Context Of Medical Education Research Articles

The Hidden Curriculum: Exposing the Unintended Lessons of Medical Education.

Introduction: The hidden curriculum is a set of ethical, moral, and value-based teachings communicated to doctors-in-training, providing a basis for their future interactions with patients, peers, and colleagues. The aim of our study is to introduce the concept of the hidden curriculum to a cohort of third-year medical students and to subsequently evaluate their understanding. In particular, we sought to measure and benchmark the degree of hidden curriculum recognition within a Canadian medical education context. With the help of student feedback, we elicited ideas for future directions.Methods: One hundred and fifty-four third-year medical students completing their obstetrics and gynaecology core clinical rotation attended a workshop on the hidden curriculum. Students completed two sets of evaluations; a voluntary anonymous pre- and post-workshop questionnaire evaluating their knowledge and opinions regarding the hidden curriculum, and a mandatory workshop evaluation. Answers to pre- and post-workshop questionnaires were compared using Mann-Whitney U test, and thematic analysis was used to code the students’ comments to identify common themes.Results: A standardized workshop on the hidden curriculum significantly improved students’ understanding and highlighted the importance of the hidden curriculum. Voluntary student comments (N = 108) were categorized according to five themes: 1) Students who were not sensitized to the hidden curriculum (8; 7.4%); 2) students who were sensitized but unaware of the hidden curriculum (12; 11.1%); 3) students who were sensitized and aware of the hidden curriculum (34; 31.5%); 4) comments on teaching methodologies/environment (43; 39.8%); and 5) suggestions for enhancement (11; 10.2%).Conclusions: A simple, cost-effective intervention, such as a workshop, can effectively assess and address the hidden curriculum. Many students are highly sensitized to and are aware of the positive and negative effects of role modeling on their development. The students are calling for similar interventions to be directed at the postgraduate and faculty level.

Science: the slow march of accumulating evidence.

Recent crises over the credibility of research in psychology and the biomedical sciences have highlighted the need for researchers to view and treat replication research as essential to the accumulation of knowledge. In this article, the authors make the case for the utility of replication in medical education research. Specifically, the authors contend that because research in medical education often adopts theories from other disciplines, replication is necessary to gauge the applicability of those theories to the specific medical education context. This article introduces readers to the two major types of replication – direct and conceptual – and provides a primer on conceptual replication. In particular, the article presents key elements of conceptual replication and considers how it can be used to strengthen approaches to knowledge generation, theory testing, and theory development in medical education research.

The relationship between perceived preceptor power use and student empowerment during clerkship rotations: a study of hidden curriculum.

Medical learners are vulnerable to the social power used by preceptors. Furthermore, an individual's perceived level of personal empowerment has been identified as a predictor of positive behaviour in education environments. The degree to which medical students feel empowered in their clinical environments factors largely into how vulnerable they are to having their professional values influenced negatively by structural and cultural aspects of these environments. The goal of this study was to explore the relationship between clerks' perceptions of personal empowerment and the social power employed by their preceptors. This research also investigates the prevalence of negative power use as a function of the hierarchical organisation of a clerkship rotation. Validated power use and empowerment surveys were modified for clinical learning environments and administered to clerkship learners across six clerkship rotations. The outcomes of the two surveys were subjected to correlational analyses. Outcomes associated with the use of each type of perceived power were analysed to determine the influence of the relative involvement of residents and staff physicians in preceptorship. Correlational analyses revealed strong relationships between clerks' perceptions of preceptor power use and their own personal empowerment. Furthermore, although participants perceived significantly more pro-social preceptor uses of power, clerks perceived a higher prevalence of coercive power on rotations with high involvement of residents as preceptors. Clerks' perceptions of empowerment correlate positively with positive power bases and negatively with negative dimensions of preceptor power. This research has implications for the importance of the development of resident and faculty staff as educators, the identification of clerks who are vulnerable to ethical violation, and for a refined understanding of the transactional way in which power is experienced in a medical education context.

Exploring patterns and pattern languages of medical education.

The practices and concepts of medical education are often treated as global constants even though they can take many forms depending on the contexts in which they are realised. This represents challenges in presenting and appraising medical education research, as well as in translating practices and concepts between different contexts. This paper explores the problem and seeks to respond to its challenges. This paper explores the application of architectural theorist Christopher Alexander's work on patterns and pattern languages to medical education. The authors review the underlying concepts of patterns and pattern language, they consider the development of pattern languages in medical education, they suggest possible applications of pattern languages for medical education and they discuss the implications of such use. Examples are drawn from across the field of medical education. The authors argue that the deliberate and systematic use of patterns and pattern languages in describing medical educational activities, systems and contexts can help us to make sense of the world, and the pattern languages of medical education have the potential to advance understanding and scholarship in medical education, to drive innovation and to enable critical engagement with many of the underlying issues in this field.

Beyond homogenization discourse: Reconsidering the cultural consequences of globalized medical education

Introduction: Global medical education standards, largely designed in the West, have been promoted across national boundaries with limited regard for cultural differences. This review aims to identify discourses on cultural globalization in medical education literature from non-Western countries.Methods: To explore the diversity of discourses related to globalization and culture in the field of medical education, the authors conducted a critical review of medical education research from non-Western countries published in Academic Medicine, Medical Education and Medical Teacher from 2006 to 2014. Key discourses about globalization and culture emerged from a preliminary analysis of this body of literature. A secondary analysis identified inductive sub-themes.Results: Homogenization, polarization and hybridization emerged as key themes in the literature. These findings demonstrate the existence of discourses beyond Western-led homogenization and the co-existence of globalization discourses ranging from homogenization to syncretism to resistance.Conclusions: This review calls attention to the existence of manifold discourses about globalization and culture in non-Western medical education contexts. In refocusing global medical education processes to avoid Western cultural imperialism, it will also be necessary to avoid the pitfalls of other globalization discourses. Moving beyond existing discourses, researchers and educators should work towards equitable, context-sensitive and locally-driven approaches to global medical education.

Integration of Spirituality in Medical Education in Iran: A Qualitative Exploration of Requirements.

Background. Healthcare system has needed to provide spiritual services, and one of the reasons for not addressing spirituality in this field is lack of training in this area. This study purpose is to explore and identify main requirements for designing this education, in Iran. Materials and Methods. This is a qualitative study with conventional content analysis method. 18 participants, who were main stakeholders in spirituality, medical education, and curriculum development, were selected by purposive sampling. Data were collected using semistructured interviews, which continued until data saturation. Results. Three main themes and their categories were extracted from analysis of data. The themes are (1) educational needs including clinical practice needs; (2) opportunities including rich background and backup, perceived clinical need, and right context of medical education for change; and (3) challenges including challenges in academic planning and barriers to implementation. Conclusion. All stakeholders acknowledged the need for addressing spirituality in formal medical education. It seems that implementation of such programs requires attention to facilitating factors and challenges proposed by those involved.

Visual analytics in healthcare education: exploring novel ways to analyze and represent big data in undergraduate medical education.

Introduction. The big data present in the medical curriculum that informs undergraduate medical education is beyond human abilities to perceive and analyze. The medical curriculum is the main tool used by teachers and directors to plan, design, and deliver teaching and assessment activities and student evaluations in medical education in a continuous effort to improve it. Big data remains largely unexploited for medical education improvement purposes. The emerging research field of visual analytics has the advantage of combining data analysis and manipulation techniques, information and knowledge representation, and human cognitive strength to perceive and recognize visual patterns. Nevertheless, there is a lack of research on the use and benefits of visual analytics in medical education.Methods. The present study is based on analyzing the data in the medical curriculum of an undergraduate medical program as it concerns teaching activities, assessment methods and learning outcomes in order to explore visual analytics as a tool for finding ways of representing big data from undergraduate medical education for improvement purposes. Cytoscape software was employed to build networks of the identified aspects and visualize them.Results. After the analysis of the curriculum data, eleven aspects were identified. Further analysis and visualization of the identified aspects with Cytoscape resulted in building an abstract model of the examined data that presented three different approaches; (i) learning outcomes and teaching methods, (ii) examination and learning outcomes, and (iii) teaching methods, learning outcomes, examination results, and gap analysis.Discussion. This study identified aspects of medical curriculum that play an important role in how medical education is conducted. The implementation of visual analytics revealed three novel ways of representing big data in the undergraduate medical education context. It appears to be a useful tool to explore such data with possible future implications on healthcare education. It also opens a new direction in medical education informatics research.

Beyond “Teach a Man to Fish”: Communal Meta-cognition as the Key to Sustainable Professional Development

Improvement in the quality of aid and development in a community requires a feedback loop within the community, known as “communal meta-cognition.” This is relevant to medical education in resource-poor countries and is illustrated with the author’s own surgical experience. The usual source of truth is unquestioned allegiance to established wisdom rather than the dynamic state that comes through the feedback loop of asking questions, most importantly of one’s self. Some elements of what this might look like in a medical education context are illustrated.

William Pickles Lecture 2013: For they are born for another time.

The poet George Seferis wrote: ‘As pines keep the shape of the wind … so words guard the shape of man.’ 1 I want to dedicate this lecture to the memory of Helen Lester. Helen was wonderful in shaping her words. She will live on in our hearts for what she achieved, just as William Pickles has left a lasting legacy. From his country practice in Wensleydale and his interest in epidemiology he brought the values of primary care to an academic world where secondary care dominated. Half a century later, the secondary ethos still tends to rule in the university arena. I am the only GP on a Council of 34 medical school deans. I will argue that a readjusted balance, away from the dominant secondary care context of medical education, is needed to produce doctors fit for future health care. The honour of presenting this lecture led me to reflect on a mantra I have frequently used: ‘Do not confine children to your own learning for they were born in another time.’ (Hebrew proverb). A fundamental fact, often overlooked by educators, is that the world as viewed through the eyes of the young is inevitably different from ours. There is a strong and natural tendency to look back to the old, perhaps unsustainable, values of our own education. We struggle to look forward. Yet the different values of the new generations may equip them better for the challenges they will inevitably face. There is potential for GPs to engage much more overtly with undergraduate education, bringing our community-based generalist expertise to the fore and strengthening our presence and leadership. I have chosen to centre my reasoning on the definition of generalist practice framed by Joanne Reeve and colleagues: ‘Generalist practice is decision making which is person-focused, not disease-focused, …

Communication skills training in medical students: do motivational orientations predict changes over time in psychosocial attributes?

Perceived psychosocial abilities (i.e., competence in addressing the psychosocial aspects of patient care) and low frustration tolerance (LFT) (i.e., intolerance of physical or emotional discomfort) have been established as significant attributes of experienced medical professionals. We aimed to expand our understanding of the role motivation plays within communication skills training by investigating whether motivation precedes or, conversely, follows psychosocial attributes. According to goal orientations theory, motivation denotes the goals students pursue when engaging in learning tasks. We hypothesized that goal orientations would predict development of psychosocial attributes. More specifically, an adaptive goal orientation (i.e., mastery goal orientation) was expected to predict perceived psychosocial abilities, whereas the maladaptive goal orientations (i.e., performance-approach and avoidance goal orientations) were hypothesized to predict LFT (frustration intolerance). The study spanned two sequential years, in which two cohorts of first-year medical students (N=151) completed questionnaires at the beginning and end of an annual physician-patient communication course. The questionnaires assessed goal orientations, perceived psychosocial abilities, and LFT. Cross-lagged analyses using Structural Equation Modeling indicated that goal orientations significantly predicted perceived psychosocial abilities, as hypothesized; however, LFT predicted maladaptive goal orientation, rather than the other way around. These findings provided further support for the contribution of goal orientations theory within medical education contexts. Medical schools are advised to consider motivational aspects when planning and implementing training programs.

Beyond prevalence to process: the role of self and identity in medical student well-being

Problematic stress levels among medical students have been well established. This stress can lead to depression, suicidal ideation, substance abuse, burnout and cynicism, having a negative effect on students and their patients. We propose to move towards examining the processes underlying well-being in some medical students and vulnerability in others. We draw upon social psychological literature to propose that self-complexity, medical student identity and associated norms all have the capacity to influence medical students' well-being in both positive and negative ways. We identify two key dilemmas facing medical students with regard to the social psychological factors investigated. First, a diverse set of interests and a high level of self-complexity is thought to buffer against the effects of stress and might also be beneficial for medical practitioners, but the intensive nature of medical education makes it difficult for students to pursue outside interests, leading to a strongly focused identity. Second, a strong group identity is associated with high levels of social support and improved well-being, but unhealthy group norms may have a greater influence on individuals who have a strong group identity, encouraging them to engage in behaviours that place their well-being at risk. A model is proposed outlining how these potentially contradictory social psychological processes may combine to impact upon medical students' well-being. There is great scope for investigating the role of self-complexity, identity and norms in the medical education context, with room to investigate each of these factors alone and in combination. We highlight how our proposed model can inform medical educators as to the students who may be most vulnerable to the effects of stress and the potential interventions from which they may benefit. We conclude that social psychological factors make a valuable contribution to understanding the complex issue of well-being in medical education.

Utilization of an Educational Information System for Medical Education

The teaching and learning environment in medical schools is significantly different from that of other academic fields. An educational information system specifically designed for medical education could be an important solution for the unique context of medical education. In this study, the concept of the educational information system has been reviewed, and how such a system can be utilized effectively for medical education has also been explored. This paper also addresses how learning management systems for online learning could be made more effective through educational information systems. The application of flipped learning, which has been developing rapidly to improve teaching and learning, for medical education was also investigated. In conclusion, it was found that educational information systems could be a solution to various teaching and learning issues in medical schools. In particular, given that high performing students tend to enter medical schools, using educational information systems to improve the teaching and learning environment in medical school should be investigated further.

How we developed a role-based portfolio for teachers’ professional development

Faculty development requires practical tools for supporting teachers’ professional development. In a modern medical education context, teachers need to adapt to various educational roles. This article describes how a role-based portfolio with a qualitative self-assessment scale was developed. It strives to encourage and support teachers’ growth in different educational roles. The portfolio was developed between 2009 and 2012 at the University of Helsinki in dialogue with teachers involved in faculty development. It is based on the role framework presented by Harden and Crosby. Today, it also involves the educational premises of constructive alignment, reflection and a scholarly approach to teaching. The role-based portfolio has led the teachers to discover new educational roles and set goals in their professional development.

Considering the Clinical Context of Medical Education

The article by Chen and colleagues in this issue suggests that the context in which clinical medical education is executed matters, especially if we intend to meet the projected future physician workforce needs in the United States. Placing learners in the highest-performing medical settings seems intuitive, but this can be disruptive to the patient care interface, especially in high-performing health care delivery systems. Simply placing learners in a well-functioning, highly reliable health care delivery system focused on systems of care and directed at improving quality and safety is not enough for learners. Educational experiences must be planned, organized, and strategically aligned with clinical operations to ensure seamless integration with highly reliable health care delivery systems. The authors draw on their experience at Geisinger Health System to explore the challenges and advantages to integrating the education and patient care missions of academic clinical sites for learners, patients, faculty, and the future of the workforce.

A conceptual framework of stress management intervention for medical students

Teaching stress management skills for medical students has been echoed as an important educational component in medical education. Discussions about approaches to teaching stress management in medical education context are largely unexplored despite of a large number of articles have emphasized on its importance. This paper describes four elements in a framework as an approach to teaching stress management skills in medical education. As one moves through the DEAL elements, it provides a greater degree of insight on stress management ability as is acquired through one’s awareness, experience and conscious effort that allow stressful situations to be handled effectively and efficiently. It may provide a useful educational framework for medical teachers to teach and assess stress management skills of medical students. It also may be used as an aid in planning, implementing and evaluating stress management programs in medical schools. The authors discuss about the implications of this framework for future research in medical education.

Ethnography in qualitative educational research: AMEE Guide No. 80

Ethnography is a type of qualitative research that gathers observations, interviews and documentary data to produce detailed and comprehensive accounts of different social phenomena. The use of ethnographic research in medical education has produced a number of insightful accounts into its role, functions and difficulties in the preparation of medical students for clinical practice. This AMEE Guide offers an introduction to ethnography – its history, its differing forms, its role in medical education and its practical application. Specifically, the Guide initially outlines the main characteristics of ethnography: describing its origins, outlining its varying forms and discussing its use of theory. It also explores the role, contribution and limitations of ethnographic work undertaken in a medical education context. In addition, the Guide goes on to offer a range of ideas, methods, tools and techniques needed to undertake an ethnographic study. In doing so it discusses its conceptual, methodological, ethical and practice challenges (e.g. demands of recording the complexity of social action, the unpredictability of data collection activities). Finally, the Guide provides a series of final thoughts and ideas for future engagement with ethnography in medical education. This Guide is aimed for those interested in understanding ethnography to develop their evaluative skills when reading such work. It is also aimed at those interested in considering the use of ethnographic methods in their own research work.

Team-based learning: A practical guide: Guide Supplement 65.1 – Viewpoint

The practical aspects and potential benefits of team-based learning (TBL) are outlined on the recent guide published by Parmelee et al. (2012). TBL provides a strategy for active student-centred collaborative learning which involves multiple small groups in a single classroom setting, incorporating many of the adult approaches to learning, more frequently seen in problem-based learning (PBL). A single teacher who is a content-expert, who need not have any experience in the group processes to deliver a successful session, instructs the student groups. Unlike PBL and traditional small group learning, TBL provides opportunities to hold each student accountable for their own performance and their individual contributions to the team (Parmelee et al. 2012). A limited search of ‘PubMed’ revealed that TBL is being used and evaluated internationally as an educational strategy, with virtually no published papers on TBL from the UK. This may suggest either little current interest on the use of TBL by UK medical educators or that the UK is currently not contributing a great deal to the literature on TBL. There may be a need to research the effectiveness and outcomes of TBL in a UK context of medical education.

Improving Undergraduate Medical Education about Pain Assessment and Management: A Qualitative Descriptive Study of Stakeholders’ Perceptions

Pain is one of the most common reasons for individuals to seek medical advice, yet it remains poorly managed. One of the main reasons that poor pain management persists is the lack of adequate knowledge and skills of practicing clinicians, which stems from a perceived lack of pain education during the training of undergraduate medical students. To identify gaps in knowledge with respect to pain management as perceived by students, patients and educators. A qualitative descriptive study was conducted. Data were generated through six focus groups with second- and fourth-year medical students, four focus groups with patients and individual semistructured interviews with nine educators. All interviews were audiotaped and an inductive thematic analysis was performed. A total of 70 individuals participated in the present study. Five main themes were identified: assessment of physical and psychosocial aspects of pain; clinical management of pain with pharmacology and alternative therapies; communication and the development of a good therapeutic relationship; ethical considerations surrounding pain; and institutional context of medical education about pain. Participating patients, students and pain experts recognized a need for additional medical education about pain assessment and management. Educational approaches need to teach students to gather appropriate information about pain, to acquire knowledge of a broad spectrum of therapeutic options, to develop a mutual, trusting relationship with patients and to become aware of their own biases and prejudice toward patients with pain. The results of the present study should be used to develop and enhance existing pain curricula content.

Reconstructing a lost tradition: the philosophy of medical education in an age of reform

At the 100th anniversary of Abraham Flexner's landmark report on medical education, critical reassessment of the direction of medical education reform evinced valuable interdisciplinary contributions from biomedicine, sociology, psychology and education theory. However, to date, philosophy has been absent from the discussion despite its long standing contribution to studies on education in other professions. This discussion paper examines how the philosophical tradition can contribute to scholarship in medical education. It begins with an explanation of the scholarly tradition of philosophy of education and its role in thinking in education more generally. It then makes links between this tradition and the context of medical education in the Flexner era of education reform. The paper then argues that this tradition is necessary to the understanding of medical education reform post-Flexner and that doctors must benefit from an education derived from this tradition in order to be able to carry out their work. These foundations are characterised as a hidden, but always present, tradition in medical education. Two ways in which this 'lost tradition' can inform medical education theory and practice are identified: firstly, by the establishment of a public canon of medical education texts that express such a tradition, and, secondly, by the incorporation of a variety of 'signature pedagogies' exemplary of liberal education.

A framework for monitoring instructional environments in a virtual world

AbstractVirtual worlds are gaining momentum as a platform for delivering simulation‐based educational experiences to students. However, a key aspect of virtual world‐based education that has received little attention is recording and analyzing students' in‐world actions. This capability is essential for assessing what students have learned through their simulation experience, and engaging the students in post‐simulation reflective learning.In this research, we present a framework for recording and analyzing students' actions in a virtual world. This framework is based upon pedagogical theories of exploratory and experiential learning, and is defined in a virtual‐world agnostic manner. The framework consists of two parts: (1) the Avatar Capabilities Model, which defines the educationally relevant actions that a student can take within a virtual world and (2) the Simulation Capture and Analysis toolkit that records and analyzes these actions, from an educational perspective. These analyses provide instructors with systematically collected evidence of the students' actions during their virtual world experience. This alleviates the need for instructors to directly observe students, thereby allowing for the scaling‐up of virtual worlds use in education. We have demonstrated the usefulness of the tool via a pilot study, with two students, in an emergency medical education context.