Med Educ Research Articles

Information processing, specificity of practice, and the transfer of learning: considerations for reconsidering fidelity

Much has been made in the recent medical education literature of the incorrect characterization of simulation along a continuum of low to high fidelity (Cook et al. JAMA 306(9): 978-988, 2011; Norman et al. Med Educ 46(7): 636-647, 2012; Teteris et al. Adv Health Sci Educ 17(1): 137-144, 2012). For the most part, the common definition within the medical education community has been that simulations that present highly realistic performance characteristics, contexts, and scenarios are referred to as high-fidelity, while simulations that reduce to-be-learned skills to simpler constructs or constituent parts are referred to as low-fidelity. The issue with this is that highly-realistic has tended to mean the degree to which the simulation looks like the criterion context with little regard for what features of the simulation are in fact relevant to the skill that the educator hopes to teach. The inherent assumption that high fidelity simulations lead to better learning-an assumption for which there is a lack of supporting evidence (Norman et al. Med Educ 46(7): 636-647, 2012)-only exacerbates the problem. So much so that some have suggested that the term be abandoned all together (Hamstra et al. Acad Med J Assoc Am Med Coll 2014). While, it is true that fidelity and its importance are misconstrued in the medical education literature, the construct, defined classically as the degree of faithfulness that exists between two entities, is still fundamental to understanding the effectiveness that any one simulation might have in preparing learners for clinical performance. However, the concept of simulation fidelity must be recast in terms of the fundamental information processing events that underpin human performance.

G199(P) Implementation of a Peer-Led Practice OSCE examination for Paediatric Medical Students at a busy Major Acute Trust

AimsPeer-graded practice examinations can help medical students to achieve higher results in their final exams,1 and peer-led exam revision courses have demonstrated high levels of satisfaction.2,3 Surveys show that the...

G277(P) Implementation of a Peer-Led Practice OSCE examination for Paediatric Medical Students at a busy Major Acute Trust

AimsPeer-graded practice examinations can help medical students to achieve higher results in their final exams (1), and peer-led exam revision courses have demonstrated high levels of satisfaction (2,3). Surveys show...

Competency 7. Develop and carry out management plans

This competency is intimately enmeshed with other competencies and domains of competence described in this document. It is perhaps most intimately linked to competency 6: “Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment.” Much of the literature refers to “making informed diagnostic and therapeutic decisions” and “developing management plans” with one voice, 1 Charlin B. Boshuizen H.P. Custers E.J. Feltovich P.J. Scripts and clinical reasoning. Med Educ. 2007; 41: 1178-1184 Crossref PubMed Scopus (260) Google Scholar , 2 Norman G. Young M. Brooks L. Non-analytical models of clinical reasoning: the role of experience. Med Educ. 2007; 41: 1140-1145 PubMed Google Scholar , 3 Schmidt H.G. Rikers R.M. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ. 2007; 41: 1133-1139 PubMed Google Scholar often under the rubric of clinical judgment. The literature on illness scripts is particularly pertinent and has been covered in the “Make informed diagnostic and therapeutic decisions…” competency.

Competency 6. Make informed diagnostic and therapeutic decisions that result in optimal clinical judgment

When considering the developmental progression of making informed diagnostic and therapeutic decisions that result in optimal clinical judgment, the role of previous clinical experience cannot be emphasized enough. 1 Schmidt H.G. Boshuizen H.P.A. On acquiring expertise in medicine. Educ Psychol Rev. 1993; 5: 205-221 Crossref Scopus (243) Google Scholar , 2 Patel V.L. Groen G.J. Patel Y.C. Cognitive aspects of clinical performance during patient workup: the role of medical expertise. Adv Heatlh Sci Educ. 1997; 2: 95-114 Crossref PubMed Scopus (30) Google Scholar , 3 Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. 1994; 69: 883-885 Crossref PubMed Scopus (204) Google Scholar , 4 Bowen J.L. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006; 355: 2217-2225 Crossref PubMed Scopus (539) Google Scholar , 5 Schmidt H.G. Rikers R.M.J.P. How expertise develops in medicine: knowledge encapsulation and illness script formation. Med Educ. 2007; 41: 1133-1139 PubMed Google Scholar , 6 Schmidt H.G. Norman G.R. Boshuizen H.P.A. A cognitive perspective on medical expertise: theory and implications. Acad Med. 1990; 65: 611-621 Crossref PubMed Scopus (889) Google Scholar , 7 Chang R.W. Bordage G. Connell K.J. The importance of early problem representation during case presentations. Acad Med. 1998; 73: S109-S111 Crossref PubMed Scopus (82) Google Scholar , 8 Bordage G. Prototypes and semantic qualifiers: from past to present. Med Educ. 2007; 41: 1117-1121 Crossref PubMed Scopus (56) Google Scholar , 9 Coderre S. Mandin H. Harasym P.H. Fick G.H. Diagnostic reasoning strategies and diagnostic success. Med Educ. 2003; 37: 695-703 Crossref PubMed Scopus (232) Google Scholar With increasing clinical experience, learners do not simply gain new knowledge in an additive manner. Rather, they reorganize existing knowledge in an elaborated way that allows them to become more efficient and effective in diagnosing and treating new patients who possess features similar to those of previous patients. 1 Schmidt H.G. Boshuizen H.P.A. On acquiring expertise in medicine. Educ Psychol Rev. 1993; 5: 205-221 Crossref Scopus (243) Google Scholar , 2 Patel V.L. Groen G.J. Patel Y.C. Cognitive aspects of clinical performance during patient workup: the role of medical expertise. Adv Heatlh Sci Educ. 1997; 2: 95-114 Crossref PubMed Scopus (30) Google Scholar , 3 Bordage G. Elaborated knowledge: a key to successful diagnostic thinking. Acad Med. 1994; 69: 883-885 Crossref PubMed Scopus (204) Google Scholar , 4 Bowen J.L. Educational strategies to promote clinical diagnostic reasoning. N Engl J Med. 2006; 355: 2217-2225 Crossref PubMed Scopus (539) Google Scholar This highly learner-specific knowledge is best gained through individual clinical experience, which is a necessary but not sufficient prerequisite for developmental advancement in making informed diagnostic and therapeutic decisions that result in optimal clinical judgment. As Kolb 10 Kolb D.A. Experiential Learning: Experience as the Source of Learning and Development. Prentice-Hall, Upper Saddle River, NJ1983 Google Scholar suggests in his experiential learning theory, this knowledge is strengthened through reflective observation, active experimentation (eg, in a simulation environment), and abstract conceptualization. In fact, the mental energy that is saved as one becomes more efficient and effective in diagnosing and treating new patients must be reinvested in reflection and new learning if one is ultimately to become an expert clinician and not just an experienced nonexpert. 11 Bereiter C. Scardemalia M. Surpassing Ourselves: An Inquiry Into the Nature and Implications of Expertise. Open Court, Chicago, Ill1993 Google Scholar

Competency 1. Communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds

The ability to communicate effectively with patients, families, and the public is a critical skill for the medical professional and has been directly related to the outcomes of clinical care. 1 Stewart M. Effective physician–patient communication and health outcomes: a review. Can Med Assoc J. 1995; : 152-159 Google Scholar The importance of this is reflected in the medical education literature in consensus statements on essential elements of communication, 2 Simpson M. Buckman R. Stewart M. et al. Doctor–patient communication: the Toronto consensus statement. BMJ. 1991; 303: 1385-1387 Crossref PubMed Scopus (599) Google Scholar , 3 Participants in the Bayer-Fetzer Conference on Physician–Patient Communication in Med Educ Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med. 2001; 76: 390-393 Crossref PubMed Scopus (584) Google Scholar in guidelines for medical school curriculum development, 4 Association of American Medical Colleges Medical School Objectives Project, Report III. Contemporary Issues in Medicine: Communication in Medicine. Association of American Medical Colleges, Washington, DC1999 Google Scholar , 5 General Medical Council Tomorrow's Doctors: Recommendations on Undergraduate Med Educ. General Medical Council, London, UK1993 Google Scholar and through increased emphasis placed on communication skills by professional practice organizations and accrediting bodies. 6 Communications Self-Evaluation Process (COM-SEP) Committee Minutes. American Board of Internal Medicine, Philadelphia, Pa1999 Google Scholar , 7 Tate P. Foulkes J. Neighbour R. et al. Assessing physicians' interpersonal skills via videotaped encounters: a new approach for the Royal College of General Practitioners membership examination. J Health Commun. 1999; 4: 143-152 Crossref PubMed Scopus (43) Google Scholar

Competency 1. Develop the ability to use self-awareness of one's own knowledge, skills, and emotional limitations that leads to appropriate help-seeking behaviors

Help-seeking behaviors stem from uncertainty. An individual's ability to deal with uncertainty is shaped by his identity development, the culture and context in which he finds himself, and the socialization process within that culture. 1 Kennedy T.J.T. Regehr G. Baker G.R. Lingard L.A. “It's a cultural expectation… ”: the pressure on medical trainees to work independently in clinical practice. Med Educ. 2009; 43: 645-653 Crossref PubMed Scopus (109) Google Scholar , 2 Forsythe G.B. Identity development in professional education. Acad Med. 2005; 80: S112-S117 Crossref PubMed Scopus (41) Google Scholar Identity development plays a critical role in the professional formation of physicians. In the early stages, one relies almost exclusively on external prompts and judgments to guide behavior. This translates into doing something because we are told to do it and either want the praise or want to avoid the consequences. 2 Forsythe G.B. Identity development in professional education. Acad Med. 2005; 80: S112-S117 Crossref PubMed Scopus (41) Google Scholar As one matures, there is a shift to more intrinsic motivation and values. One begins to look at the identity of the profession and emulate behaviors that are perceived as important in belonging to the physician community. 2 Forsythe G.B. Identity development in professional education. Acad Med. 2005; 80: S112-S117 Crossref PubMed Scopus (41) Google Scholar The perceived values of the profession are incorporated as one's own value system. It is only with greater maturity that one is able to integrate one's own personal and professional value systems in a way that minimizes conflict that may arise between the two. 2 Forsythe G.B. Identity development in professional education. Acad Med. 2005; 80: S112-S117 Crossref PubMed Scopus (41) Google Scholar

Supporting physiology learning: the development of interactive concept-based video clips

the accommodation of diverse student learning approaches and maintenance of good academic outcomes are often difficult to achieve in university courses, particularly where large classes are concerned. These issues become even more significant when dealing with first-year students in science courses

The challenge of disruptive innovation in learning technology

Care Pathway for Dying Patients. London: Department of Health 2013. 4 Anonymous. After Mid Staffs: the NHS must do more to care for the health of its staff. BMJ 2013;346: 1503. 5 Regehr G. It’s NOT rocket science: rethinking our metaphors for research in health professions education. Med Educ 2010;44:31–9. 6 Stokes D. Pasteur’s Quadrant: Basic Science and Technological Innovation. Washington, DC: Brookings Institution Press 1997. 7 Reason J. Beyond the organisational accident: the need for ‘error wisdom’ on the frontline. Qual Saf Health Care 2004;13 (Suppl 2):28–33. 8 Merton RK. The unanticipated consequences of purposive social action. Am Sociol Rev 1936;1 (894): 904. 9 Stacey RD. Strategic Management and Organisational Dynamics: The Challenge of Complexity to Ways of Thinking about Organisations. Upper Saddle River, NJ: Pearson Education 2007.

Competency-based medical education: origins, perspectives and potentialities

This article is part of a series in Medical Education entitled ‘Dialogue’. Each publication in the series will be a transcription of an e-mail discussion about a current issue in the field held by two scholars who have approached the issue from different perspectives. For further details, see the editorial published in Med Educ 2012;46 (9):826–7. In this volume, Olle ten Cate, PhD (University Medical Centre Utrecht, the Netherlands) and Stephen Billett, PhD (Griffith University, Brisbane, Queensland, Australia) conduct an e-mail conversation on competency-based professional training in medicine. The discussion addressed its roots, significance and limitations, and extended to considerations of canonical knowledge and skill versus context-dependent ability, and legitimate peripheral participation through the development of a growing portfolio of entrustable professional activities.

A conversation about the role of medical regulators

Medical EducationVolume 48, Issue 2 p. 215-218 Dialogue A conversation about the role of medical regulators Lesley Southgate, Lesley SouthgateSearch for more papers by this authorCees P M van der Vleuten, Cees P M van der VleutenSearch for more papers by this author Lesley Southgate, Lesley SouthgateSearch for more papers by this authorCees P M van der Vleuten, Cees P M van der VleutenSearch for more papers by this author First published: 12 January 2014 https://doi.org/10.1111/medu.12309Citations: 2 Correspondence: Cees P M van der Vleuten, Department of Educational Development and Research University of Maastricht, Postal Address: P.O. Box 616, 6200 MD Maastricht, the Netherlands. Tel: +31 43 3885725; Fax: +31 43 3885779; E-mail: [email protected] This article is part of a series in Medical Education entitled ‘Dialogue’. Each publication in the series will be a transcription of an e-mail discussion about a current issue in the field held by two scholars who have approached the issue from different perspectives. For further details, see the editorial published in Med Educ 2012;46 (9):826–7. In this volume, Dame Lesley Southgate, St George's Hospital Medical School, London, UK, and Professor Cees P M van der Vleuten, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, discuss the role of regulators in the quality assurance and continuing professional development of the health professional workforce. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume48, Issue2February 2014Pages 215-218 RelatedInformation

Anesthesia Literature Review

Anesthesia Literature Review

Portfolio assessment in leadership course for premedical students.

Received: November 7, 2013 • Revised: November 14, 2013 • Accepted: November 15, 2013 Corresponding Author: Jung-Ae Rhee Department of Preventive Medicine, Chonnam National University Medical School, 160 Baekseo-ro, Dong-gu, Gwangju 501-746, Korea Tel: +82.62.220.4170 Fax: +82.62.233.0305 email: jarhee@jnu.ac.kr Korean J Med Educ 2013 Dec; 25(4): 265-269. http://dx.doi.org/10.3946/kjme.2013.25.4.265 pISSN: 2005-727X eISSN: 2005-7288 C The Korean Society of Medical Education. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 서론

Quizzes and conversations: exploring the role of retrieval in medical education

Editor’s note: This article is part of a series in Medical Education entitled ‘Dialogue’. Each publication in the series will be a transcription of an e-mail discussion about a current issue in the field held by two scholars who have approached the issue from different perspectives. For further details, see the editorial published in Med Educ 2012;46(9):826–7. In this issue, Douglas P Larsen, Director for Medical Student Education for the Division of Paediatric Neurology, Washington University in St Louis, and Tim Dornan, Professor of Medical Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, discuss the roles that testing, broadly defined, and social interaction play in the acquisition and retention of medical knowledge.

Tutor-Less Problem-Based Learning in a Large Classroom Setting—Could It Also Save Costs?

Dear Editor: Klegeris et al. (2013 ) are to be congratulated for adding another important piece to our knowledge of how problem-based learning (PBL) can be implemented. As the debate about PBL is less about whether it works and more about what forms of it work, studies such as this will become more important. However, the authors miss one vital outcome measure of the research—that of cost. One of the major criticisms of PBL is that it can increase costs. Such increased costs are largely related to increased numbers of faculty. The average size of a PBL group is seven, and large faculty numbers are therefore required (Albanese, 2010 ). Anything that adjusts the student:facilitator ratio should have a dramatic effect on the number of facilitators required and thus on costs. Also, if tutor-less PBL can be carried out in a large classroom setting, then the cost of facilities will also be reduced. Forty-seven students received the intervention in this study; if we assume the group size was seven (as is usual in PBL), then this form of PBL would have saved the time of at least five tutors and the space requirements of five tutorial rooms. The costs of PBL relate mainly to faculty, facilities, scenarios, and learner inputs. Faculty and facilities are likely to make up a large majority of the costs, and these are the two components that are likely to be reduced if the study format is implemented. If the five tutors would normally have to meet their small group once per week for one half-day session in a tutorial room throughout the college year (which would constitute in the region of 30 weeks), then 75 tutor days and 75 days’ worth of room occupancies would be saved. The actual amount saved would depend on tutor salaries and room rates and would vary from country to country. At a time when student fees are increasing, any suggestions regarding more cost-effective forms of education are welcome. There is little published evidence on cost and value in PBL and some doubt as to whether cost-effectiveness and PBL are compatible, prompting Wittert and Nelson (2010 ) to entitle their chapter on the subject “Problem-Based Learning: Is a Cost Effective Approach Possible?” According to Finucane et al. (2009 ), the cost of delivering PBL to 240 students in the first 2 years of a graduate-entry medical school was €1,526,952 ($1,997,191), and the annual recurring cost was €664,000 ($868,485) per year. Klegeris et al. (2013 ) may have shown one possible cost-effective approach to this important pedagogy.

Better learning, better doctors, better community: how transforming clinical education can help repair society

This article is part of a series in Medical Education entitled ‘Dialogue’, which features transcriptions of e-mail discussions focused on a current issue in the field, between two scholars who have approached the issue from different perspectives. For further details, see the editorial published in Med Educ 2012;46(9):826–7. In this contribution, Dr David Hirsh (Associate Professor, Harvard Medical School/Cambridge Health Alliance) and Professor Paul Worley (Dean, School of Medicine, Flinders University) discuss how modern transformations in the delivery of medical education address the goal of social accountability.

How to Develop, Implement, and Assess Multi-Source Feedback (MSF) for Trainees

Abstract Introduction Multi-source feedback (MSF) imparts feedback from a multidisciplinary group of raters within the trainee's sphere of influence. Faculty involved in residency and fellowship tr...

A Call for Investment in Education of US Minorities in the 21st Century

A Call for Investment in Education of US Minorities in the 21st Century

The Current State of Sleep Medicine Education in US Neurology Residency Training Programs: Where Do We Go from Here?

To evaluate the current state of sleep medicine educational resources and training offered by US neurology residency programs. In 2010, a 20-item peer reviewed Sleep Education Survey (SES) was sent to neurology residency program directors surveying them about sleep medicine educational resources used in teaching residents. Pearson product momentum correlation was used to determine correlation of program attributes with resident interest in pursuing a career in sleep medicine. Of the programs completing the survey, 81% listed a formal sleep rotation and 24% included a forum for sleep research. A variety of innovative approaches for teaching sleep medicine were noted. Program directors noted that 5.7% residents entered sleep medicine fellowship training programs in the preceding 5 years. Programs that had a more substantial investment in sleep medicine teaching resources were more likely to report residents entering a sleep medicine training program. This is the first report providing an analysis of the current state of sleep medicine training in US Neurology Residency Programs. Our data provide evidence that investment by the residency program in sleep education may enhance the ultimate decision by the neurology trainee to pursue a career in sleep medicine.

An onion? Conceptualising and researchingidentity

An onion? Conceptualising and researching<i>identity</i>