Perspectives on Medical Education最新文献

{"title":"From Competence by Time to Competence by Design: Lessons From A National Transformation Initiative.","authors":"Jason R Frank, Andrew K Hall, Anna Oswald, J Damon Dagnone, Paul L P Brand, Richard Reznick","doi":"10.5334/pme.1342","DOIUrl":"10.5334/pme.1342","url":null,"abstract":"","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"224-228"},"PeriodicalIF":3.6,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319537","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":"Competence By Design: a transformational national model of time-variable competency-based postgraduate medical education.","authors":"Jason R Frank, Jolanta Karpinski, Jonathan Sherbino, Linda S Snell, Adelle Atkinson, Anna Oswald, Andrew K Hall, Lara Cooke, Susan Dojeiji, Denyse Richardson, Warren J Cheung, Rodrigo B Cavalcanti, Timothy R Dalseg, Brent Thoma, Leslie Flynn, Wade Gofton, Nancy Dudek, Farhan Bhanji, Brian M-F Wong, Saleem Razack, Robert Anderson, Daniel Dubois, Andrée Boucher, Marcio M Gomes, Sarah Taber, Lisa J Gorman, Jane Fulford, Viren Naik, Kenneth A Harris, Rhonda St Croix, Elaine van Melle","doi":"10.5334/pme.1096","DOIUrl":"10.5334/pme.1096","url":null,"abstract":"<p><p>Postgraduate medical education is an essential societal enterprise that prepares highly skilled physicians for the health workforce. In recent years, PGME systems have been criticized worldwide for problems with variable graduate abilities, concerns about patient safety, and issues with teaching and assessment methods. In response, competency based medical education approaches, with an emphasis on graduate outcomes, have been proposed as the direction for 21st century health profession education. However, there are few published models of large-scale implementation of these approaches. We describe the rationale and design for a national, time-variable competency-based multi-specialty system for postgraduate medical education called Competence by Design. Fourteen innovations were bundled to create this new system, using the Van Melle Core Components of competency based medical education as the basis for the transformation. The successful execution of this transformational training system shows competency based medical education can be implemented at scale. The lessons learned in the early implementation of Competence by Design can inform competency based medical education innovation efforts across professions worldwide.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"201-223"},"PeriodicalIF":3.6,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10959143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140207890","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":"Disorienting or Transforming? Using the Arts and Humanities to Foster Social Advocacy.","authors":"Snow Wangding, Lorelei Lingard, Paul Haidet, Benjamin Vipler, Javeed Sukhera, Tracy Moniz","doi":"10.5334/pme.1213","DOIUrl":"10.5334/pme.1213","url":null,"abstract":"<p><strong>Introduction: </strong>The arts and humanities (AH) have transformative potential in medical education. Research suggests that AH-based pedagogies may facilitate both personal and professional transformation in medical learners, which may then further enhance the teaching and learning of social advocacy skills. However, the potential for such curricula to advance social advocacy training remains under-explored. Therefore, we sought to identify how AH may facilitate transformative learning of social advocacy in medical education.</p><p><strong>Methods: </strong>Building upon previous research, we conducted a critical narrative review seeking examples from the literature on how AH may promote transformative learning of social advocacy in North American medical education. Through a search of seven databases and MedEdPORTAL, we identified 11 articles and conducted both descriptive and interpretative analyses of their relation to key tenets of transformative learning, including: disorientation/dissonance, critical reflection, and discourse/dialogue.</p><p><strong>Results: </strong>We found that AH are used in varied ways to foster transformative learning in social advocacy. However, most approaches emphasize their use to elicit disorientation and dissonance; there is less evidence in the literature regarding how they may be of potential utility when applied to disorienting dilemma, critical reflection, and discourse/dialogue.</p><p><strong>Discussion: </strong>The tremendous potential of AH to foster transformative learning in social advocacy is constrained due to minimal attention to critical reflection and dialogue. Future research must consider how novel approaches that draw from AH may be used for more robust engagement with transformative learning tenets in medical education.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"192-200"},"PeriodicalIF":3.6,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144352","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":"Navigating Confidentiality Dilemmas in Student Support: An Institutional Ethnography Informed Study.","authors":"Emmanuel Tan, Grainne P Kearney, Jennifer Cleland, Erik Driessen, Janneke Frambach","doi":"10.5334/pme.1151","DOIUrl":"10.5334/pme.1151","url":null,"abstract":"<p><strong>Introduction: </strong>School-level student support programmes provide students with pastoral care and support for academic, wellbeing and other issues often via a personal tutor (PT). PT work is a balancing act between respecting the confidential information divulged by students and doing what is expected in terms of accountability and duty of care. We aimed to explore how tutors manage this tension, with the aim of advancing understanding of student support programmes.</p><p><strong>Methods: </strong>This qualitative study was informed by an Institutional Ethnography approach. We conducted 11 semi-structured interviews with PTs from one medical school in Singapore. We considered how they worked in relation to relevant national and institutional-level policy documents and reporting guidelines. Data collection and analysis were iterative.</p><p><strong>Results: </strong>We crafted two composite accounts to illustrate the dilemmas faced by PTs. The first depicts a PT who supports student confidentiality in the same way as doctor-patient confidentiality. The second account is a PT who adopted a more mentoring approach. Both tutors faced confidentiality challenges, using different strategies to \"work around\" and balance tensions between accountability and maintaining trust. PTs were torn between school and student expectations.</p><p><strong>Discussion: </strong>Fostering trust in the tutor-student relationship is a priority for tutors but tensions between confidentiality, accountability and governance sometimes make it difficult for tutors to reconcile with doing what they think is best for the student. A more nuanced understanding of the concept of confidentiality may help support PTs and ultimately students.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"182-191"},"PeriodicalIF":3.6,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144353","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":"Patterns of Medical Residents' Preferences for Organizational Socialization Strategies to Facilitate Their Transitions: A Q-study.","authors":"Gerbrich Galema, Johanna Schönrock-Adema, Debbie A D C Jaarsma, Götz J K G Wietasch","doi":"10.5334/pme.1189","DOIUrl":"10.5334/pme.1189","url":null,"abstract":"<p><strong>Introduction: </strong>To facilitate various transitions of medical residents, healthcare team members and departments may employ various organizational socialization strategies, including formal and informal onboarding methods. However, residents' preferences for these organizational socialization strategies to ease their transition can vary. This study identifies patterns (viewpoints) in these preferences.</p><p><strong>Methods: </strong>Using Q-methodology, we asked a purposeful sample of early-career residents to rank a set of statements into a quasi-normal distributed grid. Statements were based on previous qualitative interviews and organizational socialization theory. Participants responded to the question, 'What are your preferences regarding strategies other health care professionals, departments, or hospitals should use to optimize your next transition?' Participants then explained their sorting choices in a post-sort questionnaire. We identified different viewpoints based on by-person (inverted) factor analysis and Varimax rotation. We interpreted the viewpoints using distinguishing and consensus statements, enriched by residents' comments.</p><p><strong>Results: </strong>Fifty-one residents ranked 42 statements, among whom 36 residents displayed four distinct viewpoints: Dependent residents (n = 10) favored a task-oriented approach, clear guidance, and formal colleague relationships; Social Capitalizing residents (n = 9) preferred structure in the onboarding period and informal workplace social interactions; Autonomous residents (n = 12) prioritized a loosely structured onboarding period, independence, responsibility, and informal social interactions; and Development-oriented residents (n = 5) desired a balanced onboarding period that allowed independence, exploration, and development.</p><p><strong>Discussion: </strong>This identification of four viewpoints highlights the inadequacy of one-size-fits-all approaches to resident transition. Healthcare professionals and departments should tailor their socialization strategies to residents' preferences for support, structure, and formal/informal social interaction.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"169-181"},"PeriodicalIF":3.6,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10941690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140144393","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":"Medical Student Intentions to Move Abroad: A UK-Based Realist Evaluation.","authors":"Elizabeth Mcculloch, Dominic W Proctor, Karen Mattick","doi":"10.5334/pme.1170","DOIUrl":"https://doi.org/10.5334/pme.1170","url":null,"abstract":"<p><strong>Introduction: </strong>Medical students moving abroad after qualification may contribute to domestic healthcare workforce shortages. Greater insights into how medical students make decisions about moving abroad may improve post-qualification retention. The aim was to develop a programme theory explaining medical students' intentions to move abroad or not.</p><p><strong>Methods: </strong>In Phase 1 the initial programme theory was generated from a literature review. In Phase 2, the theory was developed through 30 realist interviews with medical students from a medical school in the United Kingdom. In Phase 3 the final programme theory was used to produce recommendations for stakeholders.</p><p><strong>Results: </strong>The findings highlight the complex decision-making that medical students undertake when deciding whether to move abroad. We identified five contexts and six mechanisms leading to two outcomes (<i>intention to move abroad and no intention to move abroad</i>).</p><p><strong>Conclusions: </strong>This realist evaluation has demonstrated how contexts and mechanisms may interact to enable specific outcomes. These insights have allowed evidence-based recommendations to be made with a view to retaining graduates, including protected time within medical curricula to experience other healthcare systems, improved availability of domestic postgraduate posts providing domestic career certainty and stronger domestic-based social support networks for graduates.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"141-150"},"PeriodicalIF":3.6,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10885844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974089","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":"Enabling Implementation of Competency Based Medical Education through an Outcomes-Focused Accreditation System.","authors":"Timothy R Dalseg, Brent Thoma, Keith Wycliffe-Jones, Jason R Frank, Sarah Taber","doi":"10.5334/pme.963","DOIUrl":"10.5334/pme.963","url":null,"abstract":"<p><p>Competency based medical education is being adopted around the world. Accreditation plays a vital role as an enabler in the adoption and implementation of competency based medical education, but little has been published about how the design of an accreditation system facilitates this transformation. The Canadian postgraduate medical education environment has recently transitioned to an outcomes-based accreditation system in parallel with the adoption of competency based medical education. Using the Canadian example, we characterize four features of an accreditation system that can facilitate the implementation of competency based medical education: theoretical underpinning, quality focus, accreditation standards, and accreditation processes. Alignment of the underlying educational theories within the accreditation system and educational paradigm drives change in a consistent and desired direction. An accreditation system that prioritizes quality improvement over quality assurance promotes educational system development and progressive change. Accreditation standards that achieve the difficult balance of being sufficiently detailed yet flexible foster a high fidelity of implementation without stifling innovation. Finally, accreditation processes that recognize the change process, encourage program development, and are not overly punitive all enable the implementation of competency based medical education. We also discuss the ways in which accreditation can simultaneously hinder the implementation of this approach. As education bodies adopt competency based medical education, particular attention should be paid to the role that accreditation plays in successful implementation.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"75-84"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724573","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":"Coaching in Competence by Design: A New Model of Coaching in the Moment and Coaching Over Time to Support Large Scale Implementation.","authors":"Denyse Richardson, Jeffrey M Landreville, Jessica Trier, Warren J Cheung, Farhan Bhanji, Andrew K Hall, Jason R Frank, Anna Oswald","doi":"10.5334/pme.959","DOIUrl":"10.5334/pme.959","url":null,"abstract":"<p><p>Coaching is an increasingly popular means to provide individualized, learner-centered, developmental guidance to trainees in competency based medical education (CBME) curricula. Aligned with CBME's core components, coaching can assist in leveraging the full potential of this educational approach. With its focus on growth and improvement, coaching helps trainees develop clinical acumen and self-regulated learning skills. Developing a shared mental model for coaching in the medical education context is crucial to facilitate integration and subsequent evaluation of success. This paper describes the Royal College of Physicians and Surgeons of Canada's coaching model, one that is theory based, evidence informed, principle driven and iteratively and developed by a multidisciplinary team. The coaching model was specifically designed, fit for purpose to the postgraduate medical education (PGME) context and implemented as part of Competence by Design (CBD), a new competency based PGME program. This coaching model differentiates two coaching roles, which reflect different contexts in which postgraduate trainees learn and develop skills. Both roles are supported by the RX-OCR process: developing <b>R</b>elationship/<b>R</b>apport, setting e<b>X</b>pectations, <b>O</b>bserving, a <b>C</b>oaching conversation, and <b>R</b>ecording/<b>R</b>eflecting. The CBD Coaching Model and its associated RX-OCR faculty development tool support the implementation of coaching in CBME. Coaching in the moment and coaching over time offer important mechanisms by which CBD brings value to trainees. For sustained change to occur and for learners and coaches to experience the model's intended benefits, ongoing professional development efforts are needed. Early post implementation reflections and lessons learned are provided.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"33-43"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724552","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":"Competence by Design: The Role of High-Stakes Examinations in a Competence Based Medical Education System.","authors":"Farhan Bhanji, Viren Naik, Amanda Skoll, Richard Pittini, Vijay John Daniels, C Maria Bacchus, Glen Bandiera","doi":"10.5334/pme.965","DOIUrl":"10.5334/pme.965","url":null,"abstract":"<p><p>Competency based medical education is developed utilizing a program of assessment that ideally supports learners to reflect on their knowledge and skills, allows them to exercise a growth mindset that prepares them for coaching and eventual lifelong learning, and can support important progression and certification decisions. Examinations can serve as an important anchor to that program of assessment, particularly when considering their strength as an independent, third-party assessment with evidence that they can predict future physician performance and patient outcomes. This paper describes the aims of the <i>Royal College of Physicians and Surgeons of Canada's</i> (\"the Royal College\") certification examinations, their future role, and how they relate to the Competence by Design model, particularly as the culture of workplace assessment and the evidence for validity evolves. For example, high-stakes examinations are stressful to candidates and focus learners on exam preparation rather than clinical learning opportunities, particularly when they should be developing greater autonomy. In response, the Royal College moved the written examination earlier in training and created an exam quality review, by a specialist uninvolved in development, to review the exam for clarity and relevance. While learners are likely to continue to focus on the examination as an important hurdle to overcome, they will be preparing earlier in training, allowing them the opportunity to be more present and refine their knowledge when discussing clinical cases with supervisors in the Transition to Practice phase. The quality review process better aligns the exam to clinical practice and can improve the educational impact of the examination preparation process.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"68-74"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724553","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":"Design and Implementation of a National Program of Assessment Model - Integrating Entrustable Professional Activity Assessments in Canadian Specialist Postgraduate Medical Education.","authors":"Warren J Cheung, Farhan Bhanji, Wade Gofton, Andrew K Hall, Jolanta Karpinski, Denyse Richardson, Jason R Frank, Nancy Dudek","doi":"10.5334/pme.956","DOIUrl":"10.5334/pme.956","url":null,"abstract":"<p><p>Traditional approaches to assessment in health professions education systems, which have generally focused on the summative function of assessment through the development and episodic use of individual high-stakes examinations, may no longer be appropriate in an era of competency based medical education. Contemporary assessment programs should not only ensure collection of high-quality performance data to support robust decision-making on learners' achievement and competence development but also facilitate the provision of meaningful feedback to learners to support reflective practice and performance improvement. Programmatic assessment is a specific approach to designing assessment systems through the intentional selection and combination of a variety of assessment methods and activities embedded within an educational framework to simultaneously optimize the decision-making and learning function of assessment. It is a core component of competency based medical education and is aligned with the goals of promoting assessment for learning and coaching learners to achieve predefined levels of competence. In Canada, postgraduate specialist medical education has undergone a transformative change to a competency based model centred around entrustable professional activities (EPAs). In this paper, we describe and reflect on the large scale, national implementation of a program of assessment model designed to guide learning and ensure that robust data is collected to support defensible decisions about EPA achievement and progress through training. Reflecting on the design and implications of this assessment system may help others who want to incorporate a competency based approach in their own country.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"13 1","pages":"44-55"},"PeriodicalIF":4.8,"publicationDate":"2024-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10854461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139724572","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}