Is there consensus on the assessment of interprofessional learning outcomes?
Are medical schools stimulating student curiosity?
Can children acting as simulated patients provide valid OSCE scores?
How can the effectiveness of faculty development be maximised?
Twelve tips for planning and conducting a participatory evaluation
Katherine A. Moreau
The paper provides some useful tips to enhance the understanding of participatory evaluation and its value in program evaluation, which will be relevant in a range of programs and settings.
'Participatory evaluation· as an approach to program evaluation places the emphasis on collaboration between trained program evaluators and program stakeholders and can lead to meaningful evaluation findings and recommendations that can improve medical education programs. When planned and conducted well, it can also increase the utilization of evaluation findings, empower individuals and groups, as well as build needed evaluation capacity among individuals and organizations that are required to engage in ongoing evaluation activities.'
Twelve tips for the construction of ethical dilemma case-based assessment
Tsuen-Chiuan Tsai
Based on the Script Concordance Test, the ethical dilemma case-based examination (eSCT) was developed to measure ethical reasoning. The paper offers some tips and strategies for writing test materials for ethical dilemmas.
'As a written examination, eSCT has the advantages of easy test administration, being accessible to a large group. By using local experts to generate standards for scoring, the test results can be best adjusted to regional ”norms”. Therefore, eSCT can be applied meaningfully across socio-cultural boundaries and over time periods.'
International consensus statement on the assessment of interprofessional learning outcomes
Gary D. Rogers, Jill E. Thistlethwaite, Elizabeth S. Anderson, Madeleine Abrandt Dahlgren, Ruby E. Grymonpre, Monica Moran and Dujeepa D. Samarasekera
The consensus statement results from a global collaboration formed in response to an invitation by the Program Committee for the 17th international Ottawa Conference on the Assessment of Competence in Medicine and the Healthcare Professions, held in Perth, Australia in March 2016. The overarching consensus themes were: the context of interprofessional assessment, the assessment journey of teacher and student and gaps in the evidence base.
'This paper has aimed to capture the current global consensus on the assessment of IPL outcomes in preregistration health professional programs, while we await the further development of theoretical understandings and empirical evidence in this important area. We hope that it will inform local collegial discussions, as health professional educators around the world seek to devise and implement approaches to assess these outcomes in their own students. High-quality assessment of IPL, in every setting in which it takes place, can enable educators to ensure that their graduates have the capabilities they will need to practice collaboratively and optimize outcomes for their patients, clients, and communities. We invite further feedback from you, our colleagues, as you continue this important work.'
lnterprofessional collaborative reasoning by residents and nurses in internal medicine: Evidence from a simulation study
K. S. Blondon, F. Maître, V. Muller-Juge, N. Bochatay, S. Cullati, P. Hudelson, N. V. Vu, G. L. Savoldelli and M. R. Nendaz
The study explored the characteristics and strategies of collaborative reasoning in the context of internal medicine in an interprofessional setting through the development of four simulated scenarios - hemorrhagic shock, septic shock, congestive heart failure and inferior myocardial infarct.
'Our findings show evidence of collaborative reasoning between residents and nurses, expressed across the dimensions of diagnostic reasoning, patient management and monitoring, providing explanations to the patient, and team communication, powered by situational awareness. They also point to different reasoning processes used by nurses and residents. Awareness about specificities in the reasoning approaches of each profession and better understanding of collaborative reasoning can provide additional dimensions to interprofessional collaboration and education.'
Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system - An activity theory analysis
Sylvia Heeneman and Willem de Grave
Through the use of activity theory, the study looked from the perceptions of the mentor at how the activities in the mentoring process facilitated the development of self-directed learning in the student.
'Coaching skills of the mentor, the interaction with a portfolio and the context of a mentor community are important factors in a longitudinal mentor-student interaction that can translate to students' self-directed learning skills.'
Describing medical student curiosity across a four year curriculum: An exploratory study
Robert Sternszus, Alenoush Saroyan and Yvonne Steinert
Although few studies exist, it is widely considered that curiosity is important in the practice of medicine. This exploratory study suggests that medical schools may not be providing an appropriate environment to stimulate intellectual curiosity by not engaging students in active learning.
'Given the potential importance of intellectual curiosity to the practice of medicine and to becoming a physician through its hypothesized role in intellectual discovery, problem solving, self-monitoring, lifelong learning, and caring … our findings justify the importance of engaging in further study of the influence of medical education on learner state curiosity.'
Boosting clinical performance: The impact of enhanced finaI year placements
D. V. H. Williams, A. M. Reid and M. Homer
Through a retrospective analysis of final year OSCE performance, the study assessed the outcomes of the Leeds Medical School 'super-assistantship' (SA) programme introduced as a pilot project to enhance preparedness for practice. Some positive results were reported, particularly in the area of prescribing, but the importance of the readiness of the placement sites to support the students was acknowledged.
'The SA period has been observed to have measurable positive effects on assessed performance in a simulated setting. The potentiaI for improvements in prescribing performance from the period is exciting, and supports the underlying theory and previous research on the learning opportunities provided by super-assistantships. As prescribing is an essential skill that has been repeatedly identified as challenging to learn, this research recommends further extension of the opportunity for all final year students to experience an SA placement in future years.'
Can children acting as simulated patients contribute to scoring of student performance in an OSCE?
Jonathan C. Darling, Rebecca J. M. Bardgett and Matthew Homer
Local schoolchildren aged between 8–10 years were invited to participate as patients in a 4th year OSCE. The study explored whether child marking of student performance is valid and has similar statistical characteristics to adult simulated patient scores.
'Overall we found reasonable agreement between child scores, and the examiner prediction of the child score. However, children's scores tended to be more generous when examiners predicted lower-middle scores, and to a smaller extent when the examiner global rating was lower.'
Uncover it, students would learn leadership from Team-Based Learning (TBL): The effect of guided reflection and feedback
Maryam Alizadeh, Azim Mirzazadeh, Dean Parmelee, Elizabeth Peyton, Leila Janani, Gholamreza Hassanzadeh and Saharnaz Nedjat
The authors investigated the effect of guided reflection and feedback on the number of team members engaged in the team's leadership, on team decision quality and on shared leadership capacity.
'We found that reflection and feedback improved shared leadership capacity but not shared leadership behaviors or team decision quality. We propose medical educators who apply TBL, should provide guided exercise in reflection and feedback so that students may better understand the benefits of working in teams as preparation for their future roles as leaders and members of health care teams.'
Public health matters: Innovative approaches for engaging medical students
Aditya Vyas, Veena C. Rodrigues, Richard Ayres, Puja Myles, Eleanor J. Hothersall and Hugh Thomas
Whilst being increasingly recognised as important, public health is under-represented in the curriculum. This paper looks at the key challenges for public health teaching in medical schools and presents potential solutions in the form of four case studies.
'Public health should now be seen as the great enabler of modern medical practice. It promotes a more holistic understanding of what it means to be a doctor by applying the notion of patient-centred care at the population level. The increasing appreciation of public health principles, both in academia and the healthcare system, supports its inclusion within the medical curriculum, alongside a corresponding consensus at the political and pedagogical level. The challenge of establishing relevance now needs to be met at the student-teacher interface.'
A randomized controlled trial of mindfulness to reduce stress and burnout among intern medical practitioners
Michael J. Ireland, Bonnie Clough, Kim Gill, Fleur Langan, Angela O'Connor and Lyndall Spencer
The authors hypothesized that a ten-week mindfulness intervention could equip intern doctors with skills to effectively manage stress and burnout compared to giving them extra break time, and tested the hypothesis through a randomized controlled trial.
'… the current study found mindfulness training to be an effective means of reducing stress and burnout among primary care medical practitioners working within an emergency department. These effects were greater than merely offering them an extra hour break for 10 weeks. Implementing mindfulness training and interventions for doctors and doctors in training may have considerable benefits not only for the practitioners, but also their patients and workplaces.'
What makes a medical school socially accountable in Latin America? A report from a Latin American panel based on a qualitative approach
Klaus Püschel, Arnoldo Riquelme, Philippa Moore, Viviana Rojas, Andrés Perry and Jaime C. Sapag
Based on information provided by a panel of 29 academics from seven Latin American countries, the study provides perspective on the significance of social accountability of medical schools in Latin America and the barriers and facilitators for its implementation.
'Social accountability was identified as a core dimension of the mission of medical schools. The panel identified a gradient of three dimensions associated with social accountability. First, a formative dimension related to student selection, curricular structure and community based learning initiatives. Second, a societal dimension associated with institutional mission, community partnerships and social research projects. Third, a political dimension related with involvement in health policies and primary care engagement. Lack of accreditation standards was Identified as a main barrier to improve social accountability.'
Realist evaluation of faculty development for medical educators: What works for whom and why in the long-term
Olanrewaju O. Sorinola, Jill Thistlethwaite, David Davies and Ed Peile
The authors aimed to develop realist theories that explain the connections between contexts, mechanisms and outcomes to find out what works for whom and why in Faculty Development.
'The theories of motivation, engagement, positive perception and professionalisation offer faculty developers an understanding of what works for whom and why and the important interconnections between the four theories. While engagement is the bridge between motivation and learning, faculty developers can further enhance engagement by building into the work, the interests and needs of the educators (i.e. motivation). Values and perceptions influence engagement however engagement is also enhanced by the granting of degrees and career progression. Therefore addressing the four areas simultaneously maximises FD effectiveness for both educators and developers.'
Reconciling technology and humanistic care: Lessons from the next generation of physicians
Arabella L. Simpkin, Perry B. Dinardo, Elizabeth Pine and Elizabeth Gaufberg
The study looked at medical students' attitudes to technology and its impact on the delivery of humanistic patient care in seven categories: Patient perspective; Life-giving versus life-prolonging; Boundaries between human and technology; Distancing versus presence; Adapting to change; Tools to enhance care; and Definitions of technology.
'The medical students remind us that within this inherently human profession, we must take time to connect to each other and to our patients, as well as to teach and discover synergies between technology and the human touch. Patient-centered care remains the cornerstone of good medical practice. We conclude with a quote from a student's essay: “In short, it was an affirmation of what most of us know already: that technology is neither inherently good nor evil; rather, it is the user, it is us, that will define which path technology will take.” (Student 092, 4th year medical student).'
Evaluating #VetFinals: Can Twitter help students prepare for final examinations?
Tierney Kinnison, Martin Whiting, Kirsty Magnier and Liz Mossop
Social media are increasingly used in education. The study assesses their effectiveness in a range of contexts in veterinary education, to inform teachers of the potential benefits and drawbacks in order to enhance the learning experience.
'The findings indicate that the use of Twitter and the #VetFinals teaching events have been beneficial to the participating students in their final year examinations. Students engaged with the novelty of the tool and relied heavily on the facilitator to lead the session at the right pace and in the right way, with some evidence of peer learning. Unsurprisingly, motivation was based on upcoming assessments, but the lasting legacy of understanding the professional use of social media for learning is interesting and requires further evaluation. Whilst not all students will take part in this type of social media use, related resources can stilI be utilised as an additional method of examination preparation, expanding access across different learning approaches.'
Has medical education killed “silence”?
Shuh Shing Lee
In this Personal View, the author reflects on the importance of making time for students to develop the important “silent” skills of observation, reasoning and listening, and learning how to learn.
'In this fast-pacing modern world, doctors tend to concentrate on the symptoms, treat the symptoms by ordering multiple tests and drugs instead of treating the patient as a whole. With the advancement of technology, doctors look at a computer screen more than they observe their patients. Has our medical education overly emphasized on the direct problem-solving method within an assigned time frame, and neglected these “silent” skills? Have our medical students been given the time, or taught to carry out these particular skills?'
Nurses in medical education: A unique opportunity
Trevor J Barnum, Lindsay Thome and Elizabeth Even
Although there are few data comparing formal instruction by nurses and faculty to medical students, this Personal View highlights the important role that nurses can play in clinical clerkships to teach procedural skills at a time when the demands on the physician are increasing.
'As the dedicated educators we are in the unique position of getting to know the students and their learning styles on a more individualized level. We may be the person that can identify if students are struggling with clinical or interpersonal work issues as well as external stressors in their personal lives. As someone who is not faculty but still clinical, we posit that we are viewed as more approachable when it comes to asking practical questions about the logistics of care. It is essential for students to be able to ask these questions. We can provide feedback on interpersonal or communication skills. Having a greater amount of face-to-face time with the students also allows us to identify deficiencies in academic and technical abilities.'
AND IN THE LETTERS …
Teaching history enriches learning experience
Realising the benefits of medical education in rural Wales
Teaching to the opioid epidemic - an interdisciplinary approach