Background: The shift in postgraduate medical training towards a competency-based medical education framework has inspired research focused on medical educator competencies. This research has rarely considered the importance of the learning environment in terms of both setting and specialty-specific factors. The current study attempted to fill this gap by examining narrative comments from psychiatry faculty evaluations to understand learners’ perceptions of educator effectiveness. Methods: Data consisted of psychiatry faculty evaluations completed in 2015-2016 by undergraduate and postgraduate learners (N= 324) from McMaster University. Evaluations were provided for medical teachers and clinical supervisors in classroom and clinical settings. Narrative comments were analyzed using descriptive qualitative methodology by three independent reviewers to answer: “What do undergraduate and postgraduate medical learners perceive about educator effectiveness in psychiatry?” Results: Narrative comments were provided on 270/324 (83%) faculty evaluation forms. Four themes and two sub-themes emerged from the qualitative analysis. Effective psychiatry educators demonstrated specific personal characteristics that aligned with previous research on educator effectiveness. Novel themes included the importance of relationships and affective factors, including learner security and inspiration through role modeling Conclusion: Contemporary discussions about educator effectiveness in psychiatry have excluded the dynamic, relational and affective components of the educational exchange highlighted in the current study. This may be an important focus for future educational research.
Background Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear. Objective This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research. Methods This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study. Results A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance. Conclusions VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life.
Introduction The COVID‐19 pandemic has caused unprecedented stress to the medical education community, potentially worsening problems like burnout and work‐life imbalance that its members have long been grappling with. However, the collective struggle sparked by the pandemic could generate the critical reflection necessary for transforming professional values and practices for the better. In this hermeneutic phenomenological study, we explore how the community is adapting—and even reconceptualising —their personal and professional roles amidst the COVID‐19 crisis. Method Between April and October 2020, we conducted 27 (17F, 10M) semi‐structured interviews with medical trainees (8), physicians (8), graduate students (3) and PhD scientists (8) working in medical education in Canada, the United States and Switzerland. Data analysis involved a variety of strategies, including coding for van Manen's four lifeworld existentials, reflexive writing and multiple team meetings. Results Participants experienced grief related to the loss of long‐established personal and professional structures and boundaries, relationships and plans for the future. However, experiences of grief were often conflicting. Some participants also experienced moments of relief , perceiving some losses as metaphorical permissions slips to slow down and focus on their well‐being. In turn, many reflected on the opportunity they were being offered to re‐imagine the nature of their work. Discussion Participants' experiences with grief, relief and opportunity resonate with Ratcliffe's account of grief as a process of relearning the world after a significant loss. The dismantling of prior life structures and possibilities incited in participants critical reflection on the nature of the medical education community's professional practices. Participants demonstrated their desire for more flexibility and autonomy in the workplace and a re‐adjustment of the values and expectations inherent to their profession. On both individual and systems levels, the community must ensure that long‐standing calls for wellness and work‐life integration are realised—and persist—after the pandemic is over.
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