How can tools from aviation improve team communication in medicine?
What are the leadership roles expected of Residency Program Directors?
What is the long term impact of team-based learning?
How can the progress test be used to inform student progress?
Tools for structured team communication in pre-registration health professions education: A Best Evidence Medical Education (BEME) review: BEME Guide No. 41
Sharon Buckley, Lucy Ambrose, Elizabeth Anderson, Jamie J. Coleman, Marianne Hensman, Christine Hirsch, James Hodson, David Morley, Sarah Pittaway and Jonathan Stewart
Standardised protocols for information exchange between health professionals, such as Situation Background Assessment Recommendation (SBAR), are being introduced into clinical practice. Often described as ‘tools for structured communication,’ introduction of these protocols is, in part, the result of efforts to apply good practice from aviation safety to health care.
‘Following major air disasters in the 1970s and 1980s, strenuous efforts to improve aviation safety led to the development of crew resource management (CRM), a comprehensive training program that encourages the use of standardized protocols to enhance communication between members of the flight crew. Initiatives to apply CRM principles to healthcare began in the 1990s, gaining momentum following the publication in the U.S. of “To Err Is Human: Building a safer Health System,” which crystallized growing concern about the impact of medical error on patient safety.’
Twelve tips for medical students to facilitate a Photovoice project
Deep Jaiswal, Matthew J. To, Heather Hunter, Ciaran Lane, Cinera States, Brittany Cameron, Suzanne Kathleen Clarke, Catherine Cox and Anna MacLeod
Participatory action projects like Photovoice can provide medical trainees with a unique opportunity for community engagement. These twelve tips describe how to develop a Photovoice project and discuss how medical students can engage communities through a participatory action lens.
‘A socially responsive medical school responds to societal health needs by engaging students in longitudinal community-based activities. Social accountability goes one step further by emphasizing that a medical school’s focus on the priority health needs of a society should be obligatory and that educational institutions should use an evidence-based approach to addressing those needs.’
From personal to global: Understandings of social accountability from stakeholders at four medical schools
Robyn Preston, Sarah Larkins, Judy Taylor and Jenni Judd
This paper addresses the question of how social accountability is conceptualised by staff, students and community members associated with four medical schools aspiring to be socially accountable in two countries.
‘While schools aspiring to be socially accountable undertake the same activities as other medical schools, such as education, research and service; they are distinguished by their end goal or mission (or the reasons why schools undertake these activities). Socially accountable medical schools focus on the priority health concerns in their own contexts. These are the concerns or priorities of local communities and are collaboratively developed with government, health service organisations and communities themselves.’
A multi-source feedback tool for measuring a subset of Pediatrics Milestones
Alan Schwartz, Melissa J. Margolis, Sara Multerer, Hilary M. Haftel, Daniel J. Schumacher and The APPD LEARN—NBME Pediatrics Milestones Assessment Group
A report on a multi-site study of the development and implementation of an instrument for competency-based assessment in pediatrics graduate medical education.
‘The pediatrics milestones provide a roadmap for the development of pediatricians, and interviews with pediatrics residents have provided evidence for the value of their use in education and formative feedback. Milestones themselves, however, are not ideal assessment instruments, as they often comprise multiple complex behaviors and inferences about the learner.’
Exploring the potential uses of value-added metrics in the context of postgraduate medical education
Simon Gregory, Fiona Patterson, Helen Baron, Alec Knight, Kieran Walsh, Bill Irish and Sally Thomas
Increasing pressure is being placed on external accountability and cost efficiency in medical education and training internationally. Value-added analysis in postgraduate medical education potentially offers useful information, although the methodology is complex, controversial, and has significant limitations.
‘Providers are under mounting pressures from trainees, regulators and policy-makers to demonstrate and improve the quality and effectiveness of medical education and training provision. Robust cost analyses using evidence-based approaches are needed to inform funders and users about the utility and value of medical education interventions. This will aid more accurate and effective commissioning in future. Such approaches are already adopted to evaluate the value-added in other fields of education.’
What do I do? Developing a competency inventory for postgraduate (residency) program directors
Susan J. Lieff, Ari Zaretsky, Glen Bandiera, Kevin Imrie, Salvatore Spadafora and Susan Glover Takahashi
Few new Residency Program Directors (PDs) are formally trained for the demands and responsibilities of the leadership aspect of their role and currently, there are no comprehensive frameworks that describe specific leadership competencies that can inform PD self-reflection or faculty development. The authors developed a Program Director Competency Inventory (PDCI) in order to frame the performance of PDs for a multisource feedback program.
‘The leadership role of a postgraduate residency program director (PD) is becoming increasingly complex due to evolving accreditation requirements, strategic initiatives of funders, recruitment challenges, distribution of training across multiple contexts of health care delivery, major changes to medical education theory and practice and evolving technology. Effectively addressing challenges such as duty hour restrictions, competency-based education, the growing expectation of systems of assessment rather than simply tools of assessment, and the proliferation in number and complexity of resident competencies expected of physicians will require deft leadership.’
The long-term impact of team based learning on medical students’ team performance scores and on their peer evaluation scores
Nathalie K. Zgheib, Zakia Dimassi, Imad Bou Akl, Kamal F. Badr and Ramzi Sabra
The results from this longitudinal follow-up of medical students exposed to a large number of team based learning (TBL) sessions demonstrate that TBL improves medical students’ team dynamics, and also their perceived self-learning, problem solving and communication skills, and their professionalism and personal development.
‘In essence, TBL is an example of what has become known as a flipped classroom, in that students do most of the self-directed learning on their own to acquire information, and the class time with the instructor is used for higher order, analytical and synthetic mental processes, involving problem solving and decision making.’
Red, yellow and green: What does it mean? How the progress test informs and supports student progress
Karen Given, Ailish Hannigan and Deirdre McGrath
This study investigated the educational impact and acceptability of progress tests (PTs), two important components of the utility of an assessment method, particularly for formative assessments and also examined the predictive validity of the satisfactory, borderline and unsatisfactory categories commonly given to students with each individual PT result, in order to assess if the PT reliably informs students of their progress.
‘Feedback is a key feature of formative assessment. The effectiveness of feedback depends on the content and method by which it’s given, as well as the mind-set of the recipient. Negative feedback can provoke an adverse emotional response which can affect how the feedback is accepted and subsequently used, and may result in missed learning opportunities.’
The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters
Johanna Shapiro, Pavandeep Rakhra and Adrianne Wong
This paper looks at the qualities in patients that students identify as difficult, such as being angry, noncompliant, uncooperative, and excessively talkative, their perceptions of family members, and their observations about their attending physicians, concluding that, while students’ intent is toward empathy and patient-centeredness, they often feel they lack the skills to adhere to these principles in challenging patient encounters.
‘“Difficult” patients have been characterized in various ways. Research suggests often they are patients with psychiatric disorders, multiple symptoms, poorer functional status, unmet expectations, and high utilization of health care services. The “hateful” or “difficult” patient may be angry, argumentative, mistrustful, anxious, or depressed. They may also be noncompliant, resistant to forming a therapeutic alliance, and challenge the physician’s care plan.’
Medical student perceptions of research and research-orientated careers: An international questionnaire study
Garth Funston, Rory J. Piper, Claire Connell, Philip Foden, Adam M. H. Young and Paul O’Neill
Students perceive a number of key barriers to research involvement and pursuit of research-orientated careers. Programmes designed to engage students with research should focus on overcoming identified barriers. Greater effort is needed to engage female students who report more significant barriers and less desire to follow research-orientated careers.
‘The importance of engaging and inspiring the next generation of physician-scientists at an early stage is considered a key factor in reversing the decline of academic medicine. An additional issue is that academic medicine, particularly at a senior level, remains male dominated, despite the increasing number of female students and doctors in many countries. Although 43% of registered doctors in the UK are female, only 17% of professorships are held by females.’
Spaced learning using emails to integrate psychiatry into general medical curriculum: Keep psychiatry in mind
Mary C. Blazek, Bezalel Dantz, Mary C. Wright and Jess G. Fiedorowicz
Delivering spaced learning through emails, within a curriculum designed to foster engagement, may provide an efficient means of addressing the widely-recognized but elusive goal of integrating teaching across medical disciplines.
‘Spaced learning, also known as distributed practice, has been studied over half a century. Spaced learning refers to delivery of brief morsels of information repeated over time intervals, in contrast to massed learning, a bolus of information delivered all at once without breaks … Spaced delivery can be combined with the testing effect, which refers to the benefits of studying and testing, even without feedback, on learning retention.’
Teaching psychomotor skills in the twenty-first century: Revisiting and reviewing instructional approaches through the lens of contemporary literature
Delwyn Nicholls, Linda Sweet, Amanda Muller and Jon Hyett
A diverse range of health professionals use psychomotor skills as part of their professional practice roles. These skills are first taught by the educator then acquired, performed, and lastly learned. Psychomotor skills may be taught using a variety of widely-accepted and published teaching models. This paper reports eleven steps to be considered when teaching psychomotor skills.
‘The primary tenet of the skill-teaching literature asserts that skills are best learnt using a sequenced and stepped teaching approach. This dogma guides the method used to teach either a simple or complex manual task. However, the majority of skills used by health professionals are complex.’
Connectivism: A knowledge learning theory for the digital age?
John Gerard Scott Goldie
While connectivism provides a useful lens through which teaching and learning using digital technologies can be better understood and managed, there is unlikely to be a single theory that will explain learning in technological enabled networks. Educators have an important role to play in online network learning.
‘Modern society, with its rapid scientific and technological advances, has seen an exponential rise in accessible knowledge and continuously changing and emerging technologies. … Previous ways of navigating and filtering available information are likely to prove ineffective in these new contexts. The ability to access relevant information and harness the resources offered by the views and opinions of others have become important skills particularly as the need for lifelong learning, both formal and informal is increasingly recognized by individuals, organizations and institutions.’
Is there a need for a specific educational scholarship for using e-learning in medical education?
John Sandars and Poh Sun Goh
The authors propose the need for a specific educational scholarship when using e-learning in medical education. Effective e-learning has additional factors that require specific critical attention, including the design and delivery of e-learning. An important aspect is the recognition that e-learning is a complex intervention, with several interconnecting components which have to be aligned.
‘Many of us can easily recall a time when the use of e-learning has failed to deliver its expected benefits, and this is not surprising since e-learning is a ‘‘complex intervention’’. The notion of complex interventions, which are madeup of various interconnecting parts, has become widely appreciated in applied health services research but appears to be rarely considered by medical educators.’
AND IN THE LETTERS…
The unique role of student-run journals
Integrating leadership and management skills into medical school curricula
The benefits of undertaking an ERASMUS placement