Perspectives on Medical Education最新文献

{"title":"Introducing the Next Era in Assessment.","authors":"Alina Smirnova, Michael A Barone, Sondra Zabar, Adina Kalet","doi":"10.5334/pme.1551","DOIUrl":"10.5334/pme.1551","url":null,"abstract":"<p><p>In this introduction, the guest editors of the \"Next Era in Assessment\" special collection frame the invited papers by envisioning a next era in assessment of medical education, based on ideas developed during a summit that convened professional and educational leaders and scholars. The authors posit that the next era of assessment will focus unambiguously on serving patients and the health of society, reflect its sociocultural context, and support learners' longitudinal growth and development. As such, assessment will be characterized as transformational, development-oriented and socially accountable. The authors introduce the papers in this special collection, which represent elements of a roadmap towards the next era in assessment by exploring several foundational considerations that will make the next era successful. These include the equally important issues of (1) focusing on accountability, trust and power in assessment, (2) addressing implementation and contextualization of assessment systems, (3) optimizing the use of technology in assessment, (4) establishing infrastructure for data sharing and data storage, (5) developing a vocabulary around emerging sources of assessment data, and (6) reconceptualizing validity around patient care and learner equity. Attending to these priority areas will help leaders create authentic assessment systems that are responsive to learners' and society's needs, while reaping the full promise of competency-based medical education (CBME) as well as emerging data science and artificial intelligence technologies.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"1-8"},"PeriodicalIF":4.8,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972815","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":"Breaking Bad News to Learners: How Well Does the SPIKES Clinical Model Translate?","authors":"Lynnea M Mills, Olle Ten Cate, Christy Boscardin, Patricia S O'Sullivan","doi":"10.5334/pme.1521","DOIUrl":"10.5334/pme.1521","url":null,"abstract":"<p><p>When health professions learners do not meet standards on assessments, educators need to share this information with the learners and determine next steps to improve their performance. Those conversations can be difficult, and educators may lack confidence or skill in holding them. For clinician-educators with experience sharing challenging news with patients, using an analogy from clinical settings may help with these conversations in the education context. One common model in the clinical setting for 'breaking bad news' to patients is SPIKES: Set-up, Perception, Invitation, Knowledge, Emotion, and Summary/Strategy. The authors reviewed evidence in the education setting, particularly from the remediation literature, to consider how the SPIKES model might translate from clinical settings to those in which educators must share 'bad news' with learners about their academic performance. Based on available guidelines and evidence, the authors advocate that the SPIKES model can serve as a useful framework to help educators incorporate, by way of analogy, key components into these conversations, and increase the likelihood of successful outcomes.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"684-692"},"PeriodicalIF":4.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903919","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 Outcomes Are Associated with Learning About Colonialism and Its Impacts on Indigenous Peoples in Health Professional Programs? A Critical Integrative Review.","authors":"Carolyn M Melro, Kimberly Matheson, Amy Bombay","doi":"10.5334/pme.1407","DOIUrl":"10.5334/pme.1407","url":null,"abstract":"<p><strong>Background: </strong>The Truth and Reconciliation Commission of Canada called upon health professional programs to teach about historical and on-going colonalism. Since these calls to action, there has been an increase in educational opportunities on the topic. Although it is generally assumed that learning about colonialism will reduce racism and improve allyship towards Indigenous Peoples, an evaluation of this assumption is needed.</p><p><strong>Purpose: </strong>An integrated review of the literature was conducted to assess how participation in educational experiences is associated with learner outcomes and how they may vary according to course design considerations including the guiding framework, content foci, mode of delivery, activities, and duration.</p><p><strong>Methods: </strong>Studies assessing outcomes of educational activities related to the legacy of colonialism identified in a previous scoping review, as well as any such studies published since then were included in the present study. Data synthesis was performed using content analysis of the results and discussions presented in the included papers.</p><p><strong>Results: </strong>A review of 15 papers identified a backfire effect that was only evident among the studies that included a delayed post-evaluation timeframe. In two educational experiences, it was found that learners were more likely to express unfavourable attitudes towards Indigenous Peoples post-training. These educational opportunities were designed using a cultural safety framework and followed a similar course delivery (e.g., viewing of vodcasts, use of case studies) and provided similar content (historical policies, Indigenous cultural beliefs and practices).</p><p><strong>Conclusions: </strong>The findings should be interpreted with caution but point to plausible implications related to the backfire effect of educational opportunities on learners' attitudes towards Indigenous Peoples post-training.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"677-683"},"PeriodicalIF":4.8,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904003","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":"Physicians' Social Skills - Conceptualization, Taxonomy, and Behavioral Assessment.","authors":"Simon M Breil, Dorothee Amelung, Sebastian Oberst, Torsten Rollinger, Helmut Ahrens, Amelie Garbe, Martina Kadmon, Bernhard Marschall, Mitja D Back, Harm Peters","doi":"10.5334/pme.1171","DOIUrl":"10.5334/pme.1171","url":null,"abstract":"<p><p>Social skills (e.g., assertiveness, empathy, ability to accept criticism) are essential for the medical profession and therefore also for the selection and development of medical students. However, the term \"social skills\" is understood differently in different contexts. There is no agreed upon taxonomy for classifying physicians' social skills, and skills with the same meaning often have different names. This conceptual ambiguity presents a hurdle to cross-context communication and to the development of methods to assess social skills. Drawing from behavioral psychology, we aim to contribute to a better understanding of social skills in the medical context. To this end, we introduce a theoretically and empirically informed taxonomy that can be used to integrate the large number of different social skills. We consider how skills manifest at the behavioral level to ensure that we focus only on skills that are actually observable, distinguishable, and measurable. Here, behavioral research has shown that three overarching skill dimensions can be seen in interpersonal situations and are clearly distinguishable from each other: <i>agency skill</i> (i.e., getting ahead in social situations), <i>communion skill</i> (i.e., getting along in social situations), and <i>interpersonal resilience</i> (i.e., staying calm in social situations). We show that almost all social skills relevant for physicians fit into this structure. The approach presented allows redundant descriptions to be combined under three clearly distinguishable and behavior-based dimensions of social skills. This approach has implications for the assessment of social skills in both the selection and development of students.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"635-645"},"PeriodicalIF":4.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903993","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":"Challenges to Students' Learning and Wellbeing During Placement Abroad: A Qualitative Study Using Rich Pictures.","authors":"Miriam H Wijbenga, Wieke E van der Goot, Stephan P J Ramaekers, Pim W Teunissen, Robbert J Duvivier, Erik W Driessen","doi":"10.5334/pme.1618","DOIUrl":"10.5334/pme.1618","url":null,"abstract":"<p><strong>Introduction: </strong>Undergraduate healthcare students on placement abroad can experience challenges that affect their wellbeing, personal and professional development. These challenges may result in students taking a more peripheral role in workplace activities, which negatively impacts learning. We studied <i>how personal and professional challenges affect students' learning and wellbeing during a clinical placement abroad</i>.</p><p><strong>Methods: </strong>We used the rich pictures drawing method to elicit semi-structured student interviews and capture personal and professional challenges within different contexts. Language, culture, education, and belonging were used as sensitizing concepts, underlying thematic analysis. We conducted a parallel and iterative analysis of the transcripts and rich pictures. Team discussions focused on developing patterns and further conceptualization of results.</p><p><strong>Results: </strong>Based on thirteen student accounts, we identified four main themes: 'Learning to work in the international context'; 'Cultural differences shape professional identity'; 'Deliberate social connections'; and 'Personal growth through international experiences'. Active participation in local practices was crucial to overcome barriers in language, culture or education, and increase belonging. Local healthcare teams and peers supported students' wellbeing, personal and professional development by helping them establish their role as a learner, whilst exploring the scope and boundaries of their future profession.</p><p><strong>Conclusions: </strong>Language, cultural and educational challenges can be considered an inevitable part of student placement abroad. Local peers and staff may support this transition and help recognize learning opportunities and challenges in the workplace. Clinical educators can facilitate learning and wellbeing by providing social support and guidance on professional behavior, including communication.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"666-676"},"PeriodicalIF":4.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903923","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":"Enhancing Reflective Practice Using Prompts in Online Submission of Case Reports (OSCAR): An Exploratory Study Among Medical Students in Rural Longitudinal Integrated Clerkships.","authors":"William MacAskill, Hannah Woodall, Claire Dorothea Nicholls, Kay Brumpton, Janani Pinidiyapathirage","doi":"10.5334/pme.1416","DOIUrl":"10.5334/pme.1416","url":null,"abstract":"<p><strong>Introduction: </strong>Medical students learn to reflect to gain new insights into self and practice; however, allowing for reflection within a busy curriculum is challenging. In this study we embedded reflective writing prompts (RWP) into an existing assessment item, Online Submission of Case Reports (OSCAR), to investigate whether this minimalistic scaffolding intervention could develop students' reflective capacity and increase their exposure to rural social determinants of health.</p><p><strong>Methods: </strong>This study is framed by ontological realism and informed by an interpretivist stance. Focus group transcripts (medical students and educators) were inductively analysed using thematic analysis. Written OSCAR reflections were analysed in a deductive top-down method to provide a contrasting perspective and triangulation.</p><p><strong>Results: </strong>Focus groups included 27 students, 10 educators, and 52 OSCAR reflections. Inductive analysis generated three themes: Scaffolded Learning, Affording Diverse Responses, and Maximising Learning Opportunities. Deductive analysis indicated that most students (87%) demonstrated lower-order thinking.</p><p><strong>Discussion: </strong>Most participants valued the impact of RWP on students' learning. Though the RWP did not assist students to demonstrate higher-order thinking, they did increase the breadth of rural social determinants of health topics reflected upon by students, thereby increasing student knowledge of the impact of rural context on patient care.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"654-665"},"PeriodicalIF":4.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903946","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":"Proximity to Practice: The Role of Technology in the Next Era of Assessment.","authors":"Andrew E Krumm, Hollis Lai, Kayla Marcotte, Tavinder K Ark, Victoria Yaneva, Saad Chahine","doi":"10.5334/pme.1272","DOIUrl":"10.5334/pme.1272","url":null,"abstract":"<p><p>The integration of technology into health professions assessment has created multiple possibilities. In this paper, we focus on the challenges and opportunities of integrating technologies that are used during clinical activities or that are completed by raters after a clinical encounter. In focusing on technologies that are more proximal to practice, we identify tradeoffs with different data collection approaches. To maximize the benefits of integrating technology in workplace-based assessment, we describe the importance of using preexisting frameworks from the fields of assessment design, implementation research, and clinical artificial intelligence governance.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"646-653"},"PeriodicalIF":4.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11673589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903997","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":"Assessment of Clinical Reasoning During a High Stakes Medical Student OSCE.","authors":"Jeffrey Siegelman, Lisa Bernstein, Jennifer Goedken, Linda Lewin, Jason Schneider, Martha Ward, Hugh Stoddard","doi":"10.5334/pme.1513","DOIUrl":"10.5334/pme.1513","url":null,"abstract":"<p><strong>Background & need for innovation: </strong>Objective Structured Clinical Examinations (OSCEs) are commonly employed to assess clinical skills. While several existing tools address components of clinical reasoning, including the Assessment of Reasoning Tool, none are calibrated for competency-based assessment of medical students (UME) in an OSCE setting.</p><p><strong>Goal of innovation: </strong>We sought to create a clinical reasoning assessment for use in a high-stakes, summative medical student OSCE.</p><p><strong>Steps taken for development and implementation of innovation: </strong>A minimum-competency OSCE was administered to medical students following their required clinical clerkships. We developed a tool to assess clinical reasoning of medical students at the conclusion of their required clinical clerkships and deployed it during a minimum-competency OSCE exam given at that time. The highest level of the modified tool represented minimum acceptable performance for examinees.</p><p><strong>Evaluation of innovation: </strong>The scores and analyses provided evidence to support the use of this tool. Examinees' performance on clinical reasoning tasks was comparable with their overall performance on the OSCE. The sub-scores for clinical reasoning accurately distinguished successful examinees from those who did not meet the minimum performance level, providing support for the use of the tool in this high stakes setting.</p><p><strong>Critical reflection: </strong>This tool was found to be useful and defensible to assess medical students' clinical reasoning. Expanded evidence for generalizability of the tool and its utility in other settings will need to be garnered through multi-center implementation and study.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"629-634"},"PeriodicalIF":4.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830428","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":"Development and Evaluation of a Virtual Reality Program for Immediate Newborn Care Training in Nursing Education: A Feasibility Study.","authors":"Hsiao-Ying Hung, Yu-Wen Wang, Min-Chai Hsieh, Po-Yu Chen, Ying-Ju Chang","doi":"10.5334/pme.1538","DOIUrl":"10.5334/pme.1538","url":null,"abstract":"<p><strong>Introduction: </strong>Nursing education equips students with the skills necessary to navigate the clinical environment. Repetitive training in complex skills ensures patient and student safety. Immersive virtual reality (VR) offers a realistic and safe environment for such repetitive learning processes. However, the feasibility of integrating such technology into the training of immediate newborn care skills remains unexplored.</p><p><strong>Methods: </strong>In this feasibility study, the care procedure for immediate newborn care (INC) was standardized and converted into a VR teaching model. Experts and students were then recruited to assess and evaluate the suitability, usefulness and user-friendliness of the INC-VR model. A total of 35 students were recruited and allocated to a VR learning group and a traditional learning group to evaluate the INC-VR model in terms of knowledge acquisition, skill confidence, performance accuracy, and the time required to complete the INC tasks.</p><p><strong>Results: </strong>Thirteen INC care tasks were transformed into a 15-minute INC-VR model, and the suitability, usefulness, and user-friendliness of the model were validated by both students and experts. Furthermore, students in the VR group demonstrated comparable INC knowledge, confidence, and performance accuracy to those in the traditional group, with a more time-efficient learning framework (10.3 minutes vs. 35 minutes).</p><p><strong>Discussion: </strong>The INC-VR model developed herein can supplement traditional teaching to enhance students' learning. This model could provide an accessible platform for additional practice and remediation, addressing the limitations of real-time skill practice opportunities. Therefore, it may also serve as a valuable reference for other institutions developing similar VR educational tools.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"620-628"},"PeriodicalIF":4.8,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830438","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":"Identifying Behaviours Representative of Agentic Engagement in Pre-clinical Medical Education PBL Groups Based on Literature and Observations.","authors":"Alexandra Androni, Joke Fleer, Laura R Smids, Joke M van der Wouden, A Debbie C Jaarsma, Johanna Schönrock-Adema","doi":"10.5334/pme.1414","DOIUrl":"10.5334/pme.1414","url":null,"abstract":"<p><strong>Introduction: </strong>In this study we aimed to identify behaviours representative of agentic engagement in pre-clinical medical education problem-based learning (PBL) groups. Agentic engagement is defined as the proactive, intentional contributions students make to their flow of instruction. This concept, developed in secondary education, appears relevant for benefitting optimally from PBL in higher medical education.</p><p><strong>Methods: </strong>We followed a four-step process to identify any behaviours representative of agentic engagement in our PBL setting. Following a literature search on agentic engagement scales, proactive behaviour, PBL practices and adult learning, we listed behaviours that could denote agentic engagement in our context. We fine-tuned this list through exploratory observations and tailored it to our specific context of second-year PBL groups.</p><p><strong>Results: </strong>We identified ten observable student behaviours representative of agentic engagement within medical PBL groups. Some aligned with previous literature (asking questions, telling the teacher what they (dis)like, telling the teacher what they are interested in, defending opinions, expressing expectations, suggesting co-operation), and others had not been identified before as representative of agentic engagement (making learning as interactive as possible, creating alternative ways of covering the material, correcting content and enriching others' insights); thereby introducing novel behaviours unique to our setting.</p><p><strong>Discussion: </strong>In medical PBL groups, we identified both known agentic engagement behaviours and distinctive behaviours specific to our context, thereby highlighting that the expression of agentic engagement is context-bound.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"608-619"},"PeriodicalIF":4.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11623076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796425","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}