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   Table of Contents - Current issue
January-April 2019
Volume 32 | Issue 1
Page Nos. 1-50

Online since Friday, September 6, 2019

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EDITORIAL  

Co-editors' notes p. 1
Michael Glasser, Danette McKinley, Maaike FlinkenflÖgel
DOI:10.4103/1357-6283.266187  
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ORIGINAL RESEARCH ARTICLES Top

Reflection and peer feedback for augmenting emotional intelligence among undergraduate students: A quasi-experimental study from a rural medical college in central India p. 3
Abhishek Vijaykumar Raut, Subodh Sharan Gupta
DOI:10.4103/efh.EfH_31_17  
Background: Professionalism is the foundation of the doctor–patient relationship with emotional competency at its core. This competency is based on emotional intelligence (EI), contributing to effective work performance. As EI is reasonably new in health professions education in India, this study was conducted to assess the effect of reflection and peer feedback on EI scores among undergraduate medical students and explore facilitating and hindering factors for augmenting EI. Methods: This pre- and post interventional study was conducted among 94 final-year (Part I) medical students from a rural medical college in Central India. Baseline assessment of EI scores was done using a self-reported validated EI scale, and then, a mini-workshop was conducted to sensitize students on EI and to train them in writing reflection and giving peer feedback. Between the pretest and posttest, students were asked to write weekly reflection and take monthly feedback from the “peer” of their choice. Posttest assessment was done at 1 week, 1 month, and 3 months. Force-field analysis was undertaken with 10 students each with highest and lowest EI scores to assess facilitating and hindering factors. Results: There was a significant improvement (P < 0.0001) in the EI scores at each subsequent time point from baseline. Students who were male, from nuclear families and considered themselves spiritual had significantly higher median EI scores. Students reported self-motivation, social support, and openness to learn new things as enabling forces for augmenting EI. Hindering factors were time constraint and lack of mutual trust in the relationship between students. Discussion: Based on the findings, it can be concluded that personal introspection methods such as self-reflection and peer feedback help to improve the EI of undergraduate students. Therefore, it is imperative that the students are trained in these skills for building their emotional competencies.
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Seeking a stable foundation to build on: 1st-Year residents' views of high-value care teaching p. 11
Rey Perez, David Aizenberg, Trocon Davis, Kira L Ryskina
DOI:10.4103/efh.EfH_189_17  
Background: United States (US) residency programs have been recently mandated to teach the concept of high-value care (HVC) defined as care that balances the benefits of interventions with their harms and costs. We know that reflective practice is a key to successful learning of HVC; however, little is known about resident perceptions of HVC learning. To better inform HVC teaching in graduate medical education, we asked 1st-year residents to reflect on their HVC learning. Methods: We conducted three focus groups (n = 36) and online forum discussion (n = 13) of 1st-year internal medicine residents. A constructivist grounded theory approach was used to assess transcripts for recurrent themes to identify the perspectives of residents shared about HVC learning. Results: Residents perceived their learning of HVC as limited by cultural and systemic barriers that included limited time, fear of missing a diagnosis, perceived expectations of attending physicians, and poor cost transparency. While the residents reported considerable exposure to the construct of HVC, they desired a more consistent framework that could be applied in different situations. In particular, residents reported frustration with variable incentives, objectives, and definitions pertaining to HVC. Suggestions for improvement in HVC teaching outlined three main needs for: (1) a generalizable framework to systematically approach each case that could be later adapted to independent practice; (2) objective real-time data on costs, benefits, and harms of medical interventions; and (3) standardized approach to assess resident competency in HVC. Discussion: As frontline clinicians and the intended target audience for HVC education, 1st-year residents are in a unique position to provide feedback to improve HVC teaching in residency. Our findings highlight the learners' desire for a more systematic approach to HVC teaching that includes the development of a stable generalizable framework for decision-making, objective data, and standardized assessment. These findings contrast current educational interventions in HVC that aim at reducing the overuse of specific practices.
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Educational experiences in a master of health professions education program at the National Autonomous University of Mexico: A qualitative study p. 18
Melchor Sánchez-Mendiola, Tania Vives-Varela, Margarita Varela-Ruiz, Adrián Martínez-González
DOI:10.4103/efh.EfH_349_16  
Background: Medical schools and healthcare institutions need leaders with formal training in education, in order to provide quality medical teaching. An answer to this need lies in the graduate programs of health professions education. Many programs exist, but there is a dearth of publications about their educational processes and experiences. The purpose of this study was to explore the teaching and learning experiences of students, teachers, and graduates of the Master in Health Professions Education (MHPE) program at the National Autonomous University of Mexico (UNAM). Methods: A qualitative approach was used with focus group discussions with students, graduates, and teachers, to explore their opinions, feelings, and experiences about the program. Purposeful sampling of participants was done. Focus group guides were developed for the different study groups; testimonies were codified and categorized with axial coding and a constant comparison method. Results: Testimonies from 19 participants in three focus groups were obtained (five graduates, seven current students, and seven teachers). The data were grouped in seven thematic categories: expectations, feedback of research projects, the tutorial process, teaching strategies, usefulness of what was learned, professional development, and assessment. Positive elements of the program were identified as well as areas in need of improvement. Discussion: The MHPE program at UNAM has been a positive experience for students and mostly fulfilled their expectations, they learned the basic theories and practical aspects of teaching, learning, and assessment in the health professions. Some areas need improvement, such as tutor performance and timely feedback to the students. Graduates think the competencies acquired in the program are useful for their professional practice. This information will be used to improve the program. There is a need to meet international standards in MHPE programs.
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Medical student well-being and lifelong learning: A motivational perspective p. 25
Oksana Babenko, Lia M Daniels, Shelley Ross, Jonathan White, Anna Oswald
DOI:10.4103/efh.EfH_237_17  
Background: Medical school poses many pressures and challenges for individuals aspiring to health careers. Only some students, however, experience high stress and exhaustion, whereas others adaptively respond to schooling demands and engage in lifelong learning practices. By drawing on three motivation theories – self-determination theory, self-theories of ability, and achievement goal theory – this study examined the relations among motivational constructs, stress, exhaustion, and lifelong learning in medical students. Methods: All medical students in a 4-year program were invited to complete a questionnaire containing measures of psychological need satisfaction, self-theories of ability, achievement goals, stress, exhaustion, lifelong learning, and background characteristics. Using structural equation modeling, we tested a structural model that combined the three motivation theories to explain stress, exhaustion, and lifelong learning in medical students. Results: A total of 267 medical students participated in the study (response rate 42%). The results largely confirmed the hypothesized relations, revealing that unmet psychological needs and a fixed mind-set were associated with maladaptive cognitions (i.e., the pursuit of avoidance goals) and psychological distress (i.e., high stress and exhaustion). In contrast, psychological need satisfaction and a growth mind-set had distinct pathways to beneficial cognitions (i.e., mastery approach goals) and lifelong learning practices in medical students. Discussion: Adaptive motivations, cultivated through personal and environmental factors, may help to protect medical students from psychological distress and enhance their growth as lifelong learners. Understanding the mechanisms and pathways to desirable and undesirable outcomes in medical students is critical for creating learning environments that will serve these students well.
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BRIEF COMMUNICATION Top

Digital professional identity: Dear Internet! Who am I? p. 33
Saira Jawed, Usman Mahboob, Rahila Yasmeen
DOI:10.4103/efh.EfH_232_17  
Background: There is an emphasis on identity formation to complement the competency-based medical education in tomorrow's doctors, with a focus from “doing” to “being,” to deeply learn the role as a health professional. Medical students spend a considerable time on internet-based online social networking platforms. These internet-based avenues can have certain implications in the formation of their identity. Methods: The aim of this article is to discuss a highly significant way to form the professional identity that is through online social networking, which can be labeled as digital professional identity (DPI). Results: DPI is defined as “professional identity that develops through internet-based social interactions by utilizing online platforms and communication tools.” Medical students develop certain constituents of professionalism as part of their lifelong professional identity during the course of their graduation. They learn the professional ways and means to communicate on internet-based social media platforms, which affect their professional identities. Discussion: We suggest to provide institutional guidance for the medical students regarding the usage of social networking sites and forming their DPIs as a medical professional by explaining the related advantages and disadvantages. In addition, accreditation bodies need to incorporate the aspect of DPI in their competencies for professionalism.
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INVITED PAPERS Top

A network of networks: 40 years of uniting global agendas toward universal health and equitable care p. 36
Jan De Maeseneer, Amy R Clithero-Eridon, Aricia DeKempeneer, Arthur Kaufman, David Bor, Ian Cameron, Robert Woollard, Roger Strasser, William Burdick, Nicholas Torres
DOI:10.4103/efh.EfH_203_19  
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Accrediting excellence for a medical school's impact on population health p. 41
Charles Boelen, Danielle Blouin, Trevor Gibbs, Robert Woollard
DOI:10.4103/efh.EfH_204_19  
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LETTER TO THE EDITOR Top

Report of a collective construction of a new educational tool for preventing hypertension in pregnancy p. 49
Rithianne Frota Carneiro, Geraldo Bezerra da Silva Junior, Zélia Maria de Sousa Araújo Santos
DOI:10.4103/efh.EfH_18_15  
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