How can feedback be better delivered?
What can teachers do to enhance presentations to a cross-cultural audience?
How do borderline judgments compare at the station and overall test level?
What are the advantages of Longitudinal Integrated Clerkships?
Twelve tips for teaching about patients with cognitive impairment
James Michael Fisher, Ellen Tullo, Kwong Chan and Andrew Teodorczuk
These tips, compiled by healthcare professionals and educators in the UK and Australia, are divided into categories of “content”, “instructional strategy” and “assessment of learning”.
‘Learners must not be shielded from the complexity of caring for acutely ill patients with cognitive impairment in busy, clinical environments – it is important for them to witness the realities of the work that they will ultimately undertake. Rather, students need to be supported in their learning such that complexity and institutional barriers to good care for people with cognitive impairment are not their only experience.’
Twelve tips for promoting learning during presentations in cross cultural settings
Takuya Saiki, Linda Snell and Farhan Bhanji
Cultural sensitivity is important in both the design of health professions programs and the delivery of presentations in cross-cultural settings. This paper provides some useful tips to consider when preparing for the session, interaction during the session and reflection on the experience.
‘Understanding the history of education and cultural norms can help you gain insight into the educational context. Rather than simply focusing on “what’s better” or “what’s different” between cultures, a more reflective approach can use the educational and cultural differences to create culturally relevant presentations.’
Defining a set of common interprofessional learning competencies for health profession students
Maree O’Keefe, Amanda Henderson and Rebecca Chick
The authors reviewed six national and international interprofessional competency frameworks which provided 165 competency statements.
‘While there is general agreement on the importance of interprofessional learning, there is still the need for a set of specific and assessable learning outcomes that are applicable across all health professions. Ensuring achievement of the interprofessional learning competencies described in this paper will provide clarity for students, lecturers, and course coordinators regarding professional expectations from interprofessional learning activities and assessments.’
Problematizing the concept of the “borderline“ group in performance assessments
Matt Homer, Godfrey Pell and Richard Fuller
By examining the assessment profile of OSCE candidates at the end of the five year medical degree the authors found considerable variation in membership of the borderline group across stations, with implications for standard setting.
‘Developing our understanding of what is really happening at the borderline level in performance assessments should be a key focus in improving diagnostic accuracy, and in better understanding assessor decision making – ultimately leading to safer and more valid decisions with regard to student progression.’
Electronic assessment of clinical reasoning in clerkships: A mixed-methods comparison of long-menu key-feature problems with context-rich single best answer questions
Sören Huwendiek, Friedrich Reichert, Cecilia Duncker, Bas A. de Leng, Cees P.M. van der Vleuten, Arno M.M. Muijtjens, Hans-Martin Bosse, Martin Haag, Georg F. Hoffmann, Burkhard Tönshoff and Diana Dolmans
Students perceived key-feature problems as more realistic and difficult, providing a greater stimulus for the intense study of clinical reasoning than content-rich single best answer questions.
‘This study supports the idea that, from an educational perspective, both the stimulus and response format of questions seem to matter. Including KFPs with long menu in clerkship examinations seems to offer valuable opportunities to steer learning in clinical clerkships without psychometric drawbacks.’
Defining leadership competencies for pediatric critical care fellows: Results of a national needs assessment
Michael L. Green, Margaret Winkler, Richard Mink, Melissa L. Brannen, Meredith Bone, Tensing Maa, Grace M. Arteaga, Megan E. McCabe, Karen Marcdante, James Schneider and David A. Turner
Attendings, fellows and nurses rated the importance of 59 leadership skills, behaviors and attitudes for Pediatric Critical Care practitioners, of which only one – “displays honesty and integrity” – was considered essential.
‘The study found significant differences between nurses, fellows, and attendings regarding the relative importance of several leadership components. Though there was agreement among respondents that self-management and self-awareness skills are essential, there was a lack of agreement on the importance of teamwork skills and innovation skills. These findings may aid training programs in developing curricula and assessment tools focused on clinical leadership competencies necessary in the complex environment of the intensive care unit.’
Competency milestones for medical students: Design, implementation, and analysis at one medical school
Kimberly D. Lomis, Regina G. Russell, Mario A. Davidson, Amy E. Fleming, Cathleen C. Pettepher, William B. Cutrer, Geoffrey M. Fleming and Bonnie M. Miller
Milestones to measure medical student performance in core competency domains and to provide developmentally-based feedback were developed and implemented. The paper provides a two-year follow-up.
‘Preliminary findings indicate that it is feasible to create standardized milestone anchors to be applied across settings. Generally, the language of the milestone anchors is meaningful to students and to faculty members. Aggregate and individual student data regarding achievement of these milestones affirm that they distinguish relative strengths and weaknesses within the individual and among students.’
A case-based medical curriculum for the 21st century: The use of innovative approaches in designing and developing a case on mental health
Athanasios Hassoulas, Elizabeth Forty, Mathew Hoskins, James Walters and Stephen Riley
The mental health case in year 2 of the newly developed Cardiff C21 curriculum incorporates innovative approaches that are more interactive, student-centered and patient-oriented, and greatly increased student interest in psychiatry as a career choice.
‘The aspects of the case that rated highest in terms of added value to student learning and contributing significantly to students’ understanding of the topic were the fictionalized video diaries, the MSE (mental state examination) practical, and the virtual cases.’
Tolerance of ambiguity, perfectionism and resilience are associated with personality profiles of medical students oriented to rural practice
Diann S. Eley, Janni K. Leung, Narelle Campbell and C. Robert Cloninger
Having a rural background or a strong rural interest is associated with a personality profile that indicates a better capacity for coping with potential difficulties.
‘Strategies at the undergraduate and postgraduate levels which provide exposure to and nurture a genuine interest in rural or remote communities should be continued whether students come from a rural background or not.’
Comparing a longitudinal integrated clerkship with traditional hospital-based rotations in a rural setting
Rebecca Caygill, Mia Peardon, Catherine Waite and Julian Wright
Through the use of focus groups, this study from Australia compared the learning experience of third year rural medical students studying four specialties either in a traditional hospital-based rotation or in a LIC in a rural general practice setting.
‘This research reaffirms the rural effect, which shows that studying rurally can have a positive impact on learning. Rural students, both those who followed traditional hospital based learning and undertook a LIC, benefitted from greater access to patients and exposure to cases, giving them more hands on experience than their metropolitan based counterparts. In addition, this research has isolated the LIC effect, independent from the rural effect … Our study strongly supports the use of a LIC as a powerful educational tool.’
Faculty experience and engagement in a longitudinal integrated clerkship
Sarah C. Snow, Jennifer Gong and Jennifer E. Adams
The study looked at preceptors’ perceptions of teaching in a newly implemented Longitudinal Integrated Clerkship (Denver Health LIC) compared with their prior teaching in Rotation-Based Clerkships and found that teaching techniques differed significantly.
‘DH-LIC preceptors invested time and energy in the program, and the program rewarded them with close relationships with students, improved skills in terms of teaching and mentoring, and increased job satisfaction. With no additional monetary or other incentives, preceptors rated LIC teaching and involvement in the program highly.’
Flexibility in individualized, competency-based workplace curricula with EPAs: Analyzing four cohorts of physician assistants in training
Fraukje Wiersma, Josephine Berkvens and Olle ten Cate
This study from Utrecht showed that Physician Assistant training can be designed in an individualized and competency-based manner using Entrustable Professional Activities.
‘Variations in content in other health profession’s programs may be severely limited, but elective EPAs can open a way to more individualized education in a direction that resembles some of the features of the PA program.’
Feedback mapping – The curricular cornerstone of an “educational alliance”
Deborah Murdoch-Eaton and Lucy Bowen
The study looked at feedback across the 5 year undergraduate medical program with the aim of embedding a successful learner-teacher “educational alliance”.
‘Most importantly within the complexity of clinical undergraduate training, including many teachers who themselves may be in training and thus on short rotations, inevitably educators may have limited knowledge of prior curriculum content and purpose. Thus central course developers/faculty may have mistaken assumptions that all teachers and learners fully appreciate intended learning opportunities and individual developmental needs.’
The role of direct single monetary grants in residents’ choice of field of residency
Yishay Wasserstrum, Racheli Magnezi, Ofer Tamir, Stav Koren, Dor Lotan and Arnon Afek
Grants are considered to be a useful tool for addressing acute manpower shortages in certain specialties in Israeli residency programs perceived as less attractive.
‘The observed patterns of correlations between the various considerations surveyed suggests that for many, the possibility of a monetary grant has been well incorporated into a coherent set of considerations that interact with each other and are individually prioritized, rather than an external factor independent of more traditional considerations in this decision-making process.’
Room for improvement: Palliating the ego in feedback-resistant medical students
Andrew Perrella
The author makes a plea for the need to deliver feedback in a way that develops growth mindsets and resiliency, in order to encourage feedback-seeking behaviour among students.
‘… despite the best intentions of educators in fostering clinical maturity among their trainees, the fact remains that insecurity, inadequacy and invulnerability continue to drive feedback-resistance among medical students.’
Behind closed doors
Kevin Duan and Leslie Sheu
Timely feedback on performance through regular micro-coaching is important, but those giving feedback also need training in how to do it.
‘… there are many instances of successful micro-coaching taking place every day. Now is the time to step out from behind the closed doors and shift our culture into one where this is the norm and expectation.’
AND IN THE LETTERS …
Reliability of assessments
Research and publications emanate from a few well-resourced countries
The importance of mentoring for medical students
Incentivizing good teaching
Developing teaching skills in students