Theory In Medical Education Research Articles

Integrating assessment innovations in medical education

The role assessment plays in driving learning should not be underestimated. An understanding of assessment processes is clearly important for all those involved in teaching, as well as examiners and candidates. So how do we best assess learning outcomes? This article provides a balanced foundation in the theory of modern medical education for those involved in assessment at any level.

Integrating teaching innovations in medical education

Teaching is changing, but the goal remains the same. This article provides a balanced foundation in the theory of modern medical education for those involved in teaching at any level.

Churchill's Pocketbook of Surgery (3rd edn)

This is the third edition of what has in the past proved a popular book as evidenced by the publisher's commercial confidence in going to a further edition. The authors' aim as stated in the preface is to produce a concise, didactic account of the common surgical disorders that is both affordable and fits in the pocket, although not many trainees wear white coats these days! They have achieved this objective admirably and they make no claims that it is intended as a detailed text with discussions of opposing views on management. The book covers all the major spheres of surgery likely to be encountered by an SHO or SpR. As well as covering topics within general surgery, it also includes sections on neurosurgery, orthopaedics, urology and plastic surgery, so that somebody reading this book from cover-to-cover should end up with a broad knowledge, certainly from the point of view of final MB and MRCS. In addition, there are more general chapters on investigations, shock and trauma, pre- and postoperative care and malignant disease. There is also useful information on communication skills and breaking bad news. The layout is good, with boxes in the text to highlight important points and useful, simple diagrams. There is also a quick reference index for finding the sections dealing with common surgical emergencies. The text gives pointers on how to reach a differential diagnosis, which is very useful in today's era of specialisation. One of the best pieces of advice I ever had as a trainee was that it was better to know a little book well than a big book badly: this is a little book that is worth knowing well. The authors apologise in the preface for not including much that is in line with modern medical educational theory. I think the apology is unnecessary as, ultimately (despite the current enthusiasm for problem-based learning), like most practical, down-to-earth subjects, surgery is best taught in the first instance didactically rather than theoretically.

How to Use Structural Equation Modeling in Medical Education Research: A Brief Guide

Background: Structural equation modeling (SEM) is a family of statistical techniques used for the analysis of multivariate data to measure latent variables and their interrelationships. SEM has potential to advance theory and research in medical education. Purpose: The purpose of this article is to introduce SEM to medical education researchers and provide procedural information for applying SEM. Methods: We outline the basic tenets of SEM, principles of model creation, identification, estimation, and model fit to data, and the use of SEM in medical education research. Results: Although it is a powerful statistical research tool, SEM has had only limited use in medical education research. We explicate a five-step procedure for applying SEM to research problems and summarize an example of SEM to test a hypothetical model. Conclusions: Notwithstanding some pitfalls, SEM does provide promise for testing complex, integrated theoretical models and advance research in medical education.

Making sense of grounded theory in medical education

Grounded theory is a research methodology designed to develop, through collection and analysis of data that is primarily (but not exclusively) qualitative, a well-integrated set of concepts that provide a theoretical explanation of a social phenomenon. This paper aims to provide an introduction to key features of grounded theory methodology within the context of medical education research. In this paper we include a discussion of the origins of grounded theory, a description of key methodological processes, a comment on pitfalls encountered commonly in the application of grounded theory research, and a summary of the strengths of grounded theory methodology with illustrations from the medical education domain. The significant strengths of grounded theory that have resulted in its enduring prominence in qualitative research include its clearly articulated analytical process and its emphasis on the generation of pragmatic theory that is grounded in the data of experience. When applied properly and thoughtfully, grounded theory can address research questions of significant relevance to the domain of medical education.

Cultivating a Thinking Surgeon: New Perspectives on Clinical Teaching, Learning and Assessment

I like the title of this book. It presupposes that we already have a thinking surgeon, a fact that is often forgotten in this age of modernising medical careers and educational theory. The book is by two authors, one of whom is a practising surgeon and associate postgraduate dean, the other an educationalist with a background in teaching who presently holds a Chair of Education in Postgraduate Medicine. The book is designed for both teachers and learners in surgical practice. It seeks to provide challenging new perspectives that seriously question much that the current climate of education provides, by showing examples of arguments, ideas, processes and language in which to think and talk about education rationally and logically. It is divided into two sections: the first dealing with the educational foundation for cultivating a thinking surgeon, the second a more practical section on teaching, learning and assessing in surgical settings. I found it very heavy reading. Much of it is written in educational jargon. The premise is that surgical teaching will have to change in the new circumstances of the 21st century. The authors state that in the past the clinical setting was viewed as the arena in which surgeons could demonstrate clinical cases and instruct the learner in clinical and operative procedures. They feel that this approach is not commensurate with the current pressures on ways of working and that new methods and approaches to education will be required. New models of education are presented in the first section and the chapter on ‘Reflection’ is very revealing educationally. The chapter includes statements such as ‘having an experience is not the same as understanding its meaning’ and that Habermas' work on reflection ‘drives towards the ideals of empowerment and emancipation…reflection is about critique, evaluation and liberation’. I was also intrigued to learn that suitable starting points for reflection included writing a letter to a friend and experimenting with a variety of forms, e.g. prose, poetry and drama. I was sorry to see that it did not involve phoning a friend! Perhaps there is a tendency to accept that the traditional form of training provided well-trained but poorly educated surgeons. By the end of this book, I had the distinct impression that by following its recommendations we would end up with a well-educated and educationally eloquent surgeon who was poorly trained. Somewhere among all the educational jargon is a very good book with some practical common sense. As a surgeon, I found the second section of the book much better than the first, which gave one the feel of a tree-hugging medical educationalist, with designer stubble, a suede waistcoat, cords and sandals conducting holistic teaching rather than a professional surgeon. When I read the book, there was a certain sense of deja vu. I realised that for the past 20 years I'd actually been teaching and educating in the way outlined in this book but had not appreciated the terminology applied to my teaching methodology. I realise now that, over those years, my trainees have reflected, conceptualised, become emancipated, developed propositional, procedural and metacognitive knowledge over the post-ward round cup of tea. This has probably been common to many surgical firms and explains why there have been such excellent and thinking surgeons produced in this country in the past. To whom would I recommend the book? Certainly to candidates studying for a degree in medical education who will find it invaluable. It is well referenced, beautifully produced and extremely up-to-date. I would also recommend that all practising surgeons read it and form their own opinion on changes in medical education.

Item response theory: applications of modern test theory in medical education.

Item response theory (IRT) measurement models are discussed in the context of their potential usefulness in various medical education settings such as assessment of achievement and evaluation of clinical performance. The purpose of this article is to compare and contrast IRT measurement with the more familiar classical measurement theory (CMT) and to explore the benefits of IRT applications in typical medical education settings. CMT, the more common measurement model used in medical education, is straightforward and intuitive. Its limitation is that it is sample-dependent, in that all statistics are confounded with the particular sample of examinees who completed the assessment. Examinee scores from IRT are independent of the particular sample of test questions or assessment stimuli. Also, item characteristics, such as item difficulty, are independent of the particular sample of examinees. The IRT characteristic of invariance permits easy equating of examination scores, which places scores on a constant measurement scale and permits the legitimate comparison of student ability change over time. Three common IRT models and their statistical assumptions are discussed. IRT applications in computer-adaptive testing and as a method useful for adjusting rater error in clinical performance assessments are overviewed. IRT measurement is a powerful tool used to solve a major problem of CMT, that is, the confounding of examinee ability with item characteristics. IRT measurement addresses important issues in medical education, such as eliminating rater error from performance assessments.

Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery.

To examine the first decade of experience with minimal access surgery, with particular attention to issues of training surgeons already in practice, and to provide a set of recommendations to improve technical training for surgeons in practice. Concerns about the adequacy of training in new techniques for practicing surgeons began almost immediately after the introduction of laparoscopic cholecystectomy. The concern was restated throughout the following decade with seemingly little progress in addressing it. A preliminary search of the medical literature revealed no systematic review of continuing medical education for technical skills. The search was broadened to include educational, medical, and psychological databases in four general areas: surgical training curricula, continuing medical education, learning curve, and general motor skills theory. The introduction and the evolution of minimal access surgery have helped to focus attention on technical skills training. The experience in the first decade has provided evidence that surgical skills training shares many characteristics with general motor skills training, thus suggesting several ways of improving continuing medical education in technical skills. The educational effectiveness of the short-course type of continuing medical education currently offered for training in new surgical techniques should be established, or this type of training should be abandoned. At present, short courses offer a means of introducing technical innovation, and so recommendations for improving the educational effectiveness of the short-course format are offered. These recommendations are followed by suggestions for research.

La recherche en pédagogie médicale en Amérique du Nord : tour d’horizon et perspectives

Summary Research in medical education in North America at the end of the twentieth century is well established and soaring. A four-part overview is presented including, topics of research, methods of research, types of publications, and financing. Examples are presented from undergraduate medical education and surgery. Most often research is conducted in natural settings with little research funds and published in a variety of scientific journals. Research is essential both for sound design and evaluation of medical education and for the vitality and credibility of the field itself. The creation of a healthy and coherent cycle between theory and practice in medical education is proposed.

The SOCRATES curriculum: an innovative integration of technology and theory in medical education

This article describes the pilot study of an innovative medical school curriculum module that utilizes a modified problem-based learning (PBL) approach to teach medical students about management of diabetes mellitus. The PBL-based curriculum incorporated computer simulations and analysis of videotaped patient encounters in addition to independent study and group discussion. At the conclusion of the study, student knowledge and clinical decision-making skills were evaluated via questionnaires and examinations. Twenty-three students completed the workshop and all evaluation assessments. Students performed well on the case-study examinations (mean score of 3.39 out of 4) but not on the short answer essay examination, which assessed basic knowledge. Students rated the quality and appeal of the activities using Likert-type scales. In general, students perceived the activities as very worthwhile, with reasonable complexity and adequate time devoted to each activity. Students were very positive about the workshop and preceptor; 15 of the 16 items used to rate workshop appeal yielded mean scores greater than 4 (on a scale of 1 to 5, with 5 being the highest). The results of the pilot study suggest future enhancements that would further improve the outcomes of the training.

From the Editors: Research, theory and science in medical education

From the Editors: Research, theory and science in medical education

Taking It to Heart or Taking Heart?

SynopsisThis article describes the writer's experience of a cardiac unit committed to a holistic approach to health which avoids drug therapy and surgical intervention unless essential. Instead, the subject is helped to concentrate on the development or re-creation of her own self-healing and self-organising abilities. After a brief description, the events will be analysed from the point of view of medical anthropology and adult education theory and practice. The centrality of the heart in bibilical and human imagery, its use and misuse, will also be examined.

Problems of research into medical problem solving: some remarks on theory and method.

Investigators of medical problem solving, and of problem solving in general, appear to use the term problem solving to denote different concepts. Medical problem solving sometimes refers to the doctor solving the patient's problem, whereas others use it to refer to the doctor solving his own diagnostic problem. Second, 'problem' is used by some in a subjective sense (something is only called a problem if the subject has difficulties with it), and by others in an objective sense (problem being nearly synonymous with task). Finally, there is the definitional question of whether knowledge and problem solving are regarded as independent or as intimately related. What one means by problem solving, with one's research objectives (research may be aimed at medical education, medical practice or cognitive theory), constitute the major determinants of the choice of research design. It is advocated that investigators, before selecting a research design, should clarify their own definitions and research objectives, and before adopting other investigators' definitions and research designs, should consider carefully their research objectives.

Recent Advances in Theory of Medical Education

Recent Advances in Theory of Medical Education

Behavioural science theory in medical education

One of the early reforms sought in medical education was to implement ways of transforming the physician into a scientist-scholar with a preventative orientation. In part, this goal was to be achieved through exposure to behavioural sciences. This use of behavioural science theory has not, however, been well received by medical students. Students often report that theory is irrelevant and, at best, trivial. Much of the question of relevance surrounding behavioural science theory stems from the false separation of theory and practice. Theory by its very nature is tied to application and the process of problem solving. Communicating this inseparability of theory and practice is made difficult, however, by a student perspective that is egocentrically bound to the practice situation, vagueness or lack of stated objectives, the rule of thumb ethic, the belief that the worth of theory must be demonstrated immediately, and the notion that theory must be diluted in order to be relevant. Possible ways of communicating the potential importance of behavioural science theory to the practitioner include clear statements of expected outcome competencies, the presentation of conceptual schemes that enable the integration of experience, team teaching, biographical study, and theory explication. Lack of attention to developing effective ways of using theory in medical education creates the risk of producing narrow and inflexible technicians.

Theory and practice in medical education at the University of Montpellier in the thirteenth and fourteenth centuries.

Theory and practice in medical education at the University of Montpellier in the thirteenth and fourteenth centuries.