The alignment imperative in curriculum renewal

Evidence-Based Strategies for Reforming the Medical Curriculum at the National Autonomous University of Honduras: A Systematic Literature Review

Medical education worldwide has undergone numerous stages of reform. Cultural and financial restraints have decelerated progress in developing countries. Current reforms should focus on creating integrated, competency-based, and student-centered curricula that emphasize patient-centered care. The following review of literature published between 2014 and 2023 on global curricular reforms highlighted key components, challenges, and strategies for implementing or evaluating undergraduate medical programs that prioritize student-centered approaches and competency-based models. This review also compared the current curriculum at the National Autonomous University of Honduras (UNAH) with these international experiences to suggest strategies in order to encourage significant reform. The following review identified 47 articles that provided insights into ideal contexts for curricular reforms, while 15 publications detailed the current state of the UNAH medical curriculum and its potential weaknesses. Additionally, 25 articles discussed specific reforms in other countries, offering valuable results and conclusions for consideration. Drawing from these models and experiences, strategies were proposed for UNAH's curriculum reform, including identifying basic needs, defining project vision, training teaching staff and students, and integrating multidisciplinary teams of experts. Although training all teaching staff abroad may be financially unfeasible, selecting and training key individuals to train others could be a viable alternative. Successful reform requires a comprehensive, periodic, and systematic evaluation. Despite the challenges faced by developing countries, global experiences with alternative reform models offer promising solutions, providing an opportunity for the Faculty of Medical Sciences at UNAH to overcome local limitations and fulfill the primary task of training professionals who are clinically, ethically, and adaptively competent, with a focus on patient-centered and primary care approaches.

Integrating virtual patients into undergraduate health professions curricula: a framework synthesis of stakeholders' opinions based on a systematic literature review

BACKGROUND

Virtual patients (VPs) are widely used in health professions education. When they are well integrated into curricula, they are considered to be more effective than loosely coupled add-ons. However, it is unclear what constitutes their successful integration. The aim of this study was to identify and synthesise the themes found in the literature that stakeholders perceive as important for successful implementation of VPs in curricula.

METHODS

We searched five databases from 2000 to September 25, 2023. We included qualitative, quantitative, mixed-methods and descriptive case studies that defined, identified, explored, or evaluated a set of factors that, in the perception of students, teachers, course directors and researchers, were crucial for VP implementation. We excluded effectiveness studies that did not consider implementation characteristics, and studies that focused on VP design factors. We included English-language full-text reports and excluded conference abstracts, short opinion papers and editorials. Synthesis of results was performed using the framework synthesis method with Kern's six-step model as the initial framework. We appraised the quality of the studies using the QuADS tool.

RESULTS

Our search yielded a total of 4808 items, from which 21 studies met the inclusion criteria. We identified 14 themes that formed an integration framework. The themes were: goal in the curriculum; phase of the curriculum when to implement VPs; effective use of resources; VP alignment with curricular learning objectives; prioritisation of use; relation to other learning modalities; learning activities around VPs; time allocation; group setting; presence mode; VPs orientation for students and faculty; technical infrastructure; quality assurance, maintenance, and sustainability; assessment of VP learning outcomes and learning analytics. We investigated the occurrence of themes across studies to demonstrate the relevance of the framework. The quality of the studies did not influence the coverage of the themes.

CONCLUSIONS

The resulting framework can be used to structure plans and discussions around implementation of VPs in curricula. It has already been used to organise the curriculum implementation guidelines of a European project. We expect it will direct further research to deepen our knowledge on individual integration themes.

The challenge of transfer to clinical practice: The illusion of learning and illusion of teaching

There is increasing pressure to accelerate health professions education programs and educators have the challenge of ensuring that students can effectively transfer their learning into clinical practice. In this personal view, we discuss how insights from cognitive science can inform the redesign of current curricula and highlight the challenge of implementing these new approaches for instructional design and assessment. We also recommend that educators disseminate the important lessons learned from their endeavors.

Comparison of faculty and student perceptions of sexual and gender minority content in a preclerkship medical curriculum

BACKGROUND

Sexual and gender minority (SGM) persons experience stark health disparities. Efforts to mitigate disparities through medical education have met some success. However, evaluations have largely focused on subjective perspectives rather than objective measures. This study aimed to quantify Boston University School of Medicine's sexual and gender minority (SGM) education through surveys of course directors (CDs) and medical students regarding where SGM topics were taught in the preclerkship medical curriculum. Responses were compared to identify concordance between faculty intention and student perceptions regarding SGM education.

METHODS

A cross-sectional survey was distributed to preclerkship CDs and current medical students in Spring 2019 and 2021, respectively, regarding where in the mandatory preclerkship curriculum CDs deliberately taught and where first- and second-year students recalled having learned 10 SGM topic domains.

RESULTS

64.3% of CDs (n = 18), 47.0% of the first-year class (n = 71), and 67.3% of the second-year class (n = 101) responded to the surveys. Results indicate that, as anticipated, deliberate SGM teaching correlates with greater student recall as students recalled topics that were reported by CDs as intentionally taught at a significantly higher rate compared to those not intentionally taught (32.0% vs. 15.3%; p < 0.01). Students most commonly recalled learning SGM-related language and terminology, which is likely partly but not entirely attributed to curricular modifications and faculty development made between distribution of the faculty and student surveys, indicating the importance of all faculty being trained in appropriate SGM terminology and concepts. Discordance between faculty intention and student recall of when topics were taught reveals opportunities to enhance the intentionality and impact of SGM teaching.

CONCLUSIONS

Students perceive and recall SGM content that is not listed as learning objectives, and all faculty who utilize this material in their teachings should receive foundational training and be thoughtful about how information is framed. Faculty who intentionally teach SGM topics should be explicit and direct about the conclusions they intend students to draw from their curricular content.

Nursing students learning transfer from classroom to clinical practice: An integrative review

AIM

The aim of this integrative review was to examine the theoretical, qualitative, quantitative and mixed-methods literature focused on how nursing students transfer learning from theory courses into clinical practice.

BACKGROUND

As nursing curriculum aligns with the growing body of nursing knowledge, nursing students continue to develop their knowledge base and skill sets to prepare for future nursing practice. The bulk of this preparation involves developing connections between classroom/lab knowledge and further demonstrating those connections in clinical practice. However, the extant state of evidence on undergraduate nursing students' learning transfer has not yet been synthesized.

DESIGN

This integrative review was conducted using the Whittemore and Knafl framework.

REVIEW METHODS

Eight databases were searched in June 2022: MEDLINE, APA PsycInfo, EMBASE, Web of Science, CINAHL, ERIC, Academic Search Complete and Education Research Complete. Literature was included if it focused on undergraduate nursing students who have participated in at least one clinical practicum and reported on learning transfer in clinical settings. Only English-language, peer-reviewed literature was included. Two researchers independently assessed the eligibility of articles at the title-and-abstract level and at the full-text level, followed by an assessment of methodological quality. The Joanna Briggs Institute's critical appraisal checklists were used to assess theoretical papers and literature reviews and the mixed-methods appraisal tool (MMAT) was used to appraise all studies. Reference lists of included articles were searched for additional relevant literature. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines.

RESULTS

Twenty-eight articles met our inclusion criteria and were included in this review, including 20 qualitative studies, one quantitative study, three mixed-methods studies, three theoretical articles and one integrative review. The results of this review highlighted that numerous facilitators and barriers influence nursing students' ability to transfer learning within clinical learning environments. Facilitators included having knowledgeable and supportive educators and nursing staff, using strategies to promote connections, fostering reflection and aligning theory and practice. Barriers included unclear connections between course content, incongruencies between classroom and practice, lack of nurse role models, lack of real-world applicability and unsupportive nurse educators.

CONCLUSIONS

The information generated from this integrative review provides evidence about barriers that can be mitigated and facilitators that can be leveraged to facilitate undergraduate nursing students' learning transfer into clinical practice. The findings also highlighted gaps in evidence surrounding the need to understand how nursing students transfer learning from classroom settings to clinical practice settings.

Identifying emerging topics in the peer-reviewed literature to facilitate curriculum renewal and development

This article reports a bibliometric analysis of emerging topics in the psychiatric literature indexed in the MEDLINE database as a technique for renewal of clinical training curricula. Summary data of English-language articles indexed in the MEDLINE database between 1971-2018 were downloaded. Emerging topics in nine demi-decades between 1972-1976 and 2012-2016 were identified by the incremental incidence of individual Medical Subject Headings (MeSH) compared with previous years. Co-word analysis was used to investigate and visualise the relationships between emerging topics in each demi-decade. Summaries of 18 million articles annotated with psychiatric/psychological MeSH were retrieved and used to identify emerging topics. Peaks in the number of articles annotated by the top 20 emerging topics in 9 demi-decades coincided with release of the third and fourth editions of the Diagnostic and Statistical Manual which codifies psychiatric diagnoses. Themes emerging from network visualisations of the most common emerging MeSH in each demi-decade were consistent with movements in psychiatric/psychological theory and practice since the 1970s, including the recent focus on psychological and social factors implicated in suicide and suicide prevention. The identification of emerging topics within the published medical literature is a viable technique for use in curriculum renewal projects as a counterweight to biases driven by expert judgement. While indices like MEDLINE make the published literature an appealing initial step in building an empirical basis for curriculum development, it also demonstrates the potential value of less public and less structured data, such as health service electronic medical records.

University of Toronto's redesigned ophthalmology curriculum and eye dissection lab

OBJECTIVE

To present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning.

DESIGN

Curriculum review, validation, and student feedback evaluations.

PARTICIPANTS

Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program.

METHODS

Student feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012-2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017-2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test.

RESULTS

Analysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001).

CONCLUSIONS

The newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada.

Moving toward co-production: five ways to get a grip on collaborative implementation of Movement Behaviour curricula in undergraduate medical education

Several "calls to action" have imposed upon medical schools to include physical activity content in their overextended curricula. These efforts have often neither considered medical education stakeholders' views nor the full complexity of medical education, such as competency-based learning and educational inflation. With this external pressure for change, few medical schools have implemented physical activity curricula. Moreover, Canada's new 24-Hour Movement Guidelines focus on the continuum of movement behaviours (physical activity, sedentary behaviour, and sleep). Thus, a more integrated process to overcome the "black ice" of targeting all movement behaviours, medical education stakeholder engagement, and the overextended curriculum is needed. We argue for co-production in curriculum change and offer five strategies to integrate movement behaviour curricula that acknowledge the complexity of the medical education context, helping to overcome our "black ice." Our objectives were to investigate 24-Hour Movement Guideline content in the medical curriculum and develop an integrated process for competency-based curriculum renewal. Stakeholders were equal collaborators in a two-phased environmental scan of 24-Hour Movement Guideline content in the Queen's University School of Medicine. Findings and a working curriculum map highlight how new, competency-based content may be embedded in an effort to guide more relevant and feasible curriculum changes.

An international study on the implementation of programmatic assessment: Understanding challenges and exploring solutions

INTRODUCTION

Programmatic assessment is an approach to assessment aimed at optimizing the learning and decision function of assessment. It involves a set of key principles and ground rules that are important for its design and implementation. However, despite its intuitive appeal, its implementation remains a challenge. The purpose of this paper is to gain a better understanding of the factors that affect the implementation process of programmatic assessment and how specific implementation challenges are managed across different programs.

METHODS

An explanatory multiple case (collective) approach was used for this study. We identified 6 medical programs that had implemented programmatic assessment with variation regarding health profession disciplines, level of education and geographic location. We conducted interviews with a key faculty member from each of the programs and analyzed the data using inductive thematic analysis.

RESULTS

We identified two major factors in managing the challenges and complexity of the implementation process: knowledge brokers and a strategic opportunistic approach. Knowledge brokers were the people who drove and designed the implementation process acting by translating evidence into practice allowing for real-time management of the complex processes of implementation. These knowledge brokers used a 'strategic opportunistic' or agile approach to recognize new opportunities, secure leadership support, adapt to the context and take advantage of the unexpected. Engaging in an overall curriculum reform process was a critical factor for a successful implementation of programmatic assessment.

DISCUSSION

The study contributes to the understanding of the intricacies of implementation processes of programmatic assessment across different institutions. Managing opportunities, adaptive planning, awareness of context, were all critical aspects of thinking strategically and opportunistically in the implementation of programmatic assessment. Future research is needed to provide a more in-depth understanding of values and beliefs that underpin the assessment culture of an organization, and how such values may affect implementation.

Applying activity theory to undergraduate medical curriculum reform: Lessons in contradictions from multiple stakeholders' perspectives

PURPOSE

Medical school curricula require regular updating. We adopted an activity theory lens to conduct a holistic, multiple stakeholder-informed analysis of curricular reform, aiming to understand how the social relations between groups contribute to unanticipated tensions and outcomes.

METHODS

A research assistant conducted semi-structured interviews with purposively sampled (N = 19) administrative staff, faculty course leads, faculty tutors, curriculum developers, change leaders and student leaders. The team applied a framework analysis to guide within and between stakeholder comparisons.

RESULTS

Participants reported unique (N = 21) and cross-cutting (N = 17) contradictions underscoring emerging drivers of current and potential change. Unique contradictions raised by 1-2 groups represented seeds of change that had the potential to spread across all groups. By contrast, two general types of cross-cutting contradictions arose when one group had a dominant, confirming voice or two or more groups had contrasting perspectives.

CONCLUSIONS

While finding contradictions was expected, our analysis profiled their nature and some of the specific tensions they raised across and within stakeholder groups. The activity theory lens provided an accessible way to unravel curricular reform into manageable units of analysis. Systematically identifying contradictions arising from curricular reform will help stakeholders collaborate with a shared purpose toward positive, sustained change.

Assessment for Learning: The University of Toronto Temerty Faculty of Medicine M.D. Program Experience

(1) Background: Programmatic assessment optimizes the coaching, learning, and decision-making functions of assessment. It utilizes multiple data points, fit for purpose, which on their own guide learning, but taken together form the basis of holistic decision making. While they are agreed on principles, implementation varies according to context. (2) Context: The University of Toronto MD program implemented programmatic assessment as part of a major curriculum renewal. (3) Design and implementation: This paper, structured around best practices in programmatic assessment, describes the implementation of the University of Toronto MD program, one of Canada’s largest. The case study illustrates the components of the programmatic assessment framework, tracking and making sense of data, how academic decisions are made, and how data guide coaching and tailored support and learning plans for learners. (4) Lessons learned: Key implementation lessons are discussed, including the role of context, resources, alignment with curriculum renewal, and the role of faculty development and program evaluation. (5) Conclusions: Large-scale programmatic assessment implementation is resource intensive and requires commitment both initially and on a sustained basis, requiring ongoing improvement and steadfast championing of the cause of optimally leveraging the learning function of assessment.

Ottawa 2020 consensus statement for programmatic assessment - 1. Agreement on the principles

INTRODUCTION

In the Ottawa 2018 Consensus framework for good assessment, a set of criteria was presented for systems of assessment. Currently, programmatic assessment is being established in an increasing number of programmes. In this Ottawa 2020 consensus statement for programmatic assessment insights from practice and research are used to define the principles of programmatic assessment.

METHODS

For fifteen programmes in health professions education affiliated with members of an expert group (n = 20), an inventory was completed for the perceived components, rationale, and importance of a programmatic assessment design. Input from attendees of a programmatic assessment workshop and symposium at the 2020 Ottawa conference was included. The outcome is discussed in concurrence with current theory and research.

RESULTS AND DISCUSSION

Twelve principles are presented that are considered as important and recognisable facets of programmatic assessment. Overall these principles were used in the curriculum and assessment design, albeit with a range of approaches and rigor, suggesting that programmatic assessment is an achievable education and assessment model, embedded both in practice and research. Knowledge on and sharing how programmatic assessment is being operationalized may help support educators charting their own implementation journey of programmatic assessment in their respective programmes.

Post-graduate Medical Training in Intellectual and Developmental Disabilities: a Systematic Review

OBJECTIVE

Despite the increasing number of people with autism-spectrum disorder (ASD), intellectual disabilities (ID), and developmental disabilities (DDs), individuals with these conditions continue to have high levels of unmet physical and mental health needs. Robust training of health professionals can help bridge this gap. A systematic review was conducted to describe the features and educational outcomes of existing postgraduate medical education curricula to inform the development of future training to address the growing unmet care needs of people with intellectual and developmental disabilities (IDD) such as ASD and ID.

METHODS

Four major databases were searched for peer-reviewed, English-language research focusing on post-graduate training in IDD education. Educational curricula and outcomes were summarized including Best Evidence in Medical Education (BEME) Quality of Evidence and Kirkpatrick training evaluation model.

RESULTS

Sixteen studies were identified with a majority published after 2000 (69%). Pediatric departments were involved in 69%, Psychiatry 19%, Medicine-Pediatrics 19%, and Family Medicine 6.3%. Analysis of Kirkpatrick outcomes showed 31% were level 1 (satisfaction or comfort); 38% level 2 (change in objective knowledge or skills); 13% level 3 (change in behavior); and none at level 4. BEME analysis showed 19% of studies were grade 1 (no clear conclusions), 31% grade 2 (ambiguous results), and half (50%) grade 3 (conclusions can probably be based on findings), with none scoring four or higher.

CONCLUSIONS

There is a paucity of objectively evaluated research in the area. Studies reviewed show clear promise for specialized, interdisciplinary, competency-based education which may be foundational for future curriculum development.

Resident learning trajectories in the workplace: A self-regulated learning analysis

CONTEXT

Research in workplace learning has emphasised trainees' active role in their education. By focusing on how trainees fine-tune their strategic learning, theories of self-regulated learning (SRL) offer a unique lens to study workplace learning. To date, studies of SRL in the workplace tend to focus on listing the factors affecting learning, rather than on the specific mechanisms trainees use to regulate their goal-directed activities. To inform the design of workplace learning interventions that better support SRL, we asked: How do residents navigate their exposure to and experience performing invasive procedures in intensive care units?

METHODS

In two academic hospitals, we conducted post-call debriefs with residents coming off shift and later sought their elaborated perspectives via semi-structured interviews. We used a constant comparative methodology to analyse the data, to iteratively refine data collection, and to inform abductive coding of the data, using SRL principles as sensitising concepts.

RESULTS

We completed 29 debriefs and nine interviews with 24 trainees. Participants described specific mechanisms: identifying, creating, avoiding, missing and competing for opportunities to perform invasive procedures. While using these mechanisms to engage with procedures (or not), participants reported: distinguishing trajectories (i.e. becoming attuned to task-relevant factors), navigating trajectories (i.e. creating and interacting with opportunities to perform procedures), and co-constructing trajectories with their peers, supervisors and interprofessional team members.

CONCLUSIONS

We identified specific SRL mechanisms trainees used to distinguish and navigate possible learning trajectories. We also confirmed previous findings, including that trainees become attuned to interactions between personal, behavioural and environmental factors (SRL theory), and that their resulting learning behaviours are constrained and guided by interactions with peers, supervisors and colleagues (workplace learning theory). Making learning trajectories explicit for clinician teachers may help them support trainees in prioritising certain trajectories, in progressing along each trajectory, and in co-constructing their plans for navigating them.

The Harvard Medical School Pathways Curriculum: Reimagining Developmentally Appropriate Medical Education for Contemporary Learners

As the U.S. health care system changes and technology alters how doctors work and learn, medical schools and their faculty are compelled to modify their curricula and teaching methods. In this article, educational leaders and key faculty describe how the Pathways curriculum was conceived, designed, and implemented at Harvard Medical School. Faculty were committed to the principle that educators should focus on how students learn and their ability to apply what they learn in the evaluation and care of patients. Using the best evidence from the cognitive sciences about adult learning, they made major changes in the pedagogical approach employed in the classroom and clinic. The curriculum was built upon 4 foundational principles: to enhance critical thinking and provide developmentally appropriate content; to ensure both horizontal integration between courses and vertical integration between phases of the curriculum; to engage learners, foster curiosity, and reinforce the importance of student ownership and responsibility for their learning; and to support students' transformation to a professional dedicated to the care of their patients and to their obligations for lifelong, self-directed learning.The practice of medicine is rapidly evolving and will undoubtedly change in multiple ways over the career of a physician. By emphasizing personal responsibility, professionalism, and thinking skills over content transfer, the authors believe this curriculum will prepare students not only for the first day of practice but also for an uncertain future in the biological sciences, health and disease, and the nation's health care system, which they will encounter in the decades to come.

Twelve tips for assessing medical knowledge with open-ended questions: Designing constructed response examinations in medical education

Medical knowledge examinations employing open-ended (constructed response) items can be useful to assess medical students' factual and conceptual understanding. Modern day curricula that emphasize active learning in small groups and other interactive formats lend themselves to an assessment format that prompts students to share conceptual understanding, explain, and elaborate. The open-ended question examination format can provide faculty with insights into learners' abilities to apply information to clinical or scientific problems, and reveal learners' misunderstandings about essential content. To implement formative or summative assessments with open-ended questions in a rigorous manner, educators must design systems for exam creation and scoring. This includes systems for constructing exam blueprints, items and scoring rubrics, and procedures for scoring and standard setting. Information gained through review of students' responses can guide future educational sessions and curricular changes in a cycle of continuous improvement.

Exploring the Socialization Experiences of Medical Students From Social Science and Humanities Backgrounds

PURPOSE

To explore the structural, cultural, and interpersonal issues that may contribute to the inadvertent marginalization of medical students with social science and humanities (SSH) backgrounds.

METHOD

Using the hidden curriculum as an analytic construct, the lead author interviewed 14 medical students with SSH backgrounds at the University of Toronto Faculty of Medicine from February to October 2015. The authors analyzed the interview transcripts for common themes around positive and negative cultural, structural, and interpersonal dimensions of the socialization process.

RESULTS

Participants reported barriers to applying to medical school: needing to complete prerequisite courses and to do well on an exam geared toward those with a strong science background (the Medical College Admission Test) and lacking an application cohort. Some participants felt they were not ideal candidates for medical school. Participants appreciated how their SSH backgrounds and associated skill sets shaped both their perspectives on patient care and their developing professional identities. However, they perceived that others largely deemed their previous training as irrelevant, and they felt marginalized in medical school by peers, instructors, and the curriculum. These experiences led both to self-censorship, which enabled them to seem to conform to normative behaviors, and to the pursuit of reaffirming elective experiences.

CONCLUSIONS

The existing hidden curriculum inadvertently marginalizes SSH medical students; their experiences likely reflect the socialization experiences of other students from underrepresented backgrounds. Curricular and institutional reforms are imperative to shift the hidden curriculum toward one of epistemological inclusion that better supports students from nontraditional backgrounds.

Reconsidering Basic: Integrating Social and Behavioral Sciences to Support Learning

PURPOSE

The integration of basic science mechanistic knowledge (pathophysiology and etiology) with clinical features (signs and symptoms) during learning leads to robust cognitive representations in novices and supports the development of clinical reasoning, including better diagnostic accuracy and later learning of related concepts. However, previous studies have used a limited scope of traditional biomedical sciences, including biochemistry, anatomy, and physiology. The use of extended forms of foundational knowledge, including behavioral and sociological sciences, that have been proposed to support learning and performance in complex health systems remains unexplored.

METHOD

Thirty-three first-year medical students from the University of Toronto MD Program participated in the study. The effect of integrated extended basic science (EBS) learning was compared with that of clinically focused instruction on an initial assessment of diagnosis using clinical vignettes and a "preparation for future learning" assessment (PFLA) to assess learning of new related content in medical psychiatry (co-occurring physical and mental health conditions).

RESULTS

Both forms of instruction supported the development of diagnostic ability on initial assessment (t[30] = 1.20, P = .24). On the PFLA, integrated instruction of extended forms of basic science led to superior performance on assessing complex patients' health care needs (t[30] = 2.70, P < .05).

CONCLUSIONS

Similar to previous studies using integration of biomedical sciences, the integration of EBS can enhance later learning of new related concepts. These results have implications for curriculum design to support development of expert clinical reasoning.

Assigning Medical Students Learning Goals: Do They Do It, and What Happens When They Don't?

Theory: Medical curricula now include more time for trainees to manage their studying independently, yet evidence suggests that time is not well spent without guidance. Social-cognitivist models of self-regulated learning suggest value when guiding learners to set goals related to their performance processes (actions producing outcomes) versus their performance outcomes (products of performance). Hypotheses: We expected participants oriented to set process goals would demonstrate better suturing skill retention compared with participants oriented to set outcome goals. Method: We randomly assigned 41 medical students to two groups: outcome oriented or process oriented. They self-scored their performance using a visual analog scale on every third trial during 25 training trials, and during 10 retention trials 2 weeks later. Two raters assessed participants' suturing performances (process) and final products (outcome). After finding weak support for our hypothesis, we calculated a "self-monitoring calibration coefficient" as the Pearson's correlation between the raters' average score and each participant's self-scores. We used a mixed-effects analysis of variance to compare participants' performance scores as well as t tests and an analysis of variance to compare their self-monitoring calibration coefficients. Results: Analysis of skill retention data revealed a significant Group × Trial interaction, suggesting a benefit for the process group only for the 10th retention trial (p = .03). During training, the process group had significantly better (p = .02) self-monitoring calibration (r = .71 ± .29) than the outcome group (r = .38 ± .55). In retention, participants in both groups were significantly better calibrated (p = .04) with rater's scores of performance processes (r = .39 ± .60) versus performance outcomes (r = .11 ± .63). Conclusions: Our findings provide limited evidence for our original hypothesis. Perhaps more important, however, our self-monitoring calibration data highlighted inconsistencies between our interventions and our participants' apparent preferences. Not all participants adopted their assigned goal setting orientation, showing that researchers and educators must consider the extent to which trainees adopt imposed instructions in any educational intervention.

Clinician-Educator Tracks for Trainees in Graduate Medical Education: A Scoping Review

PURPOSE

Clinician-educator tracks (CETs) appear to be increasing in prevalence in graduate medical education (GME) and may play an important role in medical education workforce development. The authors conducted a scoping review to characterize the current state of knowledge about CETs' structure, content, and outcomes.

METHOD

Six databases were searched in January 2018 for English-language peer-reviewed articles published through 2017 to identify articles describing CETs in GME. To be included, the CET had to target GME learners (residents/fellows), be longitudinal, have the primary aim of developing trainees into clinician-educators (CEs), and address at least one CE core competency (direct teaching, curriculum development, mentorship/advising, leadership, assessment, educational scholarship). The authors extracted and analyzed data from included articles.

RESULTS

Of 1,434 articles identified, 19 were included in the review, representing 18 separate CETs. All but 2 CETs (11%) were specialty-specific. Most included a core curriculum with classroom-based sessions (18; 100%), workplace-based opportunities to practice skills (17; 94%), and a required scholarly project (16; 89%). Seventeen (94%) focused on skills related to direct teaching. Four (22%) identified mentoring/advising as a core curriculum focus. Five (28%) required project dissemination. Time spent in CETs varied widely (median: 166 hours; range: 8 hours/4-month period to 1,288 hours/2-year period). The most common reported outcomes were learner reactions (7; 39%) and career tracking (11; 61%).

CONCLUSIONS

This review yields a composite picture of the current state of CETs in GME. The results highlight the paucity of outcomes data and areas for potential standardization and future research.

Why We Needn't Fear the Machines: Opportunities for Medicine in a Machine Learning World

Recently in medicine, the accuracy of machine learning models in predictive tasks has started to meet or exceed that of board-certified specialists. The ability to automate cognitive tasks using software has raised new questions about the future role of human physicians in health care. Emerging technologies can displace people from their jobs, forcing them to learn new skills, so it is clear that this looming challenge needs to be addressed by the medical education system. While current medical education seeks to prepare the next generation of physicians for a rapidly evolving health care landscape to meet the needs of the communities they serve, strategic decisions about disruptive technologies should be informed by a deeper investigation of how machine learning will function in the context of medicine. Understanding the purpose and strengths of machine learning elucidates its implications for the practice of medicine. An economic lens is used to analyze the interaction between physicians and machine learning. According to economic theory, competencies that are complementary to machine prediction will become more valuable in the future, while competencies that are substitutes for machine prediction will become less valuable. Applications of machine learning to highly specific cognitive tasks will increase the performance and value of health professionals, not replace them. To train physicians who are resilient in the face of potential labor market disruptions caused by emerging technologies, medical education must teach and nurture unique human abilities that give physicians a comparative advantage over computers.

Effectiveness of discovery learning using a mobile otoscopy simulator on knowledge acquisition and retention in medical students: a randomized controlled trial

Background

Portable educational technologies, like simulators, afford students the opportunity to learn independently. A key question in education, is how to pair self-regulated learning (SRL) with direct instruction. A cloud-based portable otoscopy simulator was employed to compare two curricula involving SRL. Pre-clerkship medical students used a prototype smartphone application, a 3D ear attachment and an otoscope to complete either otoscopy curriculum.

Methods

Pre-clerkship medical students were recruited and randomized to two curriculum designs. The “Discovery then Instruction” group received the simulator one week before a traditional lecture, while the “Instruction then Discovery” group received it after the lecture. To assess participants’ ability to identify otoscopic pathology, we used a 100-item test at baseline, post-intervention and 2-week retention time points. Secondary outcomes included self-reported comfort, time spent using the device, and a survey on learning preferences.

Results

Thirty-four students completed the study. Analysis of knowledge acquisition and retention showed improvement in scores of both groups and no significant effects of group (F_1,31 = 0.53, p = 0.47). An analysis of participants’ self-reported comfort showed a significant group x test interaction (F_1,36 = 4.61, p = 0.04), where only the discovery then instruction group’s comfort improved significantly. Overall device usage was low, as the discovery then instruction group spent 21.47 ± 26.28 min, while the instruction then discovery group spent 13.84 ± 18.71 min. The discovery first group’s time spent with the simulator correlated moderately with their post-test score (r = 0.42, p = 0.07). After the intervention, most participants in both groups (63–68%) stated that they would prefer the instruction then discovery sequence.

Conclusions

Both curricular sequences led to improved knowledge scores with no statistically significant knowledge differences. When given minimal guidance, students engaged in discovery learning minimally. There is value in SRL in simulation education, and we plan to further improve our curricular design by considering learner behaviours identified in this study.