What do men have to do with it? Fathers and mid-twentieth-century childbirth

This article addresses the role of fathers during the births of their children, focusing on the United States in the mid-twentieth century when childbirth was a highly medicalized, in-hospital experience for the large majority of American women. It puts this period into the perspective of changing birth practices over time, and, using sources rich in the voices of all birth participants, especially the fathers-to-be, traces some significant changes in hospital practices. Specifically examined are men's feelings and activities while their wives were in labor and delivery, and their participation in decisions about labor induction, anesthesia, and cesarean section. In contrast to earlier writings of the author, this essay puts men at the center of some of the changes identified.     

What do I do? Developing a competency inventory for postgraduate (residency) program directors

Background: Few new Residency Program Directors (PD) are formally trained for the demands and responsibilities of the leadership aspect of their role. Currently, there are no comprehensive frameworks that describe specific leadership competencies that can inform PD self-reflection or faculty development.

Methods: The authors developed a Postgraduate Program Director Competency Inventory (PPDCI) in order to frame the performance of PDs for a multisource feedback (MSF) program. The development of the PPDCI occurred in five phases which involved: development of an initial inventory, implementation of a key informant survey of national opinion leaders, execution of a validity survey with postgraduate education leaders and committee members and implementation of a further refined inventory with 17 PD and 147 raters as part of a pilot MSF program.

Outcomes: Five distinct domains of leadership competence were identified which included: Communication and relationship management, leadership, professionalism and self-management, environmental engagement, and management skills and knowledge. The content validity of the PPDCI was endorsed by 85% of the key informants. The validity survey indicated strong endorsement of the PPDCI domains and recognition of its utility for both orientation of new PD as well as a frame for self-assessment. The pilot MSF program yielded a further refined and reduced inventory of 26 items of competence as well as recommendations for its utility.

Conclusions: Use of this leadership inventory has the potential to ensure effective leadership of postgraduate programs.     

Why do physicians volunteer to be OSCE examiners?

Recruitment of physician examiners for an objective structured clinical examination (OSCE) can be difficult. The following study will explore reasons why physicians volunteer their time to be OSCE examiners. A questionnaire was collected from 110 examiners including a fourth year formative student OSCE (SO) (n=49), formative internal medicine OSCE (IM) (n=21) and the Medical Council of Canada Qualifying Exam Part II (MCCQE II) (n=40). A 5-point Likert scale was used. Statements with high mean ratings overall included: enjoy being an examiner (4.05), gain insights into learners' skills and knowledge (4.27), and examine out of a sense of duty (4.10). The MCC participants produced higher ratings (p<0.05). Overall, OSCE examiners volunteer their time because they enjoy the experience, feel a sense of duty and gain insight into learners' skills and knowledge. The MCC examiners appear to value the experience more. The ability to provide feedback and the provision of CME credits were not significant factors for increasing examiner satisfaction.     

Ethics in human subjects research: do incentives matter?

There is considerable confusion regarding the ethical appropriateness of using incentives in research with human subjects. Previous work on determining whether incentives are unethical considers them as a form of undue influence or coercive offer. We understand the ethical issue of undue influence as an issue, not of coercion, but of corruption of judgment. By doing so we find that, for the most part, the use of incentives to recruit and retain research subjects is innocuous. But there are some instances where it is not. Specifically, incentives become problematic when conjoined with the following factors, singly or in combination with one another: where the subject is in a dependency relationship with the researcher, where the risks are particularly high, where the research is degrading, where the participant will only consent if the incentive is relatively large because the participant's aversion to the study is strong, and where the aversion is a principled one. The factors we have identified and the kinds of judgments they require differ substantially from those considered crucial in most previous discussions of the ethics of employing incentives in research with human subjects.     

What to do about medical students with unsatisfactory consultation skills?

If it is accepted that new doctors must be 'Fit to Practice' in a standard clinical house job, they should be competent in basic communication skills. Although these skills may be assessed as part of a routine OSCE-style exam in the course of the curriculum, the question is raised whether students who fail to demonstrate a minimal level of competence in this area should to be allowed to progress to the next stage of the course and eventually graduate. This paper describes our experiences with introducing 'barrier' stations in communication skills into the OSCE. Students who failed these stations, irrespective of their overall exam performance, undertook remedial studies in a compulsory two-week directed study module followed by a four-station OSCE.     

Medical teaching websites: do they reflect the learning paradigm?

Phenomenal evolution of the Internet in recent times is shifting the mode of distribution of medical knowledge from conventional lecture rooms to one that is web based. No guidelines are yet set for medical teaching websites. Hence, the authors set out to determine whether these sites uniformly reflected the Learning Paradigm. Most of the medical teaching websites were endowed with good technical support but were surprisingly falling short in reflecting the principles of learning. It is strongly suggested that a team consisting of a clinician as content provider, a web designer and a medical educationist is required to create an ideal medical teaching website.     

If formal CME is ineffective, why do physicians still participate?

Formal or traditional CME can be criticized because organizers often ignore adult learning principles when designing courses. Critics also suggest that formal CME courses have limited impact on attendees' behaviors and practices. The authors agree that attention must be paid to pedagogic principles to assure success of educational courses, but feel that the extant negative evidence related to the impact of formal CME is narrow in scope and of inadequate strength to seriously damn formal approaches. Survey responses were received from 853 practicing physicians who say they still regularly attend formal CME courses. They are motivated to attend to satisfy specific professional needs and for personal reasons. Formal CME is still popular despite what its critics say. The authors are convinced that attention to physicians' perceived needs, effective use of social marketing strategies, and adherence to adult learning principles can assure successful delivery of CME and that formal CME is a useful complement to physician-driven informal CME.     

How do medical student self-assessments compare with their final clerkship grades?

The purpose of this study was to determine how a medical student's self-assessment at the completion of the third-year Ob/gyn clerkship compares with the institution's final grades at Lehigh Valley Hospital. From November 2002 to November 2003 at completion of each six-week Ob/gyn clerkship rotation, 47 medical students assessed themselves on the following parameters: fund of knowledge, personal attitude, clinical problem-solving skills, written/verbal skills, and technical skills. Additionally, they were asked to predict their performance on the NBME Shelf Exam. Their assessments were then compared with their final clerkship grades in each of the above parameters. Chi-squared and Kendall-tau tests were used to analyse the data for degree of agreement and association, respectively. There was a statistically significant weak to moderate, positive correlation between students' self-assessment and final clerkship grade for written/verbal skills (p = 0.002, r = 0.390). A statistically significant agreement between raters was also revealed for written/verbal skills (p = 0.003). Weak, non-statistically significant, positive relationships were revealed for fund of knowledge, clinical problem-solving and technical skills. A weak, negative, non-significant relationship was revealed for personal attitudes, and there was no statistically significant relationship between students' prediction of NBME score and categorized true score (p = 0.717, r = 0.49). At the end of their Ob/gyn clerkship, third-year medical students are better at assessing their technical and written/verbal skills than their global fund of knowledge and personal attitudes. These results may suggest that students are not aware of their own personal attitudes and communication skills and how they can affect their effectiveness as a physician.     

How do postgraduate qualifications in medical education impact on health professionals?

Background and Purpose: The number of degree-awarding programmes in medical education is steadily increasing. Despite the popularity and extensive investment in these courses, there is little research into their impact. This study investigated the perceived impact of an internationally-renowned postgraduate programme in medical education on health professionals’ development as educators.

Methods: An online survey of the 2008–12 graduates from the Centre for Medical Education, University of Dundee was carried out. Their self-reported shifts in various educational competencies and scholarship activities were analysed using non-parametric statistics. Qualitative data were also collected and analysed to add depth to the quantitative findings.

Results: Of the 504 graduates who received the online questionnaire 224 responded. Participants reported that a qualification in medical education had significantly (p?<?0.001) improved their professional educational practices and engagement in scholarly activities. Masters graduates reported greater impact compared to Certificate graduates on all items, including ability to facilitate curriculum reforms, and in assessment and feedback practices. Masters graduates also reported more engagement in scholarship activities, with significantly greater contributions to journals. These qualifications equally benefited all participants regardless of age. International graduates reported greater impact of the qualification than their UK counterparts.

Conclusion: A postgraduate medical education programme can significantly impact on the practices and behaviours of health professionals in education, improving self-efficacy and instilling an increased sense of belonging to the educational community.     

What would John Dewey do? The promises and perils of pragmatic bioethics

Recent work done at the intersection of classical American pragmatism and bioethics promises much: a clarified self-understanding for bioethics, a modus vivendi for progress, and liberation from misguided and misguiding theories and principles. The revival of pragmatism outside bioethics in the past twenty years, however, has been of a distinctly anti-realist orientation. Richard Rorty, for example, has urged that there is no objective truth or good for philosophy to be concerned with. I ask whether the work in Pragmatic Bioethics follows this perilous Rortyan trend. It will move towards anti-realism if its account of the good abandons any notion of truth or objectivity, and if, in its discussion of specific problems, it divides these problems into public and the private, urging consensus as the goal of the one, and an unconstrained notion of happiness as the goal of the other. In a final section, I suggest that bioethics done in the spirit of Royce's Philosophy of Loyalty might have much to offer to those dissatisfied with anti-realism.     

Why do surgeons teach? A qualitative analysis of motivation in excellent surgical educators

Introduction: Given that teaching is so vital to the maintenance of the medical profession, it is surprising that few authors have examined the factors which motivate physicians and surgeons to engage in this activity.

Aim: It was the aim of this study to examine the factors which motivate excellent surgical educators to teach.

Methodology: Grounded theory methodology was used to analyze transcribed semi-structured interviews. The top 20 ranked surgical educators at the University of Alberta were invited to participate. In total, 15 surgeons of various specialties were interviewed.

Results: There were five main factors which motivate surgeons to teach. These were: (1) a sense of responsibility to teach future physicians (2) an intrinsic enjoyment of teaching (3) the need to maintain and expand one’s own knowledge base (4) watching students develop into competent practicing physicians and playing a role in their success, and (5) fostering positive lifelong professional relationships with learners.

Discussion: This is the first study in surgery to use an explorative qualitative methodology. This framework of motivating factors can be used to guide professional development activities. The framework represents motivating factors for those known to be effective teachers only. We plan to use this information to engage more surgeons in teaching by providing a basis for promoting education as part of a busy surgical practice.     

Problem-based learning in occupational therapy: why do health professionals choose to tutor?

For over 20 years the occupational therapy programmes offered by McMaster University and Mohawk College, Hamilton, Ontario have used small-group, problem-based learning tutorials as a major component of their curriculum. These programmes were among the first occupational therapy programmes in the world to use a problem-based tutorial format. The inclusion as tutors of both full-time faculty and clinicians, from all clinical practice areas, was central to the design of the problem-based learning courses. A survey of all tutors from the last 20 years collected information about why health professionals are motivated to tutor and what they see as challenges to maintaining this educational role. Three primary themes emerged from the data: being an educator; being a learner and present and future challenges to continuing with the tutoring role. Within the educator theme there was a secondary theme of professional duty or obligation. In addition, the participants identified suggestions for enhanced support and continuing education for tutors. This article summarizes the findings of the survey.     

Alternative learning environments: what do they contribute to professional development of medical students?

Special study modules provide opportunities for students to develop lifelong learning skills and develop areas of interest. The GMC also recommends opportunities to study topics not included in the core medical curriculum. This paper reports the evaluation of modules based within alternative learning environments developed to provide students with experiences outside traditional medical, scientific or academic cultures. The attachment was highly rated as contributing to professional development, provided novel learning experiences, and was stimulating for both students and supervisors. All students achieved new skills that they felt were pertinent to their personal development. Assessment was by standardized pro forma, including generic transferable skills and module specific outcomes. Whilst overall assessment grades were comparable to similar course components, unease amongst both students and supervisors was expressed reflecting anxieties in the diversity of workloads and assessment. Attempts to standardize assessment across the diversity of modules did not reduce anxieties and potentially detracted from the learning experiences.