January 2024


Most of our members are in for some---umm—brisk weather this week.   So, as a PSA, we’ve included this useful chart.

But even better—stay inside and read the January edition of the Journal Club…


Amit, Jon and Karen

Barriers to success for first gen students

Wright SR, Boyd VA, Okafor I, Sharma M, Giroux R, Richardson L, Brosnan C. 'First in family' experiences in a Canadian medical school: A critically reflexive study. Med Educ. 2023 Oct;57(10):980-990. https://dx.doi.org/10.1111/medu.15116

Reviewed by: Erin Peebles 

What was the study question?

Using critical reflexivity as a theoretical framework, how do ‘First in Family’(FiF) medical students experience the medical school environment?

How was the study done?

Semi-structured interviews and purposive criterion sampling were used to identify medical students that self-identified as FiF to go to university. Using Bourdieu’s key concepts of capital (economic, social, and cultural aspects that can provide advantage to certain groups), field (the places where the struggle for capital take place) and habitus (the systems and structures to which one has been exposed; do they feel like they belong?), they performed thematic analysis of 17 interviews of undergraduate medical students. 

What were the results?

Through analysis of the interviews, authors identified several themes. The first was the implicit messaging of who belongs in medical school, as FiF students identified feeling they had to work harder to belong, or felt different from everyone else, because of their upbringing. Secondly, FiF students reported difficulty reconciling their new identity as a medical professional with their previous relationships.  Finally, FiF students identified challenges in competing for residency spots, as competitive CVs meant having capital (eg. being able to engage in unpaid research during the summer) and being comfortable in the habitus (cold calling physicians to gain experience). FiF students also identified strengths to their position, in that they felt better able to identify with families experiencing challenging social and economic situations. 

How can I apply this to my work in education?

This study highlights that FiF medical students struggle in areas of capital, field, and habitus during medical school. In addition, the process of critical reflexivity shifts the focus from the ‘deficits’ of the individual to the structures and institutions that create the inequities. For medical educators engaging in diversity and equity work moving forward, a critically reflexive lens may help provide further insight into why current approaches have not proved as effective as hoped. 

Editor’s Note: This study goes beyond being diverse and equitable in recruitment but thinking how to support those students in the school. Using this framework, institutions may be able to provide a more equitable learning environment. (AKP)

Educational Alliance Enhances Feedback

Wong SN, Luo CJ, MacDonald G, Hatala R. A qualitative study of medical students' perceptions of resident feedback.  Medical Education 2022; 56:994-1001. https://doi.org/10.1111/medu.14847

Reviewed by Brittany Lissinna 

What was the study question?

What are medical students’ perspectives of feedback experiences with residents?

How was the study done?

This study used qualitative interpretive description to understand medical students’ experiences of their relationships with residents and how this impacted their interpretation of resident feedback as well as other learning on rotation. Participants included fourth year medical students who were nearing the end of their undergraduate medical education, and third year medical students nearing the end of their first clinical year and students who had less positive experiences with feedback. Individual semi-structured interviews were conducted targeting students’ feedback experiences with residents on any of their clinical rotations. Thematic analysis was used to identify themes and examine the student-resident relationship and how this impacted feedback and learning. 

What were the results?

18 fourth year and 6 third year medical students were interviewed. The three main themes identified were: 1) relationship building; 2) the student-resident relationship influences student receptivity to feedback; 3) resident feedback influences students’ experiences. The time residents take to build a relationship with the medical students on the team was recognized as positively impacting the learning environment. In settings where students perceived a supportive relationship with the resident, feedback, whether encouraging or constructive, was valued more than that which came from less supportive relationships. Resident feedback was also perceived as addressing more practical aspects of clinical work and had the potential to impact a students’ vision for their future behavior as a resident. 

How can I apply this to my work in education?

This study emphasizes the integral role residents play in the learning environment. Residents’ efforts to develop a supportive relationship with students can impact the learning experience and value placed on feedback from residents. As we continue to foster supportive learning environments for medical students, focusing our attention on opportunities to build meaningful student-resident relationships has the potential to improve learning and professional growth. 

Editor’s Note: A strength of this study was the purposive sampling used by the authors to seek out participation from students’ experiences with resident feedback were not positive, thereby exploring what made feedback experiences both good and not good and allowing for a deeper understanding of the importance of relationship building in the feedback experience. Another interesting finding was the perception of feedback as being “lower stakes” when coming from a resident, enabling students to focus on formative aspects of the feedback rather than perceive it as an assessment; this seemingly counters the often-stated adage that “assessment drives learning.” (KFo)

The “F” word

Klasen, JM; Germann, N; Lutz, S; Beck, J;  Fourie, L. Breaking the Silence: A Workshop for Medical Students on Dealing With Failure in Medicine. Academic Medicine 98(12):p 1402-1405, December 2023.   https://dx.doi.org/10.1097/ACM.0000000000005438

Reviewed by Melissa Held, MD

What was the study question?

Does medical student participation in a workshop about “failure” provide support to students and provide an understanding that failure is an important source of learning early in their medical career?

How was the study done?

As part of their medical school curriculum, the University of Basel, Switzerland offered this workshop as an elective experience. The development of this curriculum followed the 6-step approach outlined by Chen et al. The authors focused on one of their Entrustable Professional Activities (EPA 9) which is about “creating a culture of safety and improvement.”  

The 16-hour workshop was limited  to  groups of 6-10 students and given three times between 8/2021 and 2/2022 and was facilitated by the same 3 moderators.  Teaching was done virtually (due to COVID-19) and included  presentations, small group discussions, journal clubs and reflections. 

What were the results?

There were 30 participants (18 female, 12 male, mean age 25y).  19/30 anonymously completed the standard course evaluation. On a 10-point scale, with 10 being the best, students rated the course with a mean (SD) score of 8.59 (0.98).  They  rated the following dimensions on a 6-point scale (6 is best): timing: mean (SD), 5.48 (0.53); structure: mean (SD), 5.29 (0.83); additional benefit to the rest of the curriculum: mean (SD), 5.83 (0.47); own prior knowledge: mean (SD), 5.22 (0.60); potential to increase interest: mean (SD), 5.45 (0.85); and recommendation to peers: mean (SD), 5.55 (0.83).

There were also 89 qualitative comments consisting of 42 from the standard evaluation form and 47 from a daily interactive digital board. Thematic analysis revealed two main categories. First, participants perceived having increased awareness that failure is ubiquitous in medicine.  They also appreciated having a safe environment to talk about failure because most had “never had the opportunity during courses and clinical rotations.” They felt “safe to reveal personal information and discuss their experiences freely”

How can I apply this to my work in education?

Medical students often feel that any failure means they are not “cut out” for a career in medicine. Many students do not realize how common failure in medicine is or how to reflect and learn from these experiences in a manner that allows them to grow. By promoting a safe learning environment early in medical school, the stigma and shame that often surrounds failure may be reduced and contribute to a greater sense of purpose and even well-being. By presenting failures openly and normalizing the experience for students, we might better help future physicians cope with their experiences and learn from them, thereby adopting a growth mindset.

Editor’s Note:  So if they perform badly during the workshop, do they get an A? (JG)