How should you teach and assess clinical reasoning?How can EPAs be implemented in practice?Can children be used in an OSCE?What is the impact when a school emphasises social responsibility?
Diagnosis and management of clinical reasoning difficulties: Part I. Clinical reasoning supervision and educational diagnosis
Marie-Claude Audétat, Suzanne Laurin, Valérie Dory, Bernard Charlin and Mathieu R. Nendaz
One of the key aspects of clinical competence is clinical reasoning. This guide describes how knowledge of clinical reasoning processes, as well as strong educational skills are critical to the teaching and assessment of clinical reasoning in the clinical setting.
“Despite the challenges posed by the clinical setting, there are practical strategies to identify the strengths and weakness of learners’ clinical reasoning.”
Diagnosis and management of clinical reasoning difficulties: Part II. Clinical reasoning difficulties: Management and remediation strategies
Marie-Claude Audétat, Suzanne Laurin, Valérie Dory, Bernard Charlin and Mathieu R. Nendaz
This AMEE guide provides a detailed overview of the main difficulties in clinical reasoning, including the cues to look out for in clinical supervision, the root causes of each difficulty and targeted remediation strategies.
“By engaging in an educational reasoning process, clinical teachers can identify their learners’ strengths and difficulties and implement remediation strategies in the course of daily supervisions.”
Twelve tips for the implementation of EPAs for assessment and entrustment decisions
Harm Peters, Ylva Holzhausen, Christy Boscardin, Olle ten Cate and H. Carrie Chen
This article provides practical recommendations for how to implement EPAs for assessment and entrustment decisions in the workplace. Tips include using EPAs to identify/create opportunities for assessment and feedback, empowering learner ownership of the assessment process and using technology for learner tracking and program evaluation.
“As EPAs are now being implemented in many programs – UME and PGME, implementation questions emerge about paths to entrustment decisions, assessment practices and the faculty development needed for entrustment assessments.”
Twelve tips for reducing production time and increasing long-term usability of instructional video
Marie K. Norman
The use of instructional video is increasing. This article demonstrates how faculty and departments can create high-quality instructional video while using their time and resources more wisely. Tips include using video strategically, keeping videos short, using existing videos, working in teams and aiming for modularity.
“Video – with its capacity to capture important visual information, facilitate self-paced learning, make lecture content accessible to remote students, and reduce the necessity for faculty of repeat performances – offers exciting new opportunities for educators.”
Small group activities within academic communities improve the connectedness of students and faculty
Katharina Brandl, Stephen D. Schneid, Sunny Smith, Babbi Winegarden, Jess Mandel and Carolyn J. Kelly
A sense of connectedness and community is important in a medical school. The University of California, San Diego, School of Medicine implemented a curriculum change that included reduction of lectures, incorporation of problem-based learning and other small group activities. Six academic communities were introduced for teaching longitudinal curricular content and organizing extracurricular activities. Implementation of the new curriculum with more small group educational activities including academic communities enhanced connectedness between students and faculty and resulted in an increased sense of community.
“We all have an essential need to feel connected. In medical education, the relationships formed between students and faculty enhance the learning experience and the professional development of our students. Medical schools often introduce new curricula, but few assess the impact of the changes on student connectedness and sense of community.”
Evaluation in undergraduate medical education: Conceptualizing and validating a novel questionnaire for assessing the quality of bedside teaching
Katharina Dreiling, Diego Montano, Herbert Poinstingl, Tjark Muller, Sarah Schiekirka-Schwake, Sven Anders, Nicole von Steinbuchel and Tobias Raupach
This article describes an 18 item questionnaire to assess the quality of bedside teaching at two German Universities it includes six items relating to the teaching environment. It is suggested that this can be used to provide valuable feedback to encourage clinical teachers to improve their didactic skills.
“Considering the major impact teaching quality has on the student’s learning process in clinical practice, the measurement of teaching effectiveness can provide valuable feedback to encourage clinical instructors to improve their teaching. In order to produce meaningful results that will identify teachers’ individual strengths and weaknesses, evaluation tools need to be valid and reliable.”
Evolutions in clinical reasoning assessment: The Evolving Script Concordance Test
Suzette Cooke, Jean-François Lemay and Tanya Beran
This paper describes a new type of script concordance test (the E-SCT) whereby the patient’s clinical story is “evolving” and with thoughtful integration of new information at each stage, decisions related to clinical decision-making become increasingly clear. The E-SCT demonstrated very good reliability and was effective in distinguishing clinical reasoning ability across three levels of experience. Participants found the E-SCT engaging and representative of real life clinical reasoning and decision making processes.
“While the SCT assessment method has demonstrated respectable reliability across a wide variety of health professions, some critics suggest that clinical reasoning is a complex skill and to more precisely (and validly) assess this skill there is a fundamental need to unravel the underlying cognitive process required in clinical decision-making.”
Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial
Detajin Junhasavasdikul, Kanokporn Sukhato, Suthan Srisangkaew, Nawanan Theera-Ampornpunt, Thunyarat Anothaisintawee and Alan Dellow: for the T-REX group
This paper describes a well-planned and very interesting study that explores the influence of the style of content presentation on student learning outcomes – specifically the use of cartoons and a story versus traditional-style illustrated course notes to teach about intercostal chest drainage. A beneficial effect of the cartoon/story associated handout was shown to positively influence student learning outcomes and this was linked, at least in part, to a self-identified greater inclination for students, especially those with lower GPAs, to read more of the handout before the post handout evaluation.
“Our RCT found that a cartoon-style handout was able to attract more of a student’s attention and result in a higher post-learning test score when compared to a traditional handout. This effect appeared to be most marked in students with previously low academic evaluations and was independent of other factors. We hope that our study will encourage medical educators to consider using carton-style materials and to undertake further research into their effectiveness and popularity with students.”
Development of culture-sensitive clinical teacher evaluation sheet in the Japanese context
Makoto Kikukawa, Renee E. Stalmeijer, Tomoya Okubo, Kikuko Taketomi, Sei Emura, Yasushi Miyata, Motofumi Yoshida, Lambert Schuwirth and Albert J.J.A. Scherpbier
The authors developed a sophisticated evaluation sheet for clinical teachers to be filled by their postgraduate trainees, and found qualitative three common factors applied in their sheet. They proposed this as a unique evaluation sheet that reflected characteristic Japanese culture.
“The evaluation of clinical teaching is essential for understanding this concept from many points of view, such as: improvement of clinical teaching, support and motivation for a teacher, annual performance appraisals, academic advancement and promotion, evolution of the curriculum, learning for the student, improved care for patients, and better educational programs for the institution.”
Using children as standardized patients in OSCE in pediatric occupational therapy
Chung-Pei Fu, Jiann-Horng Yeh, Chia-Ting Su, Chien-Hsiou Liu, Wan-Ying Chang, Yu-Lan Chen, Ai-Lun Yang and Chih-Chia Wang
This paper describes the experience gained in the use of 44 child standardised patients in an OSCE. Ninety nine percent of children liked taking part in the OSCE and examiners felt it was helpful for their clinical training.
“It is feasible to use child SPs in OSCE in pediatric OT education. Using OSCE could help students learn better, and also help teachers tailor their teaching content to clinical needs.”
Addressing health workforce inequities in the Mindanao regions of the Philippines: Tracer study of graduates from a socially-accountable, community-engaged medical school and graduates from a conventional medical school
Servando ‘Ben’ Halili, Fortunato Cristobal, Torres Woolley, Simone J. Ross, Carole Reeve and A-J. Neusy
The Filipino Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) has adopted a strong focus on socially accountable health professional education (SAHPE) in order to address the shortage of physicians across rural and urban communities in the Western Mindanao region. Compared to graduates from a more conventional school, ADZU graduates were more likely to currently work in Government Rural Health Units, be generalist Medical Officers or Rural/Municipal Health Officers.
“Medical schools that implement a socially accountable curriculum and community-engaged rural clinical placements are more likely to produce graduates who have positive attitudes to servicing the health needs of the community and to health equity.”
Mentoring relationships between senior physicians and junior doctors and/or medical students: A thematic review
Julia Huina Sng, Yiying Pei, Ying Pin Toh, Tan Ying Peh, Shirlyn Huishan Neo and Lalit Kumar Radha Krishna
The authors report a thematic review of 49 papers which studied the mentoring relationships between senior physicians and junior doctors or students. It highlighted that mentoring success pivots on effective mentoring relationships that are effectively nurtured in mentoring environments that facilitate open discussions in a safe setting and nurture trusting personal relationships. Mentoring environments are the product of close interactions between a host organisation, mentee and mentor.
“Perhaps the most critical finding of this review revolves around mentoring environments that help develop trusting and open relationships where discussions and frank exchange of ideas and opinions on professional, academic, research, and personal issues can occur in a safe setting. Each mentoring environment is unique to the mentee and its success relies upon the efforts of the mentor, the mentee, and the host organisation.”
Exploring the role of classroom-based learning in professional identity formation of family practice residents using the experiences, trajectories, and reifications framework
Luke Y. C. Chen and Maria M. Hubinette
A case study was presented that describes how in a family medicine residents training programme classroom-based learning such as academic half days have an underappreciated role in the professional identity formation of residents. Informal social interactions and mentoring in the classroom foster peer support and resilience.
“Findings from this study suggest that individual trainees enter a classroom with experiences from practice; the classroom provides a different context where developmental trajectories can potentially be adjusted or affirmed both through informal interactions as well as the formal, stated goal of having a family medicine-centered curriculum.”
Shedding light into the black box: A prospective longitudinal study identifying the CanMEDS roles of final year medical students’ on-ward activities
Till Johannes Bugaj, Carolin Schmid, Ansgar Koechel, Jan Stiepak, Jan B. Groner, Wolfgang Herzog and Christoph Nikendei
During their final year trimester at the University of Heidelberg Medical Hospital, medical students were asked to keep a detailed record of all their onward activities. About 4308 activities were documented. The Communicator (42%), the Professional (38%), and the Collaborator (7%) were assigned as the top three CanMEDS roles. There is a need for increased efforts in creating more authentic learning experiences shifting towards more complex, supervised tasks, and improved team integration.
“To ensure skilled future physicians, improved student on-ward integration as well as desistance from excessive assignment of FY students to routine activities of limited learning value should be the paramount goals of medical educators in charge of FY medical training. CanMEDS roles that are currently underrepresented in our (FY) curriculum need to become more explicit parts of the undergraduate medical training program.”
AND IN THE LETTERS…
Best Evidence Medical Education (BEME) review process redesigned for methodological rigor, shorter timeline and author support
Responses to post-graduation surveys do not accurately reflect the workforce