This column is intended to address the kinds of knotty problems and dilemmas with which many scholars grapple in studying health professions education. In this article, the authors address the challenges in proofreading a manuscript. Emerging researchers might think that someone in the production team will catch any errors. This may not always be the case. We emphasize the importance of guiding mentees to take the process of preparing a manuscript for submission seriously.

Without haptic feedback, robotic surgeons rely on visual processing to interpret the operative field. To provide guidance for teaching in this environment, we analyzed intracorporeal actions and behaviors of a robotic surgeon. Six hours of video were captured by the intracorporeal camera during a robot-assisted lower anterior resection. After complete review, authors reduced the video to a consecutive 35 min of highly focused robotic activity and finally, a 2-min clip was subjected to microanalysis. The clip was replayed multiple times (capturing 1, 2, 10, 60 and 120 s intervals) and activities were identified, such as right and left hand motion, tissue handling and camera adjustments recorded using a software program. Activity patterns were categorized into two main themes: change in operative focus occurs when there is an inability to obtain adequate tension, and observation of robot-assisted surgery is based on an incomplete visual framework. The surgeon manipulated tissue predominantly using blunt adjustments and rarely grasped it, likely as a way to avoid tissue trauma. A magnified operative field required precise dissection, which occurs robotically with movement of a single instrument against a static field (motionless second robotic arm). This meticulous technique is unlike the bimodal manipulation often used for laparoscopic dissection. Since residents have limited active participation in robotic cases, and therefore, rely heavily on the captured image for skill acquisition, we recommend surgeons to use focus shifts as an opportunity to describe their operative decision-making and highlight instrument manipulations specific to operating with robotic technology.

Objective. This study aimed to enrich the Academy's understanding of pharmacy students' readiness for advanced pharmacy practice experiences (APPEs) by exploring the perspectives of three primary stakeholders: APPE students, APPE preceptors, and APPE faculty site directors.Methods. A descriptive qualitative study of APPE readiness was conducted using workplace learning as a guiding conceptual framework. Data were collected between March and September 2019 through semi-structured focus groups and interviews with students (five groups), preceptors (four groups), and faculty site directors (one group, two individual interviews). The data were analyzed using directed content analysis.Results. Participants described APPE readiness as a multifaceted construct comprised of four themes: learner characteristics, participation in workplace activities, relationship-building, and workplace practices to orient and support students. While all participants addressed each category, faculty site directors and preceptors tended to focus on learner characteristics, while students emphasized their participation in the workplace and relationship building.Conclusion. Knowledge is widely recognized as a requirement for APPE readiness. This study identified learner characteristics, workplace participation, and relational skills as additional requirements. Some of these criteria are challenging to assess prior to APPEs, which makes orienting students both prior to and at the start of APPEs particularly important to support readiness. Thus, a comprehensive review of APPE readiness might also include assessing the readiness of workplaces, administrators, and preceptors for APPE students.

Background

As more women become surgeons, knowledge of patient perceptions is necessary to educate this new pool of surgeons on how to maximize patient trust and foster the optimal surgeon-patient relationship.

Materials and methods

Patients in a general medicine clinic in San Francisco were surveyed. Study respondents read one of the eight short scenarios that differed by surgeon gender, surgery type (lung cancer versus breast cancer), and surgeon demeanor (more masculine--agentic versus more feminine--communal). In all scenarios, the surgeon was described as accomplished and well trained. After reading the short description, respondents rated five items from 0-5, which were averaged to create a measure of preference.

Results

Based on the 476 completed surveys, respondents did not have a significant preference for either female or male surgeons (P = 0.76). We found a significant interaction in respondent choice between the surgeon demeanor and the type of surgery (P < 0.05). Respondents preferred an agentic surgeon for lung cancer surgery and a communal surgeon for breast cancer surgery regardless of surgeon or respondent gender. No other interactions or main effects were statistically significant.

Conclusions

Our respondents did not overtly prefer a surgeon based on gender, which suggests that patients may not contribute to the traditional gender biases reported by female surgeons. Further work needs to be done to determine if our results can be replicated in different geographic regions and if there is gender stereotyping within the field of surgery.

Giving and receiving feedback are critical skills and should be taught early in the process of medical education, yet few studies discuss the effect of feedback curricula for first-year medical students. To study short-term and long-term skills and attitudes of first-year medical students after a multidisciplinary feedback curriculum. Prospective pre- vs. post-course evaluation using mixed-methods data analysis. First-year students at a public university medical school. We collected anonymous student feedback to faculty before, immediately after, and 8 months after the curriculum and classified comments by recommendation (reinforcing/corrective) and specificity (global/specific). Students also self-rated their comfort with and quality of feedback. We assessed changes in comments (skills) and self-rated abilities (attitudes) across the three time points. Across the three time points, students’ evaluation contained more corrective specific comments per evaluation [pre-curriculum mean (SD) 0.48 (0.99); post-curriculum 1.20 (1.7); year-end 0.95 (1.5); p = 0.006]. Students reported increased skill and comfort in giving and receiving feedback and at providing constructive feedback (p < 0.001). However, the number of specific comments on year-end evaluations declined [pre 3.35 (2.0); post 3.49 (2.3); year-end 2.8 (2.1)]; p = 0.008], as did students’ self-rated ability to give specific comments. Teaching feedback to early medical students resulted in improved skills of delivering corrective specific feedback and enhanced comfort with feedback. However, students’ overall ability to deliver specific feedback decreased over time.

Habits of inquiry are considered an essential component of the modern physician's profile. These habits drive physicians to recognize and address the continuous challenges inherent to the practice of medicine; consequently, they meet the aims of better patient-centered care, better health of communities, and improved functioning of the health system. Many medical schools have endeavored to integrate inquiry into their curricula as a means of supporting development of adaptive expertise, a construct that encompasses habits of inquiry. However, the diversity of conceptualizations of inquiry has resulted in correspondingly diverse instructional implementations. Much of the emphasis has been on inquiry methods (e.g., engagement in research projects, courses in research methods and statistics), but the learners' inquiry disposition and its essential attitude component have received little attention in instruction and assessment. The authors propose that both inquiry methods and attitude need to be developed explicitly and simultaneously to prepare physicians to successfully be willing and able to address the challenges of today's health care environment. Because attitudes are established predictors of behavior, a positive inquiry attitude may be the ultimate determinant of physicians' engagement in behaviors of adaptive expertise (i.e., recognizing when learned procedures do not apply, and learning or inventing effective solutions). Addressing the attitude toward inquiry as early as possible in medical school is critical because strong attitudes are difficult to modify. Thus, a curriculum that supports positive inquiry attitude formation and strengthening will carry well beyond medical school and residency training.