Evolving student–faculty partnerships in medical education through peer-assisted learning

Peer reviewed

Managing the multiplicities of graduate level education! Are Master’s students’ expectations matched by their experiences?

With rapid increases in student fees reflecting moves towards a QUASI Market model of Higher Education in the UK and across much of the Western World[1], many universities find themselves having to meet progressively higher levels of student expectations[2]. This is particularly the case at undergraduate level, where increases in fees over the past decade have far exceeded inflation. Yet with so much attention on ‘consumer savvy’ undergraduates, the question of whether Master’s level students’ expectations are matched by their experiences is one which remains largely unanswered. Grounded in an empirically grounded approach to learning and teaching developed by the paper authors[3], this paper sets out to being to answer this question. In doing so it makes a distinctive contribution to debates about graduate level engineering education and concludes with a number of recommendations. Discussion: The ‘MSc: Managing Expectations’ Project analyses the expectations and experiences of Graduate level Engineering Management Students over a two year period. Focusingon the ‘student experience’, three main concepts are identified as being particular relevant to enhancing learning [3]: Relationships: Variety: Synergy. Relationships: Based on empirical research, the significance of Relationships within the academic environment is discussed with particular attention being paid to the value of students’ social and academic support networks, including academic tutoring. Variety: Grounded in a statistical analysis of ‘engagement data’ together with survey and interview findings, the concept of variety critically examines students’ perspectives and experiencesof different approaches to learning and teaching. Synergy: Possibly the most important concept discussed within this paper, the need for constructively aligned curriculum is extended to reflect the students’ apriori knowledge and experienceas well as employer and societal demands and expectations. The conclusion brings the different concepts within the discussion together, providing a set of practical recommendations for colleagues working both at graduate and undergraduate level. References 1.Gibbs, P. (2001) "Higher education as a market: a problem or solution?." Studies in Higher Education 26. 1. pp. 85-94. 2.Tricker, T., (2005) Student Expectations-How do we measure up. University of Sheffield. Available from: http://www.persons.org.uk/tricker%20paper.pdf Accessed 9/10/14 3.Clark, R. & Andrews, J. (2014). Relationships, Variety & Synergy [RVS]: The Vital Ingredients for Scholarship in Engineering Education? A Case-Study. European Journal of Engineering Education. 39.6. pp. 585-600.

Ultrasound in undergraduate medical education: A systematic and critical review

Introduction: Point-of-care ultrasound (POCUS) use in clinical care is growing rapidly, and advocates have recently proposed the integration of ultrasound into undergraduate medical education (UME). The evidentiary basis for this integration has not been evaluated critically or systematically. In this study, we conducted a critical and systematic review framed by the rationales enumerated by advocates of ultrasound in UME in academic publications.

Methods: This research was conducted in two phases. First, the dominant discursive rationales for the integration of ultrasound in UME were identified using techniques from Foucauldian critical discourse analysis (CDA) from an archive of 403 academic publications. We then sought empirical evidence in support of theses rationales, using a critical synthesis methodology also adapted from CDA.

Results: We identified four dominant discursive rationales, with different levels of evidentiary support. Ultrasound was not demonstrated to improve students’ understanding of anatomy. The benefit of ultrasound in teaching physical examination was inconsistent,and rests on minimal evidence. With POCUS, students’ diagnostic accuracy was improved for certain pathologies, but findings were inconsistent for others. Finally, the rationale that ultrasound training in UME will improve quality of patient care was difficult to evaluate.

Discussion: Our analysis has shown that the frequently repeated rationales for the integration of ultrasound in UME are not supported by a sufficient base of empirical research. The repetition of these dominant discursive rationales in academic publications legitimizes them and may preclude further primary research. Since the value of clinical ultrasound use by medical students remains unproven, educators must consider whether the associated financial and temporal costs are justified or whether more research is required.

Disability and Participation in the Professions: Examples from Higher and Medical Education

Learners with disabilities remain under-represented in higher education and courses, such as medicine, that grant access to ‘the professions’. National and professional legislation, policy and guidance have changed over the last few decades in response to reforms in the way disability is viewed and valued by society. Principles of equal rights and equality of opportunity inform the negotiation of widened participation in the professions. However, drawing on the example of medical education, it is possible to see that widening articipation agendas may be insensitive to the needs of learners with disabilities. Analysing the development of practice and policy from a participation perspective suggests that tokenism may have played a role in deprioritising the voices of individuals with disabilities, rendering policy disconnected from the needs of marginalised groups. The concept of participatory parity may provide an opportunity to readdress this misrepresentation.

Are we asking the right questions? Rethinking post-graduate design education towards sustainable visions for the future

Our society is currently facing complex challenges, such us climate change, loss of biodiversity, ageing population, unemployment, to name but a few. This has created growing expectations on designers and engineers to explore, experiment and implement innovative solutions to such issues. At this critical time, if we want design to be part of the solution, we need to wonder whether we are asking designers suitable and sustainable questions. Both in post-graduate design education and in business, the brief still overwhelmingly requires designers to follow a linear problem-solving approach that focuses on product rather than strategies, services and systems. Traditional design briefs result no longer appropriate to face the challenges of our unsustainable world, as they relate to market, growth economy and human needs rather than society, business models and the needs of nature. Instead, we need to be asking questions about, for example, how we create sustainable business opportunities, how we overcome the barriers for change, or how we facilitate the process of innovation through design methodology. If the role of design is to create new visions and outline strategic directions towards a sustainable future world - for policy makers, businesses, communities and individual citizens – we need those stakeholders to create briefs for designers that allow them to do that. This paper will explain how the reframing of questions has been embedded into SustainRCA’s teaching practice in post-graduate design, art and engineering, leading to the development of new tools and methods, as well as some innovative outcomes

WONCA Rural Medical Education Guidebook

We are very excited to launch the WONCA Rural Medical Education Guidebook at the 12th WONCA World Rural Health Conference, Gramado, Brazil. The roots for the Guidebook go back to 1992 when a very important meeting was held on the sidelines of the WONCA Global Family Doctor conference in Vancouver, Canada. At this meeting an interested group of rural practitioners saw the need for WONCA to develop a specific focus on rural doctors. As a result, the WONCA Working Party on Rural Practice (WWPRP) was formed. The group set about producing a visionary roadmap for rural medical education in the form of a seminal document, the WONCA policy on Training for Rural Practice 1995. This was followed four years later by further recommendations made in a companion document, the WONCA policy on Rural Health and Rural Practice 1999, which was revised in 2001.

Rationing medical education.

The purpose of this paper is to discuss the role of rationing in medical education. Medical education is expensive and there is a limit to that which governments, funders or individuals can spend on it. Rationing involves the allocation of resources that are limited. This paper discussed the pros and cons of the application of rationing to medical education and the different forms of rationing that could be applied. Even though some stakeholders in medical education might be taken aback at the prospect of rationing, the truth is that rationing has always occurred in one form or another in medical education and in healthcare more broadly. Different types of rationing exist in healthcare professional education. For example rationing may be implicit or explicit or may be based on macro-allocation or micro-allocation decisions. Funding can be distributed equally among learners, or according to the needs of individual learners, or to ensure that overall usefulness is maximised. One final option is to allow the market to operate freely and to decide in that way. These principles of rationing can apply to individual learners or to institutions or departments or learning modes. Rationing is occurring in medical education, even though it might be implicit. It is worth giving consideration to methods of rationing and to make thinking about rationing more explicit.

Using serious games for improving medical education: an application to cytopathology

El objetivo principal del proyecto es desarrollar una plataforma compuesta por aplicaciones educativas gamificadas para el entrenamiento de personal médico en países de recursos limitados en citopatología mediante dispositivos Android de bajo presupuesto. Antes de desplegar la plataforma en países con recursos limitados, va a ser probada en un curso de Introducción a Citopatología de la Escuela Médica de Harvard. El proyecto final debe funcionar tanto en PCs como en dispositivos Android de bajo coste (p.e. 50 dólares americanos, Amazon Kindle Fire 7 pulgadas) y no puede depender de una conexión a internet continua. Se han analizado algunas aplicaciones con propósito de juego y simulaciones gamificadas para tener una base de conocimiento común entre expertos médicos y desarrolladores. También se han estudiado juegos y aplicaciones cuyo objetivo es hacer uso de imágenes médicas para entrenamiento de personal médico o están enfocadas al diagnóstico mediante colaboración por parte de personal no-médico. Esto nos ha permitido identificar las mejores mecánicas de juego para nuestro caso de uso. A continuación, se han comparado diferentes herramientas de edición y motores de juegos desde el punto de vista del rendimiento ofrecido, las plataformas soportadas, su documentación y licencia. Todo ello nos ha permitido elegir la tecnología de desarrollo (libGDX). Finalmente, diseñamos e implementamos un sistema integrado de aplicaciones (editor de contenido y generador de juegos). El sistema está enfocado a reducir la dependencia entre el personal experto y los desarrolladores para crear y mantener contenido educativo. Se trata de una arquitectura formada por un servicio RESTful, y un editor asociado, orientado a la gestión de contenido educativo orientado para citopatología y dos clientes para diferentes plataformas (PC y Android) que consumen dicho servicio. Finalmente, se presentan las conclusiones y el trabajo futuro del proyecto.

Construction d'une échelle décrivant les niveaux de compétence de collaboration, à partir d'indicateurs validés par des enseignants cliniciens en médecine

La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences.

Percepción de residentes de medicina de urgencias en Colombia del ambiente educativo en los servicios de urgencias

Introducción: La atención de calidad en urgencias sólo es posible si los médicos han recibido una enseñanza de alta calidad. La escala PHEEM (Postgraduate Hospital Educational Environment Measure) es un instrumento válido y fiable, utilizado internacionalmente para medir el entorno educativo, en la formación médica de posgrado. Materiales y métodos: Estudio de corte trasversal que utilizó la escala PHEEM versión en español para conocer el entorno educativo de los programas de urgencias. El coeficiente alfa de Cronbach se calculó para determinar la consistencia interna. Se aplicó estadística descriptiva a nivel global, por categorías e ítems de la escala PHEEM y se compararon resultados por sexo, año de residencia y programa. Resultados: 94 (94%) residentes llenaron el cuestionario. La puntuación media de la escala PHEEM fue 93,91 ± 23,71 (58,1% de la puntuación máxima) que se considera un ambiente educativo más positivo que negativo, pero con margen de mejora. Hubo una diferencia estadísticamente significativa en la percepción del ambiente educativo entre los programas de residencia (p =0,01). El instrumento es altamente confiable (alfa de Cronbach = 0,952). La barrera más frecuente en la enseñanza fue el hacinamiento y la evaluación fue percibida con el propósito de cumplir normas. Discusión: Los resultados de este estudio aportaron evidencia sobre la validez interna de la escala PHEEM en el contexto colombiano. Este estudio demostró cómo la medición del ambiente educativo en una especialidad médico-quirúrgica, con el uso de una herramienta cuantitativa, puede proporcionar información en relación a las fortalezas y debilidades de los programas.

The Health Behavior Change Competency Checklist (HBCCC): Instrument development and psychometric evaluation.

More than half of morbidity and mortality in the United States can be attributed to behavior-related disease, such as tobacco use, physical inactivity, poor diet and alcohol consumption. Given the increased prevalence of behaviorally related medical health concerns, physician competence in the implementation of effective behavior change strategies is quickly becoming an essential skill. However, only recently have primary care residency programs begun to systematically teach and evaluate motivational interviewing skills critical to influencing health behavior, and use of standardized, objective assessment tools to assess skillfulness has been largely absent. This paper reports the development of a checklist, the Health Behavior Change Competency Checklist (HBCCC). The instrument captures the theoretical model of behavior change, motivational interviewing, in a practical and versatile manner. Psychometric evaluation demonstrated moderate efficacy. Namely, results indicated the HBCCC possesses good reliability, as evidenced by high internal consistency, and adequate construct validity. It also displayed considerable utility and practical application. While these results provide several reasons for confidence in the HBCCC, item revision and additional testing are required in order to establish it as a meaningful and valuable instrument.

Projecto na comunidade : uma experiência pedagógica extra-hospitalar no curso da Faculdade de Medicina de Lisboa

O ensino pré-graduado extra-hospitalar é uma necessidade há muito assumida pelas escolas de medicina do mundo desenvolvido. Na Faculdade de Medicina de Lisboa, pelo menos desde 1987, o centro de saúde tem sido utilizado como um espaço docente equivalente ao hospital. O «Projecto na Comunidade» ocorreu entre 1996 e 1998. A sua descrição e avaliação são aqui apresentadas.