Context
Medical education is neither simple nor stable, and is highly contextualised. Hence, ways of perceiving multiple connections and complexity are fundamental when seeking to describe, ...understand and address concerns and questions related to change.
Proposal
In response to calls in the literature, we introduce three examples of contemporary organisational theory which can be used to understand and operationalise change within medical education. These theories, institutional logics, paradox theory and complexity leadership theory, respectively, are relatively unknown in medical education. However, they provide a way of making sense of the complexity of change creatively. Specifically, they cross‐cut different levels of analysis and allow us to ‘zoom in’ to micro levels, as well as to ‘zoom out’ and connect what is happening at the individual level (the micro level) to what happens at a wider institutional and even national or international level (the macro level), thereby providing a means of understanding the interactions among individuals, teams, organisations and systems. We highlight the potential value of these theories, provide a brief discussion of the few studies that have used them in medical education, and then briefly critique each theory.
Conclusions
We hope that by drawing the attention of readers to the potential of these management theories, we can unlock some of the complexity of change in medical education, support new ways of thinking and open new avenues for research.
Moving beyond simplistic solutions, Gordon and Cleland highlight the value of organisational theories for unlocking the complexity of change in medical education.
Health Professions' Educators (HPEs) and their learners have to adapt their educational provision to rapidly changing and uncertain circumstances linked to the COVID-19 pandemic. This paper reports ...on an AMEE-hosted webinar: Adapting to the impact of COVID-19: Sharing stories, sharing practice. Attended by over 500 colleagues from five continents, this webinar focused on the impact of the virus across the continuum of education and training. Short formal presentations on teaching and learning, assessment, selection and postgraduate training generated wide-ranging questions via the Chatbox. A thematic analysis of the Chatbox thread indicated the most pressing concerns and challenges educators were experiencing in having to adapt programmes and learning across the continuum of medical education and training. The main areas of concern were: campus-based teaching and learning; clinical teaching; selection and assessment, and educator needs. While there is clearly no one simple solution to the unprecedented issues medical education and training face currently, there were two over-arching messages. First, this is a time for colleagues across the globe to help and support each other. Second, many local responses and innovations could have the potential to change the shape of medical education and training in the future.
Objectives
‘Wicked problems’ are complex in nature, have innumerable causes associated with multiple social environments and actors with unpredictable behaviour and outcomes, and are difficult to ...define or even resolve. This paper considers why and how the frameworks of complexity theory and wicked problems can help medical educators consider selection and widening access (WA) to medicine through fresh eyes to guide future policy and practice. We illustrate how ‘wickedity’ can frame the key issues in this area, and then address steps that education stakeholders might take to respond to and act on these issues.
Methods
We used the 10 properties of a wicked problem to frame common issues in the broad field of selection and WA in medicine. We drew heavily on literature from different disciplines, particularly education, and, through debate and reflection, agreed on the applicability of the theory for illuminating and potentially addressing outstanding issues in selection and WA.
Results
Framing medical school selection using the 10 properties of wicked problems is a means of shifting thinking from erroneous ‘simple’ solutions to thinking more contextually and receptively. The wicked problem framework positions selection as a multi‐causal, complex, dynamic, social problem and foregrounds stakeholders’ views and context as being highly relevant in medical school selection.
Conclusions
The wicked problem lens shifts thinking and action from seeking one elusive, objective truth to recognising the complexity of medical school selection, managing uncertainty, questioning and considering ‘issues’ associated with medical school selection more productively. Although there are criticisms of this framework, labelling medical selection as ‘wicked’ provides original insights and genuine reframing of the challenges of this important, and high profile, aspect of medical education. Doing so, in turn, opens the door to different responses than would be the case if selection and WA were simple and readily tamed.
By discussing how complexity theory and the “wicked problems” framework can help medical educators consider selection and widening access the authors provide a new lens to guide policy and practice.
Workforce planning is a central issue for service provision and has consequences for medical education. Much work has been examined the career intentions, career preferences and career destinations ...of UK medical graduates but there is little published about medical students career intentions. How soon do medical students formulate careers intentions? How much do these intentions and preferences change during medical school? If they do change, what are the determining factors? Our aim was to compare medical students' career preferences upon entry into and exit from undergraduate medical degree programmes.
This was a cross-sectional questionnaire survey. Two cohorts 2009-10, 2010-11 of first and final year medical students at the four Scottish graduating medical schools took part in career preference questionnaire surveys. Questions were asked about demographic factors, career preferences and influencing factors.
The response rate was 80.9% 2682/3285. Significant differences were found across the four schools, most obviously in terms of student origin Scotland, rest of UK or overseas, age group, and specialty preferences in Year 1 and Year 5. Year 1 and Year 5 students' specialty preferences also differed within each school and, while there were some common patterns, each medical school had a different profile of students' career preferences on exit. When the analysis was adjusted for demographic and job-related preferences, specialty preferences differed by gender, and wish for work-life balance and intellectual satisfaction.
This is the first multi-centre study exploring students' career preferences and preference influences upon entry into and exit from undergraduate medical degree programmes. We found various factors influenced career preference, confirming prior findings. What this study adds is that, while acknowledging student intake differs by medical school, medical school itself seems to influence career preference. Comparisons across medical school populations must therefore control for differences in input the students as well as context and process the medical school when looking at output e.g., performance. A robust, longitudinal study is required to explore how medical students' career preferences change as they progress through medical school and training to understand the influence of the learning environment on training choice and outcomes.
When I say ... diversity Chiavaroli, Neville; Blitz, Julia; Cleland, Jennifer
Medical education,
10/2020, Volume:
54, Issue:
10
Journal Article
Peer reviewed
Open access
Diversity has become an important term in medical education, impacting on curriculum design, selection policies and school culture. For some, it may have acquired the status of a 'god term', an ...essential concept that influences and guides educational practice, yet may also be used as a 'rhetorical absolute', as has been suggested for the term 'competence' in medical education. This positioning recognises the significance of diversity as a concept. However, it may also do as much disservice as would resistance or scepticism, as it does not encourage the necessary 'unpacking' of the complexity and evolution of diversity as a key educational idea.The authors explore the meanings, significance, implications of the term 'diversity', arguing this crucial concept needs to be understood contextually, critically. Author abstract
Context
Many individual‐ and job‐related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees’ (residents’) and students’ views ...of the factors that are important. However, how trainees and students trade off these factors at times of important careers‐related decision making is under‐researched. Information about trade‐offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors.
Objectives
Our aim was to investigate the strength of UK medical students’ preferences for the characteristics of training posts in terms of monetary value.
Methods
We distributed a paper questionnaire that included a discrete choice experiment (DCE) to final‐year medical students in six diverse medical schools across the UK. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients.
Results
A total of 810 medical students answered the questionnaire. The presence of good working conditions was by far the most influential characteristic of a training position. Medical students consider that, as newly graduated doctors, they will require compensation of an additional 43.68% above average earnings to move from a post with excellent working conditions to one with poor working conditions. Female students value excellent working conditions more highly than male students, whereas older medical students value them less highly than younger students.
Conclusions
Students on the point of completing medical school and starting postgraduate training value good working conditions significantly more than they value desirable geographical location, unit reputation, familiarity with the unit or opportunities for partners or spouses. This intelligence can be used to address the crisis in workforce staffing that has developed in the UK and opens up fruitful areas for future research across contexts and in terms of examining stated preferences versus actual career‐related behaviour.
Medical training has traditionally depended on patient contact. However, changes in healthcare delivery coupled with concerns about lack of objectivity or standardization of clinical examinations ...lead to the introduction of the 'simulated patient' (SP). SPs are now used widely for teaching and assessment purposes. SPs are usually, but not necessarily, lay people who are trained to portray a patient with a specific condition in a realistic way, sometimes in a standardized way (where they give a consistent presentation which does not vary from student to student). SPs can be used for teaching and assessment of consultation and clinical/physical examination skills, in simulated teaching environments or in situ. All SPs play roles but SPs have also been used successfully to give feedback and evaluate student performance. Clearly, given this potential level of involvement in medical training, it is critical to recruit, train and use SPs appropriately. We have provided a detailed overview on how to do so, for both teaching and assessment purposes. The contents include: how to monitor and assess SP performance, both in terms of validity and reliability, and in terms of the impact on the SP; and an overview of the methods, staff costs and routine expenses required for recruiting, administrating and training an SP bank, and finally, we provide some intercultural comparisons, a 'snapshot' of the use of SPs in medical education across Europe and Asia, and briefly discuss some of the areas of SP use which require further research.
Objectives
The objective of the present study was to investigate to which extent preparatory self‐study can be improved by encouraging students to engage in individual self‐explanations or dyadic ...explanations (ie in pairs). Individual self‐explanations refer to an act of metacognition in which students, after having processed a certain amount of information, attempt to explain their understanding to themselves of what was just learned. Dyadic explanations refer to the same process, but instead of explaining to oneself, the student explains his/her understanding to another student.
Method
An experiment was conducted in which 120 medical students studied a video‐recorded lecture on the role of protein synthesis inhibition on memory reconsolidation. Participants were randomly allocated to one of four conditions: (1) a control condition in which they listened to the lecture once; (2) a control condition in which they listened to the lecture twice; (3) an experimental condition in which they had to listen to the lecture and provide self‐explanations individually; and (4) an experimental condition in which they had to listen to the lecture and provide dyadic explanations. Participants’ knowledge regarding the topic was measured three times: at the start and end of the experiment, and one week after the experiment to determine knowledge retention. Data were analysed by means of a 2 × 2 and 4 × 3 repeated‐measures ANOVA.
Results
The results suggest that participants who engaged in individual self‐ or dyadic explanations significantly outperformed participants in the two control conditions in terms of learning and retention (F = 5.67, Wilks Λ = 0.94, P = .019, η2 = 0.05). Moreover, the results suggest that dyadic explanations were more effective than individual self‐explanations (F = 3.70, Wilks Λ = 0.83, P = .002, η2 = 0.09).
Conclusions
These outcomes suggest that encouraging students to work in pairs or in small teams to prepare for a learning event results in superior preparation and learning.
The study explores how dyadic explanations (i.e., working in pairs) during preparatory self‐study enhances learning and retention of study materials.
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