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Background: Active learning relies on students' engagement with teachers, study materials and/or each other. Although medical education has adopted active learning as a core component of medical training, teachers have difficulties recognising when and why their students engage or disengage and how to teach in ways that optimise engagement. With a better understanding of the dynamics of student engagement in small‐group active learning settings, teachers could be facilitated in effectively engaging their students. Methods: We conducted a video‐stimulated recall study to explore medical students' engagement during small‐group learning activities. We recorded one teaching session of two different groups and selected critical moments of apparent (dis)engagement. These moments served as prompts for the 15 individual semi‐structured interviews we held. Interview data were analysed using Template Analysis style of thematic analysis. To guide the analysis, we used a framework that describes student engagement as a dynamic and multidimensional concept, consisting of behavioural, cognitive and emotional components. Results: The analysis uncovered three main findings: (1) In‐class student engagement followed a spiral‐like pattern. Once students were engaged or disengaged on one dimension, other dimensions were likely to follow suit. (2) Students' willingness to engage in class was decided before class, depending on their perception of a number of personal, social and educational antecedents of engagement. (3) Distinguishing engagement from disengagement appeared to be difficult for teachers, because the intention behind student behaviour was not always identifiable. Discussion: This study adds to the literature by illuminating the dynamic process of student engagement and explaining the difficulty of recognising and influencing this process in practice. Based on the importance of discerning the intentions behind student behaviour, we advise teachers to use their observations of student (dis)engagement to initiate interaction with students with open and inviting prompts. This can help teachers to (re‐)engage students in their classrooms. This study illuminates the dynamic process of student engagement in small‐group active learning settings and explains the difficulty teachers have recognizing and influencing engagement in practice. [ABSTRACT FROM AUTHOR]

Health professions education (HPE) research is dominated by variable-centred analysis, which enables the exploration of relationships between different independent and dependent variables in a study. Although the results of such analysis are interesting, an effort to conduct a more person-centred analysis in HPE research can help us in generating a more nuanced interpretation of the data on the variables involved in teaching and learning. The added value of using person-centred analysis, next to variable-centred analysis, lies in what it can bring to the applications of the research findings in educational practice. Research findings of person-centred analysis can facilitate the development of more personalized learning or remediation pathways and customization of teaching and supervision efforts. Making the research findings more recognizable in practice can make it easier for teachers and supervisors to understand and deal with students. The aim of this article is to compare and contrast different methods that can be used for person-centred analysis and show the incremental value of such analysis in HPE research. We describe three methods for conducting person-centred analysis: cluster, latent class and Q‑sort analyses, along with their advantages and disadvantage with three concrete examples for each method from HPE research studies. [ABSTRACT FROM AUTHOR]

This AMEE guide provides a research overview of the identification of, and responding to unprofessional behaviour in medical students. It is directed towards medical educators in preclinical and clinical undergraduate medical education. It aims to describe, clarify and categorize different types of unprofessional behaviours, highlighting students' unprofessional behaviour profiles and what they mean for further guidance. This facilitates identification, addressing, reporting and remediation of different types of unprofessional behaviour in different types of students in undergraduate medical education. Professionalism, professional behaviour and professional identity formation are three different viewpoints in medical education and research. Teaching and assessing professionalism, promoting professional identity formation, is the positive approach. An inevitable consequence is that teachers sometimes are confronted with unprofessional behaviour. When this happens, a complementary approach is needed. How to effectively respond to unprofessional behaviour deserves our attention, owing to the amount of time, effort and resources spent by teachers in managing unprofessional behaviour of medical students. Clinical and medical educators find it hard to address unprofessional behaviour and turn toward refraining from handling it, thus leading to the 'failure to fail' phenomenon. Finding the ways to describe and categorize observed unprofessional behaviour of students encourages teachers to take the appropriate actions. [ABSTRACT FROM AUTHOR]

Context: As unprofessional behaviour in physicians can compromise patient safety, all physicians should be willing and able to respond to lapses in professionalism. Although students endorse an obligation to respond to lapses, they experience difficulties in doing so. If medical educators knew how students respond and why they choose certain responses, they could support students in responding appropriately. Objectives: The aim of this study was to describe medical students' responses to professionalism lapses in peers and faculty staff, and to understand students' motivation for responding or not responding. Methods: We conducted an explorative, qualitative study using template analysis, in which three researchers independently coded transcripts of semi‐structured, face‐to‐face interviews. We purposefully sampled 18 student representatives convening at a medical education conference. Preliminary open coding of a data subset yielded an initial template, which was applied to further data and modified as necessary. All transcripts were coded using the final template. Finally, three sensitising concepts from the Expectancy–Value–Cost model were used to map participants' responses. Results: Students mentioned having observed lapses in professionalism in both faculty staff and peers. Students' responses to these lapses were avoiding, addressing, reporting or initiating policy change. Generally, students were not motivated to respond if they did not know how to respond, if they believed responding was futile and if they feared retaliation. Students were motivated to respond if they were personally affected, if they perceived the individual as approachable and if they thought that the whole group of students could benefit from their actions. Expectancy of success, value and costs each appeared to be influenced by (inter)personal and system factors. Conclusions: The Expectancy–Value–Cost model effectively explains students' motivation for responding to lapses. The (inter)personal and system factors influencing students' motivation to respond are modifiable and can be used by medical educators to enhance students' motivation to respond to lapses in professionalism observed in medical school. [ABSTRACT FROM AUTHOR]

Noting that failure is a part of learning, Mak‐van der Vossen draws metaphors from the world of medical error to suggest that 'blame‐free' approaches to educational support must be established. [ABSTRACT FROM AUTHOR]

Objectives: Workplace-based assessments are based on the principle of providing feedback to medical students on clinical performance in authentic settings. In practice, however, the assessment often overshadows the feedback. The aim of this study was to determine what problems faculty perceived when performing workplace-based assessments and what solutions they suggested to overcome these difficulties. Methods: Discussion meetings were conducted with education coordinators and faculty (n=55) from 11 peripheral hospitals concerning the difficulties encountered when conducting workplace-based assessments. We analysed the reports from these discussion meetings using an integrated approach guided by our research questions to code the data. Two researchers analysed the data independently and resolved differences of opinion through consensus. Results: The problems perceived by faculty in workplace-based assessments (difficulties) and suggestions for improvement formed the overarching themes. Problems included the short duration of clerkships, students choosing the assessment moments, the use of grades for the mini- Clinical Evaluation Exercise, the difficulty in combining teacher and assessor roles and the difficulty in giving fail judgements. Suggestions for improvement included longer clerkship duration, faculty choosing the assessment moments, using a pass/fail system for the mini-Clinical Evaluation Exercise and forward feeding of performance from earlier clerkships following a fail judgement. Conclusions: Our study indicates that faculty perceive difficulties when conducting workplace-based assessments. These assessments need periodical review to understand the difficulties faculty experience using them; they also require periodical feedback to ensure their proper and effective use. [ABSTRACT FROM AUTHOR]

Background Developing professional behaviour is an important goal of medical education in which teachers play a significant part. Many teachers can be reluctant to fail students demonstrating unprofessional behaviour. We hypothesize that supporting teachers in teaching and assessing professional behaviour and involving them in remediation will reduce this reluctance. Findings In 2010, VUmc School of Medical Sciences Amsterdam introduced an educational theme on professional behaviour for the bachelor's and master's programmes in medicine with a special emphasis on supporting teachers in teaching and assessing professional behaviour and involving them in the remediation process. Information was extracted from the student database on the number of unprofessional behaviour judgments awarded over 2008-2010 (before the intervention), and 2010-2013 (after introducing the intervention), which was compared. To find out if teachers' reluctance to fail had decreased, qualitative feedback from the teachers was gathered and analysed. Since the implementation of the educational theme, the number of unprofessional behaviour judgments has risen. The teachers are positive about the implemented system of teaching and assessing professional behaviour, and feel less reluctant to award an unsatisfactory professional behaviour judgment. Conclusions Supporting teachers in teaching and assessing professional behaviour and involving them in students' remediation appears to reduce their reluctance to fail students demonstrating unprofessional behaviour. [ABSTRACT FROM AUTHOR]

Background: Training of doctors in The Netherlands seeks to develop clinical competences including professional behaviour. Behaving as a professional is not just a desirable trait but a clearly stated requirement for doctors and medical students. Results: We designed an educational theme, Professional Behaviour (PB), as a longitudinal thread throughout our six-year curriculum after defining PB as 'The observable aspects of practising professionalism'. This definition was translated into a set of practical skills that can be observed: 'The ability to deal with tasks, to deal with others and to deal with oneself'. We assess PB 29 times in the course of the medical curriculum. Students with an unsatisfactory PB do not get their degree irrespective of their medical knowledge. We train teachers to identify and report unprofessional student behaviour, and we offer these students interventions and support. Conclusions: With the educational theme 'Professional Behaviour' we have defined PB for our institute and firmly embedded it in the medical curriculum. We use workplace learning and role models for teaching PB. Different teachers carry out multiple formative and summative assessments, using standardized assessment scales. With these measures we intend to promote a culture of excellence in PB in our institute. [ABSTRACT FROM AUTHOR]

Background: Lapses in professionalism have profound negative effects on patients, health professionals, and society. The connection between unprofessional behaviour during training and later practice requires timely identification and remediation. However, appropriate language to describe unprofessional behaviour and its remediation during residency is lacking. Therefore, this exploratory study aims to investigate which behaviours of GP residents are considered unprofessional according to supervisors and faculty, and how remediation is applied. Methods: We conducted eight semi-structured focus group interviews with 55 broadly selected supervisors from four Dutch GP training institutes. In addition, we conducted individual semi-structured interviews with eight designated professionalism faculty members. Interview recordings were transcribed verbatim. Data were coded in two consecutive steps: preliminary inductive coding was followed by secondary deductive coding using the descriptors from the recently developed 'Four I's' model for describing unprofessional behaviours as sensitising concepts. Results: Despite the differences in participants' professional positions, we identified a shared conceptualisation in pinpointing and assessing unprofessional behaviour. Both groups described multiple unprofessional behaviours, which could be successfully mapped to the descriptors and categories of the Four I's model. Behaviours in the categories 'Involvement' and 'Interaction' were assessed as mild and received informal, pedagogical feedback. Behaviours in the categories 'Introspection' and 'Integrity', were seen as very alarming and received strict remediation. We identified two new groups of behaviours; 'Nervous exhaustion complaints' and 'Nine-to-five mentality', needing to be added to the Four I's model. The diagnostic phase of unprofessional behaviour usually started with the supervisor getting a 'sense of alarm', which was described as either a 'gut feeling', 'a loss of enthusiasm for teaching' or 'fuss surrounding the resident'. This sense of alarm triggered the remediation phase. However, the diagnostic and remediation phases did not appear consecutive or distinct, but rather intertwined. Conclusions: The processes of identification and remediation of unprofessional behaviour in residents appeared to be intertwined. Identification of behaviours related to lack of introspection or integrity were perceived as the most important to remediate. The results of this research provide supervisors and faculty with an appropriate language to describe unprofessional behaviours among residents, which can facilitate timely identification and remediation. [ABSTRACT FROM AUTHOR]

Rising mental health issues is a global problem among PhD students. This study aimed to identify stressors and energizers in PhD work. PhD students at a university medical center were asked to describe the top three stressors and energizers in their PhD work through a survey. The narrative answers were subjected to content analysis. Three hundred and eighty-six PhD students participated. We identified five overarching themes: Research is challenging, Resources can be limited, Recognizing the value of work, Experience of autonomy, and Relationships are key to success. We found positive (energizers) as well as negative (stressors) comments for each theme. Supportive supervision with open communication has been identified in the literature as the most important contributor to PhD student well-being, while work-life imbalance has been identified as the most important reason for psychological distress. With our study, we add energizers and stressors that fit into a theoretical framework (Self-determination theory). This helps to understand the problem better and provide specific recommendations. Optimal challenges, resources and supervision, autonomy and good relationships at work are perceived as energizers. Challenges in research beyond capability, limitations in resources, not being valued, autonomy restriction and poor relationships at work are perceived as stressors in PhD work. [ABSTRACT FROM AUTHOR]

Introduction: Using a self-determination theory framework, we investigated burnout and engagement among PhD students in medicine, and their association with motivation, work-life balance and satisfaction or frustration of their basic psychological needs. Method: This cross-sectional study was conducted among PhD students at a university medical centre (n = 990) using an electronic survey on background characteristics and validated burnout, engagement, motivation and basic psychological needs questionnaires. Cluster analysis was performed on the burnout subscale scores to find subgroups within the sample which had similar profiles on burnout. Structural equation modelling was conducted on a hypothesized model of frustration of basic psychological needs and burnout. Results: The response rate was 47% (n = 464). We found three clusters/subgroups which were composed of PhD students with similar burnout profiles within the cluster and different profiles between the clusters. Cluster 1 (n = 199, 47%) had low scores on burnout. Clusters 2 (n = 168, 40%) and 3 (n = 55, 13%) had moderate and high burnout scores, respectively, and were associated with low engagement scores. Cluster 3, with the highest burnout scores, was associated with the lowest motivational, engagement, needs satisfaction and work-life balance scores. We found a good fit for the "basic psychological needs frustration associated with burnout" model. Discussion: The most important variables for burnout among PhD students in medicine were lack of sleep and frustration of the basic psychological needs of autonomy, competence and relatedness. These add to the factors found in the literature. [ABSTRACT FROM AUTHOR]