We argue for continued theorising of and theoretically informed applications of reflection, drawing upon epistemologies of practice and critical reflection as critical social inquiry. These directions offer medical education research broad and deep potential in theories of reflection, particularly in relation to knowledge creation within uncertain and complex situations, and challenging of dominant discourses and structures. Future work could explore how dominant epistemological positions and discourses in medicine influence theories from other disciplines when these theories are deployed in medical education.
Dr. Francis Collins, NIH Director, convened and charged the Physician-Scientist Workforce Working Group (PSW-WG) with analyzing the current composition and size of the physician-scientist biomedical workforce and making recommendations for actions that NIH should take to help sustain and strengthen a robust and diverse PSW. The need for the PSW-WG emerged from the recommendations of the Biomedical Research Workforce Working Group for strengthening the biomedical workforce. Its June 2012 report concluded that the training and career paths of physician-scientists were different than that of the non-clinician PhD workforce and that further study of this important segment of the workforce was needed.Warning bells about the health of the physician-science workforce were sounded as early as 1979 when future NIH Director James Wyngaarden observed that the physician-scientist with a medical degree was becoming "an endangered species." He had observed that MD applicants for NIH project grants represented a progressively smaller fraction of all applicants than previously, while the corresponding fraction of PhD applicants had increased dramatically. In 1996, NIH established a committee headed by David G. Nathan to make recommendations about the perceived shortfall of clinician scientists. The Nathan Committee recommended creating new career development grants for patient-oriented research and loan repayment programs to help young physician-scientists pursue research careers despite an increasing load of educational debt.In spring 2013, the PSW-WG met and established subcommittees to discuss issues confronting the physician-scientist workforce. To inform its deliberations, the PSW-WG directed quantitative analyses of NIH IMPACII and other relevant databases to answer key questions, and considered the findings from qualitative research based on focus groups and interviews with students, research deans, and early career investigators.The PSW-WG defined physician-scientists as scientists with professional degrees who have training in clinical care and who are engaged in independent biomedical research. The PSW thus includes individuals with an MD, DO, DDS/DMD, DVM/VMD, or nurses with research doctoral degrees who devote the majority of their time to biomedical research. The PSW-WG recognizes that the primary goal of professional clinical education is the training of a skilled clinical workforce in the respective areas of practice, and that the portion of such professionals devoted to research will be small. However, findings which lead to advances in practice are driven largely by the work of investigators with a variety of degrees, of whom those with clinical training contribute essential knowledge and skills.
BackgroundTeaching is a key component of medical practice, but medical students receive little formal training to develop their teaching skills. A longitudinal Students as Teachers (SAT) program was created at the University of Toronto to provide medical students with opportunities to acquire an understanding of educational pedagogy and practice teaching early in their medical training. This program was 7-months in duration and consisted of monthly educational modules, practical teaching sessions, feedback, and reflective exercises.MethodsA mixed methods study design was used to evaluate initial outcomes of the SAT program by obtaining the perspectives of 18 second-year medical students. Participants filled out questionnaires at the beginning and end of the 7-month program to indicate their skill level and confidence in teaching. Differences between pre- and post-intervention scores were further explored in a group interview of 5 participants.ResultsParticipants expressed a high degree of satisfaction with the SAT program structure and found the educational modules and practical teaching sessions to be particularly beneficial to their learning. Over the course of the program, there were significant increases in students’ confidence in teaching, and self-perceived teaching capacity and communication skills. Furthermore, participants discussed improvements in their effectiveness as learners.ConclusionsTeaching is a skill that requires ongoing practice. Our results suggest that a longitudinal program consisting of theoretical modules, practical teaching sessions, feedback, and reflective exercises for medical students may improve teaching and communication skills, and equip them with improved learning strategies. This program also provides students with insight into the experience of teaching while holding other academic and clinical responsibilities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-017-0857-8) contains supplementary material, which is available to authorized users.
ObjectivesWe reviewed the published literature on antimicrobial stewardship training in undergraduate and postgraduate medical education to determine which interventions have been implemented, the extent to which they have been evaluated, and to understand which are most effective. MethodsWe searched Ovid MEDLINE and EMBASE from inception to December 2016. Four thousand three hundred eighty-five (4385) articles were identified and underwent title and abstract review. Only those articles that addressed antimicrobial stewardship interventions for medical trainees were included in the final review. We employed Kirkpatrick’s four levels of evaluation (reaction, learning, behaviour, results) to categorize intervention evaluations. ResultsOur review included 48 articles. The types of intervention varied widely amongst studies worldwide. Didactic teaching was used heavily in all settings, while student-specific feedback was used primarily in the postgraduate setting. The high-level evaluation was sparse, with 22.9% reporting a Kirkpatrick Level 3 evaluation; seventeen reported no evaluation. All but one article reported positive results from the intervention. No articles evaluated the impact of an intervention on undergraduate trainees’ prescribing behaviour after graduation. ConclusionsThis study enhances our understanding of the extent of antimicrobial stewardship in the context of medical education. While our study demonstrates that medical schools are implementing antimicrobial stewardship interventions, rigorous evaluation of programs to determine whether such efforts are effective is lacking. We encourage more robust evaluation to establish effective, evidence-based approaches to training prescribers in light of the global challenge of antimicrobial resistance.
BackgroundUsing commercially available television and movies is a potentially effective tool to foster humanistic, compassionate and person-centred orientations in medical students.AimWe reviewed pedagogical applications of television and movies in medical education to explore whether and why this innovation holds promise.MethodsWe performed a literature review to provide a narrative summary on this topic.ResultsFurther studies are needed with richer descriptions of innovations and more rigorous research designs.ConclusionAs we move toward evidence-informed education, we need an evidence- based examination of this topic that will move it beyond a ‘show and tell’ discussion toward meaningful implementation and evaluation. Further exploration regarding the theoretical basis for using television and movies in medical education will help substantiate continued efforts to use these media as teaching tools.Electronic supplementary materialThe online version of this article (doi: 10.1007/s40037-015-0205-9) contains supplementary material, which is available to authorized users.
This review maps out empirical knowledge on the efficacy of a broad range of educational approaches in medical education. Critical knowledge gaps, and lapses in methodological rigour, are discussed, providing valuable insight for future research. The findings call attention to the need for adopting evaluative strategies that explore how contextual variabilities and individual (teacher/learner) differences influence efficacy of educational interventions. Additionally, the results underscore that extant empirical evidence does not always provide unequivocal answers about what approaches are most effective. Educators should incorporate best available empirical knowledge with experiential and contextual knowledge.
The medical education (Med Ed) research community characterises itself as drawing on the insights, methods, and knowledge from multiple disciplines and research domains (e.g. Sociology, Anthropology, Education, Humanities, Psychology). This common view of Med Ed research is echoed and reinforced by the narrative used by leading Med Ed departments and research centres to describe their activities as “interdisciplinary.” Bibliometrics offers an effective method of investigating scholarly communication to determine what knowledge is valued, recognized, and utilized. By empirically examining whether knowledge production in Med Ed research draws from multiple disciplines and research areas, or whether it primarily draws on the knowledge generated internally within the field of Med Ed, this article explores whether the characterisation of Med Ed research as interdisciplinary is substantiated. A citation analysis of 1412 references from research articles published in 2017 in the top five Med Ed journals was undertaken. A typology of six knowledge clusters was inductively developed. Findings show that the field of Med Ed research draws predominantly from two knowledge clusters: the Applied Health Research cluster (made of clinical and health services research), which represents 41% of the references, and the Med Ed research cluster, which represents 40% of the references. These two clusters cover 81% of all references in our sample, leaving 19% distributed among the other knowledge clusters (i.e., Education, disciplinary, interdisciplinary and topic centered research). The quasi-hegemonic position held by the Applied Health and Med Ed research clusters confines the other sources of knowledge to a peripheral role within the Med Ed research field. Our findings suggest that the assumption that Med Ed research is an interdisciplinary field is not convincingly supported by empirical data and that the knowledge entering Med Ed comes mostly from the health research domain.
Purpose: School settings are a common practice context for rehabilitation professionals; health advocacy is a common and challenging practice role for professionals in this context. This study explored how pediatric practitioners advocate for children with disabilities at school. Specifically, we examined everyday advocacy in the context of school-based support for children with disabilities. Method: Our theoretical framework and methodological approach were informed by institutional ethnography, which maps and makes visible hidden social coordinators of work processes with a view to improving processes and outcomes. We included families, educators, and health/rehabilitation practitioners from Ontario. Of the 37 consented informants, 27 were interviewed and 15 observed. Documents and texts were collected from the micro-level (e.g. clinician reports) and the macro-level (e.g. policies). Results: Pediatric practitioners' advocacy work included two main work processes: spotlighting invisible disabilities and orienteering the special education terrain. Practitioners advocated indirectly, by proxy, with common proxies being documents and parents. Unintended consequences of advocacy by proxy included conflict and inefficiency, which were often unknown to the practitioner. Conclusions: The findings of this study provide practice-based knowledge about advocacy for children with disabilities, which may be used to inform further development of competency frameworks and continuing education for pediatric practitioners. The findings also show how everyday practices are influenced by policies and social discourses and how rehabilitation professionals may enact change.Implications for RehabilitationRehabilitation professionals frequently perform advocacy work. They may find it beneficial to perform advocacy work that is informed by overarching professional and ethical guidelines, and a nuanced understanding of local processes and structures.Competency frameworks and education for pediatric rehabilitation professionals may be improved by: encouraging professionals to consider how their practices, including their written documents, may affect parental burden, (mis)interpretation by document recipients, and potential unintended consequences.Policies and texts, e.g. privacy legislation and the Diagnostic and Statistical Manual (DSM), influence rehabilitation professionals' actions and interactions when supporting children with disabilities at school.An awareness of the influence of policies and texts may enable practitioners to work more effectively within current systems when supporting individuals with disabilities.
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