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Medical Education

Jennifer Cleland, Steven J Durning
OBJECTIVES: This paper reviews why tensions between service and education persist and highlights that this is an area of medical education research (MER) that, to date, lacks a robust body of theory-driven research. After carrying out a review of the literature on service-education tensions in medical education and training, we turn to consider how theory can help provide new insights into service-education tensions. METHODS: We conducted a search of the literature on service-education tensions since 1998 to examine the use of theory in studies on this topic...
October 24, 2018: Medical Education
Rola Ajjawi, Glenn Regehr
No abstract text is available yet for this article.
October 21, 2018: Medical Education
Joanna Bates, Brett Schrewe, Rachel H Ellaway, Pim W Teunissen, Christopher Watling
CONTEXT: The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them. METHODS: The authors synthesise the literature related to the intersections and resulting tensions between standardization and contextual diversity in medical education. In doing so, the authors analyze the interplay between these competing concepts in two domains of medical education (admissions and competency-based medical education), and provide concrete examples drawn from the literature...
October 21, 2018: Medical Education
Gisèle Bourgeois-Law, Lara Varpio, Glenn Regehr, Pim W Teunissen
CONTEXT: The remediation of practising physicians is coming to the fore in several countries in response to increasing demands for physician accountability and quality improvement initiatives in health care. However, the profession continues to grapple with the concepts and processes of remediation, particularly for physicians in practice who struggle with performance issues related to clinical competence. This suggests that current conceptualisations of remediation might be contributing to this situation...
October 21, 2018: Medical Education
Margaret Bearman, Jennene Greenhill, Debra Nestel
CONTEXT: Simulation-based education (SBE) includes a broad spectrum of simulation activities, which are individually well researched. An extensive literature reports on SBE methods, topics and modalities, but there are limited studies investigating how simulation as a holistic phenomenon promotes learning. This study seeks to identify the ways in which health professionals narrate powerful SBE experiences and through this to understand in what ways SBE may influence learning. METHODS: Three hundred and twenty-seven narratives about powerful learning through SBE were gathered from participants' online reflections from a national faculty development programme in SBE...
October 18, 2018: Medical Education
Zac Feilchenfeld, Ayelet Kuper, Cynthia Whitehead
CONTEXT: In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education...
October 18, 2018: Medical Education
Catherine E Scarff, Margaret Bearman, Neville Chiavarolli, Steve Trumble
CONTEXT: The seemingly obvious claim that people prefer to keep mum about undesirable messages - termed 'the MUM effect' - was initially reported in the psychology literature in the 1970s. More recently, it has been discussed in contexts including performance appraisals and the reporting of unsuccessful projects in workplace settings, but only sparsely in educational ones. We wished to review the published literature on the MUM effect in order to understand the implications for clinical assessment...
October 16, 2018: Medical Education
Abigail F Winkel, Annie Robinson, Aubrie-Ann Jones, Allison P Squires
OBJECTIVE: Enhancing physician resilience has the promise of addressing the problem of burnout, which threatens both doctors and patients and increases in residents with each year of training. Programmes aimed at enhancing physician resilience are heterogeneous and use varied targets to measure efficacy, because there is a lack of clarity regarding this concept. A more robust understanding of how resilience is manifested could enhance efforts to create and measure it in physicians in training...
October 16, 2018: Medical Education
Sanne Schreurs, Jennifer Cleland, Arno M M Muijtjens, Mirjam G A Oude Egbrink, Kitty Cleutjens
CONTEXT: Resources for medical education are becoming more constrained, whereas accountability in medical education is increasing. In this constrictive environment, medical schools need to consider and justify their selection procedures in terms of costs and benefits. To date, there have been no studies focusing on this aspect of selection. OBJECTIVES: We aimed to examine and compare the costs and benefits of two different approaches to admission into medical school: a tailored, multimethod selection process versus a lottery procedure...
October 15, 2018: Medical Education
Sayra Cristancho, Emily Field, Lorelei Lingard
CONTEXT: 'Complexity' is fast becoming a 'god term' in medical education, but little is known about how scholars in the field apply complexity science to the exploration of education phenomena. Complexity science presents both opportunities and challenges to those wishing to adopt its approaches in their research, and debates about its application in the field have emerged. However, these debates have tended towards a reductive characterisation of complexity versus simplicity. We argue that a more productive discussion centres on the multiplicity of complexity orientations, with their diverse disciplinary roots, concepts and terminologies...
October 10, 2018: Medical Education
Dalal A ALQahtani, Jerome I Rotgans, Silvia Mamede, Moeber M Mahzari, Ghassan A Al-Ghamdi, Henk G Schmidt
CONTEXT: Time pressure has been implicated in the suboptimal diagnostic performance of doctors and in increases in diagnostic errors. However, the reasons underlying these effects are not clear. The aim of this study was to investigate the influence of time pressure on physicians' diagnostic accuracy and to explore the mediating effects of perceived stress (emotional pathway) and number of plausible diagnostic hypotheses (cognitive pathway) on the proposed relationship. METHODS: We conducted a randomised controlled experiment...
October 10, 2018: Medical Education
Marjan J B Govaerts, Cees P M van der Vleuten, Eric S Holmboe
CONTEXT: In health professions education, assessment systems are bound to be rife with tensions as they must fulfil formative and summative assessment purposes, be efficient and effective, and meet the needs of learners and education institutes, as well as those of patients and health care organisations. The way we respond to these tensions determines the fate of assessment practices and reform. In this study, we argue that traditional 'fix-the-problem' approaches (i.e. either-or solutions) are generally inadequate and that we need alternative strategies to help us further understand, accept and actually engage with the multiple recurring tensions in assessment programmes...
October 5, 2018: Medical Education
Stephen Gauthier, Lindsay Melvin, Maria Mylopoulos, Nadine Abdullah
OBJECTIVES: Direct observation is the foundation of assessment and learning in competency-based medical education (CBME). Despite its importance, there is significant uncertainty about how to effectively implement frequent and high-quality direct observation. This is particularly true in specialties where observation of non-procedural skills is highly valued and presents unique challenges. It is therefore important to understand perceptions of direct observation to ensure successful acceptance and implementation...
October 1, 2018: Medical Education
Marieke van der Schaaf, Arthur Bakker, Olle Ten Cate
No abstract text is available yet for this article.
September 26, 2018: Medical Education
Laura Nimmon, Sayra Cristancho
No abstract text is available yet for this article.
September 25, 2018: Medical Education
John R Boulet, Steven J Durning
CONTEXT: As the practice of medicine evolves, the knowledge, skills and attitudes required to provide patient care will continue to change. These competency-based changes will necessitate the restructuring of assessment systems. High-quality assessment programmes are needed to fulfil health professions education's contract with society. OBJECTIVES: We discuss several issues that are important to consider when developing assessments in health professions education...
September 14, 2018: Medical Education
Elizabeth Molloy, Margaret Bearman
The tension between expressing vulnerability and seeking credibility creates challenges for learning and teaching. This is particularly true in health care, in which practitioners are regarded as highly credible and making errors can often lead to dire consequences and blame. From a transformative learning perspective, expressing vulnerability may help individuals to access different ways of knowing. By contrast, from a sociological perspective, seeking to maintain credibility results in ritualised interactions and these ritualised encounters can reinforce credibility...
September 7, 2018: Medical Education
Jennifer A Cleland, Fiona Patterson, Mark D Hanson
OBJECTIVES: 'Wicked problems' are complex in nature, have innumerable causes associated with multiple social environments and actors with unpredictable behaviour and outcomes, and are difficult to define or even resolve. This paper considers why and how the frameworks of complexity theory and wicked problems can help medical educators consider selection and widening access (WA) to medicine through fresh eyes to guide future policy and practice. We illustrate how 'wickedity' can frame the key issues in this area, and then address steps that education stakeholders might take to respond to and act on these issues...
September 7, 2018: Medical Education
Harry Goldberg, Caitlin Hanlon
No abstract text is available yet for this article.
August 20, 2018: Medical Education
Carlos Fernando Collares, Dario Cecilio-Fernandes
No abstract text is available yet for this article.
August 19, 2018: Medical Education
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