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Líbera Oehlenschlage
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Background: Information retrieval in primary care is becoming more difficult as the volume of medical information held in electronic databases expands. The lexical structure of this information might permit automatic indexing and improved retrieval.
Objective: To determine the possibility of identifying the key elements of clinical studies, namely Patient-Population-Problem, Exposure-Intervention, Comparison, Outcome, Duration and Results (PECODR), from abstracts of medical journals.
Methods: We used a convenience sample of 20 synopses from the journal Evidence-Based Medicine (EBM) and their matching original journal article abstracts obtained from PubMed. Three independent primary care professionals identified PECODR-related extracts of text. Rules were developed to define each PECODR element and the selection process of characters, words, phrases and sentences. From the extracts of text related to PECODR elements, potential lexical patterns that might help identify those elements were proposed and assessed using NVivo software.
Results: A total of 835 PECODR-related text extracts containing 41,263 individual text characters were identified from 20 EBM journal synopses. There were 759 extracts in the corresponding PubMed abstracts containing 31,947 characters. PECODR elements were found in nearly all abstracts and synopses with the exception of duration. There was agreement on 86.6% of the extracts from the 20 EBM synopses and 85.0% on the corresponding PubMed abstracts. After consensus this rose to 98.4% and 96.9% respectively. We found potential text patterns in the Comparison, Outcome and Results elements of both EBM synopses and PubMed abstracts. Some phrases and words are used frequently and are specific for these elements in both synopses and abstracts.
Conclusions: Results suggest a PECODR-related structure exists in medical abstracts and that there might be lexical patterns specific to these elements. More sophisticated computer-assisted lexical-semantic analysis might refine these results, and pave the way to automating PECODR indexing, and improve information retrieval in primary care.
Context: Emotion in medical education rests between the idealised and the invisible, sitting uneasily at the intersection between objective fact and subjective values. Examining the different ways in which emotion is theorised within medical education is important for a number of reasons. Most significant is the possibility that ideas about emotion can inform a broader understanding of issues related to competency and professionalism.
Objectives: The current paper provides an overview of three prevailing discourses of emotion in medical education and the ways in which they activate particular professional expectations about emotion in practice.
Methods: A Foucauldian critical discourse analysis of the medical education literature was carried out. Keywords, phrases and metaphors related to emotion were examined for their effects in shaping medical socialisation processes.
Discussion: Despite the increasing recognition over the last two decades of emotion as 'socially constructed', the view of emotion as individualised is deeply embedded in our language and conceptual frameworks. The discourses that inform our emotion talk and practice as teachers and health care professionals are important to consider for the effects they have on competence and professional identity, as well as on practitioner and patient well-being. Expanded knowledge of how emotion is 'put to work' within medical education can make visible the invisible and unexamined emotion schemas that serve to reproduce problematic professional behaviours. For this discussion, three main discourses of emotion will be identified: a physiological discourse in which emotion is described as located inside the individual as bodily states which are universally experienced; emotion as a form of competence related to skills and abilities, and a socio-cultural discourse which calls on conceptions from the humanities and social sciences and directs our attention to emotion's function in social exchanges and its role as a social, political and cultural mediator.
Objective: To explore student experiences relating to racism, microaggressions and implicit bias within healthcare communication and medical education in the wake of the Black Lives Matter movement METHODS: Students and faculty from different racial/ethnic backgrounds, medical schools, countries, and levels of training shared their perspectives with a multi-disciplinary, international audience at the 2020 International Conference on Communication in Healthcare (ICCH).
Results: We highlight experiences shared at the symposium and demonstrate how the student voice can help shape the medical school curriculum. 3 main themes are discussed: 1) Institutional bias and racism, 2) Racial discrimination during medical training and 3) Recommendations for curricula change.
Conclusion: Racism influences many aspects of student experiences and often appears in covert and institutional forms. These shared experiences reflect a common problem faced by ethnic minority medical students.
Practice implications: Student experiences provide thoughtful recommendations for educators regarding incorporating anti-racism teaching into their curricula. It is essential that this teaching is collaborative, non-tokenistic and implemented early in the syllabus. It is beneficial for educators to build on the various existing approaches demonstrated by other institutions.
As patient populations become more diverse, it is imperative that future physicians receive proper training in order to provide the best quality of care. This study examines medical students' perceptions of how prepared they are in dealing with a diverse population and assesses how included and supported the students felt during their studies.
Based on our findings, it is recommended that medical schools incorporate diversity education into their curriculum so that health professionals can provide the best quality of care for their diverse patient populations. This education should also ensure that all students feel included in their medical education program.
A skilled medical workforce that will promote the health of all people is critical to the health of any nation [1]. As society is diverse in many respects, including gender/sex, ethnicity, nationality, age, religion, socioeconomic status, sexual orientation, and disability [2], future medical practitioners must be prepared to meet the needs of this diverse patient population [3]. This is even more relevant given the evidence that patients with underrepresented ethnic backgrounds and lower socioeconomic positions tend to receive lower quality of care than other patients and that they experience greater morbidity and mortality from various chronic diseases than nonminorities [4].
Four focus groups, consisting of three to nine students (20 students in total) from the Faculty of Medicine participated in this study. Of the participants, seven were bachelors' students and 13 were masters' students. Two out of the 20 students were international students from outside of Europe, five students had non-dominant ethnic background (including Turkish, Moroccan and Surinam), one student identified as non-binary and queer, four students had non-dominant sexual orientation (three being homosexual, one being lesbian), and one student indicated having autism.
The diversity in education theme was divided into three codes: (1) diversity incorporated within education, (2) lack of diversity in education, (3) the need for incorporating diversity into education.
In addition to a lack of diversity education in the medical curriculum, participants also observed that if attention is paid to diversity in the patient population, this is often in a stereotyping manner. This aligns with the recommendation of Lim et al. (2021) to assess and update educational material to remove stereotypes and ensure information is grounded in evidence-based medicine [37]. Other ideas participants shared were increasing diversity among the health care professional population, incorporating diversity in cases, and using more inclusive language. The few examples students shared of diversity present in their education is promising because they help students to become more aware of diversity issues.
Students also shared personal experiences of both exclusion and inclusion within their program. Although it is encouraging that diverse students shared positive experiences of open conversations [38] and feeling they belong on their program, there were also multiple instances of exclusion. Students described experiencing and observing stereotypes and prejudices related to their (minority) identities, such as ethnic background and sexual orientation. Not all students felt safe all the time, and some did not (always) feel they belong on their program. An absence of feelings of belonging could lead to exhaustion, isolation, emotional distress, and health problems [16, 39,40,41]. Also, the way the education system is organized leads in some ways to observations and experiences of exclusion.
A possible reason for students, particularly students identifying with a minority identity, to feel excluded is the lack of diversity in the medical curriculum. This was implied in statements by several participants in this study. Likewise, Hurtado and Ponjuan (2005) and Nuez (2009) found that students had a stronger sense of belonging when diversity was incorporated in the curriculum [42, 43]. Students also referred to a lack of awareness among teachers, health care professionals, and (fellow) students about diversity and its importance for creating an inclusive learning environment and delivering the best quality of care to a diverse patient population. Possibly, increasing awareness could be an important first step for incorporating diversity in education and for reducing exclusion experiences of students.
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