Perspectives on Medical Education最新文献

{"title":"Using Self-Regulated Learning Microanalysis to Examine Regulatory Processes in Clerkship Students Engaged in Practice Questions.","authors":"Mary A Andrews,&nbsp;Catherine A Okuliar,&nbsp;Sean A Whelton,&nbsp;Allison O Windels,&nbsp;Stacy R Kruse,&nbsp;Manesh G Nachnani,&nbsp;Deborah A Topol,&nbsp;Elexis C McBee,&nbsp;Michael T Stein,&nbsp;Raj C Singaraju,&nbsp;Sam W Gao,&nbsp;David S Oliver,&nbsp;Jed P Mangal,&nbsp;Jeffrey S LaRochelle,&nbsp;William F Kelly,&nbsp;Kent J DeZee,&nbsp;H Carrie Chen,&nbsp;Anthony R Artino,&nbsp;Paul A Hemmer,&nbsp;Ting Dong,&nbsp;Timothy J Cleary,&nbsp;Steven J Durning","doi":"10.5334/pme.833","DOIUrl":"10.5334/pme.833","url":null,"abstract":"<p><strong>Introduction: </strong>Self-regulated learning is a cyclical process of forethought, performance, and self-reflection that has been used as an assessment tool in medical education. No prior studies have evaluated SRL processes for answering multiple-choice questions (MCQs) and most evaluated one or two iterations of a non-MCQ task. SRL assessment during MCQs may elucidate reasons why learners are successful or not on these questions that are encountered repeatedly during medical education.</p><p><strong>Methods: </strong>Internal medicine clerkship students at three institutions participated in a SRL microanalytic protocol that targeted strategic planning, metacognitive monitoring, causal attributions, and adaptive inferences across seven MCQs. Responses were transcribed and coded according to previously published methods for microanalytic protocols.</p><p><strong>Results: </strong>Forty-four students participated. In the forethought phase, students commonly endorsed prioritizing relevant features as their diagnostic strategy (n = 20, 45%) but few mentioned higher-order diagnostic reasoning processes such as integrating clinical information (n = 5, 11%) or comparing/contrasting diagnoses (n = 0, 0%). However, in the performance phase, students' metacognitive processes included high frequencies of integration (n = 38, 86%) and comparing/contrasting (n = 24, 55%). In the self-reflection phase, 93% (n = 41) of students faulted their management reasoning and 84% (n = 37) made negative references to their abilities. Less than 10% (n = 4) of students indicated that they would adapt their diagnostic reasoning process for these questions.</p><p><strong>Discussion: </strong>This study describes in detail student self-regulatory processes during MCQs. We found that students engaged in higher-order diagnostic reasoning processes but were not explicit about it and seldom reflected critically on these processes after selecting an incorrect answer. Self-reflections focused almost exclusively on management reasoning and negative references to abilities which may decrease self-efficacy. Encouraging students to identify and evaluate diagnostic reasoning processes and make attributions to controllable factors may improve performance.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"385-398"},"PeriodicalIF":3.6,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573650/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41239963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspective-Taking and Perspective-Sharing in Pediatric Education: Exploring Connections Between Strategies of Medical Students and Patients' Caregivers.","authors":"M C L Eijkelboom,&nbsp;R A M de Kleijn,&nbsp;L Baten,&nbsp;J Frenkel,&nbsp;M F van der Schaaf","doi":"10.5334/pme.412","DOIUrl":"10.5334/pme.412","url":null,"abstract":"<p><strong>Introduction: </strong>In pediatric education, caregivers are increasingly involved to share their perspective. Yet, an in-depth understanding of the perspective-taking process between medical students and caregivers is lacking. This study explored: 1) Which strategies do medical students use to take a caregiver's perspective and which facilitators and constraints do they perceive? 2) Which strategies do caregivers use to share their perspective with students? and 3) How do students' perspective-taking strategies relate to caregivers' perspective-sharing strategies?</p><p><strong>Methods: </strong>In an online lesson: two caregivers of pediatric patients, shared their story with 27 fourth-year Dutch medical students. After the session, students undertook an assignment where they individually reflected on how they took perspective. Students' reflections were collected via audio recordings. Caregivers were individually interviewed. Data were analyzed through thematic and cross-case analysis.</p><p><strong>Results: </strong>Students used eight perspective-taking strategies, in various combinations. Students used inferential strategies, where they made inferences from available information, and cultivating strategies, where they attempted to elicit more information about the caregiver. Students perceived individual-, contextual- and caregiver-related facilitators and constraints for taking perspective. Caregivers shared their perspective by adopting multiple strategies to share their story and create a trusting learning environment. We visualized connections between students' perspective-taking strategies, facilitators/constraints, and caregivers' perspective-sharing strategies.</p><p><strong>Discussion: </strong>By combining data from both perspective-takers (students) and perspective-sharers (caregivers), this study provides a foundation for future research to study perspective-taking between students and patients in an educational context. On a practical level, our findings provide tools for students, patients, and educators to enhance perspective-taking processes.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"2 1","pages":"372-384"},"PeriodicalIF":3.6,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10558030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Written Reflection: A Systematic Review and Qualitative Synthesis of Creative Approaches to Reflective Learning Amongst Medical Students.","authors":"William MacAskill,&nbsp;Weng Joe Chua,&nbsp;Hannah Woodall,&nbsp;Janani Pinidiyapathirage","doi":"10.5334/pme.914","DOIUrl":"10.5334/pme.914","url":null,"abstract":"<p><strong>Introduction: </strong>In medical curricula, reflective learning (RL) mostly consists of writing and small-group discussion, yet accommodating diverse learning preferences is a key factor in developing lifelong reflective practitioners. Medical education uses a number of creative approaches to RL which cater to more diverse learning preferences; however, the overarching benefits of creative RL to students' development is unknown. To understand how creative RL approaches contribute to students' holistic development we performed a qualitative systematic review and synthesis.</p><p><strong>Methods: </strong>Systematic searches of PubMed, PsycINFO, and EMBASE databases identified 4986 unique records, with 15 studies meeting inclusion criteria. Included studies specifically assessed the impact of RL on medical students and utilized creative approaches to RL. Creative approaches were defined as those not predominantly focused on reflective writing or group discussion. Studies were appraised using the Critical Appraisal Skills Programme and the Checklist for Quasi-Experimental Studies.</p><p><strong>Results: </strong>We identified five distinctive RL methods: viewing, performing, creating, imagining, and mind-body. Thematic analysis generated three themes: building and maintaining relationships, personal development, and sense of belonging. These themes incorporated eight sub-themes: recognizing multiple perspectives, empathizing with others, two-way communication skills, patient centered care, processing thoughts and emotions, self-care, interacting positively with peers, and developing trust and commonality.</p><p><strong>Discussion: </strong>Creative RL approaches may foster students' sense of belonging and support interpersonal skills and personal development. In addition, creative RL activities may contribute to medical graduate's holistic development, while providing opportunities to address diverse student needs using innovative, non-conventional methods.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"361-371"},"PeriodicalIF":3.6,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10503530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review.","authors":"Weiwei Shi, Helen Qin, Brett Vaughan, Louisa Ng","doi":"10.5334/pme.1006","DOIUrl":"10.5334/pme.1006","url":null,"abstract":"<p><strong>Introduction: </strong>Medication-related errors place a heavy financial burden on healthcare systems worldwide, and mistakes are most likely to occur at the stage of prescribing. Junior doctors are more likely to make prescribing errors, and medical graduates also lack confidence and preparedness towards prescribing. Thus, this review aimed to evaluate the existing educational approaches to improve pharmacological knowledge and prescribing skills among medical students.</p><p><strong>Methods: </strong>CENTRAL, CINAHL, ERIC, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, and Scopus were searched with keywords related to \"pharmacological knowledge\", \"prescribing skills\", \"educational interventions\" for articles published since 2016.</p><p><strong>Results: </strong>3595 records were identified, and 115 full-text articles were assessed for eligibility. Eighty full-text articles were eligible and included in this review. Thirty-seven studies focused on improving prescribing skills, whilst 43 targeted pharmacological knowledge. A broad range of interventions was implemented, including e-learning, case-based, interprofessional, and experiential learning. Pharmacological knowledge and prescribing skills were measured in various ways, and all studies reported one or more positive findings at Kirkpatrick level 1 or 2. No study reported outcomes at Kirkpatrick levels 3 and 4.</p><p><strong>Discussion: </strong>The World Health Organisation's Good Guide to Prescribing was the foundation of the development of prescribing educational interventions. Emerging interventions such as experiential and interprofessional learning should be incorporated into the prescribing curriculum. Innovative approaches such as game-based learning can be considered for clinical pharmacology teaching. However, there was a lack of outcomes at Kirkpatrick levels 3 and 4. Robust methodology and reliable outcome measures are also needed in future studies.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"348-360"},"PeriodicalIF":4.8,"publicationDate":"2023-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10151320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Stops Fairness from Emerging in Assessment? The Forces on a Complex Adaptive System.","authors":"Nyoli Valentine,&nbsp;Steven J Durning,&nbsp;Ernst Michael Shanahan,&nbsp;Lambert Schuwirth","doi":"10.5334/pme.994","DOIUrl":"10.5334/pme.994","url":null,"abstract":"<p><strong>Introduction: </strong>Workplace-based assessment occurs in authentic, dynamic clinical environments where reproducible, measurement-based assessments can often not be implemented. In these environments, research approaches that respect these multiple dynamic interactions, such as complexity perspectives, are encouraged. Previous research has shown that fairness in assessment is a nonlinear phenomenon that emerges from interactions between its components and behaves like a complex adaptative system. The aim of this study was to understand the external forces on the complex adaptive system which may disrupt fairness from emerging.</p><p><strong>Methods: </strong>We conducted online focus groups with a purposeful sample of nineteen academic leaders in the Netherlands. We used an iterative approach to collection, analysis and coding of the data and interpreted the results using a lens of complexity, focusing on how individual elements of fairness work in concert to create systems with complex behaviour.</p><p><strong>Results: </strong>We identified three themes of forces which can disrupt fairness: forces impairing interactivity, forces impairing adaption and forces impairing embeddedness. Within each of these themes, we identified subthemes: assessor and student forces, tool forces and system forces.</p><p><strong>Discussion: </strong>Consistent with complexity theory, this study suggests there are multiple forces which can hamper the emergence of fairness. Whilst complexity thinking does not reduce the scale of the challenge, viewing forces through this lens provides insight into why and how these forces are disrupting fairness. This allows for more purposeful, meaningful changes to support the use of fair judgement in assessment in dynamic authentic clinical workplaces.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"338-347"},"PeriodicalIF":3.6,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10482359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Interdisciplinarity: A Bibliometric Study of Medical Education Using the Medical Education Journal List-24 (MEJ-24).","authors":"Lauren A Maggio,&nbsp;Joseph A Costello,&nbsp;Anton B Ninkov,&nbsp;Jason R Frank,&nbsp;Anthony R Artino","doi":"10.5334/pme.984","DOIUrl":"10.5334/pme.984","url":null,"abstract":"<p><strong>Introduction: </strong>Interdisciplinary research, which integrates input (e.g., data, techniques, theories) from two or more disciplines, is critical for solving wicked problems. Medical education research is assumed to be interdisciplinary. However, researchers have questioned this assumption. The present study, a conceptual replication, clarifies the nature of medical education interdisciplinarity by analyzing the citations of medical education journal articles.</p><p><strong>Method: </strong>The authors retrieved the cited references of all articles in 22 medical education journals between 2001-2020 from Web of Science (WoS). We then identified the WoS classifications for the journals of each cited reference.</p><p><strong>Results: </strong>We analyzed 31,283 articles referencing 723,683 publications. We identified 493,973 (68.3%) of those cited references in 6,618 journals representing 242 categories, which represents 94% of all WoS categories. Close to half of all citations were categorized as \"education, scientific disciplines\" and \"healthcare sciences and services\". Over the study period, the number of references consistently increased as did the representation of categories to include a diversity of topics such as business, management, and linguistics.</p><p><strong>Discussion: </strong>Our study aligns with previous research, suggesting that medical education research could be described as inwardly focused. However, the observed growth of categories and their increasing diversity over time indicates that medical education displays increasing interdisciplinarity. Now visible, the field can raise awareness of and promote interdisciplinarity, if desired, by seeking and highlighting opportunities for future growth.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"327-337"},"PeriodicalIF":3.6,"publicationDate":"2023-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10453959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What does \"Timely\" Mean to Residents? Challenging Feedback Assumptions in Postgraduate Education.","authors":"Alyssa Lip, Christopher J Watling, Shiphra Ginsburg","doi":"10.5334/pme.1052","DOIUrl":"10.5334/pme.1052","url":null,"abstract":"<p><strong>Introduction: </strong>Current orthodoxy states that feedback should be timely and face-to-face, yet the optimal timing and mode of delivery for feedback is unclear. We explored what \"optimal timing\" means from residents' points of view as feedback providers and receivers, to ultimately inform strategies to optimize feedback in training.</p><p><strong>Methods: </strong>As near-peers who have dual roles in both providing and receiving feedback, 16 subspecialty (PGY4 and 5) internal medicine residents were interviewed about their perceptions of the optimal timing and format of feedback. Using constructivist grounded theory, interviews were conducted and analyzed iteratively.</p><p><strong>Results: </strong>Drawing on their experiences as providers and recipients, residents described simultaneously considering and weighing multiple factors when deciding on when and how to provide feedback. These included their own readiness to engage in providing meaningful feedback, the perceived receptiveness of the learner and the apparent urgency of feedback delivery (e.g., if patient safety was at stake). Face-to-face verbal feedback was valued for encouraging dialogue but could be uncomfortable and limited by time constraints. Written feedback could be more honest and concise, and the possibility of asynchronous delivery had potential to overcome issues with timing and discomfort.</p><p><strong>Discussion: </strong>Participants' perceptions of the optimal timing of feedback challenge current assumptions about the benefits of \"immediate\" versus \"delayed\". The concept of \"optimal timing\" for feedback was found to be complex and context-dependent, defying a formulaic approach. There may be a role for asynchronous and/or written feedback, which has potential to address unique issues identified issues in near-peer relationships.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"218-227"},"PeriodicalIF":3.6,"publicationDate":"2023-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10275343/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9686021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Continuing Professional Development for Physicians - Time for Change: A Scoping Review.","authors":"Shera Hosseini, Louise Allen, Faran Khalid, Donny Li, Elizabeth Stellrecht, Michelle Howard, Teresa M Chan","doi":"10.5334/pme.838","DOIUrl":"10.5334/pme.838","url":null,"abstract":"<p><strong>Introduction: </strong>Evaluation of education interventions is essential for continuous improvement as it provides insights into how and why outcomes occur. Specifically, for physicians' continuing professional development (CPD) programs, which aim to upskill physicians in a range of practice-essential domains, evaluations are crucial to assure physicians' continuous development, enhanced patient care and safety. However, evaluations of health professions education (HPE) interventions tend to be outcomes focused, failing to capture how and why outcomes occur. This scoping review aimed to identify evaluation techniques used to evaluate CPD programs for physicians, and to determine how these techniques are being implemented as well as the their quality.</p><p><strong>Methods: </strong>We searched PubMed, Embase, Web of Science, among others for English publications on evaluation of CPD programs for physicians, in the past decade. We used a data charting template to extract study details regarding the evaluation techniques and produced a checklist to assess the quality of the evaluations.</p><p><strong>Results: </strong>101 studies were included; of which 91 studies did not use an evaluation framework. Our findings revealed shortcomings in the evaluations of CPD programs including lack of attention to: intervention processes; unintended outcomes and contextual factors; use of theory; evaluation framework use; and rationale for chosen evaluation method.</p><p><strong>Discussion: </strong>Our findings highlighted major gaps in the evaluation techniques employed in physicians' CPD. Attention needs to be paid to evaluating both program processes and outcomes to illuminate how and why impacts are or are not occurring.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"198-207"},"PeriodicalIF":4.8,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10237247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9994021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Art Observation Interventions to Improve Medical Students' Diagnostic Skills: A Scoping Review.","authors":"Anjali Mehta, Steven Agius","doi":"10.5334/pme.20","DOIUrl":"10.5334/pme.20","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical observation skills are fundamental to the practice of medicine. Yet, the skill of looking carefully is rarely taught within the medical curriculum. This may be a contributory factor in diagnostic errors in healthcare. A growing number of medical schools, especially in the United States, have turned to the humanities to offer visual arts-based interventions to foster medical students' visual literacy. This research aims to map the literature on the relationship between art observation training and diagnostic skills of medical students, highlighting effective teaching methodologies.</p><p><strong>Methods: </strong>Based on the Arksey and O'Malley framework, a comprehensive scoping review was conducted. Publications were identified by searching nine databases and hand searching the published and grey literature. Two reviewers independently screened each publication using the pre-designed eligibility criteria.</p><p><strong>Results: </strong>Fifteen publications were included. Significant heterogeneity exists between the study designs and the methods employed to evaluate skill improvement. Nearly all studies (14/15) reported an increase in the number of observations made post-intervention, but none evaluated long-term retention rates. There was an overwhelmingly positive response to the programme, but only one study explored the clinical relevance of the observations made.</p><p><strong>Discussion: </strong>The review establishes improved observational acumen following the intervention, however, uncovers very limited evidence towards improved diagnostic abilities. There is a need for greater rigour and consistency within the experimental designs, through using control groups, randomisation, and a standardised evaluation rubric. Further research on the optimal intervention duration and the application of skills gained to clinical practice, should be performed.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"169-178"},"PeriodicalIF":4.8,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10215995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9564272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What can Designing Learning-by-Concordance Clinical Reasoning Cases Teach Us about Instruction in the Health Sciences?","authors":"Nicolas Fernandez, Marie-France Deschênes, Haifa Akremi, Lise Lecours, Vincent Jobin, Bernard Charlin","doi":"10.5334/pme.898","DOIUrl":"10.5334/pme.898","url":null,"abstract":"<p><strong>Introduction: </strong>Learning-by-concordance (LbC) is an online learning strategy to practice reasoning skills in clinical situations. Writing LbC clinical cases, comprising an initial hypothesis and supplementary data, differs from typical instructional design. We sought to gain a deeper understanding from experienced LbC designers to better support clinician educators' broader uptake of LbC.</p><p><strong>Methods: </strong>A dialogic action research approach was selected because it yields triangulated data from a heterogeneous group. We conducted three 90-minute dialogue-group sessions with eight clinical educators. Discussions focused on the challenges and pitfalls of each LbC design stage described in the literature. Recordings were transcribed and analyzed thematically.</p><p><strong>Results: </strong>We identified three themes by thematic analysis about the challenges inherent in designing LbC that are unique for this type of learning strategy: 1) the distinction between pedagogical intent and learning outcome; 2) the contextual cues used to challenge students and advance their learning and 3) the integration of experiential with formalized knowledge for cognitive apprenticeship.</p><p><strong>Discussion: </strong>A clinical situation can be experienced and conceptualized in many ways, and multiple responses are appropriate. LbC designers use contextual cues from their experience and combine them with formalized knowledge and protocols to write effective LbC clinical reasoning cases. LbC focuses learners' attention on decision-making in grey areas that characterize the nature of professional clinical work. This in-depth study on LbC design, indicating the integration of experiential knowledge, might call for new thinking about instructional design.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"12 1","pages":"160-168"},"PeriodicalIF":4.8,"publicationDate":"2023-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9936163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}