AMEE Medical Education Guide No. 15: Problem-based learning: a practical guide

This practical guide for health professions teachers provides a perspective of one of the most important educational developments in the past 30 years.Problem-based learning (PBL) is a continuum of approaches rather than one immutable process. It is a teaching method that can be included in the teacher's tool-kit along with other teaching methods rather than used as the sole educational strategy.PBL reverses the traditional approach to teaching and learning. It starts with individual examples or problem scenarios which stimulate student learning. In so doing, students arrive at general principles and concepts which they then generalize to other situations. PBL has many advantages. It facilitates the acquisition of generic competences, encourages a deep approach to learning and prepares students for the adult learning approach they need for a lifetime of learning in the health care professions. It is also fun. PBL helps in curriculum planning by defining core, ensuring relevance of content, integrating student learning and providing prototype cases. There are also drawbacks associated with PBL. Students may fail to develop an organized framework for their knowledge. The PBL process may inhibit good teachers sharing their enthusiasm for their topic with students and student identification with good teachers.Teachers may not have the skills to facilitate PBL.The problem scenario is of crucial significance. It should engage the students' interest and be skilfully written. While the medium selected for presentation of the scenario is usually print, other media may be used.The clinical tasks carried out by the student may replace the problem scenario as the focus for learning.Students are supported during the PBL process by tutors and/or study guides.The amount of support required is inversely related to the students' prior learning and understanding of the PBL process. A range of additional learning resources and opportunities may be made available to the students, including textbooks, videotapes, computer-based material, lectures and clinical sessions. Tutors require group facilitation skills, an understanding of the PBL process and knowledge of the course and of the curriculum in general.They need special personal qualities and it is preferable if they have expertise in the content area.While special assessment processes have been developed to assess students learning by the PBL method, the general principles of assessment apply to PBL courses and a mixed menu of assessment methods needs to be employed. Curriculum design involves a skilful blend of educational strategies designed to help students achieve the curriculum outcomes. PBL may make a valuable contribution to this blend but attention needs to be paid to how it is implemented.     

Program evaluation models and related theories: AMEE guide no. 67

This Guide reviews theories of science that have influenced the development of common educational evaluation models. Educators can be more confident when choosing an appropriate evaluation model if they first consider the model's theoretical basis against their program's complexity and their own evaluation needs. Reductionism, system theory, and (most recently) complexity theory have inspired the development of models commonly applied in evaluation studies today. This Guide describes experimental and quasi-experimental models, Kirkpatrick's four-level model, the Logic Model, and the CIPP (Context/Input/Process/Product) model in the context of the theories that influenced their development and that limit or support their ability to do what educators need. The goal of this Guide is for educators to become more competent and confident in being able to design educational program evaluations that support intentional program improvement while adequately documenting or describing the changes and outcomes-intended and unintended-associated with their programs.     

Peer assisted learning: a planning and implementation framework: AMEE Guide no. 30

Much has been written about the benefits and applications of Peer Assisted Learning (PAL) in the literature. Curriculum developers increasingly consider PAL as a vehicle to help undergraduate healthcare students learn to teach; an outcome which has received more attention in the UK since the General Medical Council stated in Tomorrow's Doctors that medical graduates must 'Be able to demonstrate appropriate teaching skills'. This guide is primarily designed to assist curriculum developers, course organisers and educational researchers develop and implement their own PAL initiatives. It is structured around a PAL planning framework consisting of 24 questions. The questions are grouped in threes, around eight themes. Each question is discussed with reference to the PAL literature and other related subjects, and is exemplified by responses from a recent PAL project developed at The University of Edinburgh. Working through the 24 questions, particularly with discussion in a small planning group, will enable readers to efficiently develop their ideas for PAL into comprehensive and practical project plans cognisant of current educational theory, existing PAL literature and the local context. The framework is particularly suitable for those who want to develop healthcare undergraduate PAL initiatives yet have little or no experience of PAL, as it provides an introduction to the relevant literature field and a step-by-step process for the design and implementation of such projects. It will also be of interest to those with experience of PAL and those seeking a structured framework for planning non-PAL curriculum developments in undergraduate healthcare curricula.     

Experiential learning: AMEE Guide No. 63

This Guide provides an overview of educational theory relevant to learning from experience. It considers experience gained in clinical workplaces from early medical student days through qualification to continuing professional development. Three key assumptions underpin the Guide: learning is 'situated'; it can be viewed either as an individual or a collective process; and the learning relevant to this Guide is triggered by authentic practice-based experiences. We first provide an overview of the guiding principles of experiential learning and significant historical contributions to its development as a theoretical perspective. We then discuss socio-cultural perspectives on experiential learning, highlighting their key tenets and drawing together common threads between theories. The second part of the Guide provides examples of learning from experience in practice to show how theoretical stances apply to clinical workplaces. Early experience, student clerkships and residency training are discussed in turn. We end with a summary of the current state of understanding.     

AMEE Education Guide no. 29: evaluating educational programmes

Evaluation has become an applied science in its own right in the last 40 years. This guide reviews the history of programme evaluation through its initial concern with methodology, giving way to concern with the context of evaluation practice and into the challenge of fitting evaluation results into highly politicized and decentralized systems. It provides a framework for potential evaluators considering undertaking evaluation. The role of the evaluator; the ethics of evaluation; choosing the questions to be asked; evaluation design, including the dimensions of evaluation and the range of evaluation approaches available to guide evaluators; interpreting and disseminating the findings; and influencing decision making are covered.     

AMEE Medical Education Guide No. 22: Refreshing lecturing: a guide for lecturers

This guide provides an overview of research on lecturing, a model of the processes of lecturing and suggestions for improving lecturing, learning from lectures and ways of evaluating lectures. Whilst primarily directed at teachers in the healthcare professions, it is equally applicable to all teachers in higher education. Lectures are the most ubiquitous method of teaching so they are an important part of a teacher's repertoire. Lectures are at least as effective as other methods of teaching at imparting information and explaining. Intention, transmission and output are the basis of a model of lecturing. The key skills of preparing lectures, explaining and varying student activities may be derived from the model. Preparation is based on purposes, content, various structures of lectures and the preparation of audiovisual aids. The essential ingredients of explaining are clarity, interest and persuasion. By varying activities, one can renew attention and develop student learning. Learning from lectures can be improved by teaching students the structure of lectures and methods of listening and note-taking. Student ratings of lectures are useful but over-used and limited ways of evaluating lectures. Equally important is peer review and more important than either student ratings or peer feedback is reflection on the practice of lecturing by individuals and course teams.     

AMEE Guide no. 34: Teaching in the clinical environment

Teaching in the clinical environment is a demanding, complex and often frustrating task, a task many clinicians assume without adequate preparation or orientation. Twelve roles have previously been described for medical teachers, grouped into six major tasks: (1) the information provider; (2) the role model; (3) the facilitator; (4) the assessor; (5) the curriculum and course planner; and (6) the resource material creator (Harden & Crosby 2000). It is clear that many of these roles require a teacher to be more than a medical expert. In a pure educational setting, teachers may have limited roles, but the clinical teacher often plays many roles simultaneously, switching from one role to another during the same encounter. The large majority of clinical teachers around the world have received rigorous training in medical knowledge and skills but little to none in teaching. As physicians become ever busier in their own clinical practice, being effective teachers becomes more challenging in the context of expanding clinical responsibilities and shrinking time for teaching (Prideaux et al. 2000). Clinicians on the frontline are often unaware of educational mandates from licensing and accreditation bodies as well as medical schools and postgraduate training programmes and this has major implications for staff training. Institutions need to provide necessary orientation and training for their clinical teachers. This Guide looks at the many challenges for teachers in the clinical environment, application of relevant educational theories to the clinical context and practical teaching tips for clinical teachers. This guide will concentrate on the hospital setting as teaching within the community is the subject of another AMEE guide.     

Writing competitive research conference abstracts: AMEE Guide no. 108

The ability to write a competitive research conference abstract is an important skill for medical educators. A compelling and concise abstract can convince peer reviewers, conference selection committee members, and conference attendees that the research described therein is worthy for inclusion in the conference program and/or for their attendance in the meeting. This AMEE Guide is designed to help medical educators write research conference abstracts that can achieve these outcomes. To do so, this Guide begins by examining the rhetorical context (i.e. the purpose, audience, and structure) of research conference abstracts and then moves on to describe the abstract selection processes common to many medical education conferences. Next, the Guide provides theory-based information and concrete suggestions on how to write persuasively. Finally, the Guide offers some writing tips and some proofreading techniques that all authors can use. By attending to the aspects of the research conference abstract addressed in this Guide, we hope to help medical educators enhance this important text in their writing repertoire.     

Team-based learning: a relevant strategy in health professionals' education

For about a decade, team-based learning (TBL), as an educational strategy, has been growing in use in the US and in several other international medical schools. It is a learner-centered, small group instructional strategy with good academic outcomes and considerable potential to address many of the professional competencies that are critical for the practice of medicine. For it to be successful in a course or curriculum, its essential components must be used properly. This article explains the importance and relevance of TBL in healthcare education, supports its inclusion as an effective learning strategy, and encourages the reader to explore additional resources, including the recently published AMEE Guide in Medical Education related to the topic (Parmelee et al, 2012).     

How self-determination theory can assist our understanding of the teaching and learning processes in medical education. AMEE guide No. 59

Self-determination Theory (SDT), designed by Edward Deci and Richard Ryan, serves among the current major motivational theories in psychology. SDT research has been conducted in many areas, among which are education and health care, but its applications in medical education are rare. The potential of SDT to help understand processes in medical education justifies this Guide. SDT is explained in seven principles, one of which is the distinction of three innate psychological needs of human beings: for competence, for autonomy and for relatedness. Further, SDT elaborates how humans tend to internalise regulation of behaviour that initially has been external, in order to develop autonomous, self-determined behaviour. Implications of SDT for medical education are discussed with reference to preparation and selection, curriculum structure, classroom teaching, assessments and examinations, self-directed learning, clinical teaching, students as teachers and researchers, continuing professional development, faculty development and stress among trainees.     

Situativity theory: a perspective on how participants and the environment can interact: AMEE Guide no. 52

Situativity theory refers to theoretical frameworks which argue that knowledge, thinking, and learning are situated (or located) in experience. The importance of context to these theories is paramount, including the unique contribution of the environment to knowledge, thinking, and learning; indeed, they argue that knowledge, thinking, and learning cannot be separated from (they are dependent upon) context. Situativity theory includes situated cognition, situated learning, ecological psychology, and distributed cognition. In this Guide, we first outline key tenets of situativity theory and then compare situativity theory to information processing theory; we suspect that the reader may be quite familiar with the latter, which has prevailed in medical education research. Contrasting situativity theory with information processing theory also serves to highlight some unique potential contributions of situativity theory to work in medical education. Further, we discuss each of these situativity theories and then relate the theories to the clinical context. Examples and illustrations for each of the theories are used throughout. We will conclude with some potential considerations for future exploration. Some implications of situativity theory include: a new way of approaching knowledge and how experience and the environment impact knowledge, thinking, and learning; recognizing that the situativity framework can be a useful tool to "diagnose" the teaching or clinical event; the notion that increasing individual responsibility and participation in a community (i.e., increasing "belonging") is essential to learning; understanding that the teaching and clinical environment can be complex (i.e., non-linear and multi-level); recognizing that explicit attention to how participants in a group interact with each other (not only with the teacher) and how the associated learning artifacts, such as computers, can meaningfully impact learning.     

Aligning physical learning spaces with the curriculum: AMEE Guide No. 107

This Guide explores emerging issues on the alignment of learning spaces with the changing curriculum in medical education. As technology and new teaching methods have altered the nature of learning in medical education, it is necessary to re-think how physical learning spaces are aligned with the curriculum. The better alignment of learning spaces with the curriculum depends on more directly engaged leadership from faculty and the community of medical education for briefing the requirements for the design of all kinds of learning spaces. However, there is a lack of precedent and well-established processes as to how new kinds of learning spaces should be programmed. Such programmes are essential aspects of optimizing the intended experience of the curriculum. Faculty and the learning community need better tools and instruments to support their leadership role in briefing and programming. A Guide to critical concepts for exploring the alignment of curriculum and learning spaces is provided. The idea of a networked learning landscape is introduced as a way of assessing and evaluating the alignment of physical spaces to the emerging curriculum. The concept is used to explore how technology has widened the range of spaces and places in which learning happens as well as enabling new styles of learning. The networked learning landscaped is explored through four different scales within which learning is accommodated: the classroom, the building, the campus, and the city. High-level guidance on the process of briefing for the networked learning landscape is provided, to take into account the wider scale of learning spaces and the impact of technology. Key to a successful measurement process is argued to be the involvement of relevant academic stakeholders who can identify the strategic direction and purpose for the design of the learning environments in relation to the emerging demands of the curriculum.     

AMEE Guide No. 21: Curriculum mapping: a tool for transparent and authentic teaching and learning

The curriculum is a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment and the individual students' learning style, personal timetable and programme of work. Curriculum mapping can help both staff and students by displaying these key elements of the curriculum, and the relationships between them. Students can identify what, when, where and how they can learn. Staff can be clear about their role in the big picture. The scope and sequence of student learning is made explicit, links with assessment are clarified and curriculum planning becomes more effective and efficient. In this way the curriculum is more transparent to all the stakeholders including the teachers, the students, the curriculum developer, the manager, the public and the researcher. The windows through which the curriculum map can be explored may include: (1) the expected learning outcomes; (2) curriculum content or areas of expertise covered; (3) student assessment; (4) learning opportunities; (5) learning location; (6) learning resources; (7) timetable; (8) staff; (9) curriculum management; (10) students. Nine steps are described in the development of a curriculum map and practical suggestions are made as to how curriculum maps can be introduced in practice to the benefit of all concerned. The key to a really effective integrated curriculum is to get teachers to exchange information about what is being taught and to coordinate this so that it reflects the overall goals of the school. This can be achieved through curriculum mapping, which has become an essential tool for the implementation and development of a curriculum. Faced with curricula which are becoming more centralized and less departmentally based, and with curricula including both core and optional elements, the teacher may find that the curriculum map is the glue which holds the curriculum together.     

'The research compass': an introduction to research in medical education: AMEE Guide no. 56

This AMEE Guide offers an introduction to research in medical education. It is intended for those who are contemplating conducting research in medical education but are new to the field. The Guide is structured around the process of transforming ideas and problems into researchable questions, choosing a research approach that is appropriate to the purpose of the study and considering the individual researcher's preferences and the contextual possibilities and constraints. The first section of the Guide addresses the rationale for research in medical education and some of the challenges posed by the complexity of the field. Next is a section on how to move from an idea or problem to a research question by placing a concrete idea or problem within a conceptual, theoretical framework. The following sections are structured around an overview model of approaches to medical education research, 'The research compass'. Core to the model is the conceptual, theoretical framework that is the key to any direction. The compass depicts four main categories of research approaches that can be applied when studying medical education phenomena, 'Explorative studies'; 'Experimental studies'; 'Observational studies'; and 'Translational studies'. Future AMEE Guides in the research series will address these approaches in more detail.     

The lecture-free curriculum: Setting the stage for life-long learning: AMEE Guide No. 135

Abstract

In this AMEE Guide we propose that instruction in health sciences education transform to ‘lecture-free.’ We present rationale for this proposal, guidance on approaches and strategies to achieve the goal, likely challenges, and what we consider the value-added outcomes. We are supported by a confluence of factors: advances in the science of learning and the learning of science and clinical reasoning, incontrovertible evidence that active and engaged learning strategies have better outcomes, current and emerging technology infrastructure in and out of the classroom, and best-practice instructional design.     

AMEE Education Guide no. 28: the development and role of departments of medical education

A department of medical education is becoming an essential requirement for a medical school. This publication is intended for those wishing to establish or develop a medical education department. It may also prove useful to teachers in medicine by providing information on how such a department can support their activities. This will vary with the local context but the principles are generalizable. Medical education departments are established in response to increased public expectations relating to healthcare, societal trends towards increased accountability, educational developments, increased interest in what to teach and how to educate doctors and the need to train more doctors. The functions of a department of medical education include research, teaching, service provision and career development of the staff. The scope of its activities includes undergraduate and postgraduate education, continuing professional development and continuing medical education. These activities may be extended to other healthcare professions. Flexibility is the key to staffing a department of medical education. Various contractual arrangements, affiliations and support from non-affiliated personnel are needed to provide a multi-professional team with a range of expertise. The precise structure of the department will depend on the individual institution. The name of the department may suggest its position within the university structure. The director provides academic leadership for the department and his/her responsibilities include promotion of staff collaboration, fostering career development of the staff and establishing local, regional and international links. Financial support may come from external funding agencies, government or university sources. Some departments of medical education are financially self-supporting. The department should be closely integrated with the medical school. Support for the department from the dean is an essential factor for sustainability. Several case studies of medical education departments throughout the world are included as examples of the different roles and functions of a department of medical education.     

Effective methods of teaching and learning in anatomy as a basic science: A BEME systematic review: BEME guide no. 44

Background: Anatomy is a subject essential to medical practice, yet time committed to teaching is on the decline, and resources required to teach anatomy is costly, particularly dissection. Advances in technology are a potential solution to the problem, while maintaining the quality of teaching required for eventual clinical application.

Aim: To identify methods used to teach anatomy, including those demonstrated to enhance knowledge acquisition and retention.

Methods: PubMed, CINAHL, ERIC, Academic OneFile, ProQuest, SAGE journals and Scopus were search from the earliest entry of each database to 31 August 2015. All included articles were assessed for methodological quality and low quality articles were excluded from the study. Studies were evaluated by assessment scores, qualitative outcomes where included as well as a modified Kirkpatrick model.

Results: A total of 17,820 articles were initially identified, with 29 included in the review. The review found a wide variety of teaching interventions represented in the range of studies, with CAI/CAL studies predominating in terms of teaching interventions, followed by simulation. In addition to this, CAI/CAL and simulation studies demonstrated better results overall compared to traditional teaching methods and there is evidence to support CAI/CAL as a partial replacement for dissection or a valuable tool in conjunction with dissection.

Conclusions: This review provides evidence in support of the use of alternatives to traditional teaching methods in anatomy, in particular, the use of CAI/CAL with a number of high quality, low risk of bias studies supporting this.     

AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician

Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direct what they learn. The second is a move to outcome-based education where the learning outcomes are defined and decisions about the curriculum are based on these. These two trends are closely related. If teachers are to do a better job of assessing their students, they need an understanding of the assessment process, an appreciation of the learning outcomes to be assessed and a recognition of the most appropriate tools to assess each outcome. Assessment tools selected should be valid, reliable, practical and have an appropriate impact on student learning. The preferred assessment tool will vary with the outcome to be assessed. It is likely to be some form of written test, a performance test such as an OSCE in which the student's competence can be tested in a simulated situation, and a test of the student's behaviour over time in clinical practice, based on tutors' reports and students' portfolios. An assessment profile can be produced for each student which highlights the learning outcomes the student has achieved at the required standard and other outcomes where this is not the case. For educational as well as economic reasons, there should be collaboration across the continuum of education in test development as it relates to the assessment of learning outcomes and in the implementation of a competence-based approach to assessment.     

Producing a socially accountable medical school: AMEE Guide No. 109

Health systems worldwide are confronted with challenges due to increased demand from their citizens, an aging population, a variety of health risks and limited resources. Key health stakeholders, including academic institutions and medical schools, are urged to develop a common vision for a more efficient and equitable health sector. It is in this environment that Boelen and Heck defined the concept of the “Social Accountability of Medical Schools” – a concept that encourages schools to produce not just highly competent professionals, but professionals who are equipped to respond to the changing challenges of healthcare through re-orientation of their education, research and service commitments, and be capable of demonstrating a positive effect upon the communities they serve.

Social Accountability calls on the academic institution to demonstrate an impact on the communities served and thus make a contribution for a just and efficient health service, through mutually beneficial partnerships with other healthcare stakeholders. The purpose of this Guide is to explore the concept of Social Accountability, to explain it in more detail through examples and to identify ways to overcome obstacles to its development. Although in the Guide reference is frequently made to medical schools, the concept is equally applicable to all forms of education allied to healthcare.