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Context: Transitions of patient care responsibility occur frequently between physicians. Resultant discontinuities make it difficult for physicians to observe clinical outcomes. Little is known about what physicians do to overcome the practical challenges to learning these discontinuities create. This study explored physicians’ activities in practice as they sought follow‐up information about patients. Methods: Using a constructivist grounded theory approach, semi‐structured interviews with 18 internal medicine hospitalist and resident physicians at a single tertiary care academic medical center explored participants’ strategies when deliberately conducting follow‐up after they transitioned responsibility for patients to other physicians. Following open coding, the authors used activity theory (AT) to explore interactions among the social, cultural and material influences related to follow‐up. Results: The authors identified three themes related to follow‐up: (i) keeping lists to track patients, (ii) learning to create tracking systems and (iii) conducting follow‐up. Analysis of participants' follow‐up processes as an activity system highlighted key tensions in the system and participants’ work adaptations. Tension within functionality of electronic health records for keeping lists (tools) to find information about patients’ outcomes (object) resulted in using paper lists as workarounds. Tension between paper lists (tools) and protecting patients’ health information (rules) led to rule‐breaking or abandoning activities of locating information. Finding time to conduct desired follow‐up produced tension between this and other activity systems. Conclusion: In clinical environments characterised by discontinuity, lists of patients served as tools for guiding patient care follow‐up. The authors offer four recommendations to address the tensions identified through AT: (i) optimise electronic health record tracking systems to eliminate the need for paper lists; (ii) support physicians’ skill development in developing and maintaining tracking systems for follow‐up; (iii) dedicate time in physicians’ work schedules for conducting follow‐up; and (iv) engage physicians and patients in determining guidelines for longitudinal tracking that optimise physicians’ learning and respect patients’ privacy. [ABSTRACT FROM AUTHOR]

Background No attempt has been made to give a systematic overview of the innovative use of unannounced or incognito standardised patients. Objective To provide a systematic overview of all published studies with incognito standardised patients assessing doctors in actual practice situations using sound reliable and valid standardised patient methodology. Methods Systematic literature search in Medline, Eric and Psyclit with piloted search terms, followed by retrieving additional papers from reference lists. All papers were scored with a predefined protocol-sheet using predefined inclusion and exclusion criteria. Results Forty papers referring to 21 projects with incognito standardised patients were found and described in detail. The majority of studies were conducted in primary care and were descriptive. Discussion There is a need for research on the additional value of the incognito standardised patient methodology and for a consensus on how to report on accuracy and consistency of standardised patients. [ABSTRACT FROM AUTHOR]

Objective To develop generic criteria for the global assessment of clinical procedural competence and to quantify the extent to which existing checklists allow for holistic assessment of procedural competencies. Methods We carried out a systematic review and qualitative analysis of published clinical procedural skills assessment checklists and enumerated the contents of each. Source materials included all English-language papers published from 1990 to June 2005, identified from 18 databases, which described or referred to an assessment document for any clinical procedural skill. A pair of reviewers identified key generic themes and sub-themes through in-depth analysis of a subset of 20 checklists with iterative agreement and independent retesting of a coding framework. The resulting framework was independently applied to all checklists by pairs of reviewers checking for the emergence of new themes and sub-themes. Main outcome measures were identification of generic clinical procedural skills and the frequency of occurrence of each in the identified checklists. Results We identified 7 themes (‘Procedural competence’, represented in 85 [97%] checklists; ‘Preparation’, 65 [74%]; ‘Safety’, 45 [51%]; ‘Communication and working with the patient’, 32 [36%]; ‘Infection control’, 28 [32%]; ‘Post-procedural care’, 24 [27%]; ‘Team working’, 13 [15%]) and 37 sub-themes, which encapsulated all identified checklists. Of the sub-themes, 2 were identified after the initial coding framework had been finalised. Conclusions It is possible to develop generic criteria for the global assessment of clinical procedural skills. A third and a half of checklists, respectively, do not enable explicit assessment of the key competencies ‘Infection control’ and ‘Safety’. Their assessment may be inconsistent in assessments which use such checklists. [ABSTRACT FROM AUTHOR]

Context The inclusion of interprofessional education opportunities in clinical placements for pre-registration learners has recently been proposed as a strategy to enhance graduates' skills in collaborative practice. Objectives A realist review was undertaken to ascertain the contexts, mechanisms and outcomes of formal interprofessional clinical workplace learning. Methods Initial scoping was carried out, after which Ovid MEDLINE, CINAHL and EMBASE were searched from 2005 to April 2016 to identify formal interprofessional workplace educational interventions involving pre-registration learners. Papers reporting studies conducted in dedicated training wards were excluded, leaving a total of 30 papers to be included in the review. Results Several educational formats that combined students from medicine, nursing, pharmacy and allied health professions were identified. These included: the use of engagement by student teams with a real patient through interview as the basis for discussion and reflection; the use of case studies through which student teams work to promote discussion; structured workshops; ward rounds, and shadowing. Meaningful interprofessional student discussion and reflection comprised the mechanism by which the outcome of learners acquiring knowledge of the roles of other professions and teamwork skills was achieved. The mechanism of dialogue during an interaction with a real patient allowed the patient to provide his or her perspective and contributed to an awareness of the patient's perspective in health care practice. Medication- or safety-focused interprofessional tasks contributed to improved safety awareness. In the absence of trained facilitators or in the context of negative role-modelling, programmes were less successful. Conclusions In the design of workplace education initiatives, curriculum decisions should take into consideration the contexts of the initiatives and the mechanisms for achieving the education-related outcomes of interest. [ABSTRACT FROM AUTHOR]

The article presents a list of forthcoming papers related to medical education, including "Spaced education improves retention of clinical knowledge by medical students: a randomised controlled trial," by B. P. Kerfoot, "Free Choices: Clerkship electives in medical education," by T. Mihalynuk and "Evaluation of residency training in the delivery of culturally effective care," M. Zuniga.

Objectives: A challenge to competency‐based medical education is the verification of skill acquisition. Digital badges represent an innovative instruction strategy involving the credentialing of competencies to provide evidence for achievement. Despite increasing interest in digital badges, there has been no synthesis of the health care education literature regarding this credentialing strategy. The present authors proposed to address this gap by conducting the first systematic review of digital badges in health care education, to reveal pedagogical and research limitations, and to provide an evidence‐based foundation for the design and implementation of digital badges. Methods: A systematic search of the medical education literature from January 2008 to March 2019 was conducted using MEDLINE, Web of Science, CAB Abstracts and ScienceDirect. Included studies described digital badges in academic or professional medical education programmes in any health care profession. Included studies were appraised and quality assessment, methodological scoring, quantitative analysis and thematic extraction were conducted. Results: A total of 1050 relevant records were screened for inclusion; 201 full text articles were then assessed for eligibility, which resulted in the identification of 30 independent papers for analysis. All records had been published since 2013; 77% were journal articles, and 83% involved academic health care education programmes. Scores for quality were relatively moderate. Thematic analyses revealed implications for the design and implementation of digital badges: learner characteristics may moderate student outcomes; the novelty effect can negate the value of digital badges, and educators may overcome instruction‐related challenges with digital badges using design and implementation strategies such as the creation of badging ecosystems. Conclusions: The results indicate a growing momentum for the use of digital badges as an innovative instruction and credentialing strategy within higher education and provide evidence for outcomes within a learner‐centred, competency‐based model of medical education. There is a paucity of research to support the design and implementation of this credentialing system in health care education. The potential benefits necessitate future high‐quality analyses reporting institutional, patient and workplace‐based outcomes to evaluate the effectiveness and moderating conditions of digital badges. Digital badges represent an innovative instructional strategy involving credentialing competencies to provide evidence for skill acquisition. This systematic review reveals pedagogical, research limitations, provides an evidence‐based foundation for designing, implementing digital badges. [ABSTRACT FROM AUTHOR]

Introduction: Longitudinal Integrated Clerkships (LICs) have demonstrated benefits for students' learning and development in medical education globally. The model emphasises importance with respect to continuity and time in the workplace for learners. There is a need to explore how LICs become a viable training model for learners. An amalgamative LIC model was drawn upon to inform the design of a placement for trainee pharmacists on a hospital ward. This study sought to determine the local viability of a longitudinal placement for trainee pharmacists, using communities of practice learning theory to interpret findings. Methods: A design‐based research approach informed study design. A longitudinal placement was implemented on two hospital wards for 13 weeks. Trainees (n = 3) were interviewed four times over a 14‐week period. Ward staff (n = 14) were interviewed at week 14. Interviews were transcribed verbatim. Qualitative longitudinal analysis, using the trajectory approach, was conducted using abductive analysis. The coded data were organised into a framework and subthemes were created. Results: Trainees acquired membership within the multi‐disciplinary ward team over time. This led to an enriched learning experience and the trainee's professional development improved as they attained more responsibilities. This enabled them to make a greater contribution to patient care; more medication consultations occurred, and discharge times improved. Discussion The local viability of the longitudinal placement appears to be linked to the trainee's ability to acquire membership within the ward community of practice. Membership gave trainee's access to learning opportunities, supporting their development, and they earnt the trust of staff, leading to more responsibilities for providing patient care. Further research into developing longitudinal placements that support trainee healthcare professionals to acquire membership within communities of practice is warranted. This paper highlights the importance of healthcare trainees acquiring membership within healthcare teams to enhance their learning experience, advance their professional development and improve patient care. [ABSTRACT FROM AUTHOR]

Educators across the world are charged with the responsibility of producing core learning outcomes for medical curricula. However, much educational theory exists which deliberates the value of learning outcomes in education. This paper aims to discuss the problems surrounding outcomes-based curricula in medical education, using insights from educational theory. The paper begins with a discussion of the traditions, values and ideologies of medical curricula. It continues by analysing the issue of control within the curriculum and argues that curriculum designers and teachers control product-orientated curricula, leading to student disempowerment. The paper debates outcomes-based curricula from an ideological perspective and argues that learning outcomes cannot specify exactly what is to be achieved as a result of learning. The paper argues that medical schools should adopt a model for co-operative control of the curriculum, thus empowering learners. The paper also suggests that medical educators should determine the value of precise learning outcomes before blindly adopting an outcomes-based model. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Teodorczuk and Morris explore how novel research approaches, such as Cultural Historical Activity Theory, might shed light on how tensions can be negotiated as medical education continues to globalize. [ABSTRACT FROM AUTHOR]

Context The teaching and assessment of clinical communication have become central components of undergraduate medical education in the UK. This paper recommends the key content for an undergraduate communication curriculum. Designed by UK educationalists with UK schools in mind, the recommendations are equally applicable to communication curricula throughout the world. Objectives This paper is intended to assist curriculum planners in the design, implementation and review of medical communication curricula. The document will also be useful in the education of other health care professionals. Designed for undergraduate education, the consensus statement also provides a baseline for further professional development. Methods The consensus statement, based on strong theoretical and research evidence, was developed by an iterative process of discussion between communication skills leads from all 33 UK medical schools conducted under the auspices of the UK Council of Clinical Communication Skills Teaching in Undergraduate Medical Education. Discussion How this framework is used will inevitably be at the discretion of each medical school and its implementation will be determined by different course designs. Although we believe students should be exposed to all the areas described, it would be impractical to set inflexible competency levels as these may be attained at different stages which are highly school-dependent. However, the framework will enable all schools to consider where different elements are addressed, where gaps exist and how to generate novel combinations of domains within the communication curriculum. It is hoped that this consensus statement will support the development and integration of teaching, learning and assessment of clinical communication. [ABSTRACT FROM AUTHOR]

Introduction This paper describes the development and implementation of an educational intervention to help general practitioners (GPs) recognise young people with first episode psychosis. Method The Medical Research Council complex interventions framework was used to guide the development of the intervention. The theoretical phase included a literature review of previous educational interventions in primary care and consideration of the literature on attitude formation and change, and the relationship between attitudes and behaviour. The modelling phase included focus groups with GPs and service users, and a training needs analysis questionnaire administered to GPs. The 2-stage intervention consisted of a video featuring role-plays of primary care consultations, GP-led discussion and discussion with early intervention service users. The acceptability and utility of the educational programme was evaluated using a 5-point Likert scale questionnaire administered at the end of each session. Results General practitioners from each of the 39 intervention practices participated in the initial session and from 27 practices in the booster session. Information about symptoms and signs of first episode psychosis was the most valued aspect of the initial session. The booster session was also well received, with GPs valuing the opportunity to gain insight into first episode psychosis from users. Conclusions This paper adds a pragmatic description to the literature on the development of educational interventions in primary care. The Medical Research Council framework helped to identify and clarify component parts of the intervention and how the active components may relate to the expected outcome of behaviour change. [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]

Background Access to a well-trained workforce is one of many factors underscoring the global health divide that separates industrialized and developing nations. This paper describes the distribution and physician output of the world's medical schools, compares regional physician to population ratios, examines population trends and points out potential mismatches between output and anticipated demographic changes. Method This paper has used multiple data sources in published and electronic form from organized medicine, international health institutions and the medical literature. In addition, a stratified, random survey of 130 medical schools was conducted to determine annual numbers of graduates. Results Tracking the number and distribution of medical schools and their student capacity is a complex task. The number of medical schools and the estimated number of graduates per population vary by region. In areas of predicted substantial population growth, the production of physicians is neither adequate to meet future needs, nor sufficient to overcome low physician–population ratios. Regions with high physician–population ratios and either expected population decline or small population gains over the next 50 years appear to have an over-capacity to train medical students. Conclusion This paper emphasizes the need for new methods of tracking the global pipeline of medical education and of establishing ways of sharing expertise. The growing interdependence of nations, accentuated by globalization of the world's economies, our shared goal of achieving health for all and the migration of physicians across borders highlight the need to understand the global capacity to educate the next generation of physicians. [ABSTRACT FROM AUTHOR]

Context: The shift in medical education from time‐based learning to outcome‐based learning has drawn much attention to entrustable professional activities (EPAs) as an ideal assessment framework to translate competencies into clinical practice. Given the relative novelty of EPAs, this review aims to highlight research gaps and explore and consolidate available evidence pertaining to the development and implementation of EPAs in health care. Method: Arksey and O'Malley's scoping review framework was used to present the findings. The authors performed a systematic search of PubMed, Embase, CINAHL, Scopus, MedNar, OpenGrey and ProQuest Dissertation and Theses for English articles published from the inception of each database to May 2018. A manual search of the reference lists of the included studies was conducted and an expert panel was consulted. Two reviewers screened the articles for eligibility using the inclusion criteria. All authors extracted key data and analysed the data descriptively. Thematic analysis was used to categorise the results into themes. Results: Eighty articles were included in the review. All articles were published between 2010 and 2018. Three major themes and eight sub‐themes were generated: (i) development of EPAs (frameworks for EPA development and implementation, identifying core or specialty‐specific EPAs, and EPAs for faculty development), (ii) evaluation of EPAs and EPA entrustment factors (revised curriculum, entrustment decisions for professional activities, and feedback on implemented EPAs and the development process), and (iii) future directions and recommendations for EPAs (implementation of EPAs in undergraduate medical education and specific disciplines, and other criticisms and recommendations for EPAs). Conclusions: Entrustable professional activities are an essential means to translate competencies into observable and measurable clinical practice. However, high‐level evidence‐based research on the efficacy, development and implementation of EPAs for specific target groups (i.e. undergraduates and staff) and geographical regions (i.e. Asia and Africa) is still lacking, which suggests a direction for future research. By reviewing the literature on Entrustable Professional Activities, Shorey et al. highlight an urgent need for high‐level evidence‐based research on the efficacy, development and implementation of EPAs for specific target groups. [ABSTRACT FROM AUTHOR]

Context: Transformative learning (TL) has been described as learning that challenges established perspectives, leading to new ways of being in the world. As a learning theory it has resonated with educators globally, including those in the health professions. Described as a complex metatheory, TL has evolved over time, eliciting divergent interpretations of the construct. This scoping review provides a comprehensive synthesis of how TL is currently represented in the health professions education literature, including how it influences curricular activities, to inform its future application in the field. Methods: Arksey and O'Malley's six‐step framework was adopted to review the period from 2006 to May 2018. A total of 10 bibliographic databases were searched, generating 1532 potential studies. After several rounds of review, first of abstracts and then of full texts, 99 studies were mapped by two independent reviewers onto the internally developed data extraction sheet. Descriptive information about included studies was aggregated. Discursive data were subjected to content analysis. Results: A mix of conceptual and empirical research papers, which used a range of qualitative methodologies, were included. Studies from the USA, the UK and Australia were most prevalent. Insights relating to how opportunities for TL were created, how it manifests and influences behaviour, as well as how it is experienced, demonstrated much congruency. Conceptions of TL were seen to be clustered around the work of key theorists. Conclusions: The training of health professionals often takes place in unfamiliar settings where students are encouraged to be active participants in providing care. This increases the opportunity for exposure to learning experiences that are potentially transformative, allowing for a pedagogy of uncertainty that acknowledges the complexity of the world we live in and questions what we believe we know about it. TL provides educators in the health professions with a theoretical lens through which they can view such student learning. This scoping review enhances understanding of transformative learning by exploring ways in which it has been represented in the health professions education literature. [ABSTRACT FROM AUTHOR]

Context This paper presents a critique of current knowledge on the engagement of patients and the public, referred to here as patient and public involvement ( PPI), and calls for the development of robust and theoretically informed strategies across the continuum of medical education. Methods The study draws on a range of relevant literatures and presents PPI as a response process in relation to patient-centred learning agendas. Through reference to original research it discusses three key priorities for medical educators developing early PPI pedagogies, including: (i) the integration of evidence on PPI relevant to medical education, via a unifying corpus of literature; (ii) conceptual clarity through shared definitions of PPI in medical education, and (iii) an academically rigorous approach to managing complexity in the evaluation of PPI initiatives. Results As a response to these challenges, the authors demonstrate how activity modelling may be used as an analytical heuristic to provide an understanding of a number of PPI systems that may interact within complex and dynamic educational contexts. Conclusion The authors highlight the need for a range of patient voices to be evident within such work, from its generation through to dissemination, in order that patients and the public are partners and not merely objects of this endeavour. To this end, this paper has been discussed with and reviewed by our own patient and public research partners throughout the writing process. [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. The authors demonstrate how dominant discourses in medical education literature enable the proliferation of point‐of‐care ultrasound in medical education and how these discourses make this trend appear inevitable. [ABSTRACT FROM AUTHOR]

Context Health care organisations are increasingly conceptualised as complex, indivisible entities made up of web-like networks of staff that connect to each other in changeable ways. This study draws on the theoretical framework of activity theory and the concept of knotworking to illustrate how health professionals improvise collaboratively to negotiate everyday challenges and contribute positively to patients' health priorities. Objectives The aim of this paper is to contribute to evolving ideas about collective learning, change and improvement in secondary care by exploring how health professionals work and learn together and how this compares with earlier findings from primary care. Methods This study applied a constructionist methodology within the research paradigm of interpretivism. Qualitative data were gathered through 26 hours of observations and 17 field interviews within the natural environment of a working hospital over a 3-month period. The research site encompassed a medical receiving ward, a chronic ward, an out-patient clinic and the connecting corridors. Staff participants included a range of clinical, nursing, ancillary and clerical staff. Results The study found a recurring pattern of spontaneous team forming and interprofessional shared learning to respond to care needs within the hospital as they arise. These are presented in four analytical themes: motion, flux and the unpredictability of 'team spirit'; adaptive, responsive learning through seeing, doing and asking questions; the collective learning gap between doctors and other staff; and frustration, compassion and the desire for improvement. Conclusions Health care professionals in the hospital setting both create and experience complex inclusion and exclusion behaviours that define who is empowered to act with professional authority in any given moment of care. This paper discusses issues of power, the particular exclusion of doctors from interprofessional knotworking, and the greater emphasis on questions as the pivotal aspect of shared collective learning when compared with primary care. [ABSTRACT FROM AUTHOR]

Context Many of those involved in continuing professional development ( CPD) over the past 10 years have engaged in discussions about its goals and activities. Whereas in the past CPD was viewed as an education intervention directed towards the medical expert role, recent research highlights the need to expand the scope of CPD and to promote its more explicit role in improving patient care and health outcomes. Recent developments in quality improvement ( QI) and competency-based medical education ( CBME), guided by appropriate theories of learning and change, can shed light on how the field might best advance. This paper describes principles of QI and CBME and how they might contribute to CPD, explores theoretical perspectives that inform such an integration and suggests a future model of CPD. Discussion Continuing professional development seeks to improve patient outcomes by increasing physician knowledge and skills and changing behaviours, whereas QI takes the approach of system and process change. Combining the strengths of a CPD approach with strategies known to be effective from the field of QI has the potential to harmonise the contributions of each, and thereby to lead to better patient outcomes. Similarly, competency-based CPD is envisioned to place health needs and patient outcomes at the centre of a CPD system that will be guided by a set of competencies to enhance the quality of practice and the safety of the health system. Conclusions We propose that the future CPD system should adhere to the following principles: it should be grounded in the everyday workplace, integrated into the health care system, oriented to patient outcomes, guided by multiple sources of performance and outcome data, and team-based; it should employ the principles and strategies of QI, and should be taken on as a collective responsibility by physicians, CPD provider organisations, regulators and the health system. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 545-551 Context Most US medical schools have instituted cultural competence education in the undergraduate curriculum. This training is intended to improve the quality of care that doctors, the majority of whom are White, deliver to ethnic and racial minority patients. Research into the outcomes of cultural competence training programmes reveals that they have been largely ineffective in improving doctors' skills. In varied curricular formats, programmes tend to teach group-specific cultural knowledge, despite the vast heterogeneity of racial and ethnic groups. This cultural essentialism diminishes training effectiveness. Methods This paper proposes key curriculum content changes and suggests the inclusion of an intersectional framework in the cultural competence curriculum. This framework maintains that racial and ethnic minority groups hold multiple social statuses, called social locations, which interact with one another to uniquely shape the health views, needs and experiences of the individuals within the groups. Social locations include those defined by race, ethnicity, gender, social class and sexuality, which are experienced multiplicatively, not additively, within a particular social context. Cultural competence education must go beyond simplified cultural understandings to explore these more complex meanings. Doctors' ability to understand, communicate with and treat diverse groups can be vastly improved by applying an intersectional framework in academic research, self-awareness exercises and clinical training. Results Integrating an intersectional framework into cultural competency education can better prepare doctors for caring for racial and ethnic minority patients. This paper recommends curriculum elements for the classroom and clinical training that can improve doctor knowledge and skills for caring for diverse groups. Medical schools can use the proposed model to facilitate the development of new educational strategies and learning experiences. These improvements can lead to more equitable care and ultimately diminish disparities in health care. Although these recommendations are designed with US schools in mind, they may improve doctor understanding and care of marginal populations across the world. [ABSTRACT FROM AUTHOR]

Context Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. Methods We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. Results The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. Conclusion Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery. [ABSTRACT FROM AUTHOR]

Context Mixed methods research involves the collection, analysis and integration of both qualitative and quantitative data in a single study. The benefits of a mixed methods approach are particularly evident when studying new questions or complex initiatives and interactions, which is often the case in medical education research. Basic guidelines for when to use mixed methods research and how to design a mixed methods study in medical education research are not readily available. Methods The purpose of this paper is to remedy that situation by providing an overview of mixed methods research, research design models relevant for medical education research, examples of each research design model in medical education research, and basic guidelines for medical education researchers interested in mixed methods research. Conclusions Mixed methods may prove superior in increasing the integrity and applicability of findings when studying new or complex initiatives and interactions in medical education research. They deserve an increased presence and recognition in medical education research. [ABSTRACT FROM AUTHOR]

Context Interprofessional collaboration is gaining increasing prominence as a team-based approach to health care delivery that synergistically maximises the strengths of each health professional to enhance patient care, decrease medical errors and optimise efficiency. The often neglected role that student leaders have in preparing their peers, as the health professionals of the future, for collaboration in health care should not be overlooked. Objective This paper offers the foundational arguments supporting the integral role that student leadership in interprofessional education (IPE) can play and its comparative advantages. Methods Evidence from previous literature and the National Health Science Students’ Association in Canada was reviewed and a questionnaire on student-initiated IPE was administered among Canada’s top student leaders in this area. Results Student leadership is essential to the success of IPE because it enhances students’ willingness to collaborate and facilitates the longterm sustainability of IPE efforts. Student-initiated IPE, a subset of student leadership, is particularly important to achieving the aforementioned goals and offers a number of benefits, comparative advantages and associated challenges. Conclusions Successful student leadership in IPE will yield significant benefits for everyone in the years to come. However, it requires the support of educators, researchers and policymakers in fostering an enabling environment that will facilitate the efforts and contributions of student leaders. [ABSTRACT FROM AUTHOR]

Background A complex chain of events underpins every clinical intervention, especially those involving invasive procedures. Safety requires high levels of awareness and vigilance. In this paper we propose a structured approach to procedural training, mapping each learner's evolving experience within a matrix of clinical risk and procedural complexity. We use a traffic light analogy to conceptualise a dynamic awareness of prevailing risk and the implications of moving between zones. The importance of context We argue that clinical exposure can be consolidated by simulation where appropriate, ensuring that each learner gains the skills for safe care within the increasingly limited time available for training. To be effective, however, such simulation must be realistic, patient-focused, structured and grounded in an authentic clinical context. Challenge comes not only from technical difficulty but also from the need for interpersonal skills and professionalism within clinical encounters. Patient focused simulation Many existing simulations focus on crises, so clinicians are in a heightened state of expectation that may not reflect their usual practice. We argue that simulation should also reflect commonly occurring non-crisis situations, allowing clinicians to develop an awareness of the complex events that underpin clinical encounters. We describe a patient-focused approach to simulation, using simulated patients and inanimate models within realistic scenarios, to ground experience in authentic clinical practice and bring together the complex elements that underpin clinical events. Applications Although our argument has evolved from surgical practice and operating theatre teams, we believe it can be widely applied to the increasing number of health care professionals who perform clinical interventions. [ABSTRACT FROM AUTHOR]

Context Video has long been recognised as providing an important resource within medical education, particularly, perhaps, for training in primary health care. As a resource for research, and more specifically within qualitative social science studies of medical practice, video has proved less pervasive, despite its obvious advantages. Methods In this paper, we sketch an approach to using video to inform the analysis of medical practice and the ways in which health care is accomplished through social interaction and collaboration. Drawing on our own research, we discuss two brief examples: the first involves the use of computing technology in primary health care and the second concerns informal instruction during surgery. The examples illustrate the multimodal character of medical work, how activities are accomplished through the interplay of talk, the visual and the use of material artefacts. They also illustrate the ways in which video provides access to the complex forms of social interaction and collaboration that underpin health care. Discussion We reflect upon the research opportunities afforded by video and the ways in which video-based studies of interaction can contribute to the practice and practicalities of medicine. [ABSTRACT FROM AUTHOR]

Background Problem-based learning (PBL) as an approach to the instruction of medical students has attracted much attention in recent years. However, its effect on the performance of its graduates is the subject of considerable debate. This article presents data from a large-scale study among graduates of a problem-based medical school and those of a conventional medical school to contribute to this discussion. Purpose To study the longterm effects of problem-based medical training on the professional competencies of graduates. Methods A questionnaire was sent to all graduates since 1980 of a problem-based and a conventional medical school. Participants were requested to rate themselves on 18 professional competencies derived from the literature. Results The graduates of the PBL school scored higher on 14 of 18 professional competencies. Graduates of the problem-based school rated themselves as having much better interpersonal skills, better competencies in problem solving, self-directed learning and information gathering, and somewhat better task-supporting skills, such as the ability to work and plan efficiently. There were no sizeable differences with regard to general academic competencies, such as conducting research or writing a paper. Graduates from the conventional school rated themselves as having slightly more medical knowledge. The findings were shown to be valid and robust against possible response bias. Conclusion The findings suggest that PBL not only affects the typical PBL-related competencies in the interpersonal and cognitive domains, but also the more general work-related skills that are deemed important for success in professional practice. [ABSTRACT FROM AUTHOR]

Problem-based learning (PBL) is a method of teaching and learning that is used increasingly in medical and health care curricula worldwide. The literature on PBL is considerable and continues to develop. One important aspect of PBL is that students and tutors spend a lot of time together and this fosters an informal atmosphere that may encourage intimacy. The existing literature on PBL has not considered the emotional and psychological aspects of PBL nor the concomitant need for staff support and development.We present a discussion paper considering the ways in which educationalists using or considering using PBL could be informed by the psychological and psychotherapeutic literature on groups and group dynamics, in particular the work of Wilfred Bion. We discuss how PBL tutorials may arouse emotional responses that could result in unconsidered behaviours that impede student learning. We argue that faculty and PBL tutors need to agree and remain alert to the primary task of the group. Faculty should develop professional standards for tutors to use as reference points to ensure the group stays on course and achieves its intended outcomes.We conclude that greater attention should be paid by educationalists and faculty to identifying possible tutor emotional responses as part of initial PBL tutor training and ongoing staff development. We offer vignettes that have been successfully used in training and staff development at a UK medical school to demonstrate the practical application of our theoretical discussion. [ABSTRACT FROM AUTHOR]

Medical students face many challenges as they progress through training, some of which refer to learning how to manage the stresses and anxiety of confronting illness and suffering. In trying to relieve anxiety, they may develop maladaptive responses that lead to a decrease in their level of empathy for patients. Education should aim to teach students how to deal with their responses so that they can tolerate patients' distress and treat them effectively. This paper will address central dilemmas in students' attitudes towards patients during clerkships and suggest positive developmental goals to strive for in this formative time. It may be used as a reference tool for medical student educators and medical students to elucidate the educational tensions in teaching and learning about how to provide empathetic care. Students and teachers can benefit from an awareness of the tension between the poles of pathology and health, not knowing and too much knowing, vulnerability and denial and reaction and inaction. Medical students can learn adaptive methods of managing their anxiety about dealing with illness and death and strike a balance in their approach to patients. [ABSTRACT FROM AUTHOR]

The traditional clinical examination has been shown to have serious limitations in terms of its validity and reliability. The OSCE provides some answers to these limitations and has become very popular. Many variants on the original OSCE format now exist and much research has been done on various aspects of their use. Issues to be addressed relate to organization matters and to the quality of the assessment. This paper focuses particularly on the latter with respect to ways of ensuring content validity and achieving acceptable levels of reliability. A particular concern has been the demonstrable need for long examinations if high levels of reliability are to be achieved. Strategies for reducing the practical difficulties this raises are discussed. Standard setting methods for use with OSCEs are described. [ABSTRACT FROM AUTHOR]

This paper discusses the rationale behind, and an approach to, the development of a graduate level interdisciplinary curriculum in literature and health care that incorporates community-based learning. Such an innovative approach emerges from the recognition that professional training in both health care and humanities programmes often does not model the kinds of collaborative relationships and professional values desired by contemporary health care students, providers and patients. Recent trends in literary study and the medical humanities are described, along with the function (and benefits to students) of interdisciplinary classrooms and the role of community-based learning in higher education. The authors discuss their experiences teaching, and offer students' responses to medical humanities courses from which the concept for such a curriculum evolved. The paper offers advice on developing, evaluating and disseminating such a model curriculum for medical, nursing and graduate literature students. Proposal By linking health care with graduate English literature students, such a course would promote dialogue and understanding among health professionals, enhance student awareness of the effects of illness on patients, their caregivers and families, and encourage student activism and community service. A common set of literary works would provide a shared vocabulary and opportunities for ethical, critical and personal response. Working together in a community-based project, students from diifferent programmes would learn to appreciate alternative professional and lay perspectives on common experiences. [ABSTRACT FROM AUTHOR]

Simulation-based testing methods have been developed to meet the need for assessment procedures that are both authentic and well-structured. It is widely acknowledged that, although the authenticity of a procedure may be a contributing factor to its validity, authenticity alone never is a sufficient factor. In this paper we describe the mainstream development of various simulation-based approaches, with their strengths and weaknesses. The purpose is not to provide a review based on an extensive meta-analysis but to present crucial factors in the development of these methods and their implications for current and future developments. The description of these simulation-based instruments uses a subdivision according to the layers of Miller's pyramid. Written and computer-based simulations are aimed at measuring the ‘knows how’ layer, observation-based techniques such as standardised patient-based examinations and objective structured clinical examinations target the ‘shows how’ layer and performance practice measures assess performance at the ‘does’ layer. In all simulations, case specificity was found to pose the most prominent threat to reliability, while too much structure threatened to trivialise the assessment. The conclusion is that authentic and reliable assessment is predicated on a wise balance between efficiency and adequate content sampling. [ABSTRACT FROM AUTHOR]

This paper explores the fundamental reasons for partnership in health care and medical education. It reviews the philosophical and policy contexts of health care trends and suggests that many of these trends can be summarized as a process of diffusion relating to: (a) what is on the health agenda, (b) who sets the health agenda and (c) the increasing indeterminacy of the health agenda. Various aspects of the ‘social turn’ in health care are introduced and offered as a partial explanation for the diffusion of the health agenda. Finally, some of the implications of these discussions for medical education are set out, in particular the need for partnerships within and beyond the academy. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the importance of raising awareness on the possible consequences of the fatigue paradox to various areas, particularly on the effects of fatigue on physicians' health and well-being. Topics include the need to implement a fatigue risk management (FRM) framework in residency training to minimise medical errors and enhance patient care and the emotional functioning of fatigue resident physicians.

Introduction The 1964 revision of the Hippocratic Oath addressed the disconnection in language and context between the classical doctrine and 20th century medicine. Now, 50 years later, we argue that any revision of the Oath must be responsive to the significant social, technical and political changes that have occurred in health care. The context for the Hippocratic Oath This paper examines the ways in which health care and the health professions have changed over the last half-century and describes a range of environmental and contextual features that expose the inadequacies of the 1964 Oath in the worlds of today and the future. We note the constancy of the doctor-patient dyad in contemporary ethical codes and consider from the perspective of patient safety those aspects of care that might fall short of the optimum if the focus on the doctor is retained. We ask whether there is any merit in maintaining a focus on the ethics or professionalism of doctors, or whether more of our attention should be directed towards the ethics of health care itself. Conclusions Patient safety is widely acknowledged as a major health issue. Being open about the interdependency of doctors, the complex socio-political nature of health care, and the inevitability of errors and adverse events need not challenge the authority of the doctor. Rather, openness about both the ways in which medicine has changed and the harms that doctors may (inadvertently) cause might afford medicine the opportunity to build a different relationship with patients (and with society more broadly), that recognises complexity, human fallibility and the uncertainty of medicine. [ABSTRACT FROM AUTHOR]

Medical Education 2012: 46: 869-877 Objectives In order to be relevant and impactful, our research into health care teamwork needs to better reflect the complexity inherent to this area. This study explored the complexity of collaborative practice on a distributed transplant team. We employed the theoretical lenses of activity theory to better understand the nature of collaborative complexity and its implications for current approaches to interprofessional collaboration (IPC) and interprofessional education (IPE). Methods Over 4 months, two trained observers conducted 162 hours of observation, 30 field interviews and 17 formal interviews with 39 members of a solid organ transplant team in a Canadian teaching hospital. Participants included consultant medical and surgical staff and postgraduate trainees, the team nurse practitioner, social worker, dietician, pharmacist, physical therapist, bedside nurses, organ donor coordinators and organ recipient coordinators. Data collection and inductive analysis for emergent themes proceeded iteratively. Results Daily collaborative practice involves improvisation in the face of recurring challenges on a distributed team. This paper focuses on the theme of 'interservice' challenges, which represent instances in which the 'core' transplant team (those providing daily care for transplant patients) work to engage the expertise and resources of other services in the hospital, such as those of radiology and pathology departments. We examine a single story of the core team's collaboration with cardiology, anaesthesiology and radiology services to decide whether a patient is appropriate for transplantation and use this story to consider the team's strategies in the face of conflicting expectations and preferences among these services. Conclusions This story of collaboration in a distributed team calls into question two premises underpinning current models of IPC and IPE: the notion that stable professional roles exist, and the ideal of a unifying objective of 'caring for the patient'. We suggest important elaborations to these premises as they are used to conceptualise and teach IPC in order to better represent the intricacy of everyday collaborative work in health care. [ABSTRACT FROM AUTHOR]

An abstract of the article "Exploring meaningful and truly integrative changes: a call to arms for medical education," by J. D. Gonzalo and colleagues is presented.

The authors discuss the domain of non-technical skills (NTSs) as a subject of the health professional's education in a low- or middle-income country (LMIC). They reference and reflect on the conclusions drawn by J. Scott colleagues in their paper "Non-technical skills and health care provision in low- and middle-income countries: a systematic review" which appeared within the issue.

The article discusses patient and public involvement (PPI) in medical education. It references the article "Towards a pedagogy for patient and public involvement in medical education" by S. Regan de Bere and S. Nunn, which appears elsewhere in the issue. Details on the history of medical education methodology are presented. Other topics include patient-centered education, professionalism, community-based participatory research (CBPR), and narrative medicine.

Context Reflective practice has been suggested to be an important instrument in improving clinical judgement and developing medical expertise. Empirical evidence supporting this suggestion, however, is absent. This paper reports on an experiment conducted to study the effects of reflective practice on diagnostic accuracy. Methods Participants were 42 internal medicine residents in hospitals in 2 states in the northeast of Brazil. They diagnosed 16 clinical cases. The experiment employed a repeated measures design, with 2 independent variables: the complexity of clinical cases (simple or complex), and the reasoning approach induced to diagnose the case (participants were instructed to diagnose each case either through pattern recognition or reflective reasoning). The dependent variable was the accuracy of the diagnosis provided for each case. All participants participated in each of the 2 levels of both independent variables. Results A main effect of case complexity emerged. There was no statistically significant main effect of reflective practice. However, a significant interaction effect was found between case complexity and mode of processing (F[1,41] = 4.48, P < 0.05), indicating that although reflective practice did not make a difference to accuracy of diagnosis in simple cases, it had a positive effect when diagnosing complex cases. Conclusions Reflective practice had a positive effect on diagnosis of complex, unusual cases. Non-analytical reasoning was shown to be as effective as reflective reasoning for diagnosing routine clinical cases. Findings support the idea that reflective practice may particularly improve diagnoses in situations of uncertainty and uniqueness, reducing diagnostic errors. [ABSTRACT FROM AUTHOR]

Context Globalisation has profoundly affected health care by increasing the diversity of clinicians and their patients. Worldwide, medical schools highlight the need for students to understand and show respect for patients and peers of different ethnicities. Yet a sound theoretical approach and robust methods for learning about cultural awareness are lacking. The reasons for this are unclear. Objective To explore Year 2 medical students’ understanding of the concepts of race, ethnicity and culture. Methods This study was set in 2 universities in the north of England. The student population of each was of a similar ethnic mix but the universities differed in terms of local demography (a wide patient ethnic mix versus a predominantly White patient population with experience of social deprivation) and curricula (a curriculum involving problem-based learning and paper-based cases versus a curriculum involving early contact with patients). Participants comprised 49 Year 2 medical students (mean age 20·8 years), 40% of whom came from ethnic minority groups. Seven focus groups were held across the 2 universities to explore students’ understanding of cultural awareness. Students were asked to discuss the terms ‘race’, ‘ethnicity’, ‘culture’ and ‘cultural diversity’. Interviews were transcribed and analysed qualitatively using grounded theory. Themes were identified and validated by an independent researcher. Results Four overarching themes emerged: ‘White fears’ at discussing race-related issues; ethnic minority discomfort at being viewed as ‘different’; difficulties in relating to professional boundaries, and barriers against talking about race beyond legitimate disease-related discourse. Conclusions For students, discussion of race beyond the confines of medical discourse was problematic. If students are to develop professional holistic values towards patient care, they need more support in understanding their own personal values and uncertainties. [ABSTRACT FROM AUTHOR]

Context Although training in basic science is generally considered a critical aspect of medical education, there is little consensus regarding its precise role in clinical reasoning. Whereas some reports suggest that biomedical knowledge is rarely used in routine diagnosis, other research has found that biomedical knowledge can become an integral part of the expert knowledge base. Objective The purpose of the current paper is to present evidence in support of different views regarding the role of biomedical knowledge, including the two-world hypothesis, encapsulation theory and recent work on the role of biomedical knowledge in novice diagnosticians. The implications of these models for clinical teaching will be examined. Discussion Recent work suggests that biomedical knowledge can help novices develop a coherent and stable mental representation of disease categories. As a result, learners are able to retain clinical knowledge over time and maintain diagnostic accuracy when faced with clinical challenges. This suggests that clinical teachers should attempt to make explicit connections between biomedical knowledge and clinical facts during training. [ABSTRACT FROM AUTHOR]

Context For over 30 years, research has focused on the question of how knowledge is organised in the doctor’s mind. The development of encapsulated knowledge, followed by the formation of illness scripts, may both be considered as important stages in the development of medical expertise. Methods This paper reviews research on the knowledge encapsulation and illness script hypotheses since their initial formulation. Findings in support of these views of expertise development are reported and conflicting data are discussed. Results A great deal of empirical data have been collected over the years to investigate the view that, through clinical experiences, biomedical knowledge becomes encapsulated and eventually integrated into illness scripts. The findings of most studies, which have used various techniques to probe the ways by which students and doctors mentally represent clinical cases, are in line with this view of expertise development. However, there is still debate concerning the role of biomedical knowledge in clinical case processing. Conclusions To facilitate the development of expertise in medical school, it is important to teach the basic sciences in a clinical context, and to introduce patient problems early in the curriculum in order to support the processes of encapsulation and illness script formation. In addition, during clerkships ample time should be devoted to enabling reflection on patient problems with peers and expert doctors. [ABSTRACT FROM AUTHOR]

Context Interprofessional educational (IPE) initiatives are seen as a means to engage health care professionals in collaborative patient-centred care. Given the hierarchical nature of many clinical settings, it is important to examine how the aims of formal IPE courses intersect with the socialisation of medical students into roles of responsibility and authority. Objectives This article aims to provide an overview of doctor barriers to collaboration and describe aspects of medical education and socialisation that may limit doctor engagement in the goals of interprofessional education. Additionally, the paper examines the nature of team function in the health care system, reviewing different conceptual models to propose a spectrum of collaborative possibilities. Finally, specific suggestions are offered to increase the impact of interprofessional education programmes in medical education. Discussion An acknowledgement of power differentials between health care providers is necessary in the development of models for shared responsibility between professions. Conceptual models of teamwork and collaboration must articulate the desired nature of interaction between professionals with different degrees of responsibility and authority. Educational programmes in areas such as professionalism and ethics have shown limited success when formal and informal curricula significantly diverge. The socialisation of medical students into the role of a responsible doctor must be balanced with training to share responsibility appropriately. Doctor collaborative capacity may be enhanced by programmes designed to develop particular skills for which there is evidence of improved patient outcomes. [ABSTRACT FROM AUTHOR]

Background The assessment of clinical procedural skills has traditionally focused on technical elements alone. However, in real practice, clinicians are expected to be able to integrate technical with communication and other professional skills. We describe an integrated procedural performance instrument (IPPI), where clinicians are assessed on 12 clinical procedures in a simulated clinical setting which combines simulated patients (SPs) with inanimate models or items of medical equipment. Candidates are observed remotely by assessors whose data are fed back to the clinician within 24 hours of the assessment. This paper describes the feasibility of IPPI. Results A full-scale IPPI and 2 pilot studies with trainee and qualified health care professionals has yielded an extensive data set including 585 scenario evaluations from candidates, 60 from clinical assessors and 31 from simulated patients (SPs). Interview and questionnaire data showed that for the majority of candidates IPPI provided a powerful and valuable learning experience. Realism was rated highly. Remote and real-time assessment worked effectively, although for some procedures limited camera resolution affected observation of fine details. Discussion IPPI offers an innovative approach to assessing clinical procedural skills. Although resource-intensive, it has the potential to provide insight into individual's performance over a spectrum of clinical scenarios and at no risk to the safety of patients. Additional benefits of IPPI include assessment in real time from experts (allowing remote rating by external examiners) as well as provision of feedback from simulated patients. [ABSTRACT FROM AUTHOR]

Context China has a long tradition of education and medicine. However, limited economic conditions and a huge population mean that further development of medical education in China must be tailored to meet the country's needs. Objectives The aim of this paper is to describe current medical education practice in China with reference to the general and historical purposes of education in China and how they have affected and continue to affect student learning. Reference is also made to both Western medicine and traditional Chinese medicine. Methods It is argued that traditional educational practices in China have encouraged rote learning and that creativity is not cultivated. This affects the way many Chinese students learn medicine. Since 1949, the Chinese medical education system has developed according to its own needs. The current system for training medical students is complex, with medical school curricula lasting 3−8 years. However, medical education reform is taking place and new teaching methods are being introduced in some schools. Discussion Medical education is important to China's large population. The undergraduate medical education system is being streamlined and national standards are being established. Innovations in medical education have recently been encouraged and supported, including the adoption of problem-based learning. It is important that the momentum is kept up so that the health care of a fifth of the world's population is assured. [ABSTRACT FROM AUTHOR]

Background The role of basic science, which provides causal explanations for clinical phenomena in medical education, is poorly understood. Schmidt has postulated that expert clinicians maintain this knowledge in ‘encapsulated’ form, indexed by words or phrases describing the processes. In the present paper we show that students who learn causal explanations have a more coherent understanding of the relation between diseases and clinical features which, in turn, influences recognition of words or phrases describing ‘encapsulated knowledge’ and the ability to maintain performance under speeded conditions. Hypotheses In comparison to students who simply learn the features of 4 diagnostic categories, students who learn a causal explanation will: (a) recognise words describing encapsulated knowledge more accurately and (b) maintain or improve diagnostic performance under speeded conditions. Methods Two studies were conducted involving 4 ‘pseudo-endocrinology’ diseases and undergraduate psychology students. One group learned signs and symptoms alone; the second group also learned a causal explanation. In study 1, they were then given a recognition memory task. In study 2, they were asked to diagnose new cases either (i) as quickly as possible or (ii) taking their time. Results In study 1, while there was no difference in recognising old words (90% versus 91%), the causal group was better able to recognise encapsulated and novel consistent words (50% versus 41%) ( P = 0.02). In study 2 there was an interaction; causal students performed better under speeded conditions (71% versus 66%) but worse under thoroughness conditions (67% versus 73%), as predicted. Conclusions Causal understanding leads to more coherent understanding of clinical conditions, which in turn leads to expert-like behaviour. [ABSTRACT FROM AUTHOR]

Background Doctors' interpersonal and communication skills correlate with improved health care outcomes. International medical organisations require competency in communication skills. The Accreditation Council for Graduate Medical Education (ACGME) developed a toolbox for assessing this competency and 5 others, yet none initially for teaching these skills. Purpose and methods The original focus in the development of the ACGME competencies was evaluation. This paper represents a significant step toward defining methods for teaching communication skills competencies. A total of 16 medical education leaders from medical schools worldwide, participating in the 2003 Harvard Macy Institute Program for Physician Educators, worked together to: (1) further define the ACGME competency in interpersonal and communication skills; (2) delineate teaching strategies for each level of medical education; and (3) create a teaching toolbox to integrate communication skills competencies into medical curricula. Four subgroups defined subcompetencies, identified teaching strategies for undergraduate, graduate and postgraduate medical training and brought their work to the larger group. The expanded communication competencies and teaching strategies were determined by a consensus of the larger group, presented to 80 Harvard Macy Scholars and Faculty for further discussion, then finalised by consensus. Conclusion The teaching toolbox expands the ACGME core communication competencies, adds 20 subcompetencies and connects these competencies to teaching strategies at each level of medical training. It represents the collaboration and consensus of a diverse international group of medical education leaders in a variety of medical specialities and institutions, all involved in teaching communication skills. The toolbox is applicable globally across different settings and specialities, and is sensitive to different definitions of health care. [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]

Background The continued reduction in junior doctors' hours in the UK has made it necessary to re-examine traditional assumptions about the synonymous natures of training and service. This paper researches senior house officers' (SHOs) perceptions of ‘service’ and ‘training’, with reference to where they place activities along the training/service continuum, and the factors that lead them to classify these activities in the way they do. Methods Questionnaires were sent to all identified SHOs at Plymouth Hospitals NHS Trust (40% response rate). Three focus groups were held with 5 SHOs, 3 consultants and 2 clinical tutors. Quantitative data derived from the questionnaires were analysed usingspss. Qualitative data collected in the focus groups was coded with the aid ofn6, which facilitated the thematic analysis of transcripts. Results Analysis of the quantitative data allowed the construction of the training/service continuum diagram. Identified factors affecting the perceived training/service balance of SHO activities included: frequency, time, type and nature of work, number of patients, supervision, interaction, other commitments, purpose and focus of the activity, the individual trainee and trainer, and experience and competence. Discussion It is no longer appropriate to assume that all junior doctor activities represent either training or service individually: activities are perceived differently along the training/service continuum depending on their execution and their relation to the SHOs' learning curves. Within the reduced hours framework, it is necessary to match this balance to experience, in order for both training and service requirements to be satisfied. [ABSTRACT FROM AUTHOR]