Browsing by Author "Byram, Jessica N."
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Item Anatomy Preparedness in Medical Education: Determining and Building Sufficient Preparedness in Professional Anatomy Courses(2023-08) Balle, Megan C.; McNulty, Margaret A.; Agosto, Elizabeth R.; Byram, Jessica N.; Graunke, Steven S.; Magee, Paula A.; Williams, James C.Widely accepted as a foundational course within health professions education, anatomy is often taken at the beginning of the health professional curriculum and students are expected to be prepared for the rigors of the course. Anatomy preparedness, evaluated in this study, has been defined as matriculating into a graduate or professional anatomy course with an adequate foundation in basic anatomy knowledge. In a mixed-methods study, pre-requisite syllabi of physician assistant students were analyzed via deductive content analysis to explore common traits within each group. The top and bottom 10% performing students were invited to participate in semi-structured interviews, n=5 participated. Additionally, correlation analyses were used to determine whether performance on a basic anatomy pre-quiz could aid in identifying allied health students with the potential to struggle in a professional anatomy course. A post-course survey was given to determine in which anatomy topics students felt underprepared upon matriculation, prior anatomy experience, feelings of preparedness, and anatomy pre-requisite recommendation. Finally, a pre-matriculation program targeting under-represented in medicine (URiM) students and those at-risk for failure in the medical program was developed. Correlation analyses were used to determine if there was a relationship between performance in the pre-matriculation program and the medical anatomy course. The same post-course survey was administered and focus groups were conducted; transcripts were analyzed via deductive content analysis. Syllabi traits critical to student success included exposure to specimens/prosections, practical exams, and supply of study resources; interviewees also perceived these traits to be important. Twenty-question pre-quiz scores significantly and positively correlated with student performance in their professional anatomy course. Students reported feeling deficient in anatomicomedical terminology and the nervous system. The pre-matriculation program was a success, with students performing at or above average within their cohort and compared to other URiM students. Both allied health and pre-matriculation students recommended taking anatomy prior to professional school. As seen in this study, students are capable of success with the proper resources and support. Furthermore, allied health and medical students recognized the importance of anatomy preparedness for success in health professional anatomy coursework and their openness to resources aimed at supporting their success.Item The Effect of Identity Dissonance and Consonance on Professional Identity Formation in Medical Students(2020-03-06) Byram, Jessica N.Professional identity formation (PIF) in medical students is often considered a straightforward process of professional socialization where students adopt the norms, values, knowledge, and skills required of physicians. However, no studies have examined the processes through which medical students’ identities are transformed during the professionalization process and how their developing professional identities blend with their existing identities. Nine medical students from Indiana University School of Medicine completed this study spanning the second (MS2) and third (MS3) years of medical school. Participants completed three semi-structured interviews at the start of MS2, end of MS2, and end of MS3, and submitted 10 audio diaries at two-month intervals between interviews. In audio diary recordings, participants discussed who they wanted to be as physicians and how their experiences transformed their developing professional identities. A thematic analysis of interviews and audio diaries were used to create a framework of PIF.This study found several processes of PIF that related to how consonant one considered his/her personal identity to be to the identity of a ‘typical’ medical student and physician, and the degree to which one’s experiences fulfilled his/her expectations and conceptions of medicine, medical students, and physicians. Medical students experiencing identity consonance utilized processes to adapt their personalities and found their experiences to confirm their commitment to medicine. Those experiencing positive identity dissonance used processes to accommodate their personality and had experiences that challenged their connection to medicine. While they found medical professionalization to be arduous, their negative experiences were often seen as necessary processes. Finally, several participants experienced negative identity dissonance, in which they refused to modify their personality to match that of the "typical" medical student and doubted their ability to make it through medical education. This study identified identity dissonance in medical students and the processes they used to cope with it. Doubt has only recently been described in medical students but this study established the impact doubt has on PIF in that it prevents medical students from seeing themselves as future physicians. Dissonance was also experienced by participants who felt they did not have the identity of a typical medical student or physician (e.g., they are female, non-white, lower socioeconomic status, or introverted) and they had experiences with patients and faculty that confirmed they did not meet this stereotyped identity. Students experiencing identity dissonance, particularly those with negative experiences, are at greatest risk of internalizing a professional identity that is inconsistent with members of the profession and may even leave professional education. Medical educators need to recognize and address identity dissonance and the sources that are creating it to assist the medical students in becoming the physicians they aspire to be.Item Experiences of Residency Program Directors in Their Roles: Exploring Well-Being Through Burnout and Engagement(2022-11) Robertson, Kyle A.; Byram, Jessica N.; Hayes, Cleveland; Agosto, Elizabeth R.; McNulty, Margaret A.; Organ, Jason M.Recent literature on well-being of physicians in general, and residency program directors (PD) specifically, has demonstrated those meeting the criteria of burnout reaching almost 50% in physicians, and 20-30% in PDs. However, few studies have explored engagement, or the positive or meaningful aspects, in physicians and no studies have explored engagement in the PD and Assistant PD community. Therefore, this study employed a qualitative approach to explore the experiences of PDs and APDs as they encountered burnout, engagement, and every combination in between through their multifaceted, roles, responsibilities, and tasks embedded in their institutional context and personal lives. Phase 1 participants (n=3) included two PDs and one APD from Indiana University School of Medicine (IUSM). Participants in Phase 1 took part in three semi-structured interviews at 6-month intervals, and direct observations in their clinical, administrative, and education roles. Phase 2 participants (n=5) were PDs from IUSM who completed a single semi-structured interview based on preliminary results and exploration of Phase 1 participants’ experiences. Interviews and field notes from observations were analyzed using inductive thematic analysis, followed by a deductive application of Job Demands-Resources (JD-R) theory. Document analysis was incorporated to add context, understanding, and a rich description of the participants’ experiences. This study found multiple sub-themes situated within four major themes: It Takes a Village, Integration of the “Hats” They Wear, Motivation and the Meaning of Their Career, and Coping. Exploring the sub-themes to JD-R theory allowed contextualization of how job demands, job resources, personal resources, absence of resources, job crafting, recovery, self-undermining, and strain, interact to add context, nuance, and broader conceptualization of how PD and APD experienced their multifaceted roles. This study provides a rich description of the experiences of PDs and APDs embedded in their social context of roles, tasks, and responsibilities. These results indicated that understanding how the individual experiences their job demands as they interact with their experiences of job and personal resources, and how the individual proactively engages with their environment through job crafting and recovery enables for a nuanced appreciation of engagement and burnout.Item First patient project: Engaging pathology through the donor dissection experience and its role in professionalism(Wiley, 2024-01) Robertson, Kyle A.; Organ, Jason M.; Yard, Michael; Byram, Jessica N.; Anatomy, Cell Biology and Physiology, School of MedicineThe peer-reviewed anatomical education literature thoroughly describes the benefits and drawbacks of donor dissection. Gross anatomy laboratory environments utilizing donor dissection are generally considered to be a premier environment where students foster non-traditional discipline-independent skills (NTDIS), including the acquisition of professionalism, empathy, resilience, emotional intelligence, and situational awareness. Therefore, this IRB-approved study explored the impact of a formal humanism and pathology thread, the first patient project (FPP), on the personal and professional development of pre-professional undergraduate students in a gross anatomy dissection-based course. Five reflections from each student were collected across four cohorts (n = 74 students, 370 reflections). A post-course questionnaire collected data on student perceptions of the project. The framework method was used to analyze reflection and free response data and descriptive statistics were performed on Likert-style items using Excel. Three themes were identified to encompass the impacts of the FPP on professional development and include: Socialization (through collective dissection experience and pathology), Humanistic Qualities (respect for the donor and their history, and introspection), and Content and Skills (technical and NTDIS, anatomical knowledge). The end of course FPP survey was completed by 29 students across three cohorts (65%) and their perspectives were generally favorable regarding the promotion of respect, empathy, and humanization of their donors. This study underscores the value of incorporating humanism, pathology, and reflection, facilitated through formal curriculum for pre-professional undergraduate students. It provides evidence of the positive impact on their personal and professional development, supporting the integration of NTDIS in curricula across various disciplines.Item A Foucauldian Archaeology of Modern Medical Discourse(2020-09) Azim, Homaira M.; Scheurich, James J.; Brokaw, James J.; O'Loughlin, Valerie D.; Byram, Jessica N.Medical education researchers have long been interested in understanding medical professional identity formation and its implications for the healthcare system. Various theories have been proposed to explain identity formation. Among them, Foucault’s discourse theory maintains that it is the discourse of medicine that constitutes medical professional identities. This study deployed a Foucauldian archaeological methodology to analyze the structure of modern medical discourse and establish links between discourse and professional identity formation in medical students. A total of forty-six medical students at Indiana University School of Medicine participated in either individual or focus group interviews. Direct observation of the clinical and educational settings was also performed, which resulted in additional textual data in the form of fieldnotes. Archaeological analysis of discourse was undertaken in three levels of the statements, the discursive elements, and the discursive rules and relations. Results entailed a detailed depiction of the structure of medical discourse including discursive objects and modes of enunciation, discursive concepts, and theoretical strategies related to each object. Discursive objects are things that are talked about in modern medical discourse. This study identified four discursive objects as disease and treatment, the doctor, the human body, and the sick person. Modes of enunciation are the different ways in which people talk about objects of medicine, whereas concepts consist of the notions people draw from when talking about objects of medicine. Theoretical strategies indicate certain positions that people take in relation to the objects of medicine. Rules of formation and conditions of existence for each discursive element were also established. Since Identities are entrenched through language and interaction, developing a systematic understanding of the structure of medical discourse will shed new light on medical professional identity formation. Results of this study also have profound implications for teaching professionalism and medical humanities in medical curricula. Furthermore, as a research methodology used for the first time in medical education, archaeology not only opens new territories to be explored by future research, it also provides an entirely new way to look at them.Item How the distinctive cultures of osteopathic and allopathic medical schools affect the careers, perceptions, and institutional efforts of their anatomy faculties: A qualitative case study of two schools(Wiley, 2015-11-01) Brokaw, James J.; Byram, Jessica N.; Traser, Courtney J.; Arbor, Tafline C.; Department of Anatomy & Cell Biology, IU School of MedicineAnatomy faculties are integral to basic science instruction in medical schools, particularly given the preponderance of anatomic instruction in the preclinical curriculum. Recent years have witnessed major curricular restructuring and other emerging national trends that pose significant challenges to anatomists. An examination of anatomy faculty perceptions at two philosophically distinct medical schools within this shifting climate provides an indicator of how different institutional characteristics may impact anatomy instruction and other faculty responsibilities. Semistructured interviews of anatomy faculty from a large, well-established allopathic medical school (Indiana University School of Medicine) and a small, new osteopathic medical school (Marian University College of Osteopathic Medicine) were explored using qualitative thematic analysis. Four overarching themes were identified: (1) Institutional philosophies, such as affiliation with osteopathic versus allopathic medicine, have minimal impact on how the anatomical sciences are taught. (2) Differences in anatomy faculty experiences at these two institutions are largely driven by the institution's size and history. There is a disparity between institutions in the relative importance of teaching and research, but an ability to do research is important for both faculties. (3) Anatomy instruction and research agendas are driven by personal philosophies and interests rather than institutional philosophy. (4) Autonomy is highly valued by anatomists at both institutions. All the participants share a devotion to educating future physicians. In fact, this study identified more similarities than differences in these two faculties. Finally, we argue that shared educational resources and research collaborations can improve anatomy education and faculty development at both institutions. Anat Sci Educ. © 2015 American Association of Anatomists.Item The impact of COVID-19 on professional identity(Wiley, 2022) Byram, Jessica N.; Frankel, Richard M.; Isaacson, J. Harry; Mehta, Neil; Anatomy, Cell Biology and Physiology, School of MedicineBackground: The COVID-19 pandemic has had a profound impact on medical care and medical student education as clinical rotations were halted and students' clinical activities were drastically curtailed. Learning experiences in medical school are known to promote identity formation through teamwork, reflection, and values-based community discussion. This study explored the impact of the COVID-19 pandemic on medical students' professional identity formation (PIF). Methods: Students in all cohorts of medical education were invited by email in May 2020 to submit a written reflection about their learning experiences and impact of the pandemic on their PIF. We used iterative individual and team reviews, known as the "immersion/crystallisation" method, to code and analyse the data. Findings: Twenty-six students (20%) submitted reflections in which they discussed "changing conceptions of the role and image of a physician," "views about medical education," and the "role of students in a pandemic." Students viewed physicians as altruistic, effective communicators, and pledged to be like them in the future. Their perceptions of virtual learning were mixed, along with considerations of lost interactions with patients, and wanting to be more useful as professionals-in-training. Discussion: COVID-19 has impacted students' views of themselves and reshaped their ideas, both negatively and positively, about the profession they are entering and their role(s) in it. Conclusion: Exploring PIF and the impact of disruptions has allowed us to address the issues raised regarding clinical learning now and into the future. Reflection enhances PIF and unexpected events, such as COVID-19, offer opportunities for reflection and development.Item Integrated Case-Based Learning Session for Breast and Upper Limb Anatomy(Association of American Medical Colleges, 2024-05-10) Merritt, Emily; McNulty, Margaret A.; Byram, Jessica N.; Anatomy, Cell Biology and Physiology, School of MedicineIntroduction: Medical students are frequently introduced to medical school curricula through anatomy coursework, which often includes histology and embryology content. As medical education has increasingly emphasized integration of content areas, use of activities such as case-based learning (CBL) sessions has grown. Little published work has demonstrated the effectiveness of CBL sessions in integrating anatomy, embryology, and histology on first-year medical students' ability to improve content mastery and adapt their study techniques. Methods: We developed a CBL session that included anatomy, embryology, and histology content covering the upper extremity and breast pathology that was taught to incoming first-year medical students (N = 51) during a prematriculation program in the summers of 2022 and 2023. The session involved completion of an individual pre- and postsession quiz; group completion of clinical cases involving image interpretation, matching exercises, and construction of diagrams, flowcharts, or tables; and a postsession survey with Likert-style and free-response questions about preparation and session effectiveness. Results: Postsession quiz scores significantly improved (p < .001). On the postsession survey (response rate: 59%), students commented that they enjoyed the real-life application and integration of the cases and that the sessions improved their understanding of the connections between content areas. Other comments demonstrated that students were evaluating and adapting their study approach in preparation for the sessions, often using techniques introduced and practiced in the sessions. Discussion: CBL sessions can provide opportunities to incoming first-year medical students to practice, adapt, and evaluate study techniques while delivering integrated content.Item Investigating feelings of imposterism in first‐year medical student narratives(Wiley, 2025) Kruskie, Megan E.; Frankel, Richard M.; Isaacson, J. Harry; Mehta, Neil; Byram, Jessica N.; Anatomy, Cell Biology and Physiology, School of MedicineIntroduction: Imposter phenomenon (IP), feeling as if a person does not belong, has been reported in medical students at various rates. In medical literature, this phenomenon has often been defined as a 'syndrome', but other studies have described it as a dynamic experience that can have various impacts on different people at different time points. Although studies have linked IP with other phenomena such as burnout in residents and physicians, no studies have examined its aetiology nor how these feelings are experienced by medical students. Methods: With the use of social identity theory as a framework, the authors analysed 233 reflective essays for elements of IP across eight cohorts of medical students from two institutions. Students responded to a prompt that asked: 'What was one part of your identity that you thought you would have to change in order to become a physician?' Included reflections were analysed using the framework method. Results: Elements of IP were identified in 121 reflections (52%) and were categorised into three major themes: (1) Comparing oneself to an idealised image of a medical student, (2) Comparing oneself to an idealised image of a physician and (3) Concerns about presentation of self to others. Each theme contained two or more sub-themes. Commonly, students discussed how their own personality traits, experiences, backgrounds and identities cast doubt on their sense of belonging in medicine. Discussion: The results of this study were consistent across both institutions, suggesting that imposter feelings are common among all first-year medical students. However, the extent of the impact of these feelings on their identity formation depends on the individual lived experiences of students and the context in which these feelings arise. Encouraging reflective journaling and sharing of stories from all stages of education can normalise imposter feelings during the development of the professional identity as a physician.Item Investigating Student Perceptions of a Dissection‐Based Undergraduate Gross Anatomy Course Using Q Methodology(Wiley, 2019) Byram, Jessica N.; Organ, Jason M.; Yard, Michael; Schmalz, Naomi A.; Anatomy and Cell Biology, IU School of MedicineThe demand for upper‐level undergraduate dissection‐based anatomy courses is growing, as professional programs require more advanced anatomy training prior to matriculation. To address this need, Indiana University School of Medicine (IUSM) partnered with Indiana University‐Purdue University Indianapolis—a large, urban, life science‐focused campus nearby to IUSM—to offer an undergraduate, dissection‐based course in regional gross anatomy. Because this is a new course, a deeper post‐course evaluation of student perceptions was conducted using Q methodology. In this study, Q methodology was used to evaluate student views of the overall course structure, pre‐laboratory materials and activities, assessments, and quality of instruction. Of the 15 students in the spring semester 2018 cohort, 80% (n = 12) participated in the evaluation, and 10 of those students followed up with written explanations for their rationale in selecting the four statements with which they most strongly agreed and disagreed. The Q methodology sorted the students into one of three statistically significant groups: Motivated Dissectors (n = 6), Traditional Students (n = 3), and Inspired Learners (n = 3). Motivated Dissectors and Inspired Learners felt strongly that the course did not encourage self‐directed learning and that the pre‐laboratory materials were not adequate to prepare them for quizzes. Traditional Students, however, disagreed, having a favorable opinion of the pre‐laboratory materials, even though this group felt most strongly that the amount of material covered in the course was overwhelming. This study demonstrates the utility of Q methodology to evaluate courses to elucidate student perspectives and inform future course modifications.