A Practical Guide for Medical Teachers

Front Cover
Inside Front Cover
A Practical Guide for Medical Teachers
Copyright Page
Table Of Contents
Foreword
Preface
Contributors
1 Curriculum Development
	1 New horizons in medical education
		Integration of information
		Changing learning situations
		An authentic curriculum
		Students and student engagement
		Summary
		References
	2 Curriculum planning and development
		Introduction
		What is a curriculum?
			Identifying the need
			Establishing the learning outcomes
			Agreeing on the content
			Experience as core content
			Organizing the content
			Deciding the educational strategy
				Student-centred learning
				Problem-based learning (PBL)
				Integration and interprofessional learning
				Community-based learning
				Electives
				Systematic approach
			Choosing the teaching methods
			Preparing the assessment
			Communication about the curriculum
			Promoting an appropriate educational or learning environment
			Managing the curriculum
		Summary
		References
	3 The undergraduate curriculum
		Introduction
		Forces shaping the curriculum
		Critical components of the undergraduate medical education programme as they relate to the continuum of medical education
		Summary
		References
	4 Postgraduate medical education
		Introduction
		Functions of PGME and postgraduate trainees in a healthcare system
		Transitions in PGME
			Admissions and matching
			Transition from junior resident to senior resident
			Transition from PGME to practice
		Models of PGME
			The role of internships or foundational training
			Setting for training
			Responsibility for curricular development and management
			Post-certification training
		Teaching, learning and assessment in PGME
		External assessment in PGME: summative, certification
		PGME quality, accreditation and CQI
		Controversies in PGME
			The debate about generalism versus specialism in PGME
			The challenge of resident duty hours
			Training clinical supervisors: faculty development
		The future of PGME
		Summary
		References
	5 Continuing professional development
		Background
		How clinicians learn
			Recognizing an opportunity for improvement
			Searching for resources for learning
			Engaging in learning
			Considering prior knowledge and experience of clinician participants
			Focusing on outcomes important to clinician participants
			Respond positively to the expectations of clinician participants
			Interactivity with multiple methods and multiple exposures
			Longer sessions
			Supportive learning environment
			Trying out what was learned
			Incorporating what was learned
		Assessment and evaluation
		Summary
		References
	6 The hidden curriculum
		Historical context
		Definitions and metaphors
			Definitions
			Metaphors
		Applications: exploring/assessing the hidden curriculum
		Student mistreatment: a case study in applying the HC lens
		Summary
		References
2 Learning Situations
	7 Lectures
		Lectures in medical teaching
		Pros and cons of lectures as a primary learning event
		Learning in a lecture environment
			Attention in lecture
			Fostering engagement
			Promoting retention
		Organizing a lecture
		Teaching materials
			Audiovisuals
			Audience response system (ARS)
			Lecture recordings
		Active learning in the lecture hall
			Embedded methods
				Note check
				Low stakes writing assignment
				Think-pair-share
				Buzz groups
				Games
		The flipped classroom
			Out-of-class homework
			Developing the activity
			Running the session
			Evaluation
		Summary
		References
	8 Learning in small groups
		What is a small group?
		When to use small groups?
			What format of small-group teaching?
			What type of instructional methods?
		How to effectively conduct a small-group teaching session
			Preparing for the small-group session
			Leading the small-group session
			Conditions for an effective session
		Evaluating (assessing) the small-group session
		Evaluation of small-group teaching and participation
		Summary
		Further information
	9 Learning with patients
		Introduction
		The ‘learning triad’
			Patients
			Students
			Tutors
				Appropriate knowledge
				Appropriate skills
				Appropriate attitudes
		Educational strategies for bedside teaching
		Strategies for inpatients
			Cox’s cycle
			MiPLAN
		Strategies for outpatients
			Learner-centred approach
			Microskills for students
		Educational strategies applicable to all clinical settings
			Outcome-based education
			Time-efficient strategies for learning and performance
			Structured logbooks
			Task-based learning
			Problem-based learning
			Study guides
			Case studies
		Hospital ward opportunities – models for managing learning in the ward
			Apprenticeship/shadowing a junior doctor model
			Grand rounds
			Business ward round
			Teaching ward round
			Clinical conference
			Training ward
		Ambulatory care opportunities
			when should ambulatory care teaching be provided?
			Traditional venues
				Sitting-in model
				Apprenticeship/parallel consultation model
				Report-back model
				Grandstand model
				Breakout model
				Supervising model
			Additional venues
			Innovative venues
				Ambulatory care teaching centre (ACTC)
				Integrated ambulatory care programme
		Assessment of bedside learning
		Staff development
		Summary
		References
	10 Learning in the community
		Introduction
		What is community-based medical education?
		Goals of CBME
			Preclinical aims
			Clinical aims
				To learn about general practice/ family medicine
				To learn about a particular specialty other than general practice/family medicine
				To learn about primary care
				To learn multiple disciplines concurrently
		Practical principles for successful CBME
			The clinician–patient relationship
			The university–health service relationship
			The government–community relationship
			The personal–professional relationship
		Summary
		References
		Further reading
	11 Learning in rural and remote locations
		Introduction
		Before the learner arrives
			Program support and preceptor preparation
			A well-prepared physician’s office and staff
			Main preceptor/rural medical teacher and engaged colleagues
			Helpful hospital and healthcare organizations
			Community partnerships
		The first day
		During the rotation
			Observation/demonstration/feedback
		Assessment and wrap-up
		Troubled and troubling learners
		Summary
		Acknowledgements
		References
	12 Learning in longitudinal integrated clerkships
		Introduction
		Definition
		History
		Rationale
			Learning imperatives
			Professional imperatives
			Health system imperatives
			Societal imperatives
		Model types
			Generalist model LICs
			Multi-specialty ‘streams’ model LICs
		Strengths of LICs
			For individual students, doctors, and patients
			For organisations
			For communities
		Challenges of LICs
			For the individual students and faculty
			For organisations
			For communities
		Future visions
		Summary
		References
	13 Learning in a simulated environment
		Introduction
		Background
		Simulation as design
		Simulated patients
		Simulated patient methodology and trends in medical education
		Fundamental concepts in simulated patient methodology
		Discourses of clinical competence
		Scope of SP practice
		Hybrid simulations
		Patients’ voices
		Qualities of simulated patients
		Supporting simulated patients in role portrayal and feedback
		Simulation technology
			Physical models
			Virtual reality simulators
		Hybrid simulators
		Current and future trends
		Simulation in the twenty-first century
		Summary
		References
		Further reading and resources
	14 Distance education
		Before you begin …
		Introduction to the course
			Learning activities
			Objectives
			Contents
		What is distance learning?
		Technology and distance learning
		Feedback
			Technology
			Print
		The structure of a distance learning text
		Feedback
		Providing students with feedback on learning
		Blending different elements of the course
		Managing clinical attachments by distance learning
		Feedback
		The student’s learning experience
		Managing distance learning
		Development of distance learning courses (Table 14.11)
		Quality assurance in distance learning
		Feedback
		Conclusion
		References
		Further reading
3 Educational Strategies and Technologies
	15 Outcome-based education
		A move from process to product
		The trend towards OBE
		Why the move to OBE?
			Attention to quality of care and neglected areas of competence
			The problem of information overload
			Assessment of the learner’s progress and the continuum of education
			Student-centred and individualized learning
			Accountability
		Implementation of OBE
			Learning outcomes and instructional objectives
			Outcome frameworks
			Selecting or preparing an outcome framework
		Implementing OBE
			An outcome-based curriculum
		Myths about OBE
		Summary
		References
	16 Integrated learning
		Introduction
		Some definitions
		Rationale for integrated learning
		Strategies for integrated learning
		Barriers to integrated learning
		Integrated student assessment
		Summary
		References
	17 Interprofessional education
		Definitions
		History
		The rationale for IPE
		Curriculum development
		Learning activities
		Assessment
		Post-qualification
		Impact and effectiveness of IPE
		Faculty development for IPE
		Overcoming challenges
		Summary
		References
	18 Problem-based learning
		Perspectives in problem-based learning
			Problem-based learning format
		Creating PBL courses: a systems perspective
		Writing PBL cases
		Running PBL small groups
		Faculty as tutor
		Evaluating PBL session outcomes
		PBL controversies
		Outcomes of PBL courses
		Reasons to consider using a PBL approach
		General disadvantages of small-group learning
		Specific disadvantages of PBL as a learning format
		Issues with PBL as an educational methodology
			Matching learning objectives with educational methodology
			Extraneous load
			Variable session experiences
			Scaffolding
			Resource use
		Issues with students
			Small-group dysfunction
			Student preparation
			Evaluation and outcomes
		Issues with tutors
		Active learning beyond the PBL format – expanding the educator toolbox
		Summary
		Reference
		Further reading
	19 Team-based learning
		What is team-based learning?
		How does TBL work?
			Students’ perspective
				TBL recurring steps
					Step 1 – advance assignment
						Out-of-class/individual
					Step 2 – iRAT – individual readiness assurance test
						In-class/individual
					Step 3 – tRAT – team readiness assurance test
						In-class/team
					Step 4 – instructor clarification review
						In-class/instructor
					Step 5 – team application – tAPP
						In-class/team
					Step 3A and/or 6 – appeal
						In-class/out-of-class/team
				TBL nonrecurring steps
					Orientation
						Out-of-class/in-class/individual/team
					Peer evaluation
						Out-of-class/individual
		What does a TBL session look like?
		What are the ingredients for a successful TBL module?
			Instructor’s perspective
				TBL recurring steps
					Step 1 – situational factors and learning goals
					Step 2 – tAPP – team application
					Step 3 – iRAT/tRAT – individual readiness assurance test/team readiness assurance test
					Step 4 – advance assignment
					Step 5 – instructor clarification review
					Step 6 – appeal
				TBL nonrecurring steps
					Team formation
					Orientation
					Peer evaluation
		Why does TBL work?
			Accountability
			Immediate feedback
			Solving authentic problems
			Engagement with course content
			Learning to work collaboratively
		What can go wrong with TBL?
		Is TBL worth the effort?
			One instructor; same message
			One classroom; no spreading around or finding more faculty
			In-class meetings; all happens in the classroom
			Individual accountability; no social loafing
			Simultaneous reporting; no presentations
			Instructor clarification; immediate feedback
			Naturally functional teams; no teamwork instruction
			Self-directed and lifelong learning
		Summary
		References
		Online resources
	20 Using digital technologies
		Introduction
		The digital technology repertoire
		Using technology in medical education
		Why use digital technology?
			Exponential connectivity and integration
			Accelerating speed of action and response
			Defeating geography and temporality
			Observation
		Technology and instructional design
			Who are your learners and what learning processes work best for them?
			What are the learning and performance contexts you are working with?
			What content will be involved, how should it be structured and sequenced?
			What instructional and non-instructional strategies should you use?
			What media and delivery systems will you use?
			How will you actually conduct the design processes?
		Mobile technologies
		Preparing for e-health
		Hidden curriculum and digital technologies
		Digital professionalism
		The role of the medical e-teacher
		Summary
		References
		Further reading
	21 Instructional design
		Introduction
		The ADDIE model
		The universe of ID models
			Outcomes-based models
			Whole-task models
		Examples of ID models
			Cognitive load theory
			Nine events of instruction
			Four-component instructional design (4C/ID)
		Summary
		References
4 Curriculum Themes
	22 Basic sciences and curriculum outcomes
		Introduction
		The changing medical curriculum
		Authentic learning in basic science courses
		The active learning environment
		Use of reflective practice, critical thinking and clinical reasoning
		Innovations in teaching basic sciences
		Basic science integration throughout the curriculum
		Nontraditional discipline-independent skills
			Leadership
			Teamwork
			Professionalism
			Communication skills
			Student well-being
			Assessment of discipline-independent skills
		Learning basic science outside curricular structure
		Summary
		References
	23 Social and behavioural sciences in medical school curricula
		Introduction
		Why are the social and behavioural sciences important in medicine?
		What topics should be included in the curriculum?
			Biological mediators of SBS factors and health
			Social and cultural determinants of health, illness and disease
			Patient behaviour
			The experience of illness
			Physician–patient interactions
			Physician role and behaviour
			Health policy and economics
		Where and when should SBS be presented in the curriculum?
			Discipline-specific curricula
			Multidisciplinary
			Interdisciplinary
		Who should do the teaching design and delivery?
		How can SBS be learnt, taught and assessed?
		Assessment
		How do we implement an SBS curriculum?
		Summary
		References
		Further reading
	24 Clinical communication
		Introduction
		Using role play
			Rationale
			Formats for role play
			Conducting a role play session
		The wider context
			Other aspects of spoken communication
			Medical records
			Communication and HI-FIDELITY simulation
			Communication between colleagues
			Reading and writing
			Language, culture and the international medical graduate (IMG)
		Professionalism
		Assessment
		Conclusion
		References
		Relevant websites
		Teaching resources available online
		Support for the international doctor
	25 Ethics and attitudes
		Introduction
		Critical challenges
			Challenge 1: the changing doctor–patient relationship
			Challenge 2: cultural pluralism
			Challenge 3: the power of the hidden curriculum
		Undergraduate education
			Organizing undergraduate ethics education
				National University of Singapore Yong Loo Lin School of Medicine (NUS YLLSoM)
				David Geffen School of Medicine at UCLA (DGSOM)
		Assessment of ethical and professional attitudes
			Fitting outcomes and innovative methods
			Assessment: some difficulties
		The special nature of attitudes
		Consistent expectations
		Summary: effecting culture shift
		References
	26 Professionalism
		Introduction
		Defining professionalism
		Setting expectation: agreeing a framework for professionalism
		Developing a culture of professionalism: role modelling and the hidden curriculum
		Digital professionalism
		Educating faculty on social media
			Building in guidance on the use of social media
		Assessing professionalism
		Summary
		References
	27 Evidence-based medicine
		Introduction
		Approaches to teaching EBM
			Building-block approach
			Whole-task approach
			Integration with other courses and content
			Clinical integration
			Computer assisted and online learning approach
		Timing of EBM
		EBM instructors
		Learning resources for EBM
		EBM assessment
		Future directions for EBM teaching
		Summary
		References
	28 Patient safety and quality of care
		Introduction
		Introduction to patient safety, the tragedy of preventable harm
		New competencies and patient safety
		Reporting and learning from adverse events and close calls
		Establishing the just culture
		Teamwork skills and a deeper understanding of human factors
		Introduction to health care quality
		Teaching healthcare quality and patient safety
			A continuum of physician professional development in quality and safety
		Strategies for teaching quality and safety
		Assessment and evaluation
		Challenges that are somewhat unique to establishing a patient safety and healthcare quality educational programme
		Summary
		References
	29 Medical humanities
		Introduction
		What are the medical humanities?
		How do the medical humanities contribute to medical education?
			Preparation for medical practice
			Perspective and personal development
			Bring balance to the medical curriculum
		What educational approaches are useful in medical humanities?
		Curriculum structure
			Framework
			Outcomes-based approach to student learning (OBASL)
			Assessment
			Integration
			Compulsory or elective
		Content and delivery
			Narrative based
			Arts based
			E-learning
			Experiential learning
				Mindful practice
				Historical visits
				Service learning
		What are some practical considerations and challenges?
			Teachers
			Sustainability
			Changing role of doctors
			Cross-cultural and linguistic issues
			Realities of practice
		Summary
		Acknowledgement
		References
	30 Integrative medicine in the training of physicians
		Introduction
		Integrative medicine in undergraduate medical education
			Pre-clinical years
			Experiential learning
			Clinical years
		Clerkships
			Clinical pearls toolkit
			Interprofessional standardized patient exam
			Fourth-year advanced electives
		Integrative medicine in graduate medical education
			Residency
			Fellowship
		Summary
		References
	31 Global awareness
		Introduction
		The rationale for global awareness
		Understanding the global health agenda for medical education
		Integrating activities and resources for global awareness
		Global health training starts by understanding local health issues
		Assessment
		Preparing students for international experiences and electives
		Faculty development for global awareness
		Ethical issues and international electives
		Summary
		References
	32 Medical education in an era of ubiquitous information
		Ubiquitous information
		Data, information, knowledge
		Healthcare in the digital age (and biomedical knowledge in the cloud)
			Electronic health records
			Learning health systems
			Biomedical knowledge in the cloud
			Aids to clinical reasoning and decision making
		The digital native learner
		Three key competencies at a time of ubiquitous information and educational strategies to support the digital learner
			Metacognition and sensing gaps in one’s knowledge
			Metacognition
			Confidence calibration
		Demonstration and assessment of metacognition
		Information retrieval and the ability to form an appropriate question
			Foundational, advanced and specialized medical knowledge
			Framing an appropriate clinical question
			Assessment of information retrieval and analysis
		Evaluating and weighing evidence to make decisions; recognizing patients and interprofessional colleagues as additional sources of information
			Assessment of uncertainty/shared decision making
		Summary
		References
5 Assessment
	33 Concepts in assessment including standard setting
		Measurement theories
			Classical Test Theory (CTT)
			Generalizability Theory (GT)
			Item Response Theory (IRT)
		Types of assessment
			Formative assessment
			Summative assessment
			Diagnostic assessment
		Qualities of a good assessment
			Validity theory
		Score interpretation
			Norm-referenced score interpretation
			Criterion-referenced score interpretation
		Score equivalence
		Standards
			Relative standards
			Absolute standards
		Blueprints
		Self-assessment
		Objective versus subjective assessments
		All assessment requires judgement
		Summary
		References
	34 Written assessments
		Introduction
		Question format
		Quality control of items
		Response formats
			Short-answer open-ended questions
				Description
				When to use and when not to use
				Tips for item construction
			Essay questions
				Description
				When to use and when not to use
				Tips for item construction
			True–false questions
				Description
				When to use and when not to use
				Tips for item construction
			Multiple-choice questions
				Description
				When to use and when not to use
				Tips for item construction
			Multiple true–false questions
				Description
				When to use and when not to use
				Tips for item construction
		Stimulus formats
			Extended-matching questions
				Description
				When to use and when not to use
				Tips for item construction
			Key-feature approach questions
				Description
				Tips for item construction
			Script concordance test questions
				Description
				Tips for item construction
		Summary
		References
		Further reading
	35 Performance and workplace assessment
		Introduction
		Choosing the right assessment
		Assessments of clinical competence
			Objective structured clinical examination (OSCE)
			Other assessments of clinical competence
		Assessing performance in the workplace
			Mini clinical evaluation exercise (Mini-CEX)
			Case-based discussion (CBD) or chart-stimulated recall (CSR)
			Direct observation of procedural skills (DOPS)
			Multisource feedback (MSF)
		Outstanding issues in performance assessment
		Summary
		References
	36 Portfolios, projects and theses
		Introduction
		The objectives and contents of portfolios
			Reflections
		Electronic portfolios
		Success factors for portfolios
			Mentoring
			Feasibility
			Perceived usefulness
		Portfolio assessment
			Incorporate feedback cycles
			Obtain multiple sources of feedback
			Separate the role of the mentor and assessor
			Train the assessors
			Use a sequential procedure
			Request narrative information
			Provide quality assurance
			Use milestones
		Thesis and project circle
		Summary
		References
	37 Feedback, reflection and coaching
		Introduction
		Competency-based education
		Description of the curriculum model
			Components of the curriculum model
		Feedback
			How does the type of feedback affect learning?
			What does timely feedback mean?
			Why isn’t giving timely and specific feedback sufficient to change behaviour?
			Recommendations to feedback-givers
		Reflection
		Coaching
		Summary
		References
	38 The assessment of attitudes and professionalism
		Why assess attitudes and professionalism? Setting the boundaries
		What do we mean by professionalism? Agreeing the definition
		When should professionalism be assessed?
		How should professionalism be assessed?
			Key steps
				Step 1: A fundamental principle
				Step 2: Curriculum design
				Step 3: Consider framing assessments against a published code of conduct
				Step 4: Blueprinting
				Step 5: Be clear of the purpose of each test
				Step 6: Choosing a valid assessment tool
				Step 7: Train the assessors
				Step 8: Engage the students
			The tools
				Cognition: knows
				Cognition: knows how
				Behaviour: shows how
				Behaviour: does
		Tools across the continuum – a portfolio of professionalism
		Summary
		References
	39 Programmatic assessment
		Introduction
		The traditional approach
		Programmatic assessment
		An example
		Implementing programmatic assessment
		Summary
		References
6 Staff
	40 Staff development
		Introduction
		Common practices and challenges
			Key content areas
			Educational formats
				Decentralized activities
				Self-directed learning
				Peer coaching
				Online learning
				Mentorship
			Learning in the workplace
			Frequently encountered challenges
			Programme effectiveness
		Designing a staff development programme
			Understand the institutional/organizational culture
			Determine appropriate goals and priorities
			Conduct needs assessments to ensure relevant programming
			Develop different programmes to accommodate diverse needs
			Incorporate principles of adult learning and instructional design
			Offer a diversity of educational methods
			Promote ‘buy in’ and market effectively
			Work to overcome commonly encountered challenges
			Prepare staff developers
			Evaluate – and demonstrate – effectiveness
		Summary
		References
	41 Academic standards and scholarship
		Introduction
		Double standard: research, patient care and teaching
		Professionalizing teaching
		Broadening the definition of scholarship
		Criteria for scholarship in teaching and education
		Recognizing and evaluating a scholarly approach to teaching and educational scholarship
		Increasing support for a scholarly approach to teaching and educational scholarship
		Leadership: promoting the scholarship of teaching
		Adaptive action: leadership for scholarship
		Summary
		References
7 Students
	42 Student selection
		Introduction
		Why select?
			Selection of students by the medical school
			Selection by applicants of medicine as a career
			Implicit selection of the medical schools by applicants
			Explicit selection of medical schools by applicants
			Selection for a particular academic curriculum
			Selection by staff for staff
		The limits of selection
		Which are the canonical traits in selection?
			Intellectual ability
			Learning style and motivation
			Communicative ability
			Personality
			Surrogates for selection
		Methods and process of selection
			Assessing methods of selection
			Different methods of selection
				Open admissions and lotteries
				Administrative methods
				Assessment of application forms
				Biographical data (biodata)
				Referees’ reports
				Interviewing
				Multiple mini-interviews (MMIs)
				Psychometric testing
				Situational judgement tests
				Assessment centres
		The costs of selection
		Routine monitoring of selection
		Widening access
		Studying selection and learning from research
			Evidence-based medicine and the scientific study of selection
		Summary
		References
	43 Student support
		Supporting student learning
			Enhancing study and learning skills
			Providing support for knowledge deficits
			Monitoring student performance
		Supporting student mental and physical wellbeing
			Mentoring
			Supporting health and wellness
			Providing health and psychological services
		Providing other support services
			Supporting student career choice
			Providing financial aid services and counselling
		Creating a comprehensive student services system
			Identifying and maintaining adequate resources
			Overcoming student resistance
		Summary
		References
	44 Student engagement in learning
		Expertise
		Mastery
		Addressing our expert blind spot and developing student mastery
		Contextual learning and thinking
		Strategies for developing medical students’ contextual thinking
		Student engagement in the management of the learning environment
		Summary
		References
	45 Peer-assisted learning
		Introduction
		Defining PAL
		PAL and collaborative learning
		Theoretical basis for PAL
			Cognitive factors: challenge and support
			Communication factors
			Affective and social factors
			Organizational factors and the PAL process
		Evidence for PAL
			Advantages for tutors
			Advantages for tutees
			Advantages for the institution
		Potential disadvantages and concerns about PAL
		Components and choices in PAL
			Background
			Aims
			Tutors
			Tutees
			Interaction
			Evaluation
			Institution
			Realization
		Applications and examples of PAL in healthcare education
			Skills training in shoulder ultrasound (Knobe et al. 2010, Germany)
			Online formative assessment and feedback in clinical examination (O’Donovan & Maruthappu, 2015, United Kingdom and Malaysia)
			Researching and developing an undergraduate mental health curriculum (Furmedge et al., 2014)
		Conclusions
		Summary
		References
8 Medical School
	46 Understanding medical school leadership
		Where and how decisions are influenced in complex organizations
			Top-down decisions
			Matrix-model decisions
			Venn diagram decisions
		Relationships with the medical school departments
		Relationships with the clinical learning sites
		Relationship with the graduate medical education programmes
		Relationship with the research institutes and research centres
		Relationships with the parent university administration
		Summary
		References
	47 Medical education leadership
		Introduction
		The ‘leadership triad’
		Our current understanding of medical education leadership
		Leadership theory and practice
		Personal qualities and attributes
		Leadership is context dependent
		Leading groups and teams
		A systems perspective
		Summary
		References
		Additional reading
	48 The medical teacher and social accountability
		Introduction
		The concept of social accountability of medical schools
		Medical teachers and social accountability
		Medical teachers comprehensive roles in socially accountable medical schools
		Practical examples of medical teacher social accountability
		Research
		Summary
		References
		Further reading
	49 The educational environment
		Introduction
		What is the educational environment?
		The person level
		The group level
			Learner–learner interactions
			Learner–faculty interactions
			Learner–patient/staff interactions
		The organization level
			Physical factors
			Cultural factors
		The community and society levels
		How is the educational environment measured?
		Teaching with the educational environment in mind
			Addressing student mistreatment
			Curriculum change and the educational environment
			Faculty behaviours
			The effect of the educational environment on faculty
			Time and space
			Community building
		Summary
		References
	50 Medical education research
		Quantitative and qualitative research
		Mixed-methods research
		Reflection
		Building capacity
		Funding
		Summary
		References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W
	Y