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To explore the relationship between teaching scientific methodology in Year 2 of the medical curriculum and student attitudes towards and knowledge about science and scientific methodology. Anonymous questionnaire survey developed for this purpose. Zagreb University School of Medicine, Croatia. A total of 932 students (response rate 58%) from all 6 years were invited to participate. Score on attitude scale with 45 Likert-type statements and score on knowledge test consisting of 8 multiple choice questions. The average attitude score for all students was 166 ± 22 out of a maximum of 225, indicating a positive attitude towards science and scientific research. The students' average score on the knowledge test was 3.2 ± 1.7 on 8 questions. Students who had finished Year 2 had the highest mean attitude (173 ± 24) and knowledge (4.7 ± 1.7) scores compared with other year groups ( P < 0.001, anova and Tukey posthoc test). For students who had attended a mandatory Year 2 course on the principles of scientific research in medicine (Years 3 to 6), multiple linear regression analysis showed that knowledge test score (B = 3.4; SE = 0.4; 95% confidence interval 2.5–4.2; P < 0.001) and average grades (B = 7.6; SE = 1.5; 95% CI 4.6–10.6; P < 0.001) were significant predictors of attitude towards science, but not sex or failure to pass a year (B = − 0.6; SE = 1.7; 95% CI − 3.9–2.6; P = 0.707; and B = − 3.1; SE = 1.9; 95% CI − 6.8–5.7; P = 0.097, respectively). Medical students have generally positive attitudes towards science and scientific research in medicine. Attendance of a course on research methodology is related to a positive attitude towards science. [ABSTRACT FROM AUTHOR]

To explore the review process from the reviewers' perspective, including perceptions of the time taken to carry out a review, barriers to and facilitators of the review process, benefits of reviewing, opinions about blinded versus transparent reviews, how the process of reviewing might be made easier, and to assess reviewers' experience of, and training in, the peer review process.Reviewers forMedical Educationinvited to review over a 5-month period between 1st June and 31st October 2002 (n = 221).Postal questionnaire accompanying a request to review a manuscript.The overall response rate was 64.7% (the response rate of those completing and returning a manuscript review and a questionnaire was 87%); 30% were first-time reviewers forMedical Education, although the majority (87%) reviewed for other journals. The average time spent on the current review was just over 3 hours (184.3 minutes, median 162 minutes, range 30–810 minutes), which was stated to be about the same time as usual for the majority. Only 14% of respondents had received formal training in reviewing, although 66% said they would like such training. A total of 79.5% said they would have liked to seek a colleague's opinion, and 90% wished to receive other reviewers' comments. A wide range of problems with the review process were encountered, and the main way in which it was felt it could be made easier was to make the process electronic. Nearly three quarters of respondents said they would be happy to sign their reviews. Acting as a reviewer was seen as a professional responsibility and as an opportunity for learning.This study provides useful insights into the process of review from the reviewer's perspective. Reviewers spend a substantial amount of time on each paper. Many referees feel their reviews would benefit if they had formal training in the review process, received feedback on their reviews, or were able to ask colleagues for opinions on the paper being reviewed. Most reviewers would be willing to sign their reviews and feel that the process should be transparent. These results may help inform discussions about how to better prepare peer reviewers for their job. [ABSTRACT FROM AUTHOR]

Introduction: Queer pedagogy is a lens through which the hegemonic discourses of curricula and the heterosexual assumptions within them can be made visible. Using this lens, sexuality and gender norms incorporated in undergraduate medical and health curricula can be located and the lived experience of a curriculum examined. This paper seeks to determine the extent of hetero/cisnormativity within UK pharmacy education with the aim of problematising the normalisation of heterosexuality; following this, strategies to disrupt structured hetero/cisnormativity are considered. Methods: Online cross‐sectional surveys were distributed to course leads (n = 29) and students enrolled on undergraduate pharmacy (MPharm) programmes. Surveys captured quantitative data on curriculum design and perceived barriers to implementation of inclusive curriculum design (the espoused LGBTQI+ curriculum), as well qualitative data on the lived experience of the hidden curriculum. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed thematically. Results: Responses were received from 19 course leads and students from 25 MPharm programmes, representing varying completion rates. Findings suggest the shared values and goals of pharmacy education act to normalise and legitimise hetero and cis identities within curriculum design that othering as a consequence of heterosexual normativity is experienced and that pharmacy education is an LGBTQI+ opponent and does not adopt an ally attitude. Moreover, both educator and student data suggest that the enacted and experienced curriculum fails to prepare learners to care for LGBTQI+ people. Discussion: Despite findings suggesting the espoused or enacted curriculum absents LGBTQI+ people, and the hidden curriculum is experienced as homonegative, learners are questioning, resisting and disrupting the hetero‐ and cisnormative benevolent heterosexism within UK pharmacy curricula. This method of curricula interrogation can be adopted across health professions education as a means for ongoing problematising and disruption of normativity in clinical education. The study establishes widespread hetero/cis normativity in UK pharmacy education, exposing a hidden curriculum that opposes LGBTQIA+ people. Queer pedagogy is offered as a means of questionining, resisting, and disrupting such patterns. [ABSTRACT FROM AUTHOR]

Objectives: Although there is much evidence to support the use of simulation‐based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes. Methods: Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens. Findings: A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy‐in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE. Conclusions: Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised. Although "validity" is a central concept for educators, this research outlining the conversion of outcome frameworks to assessment practice illustrates that the concept can easily get lost in translation. [ABSTRACT FROM AUTHOR]

Context: Understanding self‐regulated learning (SRL) is complicated due to the different measures used to identify the key SRL processes. There is a growing trend in applying event measures of SRL (microanalysis and trace) but aptitude measures (questionnaires) continue to be widely used in medical education. A major concern is whether aptitude measures are a valid approach to capture the dimensions of SRL processes. This study examined correlations between SRL microanalysis, SRL trace and the Motivated Strategies for Learning Questionnaire (MSLQ) and how these measures were associated with biomedical science performance. Methods: An SRL microanalysis assessment interview was administered to 76 first‐year medical students individually when performing a biomedical science learning task. All written materials by students were collected for further trace analysis. Students completed an MSLQ 2 weeks before completing their biomedical science course. Correlation analyses were used to determine the correlations between the three SRL assessment measures. Bivariate and multiple analyses were conducted to compare students on different course or task performance using the three SRL assessment measures. Results: Microanalytic metacognitive monitoring (κ = 0.30, P <.001) and causal attributions (κ = 0.17, P =.009) had statistically significant correlations with use of the SRL trace strategy. MSLQ self‐efficacy correlated with microanalytic self‐efficacy (r =.39, P =.001). Bivariate tests showed that microanalytic metacognitive monitoring, causal attributions and adaptive inferences, and SRL trace strategy use had significant associations with task performance (P <.05). Microanalytic self‐efficacy, metacognitive monitoring and causal attributions, SRL trace strategy use and MSLQ self‐efficacy had significant associations with course performance (P <.05). Measures of use of the SRL trace strategy and MSLQ subscales did not show significant associations with task and course outcomes in multiple analyses (P >.05). Conclusions: Event measures, specifically SRL microanalysis, had greater associations with both task and course outcomes compared with the MSLQ measure. The SRL microanalysis is recommended for the assessment of SRL in biomedical science learning. However, to fully understand medical students' SRL a multidimensional assessment approach that combines event and aptitude measures should be used. Trying to measure engagement in self‐regulated learning? This paper stresses the value of prioritizing microanalysis given relationships with biomedical science learning outcomes. [ABSTRACT FROM AUTHOR]

Objective To develop and assess the feasibility and psychometric properties of multi-source feedback questionnaires to monitor international medical graduates practising in Canada under ‘defined’ licences. Method Four questionnaires (patient, co-worker, colleague and self) were developed and administered in 2 phases through paper-based and telephone or Internet formats. Reliability was assessed with Cronbach's alpha and generalisability coefficient analyses. Validity was established through mean ratings, ‘unable to respond’ rates and factor analyses. Results A total of 37 doctors participated in the 2 phases. Overall response rates were 70% for patients, 86% for co-workers, 72% for medical colleagues and 92% for self, with response rates higher for the paper-based format than the Internet and phone formats. The instruments had high internal consistency reliability, with Cronbach's alphas of 0.83 for self-assessment and > 0.90 for the other instruments. The generalisability coefficients were Ep2 = 0.71 for 25 patients on a 13-item survey, Ep2 = 0.59 for 8 co-workers on a 13-item survey, and Ep2 = 0.67 for 8 colleagues on a 21-item questionnaire. The range of mean scores was narrow (between 4 and 5) for all items and all surveys. The factor analyses identified that 2 factors accounted for 70% or more of the variance for the patient and colleague surveys and 60% of the variance for the co-worker survey. Conclusion These data suggest that the instruments have reasonable psychometric properties. Traditional survey methods (i.e. paper-based) yielded better results than Internet or phone methods for this group of doctors. [ABSTRACT FROM AUTHOR]

Objectives This study was intended to determine if previously identified educational benefits of the Harvard Medical School ( HMS) Cambridge Integrated Clerkship ( CIC) endure over time. Methods The authors' earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4-6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups. Results The response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship. Conclusions This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains. [ABSTRACT FROM AUTHOR]

Introduction Career choice, sense of professional identity and career behaviour are influenced, subject to change and capable of development through interaction with the learning environment. In this paper workplace learning discourses are used to frame ongoing concerns associated with higher specialist training. Data from the first stage of a multimethods investigation into recruitment into and retention in specialties in the West Midlands is used to consider some possible effects of the specialist learning environment on recruitment and retention. Methods The aim of the study was to identify issues, through interviews with 6 consultants and questionnaires completed by specialist registrars from specialties representing a range of recruitment levels. These would inform subsequent study of attributes and dispositions relevant to specialist practice and recruitment. The data were analysed using NVivo© software for qualitative data management. Results Participants' perceptions are presented as bipolar dimensions, associated with: curriculum structure, learning relationships, assessment of learning, and learning climate. They demonstrate ongoing struggle between different models of workplace learning. Conclusion Changes in the postgraduate education of doctors seem set to continue well into the future. How these are reflected in the balance between workplace learning models, and how they influence doctors' sense of identity as specialists suggests a useful basis for examination of career satisfaction and recruitment to specialties. [ABSTRACT FROM AUTHOR]

Aim This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision-making skills in written or computer-based formats. They are based on the concept of critical steps or ‘key features’ in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats. Method The practical steps in writing these problems are discussed and illustrated by examples. Steps include assembling problem-writing groups, selecting a suitable clinical scenario or problem and defining its key features, writing the questions, selecting question response formats, preparing scoring keys, reviewing item quality and item banking. Conclusion The KFP format provides educators with a flexible approach to testing clinical decision-making skills with demonstrated validity and reliability when constructed according to the guidelines provided. [ABSTRACT FROM AUTHOR]

Context Many individual- and job-related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees' (residents') and students' views of the factors that are important. However, how trainees and students trade off these factors at times of important careers-related decision making is under-researched. Information about trade-offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors. Objectives Our aim was to investigate the strength of UK medical students' preferences for the characteristics of training posts in terms of monetary value. Methods We distributed a paper questionnaire that included a discrete choice experiment ( DCE) to final-year medical students in six diverse medical schools across the UK. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. Results A total of 810 medical students answered the questionnaire. The presence of good working conditions was by far the most influential characteristic of a training position. Medical students consider that, as newly graduated doctors, they will require compensation of an additional 43.68% above average earnings to move from a post with excellent working conditions to one with poor working conditions. Female students value excellent working conditions more highly than male students, whereas older medical students value them less highly than younger students. Conclusions Students on the point of completing medical school and starting postgraduate training value good working conditions significantly more than they value desirable geographical location, unit reputation, familiarity with the unit or opportunities for partners or spouses. This intelligence can be used to address the crisis in workforce staffing that has developed in the UK and opens up fruitful areas for future research across contexts and in terms of examining stated preferences versus actual career-related behaviour. [ABSTRACT FROM AUTHOR]

Introduction In the context of movement towards mandatory continuing dental education, this paper describes how a delayed postal questionnaire can be used in course evaluation. Specifically, the value of the questionnaire as a tool for assessing the impact of short course attendance on general dental practice is examined. Method Questionnaires were distributed to all those attending three courses, ranging in size, in the West Midlands region. As well as reflecting on the course, respondents were asked their views on the usefulness of the questionnaire, the length of time between course attendance and assessment of impact, and types of courses likely to have greatest impact. Results Respondents thought the questionnaire an appropriate tool for assessing impact on practice, that an appropriate interval of time between the course and the delayed questionnaire is about six weeks, and that courses most likely to impact on practice are those which offer updates on common clinical topics and are hands-on in nature. Discussion A delayed questionnaire could be a useful mechanism for evaluating the impact on practice of some types of courses. Response rates from those attending large lecture courses might be low. Course evaluation is also limited by resources and time. Criteria for identifying which courses should be subject to such evaluation might include high cost per participant and links with review cycles. Conclusion There is scope for more structured evaluation of continuing dental education, including the assessment of impact on practice. The questionnaire described is a useful component of an evaluation framework. [ABSTRACT FROM AUTHOR]

ContextThe homeless are a significant group within society, which is increasing in size. They have demonstrably greater physical and mental health needs than the housed, and yet often have difficulty accessing primary health care. Medical ‘reluctance’ to look after homeless people is increasingly suggested as part of the problem. Medical education may have a role in ameliorating this. ObjectivesThis paper reports on the development and validation of a questionnaire specifically developed to measure medical students’ attitudes towards the homeless. Method and resultsThe Attitudes Towards the Homeless Questionnaire, developed using the views of over 370 medical students, was shown to have a Pearson test–retest reliability correlation coefficient of 0·8 and a Cronbach’s alpha coefficient of 0·74. ConclusionsThe Attitudes Towards the Homeless Questionnaire appears to be a valid and reliable instrument, which can measure students’ attitudes towards the homeless. It could be a useful tool in assessing the effectiveness of educational interventions. [ABSTRACT FROM AUTHOR]

Objectives Key-feature questions ( KFQs) have been developed to assess clinical reasoning skills. The purpose of this paper is to review the published evidence on the reliability and validity of KFQs to assess clinical reasoning. Methods A literature review was conducted by searching MEDLINE (1946-2012) and EMBASE (1980-2012) via OVID and ERIC. The following search terms were used: key feature; question or test or tests or testing or tested or exam; assess or evaluation, and case-based or case-specific. Articles not in English were eliminated. Results The literature search resulted in 560 articles. Duplicates were eliminated, as were articles that were not relevant; nine articles that contained reliability or validity data remained. A review of the references and of citations of these articles resulted in an additional 12 articles to give a total of 21 for this review. Format, language and scoring of KFQ examinations have been studied and modified to maximise reliability. Internal consistency reliability has been reported as being between 0.49 and 0.95. Face and content validity have been shown to be moderate to high. Construct validity has been shown to be good using vector thinking processes and novice versus expert paradigms, and to discriminate between teaching methods. The very modest correlations between KFQ examinations and more general knowledge-based examinations point to differing roles for each. Importantly, the results of KFQ examinations have been shown to successfully predict future physician performance, including patient outcomes. Conclusions Although it is inaccurate to conclude that any testing format is universally reliable or valid, published research supports the use of examinations using KFQs to assess clinical reasoning. The review identifies areas of further study, including all categories of evidence. Investigation into how examinations using KFQs integrate with other methods in a system of assessment is needed. [ABSTRACT FROM AUTHOR]

Context The shift from a time-based to a competency-based framework in medical education has created a need for frequent formative assessments. Many educational programmes use some form of written progress test to identify areas of strength and weakness and to promote continuous improvement in their learners. However, the role of performance-based assessments, such as objective structured clinical examinations ( OSCEs), in progress testing remains unclear. Objective The aims of this paper are to describe the use of an OSCE to assess learners at different stages of training, describe a structure for reporting scores, and provide evidence for the psychometric properties of different rating tools. Methods A 10-station OSCE was administered to internal medicine residents in postgraduate years ( PGYs) 1-4. Candidates were assessed using a checklist ( CL), a global rating scale ( GRS) and a training level rating scale ( TLRS). Reliability was calculated for each measure using Cronbach's alpha. Differences in performance by year of training were explored using analysis of variance ( anova). Correlations between scores obtained using the different rating instruments were calculated. Results Sixty-nine residents participated in the OSCE. Inter-station reliability was greater (0.88) using the TLRS compared with the CL (0.84) and GRS (0.79). Using all three rating instruments, scores varied significantly by year of training (p < 0.001). Scores from the different rating instruments were highly correlated: CL and GRS, r = 0.93; CL and TLRS, r = 0.90, and GRS and TLRS, r = 0.94 (p < 0.001). Candidates received feedback on their performance relative to examiner expectations for their PGY level. Conclusions Scores were found to have high reliability and demonstrated significant differences in performance by year of training. This provides evidence for the validity of using scores achieved on an OSCE as markers of progress in learners at different levels of training. Future studies will focus on assessing individual progress on the OSCE over time. [ABSTRACT FROM AUTHOR]

Context Basic science teaching in undergraduate medical education faces several challenges. One prominent discussion is focused on the relevance of biomedical knowledge to the development and integration of clinical knowledge. Although the value of basic science knowledge is generally emphasised, theoretical positions on the relative role of this knowledge and the optimal approach to its instruction differ. The present paper addresses whether and to what extent biomedical knowledge is related to the development of clinical knowledge. Methods We analysed repeated-measures data for performances on basic science and clinical knowledge assessments. A sample of 598 medical students on a traditional curriculum participated in the study. The entire study covered a developmental phase of 2 years of medical education. Structural equation modelling was used to analyse the temporal relationship between biomedical knowledge and the acquisition of clinical knowledge. Results At the point at which formal basic science education ends and clinical training begins, students show the highest levels of biomedical knowledge. The present data suggest a decline in basic science knowledge that is complemented by a growth in clinical knowledge. Statistical comparison of several structural equation models revealed that the model to best explain the data specified unidirectional relationships between earlier states of biomedical knowledge and subsequent changes in clinical knowledge. However, the parameter estimates indicate that this association is negative. Discussion Our analysis suggests a negative relationship between earlier levels of basic science knowledge and subsequent gains in clinical knowledge. We discuss the limitations of the present study, such as the educational context in which it was conducted and its non-experimental nature. Although the present results do not necessarily contradict the relevance of basic sciences, we speculate on mechanisms that might be related to our findings. We conclude that our results hint at possibly critical issues in basic science education that have been rarely addressed thus far. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the effectiveness and efficiency of three short-listing methodologies for use in selecting trainees into postgraduate training in general practice in the UK. Methods This was an exploratory study designed to compare three short-listing methodologies. Two methodologies – a clinical problem-solving test (CPST) and structured application form questions (AFQs) – were already in use for selection purposes. The third, a new situational judgement test (SJT), was evaluated alongside the live selection process. An evaluation was conducted on a sample of 463 applicants for training posts in UK general practice. Applicants completed all three assessments and attended a selection centre that used work-related simulations at final stage selection. Applicant scores on each short-listing methodology were compared with scores at the selection centre. Results Results indicate the structured AFQs, CPST and SJT were all valid short-listing methodologies. The SJT was the most effective independent predictor. Both the structured AFQs and the SJT add incremental validity over the use of the CPST alone. Results show that optimum validity and efficiency is achieved using a combination of the CPST and SJT. Conclusions A combination of the CPST and SJT represents the most effective and efficient battery of instruments as, unlike AFQs, these tests are machine-marked. Importantly, this is the first study to evaluate a machine-marked SJT to assess non-clinical domains for postgraduate selection. Future research should explore links with work-based assessment once trainees are in post to address long-term predictive validity. [ABSTRACT FROM AUTHOR]

Objective This study investigated the relationship between perceived family support and coping efficacy in premedical (i.e. prior to entering medical school) students, an understudied subset of undergraduate students who are particularly at risk for academia- related stress. The relationships between students’ perceived academic coping abilities and their academic behaviours and experiences of stress have been considered within the vocational literature. However, an understanding of factors that inform coping efficacy beliefs is lacking. Methods A total of 238 premedical students provided demographic information regarding themselves and their parents. Students also completed a paper questionnaire containing a coping efficacy scale and items assessing their level of family support. Results Correlational analyses revealed significant positive relationships between family support and students’ perceived abilities to cope with anticipated academic barriers as hypothesised. Bivariate comparisons of mean coping efficacy scores revealed that racial or ethnic minority students reported significantly higher coping efficacy beliefs than did White students. Students with doctor mothers also reported significantly higher coping efficacy than students with mothers employed in other health-related fields. No significant differences in coping efficacy were found when those with doctor fathers versus those with fathers in other health-related fields were compared. Conclusions Findings from the present study indicate that perceived family support plays a key role in establishing premedical students’ confidence in their ability to cope with the challenges of academic life. These findings have important implications for further studies on coping and stress in premedical students. [ABSTRACT FROM AUTHOR]

Context The objective of this research was to explore medical students’ experience of challenges to their ethical knowledge and understanding in clinical practice, and to investigate their need and preference for support when faced with such challenges. Methods We carried out a cross-sectional survey using web-based and paper questionnaires. Questions were designed using examples of ethical challenges identified in the previous literature. The study involved 3 UK university medical schools. All incorporate ethics teaching programmes in problem-based learning curricula. Participants were 732 (30% of total) senior undergraduate medical students learning within the clinical environment. Results Students regularly experienced situations in clinical teaching settings that challenged their ethical values. Despite self-reports of good levels of confidence in their knowledge of ethical principles, medical students reported low levels of confidence in their ability to address these challenges, and perceived a need for additional support from clinical teachers. Conclusions Complex and ethically challenging situations occur commonly in medical education. Many students feel that they do not currently access sufficient support from staff to address these. Clinical teachers were identified as the most relevant providers of guidance. The nature of medicine and its delivery makes it highly likely that medical students will come into contact with ethically challenging situations. Appropriate educational provision therefore requires medical educators to be equipped with the knowledge and the skills to engage with students’ ethical concerns. [ABSTRACT FROM AUTHOR]

Aims This paper describes the process of validating the Readiness for Interprofessional Learning Scale (RIPLS) for use with postgraduate health care professionals. Context The RIPLS questionnaire has proved useful in the undergraduate context, enabling tutors to assess the readiness of students to engage in interprofessional learning (IPL). With the drive in the National Health Service (NHS) to deliver health care in interprofessional teams, it seems logical to ask whether postgraduate education should, or could, be delivered successfully in interprofessional contexts. As a preliminary to undertaking an extended IPL project, the researchers tested the validity of the RIPLS tool in the postgraduate health care context. Method A modified version of the RIPLS questionnaire was administered to all general practitioners, nurses, pharmacists and allied health professionals in the Dundee Local Health Care Cooperative (LHCC) ( n = 799). A total of 546 staff responded (68%). Results Three factors, comprising 23 statements, emerged from the statistical analysis of the survey data, namely, teamwork and collaboration, sense of professional identity and patient-centredness. The internal consistency measure was 0.76. Analysis of variance suggested some key differences between the different professions in respect of the factors. Conclusions The RIPLS questionnaire was validated for use in the postgraduate context, thus providing researchers with a tool for assessing health professionals' attitudes towards interprofessional learning at practice level, community health partnership level or at a national level of education and training. Significant differences between professional groups should be taken into account in designing any interprofessional learning programme. [ABSTRACT FROM AUTHOR]

Introduction Medical programmes across Canada recognise the increased need for Aboriginal doctors. This study aimed to determine Canadian medical programmes' commitment towards Aboriginal health issues, recruitment, admission policies, educational opportunities and support offered to Aboriginal medical undergraduate students. Methods Medical school websites were initially reviewed to identify recruitment initiatives, admission policies and curriculum activities related to Aboriginal health. A questionnaire was sent to each dean of medicine to collect additional data on the programmes' recruitment strategies, admission policies, educational opportunities and the type of support offered to Aboriginal medical students. Results Sixteen medical programmes completed the questionnaire (return rate = 100%). There were 56 Aboriginal medical students enrolled across these medical programmes. More than 75% of students were completing their training in a western province. Over half of the medical programmes had recruitment initiatives and admission policies specific to Aboriginal applicants and the majority reported that their programmes' curricula included learning objectives specific to Aboriginal health. Most offered lectures and training opportunities to medical students and few offered core curriculum activities focusing on Aboriginal health. Discussion This descriptive paper offers a snapshot of initiatives across medical programmes aimed at increasing the number of Aboriginal applicants and medical students and at supporting their journeys towards the attainment of medical degrees. More research is needed to evaluate these initiatives' effectiveness. The results of such studies would not only provide needed information aimed at meeting the specific health needs of Aboriginal people, but may also contribute towards the laying of a framework to help narrow the gaps that exist within health care delivery to other minority groups. [ABSTRACT FROM AUTHOR]

Medical student numbers in Britain are increasing rapidly, beyond the capacity of most teaching hospitals, with more clinical teaching taking place in district general hospitals (DGHs). Surveys show that students value the intensive clinical teaching, smaller student numbers and perceived greater friendliness in DGHs. This paper explores DGH staff attitudes to teaching − their level of initial enthusiasm, their attitudes to current teaching, its effect on the hospital and to the sustainability of DGH undergraduate teaching − as both student numbers and service workloads continue to rise. Semi-structured interviews with 6 key informants were used to generate themes for a 19-question pre-piloted anonymous postal questionnaire sent to all 68 staff involved in undergraduate medical teaching in Northampton General Hospital. The total response included 85% of consultants. Responses in the 3 staff groups were similar. Most respondents felt enthusiastic at the prospect of medical students, although they realised that this would be intellectually challenging and increase time pressures. These predictions were largely fulfilled. Respondents felt that in comparison to teaching hospitals the DGH teaching was more clinically based and consultant-led, with more approachable staff. Currently 41 respondents (82%) felt that they had inadequate teaching time. A majority felt that the arrival of students had improved patient care and that their department had benefited. Thirty-seven responders (74%) felt that the planned doubling of student numbers would impose an unsustainable departmental load, and would compromise teaching quality. The change felt most necessary to support additional teaching was increased clinical medical staff. Better co-ordination between the DGH and the medical school was also felt necessary. The most popular choice for the distribution of extra teaching finance was to the teacher's directorate, i.e. speciality [33 (66%)]. Forty-four (86%) felt that increased student numbers would have a significant impact on the character of the hospital. The 108 free-text comments (2.1 per respondent) centred on hospital character and the benefits of students. This study shows a considerable initial enthusiasm for teaching in DGH staff, which is persisting despite increasing student numbers. However, the current teaching load is seen to be substantial. Teaching more students is likely to produce major problems, based on lack of teaching time and increasingly heavy service commitments rather than lack of patients. This is likely to be a widespread problem for DGHs. Failure to ensure adequate teaching staff and facilities as well as co-ordination could threaten the sustainability of this potentially valuable teaching initiative. [ABSTRACT FROM AUTHOR]

Feedback on presentation skills is important for developing skilled educators, but often this feedback is based on evaluation tools that have been developed with little concern for psychometric issues or for how the information will be used for feedback. The purpose of this study was to develop a reliable participant questionnaire to assess the quality of continuing medical education (CME) presentations and to provide presenters with feedback.The questionnaire was developed using an iterative approach, with doctors as raters, and tested during a variety of CME presentations. The resulting questionnaire consists of 9 items rated on a 7-point Likert scale. The psychometric analysis reported in this paper was completed using data from grand rounds presentations.Psychometric analysis, based on 319 evaluations from 17 presentations (average of 19 evaluations/presentation), revealed a high level of reliability (0.91), indicating that the items met a reasonable standard and that the raters were discriminating between the quality of the presentations adequately.This 9-item, participant questionnaire provides a reliable measure of the quality of CME presentations, while also providing presenters with useful feedback. Further studies will investigate if this instrument can be used to assess other CME formats and how best to provide feedback to presenters. [ABSTRACT FROM AUTHOR]

This paper reports on consultants' self-assessed changes in their teaching and training practices over an 8–10-month period. It compares the changes between a group undergoing a 3-day teaching course (participants) and a sample group taken from the course waiting list (controls). A questionnaire listing 18 teaching skills was given to the participants immediately prior to the course and 8−10 months later, and to the controls at the same time intervals. Respondents were asked to rate their ability, frequency of use of each skill, as well as their teaching confidence and effectiveness. Additionally, the second questionnaire asked respondents to identify changes they had made to their teaching. A total of 63% (54) of participants and 51% (23) of controls completed both questionnaires. Changes of 2 + on the rating scales were seen as genuine. The number of such changes was calculated for each individual and on each skill for the 2 groups. Data were analysed using a Mann–Whitney U-test. The majority of course participants reported positive changes in teaching ability on a significantly greater number of skills than did the control group. As a group, changes in ability in 16 of the teaching skills were significantly greater for the participants than for the controls. Increased ability resulted in participants' increased frequency of use of only 4 of the teaching skills. The majority in the participant group reported changes to their teaching. Only a minority in the control group reported such changes. These changes were consistent with course topics and the teaching skills needed to meet General Medical Council recommendations for the education of new doctors. The teaching course is an effective vehicle for increasing consultants' teaching skills. [ABSTRACT FROM AUTHOR]

This paper describes the context of interprofessional training on clinical education wards (CEWs) and reports students' perceptions of this type of interprofessional and professional training. A 2-week interprofessional clinical course was designed for medical students in their surgical eighth term, and nursing, occupational therapy and physiotherapy students, all in their sixth term. Clinical tutors were responsible for the patients and also supervised the students. The goals for the students included: to provide the patients with good medical care, nursing and rehabilitation; to develop their own professional roles; to enhance their level of understanding of the other professions; to stress the importance of good communication for teamwork and for patient care; to enhance understanding of the role of the patient, and to become more aware of ethical aspects of health care. A questionnaire developed by teachers from the 4 educational departments was used. A total of 962 students responded (78%). The CEWs provided the students with good clinical practice in terms of training in their own professions as well in learning more about the other professions. The importance of good communication for teamwork and for patient care was recognised. The quality of supervision and students' perception of their own professional roles were important factors regarding satisfaction with the CEW course. The CEW course seemed to provide the students with an opportunity to develop their own professional roles and their functions as team members. [ABSTRACT FROM AUTHOR]

In problem-based learning (PBL), problems represent the starting point of students' learning activities. Therefore, the quality of these problems should be high, in that they should be of an adequate level of complexity and structuredness. Previous research has proposed several guidelines for constructing problems, but some of them are rather vague and are not based on empirical evidence. The present study aimed to validate a short questionnaire that can be used to assess the degree of complexity and structuredness of PBL problems. This paper outlines Jonassen's theory, on which the questionnaire is based, and its relationship and applicability to PBL problems. The questionnaire was validated by means of confirmatory factor analysis. The results showed that students were able to distinguish PBL problems that were too simple and those that were too well-structured, but found it difficult to distinguish problems that were too complex or too ill-structured. The questionnaire may be used to measure the levels of complexity and structuredness of a problem as perceived by students and can provide teachers with feedback about the quality of problems. [ABSTRACT FROM AUTHOR]

Introduction The General Medical Council (GMC) has stressed the importance of medical students' attitudes towards learning. However, few studies have explored medical students' attitudes towards communication skills learning. This study explores the relationship between the attitudes of medical students at two different schools and their demographic and education-related characteristics. Methods A total of 490 medical students from the Universities of Nottingham (Years 1 and 2) and Leicester (Year 1) completed the 26-item Communication Skills Attitude Scale (CSAS) and a personal details questionnaire satisfactorily. The relationships between students' attitudes and their demographic and education-related characteristics were analysed separately for Nottingham and Leicester students using both univariate and multivariate statistics. Results The attitudes of Nottingham and Leicester medical students towards communication skills learning were significantly associated with a number of demographic and education-related characteristics. Both Nottingham and Leicester students with more positive attitudes towards communication skills learning tended to be female, tended to think their communication skills needed improving and tended not to have parents who were doctors. Both Nottingham and Leicester students with more negative attitudes towards communication skills learning tended to think their communication skills did not need improving. Discussion The results indicate that medical students' attitudes towards communication skills learning are associated with their demographic and education-related characteristics. These findings have a number of implications for educational practice and further research and these are discussed in this paper. [ABSTRACT FROM AUTHOR]

Objective To survey medical students’ views about the purposes and fairness of assessment procedures. Method The survey used a 19-item questionnaire designed for self-completion. Respondents were invited to ‘strongly agree’, ‘agree’, ‘disagree’ or ‘strongly disagree’ with a series of statements about the purposes and fairness of assessment. There was space for free text comments relating to each statement. Results A total of 312 students out of a sample of 381 completed questionnaires (82% response rate). Whilst the majority of students (> 95%) agreed that ensuring competence, providing feedback and guiding student learning were important purposes of assessment, only half (51%) felt that assessment should be used to predict performance as a doctor. A clear majority of students (81%) agreed that, on the whole, assessment at Newcastle Medical School was fair. Data interpretation papers (comprising a combination of multiple true/false, ‘one best answer’ and short answers) were perceived to be the fairest assessment tool; the assessment of clinical rotations by supervisors was perceived as the least fair. Differences in perception about the fairness of several assessment methods emerged between junior and senior students. A large number of respondents expressed desire for the provision of more feedback on performance in order to guide future learning. Conclusions Whilst students’ views about the fairness of specific assessment tools may sometimes be at variance with published research on assessment, their perceptions will influence the acceptability of assessment. Students would welcome the introduction of methods that provide meaningful assessment feedback. [ABSTRACT FROM AUTHOR]

Context Medical students experience significant stress and stress-related problems. The benefits of support during training are described in this paper. Recently, student support systems have become increasingly stretched as medical schools merge, courses become modular and staff face increasing clinical and research pressures. The pastoral support system at St Bartholomew's and the Royal London School of Medicine has been changed in response to an evaluation of the old system of personal tutors. Pastoral care is now provided by a group of willing staff members known to have an interest in student welfare. The group is known as the `Pastoral Pool' (PP). Methods Students and staff PP members completed similar questionnaires addressing their expectations of the PP and identifying the need for support systems in general. Pastoral Pool activity was investigated using confidential record sheets stating the frequency, duration and content of each PP encounter. Results Students were aware of the PP and many would consider using it. Staff and students agreed over the functions of the PP. Students frequently expressed concerns over confidentiality within the system. Uptake was low, with only 3% of students approaching the PP and the majority of PP work performed by only two staff members. The content of meetings was often multifactorial and usually on a subject within the PP remit. Conclusions The PP is beneficial because pastoral care is provided only by dedicated staff members with an interest in student welfare. Membership is small enough to enable staff training and development. However, the system relies on self-referral by students. Rather than preventing problems arising, it therefore provides secondary support to those students insightful enough to identify their problems and motivated enough to seek help. [ABSTRACT FROM AUTHOR]

Purpose This paper reports a study which attempted to examine the influence of a varied assessment programme on student motivation to learn in an undergraduate therapy degree course. Methods In March 1997 a questionnaire was distributed to 98 third-year occupational therapy and physiotherapy students at the Southampton University School of Occupational Therapy and Physiotherapy. Using closed and open questions the questionnaire required the students to consider all the assessments they had taken in their 3 years of study and provide information about which type of assessment they found most motivating for their learning, and why. Results and conclusions The results revealed that students found a wide range of assessments motivating. There was some satisfaction with the mix and range of assessments. Three assessments emerged as the most motivating for student learning: Clinical/fieldwork II and III and Methods of inquiry III. In addition, four factors associated with assessment appeared to influence student motivation: perceived relevance and content of the assessment, enthusiastic lecturers and group influences. These factors need to be explored in more detail but in order to do so, educators need to be prepared to engage in an open dialogue with students about the learning climate that is created within higher education. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to investigate whether self‐disclosed disability and self‐reported program access are associated with measures of empathy and burnout in a national sample of US medical students. Methods: The authors obtained data from students who responded to the Association of Medical Colleges (AAMC) Year 2 Questionnaire (Y2Q) in 2019 and 2020. Data included demographic characteristics, personal variables, learning environment indicators, measures of burnout (Oldenburg Burnout Inventory for Medical Students), empathy (Interpersonal Reactivity Index) and disability‐related questions, including self‐reported disability, disability category and program access. Associations between disability status, program access, empathy and burnout were assessed using multivariable logistic regression models accounting for YQ2 demographic, personal‐related and learning environment measures. Results: Overall, 23 898 (54.2%) provided disability data and were included. Of those, 2438 (10.2%) self‐reported a disability. Most medical students with disabilities (SWD) self‐reported having program access through accommodations (1215 [49.8%]) or that accommodations were not required for access (824 [33.8%]). Multivariable models identified that compared with students without disabilities, SWD with and without program access presented higher odds of high exhaustion (1.50 [95% CI, 1.34–1.69] and 2.59 [95% CI, 1.93–3.49], respectively) and lower odds of low empathy (0.75 [95% CI, 0.67–.85] and 0.68 [95% CI, 0.52–0.90], respectively). In contrast, multivariable models for disengagement identified that SWD reporting lack of program access presented higher odds of high disengagement compared to students without disabilities (1.43 [95% CI, 1.09–1.87], whereas SWD with program access did not (1.09 [95% CI, 0.97–1.22]). Conclusions: Despite higher odds of high exhaustion, SWD were less likely to present low empathy regardless of program access, and SWD with program access did not differ from students without disabilities in terms of disengagement. These findings add to our understanding of the characteristics and experiences of SWD including their contributions as empathic future physicians. Meeks et al. demonstrate that program access is essential for the wellbeing of students with disabilities while showing that they may be more empathic physicians. #DocsWithDisabilities [ABSTRACT FROM AUTHOR]

Context: Applicant perceptions of selection methods can affect motivation, performance and withdrawal and may therefore be of relevance in the context of widening access. However, it is unknown how applicant subgroups perceive different selection methods. Objectives: Using organisational justice theory, the present multi‐site study examined applicant perceptions of various selection methods, rationales behind perceptions and subgroup differences. Methods: Applicants to five Dutch undergraduate health professions programmes (N = 704) completed an online survey including demographics and a questionnaire on applicant perceptions applied to 11 commonly used selection methods. Applicants rated general favourability and justice dimensions (7‐point Likert scale) and could add comments for each method. Results: Descriptive statistics revealed a preference for selection methods on which applicants feel more 'in control': General favourability ratings were highest for curriculum‐sampling tests (mean [M] = 5.32) and skills tests (M = 5.13), while weighted lottery (M = 3.05) and unweighted lottery (M = 2.97) were perceived least favourable. Additionally, applicants preferred to distinguish themselves on methods that assess attributes beyond cognitive abilities. Qualitative content analysis of comments revealed several conflicting preferences, including a desire for multiple selection methods versus concerns of experiencing too much stress. Results from a linear mixed model of general favourability indicated some small subgroup differences in perceptions (based on gender, migration background, prior education and parental education), but practical meaning of these differences was negligible. Nevertheless, concerns were expressed that certain selection methods can hinder equitable admission due to inequal access to resources. Conclusions: Our findings illustrate that applicants desire to demonstrate a variety of attributes on a combination of selection tools, but also observe that this can result in multiple drawbacks. The present study can help programmes in deciding which selection methods to include, which more negatively perceived methods should be better justified to applicants, and how to adapt methods to meet applicants' needs. The authors report that applicants to undergraduate health professions education prefer selection methods that provide a sense of control and allow the demonstration of more than just academic ability. [ABSTRACT FROM AUTHOR]

Background Cardiopulmonary resuscitation (CPR) training for undergraduate medical students and junior doctors has been noted to be poor in the past. Attempts have been made over the last decade to improve CPR training for all health professionals. Aim This study aimed to determine if CPR training for undergraduate medical students in a single institution improved after initial concerns in 1992, and to observe trends in CPR training over five years. Methods Prospective single centre observational cohort survey by means of a 2-page self completed questionnaire to final year undergraduate medical students at the University of Glasgow (1993–97 inclusive). Results Mean annual response rate 58% (range 48% – 67%). 99% of responders had been trained in basic life support during undergraduate training. The use of simulated arrests for training increased significantly. CPR training was concentrated in the first and final years. Training in all aspects of advanced life support increased, as did the students' confidence in these techniques. Student satisfaction with the amount of basic life support training increased very significantly and there was a small, but significant increase in student satisfaction with advanced life support training. Overall confidence at the prospect of being a member of the resuscitation team on qualification did not increase. Conclusions There has been a sustained improvement in CPR training at this institution since 1993. Improvements in the training of specific advanced life support techniques does not lead to improved overall confidence in using these skills on qualification. Advanced life support training requires further expansion. [ABSTRACT FROM AUTHOR]

Context Clinical supervisors make judgements about how much to trust learners with critical activities in patient care. Such decisions mediate trainees' opportunities for learning and competency development and thus are a critical component of education. As educators apply entrustment frameworks to assessment, it is important to determine how narrative feedback reflecting entrustment may also address learners' educational needs. Methods: In this study, we used artificial intelligence (AI) and natural language processing (NLP) to identify characteristics of feedback tied to supervisors' entrustment decisions during direct observation encounters of clerkship medical students (3328 unique observations). Supervisors conducted observations of students and collaborated with them to complete an entrustment‐based assessment in which they documented narrative feedback and assigned an entrustment rating. We trained a deep neural network (DNN) to predict entrustment levels from the narrative data and developed an explainable AI protocol to uncover the latent thematic features the DNN used to make its prediction. Results: We found that entrustment levels were associated with level of detail (specific steps for performing clinical tasks), feedback type (constructive versus reinforcing) and task type (procedural versus cognitive). In justifying both high and low levels of entrustment, supervisors detailed concrete steps that trainees performed (or did not yet perform) competently. Conclusions: Framing our results in the factors previously identified as influencing entrustment, we find a focus on performance details related to trainees' clinical competency as opposed to nonspecific feedback on trainee qualities. The entrustment framework reflected in feedback appeared to guide specific goal‐setting, combined with details necessary to reach those goals. Our NLP methodology can also serve as a starting point for future work on entrustment and feedback as similar assessment datasets accumulate. Using natural language processing, Gin et al demonstrate how narrative feedback and entrustment decisions are intertwined, providing empirical evidence regarding how formative processes can help trainees achieve competencies. [ABSTRACT FROM AUTHOR]

Context The need for a comprehensive framework of teaching activities in undergraduate medical education was identified by colleagues involved in teacher training at the University of Edinburgh, UK and Karolinska Institutet, Sweden. Such a framework could be used to develop training programmes for medical teachers, to help experienced teachers to reflect upon and communicate with others about their practice, and as a focus for further research on medical teaching. Methods A provisional framework of medical teaching activities and a model illustrating how these activities are situated within the wider context of learning and teaching were developed iteratively using the literature and pilot studies. The provisional framework and model were then methodically tested using journal analysis, brainstorming sessions and focus group sessions with medical teachers and teacher trainers in both institutions. Data gathered from this research were analysed and used to further develop the framework and model. Results Many of the provisional teaching activities in the framework were further developed in response to the research data and some new activities were added. Teaching activities seemed to cluster into three domains: ‘Facilitating’, ‘Managing’, and ‘Learning and Community Building’. Specific tasks were identified relating to planning, administering, resourcing, implementing and evaluating each teaching activity. Participants found the model of learning and teaching helpful and felt it adequately represented the place of teaching activities within the wider context of undergraduate medical education. The framework and model are now being used by the authors in faculty development, undergraduate teaching and further research. [ABSTRACT FROM AUTHOR]

Objective To obtain an understanding of basic science medical teachers’ conceptions of learning and their ideas for facilitation of learning. Methods Teaching staff at a biomedical centre ( n = 62) were asked to describe their definitions of learning, their suggestions for how to solve an applied educational problem and their intended activities when teaching students. The research was carried out using a questionnaire consisting of open-ended and fixed-choice questions. Results Although 1 in 4 teachers endorsed constructivist conceptions of learning, only 1 in 8 actually reported using activating teaching strategies. Conceptions of learning did not co-vary with teaching practice. Conclusions The assumption that conceptions of learning and teaching practice are aligned was challenged. The current questionnaire could be used as an intervention tool for educational development to map whether or not there is a match between teachers’ conceptions and their practice. [ABSTRACT FROM AUTHOR]

Context Weak students may pass unnoticed through their undergraduate programme until they fail a summative assessment. Early recognition and support of struggling students is crucial if they are to avoid subsequent failure at high stakes assessments. Methods We introduced a whole-class formative assessment 5 months before a summative assessment. Subsequently, we supported poorly performing students with academic guidance interviews and remedial support. Results The programme was evaluated by questionnaires issued to staff and students involved in the guidance interviews, and by recording the performance of students who had failed the formative assessment in the subsequent summative assessment. Conclusions We conclude that the rescue of failing students requires early recognition and tailored intervention, with support for all participants. [ABSTRACT FROM AUTHOR]

Objective To explore attitudes among National Health Service consultants responsible for delivering basic clinical teaching to medical students. Design Postal questionnaire. Subjects and setting A total of 308 acute hospital trust consultants working in 4 ‘new’ and 4 ‘established’ teaching hospitals in the West Midlands metropolitan area, and involved in the delivery of clinical teaching to Year 3 medical students at the University of Birmingham Medical School during 2002−03. Main outcome measure(s) The questionnaire explored contractual requirements, actual teaching commitments and perceptions of medical students' knowledge and attitudes. Responses from doctors and surgeons and from respondents working in established and new teaching hospitals were compared. Results A total of 249 responses were received (response rate 80.8%). Although many consultants enjoy teaching students, their enjoyment and their ability to deliver high standards of teaching are compromised by time and resource constraints. For many the situation is aggravated by the perceived inappropriate organisation of the clinical teaching curriculum and the inadequate preparation of students for clinical practice. Linking these themes is the overarching perception among teachers that neither service nor educational establishments afford teaching the levels of recognition and reward associated with clinical work or research. Conclusion To overcome barriers to teaching requires more reciprocal links between hospital staff and medical schools, opportunities for consultants to understand and to comment on curricular and timetable developments, and, perhaps most importantly, recognition (in contractual, financial, managerial and personal terms) of the importance of undergraduate teaching in the competing triad of service, research and education. [ABSTRACT FROM AUTHOR]

Most evidence-based practice (EBP) educational assessment tools evaluated to date have focused on specific knowledge components or technical skills. Other important potential barriers to the adoption of EBP, such as attitudinal, perceptual and behavioural factors, have yet to be studied, especially in the undergraduate setting. Therefore, we developed and validated a knowledge, attitude and behaviour questionnaire designed to evaluate EBP teaching and learning in an undergraduate medical curriculum. We derived the questionnaire from a comprehensive literature review, informed by international and local experts and a Year 5 student focus group. We determined its factor structure and refined and validated the questionnaire according to the responses of a cohort of Year 5 and a combined group of Years 2 and 3 students using principal components factor analysis with varimax rotation. Factor reliability was computed using Cronbach's alpha coefficient. We assessed construct validity by correlating the factors with other measures of EBP activity and examined responsiveness through paired t-test of the pre/post factor mean scores. A 43-item questionnaire was developed. Four factors were identified from both student groups. The overall questionnaire as well as each factor had high construct validity (Cronbach's alpha > 0·7 for each scale). No significant correlations were found between the 4 factors, confirming their orthogonality. Positive correlations, however, resulted between factor mean scores and other EBP activities. The responsiveness of the questionnaire was satisfactory. A reliable knowledge, attitude and behaviour measure of EBP teaching and learning appropriate for undergraduate medical education has been developed and validated. [ABSTRACT FROM AUTHOR]

Context Academic integrity is fundamental to the role of aspiring doctors. However, little is known about Middle Eastern students' perceptions and experiences of educational dishonesty. Purpose To describe the self-reported attitudes and behaviours of senior medical students and interns regarding educational integrity and to determine whether there are any differences according to gender and year of study. Design Cross-sectional study using a self-administered questionnaire to 88 participants. Setting Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, UAE. Results A total of 82 (93·2%) respondents considered educational misconduct to be wrong. A total of 78 (88·6%) participants would not engage in such activities. Unethical educational practices such as plagiarism were viewed less seriously than other aspects of educational misconduct such as misuse of power. Female students were significantly less likely than males to report that they would engage in dishonest educational practices (P = 0·04). Interns were more stringent than medical students regarding penalties appropriate for academic misconduct (P = 0·002). Only 13 (15%) subjects stated that they would inform faculty of dishonest behaviour on the part of their peers. Conclusion Most participants, particularly females and interns, consider educational misconduct to be wrong and would not engage in such activities. [ABSTRACT FROM AUTHOR]

Introduction There is little information available on the effects of problem-based undergraduate curricula on doctors and their performances after graduation. Therefore, we conducted a questionnaire study of all graduates of the new medical programme at the Faculty of Health Sciences, Linköping University. Methods All 446 medical students who had graduated from the new programme were asked to fill in a questionnaire about selected activities during their studies and their careers after graduation. They were also asked to evaluate the quality of their undergraduate education retrospectively. Statistical analysis was performed using descriptive, multivariate and bivariate approaches. Results A total of 77% of the graduates responded. They showed a high degree of overall contentment with their undergraduate education and felt well prepared for professional life during their preregistration period and specialist education (mean = 4·0 on a 6-point Likert scale ranging from 0 to 5). They felt especially well prepared in terms of skills for communication with patients, collaboration with other health professionals and development of critical thinking/scientific attitudes. The students' age at the beginning of their studies correlated positively with their contentment as graduates, especially in terms of preparation for patient communication and collaboration with other health professionals. No differences between students originally admitted via a local admission procedure and those admitted via a national procedure were detected concerning retrospective evaluation of undergraduate medical education. Conclusion Graduates of the new curriculum showed a high degree of satisfaction with their undergraduate education and its preparation of them for medical practice. Specifically, they were very content with the particular emphases of the new curriculum. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to develop and validate a questionnaire to evaluate the effectiveness of evidence-based practice (EBP) teaching. Methods The 152 questionnaires completed by health care professionals with a range of EBP experience were used in this study. Cronbach’s alpha for the knowledge and attitude questions indicated a satisfactory level of internal consistency (i.e. >0·60). Results The discriminative validity was evidenced by a statistically significant difference in the knowledge and attitude scores of ‘novices’ (i.e. little or no prior EBP education) compared with ‘experts’ (i.e. health care professionals and academics currently teaching EBP). Moderate to good (≥0·4) sensitivity index scores were observed for both knowledge and attitude scores as the result of comparing individuals before and after an EBP intervention. Conclusions The results of this validation study indicate that the developed questionnaire is a satisfactory tool with which to evaluate the effectiveness of EBP teaching interventions. [ABSTRACT FROM AUTHOR]

ObjectiveTo develop new methods of evaluating face validity in the context of a revised final professional examination for medical undergraduates, organized on three sites, over 2 days. MethodsThe opinion of the students and examiners was surveyed by Likert-style questionnaires, with additional open comments. Expert opinion was gathered from external examiner reports and a recent Quality Assurance Agency (QAA) Subject Review Report. ResultsThe questionnaires had an overall response rate of 84%. Internal reliability, assessed by comparing responses to appropriate questions, was good with an equivalence of 45% (weighted kappa 0·54) for the students and 33% (weighted kappa 0·41) for the assessors. There was little evidence of inconsistency between days or sites. The majority of the opinions from the students, examiners and external experts were positive. Negative comments related to time pressure and case mix. ConclusionThe measurement of face validity proved feasible and valuable and will assist in the further development of the course and the examination. [ABSTRACT FROM AUTHOR]

Objectives: Insufficient sleep affects circadian hormonal profiles and inflammatory markers and may modulate attention, executive functioning and decision‐making. Medical professionals and specifically resident physicians, who are involved in long‐term nightshift schedules during their post‐graduate training, are prone to acute and chronic sleep deprivation and disruption, putting them at risk for making medical errors. The aim of the study was to evaluate the impact of chronic and acute‐on‐chronic sleep deprivation and disruption among residents on selected physiological and cognitive measures. Methods: Thirty‐three medical and surgical residents were evaluated twice ‐ at baseline and after a 26‐hour shift. Eighteen young attending physicians who did not engage in nightshift schedules served as controls and were evaluated once. Measures included morning cortisol and high‐sensitivity C‐reactive protein (hs‐CRP), computerised tests of attention and behaviour, the Behaviour Rating Inventory of Executive Function, a risk‐taking questionnaire and the Pittsburgh Sleep Quality Index. Results: Residents, but not attendings, reported chronic sleep disruption and deprivation. Residents at baseline exhibited reduced morning cortisol levels and elevated hs‐CRP levels, compared to attendings. Residents at baseline had impaired global executive function compared to attendings. A nightshift with acute sleep deprivation further reduced residents' executive function. Residents at baseline and after a nightshift demonstrated increased impulsivity and slower processing time than attendings. Residents and attendings did not differ in risk‐taking tendencies which were assessed in a separate cohort. Conclusions: In a real‐life setting, resident physicians exhibit increased low‐grade systemic inflammation (hs‐CRP) and impaired HPA‐axis function. Their chronic sleep curtailment is associated with greater impulsivity, slower cognitive processing, and impaired executive function. Future research is warranted to understand how improving working schedule by increasing sleep duration may minimise the short‐term and potential long‐term risks to physicians in training. The authors demonstrate that not only does chronic sleep deprivation impair a variety of mental and physical functions, but some effects are further aggravated by the acute sleep restriction of night calls. [ABSTRACT FROM AUTHOR]

Objectives: Cognitive load theory (CLT) focuses on the limited bandwidth of working memory. Core to CLT is the concept of cognitive overload, which occurs when working memory demands exceed working memory capacity, and learning and performance suffer. Within health professions education (HPE), workplace learning settings are very complex, placing learners at high risk of cognitive overload. Although continuous monitoring of physiologic parameters can indicate states of high cognitive load, how to practically identify cognitively overloaded learners within everyday workplace settings is not well understood. We sought to characterise how attending physicians described their perceiving of cognitive overload among learners in two different workplace settings: the gastrointestinal endoscopy suite and the intensive care unit. Methods: We performed a secondary qualitative analysis of transcripts of interviews with workplace teachers that had been carried out during two previous studies. These studies had addressed different objectives but both were informed by CLT. Each included questions that prompted participants to reflect on how they perceived cognitive overload to manifest among learners in the workplace. To investigate the phenomenon of cognitive overload, we developed a new codebook and performed content analysis. Results: We analysed 42 interview transcripts (22 endoscopists, 12 hospitalists, eight intensivists). Participants described four behaviours they had witnessed among learners they thought were cognitively overloaded: poor performance on workplace tasks; non‐verbal physical manifestations (including posture, eye and body movements and autonomic functions); verbal utterances (words and sounds), and interpersonal interactions with team members. Endoscopists often described individually oriented examples, whereas intensivists and hospitalists tended to frame examples within an interpersonal context. Conclusions: We identified four overarching ways in which HPE workplace teachers perceived learners as appearing to be cognitively overloaded. Workplace teachers and learners should be mindful of and watch for these signs, which may signal states of cognitive overload. Earlier recognition of cognitive overload may facilitate timely action to reduce cognitive overload and promote learning. To help educators identify cognitively overloaded trainees, Sewell et al. characterize four different indicators of overload that manifest in the HPE workplace. [ABSTRACT FROM AUTHOR]

Context: Cognitive load theory states that one way to optimise learning is to decrease extraneous cognitive load, defined as information not relevant to task completion. Worked examples, which show the learner the logic behind the solving of a problem, can decrease extraneous load. However, there is little research to guide the optimal formatting of worked examples. Methods: In a crossover design, first‐year medical students were randomised to worked examples of bradycardias with salient features first and tachycardias with discriminatory features second (n = 33) or worked examples of bradycardias with discriminatory features first and tachycardias with salient features second (n = 32). After each learning phase, participants completed a testing phase. Diagnostic accuracy and reported cognitive load were compared between the two worked example formats, as well as with data for a group of historical controls, consisting of medical students interpreting electrocardiogram rhythms without worked examples. Each module concluded with a questionnaire in which the learner was asked to rate his or her perceptions of the difficulty of the core content, the clarity with which the information was presented, and perceived learning. Results: Worked examples highlighting salient and discriminatory features were associated with similar levels of diagnostic accuracy (56% and 60%, respectively; P =.32). Both worked example conditions were associated with higher diagnostic accuracy than was found in historical controls (P <.0001). There was no difference in the extraneous load experienced between worked examples highlighting salient features and those highlighting discriminatory features (12.5 ± 6.1 and 11.9 ± 6.1, respectively; P =.52). Participants reported greater intrinsic load in the worked examples highlighting salient rather than discriminatory features (17.1 ± 4.9 and 15.5 ± 4.6, respectively; P =.01). Conclusions: Discriminatory feature‐based worked examples were associated with less intrinsic cognitive load, but this did not translate into any meaningful difference in diagnostic performance. Instruction with worked examples improved diagnostic performance regardless of whether salient or discriminatory features were highlighted. Worked examples are helpful, but when and by how much? Thach et al experimentally provide support for the use of discriminating over salient features when training ECG interpretation. [ABSTRACT FROM AUTHOR]

Objectives: Recent studies suggest that traditional male‐female differences may be changing in terms of what is valued in a medical career but there have been no studies directly quantifying the relationship between gender and stated career‐related preferences. To address this gap, we examined the differences between male and female doctors in terms of the strength of their work‐related preferences at the point of eligibility to enter residency or specialty training in the UK. Methods: This was a quantitative study using a survey incorporating a discrete choice experiment (DCE). Respondents were asked a series of questions in which they had to choose between two or more scenarios, differing in terms of attributes. The attributes were: location; familiarity with specialty; culture of the working and learning environment; earnings; working conditions, and opportunities for professional development. The main outcome measure was willingness to accept compensation to forgo a desirable attribute within a training position. Conditional logistic regression models were run separately for males and females. Results: A total of 5005 out of 6890 (73%) Foundation Year 2 doctors completed the DCE. The relative value of each attribute was similar for males and females, with location most valued and familiarity with the specialty least valued. There was a pattern of female respondents valuing the move between the best and worst levels of each training attribute more than men, and significantly more than men in respect of the importance of working culture. Conclusions: This study adds to existing knowledge in terms of quantifying gendered values in respect of training or residency preferences. That men value a supportive working culture significantly less than women is well established. However, our findings that location, working conditions and working culture are increasingly important to both men and women, suggests that traditional gender norms may be changing. This intelligence can inform gender‐responsive workforce planning and innovation, and future research. Despite traditional gender norms being sufficiently established to become stereotypes, the authors report that location, working conditions and working culture are increasingly important to both male and female doctors‐in‐training. [ABSTRACT FROM AUTHOR]

Context: Non‐technical skills (NTS) training should be incorporated into medical students' education and simulation‐based approaches are often utilised to facilitate this. Such experiences have the potential to foster transformative learning by facilitating a reassessment of one's prior assumptions and a significant shift in one's outlook, referred to as the process of perspective transformation. The aim of this research was to explore how NTS training might facilitate transformative learning in final‐year medical students. Methods: Following ethical approval, medical student volunteers from four medical schools (Aberdeen, Dundee, Edinburgh and Glasgow) participated in simulation sessions, were debriefed with an emphasis on NTS using a behavioural marker system and then took part in focus groups. Focus group discussions were semi‐structured and questions were based on the phases of perspective transformation identified by Jack Mezirow. Focus group discussions were audiorecorded, transcribed verbatim, anonymised and analysed using template analysis. Results: A total of 33 medical students took part in five focus groups. There was evidence of the following stages of perspective transformation: Phase 2 (self‐examination with emotional disturbance, including fear, anxiety, guilt, shame and frustration); Phase 3 (critical assessment of assumptions, including the undervaluing of NTS, recognising that technical skills alone are insufficient, and recognising that it is possible to improve one's NTS); Phase 5 (exploring options for new roles, relationships and actions), and Phase 6 (planning a course of action for future simulations, as a medical student and as a doctor). Conclusions: This study deepens our understanding of how exposure to NTS training in simulation‐based education influences the learning of medical students and shows that such exposure can result in the cognitive phases of transformative learning. It provides us with valuable insights into medical students' perspectives on their learning of NTS at a pivotal stage in training and represents an interesting way of assessing the educational impact of such sessions. [ABSTRACT FROM AUTHOR]

Objectives To deliver and evaluate an internet course in change management for primary care professionals. Design A 12-week course delivered over the internet. Respondents were allocated into two groups: one had access to the course tutor individually, while the other could also communicate with the rest of the learner group. Learning outcomes were assessed by means of pre- and post-intervention questionnaires and by interviews with some participants. Subjects 111 primary care professionals. Results Subjects showed significant improvements on all learning outcomes. The group with access to the course tutor alone completed more units and had greater improvements in their learning outcomes. More of this group completed the course and completed a portfolio. Respondents who could communicate with other members of the group did not find this a positive experience. Conclusion The internet can be used to deliver learning in change management to primary care professionals. Access to a discussion forum did not improve, and possibly impaired learning. More work is needed on the mentoring of internet learning. [ABSTRACT FROM AUTHOR]

Context: High‐quality research into education costs can inform better decision making. Improvements to cost research can be guided by information about the research questions, methods and reporting of studies evaluating costs in health professions education (HPE). Our objective was to appraise the overall state of the field and evaluate temporal trends in the methods and reporting quality of cost evaluations in HPE research. Methods: We searched the MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, Business Source Complete and ERIC (Education Resources Information Centre) databases on 31 July 2017. To evaluate trends over time, we sampled research reports at 5‐year intervals (2001, 2006, 2011 and 2016). All original research studies in HPE that reported a cost outcome were included. The Medical Education Research Study Quality Instrument (MERSQI) and the BMJ economic checklist were used to appraise methodological and reporting quality, respectively. Trends in quality over time were analysed. Results: A total of 78 studies were included, of which 16 were published in 2001, 15 in 2006, 20 in 2011 and 27 in 2016. The region most commonly represented was the USA (n = 43). The profession most commonly referred to was that of the physician (n = 46). The mean ± standard deviation (SD) MERSQI score was 10.9 ± 2.6 out of 18, with no significant change over time (p = 0.55). The mean ± SD BMJ score was 13.5 ± 7.1 out of 35, with no significant change over time (p = 0.39). A total of 49 (63%) studies stated a cost‐related research question, 23 (29%) stated the type of cost evaluation used, and 31 (40%) described the method of estimating resource quantities and unit costs. A total of 16 studies compared two or more interventions and reported both cost and learning outcomes. Conclusions: The absolute number of cost evaluations in HPE is increasing. However, there are shortcomings in the quality of methodology and reporting, and these are not improving over time. Cost may be most influential yet least studied determinant of practice in health professional education. In this systematic review, Foo et al. explore the state of the literature regarding formal use of cost‐evaluations. [ABSTRACT FROM AUTHOR]

Context: Medical schools face growing pressures to develop quality improvement (QI) strategies to ensure the continuous quality of their education. To best achieve quality, both organisational processes and culture need to be oriented towards quality. Quality processes already exist at medical schools, at least externally driven by accreditation. However, the dominant culture in most medical schools is not typically oriented towards quality. Objectives: This study explores whether QI practices are recognised as such in organisations not culturally QI‐oriented. Specifically, it examines faculty members' perceptions about the degree of QI implementation in their medical education programmes. Understanding this perception will inform medical school leadership on how best to use resources for a successful execution of the school's QI vision. Methods: Leaders, clinical teachers and formal teachers at 16 of the 17 Canadian medical schools were invited to complete the 'Are We Making Progress?' questionnaire of the Malcolm Baldrige National Quality Award framework, the results of which have been broadly validated. The questionnaire measures the perceived level of QI implementation within organisations using 40 statements grouped under the framework's seven domains of performance excellence. Results: A total of 491 respondents from 11 (69%) schools completed the questionnaire; 173 (35%) identified as clinical teachers, 150 (31%) as formal teachers, and 168 (34%) as leaders. Perceived QI implementation levels were low across programmes (0.70–1.90 in Rasch person measures) and for each category of respondents. This was especially true for the domains of 'Strategy', 'Measurement/analysis/knowledge management' and 'Operations'. Leaders' perceptions of QI implementation were higher than those of teachers. Conclusions: Medical schools' existing QI processes are not recognised as QI activities. For QI strategies to succeed, a programme's culture must embrace QI. In the execution of their QI visions, medical schools should spend resources on embedding quality in the organisation culture in addition to strengthening existing QI practices, especially in the domains listed above. Blouin reports on how the culture of medical schools, specifically their quality orientation, impact on the degree to which Quality Improvement initiatives are considered to be implemented effectively. [ABSTRACT FROM AUTHOR]