Medical Student Portfolios: A Systematic  Scoping Review

Tan, Rei; Ting, Jacquelin Jia Qi; Hong, Daniel Zhihao; Lim, Abner Herbert; Ong, Yun Ting; Pisupati, Anushka; Chong, Eleanor Jia Xin; Chiam, Min; Lee, Alexia Sze Inn; Tan, Laura Hui Shuen; Chin, Annelissa; Wijaya, Limin; Fong, Warren; Krishna, Lalit Kumar Radha

doi:10.1177/23821205221076022

Cited by 17 publications

(8 citation statements)

References 141 publications

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“…Consequently, it also underlines the potential for a RToP-based tool, designed to evaluate the physician’s needs, coping and progress. Both considerations coalesce to highlight the need for a portfolio-based program as an additional source of reflection and to guide support and oversight of physicians [ 40 – 46 ].…”

Section: Resultsmentioning

confidence: 99%

“…Such a comprehensive assessment and support mechanism for physicians may be structured around a portfolio-based program [ 40 , 46 ] and supported by a RToP-based assessment tool. This portfolio-based program echoes Fronek et al [ 48 ]’s calls for “a model of training that can meet multi-level learning needs of practitioners” that “is delivered along the professional life span[ing] and incorporate[ing] external reinforcement, inclusive of peer support and supervision opportunities”.…”

Section: Resultsmentioning

confidence: 99%

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Physician-patient boundaries in palliative care

Lim

Rahman

et al. 2023

BMC Palliat Care

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Background Nurturing effective physician-patient relationships is essential to the provision of patient-centred care. Palliative care physicians may apply boundary-crossings or breaches in professional standards to nurture effective physician-patient relationships. Being highly individualized and shaped by the physician’s narratives, clinical experience, and contextual considerations, boundary-crossings are susceptible to ethical and professional violations. To better appreciate this concept, we employ the Ring Theory of Personhood (RToP) to map the effects of boundary-crossings on the physician’s belief systems. Methods As part of the Tool Design SEBA methodology, a Systematic Evidence-Based Approach (SEBA) guided systematic scoping review was employed to guide the design of a semi-structured interview questionnaire with palliative care physicians. The transcripts were simultaneously content and thematically analysed. The themes and categories identified were combined using the Jigsaw Perspective and the resulting domains formed the basis for the discussion. Results The domains identified from the 12 semi-structured interviews were catalysts and boundary-crossings. Boundary-crossings attempt to address threats to a physician’s belief systems (catalysts) and are highly individualized. Employ of boundary-crossings depend on the physician’s sensitivity to these ‘catalysts’, their judgement and willingness to act, and their ability to balance various considerations and reflect on their actions and their ramifications. These experiences reshape belief systems, understandings of boundary-crossings and may influence decision-making and practice, underscoring the potential for greater professional breaches when unchecked. Conclusion Underlining its longitudinal effects, the Krishna Model underscores the importance of longitudinal support, assessment and oversight of palliative care physicians, and lays the foundation for a RToP-based tool to be employed within portfolios.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Physician-patient boundaries in palliative care

Lim

Rahman

et al. 2023

BMC Palliat Care

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“…To begin, the Krishna Model of Reflective Writing (Fig. 3 ) builds on the Krishna-Pisupati Model [ 10 ] used to describe evaluations of professional identity formation (PIF) [ 8 , 10 , 24 , 251 ]. Evidenced in studies of how physicians cope with death and dying patients, moral distress and dignity-centered care [ 46 , 54 ], the Krishna-Pisupati Model suggests that the physician’s belief system is informed by their self-concepts of personhood and identity.…”

Section: Discussionmentioning

confidence: 99%

A systematic scoping review of reflective writing in medical education

Lim

Ong

et al. 2023

BMC Med Educ

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Background Reflective writing (RW) allows physicians to step back, review their thoughts, goals and actions and recognise how their perspectives, motives and emotions impact their conduct. RW also helps physicians consolidate their learning and boosts their professional and personal development. In the absence of a consistent approach and amidst growing threats to RW’s place in medical training, a review of theories of RW in medical education and a review to map regnant practices, programs and assessment methods are proposed. Methods A Systematic Evidence-Based Approach guided Systematic Scoping Review (SSR in SEBA) was adopted to guide and structure the two concurrent reviews. Independent searches were carried out on publications featured between 1st January 2000 and 30th June 2022 in PubMed, Embase, PsychINFO, CINAHL, ERIC, ASSIA, Scopus, Google Scholar, OpenGrey, GreyLit and ProQuest. The Split Approach saw the included articles analysed separately using thematic and content analysis. Like pieces of a jigsaw puzzle, the Jigsaw Perspective combined the themes and categories identified from both reviews. The Funnelling Process saw the themes/categories created compared with the tabulated summaries. The final domains which emerged structured the discussion that followed. Results A total of 33,076 abstracts were reviewed, 1826 full-text articles were appraised and 199 articles were included and analysed. The domains identified were theories and models, current methods, benefits and shortcomings, and recommendations. Conclusions This SSR in SEBA suggests that a structured approach to RW shapes the physician’s belief system, guides their practice and nurtures their professional identity formation. In advancing a theoretical concept of RW, this SSR in SEBA proffers new insight into the process of RW, and the need for longitudinal, personalised feedback and support.

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“…Drawing on recent studies on longitudinal support and assessments of medical students the use of a tool to assess MD based on the RToP could be included within a medical student's [126] to assess progress and direct support. As we look forward to engaging in this growing field, we are especially hopeful for greater understanding of the long-term effects of MD in various cultures and to evaluate the efficacy of support mechanisms for 'at risk' and 'recovering' medical students.…”

Section: Discussionmentioning

confidence: 99%

A systematic scoping review moral distress amongst medical students

et al. 2022

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Background Characterised by feelings of helplessness in the face of clinical, organization and societal demands, medical students are especially prone to moral distress (MD). Despite risks of disillusionment and burnout, efforts to support them have been limited by a dearth of data and understanding of MD in medical students. Yet, new data on how healthcare professionals confront difficult care situations suggest that MD could be better understood through the lens of the Ring Theory of Personhood (RToP). A systematic scoping review (SSR) guided by the RToP is proposed to evaluate the present understanding of MD amongst medical students. Methods The Systematic Evidence-Based Approach (SEBA) is adopted to map prevailing accounts of MD in medical students. To enhance the transparency and reproducibility, the SEBA methodology employs a structured search approach, concurrent and independent thematic analysis and directed content analysis (Split Approach), the Jigsaw Perspective that combines complementary themes and categories, and the Funnelling Process that compares the results of the Jigsaw Perspective with tabulated summaries to ensure the accountability of these findings. The domains created guide the discussion. Results Two thousand six hundred seventy-one abstracts were identified from eight databases, 316 articles were reviewed, and 20 articles were included. The four domains identified include definitions, sources, recognition and, interventions for MD. Conclusions MD in medical students may be explained as conflicts between the values, duties, and principles contained within the different aspects of their identity. These conflicts which are characterised as disharmony (within) and dyssynchrony (between) the rings of RToP underline the need for personalised and longitudinal evaluations and support of medical students throughout their training. This longitudinal oversight and support should be supported by the host organization that must also ensure access to trained faculty, a nurturing and safe environment for medical students to facilitate speak-up culture, anonymous reporting, feedback opportunities and supplementing positive role modelling and mentoring within the training program.

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Medical Student Portfolios: A Systematic Scoping Review

Cited by 17 publications

References 141 publications

Physician-patient boundaries in palliative care

Physician-patient boundaries in palliative care

A systematic scoping review of reflective writing in medical education

A systematic scoping review moral distress amongst medical students

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