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Although rhetoric abounds about the importance of patient-, person- and relationship-centered approaches to health care, little is known about how to address the problem of dehumanization through medical and health professions education. One promising but under-theorized strategy is to co-produce education in collaboration with health service users. To this end, we co-produced a longitudinal course in psychiatry that paired people with lived experience of mental health challenges as advisors to fourth-year psychiatry residents at the University of Toronto. The goal of this study was to examine this novel, relationship-based course in order to understand co-produced health professions education more broadly. Using qualitative interviews with residents and advisors after the first iteration of the course, we explored how participants made meaning of the course and of what learning, if any, occurred, for whom and how. We found that the anthropological theory of liminality allowed us to understand participants' complex experiences and illuminated how this type of pedagogy may work to achieve its effects. Liminality also helped us understand why some participants resisted the course, and how we could more carefully think about co-produced, humanistic education and transformative learning.

Objective: The authors argue that adopting evidence-based psychiatry will require a paradigm shift in the training of psychiatry residents, and offer some suggestions for how this transformation might be achieved. Methods: The authors review the growing literature that addresses how best to teach evidence-based medicine and highlight several examples of innovative instructional and assessment methods. Results: Little is known about how best to instill among residents the attitudes, knowledge, skills, and behaviors that are necessary to practice evidence-based psychiatry. However, there are indications that the integration of evidence-based medicine instruction into routine clinical care and the alignment of the "hidden curriculum" with evidence-based practice are important. Conclusion: A whole-program approach may be necessary to create the conditions required in postgraduate training to produce evidence-based psychiatrists.

Medical Education 2012: 46: 326-335 Context The inadequacy of self-assessment as a mechanism to guide performance improvements has placed greater emphasis on the value of testing as a pedagogic strategy. The mechanism whereby testing influences learning is incompletely understood. This study was performed to examine which aspects of a testing experience most influence self-regulated learning behaviour among medical students. Methods Sixty-seven medical students participated in a computer-based, multiple-choice test. Initially, participants were instructed to attempt only items for which they felt confident of their response. They were then asked to indicate their best responses to deferred items. Students were then given an opportunity to review the items, with correct responses indicated. Accuracy, the attempt/defer decision and the time taken to reach this decision were recorded, along with participants' ratings of their confidence in each response and the time spent reviewing each item on completion of the test. Results Students correctly answered a larger proportion of attempted items than deferred items (71% versus 40%; p < 0.001), and indicated a higher mean confidence in responses to items they answered correctly compared with items they answered incorrectly (70 versus 46; p < 0.001). They spent longer reviewing items they had answered incorrectly than correctly (8.3 versus 4.0 seconds; p < 0.001), and paid particular attention to items for which the attempt/defer decision and accuracy were discordant (p < 0.01). The amount of time required to make a decision on whether or not to answer a test question was also related to reviewing time. Conclusions Medical students showed a robust ability to accurately and consciously self-monitor their likelihood of success on multiple-choice test items. By focusing their subsequent self-regulated learning on areas in which performance and self-monitoring judgements were misaligned, participants reinforced the importance of providing learners with opportunities to discover the limits of their ability and further elucidated the mechanism through which test-enhanced learning might be derived. [ABSTRACT FROM AUTHOR]