Since 1765, five major curricular reform movements have catalyzed significant changes in North American medical education. This article describes each reform movement in terms of its underlying educational practices and principles, inherent instructional problems, and the innovations that were carried forward. When considering the motivating factors underlying these reform movements, a unifying theme gradually emerges: increasing interest in, attention to, and understanding of the knowledge-base structures and cognitive processes that characterize and distinguish medical experts and novices. Concurrent with this emerging theme is a growing realization that medical educators must call upon and utilize the literature, research methods, and theoretical perspectives of cognitive science if future curricular reform efforts are to move forward efficiently and effectively. The authors hope that the discussion and perspective offered herein will broaden, stimulate, and challenge educators as they strive to create the reform movements that will define 21st-century medical education.

This study uses multivariate analysis of a large panel dataset to examine the determinants of principal retention (and, thus, the determinants of attracting a principal away from her current position). The empirical model incorporates measures of a principal's traits and of the organizational structure, culture, and situational context within a school. The discussion focuses on (1) the impact of salary, school characteristics, and principal traits and on (2) their associated policy implications. Evidence from the study suggests that schools with higher proportions of at-risk students and less-qualified teachers are disadvantaged with respect to their ability to retain (and attract) principals. At the same time, the evidence suggests that higher salaries can be used to compensate for these disparities.

Background Given an unacceptably high incidence of diagnostic errors, we sought to identify the key competencies that should be considered for inclusion in health professions education programs to improve the quality and safety of diagnosis in clinical practice. Methods An interprofessional group reviewed existing competency expectations for multiple health professions, and conducted a search that explored quality, safety, and competency in diagnosis. An iterative series of group discussions and concept prioritization was used to derive a final set of competencies. Results Twelve competencies were identified: Six of these are individual competencies: The first four (#1–#4) focus on acquiring the key information needed for diagnosis and formulating an appropriate, prioritized differential diagnosis; individual competency #5 is taking advantage of second opinions, decision support, and checklists; and #6 is using reflection and critical thinking to improve diagnostic performance. Three competencies focus on teamwork: Involving the patient and family (#1) and all relevant health professionals (#2) in the diagnostic process; and (#3) ensuring safe transitions of care and handoffs, and “closing the loop” on test result communication. The final three competencies emphasize system-related aspects of care: (#1) Understanding how human-factor elements influence the diagnostic process; (#2) developing a supportive culture; and (#3) reporting and disclosing diagnostic errors that are recognized, and learning from both successful diagnosis and from diagnostic errors. Conclusions These newly defined competencies are relevant to all health professions education programs and should be incorporated into educational programs.

Diagnostic error is increasingly recognized as a major patient safety concern. Efforts to improve diagnosis have largely focused on safety and quality improvement initiatives that patients, providers, and health care organizations can take to improve the diagnostic process and its outcomes. This educational policy brief presents an alternative strategy for improving diagnosis, centered on future healthcare providers, to improve the education and training of clinicians in every health care profession. The hypothesis is that we can improve diagnosis by improving education. A literature search was first conducted to understand the relationship of education and training to diagnosis and diagnostic error in different health care professions. Based on the findings from this search we present the justification for focusing on education and training, recommendations for specific content that should be incorporated to improve diagnosis, and recommendations on educational approaches that should be used. Using an iterative, consensus-based process, we then developed a driver diagram that categorizes the key content into five areas. Learners should: 1) Acquire and effectively use a relevant knowledge base, 2) Optimize clinical reasoning to reduce cognitive error, 3) Understand system-related aspects of care, 4) Effectively engage patients and the diagnostic team, and 5) Acquire appropriate perspectives and attitudes about diagnosis. These domains echo recommendations in the National Academy of Medicine’s report Improving Diagnosis in Health Care. The National Academy report suggests that true interprofessional education and training, incorporating recent advances in understanding diagnostic error, and improving clinical reasoning and other aspects of education, can ultimately improve diagnosis by improving the knowledge, skills, and attitudes of all health care professionals.

An analysis of survey data is used to examine the practices used to hire teachers, the level of principal autonomy within the process, the attributes sought in teachers, and to compare each based upon the characteristics of schools and of principals. Findings indicate that urban and low-performing schools (and the principals of these schools) are disadvantaged with respect to their ability to recruit and to hire highly qualified teachers and that, in general, principal autonomy in hiring teachers, teacher hiring practices, the attributes sought in teachers, and the constraints and limitations within the teacher hiring process are largely determined by the organizational structure, culture, and situational context of a schoolIn addition, a causal model is used to examine the extent to which newly hired principals hire teachers with much better (or much worse) qualifications than the teachers hired by their predecessors and to examine the relationship between principal effectiveness, in this regard, and the traits of principals. Findings indicate that there is a remarkable consistency in principals' effectiveness (and ineffectiveness) in hiring teachers and that, for principals to be effective, their traits and attributes must beWe are grateful to Jim Wyckoff, Hamp Lankford, Sue Faerman, and Steve Jacobson for their comments and suggestions. In addition, we appreciate the comments on preliminary analysis from 88 Frank Papa, Jr. and Iris Baxter appropriately matched with the organizational structure, culture, and situational context of a school. That is, there is no systematic relationship between principal effectiveness and the traits and attributes of principals except for district experience, which has a positive and significant impact on principal effectiveness and which, on average, is likely to have a positive and significant impact on the matches between a principal and a school.