Progress in improving the credibility of teachers' descriptive evaluations of students and residents has not kept pace with the progress made in improving the credibility of more quantified methods, such as multiple-choice examinations and standardized patient examinations of clinical skills. This article addresses innovative approaches to making the ongoing in-training evaluation (ITEv) of trainees during their clinical experiences more reliable and valid. The innovations include the development of a standard vocabulary for describing the progress of trainees from "reporter" to "interpreter" to "manager" and "educator" (RIME), the use of formal evaluation sessions, and closer consideration of the unit of clinical evaluation (the case, the rotation, or the year). The author also discusses initial results of studies assessing the reliability and validity of descriptive methods, as well as the use of quantified methods to complement descriptive methods. Applying basic principles--the use of a taxonomy of professional development and statistical principles of reliability and validity--may foster research into more credible descriptive evaluation of clinical skills.
Our unified model is consistent with the tenets of cognitive load, situated cognition and ecological psychology theories. A number of potentially modifiable influences on clinical reasoning were identified. Implications for doctor training and practice are discussed.
A central tenet of Flexner's report was the fundamental role of science in medical education. Today, there is tension between the time needed to teach an ever-expanding knowledge base in science and the time needed for increased instruction in clinical application and in the behavioral, ethical, and managerial knowledge and skills needed to prepare for clinical experiences. One result has been at least a perceived reduction in time and focus on the foundational sciences. In this context, the International Association of Medical Science Educators initiated a study to address the role and value of the basic sciences in medical education by seeking perspectives from various groups of medical educators to five questions: (1) What are the sciences that constitute the foundation for medical practice? (2) What is the value and role of the foundational sciences in medical education? (3) When and how should these foundational sciences be incorporated into the medical education curriculum? (4) What sciences should be prerequisite to entering the undergraduate medical curriculum? (5) What are examples of the best practices for incorporating the foundational sciences into the medical education curriculum? The results suggest a broad group of experts believes that an understanding of basic science content remains essential to clinical practice and that teaching should be accomplished across the entire undergraduate medical education experience and integrated with clinical applications. Learning the sciences also plays a foundational role in developing discipline and rigor in learners' thinking skills, including logical reasoning, critical appraisal, problem solving, decision making, and creativity.
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