Online interprofessional education facilitation: A scoping review

Introduction: The use of online media to deliver interprofessional education (IPE) is becoming more prevalent across health professions education settings. Facilitation of IPE activities is known to be critical to the effective delivery of IPE, however, specifics about the nature of online IPE facilitation remains unclear.

Aim: To explore the health professions education literature to understand the extent, range and nature of research on online IPE facilitation.

Methods: Scoping review methodology was used to guide a search of four electronic databases for relevant papers. Of the 2095 abstracts initially identified, after screening of both abstracts and full-text papers, 10 studies were selected for inclusion in this review. Following abstraction of key information from each study, a thematic analysis was undertaken.

Results: Three key themes emerged to describe the nature of the IPE facilitation literature: (1) types of online IPE facilitation contributions, (2) the experience of online IPE facilitation and (3) personal outcomes of online IPE facilitation. These IPE facilitation themes were particularly focused on facilitation of interprofessional student teams on an asynchronous basis.

Discussion: While the included studies provide some insight into the nature of online IPE facilitation, future research is needed to better understand facilitator contributions, and the facilitation experience and associated outcomes, both relating to synchronous and asynchronous online environments.     

Twelve tips for effective body language for medical educators

Background: A significant proportion of human communication is nonverbal. Although the fields of business and psychology have significant literature on effectively using body language in a variety of situations, there is limited literature on effective body language for medical educators.

Aim: To provide 12 tips to highlight effective body language strategies and techniques for medical educators.

Method: The tips provided are based on our experiences and reflections as clinician-educators and the available literature.

Results: The 12 tips presented offer specific strategies to engage learners, balance learner participation, and bring energy and passion to teaching.

Conclusions: Medical educators seeking to maximize their effectiveness would benefit from an understanding of how body language affects a learning environment and how body language techniques can be used to engage audiences, maintain attention, control challenging learners, and convey passion for a topic. Understanding and using body language effectively is an important instructional skill.     

Twelve tips on how to establish a new undergraduate firm on a critical care unit

Background: Little is known about undergraduate teaching in critical care unit (CrCU) and many undergraduate curricula lack placements in CrCU.

Aims: To describe how our CrCU succeeded in developing a novel placement for Year 3 undergraduate medical students.

Methods: Particular emphasis was placed on a robust timetable incorporating a variety of activities, a dedicated and thorough induction, and a mix of teaching methods such as formal and informal, consultant-led, and skills. Services allied to CrCU were also utilized.

Results: Our new firm has exceeded all expectations and, based on student feedback, received the “Firm of the Year” award for several years in succession. It now serves as a model of undergraduate teaching in our hospital.

Conclusions: Educationalists and intensivists should work together to unlock the full potential of this rich learning environment. Professional societies in critical care medicine should take the opportunity to develop more interest in undergraduate 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.     

Toward interprofessional learning and education: Mapping common outcomes for prequalifying healthcare professional programs in the United Kingdom

Introduction: Interprofessional education (IPE) continues to be a key component in prequalifying health professional education, with calls for regulators to publish a joint statement regarding IPE outcomes. To date, the regulatory documents for healthcare education in the United Kingdom have not been examined for common learning outcomes; information that could be used to inform such a statement and to identify opportunities for interprofessional learning.

Methods: A mapping of the outcomes/standards required by five, UK, health profession regulatory bodies was undertaken. This involved the identification of common outcomes, a keyword search and classification of common outcomes/standards; presented as themes and subthemes.

Results: Seven themes were identified: knowledge for practice, skills for practice, ethical approach, professionalism, continuing professional development (CPD), patient-centered approach and teamworking skills, representing 22 subthemes. Each subtheme links back to the outcomes/standards in the regulatory documents.

Conclusions: This study identifies the key areas of overlap in outcomes/standards expected of selected healthcare graduates in the United Kingdom. The mapping provides a framework for informing prequalifying IPE curricula, for example, identifying possible foci for interprofessional education outcomes and associated learning opportunities. It allows reference back to the standards set by regulatory bodies, a requirement for all institutions involved in health profession education.     

Social media and professional identity: Pitfalls and potential

Introduction: Social media developments have completely changed how information is accessed and communicated. While great potential exists with these platforms, recent reports of online unprofessional behavior by doctors has threatened the medical professional identity; a matter of critical importance for clinicians and medical educators. This paper outlines a role for social media in facilitating support for clinicians and medical teachers; it will raise awareness of pitfalls and explain ethical and legal guidelines.

Methods: An analysis of inappropriate behaviors and conflicting attitudes regarding what is acceptable in online posts, including the inter-generational contrast in online presence and perceptions of where the boundaries lie.

Results and discussion: Guidance documents are analyzed and potentially confusing and conflicting statements are identified and clarified. The authors believe that clinicians and medical students must follow ethical imperatives in both personal and professional spheres.

Conclusions: It is essential that medical educational and professional bodies encourage clinicians to support one another and share information online while providing clear legal and ethical advice on maintaining standards and avoiding common pitfalls. Education on the responsible use of social media and associated risk awareness should be a priority for medical school curricula.     

Twelve tips for teaching brief motivational interviewing to medical students

Background: Shifting from paternalistic to patient-centred doctor-patient relationships has seen a growing number of medical programs incorporate brief motivational interviewing training in their curriculum. Some medical educators, however, are unsure of precisely what, when, and how to incorporate such training.

Aims: This article provides educators with 12 tips for teaching brief motivational interviewing to medical students, premised on evidence-based pedagogy.

Methods: Tips were drawn from the literature and authors’ own experiences.

Results: The 12 tips are: (1) Set clear learning objectives, (2) Select experienced educators, (3) Provide theoretical perspectives, (4) Share the evidence base, (5) Outline the “spirit”, principles, and sequence, (6) Show students what it looks like, (7) Give students a scaffold to follow, (8) Provide opportunities for skill practice, (9) Involve clinical students in teaching, (10) Use varied formative and summative assessments, (11) Integrate and maintain, and (12) Reflect and evaluate.

Conclusions: We describe what to include and why, and outline when and how to teach the essential components of brief motivational interviewing knowledge and skills in a medical curriculum.     

How patient educators help students to learn: An exploratory study

Introduction: Benefits of the active involvement of patients in educating health professionals are well-recognized but little is known about how patient educators facilitate student learning.

Method: This exploratory qualitative study investigated the teaching practices and experiences that prepared patient educators for their roles in a longitudinal interprofessional Health Mentors program. Semi-structured interviews were conducted with eleven experienced health mentors. Responses were coded and analyzed for themes related to teaching goals, methods, and prior experiences.

Results: Mentors used a rich variety of teaching methods to teach patient-centeredness and interprofessionalism, categorized as: telling my story, stimulating reflection, sharing perspectives, and problem-solving. As educators they drew on a variety of prior experiences with teaching, facilitation or public speaking and long-term interactions with the health-care system.

Conclusions: Patient educators use diverse teaching methods, drawing on both individualistic and social perspectives on learning. A peer-support model of training and support would help maintain the authenticity of patients as educators. The study highlights inadequacies of current learning theories to explain how patients help students learn.     

Peer group reflection on student ratings stimulates clinical teachers to generate plans to improve their teaching

Background: Previous studies have demonstrated that student ratings of a teachers’ performance do not incentivize clinical teachers to reflect critically and generate plans to improve their teaching. Peer group reflection might offer a solution in mediating this change.

Aim: To investigate: (a) to which extent clinical teachers perceive self-evaluation, student ratings and peer group reflection effective; and (b) whether additional peer group reflection fosters critical reflection and the translation of feedback into concrete plans of action.

Method: We conducted a quasi-experiment, inviting two groups of 10 clinical teachers each (1) to complete a self-evaluation and (2) subsequently examine their student ratings. One group participated in (3) an additional peer group reflection meeting. All participants were finally requested to define plans for improvement and evaluate each activity’s effectiveness.

Results: Participants perceived all three activities to be effective. Levels of reflection did not differ across the two groups. However, participation in peer group reflection did result in generating more concrete plans to change clinical teaching.

Conclusions: Peer group reflection on student ratings shows promise as tool to assist clinical teachers in generating plans for improvement. Future research should focus on whether teaching indeed improves with the introduction of peer group reflection.     

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.     

International infectious diseases teaching to undergraduate medical students: A successful European collaborative experience*

Context: The emerging global-health paradigm requires medical teaching to be continuously redefined and updated; to this end, transnational approaches should be encouraged and medical training harmonized. Infectious diseases (ID) teaching in the current context of emerging infections, fast-increasing bacterial resistance and large-scale human migration, was chosen to develop a common international course.

Objective: We report the successful implementation of a joint European undergraduate course aiming to (i) develop a common ID core curriculum among European medical schools; (ii) promote mobility among teachers and students (iii) promote international cooperation among European teachers.

Methods: The course was built around teachers’ mobility. It was delivered in English by a team of European medical educators from Paris Descartes University, Università Cattolica del Sacro Cuore in Rome and the University of Edinburgh to groups of 25–30 undergraduate medical students at each university. Partner Institutions officially recognized the course as substitutive of or additive to the regular curriculum.

Results: The course has been running for 3 years and received excellent satisfaction scores by students and staff as regards to scientific content, pedagogy and international exchanges.

Conclusion: This cooperative approach demonstrates the feasibility of a harmonized European undergraduate medical education, having ID as a test experiment for future developments.     

Peer assessment in the objective structured clinical examination: A scoping review

Background: The objective structured clinical examination (OSCE), originally designed with experts assessing trainees’ competence, is more frequently employed with an element of peer assessment and feedback. Although peer assessment in higher education has been studied, its role in OSCEs has not reviewed.

Aims: The aim of this study is to conduct a scoping review and explore the role of peer assessment and feedback in the OSCE.

Methods: Electronic database and hand searching yielded 507 articles. Twenty-one full records were screened, of which 13 were included in the review. Two independent reviewers completed each step of the review.

Results: Peer-based OSCEs are used to assess students’ accuracy in assessing OSCE performance and to promote learning. Peer examiners (PE) tend to award better global ratings and variable checklist ratings compared to faculty and provide high-quality feedback. Participating in these OSCEs is perceived as beneficial for learning.

Conclusions: Peer assessment and feedback can be used to gauge PE reliability and promote learning. Teachers using these OSCEs must use methodology which fits their purpose. Competency-based education calls for diversification of assessment practices and asks how assessment impacts learning; the peer-based OSCE responds to these demands and will become an important practice in health professions education.     

How characteristic routines of clinical departments influence students’ self-regulated learning: A grounded theory study

Background: In clerkships, students are expected to self-regulate their learning. How clinical departments and their routine approach on clerkships influences students’ self-regulated learning (SRL) is unknown.

Aim: This study explores how characteristic routines of clinical departments influence medical students’ SRL.

Methods: Six focus groups including 39 purposively sampled participants from one Dutch university were organized to study how characteristic routines of clinical departments influenced medical students’ SRL from a constructivist paradigm, using grounded theory methodology. The focus groups were audio recorded, transcribed verbatim and were analyzed iteratively using constant comparison and open, axial and interpretive coding.

Results: Students described that clinical departments influenced their SRL through routines which affected the professional relationships they could engage in and affected their perception of a department’s invested effort in them. Students’ SRL in a clerkship can be supported by enabling them to engage others in their SRL and by having them feel that effort is invested in their learning.

Conclusions: Our study gives a practical insight in how clinical departments influenced students’ SRL. Clinical departments can affect students’ motivation to engage in SRL, influence the variety of SRL strategies that students can use and how meaningful students perceive their SRL experiences to be.     

How physicians teach in the clinical setting: The embedded roles of teaching and clinical care

Background: Clinical teaching lies at the heart of medical education. However, few studies have explored the embedded nature of teaching and clinical care. The goal of this study was to examine the process of clinical teaching as it naturally, and spontaneously, unfolds in a broad range of authentic contexts with medical students and residents.

Methods: This focused ethnographic study consisted of 160 hours of participant observation and field interviews with three internal medicine teams. Thematic analysis guided data organization and interpretation.

Findings: Three overlapping themes emerged: the interconnectedness between clinical work and pedagogy; a multiplicity of teachers; and the influence of space and artifacts on teaching and learning. Clinical teaching, which was deeply embedded in clinical care, was influenced by the acuity of patient problems, learner needs, and the context in which teaching unfolded; it also occurred on a spectrum that included planned, opportunistic, formal, and informal teaching (and learning).

Conclusions: Study findings suggest that clinical teaching, which is marked by an intersection between service and teaching, can be viewed as an example of work-based teaching. They also yield suggestions for the enhancement of clinical teaching in inpatient settings, faculty development, and educational policies that recognize clinical teaching and learning.     

Twelve tips for medical students to make the best use of ward-based learning

Background: With a multitude of healthcare professionals willing to teach, a placement on a ward is an invaluable learning opportunity; yet as students, we often struggle to maximize this placements’ potential.

Aim: This article provides 12 tips for medical students to optimize their learning in a ward-based environment.

Methods: Current literature and personal experiences of the authors were used to develop the tips.

Results: The 12 tips are (1) prepare yourself, (2) identify knowledge, skills, and attributes, (3) engage in peer-to-peer learning, (4) get to know the interprofessional team, (5) talk to the patient first, (6) present findings and gain feedback, (7) tap into seniors’ experience, (8) immerse yourself and be proactive, (9) check patient notes, (10) manage the clock, (11) enhance your CV, and (12) embrace the spirit of lifelong learning.

Conclusion: These tips will enable us to effectively improve our learning and positively shape us into outstanding future doctors.     

How teachers can help learners build storage and retrieval strength

Aim: To be an effective teacher, content expertise is necessary but alone does not guarantee optimal learning outcomes for students. In this article, the authors discuss ways in which medical teachers can shape the learning of their students and enable them to become more efficient and effective learners.

Methods: Using Bjork and Bjork's new theory of disuse as their framework, the authors discuss strategies to improve storage strength of to-be-learned information and strategies to improve retrieval strength of learned information.

Results: Strategies to improve storage strength include optimizing cognitive load, providing causal explanations, and giving effective feedback. Strategies to improve retrieval strength include situated cognition and various types of retrieval practice.

Conclusions: Adopting these teaching strategies should hopefully help teachers improve the learning outcomes of their students, but there is still a need for further research into the science of learning and the science of instruction, including comparative effectiveness of different teaching strategies and how best to translate findings from the psychology literature into medical education.     

New perspectives on health professions students’ e-learning: Looking through the lens of the “visitor and resident” model

Background: The growth of e-learning in health professional education reflects expansion of personal use of online resources. Understanding the user perspective in a fast-changing digital world is essential to maintain the currency of our approach.

Methods: Mixed methods were used to investigate a cohort of postgraduate, e-learning healthcare students’ perspectives on their use of online resources for personal and/or professional roles, via questionnaire and student-constructed diagrams, capturing use of online resources (underpinned by White’s model of “resident” and “visitor” online engagement). Semistructured interviews explored the use and value of resources afforded via the online environment.

Results: The 45 study participants described a range of prior experiences with online resources in personal and professional capacities, but overall students tended to use online “tools” (“visitor” mode) rather than highly collaborative networks (“resident” mode). In relation to e-learning, the dominant interview theme was valuing knowledge transfer from the tutor and using “visitor” behaviors to maximize knowledge acquisition. Peer-learning opportunities were less valued and barriers to collaborative “resident” modes were identified.

Conclusions: These findings help to inform e-learning course design to promote engagement. The results enable recommendations for use of the “Visitor and Residents” model and for planning activities that learners might utilize effectively.     

Twelve tips for the recruitment and retention of general practitioners as teachers of medical students

Background: Primary care physicians have become a fundamental aspect of teaching in modern medical school curricula worldwide with a significant proportion of undergraduate teaching taking place in primary care. There are calls for this to increase with more patient care occurring in the community but teaching capacity in primary care is a potential challenge. Medical schools, therefore, need strategies to be able to increase their primary care physician teaching workforce.

Methodology: We asked all Heads of General Practice Teaching in UK medical schools to share their three top tips for recruiting and retaining GPs to teach undergraduate students. The majority (two-thirds) of medical schools responded and we have summarized the answers into the following twelve tips.

Results: Although the twelve tips are varied and comprehensive, including broad topics such as finances and training, one clear theme running through the majority of tips is good communication and relationships between education teams and GPs.

Conclusions: The solutions to recruiting and retaining GPs to teach undergraduate medical students are clearly multifactorial and complex. We hope that by presenting suggestions from UK GP heads of teaching as these twelve tips provides some helpful, thought-provoking ideas and inspiration for both the UK and internationally.     

Development of culture-sensitive clinical teacher evaluation sheet in the Japanese context

Aim: Many instruments for evaluating clinical teaching have been developed, albeit most in Western countries. This study aims to develop a validated cultural and local context sensitive instrument for clinical teachers in an East Asian setting (Japan), Japanese Clinical Teacher Evaluation Sheet (JaCTES).

Methods: A multicenter, cross-sectional evaluation study was conducted. We collected a total of 1368 questionnaires on 304 clinical teachers, completed by residents in 16 teaching hospitals. The construct validity was examined by conducting a factor analysis and using structural equation modeling (SEM). We also assessed the reliability using generalizability analysis and decision study.

Results: Exploratory factor analysis resulted in three-factor (role model, teaching activities, and accessibility) model including 18 items. Confirmatory factor analysis was performed, using SEM. The comparative fit index was 0.931 and the root mean square error of approximation was 0.087, meaning an acceptable goodness of fit for this model. To obtain a reliable dependability-coefficient of at least 0.70 or higher, 5–8 resident responses are necessary.

Discussion and conclusion: JaCTES is the first reported instrument with validity evidence of content and internal structure and high feasibility in Japan, an East Asian setting. Medical educators should be aware of the local context and cultural aspects in evaluating clinical teachers.     

Utility of selection methods for specialist medical training: A BEME (best evidence medical education) systematic review: BEME guide no. 45

Background: Selection into specialty training is a high-stakes and resource-intensive process. While substantial literature exists on selection into medical schools, and there are individual studies in postgraduate settings, there seems to be paucity of evidence concerning selection systems and the utility of selection tools in postgraduate training environments.

Aim: To explore, analyze and synthesize the evidence related to selection into postgraduate medical specialty training.

Method: Core bibliographic databases including PubMed; Ovid Medline; Embase, CINAHL; ERIC and PsycINFO were searched, and a total of 2640 abstracts were retrieved. After removing duplicates and screening against the inclusion criteria, 202 full papers were coded, of which 116 were included.

Results: Gaps in underlying selection frameworks were illuminated. Frameworks defined by locally derived selection criteria, and heavily weighed on academic parameters seem to be giving way to the evidencing of competency-based selection approaches in some settings.

Regarding selection tools, we found favorable psychometric evidence for multiple mini-interviews, situational judgment tests and clinical problem-solving tests, although the bulk of evidence was mostly limited to the United Kingdom. The evidence around the robustness of curriculum vitae, letters of recommendation and personal statements was equivocal. The findings on the predictors of past performance were limited to academic criteria with paucity of long-term evaluations. The evidence around nonacademic criteria was inadequate to make an informed judgment.

Conclusions: While much has been gained in understanding the utility of individual selection methods, though the evidence around many of them is equivocal, the underlying theoretical and conceptual frameworks for designing holistic and equitable selection systems are yet to be developed.