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This study aimed to investigate the perceptions of dental students and teachers about introducing metacognition pedagogy within an established clinical professional curriculum to provide primary data informing its feasibility. A qualitative study using phenomenography methodology was undertaken as part of a master's dissertation. Semi-structured interviews were conducted on 16 participants which included 9 clinical teachers and 7 dental students. Metacognition pedagogy was positively perceived by most of the participants as being beneficial to students' learning in oral health education. A few reported some negativity. All participants identified some challenges to be addressed if a metacognition pedagogy was to be implemented in the undergraduate curriculum. According to the perceptions of most participants in the study, metacognition emerged as a potential factor in improving student learning and exam performance, and facilitating the development of critical thinking, professionalism, and clinical skills. In the context of rigorous, demanding, and challenging courses, and recognising the complexities and uncertainties inherent in health professional working environments, metacognition emerges as a valuable tool, fostering self-awareness, regulation, and adaptability. Ultimately, metacognition has the capability to shape more adept learners and clinicians, yielding benefits for students, teachers, and patients alike. [ABSTRACT FROM AUTHOR]

This study aims to understand what is known about the high performing or exceptional learner in medical education. There is a rich literature about learners in difficulty, yet little is known about those performing at the high end, also known as exceptional learners. A qualitative study was undertaken whereby 15 faculty members at the University of Toronto were interviewed to explore their experiences with these learners. Based on the findings, we developed a framework to categorize characteristics of exceptional learners by differentiating them as either 'Being' (a pre-existing attribute or set of values that the learner possesses from the start of training) or 'Doing' (demonstrable characteristics that can be observed or measured). Using this framework, we identified five characteristics in the category of 'Being', five in the category of 'Doing', and two that could be situated in either or both. Utilizing this framework to describe exceptional learners will aid teachers in identifying them early in their training so that their training experience can be enhanced. This novel approach contributes to our knowledge of the exceptional medical learner. The optimization of the training experience will maximize the opportunity to ensure that these learners reach their full potential to contribute to the healthcare system. [ABSTRACT FROM AUTHOR]

Current literature recommends assessment of communication skills in medical education combining different settings and multiple observers. There is still a gap in understanding about whether and how peers assessment facilitates learning in communication skills training. We designed a qualitative study using focus group interviews and thematic analysis, in a medical course in the Netherlands. We aimed to explore medical students' and teachers' experiences, perceptions, and perspectives about challenges and facilitating factors in PACST (Peer assessment in medical communication skills training). Most of the participants reported that peer feedback was a valuable experience when learning communication skills. The major challenges for the quality and credibility of PACST reported by the participants are the question whether peer feedback is critical enough for learning and the difficulty of actually engaging students in the assessment process. Teachers reviewing students' peer assessments may improve the quality and their credibility and the reviewed assessments can best be used for learning purposes. We suggest to pay sufficient attention to teachers' roles in PACST, ensuring a safe and trustworthy environment and additionally helping students to internalize the value of being vulnerable during the evaluation process. [ABSTRACT FROM AUTHOR]

Engagement with medical education podcasts among health professions learners has been increasing steadily over the last several years. Prior '12 Tips' publications have focused on helping medical educators create and publish their own podcasts. However, there is a gap in available resources to help educators incorporate an already existing and growing library of medical education podcasts into their curriculum rather than create their own. In this paper, the authors provide medical educators '12 Tips' on how to integrate podcasts into their teaching sessions grounded in fundamental principles of curriculum development, cognitive science, and accessibility. [ABSTRACT FROM AUTHOR]

The study objective was to develop and validate a questionnaire to capture facilitation activities in PBL by the tutor and the group with reference to a theoretical model of teaching quality. We developed 19 items assigned to six factors to evaluate collaborative learning processes in relation to facilitation by the tutor and the student PBL group. We analysed construct and criterion validity in 419 undergraduate medical students in 152 online PBL groups. Construct validity was confirmed based on factor dimensionality in line with the theoretical assumptions as well as satisfactory internal reliabilities and intraclass correlation coefficients. Criterion validity was supported by the correlation of a) tutor facilitation activities with the success of group self-facilitation and b) facilitation activities with learning gain and satisfaction in the PBL sessions. The questionnaire provides a more comprehensive understanding of collaborative learning processes in PBL and the interplay between facilitation activities by the tutor and the group. [ABSTRACT FROM AUTHOR]

Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform. [ABSTRACT FROM AUTHOR]

Domestic violence (DV) is common in the Australian community so it is likely that there will be medical students who are affected personally by DV. Some of these students may find DV training confronting or even re-traumatising. A trauma-informed medical education (TIME) framework utilising trauma-informed care principles may minimise this risk to students. We aimed to explore educators' perceptions of student well-being in Australian medical school DV training. This descriptive qualitative study interviewed 13 educators with experience teaching DV in Australian medical schools using an interpretivist methodology and a TIME framework. Interview data was thematically analysed to identify themes. Four key themes included (1) educators thrown in at the deep end; (2) keeping students emotionally safe; (3) a trauma-informed learning environment and; (4) challenges of student DV disclosures. Few of the participants had received training in DV. Educators used methods such as trigger warnings and ground rules to improve student's emotional safety. Experienced educators dealt with disclosures of DV by students which led to role confusion. There is a need for increased training of medical educators that includes awareness and implementation of TIME principles when training medical students in DV as well as increased supports and resources for educators. [ABSTRACT FROM AUTHOR]

Remote consulting has become part of the medical student clinical experience in primary care, but little research exists regarding the impact on learning. To describe the experiences of General Practitioner (GP) educators and medical students in using student-led remote consultations as an educational tool. A qualitative, explorative study conducted at four UK medical schools. GP educators and medical students were purposively sampled and interviewed. Nine themes arose: practical application, autonomy, heuristics, safety, triage of undifferentiated patients, clinical reasoning, patient inclusion in student education, student–patient interaction, and student–doctor interaction. Remote consulting has become part of the clinical placement experience. This has been found to expose students to a wider variety of clinical presentations. Verbal communication, history-taking, triage, and clinical reasoning skills were practised through remote consulting, but examination skills development was lacking. Students found building rapport more challenging, although this was mitigated by having more time with patients. Greater clinical risk was perceived in remote consulting, which had potential to negatively impact students' psychological safety. Frequent debriefs could ameliorate this risk and positively impact student–doctor relationships. Student autonomy and independence increased due to greater participation and responsibility. Pre-selection of patients could be helpful but had potential to expose students to lower complexity patients. Practice points Remote consulting confers unique educational benefits. Remote consulting can help develop history-taking and communication skills, as well as clinical reasoning skills. The psychological safety of the student and the supervisory risk of the tutor can be impacted by remote consulting, but frequent debriefs between the student and tutor can help mitigate this risk. Learning how to conduct remote, and face-to-face consultations is important in medical education. [ABSTRACT FROM AUTHOR]

A shift to remote consulting characterised the early stages of the COVID-19 pandemic in general practice which resulted in significant changes in the delivery of medical education. It is unclear whether these changes have been sustained and how they are perceived by faculty. We surveyed a defined population of GP practices during April 2022 with questions to elicit estimates of medical student involvement in different types of remote consultation and supervisor ratings of their confidence in supervising different modalities of remote consultation. We performed thematic analysis on free text responses from a 'resistance to change' perspective. A response rate of 96% (n = 115) was achieved. Analysis of quantitative data identified that a significant proportion of student consultations were remote, however there was a large variation between practices. Supervisor confidence was lowest for students consulting from home. Thematic analysis identified ways in which clinical supervisors may perceive the innovation to be at odds with their overriding commitments to safety, simplicity and quality. Remote consultations form a significant proportion of medical student activity in many practices. Some supervisors are reluctant to supervise medical students consulting from home and our findings suggest ways of addressing this so that the benefits of the innovation can be harnessed. [ABSTRACT FROM AUTHOR]

Medical students' transition to postgraduate training, given the complexity of new roles and responsibilities, requires the engagement of all involved stakeholders. This study aims to co-create a transition curriculum and determine the value of involving the key stakeholders throughout such transition in its design process. We conducted a mixed-methods study involving faculty/leaders (undergraduate/postgraduate), final-year medical students, and chief residents. It commenced with eight co-creation sessions (CCS), qualitative results of which were used to draft a quantitative survey sent to non-participants, followed by two consensus-building CCS with the original participants. We applied thematic analysis for transcripts of all CCS, and mean scores with standard deviations for survey analysis. We identified five themes: adaptation, authenticity, autonomy, connectedness, and continuity, embedded in the foundation of a supportive environment, to constitute a Model of Learning during Transition (MOLT). Inclusion of various stakeholders and optimizing their representation brought rich perspectives to the design process. This was reinforced through active students' participation enabling a final consensus. Bringing perspectives of key stakeholders in the transition spectrum enriches transition curricula. The proposed MOLT can provide a guide for curriculum designers to optimize the final year of undergraduate medical training in preparing students for postgraduate training with essential competencies to be trained. [ABSTRACT FROM AUTHOR]

The Lean Startup approach allows innovators (including innovative educators) to rapidly identify and refine promising ideas into models that actually work. Our aim is to outline key principles of Lean Startup, apply these to health professions education, and illustrate these using personal experience. All innovations are grounded in numerous assumptions; these assumptions should be explicitly identified, prioritized, and empirically tested ('validated learning'). To identify and test assumptions, innovators need to get out of the office and interact with customers (learners, teachers, administrators, etc). Assumptions are tested using multiple quick cycles of Build (a 'minimal viable product' [MVP]), Measure (using metrics that relate meaningfully to the assumption), and Learn (interpret data and decide to persevere with further refinements, or pivot to a new direction). The MVP is a product version that allows testing of one or more key assumptions with the least effort. We describe a novel 'Lean Education Canvas' that synopsizes an innovation and its business model on one page, to help identify assumptions and monitor progress. We illustrate these principles using three cases from health professions education. Lean Startup has tremendous potential for rapid, robust innovation and evaluation in education. Practice points The Lean Startup approach allows innovators (including innovative educators) to rapidly identify and refine promising ideas into models that actually work. All innovations are grounded in numerous assumptions; these assumptions should be explicitly identified, prioritized, and empirically tested ('validated learning'). To identify and test assumptions, innovators need to get out of the office and interact with customers (learners, teachers, administrators). Assumptions are tested using multiple fast, iterative cycles of Build (a minimal viable product), Measure (using metrics that relate meaningfully to the assumption), and Learn (interpret data and decide to persevere with further refinements, or pivot to a new direction). The 'minimal viable product' (MVP) is a version of the product that allows innovators to test one or more key assumptions with the least effort. [ABSTRACT FROM AUTHOR]

There are inadequacies in the practice-readiness of junior doctors for providing acute care in areas of clinical deterioration. In addition, the existing undergraduate curricula are fragmented in how acute care is taught in medical schools. We propose twelve tips for developing a systematic acute care curriculum, including what to teach, how to teach it and, how to assess. Furthermore, we propose and incorporate an acute care learning dashboard as an assessment tool which collates and demonstrates the occurrence of learning, faculty feedback, and students' reflection. We also summarise the existing online resources available for acute care training. We hope to address the existing issues and improve acute care training to prepare the graduates to become practice-ready professionals. [ABSTRACT FROM AUTHOR]

For every commencing cohort of medical students, a small but significant number will experience an interruption to their academic progression because of academic difficulties, health concerns or external influences outside of the students' control. During the process of researching the factors surrounding difficulties with academic progression, students told us many ways that they have learned from that experience, which then allowed most of them to graduate. This paper combines the shared experiences of students who have had an interruption, and those of the authors as medical educators. [ABSTRACT FROM AUTHOR]

Obtaining high quality feedback in residency education is challenging, in part due to limited opportunities for faculty observation of authentic clinical work. This study reviewed the impact of interprofessional bedside rounds ('iPACE™') on the length and quality of faculty narrative evaluations of residents as compared to usual inpatient teaching rounds. Narrative comments from faculty evaluations of Internal Medicine (IM) residents both on usual teaching service as well as the iPACE™ service (spanning 2017–2020) were reviewed and coded using a deductive content analysis approach. Six hundred ninety-two narrative evaluations by 63 attendings of 103 residents were included. Evaluations of iPACE™ residents were significantly longer than those of residents on usual teams (109 vs. 69 words, p < 0.001). iPACE™ evaluations contained a higher average occurrence of direct observations of patient/family interactions (0.72 vs. 0.32, p < 0.001), references to interprofessionalism (0.17 vs. 0.05, p < 0.001), as well as specific (3.21 vs. 2.26, p < 0.001), actionable (1.01 vs. 0.69, p < 0.001), and corrective feedback (1.2 vs. 0.88, p = 0.001) per evaluation. This study suggests that the iPACE™ model, which prioritizes interprofessional bedside rounds, had a positive impact on the quantity and quality of feedback, as measured via narrative comments on weekly evaluations. [ABSTRACT FROM AUTHOR]

Medical school curricula require regular updating. We adopted an activity theory lens to conduct a holistic, multiple stakeholder-informed analysis of curricular reform, aiming to understand how the social relations between groups contribute to unanticipated tensions and outcomes. A research assistant conducted semi-structured interviews with purposively sampled (N = 19) administrative staff, faculty course leads, faculty tutors, curriculum developers, change leaders and student leaders. The team applied a framework analysis to guide within and between stakeholder comparisons. Participants reported unique (N = 21) and cross-cutting (N = 17) contradictions underscoring emerging drivers of current and potential change. Unique contradictions raised by 1–2 groups represented seeds of change that had the potential to spread across all groups. By contrast, two general types of cross-cutting contradictions arose when one group had a dominant, confirming voice or two or more groups had contrasting perspectives. While finding contradictions was expected, our analysis profiled their nature and some of the specific tensions they raised across and within stakeholder groups. The activity theory lens provided an accessible way to unravel curricular reform into manageable units of analysis. Systematically identifying contradictions arising from curricular reform will help stakeholders collaborate with a shared purpose toward positive, sustained change. [ABSTRACT FROM AUTHOR]

Teaching diagnostic reasoning and giving feedback has an important role in medical education. Clinicians who teach may recognise errors, but be unfamiliar with the terminology used to describe them, leading to a lack of consistent and useful student feedback. This prospective project evaluation study aimed to develop an examiner training package regarding errors in diagnostic reasoning, utilising consistent language and feedback tool, and report on diagnostic reasoning errors in second year medical students over the transition from preclinical to early clinical training at objective structured clinical exams (OSCEs). Likert questionnaire regarding examining, assessment and feedback pre- and post-training showed improvement in all measures, including examiner feedback confidence post training (p <.001). Students (n = 235) within the cohort were examined at the first preclinical OSCE 12 weeks into the teaching year and 236 students at the end of year OSCE. A range of 0–6 diagnostic reasoning errors were reported for individual students. When comparing mean history station scores at the preclinical OSCE for students who were observed to have diagnostic reasoning errors, students with 'poor pattern recognition' had a 4.2% lower score than those without this error type (p =.04, 95% CI of difference.14, 8.32), while those with 'unfocused data collection' error had a station score 7.7% lower than those without this error (p <.001, 95% CI of difference 3.50, 11.99). At the end of teaching year clinical OSCE, all common error types were associated with poorer performance. Error pattern shifted through the two longitudinal assessments, resulting in 'poor pattern recognition' having reduced and 'too narrow' and 'premature closure' increased rates. Incorporating the identification and feedback of common diagnostic reasoning errors into existing clinical assessments was feasible and easy to implement. Understanding, identifying and providing consistent feedback on common errors assists educators and could guide curriculum design. [ABSTRACT FROM AUTHOR]

Inclusive educational leaders promote teacher team functioning. To support leader inclusiveness, we designed and implemented a faculty development programme focusing on leader identity formation. We investigated (1) how participants' leader identity developed throughout the programme and (2) how the design principles contributed to this process, according to participants. A design-based research approach was followed. Participants were 7 course coordinators, leading an interdisciplinary teacher team. To study leader identity development, participants repeatedly filled out a validated questionnaire. To investigate how design principles contributed, observational field notes, facilitator debriefings, a programme evaluation questionnaire and a semi-structured focus group were used. Thematic analysis was applied for qualitative data. Participants gained broader views on leadership, moving from individual dominance towards engaging team members. Most participants initially experienced a deconstruction of their former leader identity and became motivated to improve leadership qualities. Competence-building, reflecting and receiving feedback on workplace experiences, and practicing in a safe environment were perceived to be key for identity development. We developed and evaluated a leader identity programme which can convert teachers' classic leadership views towards views incorporating social interactions and relationships. We demonstrated how social interactions provide opportunities to learn from pe.ers in the work environment. [ABSTRACT FROM AUTHOR]

Since people with disabilities (PwD) are underrepresented in medical education, the authors of this article conducted a qualitative research in the form of an in-depth interview with students with disabilities from a medical school in Brazil, to characterize their experiences in medical education and identify barriers and facilitators to inclusion. Participants were recruited by snowball sampling, signed an informed consent form, and completed a socioeconomic questionnaire. They were interviewed individually with open-ended questions so that they could develop narratives. The students identified some barriers to inclusion - teachers' lack of knowledge about students' special needs, students' own lack of knowledge about their needs during the medical course, underestimation of the disability by teachers and classmates, difficult access to college buildings - and facilitators, such as acceptance of the disability by professors and colleagues, proactivity of professors and colleagues in adapting practical learning scenarios. Students identified peer and teacher acceptance as an important determinant of inclusion, which is in line with the biopsychosocial view of disability. They also reported doubts about their ability to practice medicine, which dialogues with literature research that points to a medical culture that expects nothing less than perfection from students. [ABSTRACT FROM AUTHOR]

Accreditation is widely used by medical schools around the word to evaluate their curricula and educational processes, although its impacts on those involved in the 'frontline' of medical education receive little attention. This study systematically identified and synthesised qualitative studies that have explored medical teachers' and students' experiences of accreditation. Four databases (Pubmed, EMBASE, ERIC, and PsychINFO) were searched for relevant published articles. Synthesis was performed using meta-ethnography. Eighteen articles were included in the final synthesis with 1017 individual participants from 10 countries. Findings were categorised into four domains, including navigating power differentials, evaluating credibility, influencing medical programmes, and culture and behaviour. The synthesis demonstrates divergent views on the value of accreditation in medical schools from students and staff including both positive and negative impacts on medical education programmes and stakeholders. Although accreditation is perceived to have many benefits, it also has a number of unintended consequences, including on staff morale, student-teacher relationships, and teacher workloads. Medical teachers also have a number of concerns about the credibility of accreditation standards, assessors, and processes. Regulators and policymakers should consider the views of teachers and students as they seek to improve current accreditation practices. [ABSTRACT FROM AUTHOR]

Medical educators' stressors continue to increase, and they increasingly find themselves removed from their learners. This distance is thought to contribute to the disenchantment many educators feel. The challenge for educators is to reengage with their learners and restore their satisfaction in teaching. Mindful teaching can help educators meet this challenge. Mindful teaching is not an instructional technique; rather, it is a way of being that the teacher embodies. Mindful teachers practice awareness, acceptance and curiosity. They recognize the needs of their learners, engaging with learners who are 'at the ready'; encouraging those who might not be engaged; and advocating for those who need support. These educators are less susceptible to burnout and help learners develop their own mindfulness. The Tips noted in this article can help educators make deeper connections with their learners, garner greater sense of personal accomplishment and become invigorated by their learners' achievements. [ABSTRACT FROM AUTHOR]

Learning opportunities in teaching hospitals are gated by clinical teachers. One way to unpack their decision-making is to employ a 'trust and risk' model. This study aimed to uncover clinical teachers' experience of trust, risk and vulnerability as they participate in medical education. Hospital-based clinical teachers were interviewed about trust, risk and vulnerability in medical education. Data analysis was undertaken using a constructivist, qualitative framework. Twenty demographically diverse clinical teachers participated. Trust and risk were regarded as fundamental workplace and teaching concepts. Their concerns fell into three domains of risk: clinical, teaching and personal. Being trusted unlocked clinical learning opportunities, whereas trust failure limited future participation. Feeling trusted or not affected wellbeing and self-efficacy. Trust and risk pitfalls in education included bias, asymmetry and sidelining. This study adds to the literature by voicing clinical teachers' personal risks and vulnerabilities. Attention was drawn to the benefits of being perceived as trustworthy, and to the clinical, teaching and personal vulnerabilities of trust failure. If expert judgement of trustworthiness is to be legitimised as meaningful assessment, clinical teachers must be aware not only of how trust is built, but also the pitfalls of trust failure. [ABSTRACT FROM AUTHOR]

Educational coproduction, in which learners partner with educators to create and improve their educational experiences, can facilitate student-centered medical education. Empirical descriptions of best practices for involving students in clinical curricular coproduction are needed. We aimed to understand faculty and student perspectives on methods, perceived benefits, and common barriers and solutions to clinical curricular coproduction. We conducted an international mixed-methods study of clinical curricular coproduction in undergraduate medical education and longitudinal integrated clerkships specifically. Faculty and students identified through an international listserv received an electronic survey to identify methods, benefits, and challenges of clinical curricular coproduction. We conducted semi-structured interviews with a subset of survey participants. We present descriptive statistics for survey data and themes derived from inductive qualitative analysis. Two hundred forty-seven individuals (104 faculty; 143 students) representing 52 medical schools in eight countries completed the survey. Methods for clinical curricular coproduction ranged from informal, low-intensity learner involvement (e.g. verbal feedback) to formal, high-intensity learner involvement (e.g. committee membership). Perceived benefits included improvements in student-faculty relationships, program culture and design, and student development. Structural issues (e.g. scheduling) were the most common perceived barriers. Clinical curricular coproduction among faculty and students is perceived to enhance collaboration, enable curriculum change, and support students' professional development. Our study offers empirical guidance for involving students as partners in clinical curricular coproduction. [ABSTRACT FROM AUTHOR]

Faculty development (FD) supports health professions educators to develop knowledge, skills, and expertise. Whilst formal FD is a focus in the health professions education (HPE) literature, little is known about how FD occurs informally. We sought to identify opportunities and constraints for informal FD amongst health professions educators in the academic (university) setting and understand how they engage with these opportunities. This exploratory study was conducted in one Australian university. Interviews and focus groups were conducted with undergraduate and postgraduate teachers and assessors (teachers) (n = 10); teaching team and program leaders (mid-level leaders) (n = 8); and senior (university-level) leaders (n = 2). We analysed data thematically and applied situated cognition theory. We identified three everyday educational practices that provide opportunities for informal FD in the academic setting: (1) applying evidence to; (2) evaluating; and (3) sharing, educational practice. Engaging with these opportunities was shaped by individuals' motivation and proactivity to engage in professional learning (effectivities) and organisational culture and structures (constraints). Applying evidence to, evaluating, and sharing educational practice provide valuable contexts for ongoing learning in the academic setting. Assisting educators and organisations to recognise and leverage these 'in situ' FD opportunities is vital in fostering a continuous learning culture. [ABSTRACT FROM AUTHOR]

Evaluating continuing professional development (CPD) programs is essential to demonstrate their value to participants and their institutions, and to inform the improvement and quality of CPD programs. Existing surveys measure a narrow range of impacts. This study developed a survey that can measure a broad range of impacts of CPD programs, not just those that are easily measured such as knowledge, skills, attitudes and confidence. The development of the CPD Impacts Survey (CPDIS) was informed by best practice guidelines. A systematic scoping review, qualitative interviews, and existing survey instruments were used to develop the initial survey items. Past participants from two international health professions education institutes completed the survey (n = 292). Principal component analysis (PCA) was used to refine the survey. The PCA provided a three-component solution. Component 1 (learnings and self-efficacy), Component 2 (networking and building community), and Component 3 (achievement and validation) comprising 47, 14, and 13 items, respectively. The three components had high internal consistency (α =.98, α =.95, α =.92, respectively). The CPDIS is the first survey to assess a broader range of impacts of CPD programs. Given the substantial financial and opportunity costs of participation in CPD, the CPDIS will allow more efficient and accurate evaluation of the utility and value of CPD programs. [ABSTRACT FROM AUTHOR]

Using revised Bloom's taxonomy, some medical educators assume they can write multiple choice questions (MCQs) that specifically assess higher (analyze, apply) versus lower-order (recall) learning. The purpose of this study was to determine whether three key stakeholder groups (students, faculty, and education assessment experts) assign MCQs the same higher- or lower-order level. In Phase 1, stakeholders' groups assigned 90 MCQs to Bloom's levels. In Phase 2, faculty wrote 25 MCQs specifically intended as higher- or lower-order. Then, 10 students assigned these questions to Bloom's levels. In Phase 1, there was low interrater reliability within the student group (Krippendorf's alpha = 0.37), the faculty group (alpha = 0.37), and among three groups (alpha = 0.34) when assigning questions as higher- or lower-order. The assessment team alone had high interrater reliability (alpha = 0.90). In Phase 2, 63% of students agreed with the faculty as to whether the MCQs were higher- or lower-order. There was low agreement between paired faculty and student ratings (Cohen's Kappa range.098–.448, mean.256). For many questions, faculty and students did not agree whether the questions were lower- or higher-order. While faculty may try to target specific levels of knowledge or clinical reasoning, students may approach the questions differently than intended. [ABSTRACT FROM AUTHOR]

Role modeling significantly affects medical students' values, attitudes, and professional behaviors. Role modeling is a complex and multidimensional process that necessitates accurate perception and adequate knowledge and skills. However, most clinical educators do not have adequate awareness and knowledge about the positive and negative effects of role modeling. We aimed to explore clinical educators' perceptions of role modeling after participating in a role modeling educational program. This qualitative study was conducted on eighteen clinical educators who were voluntarily participated in a three-month role modeling educational program. Data were collected using reflection paper writing and were analyzed through conventional content analysis. Data analysis resulted in the development of three main categories, namely closer attention to role modeling and effort for its promotion, deliberate effort to display role modeling, and creating a positive environment to increase the effectiveness of role modeling. Clinical educators have limited role modeling knowledge and skills, and hence, educational programs are required to improve their role modeling knowledge, attitudes, and skills. Role modeling educational programs should aim at developing educators' awareness and knowledge about role modeling, develop their reflection and self-control abilities, and sensitize them to the importance of deliberate use of role modeling. [ABSTRACT FROM AUTHOR]

Steering planetary and human health towards a more sustainable future demands educated and prepared health professionals. This research aimed: to explore health professions educators' sustainable healthcare education (SHE) knowledge, attitudes, self-efficacy and teaching practices across 13 health professions courses in one Australian university. Utilising a sequential mixed-methods design: Phase one (understanding) involved an online survey to ascertain educators' SHE knowledge, attitudes, self-efficacy and teaching practices to inform phase two (solution generation), 'Teach Green' Hackathon. Survey data was descriptively analysed and a gap analysis performed to promote generation of solutions during phase two. Results from the hackathon were thematically analysed to produce five recommendations. Regarding SHE, survey data across 13 health professions disciplines (n = 163) identified strong content knowledge (90.8%); however, only (36.9%) reported confidence to 'explain' and (44.2%) to 'inspire' students. Two thirds of participants (67.5%) reported not knowing how best to teach SHE. Hackathon data revealed three main influencing factors: regulatory, policy and socio-cultural drivers. The five actionable recommendations to strengthen interdisciplinary capacity to integrate SHE include: inspire multi-level leadership and collaboration; privilege student voice; develop a SHE curriculum and resources repository; and integrate SHE into course accreditation standards. [ABSTRACT FROM AUTHOR]

The Master Adaptive Learner (MAL) theoretical framework describes an integrated approach to learning that combines features of educational theory on self-regulated learning and aspects of quality improvement. In order to develop MAL students, it is important to pay attention to the learning environment. To describe educators' perspectives about the learning environment needed to promote the development of master adaptive learners. Thematic analysis of reports by medical educators who were workshop participants at a national presentation on creating effective learning environment to develop MAL in undergraduate medical education. Three themes educators considered important in the development of the Master Adaptive Learner were Adaptive Educator, Support for Learning, and Institutional Commitment. These findings suggest that in order to support the MAL, an educational setting should provide faculty who can be flexible and adapt to the developing MAL, learning experiences that support active learning, focused on groups as well as developing individual learners. Leaders in the educational setting should demonstrate a commitment to creating a culture to support learning and provide appropriate resources to that end. Learning environments to develop master adaptive learners need to have adaptive educators, teaching, learning, and institutional culture to support challenge and grow Master Adaptive Learners. [ABSTRACT FROM AUTHOR]

Novel uses of video aim to enhance assessment in health-professionals education. Whilst these uses presume equivalence between video and live scoring, some research suggests that poorly understood variations could challenge validity. We aimed to understand examiners' and students' interaction with video whilst developing procedures to promote its optimal use. Using design-based research we developed theory and procedures for video use in assessment, iteratively adapting conditions across simulated OSCE stations. We explored examiners' and students' perceptions using think-aloud, interviews and focus group. Data were analysed using constructivist grounded-theory methods. Video-based assessment produced detachment and reduced volitional control for examiners. Examiners ability to make valid video-based judgements was mediated by the interaction of station content and specifically selected filming parameters. Examiners displayed several judgemental tendencies which helped them manage videos' limitations but could also bias judgements in some circumstances. Students rarely found carefully-placed cameras intrusive and considered filming acceptable if adequately justified. Successful use of video-based assessment relies on balancing the need to ensure station-specific information adequacy; avoiding disruptive intrusion; and the degree of justification provided by video's educational purpose. Video has the potential to enhance assessment validity and students' learning when an appropriate balance is achieved. [ABSTRACT FROM AUTHOR]

Team-based learning (TBL) is gradually being integrated into Chinese medical education. This study reports its current application status in Chinese medical schools, as well as the underlying challenges and strategies to improve TBL application. We screened publication databases and surveys to investigate TBL usage and concerns regarding TBL application by Chinese medical educators. Articles published by 79 Chinese medical schools include 163 articles among 20 topic areas of basic medicine and 226 articles among 16 clerkship disciplines. The opinions of 123 Chinese medical teachers were solicited from 46 medical schools in 26 provinces/municipalities. Approximately less than half of Chinese medical schools used TBL in basic medicine or clerkship disciplines. Among these, only 10% of schools reported TBL usage in both clerkship disciplines and basic medicine. Both quantitative and qualitative results revealed that public awareness of TBL, executive support, professional training, sharing of resources and integration of multiple disciplines are critical factors in facilitating TBL application, and in recruiting and developing TBL teachers. TBL application in Chinese medical education is limited. Executive/financial support and establishment of a platform to provide technical support, share resources and regulate TBL practice quality will facilitate TBL application in Chinese medical education. [ABSTRACT FROM AUTHOR]

Teaching in a learner-centred clinical setting requires clinical teachers trained in diagnosing and addressing learner needs and interests in order to create an optimal learning environment. These educational skills may not have been explicitly addressed in medical training in the past, when little to no focus was devoted to the learning environment and promoting learner-centredness. Thus, clinical teachers may be left without a model for their important and nuanced role as facilitators of learning in the current environment. We propose that clinical teachers frame their educational approach through the lens of teachers' perspectives. Not only does this model illustrate the factors that influence and modify clinical teachers' mindset, but it also demonstrates the impact that teachers' experiences may have upon creating the learning environment and determining educational outcomes. This model also identifies a feasible starting point for essential staff development: refining communication skills for use in the educational setting. With this training and model to frame understanding, clinical teachers may be better prepared to fulfill their essential role in the learner-centred educational clinical environment. [ABSTRACT FROM AUTHOR]

Introduction: Teachers' conceptions of learning and teaching (COLT) affect their teaching behaviour. The 18 item COLT instrument has been developed in the Netherlands and comprises three scales, 'teacher centredness', 'appreciation of active learning' and 'orientation to professional practice'. Previously we found five teacher profiles. The aim of this study was to find out if the COLT instrument can be used in an international setting. Methods: Data were collected with the web-based COLT. Cronbach's alphas of the three COLT scales were calculated. Subsequently a cluster analysis was conducted to identify different teacher profiles, followed by a split half validation procedure. Results: Respondents (n = 708) worked in 28 countries. Cronbach's alphas were 0.67, 0.54, and 0.66. A six-cluster solution fitted best, based on meaning and explained variance. The sixth teacher profile scored high on 'teacher centredness', average on 'appreciation of active learning' and low on 'orientation to professional practice'. The split half validation resulted in a Cohen's kappa of 0.744. Discussion: Cronbach's alphas indicated acceptable reliablities for all three subscales. The new, sixth profile was labelled 'neo-transmitter'. Conclusion: We found evidence supporting the validity of the use of COLT in an international context and identified a new, sixth teacher profile. [ABSTRACT FROM AUTHOR]

Introduction: The role of medical students in catalyzing and leading curricular change in US medical schools is not well described. Here, American Medical Association student and physician leaders in the Accelerating Change in Medical Education initiative use qualitative methods to better define student leadership in curricular change. Methods: The authors developed case studies describing student leadership in curricular change efforts. Case studies were presented at a national medical education workshop; participants provided worksheet reflections and were surveyed, and responses were transcribed. Kotter's change management framework was used to categorize reported student roles in curricular change. Thematic analysis was used to identify barriers to student engagement and activators to overcome these barriers. Results: Student roles spanned all eight steps of Kotter's change management framework. Barriers to student engagement were related to faculty (e.g. view student roles narrowly), students (e.g. fear change or expect faculty-led curricula), or both (e.g. lack leadership training). Activators were: (1) recruiting collaborative faculty, staff, and students; (2) broadening student leadership roles; (3) empowering student leaders; and (4) recognizing student successes. Conclusions: By applying these activators, medical schools can build robust student–faculty partnerships that maximize collaboration, moving students beyond passive educational consumption to change agency and curricular co-creation. [ABSTRACT FROM AUTHOR]

Introduction: Student-staff partnerships as a concept to improve medical education have received a growing amount of attention. Such partnerships are collaborations in which students and teachers seek to improve education by each adding their unique contribution to decision-making and implementation processes. Although previous research has demonstrated that students are favourable to this concept, teachers remain hesitant. The present study investigated teachers' conceptions of student-staff partnerships and of the prerequisites that are necessary to render such partnerships successful and enhance educational quality. Method: We conducted semi-structured interviews with 14 course coordinators who lead course design teams and also teach in 4 bachelor health programmes, using Bovill and Bulley's levels of student participation as sensitising concepts during data analysis. Results: The results pointed to three different conceptions of student-staff partnerships existing among teachers: Teachers teach and students study; teachers teach and value students' feedback; and teachers and students co-create. The prerequisites for effective co-creation teachers identified were: Teachers must be open to involve students and create dialogues; students must be motivated and have good communication skills; the organisation must be supportive; and teachers should have the final say. Conclusion: We conclude that teachers' conceptions are consistent with Bovill and Bulley's levels of student participation. Under certain conditions, teachers are willing to co-create and reach the highest levels of student participation. [ABSTRACT FROM AUTHOR]

Background: Effectively managing clinical uncertainty is increasingly recognized as a goal of medical education. Stress from uncertainty has been associated with depression and burnout in trainees and may also impact patient care. Despite its importance, however, strategies to embrace uncertainty in clinical practice are lacking. Aims: The literature on uncertainty in medicine was reviewed. Incorporating insights from faculty and students, 12 tips for healthcare educators to help themselves and others thrive in the face of clinical uncertainty were developed. Results: Educators will find the tips practical and easy to implement in their day-to-day interactions as clinicians and teachers. Tips are divided into tips for oneself; for implementing with students and trainees; and for implementing with patients and in healthcare systems. Conclusions: These tips can enhance healthcare professionals' and students' ability to thrive in the face of uncertainty. Strategies to embrace uncertainty are critical for ourselves, our trainees, our patients, and our healthcare systems. [ABSTRACT FROM AUTHOR]

Introduction: Role models have an important impact on the professional behavior of medical students. Previous investigations help us understand how to improve role modelling. However, studies aiming at enhancing role modelling among clinical educators are very limited and generally lack comprehensive evaluations of the designed programs. We intended to gather robust evidence on the effectiveness of a longitudinal program for enhancing role modelling. Methods: Clinical educators were divided into intervention and control groups. The longitudinal program, developed based on the exposure phase of the 'Positive Doctor Role Modelling' framework, was delivered during three months of onsite and online sessions. The effectiveness of the program was assessed in three levels of reaction, learning, and behavior. Results: In the intervention group (N = 18), the mean score of satisfaction was 4.7 (SD = 0.5), and the learning (awareness about role modelling) improved significantly after the program (3.33–4.34), comparing to the control group (3.53–3.63). There was no significant difference in terms of behavior improvement between the two groups, before and after the program. Conclusions: Our findings indicate that our longitudinal faculty development program on role modelling was highly appreciated by clinical educators, and improved their awareness and deliberate role modelling. [ABSTRACT FROM AUTHOR]

Introduction: Observations of medical student participation in entrustable professional activities (EPAs) provide insight into the student's ability to synthesize competencies across domains and effectively function in different clinical scenarios. Both Supervisory and Co-Activity Assessment Scales have been recommended for use with medical students. Methods: Students were assessed on EPAs during Acting Internships in Medicine and Pediatrics. Two rating scales were modified based on expert review and included throughout the 2017–18 academic year. Statistical analysis was conducted to clarify relationships between the scales. Raters were interviewed to explore their interpretations and response processes. Results: The results of the McNemar test suggest that the scales are different (p-value <.01). Co-activity and Supervisory EPA ratings are related, but not interchangeable. This finding concurs with themes that emerged from response process interviews: (1) the scales are not directly parallel (2) rater preference depends on diverse factors and (3) rater comments are crucial for guiding students' future learning. Conclusion: The modified Chen Supervisory Scale and the modified Ottawa Co-Activity Scales are measuring different aspects of the entrustable professional activity landscape. Both scales can provide useful information to the learner and the assessment system, but they should not be treated as interchangeable assessments. [ABSTRACT FROM AUTHOR]

Purpose: Current medical education models maintain that competencies such as professionalism and communication can be taught; however, some argue that certain attributes that make up these competencies, such as empathy, are fixed. Teachers' implicit theories, or mindsets (beliefs about the fixed versus learnable nature of human attributes) have been shown to impact their teaching and assessment practices; but little work has explored mindsets in medical education. We examined clinical supervisors' mindsets of two cognitive attributes (intelligence and clinical reasoning) and two affective attributes (moral character and empathy). Methods: Clinical supervisors (n = 40) from three specialities completed a survey designed to measure mindsets using two existing instruments for intelligence and moral character and 18 new items for clinical reasoning and empathy. Participants completed the survey twice for test-retest reliability (n = 25). Results: New items had satisfactory psychometric properties. Clinical supervisors' mindsets were mixed. Only 8% of participants saw clinical reasoning as fixed while more saw empathy (45%), intelligence (53%), and moral character (53%) as fixed – running counter to current educational models that characterize these attributes as learnable. Conclusion: This study provides evidence supporting the use of these new tools to measure mindsets that may help to better understand the impact of mindsets on medical education. [ABSTRACT FROM AUTHOR]

Introduction: The theory of threshold concepts conjectures that there are areas in every educational curriculum that are challenging; however, mastering these areas transform the learner's view of the subject. In psychiatry, research into threshold concepts can inform educators so that they can better support students with mastering these challenging areas. Purpose: To identify threshold concepts, we conducted semi-structured interviews with six psychiatry educators and free-text surveys with medical students. To identify avenues for improving the curriculum, we discussed with educators, ways of improving understanding and looked at different approaches to learning. Materials and methods: From our analysis of all responses, we derived three threshold concepts: Therapeutic Risk-Taking, the Biopsychosocial Model, and the Concept of Diagnosis in psychiatry. The majority of students experienced difficulties grasping these concepts and applying them in their patient interactions. Results and conclusions: Hence, we propose focused teaching activities that can help students cross these thresholds: student Balint groups exploring therapeutic risk, student Balint groups exploring the role of a psychiatrist, exposure to psychological therapies/psychotherapy skills and explicit diagnostic reasoning. These activities can be integrated into the undergraduate curriculum to help medical students develop a better understanding and appreciation of psychiatry. [ABSTRACT FROM AUTHOR]

Introduction: Student participation has shown positive effects on the curriculum development process for a single health profession. This qualitative study explores faculty members' and students' perceptions and experiences regarding student participation in interprofessional course development. Methods: Interprofessional courses were developed and implemented by interprofessional teams of faculty members and students. Two focus group discussions were carried out: one with faculty members and one with students. Results: Students contributed to both the process and the results of interprofessional course development in a complementary manner. Student participation was facilitated via motivation for and through work on interprofessional education, a balance between clarity on tasks and students' autonomy, and a low-hierarchy team atmosphere. Students developed professionally, and faculty members saw them as future ambassadors for interprofessional collaboration. Conclusions: This study provides multiple qualitative evidence for a positive, complementary role of student participation in interprofessional course development. A number of factors were identified that should be nurtured to facilitate this effect. Our findings may stimulate and guide other schools to actively involve students in the development of interprofessional education. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to develop the competency framework for Doctoral graduates in Health Professions Education, which is the first step in implementing an outcome-based curriculum. Method: The present study conducted in three phases. First, viewpoints of 100 stakeholders, including students, graduates, faculty members, and educational managers were explored by using Nominal Group technique, survey, and telephone interviews. The extracted codes classified in subcategories and categories through an inductive content analysis approach. In phase two, the findings converted to competency components, sub-domains and competency domains in working groups. Finally, the content validity of the developed components evaluated through qualitative and quantitative approaches. Results: 535 codes, 12 sub-categories, and 7 categories extracted from stakeholders' viewpoints, which were refined to 65 competency components, 12 sub-domains and 7 competency domains in working groups. The final competency framework includes 54 competency components in seven competency domains of a "professional expert", "research and scholarship", "teaching", "interdisciplinary collaboration", "leadership and management", "professionalism", "personal and professional development". Conclusion: Competency framework is essential for the development of a comprehensive and integrated curriculum. It would be possible to implement a competency-based curriculum in the Doctoral program of Health Professions Education by developing the competency framework. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses various reports within the issue on topics including competency-based medical education (CBME), concept of entrustment, and ways conflict may arise within a clinical competency committee (CCC).

The authors propose the option of anonymity for educators or peers when reporting students' unprofessionalism. They discuss the reason behind the persistence of the dilemma of fairness in assessment and identification of students' unprofessional behavior, the reason why permissive approaches to unprofessionalism of students are unacceptable, and the need to consider the rights of educators when making a disclosure in the public's interest.

Purpose: Medical schools are expected to engage in ongoing reflection to maintain the quality of the education they deliver, that is, to cultivate a Quality Culture. Quality Culture integrates the culture of an organization with its structure and management processes. The culture of medical schools has not been previously studied. Organizational cultures can be identified using the Competing Value Questionnaire, and classified into four types, based on organizations' climate, leader style, reward systems, and strategic emphasis. Clan and Open cultures are typically positively associated with quality improvement. This study identifies the dominant organizational cultures of Canadian medical schools. Method: Sixteen of the 17 Canadian medical schools were invited to participate; one school was excluded due to ongoing accreditation activities. Faculty members of participating schools were surveyed. Results: Eleven (69%) schools participated. Nine had a dominant Hierarchical culture; two had a dominant Clan culture. Conclusions: Only two schools had a Clan culture, which might better support ongoing reflections on quality improvement. Schools leaders should examine the staff climate, leadership style, rewards system, and strategic emphasis in place at their school; these will provide clues to the existing culture and help prioritize changes required to support the implementation of a Quality Culture. [ABSTRACT FROM AUTHOR]

Introduction: A new form of internationalization has been trending upward in the medical education realm: crossborder medical curriculum partnerships established to deliver the same, or adapted, curriculum to groups of geographically separated students. This study aims to investigate crossborder medical curriculum partnerships by exploring the experiences of teachers at the recipient institution who have a key role in delivering the program. Methods: From four pioneering recipient medical schools, 24 teachers participated in a Q-sort study. Each participant rank-ordered 42 statements about teaching in a crossborder medical curriculum on a scale from −5 (indicating strong disagreement) to +5 (indicating strong agreement). The authors conducted a "by-person" factor analysis to uncover distinct patterns in the ranking of statements, using the statistical results and participants' comments about their Q sorts to interpret these patterns and translate them into distinct viewpoints. Results: Three viewpoints emerged, reflecting: (1) a feeling of connectedness with the partner institution, trust in the quality of the curriculum, and appreciation of interinstitutional relationships; (2) the partnership's attractiveness because of the career opportunities it offers; and (3) concerns over the quality of graduates because of doubts about the appropriateness of the didactic model and insufficient attention to local healthcare needs, and over the practical feasibility of such partnerships. Conclusions: The three viewpoints identified revealed a pallet of views on how host teachers might experience their work. It shows the heterogeneous features of this group and seems to counterbalance reports that they are feeling "deprived" from their role as teacher. Two viewpoints featured an appreciation of interinstitutional relationships and of the partnership, especially when perceiving a degree of autonomy. Partners can capitalize on all different viewpoints by deploying procedure and policies to raise the quality of education delivery. [ABSTRACT FROM AUTHOR]

Background: The Division of Orthopaedic Surgery at the University of Toronto implemented a pilot residency training program that used a competency-based framework in July of 2009. The competency-based curriculum (CBC) deployed an innovative, modularized approach that dramatically intensified both the structured learning elements and the assessment processes. Methods: This paper discusses the initial curriculum design of the CBC pilot program; the refinement of the curriculum using curriculum mapping that allowed for efficiencies in educational delivery; details of evaluating resident competence; feedback from external reviews by accrediting bodies; and trainee and program outcomes for the first eight years of the program's implementation. Results: Feedback from the residents, the faculty, and the postgraduate residency training accreditation bodies on the CBC has been positive and suggests that the essential framework of the program may provide a valuable tool to other programs that are contemplating embarking on transition to competency-based education. Conclusions: While the goal of the program was not to shorten training per se, efficiencies gained through a modular, competency-based program have resulted in shortened time to completion of residency training for some learners. [ABSTRACT FROM AUTHOR]