Abstract
Objective
Describe a student coproduced curriculum to lay the foundation for professional identity development (PID).
Methods
Occurring during the introductory course of medical school, the Grab Bag Activity (GBA) is coordinated by upper-level students to offer informal, self-selected activities sponsored by upper-level students or faculty for incoming first-year students. Various levels of relationship are fostered: student to peer, student to near-peer, and student to faculty. Role-modeling, self-reflection, and coproduction of curriculum occur in these relationships.
Results
Participation has grown over the years of offering the GBA. Formal student feedback suggests perceived value of this activity. Students report increased confidence in communication, wellness, and career advancement awareness after involvement in the introductory course (including the GBA).
Conclusion
This large-scale, student coproduced GBA lays the foundation of PID through building community and fostering role-modeling between students and faculty. A detailed assessment of GBA is needed to further define the benefit perceived from students.
Supplementary Information
The online version contains supplementary material available at 10.1007/s40670-024-02100-1.
Keywords: Student-centered Curriculum, Undergraduate Medical Education, Professional Identity Development, Learning Environment
Background
Professional identity development (PID), or developing one’s ability to think, act, and feel like a physician, is an ongoing process of becoming a physician [1]. PID depends on self-reflection, modeling relationships, well-being, and resilience [1]. As students engage with their peers, near-peers (upper-level students), and faculty, they find mentors to model themselves after and form relationships, thereby promoting PID [1]. Regarding near-peer teaching, student mentors and mentees mutually benefit. The mentors (upper-level students) improve self-reflection, communication, and leadership skills [2]. The mentees (lower-level students) find a trusted near-peer advisor who can relate to the current experience intimately, increasing trust and understanding [2].
Mentorship and advising can occur through learning communities (LCs) [3], or intentional longitudinal groupings of students during pre-clerkship years. LCs improve the learning environment (LE) through social interaction among medical students of different classes [4, 5] and collaboration with faculty to develop and deliver curricula (co-production) [5, 6].
The Medical School Learning Environment Survey (MSLES) defines a positive LE as allowing for interests outside of medicine and informal activities among students, as well as providing guidance to lower-level students from upper-level students and involved faculty [4]. Working together, students and faculty have greater investment in the curriculum, an improvement mindset, and an enhanced experience [7, 8]. The improvement mindset correlates to the self-reflection component of PID. The role-modeling between students, near-peers, and faculty affects one’s perception of the LE [1, 4]. Social connectedness and role-modeling feeds into a loop of self-reflection and resilience, thereby promoting well-being and reducing burnout (see Fig. 1) [1].
Fig. 1.
The relationships formed through the Grab Bag Activity and how they contribute to professional identity development (PID) and learning environment (LE)
Recognizing the interconnectedness of the LE and PID, we collaborated with our students to develop a unique activity meant to lay the foundation for PID and LE in medical school for incoming medical students while offering an opportunity for coproduction of curriculum to upper-level students: the Grab Bag Activity (GBA).
Activity
The GBA is embedded into the introductory course required for all first-year medical students at University of Texas Medical Branch John Sealy School of Medicine (UTMB JSSOM) at Galveston, TX. US medical education is a 4-year post-baccalaureate program with 2 years of primarily pre-clinical and 2 years of clinical education. The 4-week introductory course is entitled Mindfully Evolving, Thriving, and Advocating (META). META offers students a “what to expect in med school” experience emphasizing four pillars: cultural humility, clinical skills, wellness, and evidence-based learning strategies. Most coursework takes place in predetermined large- and small-group sessions. The following are examples of sessions:
Cultural humility: patients’ lived experience seminars, social determinants of health topics (SDOH)
Clinical skills: procedure simulation, physical examination basics
Wellness: mindfulness, campus- and community-based resources
Learning: systems-based thinking, library resources, study tips
A key backbone of META is the Student Committee, volunteer students who collaborate with faculty on design and execution of curricula (coproduction). During the initial curricula development, a student priority was informal peer-to-peer and student-to-faculty interaction. The student committee took leadership of this priority and developed the GBA. The GBA acts as an adjunct to the main META coursework to facilitate networking with peers, near-peers, and faculty. Just as a grab bag situation consists of multiple items available to pick from, the GBA hosts short, informal sessions covering a variety of interests.
The GBA subcommittee solicitated sessions, arranged scheduling, maintained the session repository, and collaborated with the META course directors. Activities were offered dependent on social distancing recommendations during the SARS-CoV-2 pandemic (e.g., the initial iteration of the course was predominantly virtual in 2020).
Activities aligned with predetermined themes: Caring for Self, Caring for Others, and Arts and Humanities. “Caring for Self” activities promoted well-being, informal social interactions, and self-reflection. “Caring for Others” events introduced SDOH topics and community-based resources. “Arts and Humanities” events demanded introspection and abstract thinking, meant to promote empathy regarding another person’s lived experience.
The Learner Experience
Approximately 240 incoming medical students are in each incoming class at UTMB and participate in META (and the GBA) annually. Approximately 960 students have participated since the introduction of META in 2020. Students participated in at least three self-selected activities (one per theme). The pre- and post- survey for META was sent to all participating students and allowed for general feedback, including regarding the GBA. Certain questions in the survey reflected the aims of the GBA.
Results
Subcommittee
The number of students involved in the GBA Subcommittee has increased annually. It started with three students in 2020, then increased to seven, eleven, and then seventeen most recently in 2023.
Activities
There were 40 unique sessions in 2020, 46 in 2021, 56 in 2022, and 68 in 2023. The following are examples of the sessions offered:
“Caring for Self”: wellness (“Thriving in Medical School for Non-Traditional Students,” meditation), hobby (Running Club, Fishing Club) and professional interest groups (“Q&A with Surgery Program Director,” Women in Anesthesiology), and studying (“Guide to guides: resource management study skills,” “Surviving Med School Terminology,” “Research in Medical School”).
“Caring for Others”: simulation and suturing, orientation for the student-run clinic, Objective Structure Clinical Examination (OSCE) practice, and lectures (“Street Medicine,” “Gun Deaths: A public health crisis”)
“Arts and Humanities”: Theatre/Improv in Healing, Music in Healing collaboration with the local orchestra, Anatomy Journaling Workshop, and Intro to Medical Humanities.
Feedback
Student feedback about the GBA mentioned a few points. Many students expressed appreciation for facilitation of informal social interaction among students and for the variety of topics. Some reported sign-up difficulties. A few suggested ways to improve the activity.
Pre-/post-survey responses from 2022 and 2023 showed confidence increases across multiple domains (see Fig. 2). The question asked, “Before starting/after META, how confident were you that you had the knowledge and skills to: 1) effectively communicate with colleagues in medicine and other health professions? 2) effectively study during medical school? 3) create a wellness plan for yourself? 4) bond with classmates? 5) create balance in your life even during stressful times? 6) identify and pursue opportunities that will advance your future career goals? 7) cultivate hobbies and nurturing relationships during stressful times? 8) be vulnerable with classmates?” 272 students completed the pre-survey (56%) and 214 completed the post-survey (44%).
Fig. 2.
Degree of confidence reported by students in 2022–2023 before (left) and after (right) META. Degree of confidence increased across all domains
Discussion
The GBA is a large-scale student-coproduced curriculum adjunct designed to have a wrap-around effect benefiting lower-level students, upper-level students, and faculty based on a theoretical framework relating to PID and LE (Fig. 1). We share our curriculum to articulate a theoretical rationale for why this program receives continued support from our students. Lower-level students have a chance to develop a positive LE at the start of medical school through self-selected activities and introduction to near-peers and faculty. The confidence boost in communication, peer and faculty guidance, and wellness measures will form a positive foundation to help them navigate the arduous years of study ahead. These domains reflect the components of the MSLES: interests outside medicine, informal gatherings among students, upper-level students providing guidance, and available faculty [4]. For upper-level students interested in medical education, they have a chance to coproduce coursework with faculty role models. This interaction promotes a growth mindset for both the students and faculty involved [7]. This collaboration links back to the self-reflection and modeling relationships that are integral to PID [1]. Students whose priority is social connectedness have the chance to plan and host a singular event through their interest group. Students become involved in many ways, fostering community on the campus at large.
We demonstrate the feasibility of a large-scale, student-coproduced curriculum to promote LE and PID among students and faculty alike. Longevity of the GBA is anticipated through the ongoing partnership with student organizations and community resources. Next steps include formal assessment of the GBA. Collaboration with other medical schools to promote similar large-scale, student-driven programs would assist with assessing the derived value for each level of student and faculty involvement.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
We acknowledge the contributions from Dawnelle Schatte, one of the original course directors for META who assisted in the development of the GBA. We appreciate the support from UTMB John Sealy School of Medicine leadership for the development of and iterative improvement of META and the GBA. Figure 1 was made with Biorender.com.
Author Contribution
The first two authors contributed to the literature review, drafting, and final approval of the manuscript. The last two authors contributed to the curriculum’s design, editing process, and final approval of the manuscript.
Data Availability
Data will be shared through the corresponding author if requested.
Declarations
The University of Texas Medical Branch Institutional Review Board (UTMB IRB) reviewed our proposed manuscript and deemed it to be a non-regulatory activity. Informed consent was not required.
Conflict of Interest
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Wald HS. Professional identity (trans)formation in medical education: reflection, relationship, resilience. Acad Med J Assoc Am Med Coll. 2015;90(6):701–6. 10.1097/ACM.0000000000000731. [DOI] [PubMed] [Google Scholar]
- 2.Akinla O, Hagan P, Atiomo W. A systematic review of the literature describing the outcomes of near-peer mentoring programs for first year medical students. BMC Med Educ. 2018;18(1):98. 10.1186/s12909-018-1195-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Ferguson KJ, Wolter EM, Yarbrough DB, Carline JD, Krupat E. Defining and describing medical learning communities: results of a national survey. Acad Med. 2009;84(11):1549. 10.1097/ACM.0b013e3181bf5183. [DOI] [PubMed] [Google Scholar]
- 4.Smith SD, Dunham L, Dekhtyar M, et al. Medical student perceptions of the learning environment: learning communities are associated with a more positive learning environment in a multi-institutional medical school study. Acad Med. 2016;91(9):1263. 10.1097/ACM.0000000000001214. [DOI] [PubMed] [Google Scholar]
- 5.Rosenbaum ME, Schwabbauer M, Kreiter C, Ferguson KJ. Medical students’ perceptions of emerging learning communities at one medical school. Acad Med. 2007;82(5):508. 10.1097/ACM.0b013e31803eae29. [DOI] [PubMed] [Google Scholar]
- 6.Bicket M, Misra S, Wright SM, Shochet R. Medical student engagement and leadership within a new learning community. BMC Med Educ. 2010;10(1):20. 10.1186/1472-6920-10-20. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Sandars J, Goh PS. Design thinking in medical education: the key features and practical application. J Med Educ Curric Dev. 2020;7:238212052092651. 10.1177/2382120520926518. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Könings KD, Mordang S, Smeenk F, Stassen L, Ramani S. Learner involvement in the co-creation of teaching and learning: AMEE Guide No. 138. Med Teach. 2021;43(8):924–36. 10.1080/0142159X.2020.1838464. [DOI] [PubMed] [Google Scholar]
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Supplementary Materials
Data Availability Statement
Data will be shared through the corresponding author if requested.