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The curriculum at the Medical School, University of Tromsø reserves 23 weeks for optional studies, including a period of 12 weeks at the end of the fifth year when the students carry out an independent study and write a short thesis. Of the first 417 doctors (graduation year 1979-89) from Tromsø 84.6% answered a postal questionnaire asking them to evaluate this part of the curriculum. These postgraduates report high levels of satisfaction with and benefit from this part of the curriculum. A total of 26.8% started working on their thesis before the final 12-week period, 32.6% had also published their study, half of these in international journals, and 75.6% found that the skills acquired during the final optional period had been useful in their subsequent work, irrespective of specialty. In conclusion, postgraduates consider their work in preparing a scientific paper as an important and integral part of medical studies.

There are few publications summarising the main issues concerning pathology teaching and learning within undergraduate medical degrees. This article examines the themes that have emerged from the literature over the last 2 decades. A literature search was performed using PubMed, which identified 86 relevant papers in the English language. The themes discussed in the literature included the timing and duration of pathology courses, the appropriate pathology teacher for medical students, the teaching strategies used for pathology, and the methods used to assess learning. With the gradual increase of integrated medical curricula, it is important for pathology teachers to engage in the change process and help to shape the new-style courses. One of the positive aspects of change is that it can provide an opportunity to rethink current practice. It is hoped that this paper might stimulate discussion about how pathology is taught and learnt, leading to further developments in this area. [ABSTRACT FROM AUTHOR]

Aim This study was conducted to investigate the value of a written knowledge test of communication skills for predicting scores on a performance test of communication skills. Method A paper-and-pencil test of knowledge about communication skills and a performance test of communication skills, consisting of four stations with standardised patients, were administered to students of two classes of the medical schools of Maastricht and Leiden, the Netherlands. The results on these tests were compared. Results From the results of both instruments, the classes of the participating students could be recognised equally well: 60% correct qualifications of the classes by the knowledge test and 64% by the multiple station examination. Between the two tests an overall, disattenuated correlation of 0·60 was found (N = 133, P < 0·01), suggesting moderate predictive value of the knowledge test for the performance test of communication skills. The correlation is stronger for students from Maastricht medical school than for their colleagues in Leiden. Correlation between the knowledge of communication skills test and other available test results of the participating Maastricht students is close to zero, suggesting that the test measures a distinct quality of students' competence. Discussion The paper-and-pencil test of knowledge of communication skills has predictive value for the performance of these skills, but this value seems to be less pronounced than similar findings for clinical procedural skills. The stronger relationship between 'knowing how' and 'showing' in the Maastricht student group might be indicative of an effect of the training format. [ABSTRACT FROM AUTHOR]

Objectives To explore the feasibility and value of using real patients as trigger material in problem-based learning (PBL). Design A questionnaire was given to all students participating in a PBL module including a question about ‘the added value of using real, as opposed to paper cases’, in problem-based learning. Resources used by students and assessment of feasibility were recorded by the course tutors. Setting A 7-week student-selected problem-based module in general practice in the fourth-year undergraduate medical curriculum, University of Newcastle upon Tyne. Subjects 69 students participating in the module over 2 years. Results All students valued the use of real patients. A total of 10 categories were identified, all congruent with accepted educational principles for effective adult learning. Real patients stimulated the use of a very wide range of resources and imaginative presentation of what had been learned. Conclusion Real patients are potent trigger stimuli in problem-based learning. The use of real patients in this general practice-based module presented no organizational or ethical difficulties. Their use should be considered more widely. [ABSTRACT FROM AUTHOR]

In a recent review article, Colliver concluded that there was no convincing evidence that problem-based learning was more effective than conventional methods. He then went on to lay part of the blame on cognitive psychology, claiming that ‘the theory is weak, its theoretical concepts are imprecise... the basic research is contrived and ad hoc’. This paper challenges these claims and presents evidence that (a) cognitive research is not contrived and irrelevant, (b) curriculum level interventions are doomed to fail and (c) education needs more theory-based research. [ABSTRACT FROM AUTHOR]

Objectives: This paper aims to discuss the recurring education-related issue of the high-fidelity simulation myth. In the current instantiation, educators erroneously believe that trainees benefit from authentic uncertainty and surprise in simulation-based training., Methods: We explore the origins of this myth within the experiential learning and social constructivism theories and propose an evidence-based solution of transparent and guided instruction in simulation., Results: Constructivist theories highlight meaning making as the benefit of inquiry and discovery learning strategies. Inappropriate translation of this epistemology into an element of curriculum design creates unfortunate unintended consequences., Conclusions: We propose that the translation of constructivist theories of learning within simulation-based education has resulted in a pervasive myth, which decrees that scenarios must introduce realistic tension or surprises to encourage exploration and insightful problem solving. We argue that this myth is masquerading as experiential learning. In this narrative review, we interpret our experiences and observations of simulation-based education through our expertise in education science and curriculum design. We offer anecdotal evidence along with a review of selected literature to establish the presence of this previously undetected myth., (© 2020 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Context: Health advocacy is an essential component of postgraduate medical education, and is part of many physician competency frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) roles. There is little consensus about how advocacy should be taught and assessed in the postgraduate context. There are no consolidated guides to assist in the design and implementation of postgraduate health advocacy curricula., Objectives: This scoping review aims to identify and analyse existing literature pertaining to health advocacy education and assessment in postgraduate medicine. We specifically sought to summarise themes from the literature that may be useful to medical educators to inform further health advocacy curriculum interventions., Methods: MEDLINE, Embase and ERIC were searched using MeSH (medical student headings) and non-MeSH search terms. Additional articles were found using forward snowballing. The grey literature search included Google and relevant stakeholder websites, regulatory bodies, physician associations, government agencies and academic institutions. We followed a stepwise scoping review methodology, followed by thematic analysis using an inductive approach., Results: Of the 123 documents reviewed in full, five major themes emerged: (i) conceptions of health advocacy have evolved towards advocating with rather than for patients, communities and populations; (ii) longitudinal curricula were less common but appeared the most promising, often linked to scholarly or policy objectives; (iii) hands-on, immersive opportunities build competence and confidence; (iv) community-identified needs and partnerships are increasingly considered in designing curriculum, and (v) resident-led and motivated programmes appear to engage residents and allow for achievement of stated outcomes. There remain significant challenges to assessment of health advocacy competencies, and assessment tools for macro-level health advocacy were notably absent., Conclusions: There is considerable heterogeneity in the way health advocacy is taught, assessed and incorporated into postgraduate curricula across programmes and disciplines. We consolidated recommendations from the literature to inform further health advocacy curriculum design, implementation and assessment., (© 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

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 evaluate potential learning outcomes for pre-registration house officer (PRHO) training and develop an evidence base for informed decision making. A 2-stage Delphi process was employed to establish the opinions of Scottish stakeholders with regard to learning outcomes for the PRHO year. Doctors involved in the provision of PRHO training, including deans, postgraduate tutors and general practitioners (GPs) with trainees, were invited to participate in the study. Respondents rated a range of outcomes according to which they believed should be included or excluded from the PRHO training year. Learning outcomes identified for PRHOs were grouped under the 12-domain framework of the 3-circle model: ‘What the doctor can do’, ‘How they approach their practice’ and ‘Their professionalism’. Based on the consensus opinions gained in the Delphi study, the ratings were classified into priority groupings. Priority 1 contained 45 of the original 81 learning outcomes, representing each area of the 3-circle model, with emphasis on the domains of clinical skills, patient investigation/management, communication, appropriate attitudes and personal development. Health promotion and disease prevention was the only domain not represented at priority 1. Priority 2 contained 24 outcomes with emphasis on the understanding of clinical skills, patient management and personal development. Priority 3 contained 12 outcomes indicating a lack of emphasis for some outcomes, particularly the role of the doctor and health promotion. Consensus on the learning outcomes for PRHO training has been achieved, providing an evidence base for curriculum planning. The relative priority assigned to these outcomes can facilitate the use of the evidence. This evidence base should be referred to when reviewing any PRHO training programme. [ABSTRACT FROM AUTHOR]

Context: The hidden curriculum is a learning dimension made up of culturally acquired, unintended lessons. Although nurse educators are not fully aware of it, through the hidden curriculum students are prepared for adult professional roles, internalising professional values and developing a professional identity. However, academic nursing education has paid relatively scarce attention to it. The objective was to map the nursing education literature about the hidden curriculum and to identify and verify to which of the four areas suggested by Hafferty (institutional policies, resource allocation decisions, institutional slang and evaluation) it refers., Methods: A scoping study was conducted. In July 2018, a search was performed in MEDLINE/PubMed, Scopus, EBSCO/ Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Library databases, without time or language restrictions. Two authors independently performed the selection of studies, which followed the preferred reporting items for systematic reviews and meta-analysis (PRISMA) flowchart. Data charting was conducted with both an analytical and a narrative approach., Results: The study included 18 articles, 13 of which were published during the last 5 years. A total of 12 were research articles, 10 of which used qualitative methodology. Regarding the area of analysis, all four areas could be identified within nursing education literature. The most widely explored area proved to be institutional policies, mentioned by 15 articles, predominantly to highlight the negative effect of the hidden curriculum. Some relational aspects, attributed to the hidden curriculum within nursing literature, belong to the informal curriculum., Conclusions: The hidden curriculum in nursing education remains a largely overlooked topic. It appears to be a broader concept than that theorised by Hafferty, often also encompassing the informal curriculum. Furthermore, the literature reviewed mostly highlights the negative consequences of the hidden curriculum, such as the difficulty of transmitting professional values and ethics. Conversely, future researchers should concentrate on its positive consequences as a way to limit the loss of professional values., (© 2019 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Context: Realist evaluation is increasingly employed in health professions education research (HPER) because it can unpack the extent to which complex educational interventions work (or not), for whom under what circumstances and how. While realist evaluation is not wedded to particular methods, realist interviews are commonly the primary, if not only, data collection method in realist evaluations. While qualitative interviewing from an interpretivist standpoint has been well‐articulated in the HPER literature, realist interviewing differs substantially. The former elicits participants' views and experiences of a topic of inquiry, whereas realist interviewing focuses on building, testing and/or refining programme theory. Therefore, this article aims to help readers better understand, conduct, report and critique realist interviews as part of realist evaluations. Methods: In this paper, we describe what realist approaches are, what realist interviewing is and why realist interviewing matters. We outline five stages to realist interviewing (developing initial programme theory, realist sampling/samples, the interview itself, realist analysis and reporting realist interviews), drawing on two illustrative cases from our own realist evaluations employing interviewing to bring theory to life. We provide a critical analysis of 12 realist evaluations employing interviewing in the HPER literature. Alongside reporting standards, and our own realist interviewing experiences, this critical analysis of published articles serves to foreground our recommendations for realist interviewing. Conclusions: We encourage HPE researchers to consider realist interviews as part of realist evaluations of complex interventions. Our critical analysis reveals that realist interviews can provide unique insights into HPE, but authors now need to report their sampling approach, type of interviewing and interview questions more explicitly. Studies should also more explicitly draw on existing realist interviewing literature and follow reporting guidelines for realist evaluations. We hope this paper provides a useful roadmap to conducting, reporting and critically appraising realist interviews in HPER. Realist interviews are increasing in #MedEd #HPE but how can we better understand, conduct, report & critique them? This work teaches us that @charlreessidhu @KarenMattick @VanNBNguyen @crndvs [ABSTRACT FROM AUTHOR]

Introduction: Documents, from policies and procedures to curriculum maps and examination papers, structure the everyday experiences of health professions education (HPE), and as such can provide a wealth of empirical information. Document analysis (DA) is an umbrella term for a range of systematic research procedures that use documents as data., Methods: A meta-study review was conducted with the aims of describing the current state of DA in HPE, guiding researchers engaging in DA and improving methodological, analytical and reporting rigour. Structured searches were conducted, returns were filtered for inclusion and the 115 remaining articles were critically analysed for their use of DA methods and methodologies., Results: There was a significant increase in the number of articles reporting the use of DA over time. Sixty-three articles were single method (DA only), while the others were mixed methods research (MMR). Overall, there were major lacunae in terms of why documents were used, how documents were identified, what the authors did and what they found from the documents. This was particularly apparent in MMR where DA reporting was typically poorer than the reporting of other methods in the same paper., Discussion: Given these many lacunae, a framework for reporting on DA research was developed to facilitate rigorous DA research and transparent, complete and accurate reporting of the same, to help readers assess the trustworthiness of the findings from document use and analysis in HPE and, potentially, other domains. It was also noted that there are gaps in HPE knowledge that could be addressed through DA, particularly where documents are conceptualised as more than passive holders of information. Scholars are encouraged to reflect more deeply on the applications and practices of DA, with the ultimate aim of ensuring more substantive and more rigorous use of documents for understanding and constructing meaning in our field., (© 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Purpose: This review aimed to synthesise some of the extant work on the use of entrustable professional activities (EPAs) for postgraduate physicians, to assess the quality of the work and provide direction for future research and practice. Method: Systematic searches were conducted within five electronic databases (Medline, Scopus, Web of Science, PsycINFO and CINAHL) in September 2018. Reference lists, Google Scholar and Google were also searched. Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results: In total, 49 studies were included, classified as Development of EPAs (n = 37; 76% of total included), Implementation and/or assessment of EPAs (n = 10; 20%), or both (n = 2; 4%). EPAs were described for numerous specialties, including internal medicine (n = 14; 36%), paediatrics (n = 8; 21%) and psychiatry (n = 4; 10%). Of the development studies, 92% utilised more than one method to generate EPAs. The two most commonly used methods were developing initial EPAs in a working group, (n = 27; 69%) and revising through deliberation (n = 21; 54%). Development papers were of variable quality (mean QATSDD score = 20, range 6–41). Implementation and assessment studies utilised methods that included observing trainee performance (n = 6; 50%) and enrolling trainees in competency‐based curricula, which included EPAs (n = 4; 33%). The methodological quality of these implementation studies varied (mean QATSDD score = 19.5, range = 6–32). Conclusions: This review highlighted a need for: (i) consideration of best practice guidelines for EPA development; (ii) focus on the methodological quality of research on EPA development and of EPAs, and (iii) further work investigating the implementation of EPAs in the curriculum. The authors' review of the Entrustable Professional Activities literature highlights the importance of best practice guidelines and the need for further work to investigate EPA implementation in the curriculum. [ABSTRACT FROM AUTHOR]

Background: Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program. Methods: We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third‐ and fourth‐year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data. Results: The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation. Conclusions: We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA. This study delves into how a medical training fosters socially accountable physicians. Findings underscore the importance of experiential learning, community engagement, and collaborative curriculum development. #MedEd #SocialAccountability [ABSTRACT FROM AUTHOR]

Background: Health professions education teaches students to notice particular things, but has given little attention to teaching 'noticing' as a form of personal inquiry. The former is self‐evidently important, as it develops a way of seeing and behaving that is uniquely relevant to each health profession. Despite this emphasis, health professionals may fail to notice 'warning signs' in patients, be unaware of their own biases or develop unrecognised habits that have moved away from accepted standards. It has been suggested that such 'not noticing' is currently endemic. Approach: We situate our exploration of noticing in the mathematics and science education literature and John Mason's treatise on 'The discipline of noticing', differentiating between the observations that people make as they go about their lives ('ordinary' noticing), the specialised noticing that underpins professional expertise (Professional Noticing) and practices that can enhance the capacity to notice and to learn from experience (Intentional Noticing). We make the case for teaching health professions students about these conceptualisations of noticing, being able to notice with all our senses, and learning about the practices of Intentional Noticing in particular, which we suggest will have utility across health professional careers and personal lives. Implications: We acknowledge the difficulties in transferring heterogenous finding from one field to another but suggest that there are gains to be made in applying these noticing concepts to health professions education. We tentatively propose some strategies and activities for developing Professional Noticing and the practices of Intentional Noticing and link them to a new module that we are piloting with health professions students. As well as aiding health professionals sharpen their noticing abilities, reinvigorate their practice and interrogate assumptions that underpin health care, we suggest that ideas about 'noticing' may also help educators and researchers in the health professions reimagine their work. 'Not noticing' can have profound consequences for patients. In this paper, the authors explore how concepts of noticing that have been utilized in teacher education can be applied in health professions education. [ABSTRACT FROM AUTHOR]

Context: Medical education has not been immune from forces for globalisation in the contemporary world. At the same time the social accountability of medical schools in addressing local health priorities has been emphasised. This paper explores the global–local tension in medical education through a careful selection of key overview papers. Globalisation: Globalisation in medical education has taken two main forms: economic and altruistic. The former includes licensing curricula, recruiting internationally and establishing 'offshore' schools or campuses. Altruistic collaborations focus on the spread of learning and educational innovations. Both forms bring benefits but have been subject to critique for their differential impact and focus on educational inputs rather than outputs. Social Accountability: Social accountability requires medical schools to direct their activities to local priorities and to serving local health systems. Adoption of the principles of social accountability compels all medical schools to ask questions of their educational programmes and graduate outcomes. However, these are globally interdependent questions and are the intent of some well‐known social accountability collaborations. It is naïve to think that adoption of a social accountability agenda by all medical schools would necessarily reduce global health inequity. A recent Australian example shows that workforce maldistribution, for example, is resistant to even high‐level intervention. Conclusions: It is yet too early to fully accept that 'think global, act local can be turned on its head'. There is much research to be carried out, particularly on the outcomes and impacts of medical education. Establishing cause and effect is a challenge, as is determining whether globalisation or localisation can contribute to greater global health equity. If we are ever to resolve the global–local tension in medical education, we need more evidence on the outcomes of what we do, whether globally or locally inspired. Prideaux shines a light on global vs local tension in medical education, suggesting that we need to determine the outcomes of our programs whether globally or locally inspired. [ABSTRACT FROM AUTHOR]

Context: Medical education has a role in preparing future health care practitioners to have the skills to meaningfully address health disparities while providing effective clinical care considerate of diversity in our societies. This calls for medical education researchers to approach their craft in ways that prioritise and value inputs from a broader range of perspectives and worldviews in an effort to redress the negative impacts of social, political and structural forces on health outcomes. Methods: Given the entrenched health inequities experienced by Indigenous populations across the globe, this paper details an approach to medical education research put forward by Canadian Mi'kmaw Elders Murdena and Albert Marshall and named 'two‐eyed seeing'. This approach provides the opportunity for medical education researchers to address the ongoing impacts of colonisation, racism and marginalisation on health outcomes by prioritising Indigenous worldviews in medical curricula. The need for researchers and medical academies to critically consider Indigenous governance and processes of respectful knowledge sharing within the wider institutional and societal contexts is addressed. Conclusions: The benefits of two‐eyed seeing in the context of better preparing the future workforce to effectively meet the needs of those most vulnerable, and to action change against health inequities, situate it as a promising research approach in medical education. In this 'research approaches' article, McKivett et al. explore the goal of addressing health disparities and argue for the inclusion and prioritisation of diverse perspectives and ways of knowing. [ABSTRACT FROM AUTHOR]

Context: Community and consumer involvement in health professions education (HPE) is of growing interest among researchers and educators, particularly in preparing health care graduates to effectively learn from, and collaborate with, people with lived experience of health issues. However, to date there has been limited direction on methodological approaches to engage health care consumers in the research and co-design of HPE., Approach: In this paper, we describe the background to our work with health care consumers including the five core principles for successful co-design (inclusive; respectful; participative; iterative; outcomes focused) and how they can be applied as a research approach in HPE. We introduce the use of arts and humanities-based teaching methodologies including engagement, meaning-making and translational education strategies to illustrate how this research approach has been applied to reframe mental health education and practice in Australia. Furthermore, we share some reflective insights on the opportunities and challenges inherent in using a co-design research approach in HPE., Conclusions: For the consumer voice to be embedded across HPE, there needs to be a collective commitment to curriculum redesign. This paper advances our understandings of the educational research potential of working with health care consumers to co-design rich and authentic learning experiences in HPE. Co-design research approaches that partner with and legitimise health care consumers as experts by experience may better align education and health professional practice with consumers' actual needs, an important first step in transforming hierarchical health care relationships towards more humanistic models of care., (© 2020 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

The 2023 State of the Science guest editors (and colleagues) reflect on the many definitions of quality and challenges created for a field that emphasises quality improvement. [ABSTRACT FROM AUTHOR]

Context The practices and concepts of medical education are often treated as global constants even though they can take many forms depending on the contexts in which they are realised. This represents challenges in presenting and appraising medical education research, as well as in translating practices and concepts between different contexts. This paper explores the problem and seeks to respond to its challenges. Methods This paper explores the application of architectural theorist Christopher Alexander's work on patterns and pattern languages to medical education. The authors review the underlying concepts of patterns and pattern language, they consider the development of pattern languages in medical education, they suggest possible applications of pattern languages for medical education and they discuss the implications of such use. Examples are drawn from across the field of medical education. Results The authors argue that the deliberate and systematic use of patterns and pattern languages in describing medical educational activities, systems and contexts can help us to make sense of the world, and the pattern languages of medical education have the potential to advance understanding and scholarship in medical education, to drive innovation and to enable critical engagement with many of the underlying issues in this field. [ABSTRACT FROM AUTHOR]

Context Figured Worlds is a socio-cultural theory drawing on Vygotskian and Bakhtinian traditions, which has been applied in research into the development of identities of both learners and teachers in the wider education literature. It is now being adopted in medical education. Objective The objective of this paper is to show what Figured Worlds can offer in medical education. Having explained some of its central tenets, we apply it to an important tension in our field. Methods The assumption that there is a uniform 'good doctor' identity, which must be inculcated into medical students, underlies much of what medical educators do, and what our regulators enforce. Although diversity is encouraged when students are selected for medical school, pressure to professionalise students creates a drive towards a standardised professional identity by graduation. Using excerpts from reflective pieces written by two junior medical students, we review the basic concepts of Figured Worlds and demonstrate how it can shed light on the implications of this tension. Taking a Bakhtinian approach to discourse, we show how Adam and Sarah develop their professional identities as they negotiate the multiple overlapping and competing ways of being a doctor that they encounter in the world of medical practice. Each demonstrates agency by 'authoring' a unique identity in the cultural world of medicine, as they appropriate and re-voice the words of others. Discussion Finally, we consider some important areas in medical education where Figured Worlds might prove to be a useful lens: the negotiation of discourses of gender, sexuality and social class, career choice as identification within specialty-specific cultural worlds, and the influence of hidden and informal curricula on doctor identity. [ABSTRACT FROM AUTHOR]

Context: In recent years, point-of-care ultrasound (POCUS) has become a widely used clinical tool in a number of clinical specialties. In response, POCUS has been incorporated into medical curricula across the learning continuum, bolstered by enthusiastic appraisals of the technology's benefits for learners, clinicians and patients. In this project, we have sought to identify and understand the effects of dominant discourses influencing the integration of POCUS into medical education., Methods: We conducted a Foucauldian critical discourse analysis (CDA) to identify and analyse discourses that legitimise and privilege the use of POCUS in medical education. We assembled an archive of 473 texts published between 1980 and 2017. Each article in the archive was analysed to identify frequently occurring truth statements (expressing concepts whose truths are unquestioned within particular discourses) that we used to characterise the major discourses that construct representations of POCUS in medical education., Results: We identified three dominant discourses: (i) a visuo-centric discourse prioritising the visual information as truth over other clinical data; (ii) a utilitarian discourse emphasising improvements in patient care; and (iii) a modernist discourse highlighting the current and future needs of clinicians in our technological world. These discourses overlap and converge; the core discursive effect makes the further elevation of POCUS in medical education, and the resulting attenuation of other curricular priorities, appear inevitable., Conclusions: The three dominant discourses identified in this paper engender ideal conditions for the proliferation of POCUS in medical education through curricular guidelines, surveys of adherence to these guidelines and authoritative position statements. By identifying and analysing these dominant discourses, we can ask questions that do not take for granted the assumed truths underpinning the discourses, highlight potential pitfalls of proposed curricular changes and ensure these changes truly improve medical education., (© 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Context: Studies about the impact of global health electives on host institutions are scarce and often made from the perspective of institutions that send students. The present research examined the impact of short‐term electives in global health (STEGHs) from the under‐represented perspective of host institutions in Benin. Methods: The authors conducted 30 semi‐structured interviews from a convenience sample of Beninese health care professionals who had hosted Canadian medical students. Interviewees had previously supervised STEGHs in one of the five different institutions. A subsequent qualitative thematic analysis methodology was used to compilate codes and generate themes. Results: Hosting STEGH students motivated respondents to increase their medical knowledge through self‐driven learning. They perceived an improvement in the quality of their care and felt a negligible impact on patient safety. They negatively commented on the lack of clear pedagogic objectives that they could rely on. Interviewees think current STEGH partnerships do not advantage them because institutions that send students offer little support during the electives. Furthermore, sending institutions do not offer the same opportunity for local medical students or professionals to take part in such electives outside of Benin. Conclusions: Although host health care professionals evaluated global health electives positively overall, specific improvements could mitigate their negative impacts and help create a more balanced partnership between sending and host institutions. Sending institutions could involve host institutions in curriculum planning. They could invest in building reciprocal elective programmes to receive students from elsewhere. Meanwhile they can maximise the transfer of relevant medical knowledge, and provide expertise, resources and support during the electives. International electives in Global Health offer valuable learning. However, benefits and problems must be considered, a ratio that can be inequitable. This paper highlights host institution perspectives to help bring such opportunities into balance. [ABSTRACT FROM AUTHOR]

Objective: Is the statement 'assessment drives learning' a myth? Background: Instructors create assessments and students respond to these assessments. Although such responses are often labelled indications of learning, the responses educators observe can also be considered a performance. When responses are aligned with generating stable changes, then assessment drives learning. When responses are not aligned with stable changes, we must consider them to be something else: a performance put on partially or fully for the sake of implying capability rather than actual learning. The alignment between the assessments educators create and the way students respond to these assessments is determined by the actions students take in our curriculum, in preparation for our assessments and after engaging with our assessments. Conclusions: Not all assessments need to or should support learning, but when we assume all assessments 'drive learning', we endorse the myth that assessment is necessarily a formative aspect of our curricula. When we create assessments that encourage performance activities such as cramming, competing for tutorial airtime and impression management in the clinical setting we drive students to a performance. By thinking about how our students, institutions, curricula and assessments support learning and how well they support performance, we can modify and more fully align our curricular and assessment efforts to support learners in achieving their (and our) desired outcome. So, is the phrase 'assessment drives learning' a myth? This paper will conclude that it often is but we as educators must, through our leadership, move this myth towards a reality. Assessment drives learning may be the most commonly stated phrase in medical education. Here Scott demonstrates that how curriculum and assessments are organized and structured may drive students to perform for faculty rather than learn for themselves. [ABSTRACT FROM AUTHOR]

Context This paper sets out to analyse and interpret the complex events of the last 20 years in order to understand how the teaching and learning of clinical communication has emerged as a core part of the modern undergraduate medical curriculum in most medical schools in the UK. Methods The paper analyses the effects of key political, sociological, historical and policy influences on clinical communication development. Results Political influences include: the effects of neo-liberalism on society and on the professions in general; the challenging of traditional notions of professionalism in medicine; the creation of an internal market within the National Health Service, and the disempowerment of the medical lobby. Sociological influences include: the effects of a ‘marketised’ society on medicine and subtle shifts in the doctor−patient relationship because of this; the emergence of globalised information through the Internet, and the influence of increased litigation against doctors. Historical influences include: the effects of a change in emphasis for medical education away from an inflated factual curriculum towards a curriculum that recognises the importance of student attitudes and the teaching and learning of clinical communication skills. Policy influences include the important effects of Tomorrow's Doctors and the Dearing Report on the modern medical curriculum. Conclusions The paper concludes with a developmental map that charts the complex influences on clinical communication teaching and learning and a brief commentary on the growing body of teachers who deliver and develop the subject today. [ABSTRACT FROM AUTHOR]

Context: Goals of care (GoC) discussions occur amongst patients, family members and clinicians in order to establish plans of care and are invaluable aspects of end‐of‐life care. In previous research, medical learners have reported insufficient training and emotional distress about end‐of‐life decision making, but most studies have focused on postgraduate trainees and have been quantitative or have evaluated specific educational interventions. None have qualitatively explored medical students' experiences with GoC discussions, their perceptions of associated hidden curricula, and the impacts of these on professional identity formation (PIF), the individualised developmental processes by which laypersons evolve to think, act and feel like, and ultimately become, medical professionals. Methods: Using purposive sampling at one Canadian medical school, individual semi‐structured interviews were conducted with 18 medical students to explore their experiences with GoC discussions during their core internal medicine clerkship. Interviews were audiorecorded, transcribed and anonymised. Concurrently with data collection, transcripts were analysed iteratively and inductively using interpretative phenomenological analysis, a qualitative research approach that allows the rich exploration of subjective experiences. Results: Participants reported minimal support and supervision in conducting GoC discussions, which were experienced as ethically challenging, emotionally powerful encounters exemplifying tensions between formal and hidden curricula. Role modelling and institutional culture were key mechanisms through which hidden curricula were transmitted, subverting formal curricula in doing so and contributing to participants' emotional distress. Participants' coping responses were generally negative and included symptoms of burnout, the pursuit of standardisation, rationalisation, compartmentalisation and the adaptation of previously held, more idealised professional identities. Conclusions: GoC discussions in this study were often led by inexperienced medical students and impacted negatively on their PIF. Through complex emotional processes, they struggled to reconcile earlier concepts of physician identities with newly developing ones and often reluctantly adopted suboptimal professional behaviours and attitudes. Improved education about GoC discussions is necessary for patient care and may represent concrete and specific opportunities to influence students' PIF positively. The research described in this paper illustrates how leading goals‐of‐care discussions as a very junior learner can lead to emotional distress and have negative impacts on professional identity development. [ABSTRACT FROM AUTHOR]

Origins and context The concept of ‘the social accountability of medical schools’ is moving from the peripheral preoccupation of a few to a more central concern of medical schools themselves. Born of concerns about the professionalism and relevance of both the institutions and their graduates, it is seen increasingly as an urgent call to focus the considerable social resources vested in academic health science institutions on addressing the priority health concerns of the societies they serve. For a profession embedded in an ethos of service, this would seem an obvious transition. However, as with any movement towards transformative change, it runs the risk of being more mantra and rhetoric than mandate and responsibility. Needed response Proceeding from the assumption that good intentions alone are not enough, this paper seeks to outline the historical development and some current expression of the concept throughout the world. The sadly divergent wealth and health status of modern societies calls for very different actions by medical schools across the spectrum from the least endowed to the wealthiest of schools. In a profession claiming centuries of cohesive commitment to the welfare of others, it is increasingly urgent that the current generation of medical educators converge on a relevant set of principles and coherent activities. Tools for the task While recognising that they are closely intertwined, the paper outlines the difference between the social accountability of the institutions themselves and the social accountability of the graduates they produce. It outlines both individual examples and the international initiatives that are fostering and facilitating institutional collaborations to bring both progress and optimism to this daunting task. It provides connections to practical resources for those who are committed to that task. Other papers in this series add further practical insights into the central role that medical educators must play if we are to fulfil the responsibilities we carry with the privilege of our profession. [ABSTRACT FROM AUTHOR]

CONTEXT The evaluation of training is problematic and the evidence base inconclusive. This situation may arise for 2 main reasons: training is not understood as a complex intervention and, related to this, the evaluation methods applied are often overly simplistic. METHOD This paper makes the case for construing training, especially in the field of specialist medical education, as a complex intervention. It also selectively reviews the available literature in order to match evaluative techniques with the demonstrated complexity. CONCLUSIONS Construing training as a complex intervention can provide a framework for selecting the most appropriate methodology to evaluate a given training intervention and to appraise the evidence base for training fairly, choosing from among both quantitative and qualitative approaches and applying measurement at multiple levels of training impact. [ABSTRACT FROM AUTHOR]

Human error can be expected to play a significant role in adverse outcomes in perinatal acute care. In acute care of the adult, simulator based training is recommended and used to improve patient safety. Our general goal is to develop model-driven foetal and neonatal educational simulators and curricula. The specific objectives of this paper are to introduce the reader to the perinatal acute care context and simulator design considerations, as well as to give initial results and describe ongoing developments. A brief description of adult simulators and simulation engines is followed by a more detailed description of a foetal distress simulator (FDS) and of models for a neonatal simulator developed at the University of Porto. Ongoing developments involve the modelling of foetal baroreflexes, the effect of uterine contractions, and an adapted method for estimating foetal heart rate variability parameters. We present FDS simulation results reflecting the changes in oxygen supply to the foetus and the foetal heart rate in response to a reduction in uterine blood flow. We also present a structural diagram of a model for the educational simulation of congenital heart disease and preliminary simulation results reflecting a patent ductus arteriosus. We expect that, after initial clinical and educational validation, the presented models and simulators will play a role in simulator-based educational programmes contributing to increased perinatal safety. [ABSTRACT FROM AUTHOR]

In recent years, following the publication of Tomorrow's Doctors, the undergraduate medical curriculum in most UK medical schools has undergone major revision. This has resulted in a significant reduction in the time allocated to the teaching of the basic medical sciences, including anatomy. However, it is not clear what impact these changes have had on medical students' knowledge of surface anatomy. This study aimed to assess the impact of these curricular changes on medical students' knowledge of surface anatomy. Medical student intakes for 1995–98 at the Queen's University of Belfast, UK. The students were invited to complete a simple examination paper testing their knowledge of surface anatomy. Results from the student intake of 1995, which undertook a traditional, ‘old’ curriculum, were compared with those from the student intakes of 1996−98, which undertook a new, ‘systems-based’ curriculum. To enhance linear response and enable the use of linear models for analysis, all data were adjusted using probit transformations of the proportion (percentage) of correct answers for each item and each year group. The student intake of 1995 (old curriculum) were more likely to score higher than the students who undertook the new, systems-based curriculum. The introduction of the new, systems-based course has had a negative impact on medical students' knowledge of surface anatomy. [ABSTRACT FROM AUTHOR]

Introduction This paper presents a personal view of the relationship between science and the humanities within medical education, arguing for a more even balance between the two. This view stems from the author's recent experience of exploring the literature of learning theory and the social sciences. Background For historical reasons, medical education is dominated by a positivistic paradigm which assumes the existence of a single objective external reality. This can seduce us into believing that positivism is not a paradigm at all, but simply how the universe really is. Clinical practice, however, takes place in a much less certain world, where reconciling different interpretations of truth is an everyday necessity. This paper outlines the perils of uncritical adherence to a traditionally `scientific' mode of thinking. Total internal reflection In physics, total internal reflection is a phenomenon whereby light is reflected from the surface of a liquid without penetrating it, thereby making it impossible for anyone within a pool of water to see outside it. The author uses this concept as a metaphor to describe a limitation of perspective which characterises orthodox medical training, cutting students off from valuable sources of insight and understanding. Conclusions Medical education often fails to provide learners with the tools they need to interpret the literature of other disciplines. In particular, it ignores the importance of recognising different perspectives. The paper ends by pleading for a more inclusive approach to alternative paradigms within our educational system. [ABSTRACT FROM AUTHOR]

Background In recognition of the views advanced by the philosopher Maurice Merleau-Ponty, this paper considers some of the implications for medical practice and, hence, medical education, of recognizing the human body as an `intertwining' of the natural (or physical) and the existential (or experiential) – something which is taken for granted in ordinary experience, but which becomes the medium through which disease can manifest itself in illness and disability. Our condition is the condition of creatures of frail flesh. Perhaps because this `intertwining' is taken for granted, we tend to overlook the extent to which it is metaphysically astounding, even though it constitutes the daily arena and phenomena of clinical medicine. Clinical medicine is, among other things, the routine intervention in this intertwining. This fact is largely discounted by biomedical science, which concentrates on `the natural' at the expense of neglecting `the existential'. Such neglect arguably underlies the perceived deficiencies in medical education that the GMC sought to redress in its landmark document Tomorrow's Doctors . Proposal If the humanities disciplines concern themselves with recording and interpreting human experiences, the `medical humanities' do so for the human experiences of illness, disability and medical intervention. This paper argues for an integrated conception of the medical humanities, and for their incorporation into the core medical curriculum. The paper concludes by outlining a proposed core module in medical humanities, based around a syllabus divided not into the characteristic enquiries of constituent disciplines, but rather into groups of topics relating to key philosophical questions prompted by the `intertwining' in embodied human nature. [ABSTRACT FROM AUTHOR]

Introduction There is growing interest in methods of teaching critical appraisal skills at undergraduate and postgraduate levels. We describe an approach using a journal club and subsequent letter writing to teach critical appraisal and writing skills to medical undergraduates. Methods The exercise occurs during a 3-week public health medicine attachment in the third year of the undergraduate curriculum. Students work in small groups to appraise a recently published research paper, present their findings to their peers in a journal club, and draft a letter to the journal editor. Evaluation took place through: informal and formal feedback from students; number of letters written, submitted and published, and a comparison of marks obtained by students submitting a literature review assignment with and without critical appraisal teaching during the public health attachment. Results Feedback from students was overwhelmingly positive. In the first 3½ years, 26 letters have been published or accepted for publication, and 58 letters published on the Internet. There were no significant differences in overall marks or marks for the critical appraisal component of the literature review assignments between the two student groups. Discussion We believe our approach is an innovative and enjoyable method for teaching critical appraisal and writing skills to medical students. Lack of difference in marks in the literature review between the student groups may reflect its insensitivity as an outcome measure, contamination by other critical appraisal teaching, or true ineffectiveness. [ABSTRACT FROM AUTHOR]

Objectives The new curriculum at King’s College School of Medicine and Dentistry, which commenced in September 1996, requires all medical undergraduates to have a general practice placement throughout the 5␣years of their medical education. Design This paper discusses recruitment, training and support of teaching practices for the new curriculum, reviews the distribution of single-handed general practices in the network and, via a selection of monitoring and evaluation procedures, discusses the implications of a policy which is inclusive of single-handed practices. The findings relate to the experience of the first semester of the first year of the new curriculum. It also examines the contributions that single-handed practices have made to the teaching network and the kind of support needed, if single-handed practices are to continue to contribute to the King’s teaching network. Setting King’s College School of Medicine and Dentistry. Subjects Medical undergraduates. Results The findings of this paper revealed that over a third of general practice provision is via single-handed practices in South-east London. Within the undergraduate teaching network, 10% of practices are single-handed. Students are welcomed and receive a learning experience comparable to those students in larger practices. Attendance at training events has proved difficult for some of these tutors, but the extra input from the department, in order to address this deficit, has not been onerous. Indeed, single-handed practices have not been unique with regard to difficulties in attendance at training events. Conclusions The study concludes that single-handed practices can make satisfactory provision for undergraduates in the new curriculum and there is no evidence from this study to suggest otherwise. [ABSTRACT FROM AUTHOR]

Context: Patients are increasingly being engaged in providing feedback and consultation to health care institutions, and in the training of health care professionals. Such involvement has the potential to disrupt traditional doctor-patient power dynamics in significant ways that have not been theorised in the medical literature. Critical theories can help us understand how power flows when patients are engaged in the training of medical students., Methods: This paper applies postcolonial theory to the involvement of patients in the development and delivery of medical education. First, I review and summarise the literature around patient involvement in medical education. Subsequently, I highlight how postcolonial frameworks have been applied to medical education more broadly, extrapolating from the literature to apply a postcolonial lens to the area of patient engagement in medical education., Conclusion: Concepts from postcolonial theory can help medical educators think differently about how patients can be engaged in the medical education project in ways that are meaningful and non-tokenistic. Specifically, the positioning of the patient as 'subaltern' can provide channels of resistance against traditional power asymmetries. This has curricular and methodological implications for medical education research in the area of patient engagement., (© 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

As a reflection on the Edinburgh Declaration, this conceptual synthesis presents six important challenges in relation to the role of medical education in meeting current national health priorities., Context: This paper presents a conceptual synthesis of current efforts in medical education to incorporate national health priorities as a reflection on how the field has evolved since the Edinburgh Declaration. Considering that health needs vary from country to country, our paper focuses on three broad and cross-cutting themes: health equity, health systems strengthening, and changing patterns of disease., Methods: Considering the complexity of this topic, we conducted a targeted search to broadly sample and critically review the literature in two phases. Phase 1: within each theme, we assessed the current challenges in the field of medical education to meet the health priority. Phase 2: a search for various strategies in undergraduate and postgraduate education that have been tested in an effort to address the identified challenges. We conducted a qualitative synthesis of the literature followed by mapping of the identified challenges within each of the three themes with targeted efforts., Findings: We identified six important challenges: (i) mismatch between the need for generalist models of health care and medical education curricula's specialist focus; (ii) attitudes of health care providers contributing to disparities in health care; (iii) the lack of a universal approach in preparing medical students for 21st century health systems; (iv) the inability of medical education to keep up with the abundance of new health care technologies; (v) a mismatch between educational requirements for integrated care and poorly integrated, specialised health care systems; and (vi) development of a globally interdependent education system to meet global health challenges. Examples of efforts being made to address these challenges are offered., Discussion: Although strategies for combatting these challenges exist, the effectiveness of educational models depends on them being locally adaptable and applicable. Curricular reform must go hand-in-hand with research and evaluation to develop comprehensive futuristic models of teaching and learning that will adequately prepare health professionals to address the challenges., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Context: In 1988, the Edinburgh Declaration challenged medical teachers, curriculum designers and leaders to make an organised effort to change medical education for the better. Among a series of recommendations was a call to integrate training in science and clinical practice across a breadth of clinical contexts. The aim was to create physicians who could serve the needs of all people and provide care in a multitude of contexts. In the years since, in the numerous efforts towards integration, new models of curricula have been proposed and implemented with varying levels of success., Scope of Review: In this paper, we examine the evolution of curricular integration since the Edinburgh Declaration, and discuss theoretical advances and practical solutions. In doing so, we draw on recent consensus reports on the state of medical education, emblematic initiatives reported in the literature, and developments in education theory pertinent to the role of integrated curricula., Conclusions: Interest in integration persists despite 30 years of efforts to respond to the Edinburgh Declaration. We argue, however, that a critical shift has taken place with respect to the conception of integration, whereby empirical models support a view of integration as pertaining to both cognitive activity and curricular structure. In addition, we describe a broader definition of 'basic science' relevant to clinical practice that encompasses social and behavioural sciences, as well as knowledge derived from biomedical science., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Context: In 1988, the World Federation of Medical Education called for reform in medical education, publishing 12 recommendations. The sixth recommendation of this Edinburgh Declaration was to 'complement instruction about the management of patients with increased emphasis on promotion of health and prevention of disease'. Thirty years on, this paper reports an exploration of what has changed since then., Methods: Several search strategies were used, including websites of medical standards organisations, and formal searches of PubMed and Google Scholar using key words such as 'medical education standards', 'health promotion', 'illness prevention', 'effectiveness' and 'assessment'. As these searches produced more descriptive than evidence-based papers, the exploration widened to follow evolving discussions about changing emphases in medical education relevant to public health., Results: Health promotion and illness prevention are in the undergraduate medical education standards of the more influential regulators. There is little evidence of the impact of this inclusion on graduate outcomes and later medical practice, although 'differently educated' doctors may have contributed to the success of broader public health strategies achieved through reorganisation of health care, media campaigns and legislation changes. There is greater success in postgraduate specialty training of general practitioners and public health doctors. The discussion about public health interventions and the roles of doctors has moved on to topics such as patient safety, the health of doctors, global health and planetary health., Conclusions: The inclusion of health promotion and illness prevention strategies in undergraduate curricula varied considerably, but was strongest in programmes claiming social accountability and responding to medical education standards of the more influential regulators. However, the contribution of medical education to improvements in health care and the health of populations is difficult to measure. It may be timely to revisit the purpose and practicality of broadening the scope of undergraduate medical curricula in public health medicine., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)

Introduction: Many doctors, across grades and specialities, supervise or advise students and juniors undertaking elective placements. Electives form part of medical curricula on a worldwide scale. The Medical Schools Council (MSC) Electives Committee in the UK identified a gap in the current literature in relation to provision of comprehensive recommendations for the design and management of undergraduate elective programmes. Electives afford many known benefits for medical and other health care students, but the context, and risks (impacting potentially on patient, public and student well-being) are usually different from those associated with 'home' clinical placements., Aim: The aim is to share experiences and good practice within UK Medical Schools, and inform and inspire others involved with similar programmes across the globe., Method: This paper reports the results of the formation of a sub-group to draft a set of recommendations, drawing on the reported experiences of academic elective leads across all UK schools, and including input from the MSC, and the student group Medsin (to capture the learner voice). The final document was the result of a national consultative process of four iterations. The end document was approved at school level, e.g. by curriculum committee, by each of the participating schools., Recommendations: The recommendations consolidate the experiences of 30 participating UK medical schools. The consultation process generated 17 pre-departure recommendations, seven during elective recommendations, 11 post elective recommendations and a further four recommendations relating to infectious disease., Conclusion: We believe developing elective programmes using collective recommendations will provide a basis for a safer and more structured approach to a medical elective without losing the uniqueness and creative experiences valued by participants. Issues relating to undergraduates leaving their home school to experience medicine in a new context or country replicate across sites, so many recommendations will be transferable internationally., (© 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.)