Feedback mapping – The curricular cornerstone of an “educational alliance”

Purpose: The “educational alliance” concept articulates a collaborative framework to facilitate effective feedback through transparency of opportunities aligned with learner stage and intended educational outcomes. Using this framework, we evaluated feedback across a 5 year undergraduate medical program to support embedding a successful learner – teacher “educational alliance”.

Method: A comprehensive mapping exercise used an iterative action research process of source documentary analysis, consultations with key curriculum stakeholders and qualitative analysis. The “educational alliance” model provided a critical lens through which to ensure feedback opportunities aligned with intended learning outcomes and developmental progression.

Results: Key information about the type, frequency and timing of feedback opportunities was identified within 188 curricular components. The purpose and intended learning outcomes were mapped, aligning with the stage of learning and with an expectation of supporting learners’ capacity for self-regulation. This focus providing clear articulation of feedback opportunities supported the longitudinal developmental curricular review, and facilitated enhanced awareness of dialogic feedback within the “educational alliance”.

Conclusions: Explicit alignment of learning intentions between learner and educator is key to forming a successful “educational alliance”. The feedback map provides clarity ensuring mutual understanding of intended learning outcomes. The iterative process additionally certified feedback aligned with maturing learner developmental needs across the program.     

Twelve tips for choosing and surviving a PhD in medical education – a student perspective

The decision to undertake a PhD in medical education could mark a critical point in defining your future career. Attaining the highest level of degree in such a diverse and rewarding area as medical education may not only provide you with an opportunity to undertake important new research, but could also unlock different job opportunities. As is often the case, such rewards are not gained lightly. There can be real challenges in making the decision to undertake and then to successfully navigate a PhD. The specific subject and process of each doctorate is unique, leaving many prospective and current students uncertain as to what to expect. We offer our twelve tips from the perspective of two current PhD students to help guide those who share our interest in medical education and are considering doctoral study.     

Empathy training in medical students – a randomized controlled trial

Aim: Empathy is a core element in the doctor–patient relationship. This study examined whether empathy in medical students can be improved by specific training.

Methods: 158 medical students were randomized into two groups. The intervention group participated in an empathy skills training with simulated patients (SPs). The control group participated in a history course. After the intervention, empathy was assessed by blinded SPs and experts in an Objective Structured Clinical Examination (OSCE). Students also filled out a self-assessment concerning their attitude on empathy (Jefferson Scale of Physician Empathy Student Version, JSPE-S-S).

Results and Conclusions: Participants of the intervention group showed significantly higher levels of empathy when rated by SPs and experts than the control group. In contrast to that, no significant group differences were observed in self-rated empathy. The results underpin the value of empathy skills trainings in medical school study programs.     

Is there a place for music in medical school?

Music permeates the medical literature regarding disease therapy. However, there are only few articles concerning music as a tool for development of cultural competency and interpersonal relations. We share our experience of forming a musical act of students and faculty at a medical school. We believe that this group has encouraged medical humanism and enhanced communication in the learning environment.     

Is there a need for a specific educational scholarship for using e-learning in medical education?

We propose the need for a specific educational scholarship when using e-learning in medical education. Effective e-learning has additional factors that require specific critical attention, including the design and delivery of e-learning. An important aspect is the recognition that e-learning is a complex intervention, with several interconnecting components that have to be aligned. This alignment requires an essential iterative development process with usability testing. Effectiveness of e-learning in one context may not be fully realized in another context unless there is further consideration of applicability and scalability. We recommend a participatory approach for an educational scholarship for using e-learning in medical education, such as by action research or design-based research.     

Bridging generation gaps in medical education: a “light bulb moment” at the Association for Medical Education in Europe annual conference in Barcelona

Generation gaps have been described before and so have ways to deal with them. But they were mainly focused on the teachers. We would like to bridge these generation gaps, not only by creating awareness but also by learning from each other. This leads to better equipped doctors across all generations and promotes lifelong learning instantaneously.     

Are extended-matching multiple-choice items appropriate for a final test in medical education?

At the Faculty of Medicine of the KU Leuven a 'final' test is being developed, part of which consists of extended matching multiple-choice questions (EMQs). These are problem-oriented questions referring to a realistic case, with the correct answer to be chosen from a list of 7-26 possible answers. The same list can be used for several questions (cases). Staff members of 10 medical specialties have developed about 900 questions. In order to test the quality of these questions, they were submitted in series of 100 questions to 251 final-year students who were not specifically prepared for content, or for question format. The organization of the test ran without problems. It was possible to answer 100 EMQs within half a day (i.e. 4 hours). Fatigue had no measurable influence on the score over this period but increasing familiarity with the question format was observed. In order to obtain a reliable series of questions those questions that correlated negatively with the total score were deleted until a Cronbach alpha of 0.80 was reached. Split-half reliability coefficients were of the same order of magnitude. The score on a questionnaire concerning the perception of the test indicated poor face validity. The procedure of test construction gave arguments for content validity. The correlation between test score and total examination score of each of the 7 years of medical education was statistically significant, which indicates criterion validity. Therefore, starting from 100 EMQs per student it was possible to develop a reliable and valid test. EMQs seem to be appropriate for a final test of clinical knowledge in medical education.     

Is there a place for medical students in research laboratories? A student's perspective

Based on personal experience gained in two medical schools, one from a developed and one from a developing European country, I present a short discourse on the introduction of undergraduate medical students to research. The potential benefit of research for professional profile and overall competency building is emphasized and the possibility of counterbalancing the present crisis in academic medicine through undergraduate research is discussed.     

What makes a medical school socially accountable in Latin America? A report from a Latin American panel based on a qualitative approach

Background: Latin America is a region with huge health inequalities and a tremendous growth in the number of medical schools during the last decades. The role of the medical schools in reducing health inequality has not been systematically explored.

Methods: A qualitative framework method was used to explore the meaning, barriers, and facilitators of the concept of the social accountability of medical schools in Latin America. Twenty nine Latin American academic leaders from seven countries participated in an expert panel discussion. The Atlas ti.7 software was used to analyze the information.

Results: Social accountability was identified as a core dimension of the mission of medical schools. The panel identified a gradient of three dimensions associated with social accountability. First, a formative dimension related to student selection, curricular structure and community based learning initiatives. Second, a societal dimension associated with institutional mission, community partnerships, and social research projects. Third, a political dimension related with involvement in health policies and primary care engagement. Lack of accreditation standards was identified as a main barrier to improve social accountability.

Conclusions: Latin American leaders consider that medical schools should develop specific formative, societal, and political initiatives in order to be socially accountable.     

Tensions in mentoring medical students toward self-directed and reflective learning in a longitudinal portfolio-based mentoring system – An activity theory analysis

Background: In medical education, students need to acquire skills to self-direct(ed) learning (SDL), to enable their development into self-directing and reflective professionals. This study addressed the mentor perspective on how processes in the mentor–student interaction influenced development of SDL.

Methods: n?=?22 mentors of a graduate-entry medical school with a problem-based curriculum and longitudinal mentoring system were interviewed (n?=?1 recording failed). Using activity theory (AT) as a theoretical framework, thematic analysis was applied to the interview data to identify important themes.

Results: Four themes emerged: centered around the role of the portfolio, guiding of students’ SDL in the context of assessment procedures, mentor-role boundaries and longitudinal development of skills by both the mentor and mentee. Application of AT showed that in the interactions between themes tensions or supportive factors could emerge for activities in the mentoring process.

Conclusion: The mentors’ perspective on coaching and development of reflection and SDL of medical students yielded important insights into factors that can hinder or support students’ SDL, during a longitudinal mentor–student interaction. Coaching skills of the mentor, the interaction with a portfolio and the context of a mentor community are important factors in a longitudinal mentor–student interaction that can translate to students’ SDL skills.     

What works best in a general practice specific OSCE for medical students: Mini-CEX or content-related checklists?

Abstract

Aim: To develop and pilot a General Practice (GPr) OSCE assessing medical students dealing with patient encounters, which are typical for GPr and to compare different measurement instruments (global ratings, content-specific checklists).

Methods: A blueprint based on Entrusted Professional Activities was used to develop prototypical OSCE stations. Four stations were tested with voluntary medical students. Students were videotaped and assessed with self-developed content-specific checklists, a global rating for communication skills, and mini-CEX. Results were compared according to students’ phases of studies.

Results: All three measurements were able to discriminate between clinical and pre-clinical students. Clearest results were achieved by using mini-CEX. Content-specific checklists were not able to differentiate between those groups for the more difficult stations. Inter-station reliability for the global ratings was sufficient for high-stakes exams. Students enjoyed the OSCE-setting simulating GPr consultation hours. They would prefer feedback from GPs after the OSCE and from simulated patients after each encounter.

Discussion and conclusion: Although the OSCE was short, results indicate advantages for using a global rating instead of checklists. Further research should include validating these results with a larger group of students and to find the threshold during the phases of education for switching from checklists to global ratings.     

First experience with multiple mini interview for medical school admission in Brazil: Does it work in a different cultural scenario?

Purpose: Evaluation of non-cognitive skills never has been used in Brazil. This study aims to evaluate Multiple Mini Interviews (MMI) in the admission process of a School of Medicine in São Paulo, Brazil.

Methods: The population of the study comprised 240 applicants summoned for the interviews, and 96 raters. MMI contributed to 25% of the applicants’ final grade. Eight scenarios were created with the aim of evaluating different non-cognitive skills, each one had two raters. At the end of the interviews, the applicants and raters described their impressions about MMI. The reliability of the MMI was analyzed using the Theory of Generalization and Many-Facet Rasch Model (MFRM).

Results: The G-study showed that the general reliability of the process was satisfactory (coefficient G?=?0.743). The MMI grades were not affected by the raters’ profile, time of interview (p?=?0.715), and randomization group (p?=?0.353). The Rasch analysis showed that there was no misfitting effects or inconsistent stations or raters. A significant majority of the applicants (98%) and all the raters believed MMIs were important in selecting students with a more adequate profile to study medicine.

Conclusions: The general reliability of the selection process was excellent, and it was fully accepted by the applicants and raters.     

Plus ça change,plus c’est pareil: Making a continued case for the use of MCQs in medical education

Despite the increased emphasis on the use of workplace-based assessment in competency-based education models, there is still an important role for the use of multiple choice questions (MCQs) in the assessment of health professionals. The challenge, however, is to ensure that MCQs are developed in a way to allow educators to derive meaningful information about examinees’ abilities. As educators’ needs for high-quality test items have evolved so has our approach to developing MCQs. This evolution has been reflected in a number of ways including: the use of different stimulus formats; the creation of novel response formats; the development of new approaches to problem conceptualization; and the incorporation of technology. The purpose of this narrative review is to provide the reader with an overview of how our understanding of the use of MCQs in the assessment of health professionals has evolved to better measure clinical reasoning and to improve both efficiency and item quality.     

Interest and perceived barriers toward careers in academic medicine among medical students at Alfaisal University – College of Medicine: A Saudi Arabian perspective

Abstract

Aims: [1] Identify the percentage of undergraduate students who are interested in academic medicine (AM) careers, [2] Explore the relationship between students’ characteristics, previous experiences and interest in AM careers and [3] Determine students’ perceived barriers toward AM careers at Alfaisal University – College of Medicine.

Methods: An online, anonymous, random, self-rating survey was administered during spring 2013–2014 to second-year and third-year students (n?=?302). Chi-square test was used to correlate between interest in AM careers and students’ characteristics. Mann–Whitney U-test was used to compare the mean 5-point Likert scale responses between male and female students.

Results: A total of 231 students participated in the survey (response rate: 76.5%). A total of 32 students (13.9%) expressed interest in AM careers, and this percentage significantly differed by gender, academic year, interest in teaching and research and previous research experiences (p?<?0.05). The top three barriers were “lower income” (77.5%), “competing pressures to fulfill clinical-teaching-research duties” (73.6%) and “lack of career advising” (69.7%). As opposed to males, females achieved higher statistically significant differences of means regarding: “competing pressures to fulfill clinical-teaching-research duties” (p?<?0.001) and “lack of same-gender role models in AM careers” (p?<?0.000).

Conclusions: AM careers were unpopular by students. Curricular, extracurricular and institutional measures should be implemented to rectify this dilemma.