Facilitating students' reflective practice in a medical course: literature review

Introduction:
Reflection and reflective practice is of increasing importance in medical education curricula. The aim of this review is to summarise the literature published around facilitating refection in a medical course, and to answer the question: What is the current evidence regarding learning and development moments across the medical curriculum in developing students' reflective practice?

Methods:
A review of the literature was undertaken using defined databases and the search terms 'medical students', 'medical education', 'reflection', 'reflect*' and 'medicine'. The search was limited to peer-reviewed published material in English and between the years 2001 and 2011, and included research, reviews and opinion pieces. Results: Thirty-six relevant articles were found, identifying enhancing factors and barriers to effectively teaching reflective practice within medical curricula, relating to: The breadth of the meaning of reflection; facilitating reflection by medical educators; using written or web-based portfolios to facilitate reflection; and assessing the reflective work of students.

Discussion:
A variety of reflective purposes was found in this literature review. Evidence indicates that, if students are unclear as to the purpose of reflection and do not see educators modelling reflective behaviours, they are likely to undervalue this important skill regardless of the associated learning and development opportunities embedded in the curriculum.

Medical tourism: a conceptual framework for an innovation in global healthcare provision

The purpose of this chapter is to establish a conceptual model that can potentially fill research gaps in the literature about medical tourism as an innovative concept in global healthcare provision by developing emerging economies as they are providing low cost alternatives in medical treatment at internationally accredited medical facilities to treat patients from developed countries. Major databases such as Ebscohost and Emerald have been used to search relevant literature. The literature on medical tourism is reviewed so as to understand the key drivers of medical tourism as well as research gaps in the existing literature. Three major drivers of medical tourism have been identified, namely cost, waiting time, and perceived quality. Further empirical research is needed to test the conceptual model in order to better understand what drives a decision to engage in medical tourism. This chapter makes three major contributions; firstly, the identification of the medical tourism literature from the service marketing and management perspectives; secondly, to propose a conceptual model representing innovation in medical tourism for global healthcare by developing emerging economies; thirdly, the identification of research gaps in the medical tourism literature through which future research can further the knowledge of why people travel to developing countries for medical treatment.

The multiple mini-interview (MMI) in medical student selection

An historical survey of medical student selection identified the multiple mini-interview (MMI) as a promising tool for the assessment of non-cognitive qualities. The Deakin MMI was found to be reliable and useful in predicting performance during the medical course when used with other established selection criteria such as GPA.

Demographic and socio-cultural correlates of medical mistrust in two Australian states:Victoria and South Australia

Studies on medical mistrust have mainly focused on depicting the association between medical mistrust and access/utilization of healthcare services. The effect of broader socio-demographic and psycho-social factors on medical mistrust remains poorly documented. The study examined the effect of broader socio-demographic factors, acculturation, and discrimination on medical mistrust among 425 African migrants living in Victoria and South Australia, Australia. After adjusting for socio-demographic factors, low medical mistrust scores (i.e., more trusting of the system) were associated with refugee (β=−4.27, p<0.01) and family reunion (β=−4.01, p<0.01) migration statuses, being Christian (β=−2.21, p<0.001), and living in rural or village areas prior to migration (β=−2.09, p<0.05). Medical mistrust did not vary by the type of acculturation, but was positively related to perceived personal (β=0.43, p<0.001) and societal (β=0.38, p<0.001) discrimination. In order to reduce inequalities in healthcare access and utilisation and health outcomes, programs to enhance trust in the medical system among African migrants and to address discrimination within the community are needed.

Doctors under the microscope: the birth of medical audit

In 1989 a UK government White Paper introduced medical audit as a comprehensive and statutory system of assessment and improvement in quality of care in hospitals. A considerable body of research has described the evolution of medical audit in terms of a struggle between doctors and National Health Service managers over control of quality assurance. In this paper we examine the emergence of medical audit from 1910 to the early 1950s, with a particular focus on the pioneering work of the American surgeons Codman, MacEachern and Ponton. It is contended that medical professionals initially created medical audit in order to articulate a suitable methodology for assessing individual and organisational performance. Rather than a means of protecting the medical profession from public scrutiny, medical auditing was conceived and operationalised as a managerial tool for fostering the active engagement of senior hospital managers and discharging public accountability. These early debates reveal how accounting was implicated in the development of a system for monitoring and improving the work of medical professionals, advancing the quality of hospital care, and was advocated in ways, which included rather than excluded managers.

Medical image retrieval based on unclean image bags

Traditional content-based image retrieval (CBIR) scheme with assumption of independent individual images in large-scale collections suffers from poor retrieval performance. In medical applications, images usually exist in the form of image bags and each bag includes multiple relevant images of the same perceptual meaning. In this paper, based on these natural image bags, we explore a new scheme to improve the performance of medical image retrieval. It is feasible and efficient to search the bag-based medical image collection by providing a query bag. However, there is a critical problem of noisy images which may present in image bags and severely affect the retrieval performance. A new three-stage solution is proposed to perform the retrieval and handle the noisy images. In stage 1, in order to alleviate the influence of noisy images, we associate each image in the image bags with a relevance degree. In stage 2, a novel similarity aggregation method is proposed to incorporate image relevance and feature importance into the similarity computation process. In stage 3, we obtain the final image relevance in an adaptive way which can consider both image bag similarity and individual image similarity. The experiments demonstrate that the proposed approach can improve the image retrieval performance significantly.