Vers un modèle de bien-être favorisant l’autonomie dans l’éducation médicale canadienne
DOI :
https://doi.org/10.36834/cmej.75312Résumé
Résumé
Objectif : La détresse de l’apprenant est un enjeu grave pour la médecine aujourd’hui, et les institutions d’enseignement médical ont été appelées à participer à sa résolution. Malheureusement, la majorité d’entre elles ont réagi par l’élaboration d’interventions axées sur le « bien-être » de l’individu au lieu de s’attaquer au système et à la culture qui minent depuis longtemps la profession. En conséquence, les apprenants en médecine sont contraints de suivre des formations sur la résilience, la pleine conscience et l’épuisement professionnel.
Approche : Fondé sur des données empiriques et une théorie éprouvée, j’avance dans ce commentaire l’argument central selon lequel ces interventions sont inopportunes, insultantes et psychologiquement préjudiciables aux apprenants, et qu’elles doivent cesser.
Contribution : Dans le prolongement de travaux antérieurs dans ce domaine, je présente d’abord trois problèmes fondamentaux liés aux interventions individuelles favorisant le bien-être. Je préconise ensuite un changement de paradigme dans la manière d’aborder le « bien-être » dans l’enseignement médical. Enfin, je propose une feuille de route, fondée sur des données probantes et la théorie de l’autodétermination, pour apporter des améliorations opportunes, durables et socialement responsables au niveau systémique, des améliorations qui profiteraient à tous les acteurs du domaine médical, des responsables aux patients en passant par les enseignants et les apprenants.
Statistiques
Références
Bourcier D, Far R, King L, et al. Medical student wellness in Canada: time for a national curriculum framework. Can Med Educ J. Published online 2021. https://doi.org/https://doi.org/10.36834/cmej.73008
Tepper J, Champion C, Johnston T, et al. Medical Student Health and Wellbeing.; 2015.
Bourcier D, Far R, King L. CFMS Wellness Curriculum Framework.; 2020. https://www.cfms.org/files/wellness-resources/CFMS-Wellness-Curriculum-Framework_FINAL.pdf
Ryff CD, Singer BH. Know thyself and become what you are: A eudaimonic approach to psychological well-being. J Happiness Stud. 2008;9(1):13-39. https://doi.org/10.1007/s10902-006-9019-0
Neufeld A. A commentary on “Medical student wellness in Canada: time for a national curriculum framework". Can Med Educ J. Published online 2021. https://doi.org/https://doi.org/10.36834/cmej.74143
Dobkin PL, Hutchinson TA. Teaching mindfulness in medical school: Where are we now and where are we going? Med Educ. Published online 2013. https://doi.org/10.1111/medu.12200
Madva A. The Inevitability of Aiming for Virtue. In: Overcoming Epistemic Injustice; 2019.
Sebring JCH. Towards a sociological understanding of medical gaslighting in western health care. Sociol Heal Illn. 2021;43(9). https://doi.org/10.1111/1467-9566.13367
Fraser S. The toxic power dynamics of gaslighting in medicine. Can Fam Physician. 2021;67(5). https://doi.org/10.46747/cfp.6705367
Kunzler AM, Helmreich I, König J, et al. Psychological interventions to foster resilience in healthcare students. Cochrane Database Syst Rev. 2020;2020(7). https://doi.org/10.1002/14651858.cd013684
Ricker M, Brooks AJ, Bodine S, Lebensohn P, Maizes V. Well-being in residency: Impact of an online physician well-being course on resiliency and burnout in incoming residents. Fam Med. 2021;53(2). https://doi.org/10.22454/FamMed.2021.314886
Dyrbye L, Shanafelt T. A narrative review on burnout experienced by medical students and residents. Med Educ. Published online 2016. https://doi.org/10.1111/medu.12927
Naji L, Singh B, Shah A, et al. Global prevalence of burnout among postgraduate medical trainees: a systematic review and meta-regression. C open. 2021;9(1). https://doi.org/10.9778/cmajo.20200068
West C, Dyrbye L, Sinsky C. Resilience and burnout among physicians and the general US working population. JAMA - J Am Med Assoc. 2020;3(7). https://doi.org/https://doi.org/10.1001/jamanetworkopen.2020.9385
Ryan RM, Deci EL. Self-Determination Theory: Basic Psychological Needs in Motivation Development and Wellness. Guilford Publishing; 2017.
Kusurkar RA, Croiset G, Mann K V., Custers E, ten Cate O. Have motivation theories guided the development and reform of medical education curricula? A review of the literature. Acad Med. 2012;87(6):735-743. https://doi.org/10.1097/ACM.0b013e318253cc0e
Kusurkar RA, Ten Cate TJ, Vos CMP, Westers P, Croiset G. How motivation affects academic performance: A structural equation modelling analysis. Adv Heal Sci Educ. 2013;18(1):57-69. https://doi.org/10.1007/s10459-012-9354-3
Kusurkar RA, Croiset G, Galindo-Garré F, Ten Cate O. Motivational profiles of medical students: Association with study effort, academic performance and exhaustion. BMC Med Educ. Published online 2013. https://doi.org/10.1186/1472-6920-13-87
Neufeld A, Malin G. Exploring the relationship between medical student basic psychological need satisfaction, resilience, and well-being: A quantitative study. BMC Med Educ. Published online 2019. https://doi.org/10.1186/s12909-019-1847-9
Neufeld A, Malin G. How medical students’ perceptions of instructor autonomy-support mediate their motivation and psychological well-being. Med Teach. Published online 2020. https://doi.org/10.1080/0142159X.2020.1726308
Neufeld A, Malin G. Need fulfillment and resilience mediate the relationship between mindfulness and coping in medical students. Teach Learn Med. Published online 2021. https://doi.org/10.1080/10401334.2021.1960533
Neufeld A, Malin G. Basic psychological needs, more than mindfulness and resilience, relate to medical student stress: a case for shifting the focus of wellness curricula. Med Teach. Published online 2020. https://doi.org/10.1080/0142159X.2020.1813876
Kusurkar RA, van der Burgt SME, Isik U, et al. Burnout and engagement among PhD students in medicine: the BEeP study. Perspect Med Educ. 2021;10(2). https://doi.org/10.1007/s40037-020-00637-6
Williams GC, Deci EL. The importance of supporting autonomy in medical education. Ann Intern Med. Published online 1998. https://doi.org/10.7326/0003-4819-129-4-199808150-00007
Williams GC, Deci EL. Internalization of biopsychosocial values by medical students: A test of self-determination theory. J Pers Soc Psychol. 1996;70(4):767-779. http://dx.doi.org/10.1037/0022-3514.70.4.767
Patrick H, Williams GC. Self-determination in medical education: encouraging medical educators to be more like blues artists and poets. Theory Res Educ. Published online 2009. https://doi.org/10.1177/1477878509104323
Ten Cate TJ, Kusurkar RA, Williams GC, ten Cate OTJ, Kusurkar RA, Williams GC. How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE Guide No. 59. Med Teach. 2011;33(12):961-973. https://doi.org/10.3109/0142159X.2011.595435
Baldwin CD, Craig MS, Garfunkel LC, et al. Autonomy-supportive medical education: let the force be within you! Acad Med. Published online 2012. https://doi.org/10.1097/ACM.0b013e31826cdc3f
Kusurkar RA, Croiset G. Autonomy support for autonomous motivation in medical education. Med Educ Online. Published online 2015. https://doi.org/10.3402/meo.v20.27951
Hoffman BD. Using Self-Determination Theory to Improve Residency Training. Acad Med. Published online 2015. https://doi.org/10.1097/acm.0000000000000523
Orsini C, Binnie VI, Wilson SL. Determinants and outcomes of motivation in health professions education: a systematic review based on self-determination theory. J Educ Eval Health Prof. 2016;13:19. https://doi.org/10.3352/jeehp.2016.13.19
Lawrence C, Mhlaba T, Stewart KA, Moletsane R, Gaede B, Moshabela M. The hidden curricula of medical education: A scoping review. Acad Med. Published online 2018. https://doi.org/10.1097/ACM.0000000000002004
Seo C, Corrado M, Fournier K, Bailey T, Haykal KA. Addressing the physician burnout epidemic with resilience curricula in medical education: a systematic review. BMC Med Educ. 2021;21(1). https://doi.org/10.1186/s12909-021-02495-0
Chung MP, Thang CK, Vermillion M, Fried JM, Uijtdehaage S. Exploring medical students’ barriers to reporting mistreatment during clerkships: a qualitative study. Med Educ Online. 2018;23(1). https://doi.org/10.1080/10872981.2018.1478170
Bell A, Cavanagh A, Connelly CE, Walsh A, Vanstone M. Why do few medical students report their experiences of mistreatment to administration? Med Educ. 2021;55(4). https://doi.org/10.1111/medu.14395
Rotenstein LS, Ramos MA, Torre M, et al. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students a systematic review and meta-analysis. JAMA Published online 2016. https://doi.org/10.1001/jama.2016.17324
Neufeld A, Malin G. How medical students cope with stress: a cross-sectional look at strategies and their sociodemographic antecedents. BMC Med Educ. 2021;21(1). https://doi.org/10.1186/s12909-021-02734-4
Ryan RM, Weinstein N. Undermining quality teaching and learning: A self-determination theory perspective on high-stakes testing. Theory Res Educ. Published online 2009. https://doi.org/10.1177/1477878509104327
Weinstein N, Brown KW, Ryan RM. A multi-method examination of the effects of mindfulness on stress attribution, coping, and emotional well-being. J Res Pers. Published online 2009. https://doi.org/10.1016/j.jrp.2008.12.008
Weinstein N, Ryan RM. A self-determination theory approach to understanding stress incursion and responses. Stress Heal. Published online 2011. https://doi.org/10.1002/smi.1368
Colenbrander L, Causer L, Haire B. “If you can’t make it, you’re not tough enough to do medicine”: a qualitative study of Sydney-based medical students’ experiences of bullying and harassment in clinical settings. BMC Med Educ. 2020;20(1). https://doi.org/10.1186/s12909-020-02001-y
Kassebaum DG, Cutler ER. On the culture of student abuse in medical school. Acad Med. 1998;73(11). https://doi.org/10.1097/00001888-199811000-00011
Mansukhani MP, Kolla BP, Surani S, Varon J, Ramar K. Sleep deprivation in resident physicians, work hour limitations, and related outcomes: A systematic review of the literature. Postgrad Med. 2012;124(4). https://doi.org/10.3810/pgm.2012.07.2583
Rasche K, Orth M. Shift work in health-care system: Consequences for nurses, doctors, and patients. Atemwegs- und Lungenkrankheiten. 2019;45(10). https://doi.org/10.5414/ATX02455
Li-Sauerwine S, Rebillot K, Chung AS, Coates WC, Shah S, Yarris LM. Moving beyond personal factors: A national study of wellness interventions in emergency medicine residency programs. AEM Educ Train. 2021;5(4). https://doi.org/10.1002/aet2.10690
Neufeld A. Autonomy-Supportive Teaching in Medicine: From Motivational Theory to Educational Practice. MedEdPublish. 2021;10(1). https://doi.org/10.15694/mep.2021.000117.1
Deci EL, Ryan RM, Vallerand RJ, Pelletier LG. Motivation and Education: The Self-Determination Perspective. Educ Psychol. Published online 1991. https://doi.org/10.1080/00461520.1991.9653137
Teixeira PJ, Marques MM, Silva MN, et al. A classification of motivation and behavior change techniques used in self-determination theory-based interventions in health contexts. Motiv Sci. Published online 2020. https://doi.org/10.1037/mot0000172
Reeve J. Self-Determination Theory Applied to Educational Settings. In: Handbook of Self-Determination Research. ; 2002.
Earl S. Building autonomous learners: perspectives from research and practice using self-determination theory. Br J Educ Stud. 2019;67(2). https://doi.org/10.1080/00071005.2019.1577592
Tepper J, Champion C, Johnston T, et al. Medical Student Health and Wellbeing.; 2015. https://www.cfms.org/files/position-papers/Wellness Position Paper_Aug19.pdf
King L, Yuan JH, Li H, Do V. Canadian Federation of Medical Students response to “The alarming situation of medical student mental health.” Can Med Educ J. Published online 2021. https://doi.org/10.36834/cmej.71777
Smith C. The Ultimate Change Management Process Flow. The Change Blog. Published 2018. https://change.walkme.com/change-management-process-flow/ [Accessed Mar 3, 2022].
Paul S. 5 Advice that actually will help take charge of life. Published 2022. https://suvadeeppaul.medium.com/5-laws-to-help-you-charge-of-your-life-f30477f63628 [Accessed Apr 20, 2022].
Téléchargements
Publié-e
Comment citer
Numéro
Rubrique
Licence
(c) Tous droits réservés Adam Neufeld 2022
Cette œuvre est sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
La soumission d’un manuscrit original à la revue constitue une indication qu’il s’agit d’un travail original, qu’il n’a jamais été publié et qu’il n’est pas envisagé pour publication dans une autre revue. S’il est accepté, il sera publié en ligne et ne pourra l’être ailleurs sous la même forme, à des fins commerciales, dans quelque langue que ce soit, sans l’accord de l’éditeur.
La publication d’une recherche scientifique a pour but la diffusion de connaissances et, sous un régime sans but lucratif, ne profite financièrement ni à l’éditeur ni à l’auteur.
Les auteurs qui publient dans la Revue canadienne d’éducation médicale acceptent de publier leurs articles sous la licence Creative Commons Paternité - Pas d’utilisation commerciale, Pas de modification 4.0 Canada. Cette licence permet à quiconque de télécharger et de partager l’article à des fins non commerciales, à condition d’en attribuer le crédit aux auteurs. Pour plus de détails sur les droits que les auteurs accordent aux utilisateurs de leur travail, veuillez consulter le résumé de la licence et la licence complète.
