Problematising standards in an era of increasing transparency

Ajjawi, Rola

doi:10.1111/medu.13371

Cited by 2 publications

(5 citation statements)

References 12 publications

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“…Standards may stay the same, but they are not stable constructs when implemented; rather, as they are enacted locally they shift. This leads to the constant question of whether any specific enactment is ‘true enough’ to the standard …”

Section: Discussionmentioning

confidence: 99%

“…However, standards adopted into different local contexts may be enacted differently. For instance, many ‘standard’ products such as McDonalds, Cadbury, Coca‐Cola, Toyota and Netflix are re‐engineered for different markets, creating multiple different ‘standards’ that are contextually dependent . Standards, then, are rarely applied in a uniform way; as standards are created, changed, operationalised and withdrawn, standardisation shifts and diversifies…”

Section: Contextualisation and Standardisationmentioning

confidence: 99%

“…For instance, many 'standard' products such as McDonalds, Cadbury, Coca-Cola, Toyota and Netflix are re-engineered for different markets, creating multiple different 'standards' that are contextually dependent. 12 Standards, then, are rarely applied in a uniform way; as standards are created, changed, operationalised and withdrawn, standardisation shifts and diversifies. 13 In medical education, standards are set through consensus by accreditation organisations, [14][15][16] through evidence in peer-reviewed literature, 17 through national examinations, 18,19 through common competency frameworks, 20,21 through national or international committees (such as the Foundation for Advancement of International Medical Education and Research) 22 and through political processes (such as the Bologna Process).…”

Section: Contextualisation and Standardisationmentioning

confidence: 99%

“…This leads to the constant question of whether any specific enactment is 'true enough' to the standard. 12,13 Standardisation brings benefits: its common articulations and assumptions can facilitate mobility, promote patient safety, drive continuous quality improvement and enable the diffusion of best practices. Standardisation can also help to embed principles of fairness, equity, reliability and validity in high-stakes processes, while reassuring stakeholders, including the public, about the quality of medical education as a whole.…”

Section: Competency-based Medical Educationmentioning

confidence: 99%

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Embracing standardisation and contextualisation in medical education

et al. 2018

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Context The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them. Methods The authors synthesise the literature related to the intersections and resulting tensions between standardization and contextual diversity in medical education. In doing so, the authors analyze the interplay between these competing concepts in two domains of medical education (admissions and competency‐based medical education), and provide concrete examples drawn from the literature. Results Standardization offers many rewards: its common articulations and assumptions promote patient safety, foster continuous quality improvement, and enable the spread of best practices. Standardization may also contribute to greater fairness, equity, reliability and validity in high stakes processes, and can provide stakeholders, including the public, with tangible reassurance and a sense of the stable and timeless. At the same time, contextual variation in medical education can afford myriad learning opportunities, and it can improve alignment between training and local workforce needs. The inevitable diversity of contexts for learning and practice renders any absolute standardization of programs, experiences, or outcomes an impossibility. Conclusions The authors propose a number of ways to examine the interplay of contextual diversity and standardization and suggest three ways to move beyond an either/or stance. In reconciling the laudable goals of standardization and the realities of the innumerable contexts in which we train and deliver care, we are better positioned to design and deliver a medical education system that is globally responsible and locally engaged.

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Section: Discussionmentioning

confidence: 99%

Section: Contextualisation and Standardisationmentioning

confidence: 99%

Section: Contextualisation and Standardisationmentioning

confidence: 99%

Section: Competency-based Medical Educationmentioning

confidence: 99%

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Embracing standardisation and contextualisation in medical education

et al. 2018

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“…These findings suggest that the structure and culture of surgical training may not encourage engagement with certain learning activities—those which are useful for personal development, but not essential to progression. Mandating SBE may appear to address this barrier, but may actually only perpetuate a “tick box” culture [21, 22]. Essentially, assessment must be coupled to routine clinical practice if learners are to engage otherwise the task becomes an obligation rather than a learning opportunity.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to deliberate practice using take-home laparoscopic simulators

et al. 2018

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Background Several regions in the UK and Ireland have delivered home-based laparoscopic simulation programmes in an attempt to progress surgical trainees’ skills through deliberate practice. However, engagement with these programmes has been poor. This study aims to uncover the barriers to engagement with home-based simulation, with a view to developing an improved programme. Methods This was a qualitative study using focus groups with key stakeholders including junior surgical trainees, consultants/attendings and simulation faculty. Data were collected across four regions in three countries. Data were audio-recorded, transcribed and a thematic analysis was performed using NVivo software. Results Sixty-three individuals were interviewed in 12 focus groups (43 trainees, 20 trainers). Trainees cited competing commitments as a barrier to engaging with home-based simulation. They tended to focus on scoring ‘points’ towards career progression rather than viewing tasks as interesting, or associated with personal development. Their view was that this approach is perpetuated by the training system, which rewards trainees for publications and exams, but not for operative skill. Trainees were unsatisfied with metric feedback and wanted individual feedback from consultants (attendings). Trainees perceived consultants as lacking interest in the programmes and training in general. However, some consultants were unaware of the programmes being delivered and others felt lacking in confidence to deliver the necessary training. Conclusions Scheduled simulation sessions which provide trainees with the opportunity for consultant feedback may improve engagement. Tackling the ‘point-scoring’ culture is more challenging. This could be addressed by modified assessment structures, greater recognition and accountability for trainers, and recognition and funding of simulation strategies including in-house skills sessions.

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Problematising standards in an era of increasing transparency

Cited by 2 publications

References 12 publications

Embracing standardisation and contextualisation in medical education

Embracing standardisation and contextualisation in medical education

Barriers and facilitators to deliberate practice using take-home laparoscopic simulators

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