Perez Grace, Malhi Rebecca, Bressler Kamiko, Monaghan Melissa, Johnston Aaron
Distributed Learning and Rural Initiatives, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Family Medicine, University of British Columbia, Vancouver, BC, Canada.
Front Med (Lausanne). 2024 Dec 10;11:1452932. doi: 10.3389/fmed.2024.1452932. eCollection 2024.
The shortage of physicians in rural Canada is a continuing challenge. Canadian medical schools have adapted strategies to increase the supply of rural physicians. This study appraises the effectiveness of the living library (also called Human Library©) in medical education, as an avenue for medical and pre-medical students to engage in dialogue with rural health professionals. Similar to a conventional library, readers check out books, except that "books" are human volunteers willing to share relevant personal experiences, and "readers" are the learners. The reading is the personal interaction between human books and students through narratives of experiences. The program "The Library of Life-Stories of Rural Medicine" (TLoL), was developed to provide students with better understanding of rural life and practice through narratives.
This is a mixed methods study, using pre- and post-event surveys. Statistical comparisons were done using Wilcoxon and McNemar's tests. Thematic analysis was used to explore students' expectations of TLoL and to describe their experience and key takeaways.
Most of the participants were from an urban background, had low familiarity with rural medicine and only 44% would consider a rural career prior to TLoL. After TLoL, improvements were observed in: (i) envisioning rural medicine as career option ( = 0.009), (ii) appreciation of rural living ( = 0.013), (iii) need for rural physicians ( < 0.001). and (iv) rural practice consideration ( = 0.001). Themes from students' motivations for participation were: (i) students' curiosity, interest, and (ii) their willingness to engage in dialogue with the human books. Themes from the key takeaways were that TLoL allowed students: (i) to walk in a rural professional's shoes, enabling them to see "rural" in a new light, and (ii) to self-reflect and gain a sense of personal growth.
Students made gains in attitudes and perceptions toward rural practice. Narratives have the power to challenge held beliefs around rural practice and life, and can encourage students to consider things that traditional medical teaching may not. TLoL can be an effective learning modality in medical education to provide information about rural medicine, in combination with learning opportunities such as rural block rotations and longitudinal clinical clerkship immersions.
加拿大农村地区医生短缺一直是一项挑战。加拿大医学院校已采取策略来增加农村医生的供应。本研究评估了“真人图书馆”（也称为“人类图书馆©”）在医学教育中的有效性，这是医学及医学预科学生与农村卫生专业人员进行对话的一种途径。与传统图书馆类似，读者借阅书籍，只不过这里的“书籍”是愿意分享相关个人经历的志愿者，而“读者”则是学习者。阅读是通过经历叙事在“真人书籍”与学生之间进行的个人互动。“农村医学人生故事图书馆”（TLoL）项目旨在通过叙事让学生更好地了解农村生活与实践。
这是一项采用事件前后调查的混合方法研究。使用威尔科克森检验和麦克尼马尔检验进行统计比较。采用主题分析法来探究学生对TLoL的期望，并描述他们的经历及关键收获。
大多数参与者来自城市背景，对农村医学了解较少，且在参加TLoL之前只有44%的人会考虑从事农村医疗职业。参加TLoL之后，在以下方面有了改善：（i）将农村医学视为职业选择（=0.009），（ii）对农村生活的认同感（=0.013），（iii）对农村医生的需求（<0.001），以及（iv）对农村医疗实践的考虑（=0.001）。学生参与的动机主题有：（i）学生的好奇心、兴趣，以及（ii）他们与“真人书籍”进行对话的意愿。关键收获主题是TLoL让学生：（i）设身处地体验农村专业人员的工作，使他们以全新视角看待“农村”，以及（ii）进行自我反思并获得个人成长感。
学生在对农村医疗实践的态度和认知方面取得了进步。叙事能够挑战围绕农村医疗实践和生活所持有的信念，并能鼓励学生思考传统医学教学可能未涉及的内容。TLoL可以成为医学教育中的一种有效学习方式，与农村轮转实习和纵向临床实习等学习机会相结合，提供有关农村医学的信息。
