Understanding Medical Education: Evidence,Theory and Practice

Cover......Page 1
Title page......Page 5
Copyright page......Page 6
Contents......Page 7
Contributors......Page 9
Foreword to the second edition......Page 13
Preface......Page 15
Part 1: Foundations......Page 17
Challenges and preoccupations......Page 19
Scholarship and the pursuit of excellence......Page 21
Adult learning principles......Page 23
Implications for educational practice......Page 24
Social cognitive theory......Page 25
Self-efficacy......Page 26
Implications for educational practice......Page 27
Models of reflective practice......Page 28
Implications for educational practice......Page 30
Transformative learning......Page 31
Self-directed learning......Page 32
Implications for educational practice......Page 34
Situated learning......Page 35
Implications for educational practice......Page 37
Learning in communities of practice......Page 38
Virtual communities of practice......Page 39
Implications for educational practice......Page 40
Connections......Page 41
Acknowledgement......Page 42
Introduction......Page 47
What is curriculum?......Page 48
Standards for design......Page 49
Curriculum in context......Page 50
Factors that influence curriculum design......Page 51
Theories of learning......Page 52
Theory and practice of the discipline......Page 53
The purpose and components of curriculum design......Page 54
How do we express the overall purpose of an educational programme?......Page 55
How can we describe specific intended achievements?......Page 56
How will the programme be organised?......Page 57
How do we determine the experiences that will further those purposes?......Page 59
How can we determine whether the purposes are being attained?......Page 60
A critical approach to quality......Page 63
Discourses of quality......Page 65
Scientific......Page 67
Professional......Page 68
Quality and safety: risk and regulation......Page 69
From self-regulation to watchdog compliance......Page 70
How well do quality frameworks evaluate the quality of pedagogy?......Page 71
Conclusions......Page 73
Part 2: Educational Strategies......Page 77
What is problem-based learning?......Page 79
Sources of problems......Page 80
Selection and training of facilitators......Page 81
Optimal size......Page 82
Structure and roles......Page 83
Instructional resources......Page 84
Programme evaluation......Page 85
Multiple-choice exams......Page 86
Peer evaluations......Page 87
Co-operative learning......Page 88
Integrated System Model......Page 89
Effectiveness of PBL......Page 90
Summary......Page 92
Acknowledgements......Page 93
Defining interprofessional education......Page 97
Competing terms......Page 98
The diversity of interprofessional education......Page 99
The perceived relevance of the learning opportunity......Page 101
The self-concept of the learner......Page 102
Interprofessional education and the curriculum......Page 103
Shadowing......Page 104
The role of facilitation......Page 105
The assessment of interprofessional education......Page 106
Tidal flows in interprofessional education......Page 107
References......Page 108
Further reading......Page 112
The changing landscape of medical education and training......Page 113
Learning and work......Page 114
Work-based learning......Page 115
Cognitive conceptions of learning......Page 116
Social-contextual conceptions of learning......Page 117
Curriculum and work-based learning: a complex relationship......Page 120
Implications for the clinical teacher......Page 121
Implications for educational leaders and managers......Page 122
Conclusion......Page 123
Introduction......Page 127
What does supervision mean?......Page 128
What is supervision for?......Page 129
Careers......Page 130
Clinical supervision......Page 131
Professional supervision......Page 132
Coaching......Page 133
Conceptual frameworks for supervision......Page 134
Facilitation versus training......Page 135
Raising the profile of supervision: changing the culture of medicine......Page 136
References......Page 137
The learner experience......Page 139
What constitutes a small group?......Page 140
Housekeeping......Page 141
Getting started......Page 142
Techniques to use in small groups......Page 143
The interprofessional group......Page 146
Dealing with difficult group members......Page 147
The reticent group member......Page 148
Exploring boundaries......Page 149
Can a group survive with a series of different facilitators?......Page 150
Summary......Page 151
Clinical knowledge......Page 153
Memory, learning and performance......Page 154
Limits to learning......Page 155
Organisational aspects......Page 156
Preparation......Page 157
Content......Page 158
Aids to lecturing......Page 159
Delivery......Page 160
Beyond lecturing......Page 161
Conclusion......Page 163
Examples of learning technology......Page 165
Changing the nature of work......Page 167
Learning processes......Page 168
Knowledge and innovation transfer......Page 169
Planning to use TEL: Evaluation frameworks......Page 170
Superficial learning......Page 171
The need for rigorous research......Page 172
Mobile devices for learning......Page 173
Conclusions......Page 174
Computers and learning......Page 177
Computer-aided learning......Page 178
Simulation......Page 179
Learning styles and e-Learning......Page 180
Workplace-based learning and continuing professional development......Page 181
E-portfolios......Page 182
Administration and management......Page 184
Wikis......Page 185
Massive open online courses......Page 186
Conclusions......Page 187
Further reading......Page 189
What is simulation?......Page 191
Simulation fidelity......Page 192
Part-task trainers......Page 193
Virtual reality and haptic systems......Page 194
Simulated environments......Page 195
Cognitivism......Page 196
Unlearning and skill decay......Page 197
The feedback process......Page 198
Teaching and learning a practical skill......Page 199
Assessment......Page 200
Limitations to simulation......Page 201
The future of simulation......Page 202
Open or closed......Page 209
Goals and their relation to portfolio design......Page 210
Setting learning goals......Page 211
Strategies in portfolio assessment......Page 212
Cycles of reflection......Page 213
Acknowledgement......Page 214
Introduction......Page 217
Planning......Page 218
Learning......Page 220
Feedback and assessment......Page 222
Adjustment......Page 223
Conclusion......Page 225
Acknowledgement......Page 226
Introduction......Page 229
Helping students to learn from the humanities......Page 230
Meeting curricula requirements......Page 231
Learning in a variety of settings and early clinical experience......Page 232
Up-to-date learning and teaching systems: Integration and problem-based learning......Page 233
History of medicine......Page 234
Narrative medicine......Page 235
Spirituality......Page 236
Course design and assessment......Page 237
Programme evaluation and research opportunities......Page 238
Resources......Page 239
Conclusion......Page 240
Patients, users and consumers......Page 243
Context of patient involvement......Page 244
The Cambridge framework......Page 245
Levels of patient involvement......Page 246
Benefits and disadvantages......Page 250
Ethical issues......Page 251
Simulated patients......Page 252
Conclusions......Page 253
Part 3: Assessment......Page 257
How to choose the best approaches to assessment......Page 259
Validity......Page 260
Acceptability......Page 262
Objective Structured Clinical Examinations and simulated patients......Page 263
Oral examinations......Page 264
Portfolios......Page 265
Assessment possibilities unique to computer testing......Page 266
Combining assessment methods......Page 267
Epilogue......Page 268
Acknowledgement......Page 269
Historical background......Page 271
Formats of written assessment......Page 272
Constructed response formats......Page 273
Selected response formats......Page 280
Extended matching questions......Page 281
Script concordance items......Page 283
Formats using both selected and constructed responses......Page 285
Computer-based written assessment......Page 287
Item analysis......Page 288
Summary......Page 291
Introduction......Page 295
Nature of the judgement......Page 296
Mini-CEX......Page 297
DOPS......Page 298
CSR......Page 300
Portfolios......Page 302
Reliability......Page 304
Need for other forms of assessment......Page 305
Acknowledgements......Page 306
The long case......Page 309
Objective Structured Clinical Examinations......Page 310
Educational impact......Page 311
Blueprinting......Page 312
Station development......Page 313
Piloting......Page 314
Examiner training......Page 315
Practical considerations......Page 316
Acknowledgement......Page 318
The need to make decisions......Page 321
Norm- versus criterion-referenced standards......Page 322
Test-centred methods......Page 323
Ebel method......Page 324
Bookmark method......Page 325
Borderline group method......Page 326
Hofstee method......Page 327
Selecting a criterion-referenced standard setting method......Page 328
Gathering validity evidence to support a cut-score......Page 329
Conclusions......Page 330
Introduction......Page 333
Characteristics of formative assessment......Page 334
Student perspectives......Page 335
Effective feedback......Page 336
Education for feedback......Page 337
Feedback in experiential learning settings......Page 338
Helpful and unhelpful feedback......Page 339
Examples of formative assessment in undergraduate medical education......Page 341
References......Page 343
Part 4: Research and Evaluation......Page 345
Theoretical frameworks in education and the social sciences......Page 347
Positivism......Page 348
The positivist researcher......Page 349
Critical theory and related ideological positions......Page 350
Constructivism......Page 351
Knowledge, values and ethics......Page 352
Ontology, epistemology and methodology......Page 353
Reconciling and combining research frameworks......Page 354
The research proposal......Page 357
What is ethics?......Page 358
Ethical approval of research in medical education......Page 360
Application of knowledge......Page 361
Conclusions......Page 362
The quantitative paradigm......Page 365
The research question......Page 366
The experimental tradition......Page 368
Study designs......Page 369
Three or more groups, and factorial designs......Page 372
Summary......Page 373
The psychometric tradition......Page 374
Reliability......Page 375
Validity......Page 376
Analysis......Page 378
Cronbach’s ‘two disciplines’......Page 379
Systematic reviews and meta-analysis......Page 380
Critical reviews......Page 381
Discussion......Page 382
Qualitative research paradigms......Page 387
Relationship between qualitative and quantitative research......Page 388
Grounded theory......Page 389
Qualitative research methods......Page 390
Data collection methods......Page 391
Data analysis methods......Page 393
Sampling: Adequacy and appropriateness......Page 394
Data collection: Authenticity and reflexivity......Page 395
Data analysis: Clarity and audit trails......Page 396
Conclusions......Page 397
What is programme evaluation?......Page 401
Theory in evaluation......Page 402
Conceptual models and approaches......Page 403
Ethics in programme evaluation......Page 404
Questionnaires......Page 405
Group consensus techniques......Page 406
Self-ratings......Page 407
Promoting the use of evaluation findings......Page 408
Challenges in educational evaluation......Page 409
Example 1: Evaluation of a course or curriculum......Page 410
Example 2: Evaluation of faculty development programmes......Page 411
Example 3: Evaluation of the educational climate......Page 412
Part 5: Staff and Students......Page 417
Introduction......Page 419
Undergraduate selection......Page 420
Selection process......Page 421
Validity......Page 422
Predictive validity and the ‘criterion problem’......Page 424
Interviews......Page 425
References and referees’ reports......Page 426
General mental ability and aptitude tests......Page 427
Personality inventories......Page 428
Situational judgement tests......Page 429
Opportunities for further research......Page 430
Need for support in medical careers......Page 437
Improving the quality of careers support......Page 438
Specialty choice......Page 439
The Myers–Briggs Type Indicator......Page 440
Sci59 Specialty Choice Inventory......Page 441
Contemporary developments in vocational psychology......Page 442
Helping those whose career plans appear unrealistic......Page 443
Conclusions......Page 444
Introduction......Page 449
Getting the right system in place......Page 450
Planning the first discussion......Page 451
Obtaining background information......Page 452
Occupational health assessments......Page 453
Behavioural assessments......Page 454
Communication and language assessments......Page 455
Mustering resources......Page 456
Setting goals and time lines......Page 457
Evaluation......Page 458
Conclusion......Page 459
Defining diversity......Page 461
Impact......Page 462
Competence......Page 463
The socio-political context......Page 464
Cultural diversity......Page 465
Cross-cultural communication......Page 466
Diversity in medical education......Page 467
Using cultural brokers......Page 468
Conclusions......Page 469
Web-based resources......Page 470
What is a medical educator?......Page 471
A curriculum for staff development?......Page 472
‘Formal’ approaches to developing medical educators......Page 474
‘Informal’ approaches to developing medical educators......Page 475
How can we start early?......Page 477
What is known about effectiveness?......Page 478
What theoretical frameworks can guide the development of medical educators?......Page 479
Situated learning......Page 480
Conduct needs assessments to ensure relevant programming......Page 481
Promote buy-in and market effectively......Page 482
Conclusion......Page 483
Acknowledgements......Page 484
Introduction......Page 489
Leadership and management......Page 490
A brief history of leadership......Page 491
Formal management: managerial leadership......Page 492
Collegial management: transformational, interpersonal and distributed leadership......Page 493
Political management: transactional leadership......Page 494
Subjective management: post-modern leadership......Page 495
Cultural management: value-led leadership......Page 496
Leading teams......Page 497
Leading change......Page 498
Leading complex systems......Page 499
Setting direction......Page 500
Leading for improvement......Page 502
The wider agenda......Page 503
Summary......Page 504
Index......Page 509