering an adapted questionnaire on PIF. We completed a series of FGDs following questionnaire administration. Quantitative and thematic analyses were conducted sequentially. RESULTS & DISCUSSION: A total of 433 respondents completed the questionnaire. There were statistically significant differences among subjects on the subscales "Recognition and internalization of professional roles" and "Self-control in professional behavior"; the more senior students had higher scores. We conducted 6 FGDs in total. The results characterize PIF as a complex, dynamic, and longitudinal journey to becoming a medical doctor that is closely related to a student's motivation. The FGDs also highlight the importance of both internal factors (students' values, attributes, and personal circumstances) and external factors (curriculum, the learning environment, workplace-based learning, and external expectations) for PIF in medical education. CONCLUSION: Higher-level students show higher scores in some aspects of PIF, which further validates the potential use of the questionnaire to monitor PIF, a dynamic process influenced by internal and external factors. Generating awareness among medical students and encouraging reflection on their PIF stage may be crucial for PIF processes.

Burnout and quality of life of medical residents: a mixed-method study.

PURPOSE: Currently there are a limited number of comprehensive studies exploring in more depth the relationship between burnout and quality of life (QoL) of medical residents during residency training. This study aims to examine the correlation between burnout and residents' QoL and explore the factors associated with burnout in residency training. METHODS: This was a mixed-method study. The first stage was a quantitative study using cross-sectional design to administer the Maslach Burnout Inventory Human Service Survey and World Health Organization Quality of Life-BREF instruments to 86 medical residents, followed with the qualitative study through 10 in-depth interviews. RESULTS: Twenty-seven residents (31.4%) experienced severe emotional exhaustion (EE), 22 (25.6%) experienced severe depersonalization (DP), and 40 (46,5%) experienced low personal accomplishment (PA). Factors increasing the likelihood of experiencing burnout were being surgical residents for EE (2.65 times), dealing with difficult/rare cases for DP (1.14 points), and working hours for PA (1.03 points). The QoL was influenced by the three burnout domains, marital status, education level, gender, age, type of residency, night shift, difficult/rare cases, working hours, and number of emergency cases. Factors influencing burnout, both intrinsic and extrinsic, were identified and divided into causative and protective factors. CONCLUSION: The current study has examined the relationship between burnout and QoL and identified factors affecting residents' burnout. Both intrinsic factors, such as spirituality, and extrinsic factors which include duration of shift, work facilities, and teacher-senior-junior relationships, affect burnout. Supervision and academic regulation are some of the solutions expected by the residents to minimize burnout.

"To obey or not to obey" - Medical students' response towards professional dilemmas in a hierarchical and collectivist culture.

BACKGROUND: Clinical clerkship programme in medical schools were developed to provide students with direct interactions with patients and observe clinical teachers in practice. However, professional dilemmas are prone to occur due to the nature of experiential learning. Several studies across different cultures showed that medical students responded differently towards professional dilemma. AIMS: This study aims to explore how medical students respond to professional dilemmas occurred during their clinical clerkships and to what extent culture influences the responses. METHOD: A qualitative descriptive approach was used in this study. We conducted four focus group discussions with final year medical students who were selected using maximum variety sampling method. Thematic analysis was conducted following the transcription of the focus groups. RESULTS: We identified the impact of dilemmas on students' emotions and concerns, students' responses towards professional dilemmas, and factors affecting responses to dilemmas in clinical clerkship, which confirmed that cultures played roles in how students responded towards professional dilemmas. CONCLUSION: This study has identified that culture, to some extent, influenced the way students responded to professional dilemmas. Therefore, it is paramount to develop a conducive and culturally sensitive educational environment and students' ability to learn from professional dilemma experienced in the workplace for developing their professional identity.

Professional identity formation of medical teachers in a non-Western setting.

INTRODUCTION: Understanding and supporting professional identity formation (PIF) among medical teachers has become increasingly important in faculty development programs. In this study, we explored medical teachers' PIF in Indonesia. METHODS: We conducted a qualitative descriptive study using focus group discussions (FGDs) at four medical schools in Indonesia. Basic science and clinical teachers from four different schools were selected to participate. Data were transcribed, coded, and analysed to develop themes and subthemes. RESULTS: Seventeen FGDs were completed, involving 60 basic science and 59 clinical teachers. Four major themes regarding the formation of medical teachers' professional identity emerged: an internal dialogue between intrinsic values and external influences, empowerment through early socialization, experiential workplace learning, and envisioning the future. The PIF process was similar for basic science and clinical teachers. CONCLUSION: Our findings suggested that PIF among medical teachers in a non-Western setting is a continuous and dynamic process that is shaped by key socialization factors (e.g. role models, workplace learning, peer support), with significant influences from religious beliefs, family values, and societal recognition. Faculty development programs should consider the dynamic and continuous nature of PIF among medical teachers and encourage clinicians and basic scientists to explore their values and beliefs, realize their goals, and envision their future.

The relationships between resilience and student personal factors in an undergraduate medical program.

BACKGROUND: Resilience is an essential aspect of wellbeing that plays a major role in undergraduate medical education. Various personal and social factors are known to affect resilience. Empirical evidence remains limited regarding resilience and the personal factors that affect it among undergraduate medical students in an Asian setting. Therefore, this study aims to identify undergraduate medical students' level of resilience and its relationships to personal factors in Indonesia. METHODS: This cross-sectional study was conducted among undergraduate medical students in years 1-6. Respondents were asked to complete three validated questionnaires: the Connor-Davidson Resilience Scale (CD-RISC) to measure resilience, the Brief-COPE to assess coping mechanisms, and the Big Five Personality Test to measure five personality dimensions. Descriptive and Pearson's correlation analyses were completed to explore relationships between each variable. Regression analysis was completed to analyze the extent to which coping mechanisms, personality, and academic achievement explained the variation in resilience scores. RESULTS: A total of 1040 respondents completed the questionnaires (a 75.42% response rate). Students in both preclinical and clinical stages had quite good levels of resilience and higher scores on adaptive coping mechanisms than on maladaptive coping mechanisms. Adaptive and maladaptive coping mechanisms, Big Five Personality traits (extraversion, agreeableness, conscientiousness, neuroticism, and openness), and students' academic achievement explained 46.9% of students' resilience scores. CONCLUSIONS: Although the resilience scores in this study were comparable to resilience scores among undergraduate medical students in other settings, we found that coping mechanisms, personality traits, and academic performance may predict resilience among medical students.

Relationship between empathy and motivation in undergraduate medical students.

Background: Undergraduate medical education is important for encouraging empathy which is a critical component of patient-physician communication. Studies show a decline in empathy once medical students enter their clinical years. Since empathy is also a "motivated phenomenon", the current study aims to explore the relationship between empathy and students' motivation types. Methods: This cross-sectional study used a total sampling approach to recruit medical students in years 1-5. The Jefferson Scale of Physician Empathy (JSPE) was used to measure empathy in medical students and the Academic Motivation Scale (AMS) was utilised to assess student motivation. Following descriptive analyses, the differences in empathy scores based on motivation type was assessed using Kruskal-Wallis test and post-hoc Mann-Whitney test. Furthermore, the Spearman's rank correlation analysis was completed to assess the relationship between students' empathy and motivation type. The analyses were completed for each of year 1-5. Results: A total of 827 completed questionnaires (71.3% response rate) were analysed, showing strong internal consistency. Most students displayed high intrinsic and high controlled motivation. Motivation type was found to be consistently associated with empathy. Conclusions: The present study highlights the association of motivation with empathy in undergraduate medical students with an increasingly low empathy score the more the motivation profile is towards being Low Intrinsic and Low Controlled.

Exploration of constructive feedback practices in dental education chairside teaching: A case study.

BACKGROUND: Chairside teaching is one of the teaching-learning methods in clinical dental education in which direct care is provided to patients. When students have been deemed competent in carrying out procedures on a dental phantom, they need clinical experience on patients, with guidance and constructive feedback from clinical teachers. Constructive feedback is an important learning platform in helping students analyse the strong and the weak aspects of their performance in order to identify required improvements. This study aimed to explore the practice of giving constructive feedback in chairside teaching. METHOD: A qualitative method with a case study design. Data were collected through in-depth interviews and focus group discussions (FGDs) with clinical teachers and students in clinical rotation. Data triangulation was carried out by observing the practice of giving constructive feedback in chairside teaching and document analysis from January to April 2019. Results of the in-depth interviews and FGDs were transcribed verbatim and analysed using a thematic analysis approach. RESULT: In-depth interviews with five programme coordinators and FGDs with two groups of clinical teachers (N = 8 and N = 6) and two clinical student groups (N = 8 each). Three main themes emerged in this study: ways to provide feedback, challenges on feedback provision and challenges on feedback follow-up. CONCLUSION: Differences in perception between clinical teachers and students were identified, influenced by students' interactions with the learning environment. Interventions are to be encouraged that involve teachers, students and institutions, and the interactions amongst the three.