Calls are increasing for American health care to be organized as a learning health care system, defined by the Institute of Medicine as a health care system “in which knowledge generation is so ...embedded into the core of the practice of medicine that it is a natural outgrowth and product of the healthcare delivery process and leads to continual improvement in care.” We applaud this conception, and in this paper, we put forward a new ethics framework for it. No such framework has previously been articulated. The goals of our framework are twofold: to support the transformation to a learning health care system and to help ensure that learning activities carried out within such a system are conducted in an ethically acceptable fashion.
The singular focus of public debate on the "top 1 percent" of households overlooks the component of earnings inequality that is arguably most consequential for the "other 99 percent" of citizens: the ...dramatic growth in the wage premium associated with higher education and cognitive ability. This Review documents the central role of both the supply and demand for skills in shaping inequality, discusses why skill demands have persistently risen in industrialized countries, and considers the economic value of inequality alongside its potential social costs. I conclude by highlighting the constructive role for public policy in fostering skills formation and preserving economic mobility.
Background: The emergence of the internet, particularly Web 2.0 has provided access to the views and opinions of a wide range of individuals opening up opportunities for new forms of communication ...and knowledge formation. Previous ways of navigating and filtering available information are likely to prove ineffective in these new contexts. Connectivism is one of the most prominent of the network learning theories which have been developed for e-learning environments. It is beginning to be recognized by medical educators. This article aims to examine connectivism and its potential application.
Content: The conceptual framework and application of connectivism are presented along with an outline of the main criticisms. Its potential application in medical education is then considered.
Conclusions: While connectivism provides a useful lens through which teaching and learning using digital technologies can be better understood and managed, further development and testing is required. There is unlikely to be a single theory that will explain learning in technological enabled networks. Educators have an important role to play in online network learning.
Bias and discrimination are embedded within the history, norms, and practices of the health professions institution, and their negative impacts are pervasive in the health professions learning ...environment. These forces impair the ability to take care of patients, recruit and support diverse health care providers, and prepare the next generation of clinicians for practice. Fortunately, there are effective interventions and strategies for addressing bias and discrimination within learning environments and to both prevent and ameliorate their negative effects. This Perspective lays out a vision for health professions learning environments that are free from bias and discrimination and makes 5 recommendations, with supporting actions, that will help the leaders of health care institutions achieve this goal.
The authors describe a method for integrating video into the work of elementary literacy coaches. Drawing on their research in developing an online application of a successful literacy-coaching ...program called Content-Focused Coaching, the authors describe an approach that coaches can use to reflect with teachers on their video recorded lessons to advance the quality of their classroom text discussions.
A physiologist's view of homeostasis Modell, Harold; Cliff, William; Michael, Joel ...
Advances in physiology education,
12/2015, Volume:
39, Issue:
4
Journal Article
Peer reviewed
Open access
Homeostasis is a core concept necessary for understanding the many regulatory mechanisms in physiology. Claude Bernard originally proposed the concept of the constancy of the "milieu interieur," but ...his discussion was rather abstract. Walter Cannon introduced the term "homeostasis" and expanded Bernard's notion of "constancy" of the internal environment in an explicit and concrete way. In the 1960s, homeostatic regulatory mechanisms in physiology began to be described as discrete processes following the application of engineering control system analysis to physiological systems. Unfortunately, many undergraduate texts continue to highlight abstract aspects of the concept rather than emphasizing a general model that can be specifically and comprehensively applied to all homeostatic mechanisms. As a result, students and instructors alike often fail to develop a clear, concise model with which to think about such systems. In this article, we present a standard model for homeostatic mechanisms to be used at the undergraduate level. We discuss common sources of confusion ("sticky points") that arise from inconsistencies in vocabulary and illustrations found in popular undergraduate texts. Finally, we propose a simplified model and vocabulary set for helping undergraduate students build effective mental models of homeostatic regulation in physiological systems.
This forum highlights research that literacy teachers, students, and others can explore, use, or adapt as they provide literacy instruction and develop related programs and research agendas.
Medical Education 2012: 46: 58–70
Context Interprofessional education (IPE) is not a recent phenomenon and has been the subject of several World Health Organization reports. Its focus is on health ...professionals and students learning with, from and about one another to improve collaboration and the quality of patient care. The drivers for IPE include new models of health care delivery in the context of an ageing population and the increasing prevalence of long‐term chronic disease, in addition to the patient safety agenda. The delivery of complex health care requires a team‐based and collaborative approach, although teamwork and collaborative practice are not necessarily synonymous. The rationale for IPE is that learning together enhances future working together.
Discussion Systematic reviews of IPE have shown some evidence that IPE fosters positive interaction among different professions and variable evidence that it improves attitudes towards other professionals. Generalisation across published papers is difficult because IPE initiatives are diverse and good evaluation methodology and data are lacking. In terms of constructive alignment from an education viewpoint, there is a need for educators to define learning outcomes and match these with learning activities to ensure that IPE demonstrates added value over uniprofessional learning. Assessment is difficult as pre‐qualification professional education focuses on the individual and professional accreditation organisations mandate only for their own professions.
Conclusions Interprofessional education draws from a number of education, sociology and psychology theories, and these are briefly discussed. The most pressing research questions for the IPE community are defined and the challenges for IPE explored.
Academic global health programs are growing rapidly in scale and number. Students of many disciplines increasingly desire global health content in their curricula. Global health curricula often ...include field experiences that involve crossing international and socio-cultural borders. Although global health training experiences offer potential benefits to trainees and to sending institutions, these experiences are sometimes problematic and raise ethical challenges. The Working Group on Ethics Guidelines for Global Health Training (WEIGHT) developed a set of guidelines for institutions, trainees, and sponsors of field-based global health training on ethics and best practices in this setting. Because only limited data have been collected within the context of existing global health training, the guidelines were informed by the published literature and the experience of WEIGHT members. The Working Group on Ethics Guidelines for Global Health Training encourages efforts to develop and implement a means of assessing the potential benefits and harms of global health training programs.
Abstract
Objective
Current guidelines recommend management of musculoskeletal pain conditions from a biopsychosocial approach; however, biopsychosocial interventions delivered by physical therapists ...vary considerably in effectiveness. It is unknown whether the differences are explained by the intervention itself, the training and/or competency of physical therapists delivering the intervention, or fidelity of the intervention. The aim was to investigate and map the training, competency assessments, and fidelity checking of individualized biopsychosocial interventions delivered by physical therapists to treat musculoskeletal pain conditions.
Methods
A scoping review methodology was employed, using Arksey and O’Malley’s framework. Seven electronic databases were searched between January and March 2019, with a bridge search completed in January 2020. Full-text peer-reviewed articles, with an individualized biopsychosocial intervention were considered, and 35 studies were included.
Results
Reporting overall was sparse and highly variable. There was a broad spectrum of training. More sophisticated training involved workshops combining didactic and experiential learning over longer durations with supervision and feedback. Less sophisticated training was brief, involving lectures or seminars, with no supervision or feedback. Competency assessments and fidelity testing were underperformed.
Conclusions
Training in some interventions might not have facilitated the implementation of skills or techniques to enable the paradigm shift and behavior change required for physical therapists to effectively deliver a biopsychosocial intervention. Lack of competency assessments and fidelity checking could have impacted the methodological quality of biopsychosocial interventions.
Impact
This study highlighted problematic reporting, training, assessment of competency, and fidelity checking of physical therapist–delivered individualized biopsychosocial interventions. Findings here highlight why previous interventions could have shown small effect sizes and point to areas for improvement in future interventions. These findings can help inform future research and facilitate more widespread implementation of physical therapist–delivered biopsychosocial interventions for people with musculoskeletal pain and thereby improve their quality of life.
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