Paul Haidet

The need for team-oriented skills has become more pronounced as healthcare models become more complex. Many undergraduate medical education (UME) programs, particularly in Australia, Canada, and the United Kingdom, define teamwork as fundamental to physician training. U.S. UME programs, however, face challenges in defining and teaching teamwork competencies. Some programs have chosen to define and teach these competencies through curricula that require students to explore health systems science issues through team-based experiences in classroom-, community-, and project-based settings. This qualitative study aims to understand how first-year medical students experience and develop as team members. Students at two U.S. medical schools with team-based curricula were asked during one-hour focus groups to reflect on their teamwork experiences, environmental factors affecting their team performance, and their evolving views on the physician’s role in patient care. Focus group transcripts were coded and thematically analyzed using the Team Effectiveness (TE) framework, which assesses team function along eight dimensions (Real Team, Compelling Purpose, Right People, Sound Structure, Supportive Context, Team Communication, Collaboration, and Coaching). Thirty-nine students participated in 11 focus groups. Four themes emerged: (1) Structured classroom settings were ideal for safe practice and rapid team adaptation, (2) Less structured community- and project-based settings encouraged supportive team dynamics but were more challenging, (3) Balancing structure with flexibility was essential in developing teamwork skills, and (4) Teamwork reinforced key health systems science concepts, including relationship building, advocacy, and systems citizenship. Students also reported shifts in their perceptions of physician roles from independent to integrated decision-makers. Findings align with previous research on team effectiveness, supporting a health systems science curricular approach to helping students develop teamwork skills. However, attention must be paid to balancing structured guidance with flexibility to explore systems-related concepts and teamwork skills. Through teamwork, students’ identities evolved within 10 months, including redefinitions of their roles within a healthcare context. Teaching students how to work in teams within the context of a health systems science curriculum can help students identify with and recognize the importance of collaborative practice.

Introduction: The arts and humanities (AH) have transformative potential in medical education. Research suggests that AH-based pedagogies may facilitate both personal and professional transformation in medical learners, which may then further enhance the teaching and learning of social advocacy skills. However, the potential for such curricula to advance social advocacy training remains under-explored. Therefore, we sought to identify how AH may facilitate transformative learning of social advocacy in medical education. Methods: Building upon previous research, we conducted a critical narrative review seeking examples from the literature on how AH may promote transformative learning of social advocacy in North American medical education. Through a search of seven databases and MedEdPORTAL, we identified 11 articles and conducted both descriptive and interpretative analyses of their relation to key tenets of transformative learning, including: disorientation/dissonance, critical reflection, and discourse/dialogue. Results: We found that AH are used in varied ways to foster transformative learning in social advocacy. However, most approaches emphasize their use to elicit disorientation and dissonance; there is less evidence in the literature regarding how they may be of potential utility when applied to disorienting dilemma, critical reflection, and discourse/dialogue. Discussion: The tremendous potential of AH to foster transformative learning in social advocacy is constrained due to minimal attention to critical reflection and dialogue. Future research must consider how novel approaches that draw from AH may be used for more robust engagement with transformative learning tenets in medical education.

The arts and humanities (A&H) play a fundamental role in medical education by supporting medical learners' development of core competencies. Like all medical curricula, those integrating the A&H are more likely to achieve the desired outcomes when the learning domains, goals, objectives, activities, and evaluation strategies are well-aligned. Few faculty development programs focus on helping medical educators design A&H curricula in a scholarly manner. The Prism Model, an evidence-based tool, supports educators developing A&H medical curricula in a rigorous way for maximum impact. The model posits that the A&H can serve four pedagogical functions for medical learners: 1) skill mastery, 2) perspective taking, 3) personal insight, and 4) social advocacy. Although this model has been described in the literature, no practical guidance exists for medical educators seeking to apply it to the development of a specific curriculum. This paper provides a step-by-step demonstration of how to use the Prism Model to design an A&H curriculum. Beginning with the first step of selecting a learning domain through the final step of curriculum evaluation, this paper helps medical educators apply the Prism Model to develop A&H curricula with intentionality and rigour to achieve the desired learning outcomes.

He's my age. The thought kept coming, like a deranged mantra, over and over, every time I saw Charlie's name on my schedule. Even after two decades, my brain goes first to the fact that Charlie was my age. I was 30-something, an idealistic, newly-minted attending physician at the Veterans Hospital. One day, a liver specialist called and said, "I have a patient that needs your special expertise." I was wary. When a specialist calls a primary care doc asking for their "special expertise," something is afoot, and it's never good. Charlie was perfectly average: average height, average build, average eyes, albeit with an air of sadness. I imagined him during his prior military service working as a spy, not ever arousing suspicion because of his unmemorable appearance.

Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.

Phenomenon: Transformative learning is a theory in which individuals construct new or revised interpretations of the meaning of an experience. COVID-19 offers a rare opportunity to better understand how individuals respond to and make meaning within the shared context of an extraordinary event. We aimed to examine if and how residents and fellows engaged in transformative learning when caring for COVID-19 positive patients during the initial peak of the pandemic (Spring 2020). Approach: We conducted an interpretive qualitative study to identify themes pertaining to transformative learning. We used semi-structured interviews of residents and fellows who were directly or indirectly involved in the care of COVID-19 positive patients admitted to the inpatient wards or the intensive care units during the first peak of the pandemic (defined as March 11th – May 28th, 2020) at our Mid-Atlantic academic health system. We used the medium of comics to depict select interviewees’ experiences during the pandemic as a novel way to represent themes from the interviews. Findings: Three main themes arose from our qualitative analysis. These included “a sense of guilt,” “the impact on training,” and “venues and processes for reflection.” In comparing their experiences with colleagues and friends at other institutions with higher COVID-19 case volume, trainees reflected on how they felt lucky, and this led to guilt, although not necessarily transformation. The impact of COVID-19 on the training environment had transformative potential. Trainees challenged their previously held assumptions on the necessity of various surgeries, in-person visits, and physical examination maneuvers when COVID-19 posed a barrier. Finally, while trainees recalled multiple situations throughout the pandemic when they believed they were engaging in reflection, such reflection did not appear to reach so deep as to alter participants’ underlying assumptions until the research interview itself, suggesting that transformation was incomplete. Insights: Our purposive sample of residents and fellows who cared for COVID-19 positive patients during the initial peak of the pandemic made meaning of their experience in multiple ways. The largest shift in worldview due to the pandemic appeared to be related to the instrumental utility of certain common medical practices or procedures. This, in turn, was the most prominent influence on how these trainees felt they would practice in the future, and translated to a shift in how they appraised evidence. However, lack of opportunity for reflection may have adversely impacted the ability for transformation to take place. Given that multiple trainees showed appreciation for the critical reflection venue that was the research interview, academic leadership should ensure similar venues exist during training, even after the pandemic ends.