Implementing competency-based medical education: What changes in curricular structure and processes are needed?

Medical educators must prepare for a number of challenges when they decide to implement a competency-based curriculum. Many of these challenges will pertain to three key aspects of implementation: organizing the structural changes that will be necessary to deliver new curricula and methods of assessment; modifying the processes of teaching and evaluation; and helping to change the culture of education so that the CBME paradigm gains acceptance. This paper focuses on nine key considerations that will support positive change in first two of these areas. Key considerations include: ensuring that educational continuity exists amongst all levels of medical education, altering how time is used in medical education, involving CBME in human health resources planning, ensuring that competent doctors work in competent health care systems, ensuring that information technology supports CBME, ensuring that faculty development is supported, ensuring that the rights and responsibilities of the learner are appropriately balanced in the workplace, preparing for the costs of change, and having appropriate leadership in order to achieve success in implementation.     

Lifelong learning skills: how experienced are students when they enter medical school?

Widening participation initiatives together with changes in school curricula in England may broaden the range of lifelong learning skills experience of new undergraduates. This project examines the experience levels of current students, as a comparative baseline. First-year medical students completed a questionnaire on arrival, investigating their practice of 31 skills during the previous two years. Responses show that most students have regularly practised transferable skills. However, significant numbers report little experience, particularly in IT skills such as email, using the Internet, spreadsheets and databases. Some remain unfamiliar with word processing. Library research, essay writing and oral presentation are also rarely practised by substantial numbers. One-third of students lack experience of evaluating their own strengths and weaknesses. Current students already show diversity of experience in skills on arrival at medical school. Changes in the near future may increase this range of experience further, and necessitate changes to undergraduate courses.     

From undergraduate medical education to pre-registration house officer year: how prepared are students?

Studies in the United Kingdom show that the first year of being a new doctor is a difficult transition from being an undergraduate medical. These doctors feel ill-prepared by their undergraduate medical student education and ill-equipped for their new role. This is a questionnaire study looking at 193 pre-registration house officers (PRHOs) and 212 consultant educational supervisors within the West Midlands Deanery in England, UK. The study asked how well prepared these new doctors were in seventeen basic subject areas (using a General Medical Council based template), and also, using the same template, how well prepared their consultant educational supervisors felt they were. Statistical testing included ranking of subject areas for each group, reliability testing and comparisons of views of house officers and consultants. Both groups ranked communication skills areas highest (best prepared) and ranked basic doctoring skills (such as prescribing, treatment, decision making and emergencies) lowest. House officers rated themselves significantly higher than did their consultant supervisors in thirteen out of the seventeen areas tested. In discussion, we ask if we have gone too far in teaching effective communication at the expense of basic doctoring skills. We also consider whether indeed young doctors have an inflated opinion of their own competencies, or are the older generation seeing the world through rose tinted spectacles?     

Where are we with Web-based learning in medical education?

This article summarizes several years of research in Web-based learning (WBL) to illustrate that, in general, research fails to address the questions that will inform our use of this powerful tool. In particular, media-comparative research--the comparison of WBL to another medium (e.g. lecture)--is hopelessly confounded and does little to inform practice. Rather than asking 'If' we should use WBL (we should!), researchers should ask 'How' and 'When' to use WBL. 'How' will be answered by evaluating specific elements of instructional design including theory-based instructional methods, adaptations to individual characteristics and details of presentation enhancements. 'When' will require study of issues such as just-in-time learning, effective use of simulation, and integration of WBL within and between institutions. Both quantitative and qualitative research methods will be useful. Educators should also look outside medical education for evidence and theories to guide their practice. Finally, while WBL has many advantages it is not inherently better than other media. The author suggests that learning outcomes be defined first and WBL be used only when it appears to be the most effective means of achieving these outcomes.     

Randomized controlled trials and meta-analysis in medical education: what role do they play?

Education researchers seek to understand what works, for whom, in what circumstances. Unfortunately, educational environments are complex and research itself is highly context dependent. Faced with these challenges, some have argued that qualitative methods should supplant quantitative methods such as randomized controlled trials (RCTs) and meta-analysis. I disagree. Good qualitative and mixed-methods research are complementary to, rather than exclusive of, quantitative methods. The complexity and challenges we face should not beguile us into ignoring methods that provide strong evidence. What, then, is the proper role for RCTs and meta-analysis in medical education? First, the choice of study design depends on the research question. RCTs and meta-analysis are appropriate for many, but not all, study goals. They have compelling strengths but also numerous limitations. Second, strong methods will not compensate for a pointless question. RCTs do not advance the science when they make confounded comparisons, or make comparison with no intervention. Third, clinical medicine now faces many of the same challenges we encounter in education. We can learn much from other fields about how to handle complexity in RCTs. Finally, no single study will definitively answer any research question. We need carefully planned, theory-building, programmatic research, reflecting a variety of paradigms and approaches, as we accumulate evidence to change the art and science of education.     

Preparation for practice: how can medical schools better prepare PRHOs?

There is growing evidence that new PRHOs feel unprepared for their first post. This study compared three cohorts of graduates, the first from a traditional systems-based curriculum, the second from the same systems-based curriculum, who had also taken an intercalated degree, and the third from a PBL curriculum who had not intercalated. Subjective reports of confidence in clinical skills, anxiety and feelings of preparedness for practice were assessed using a previously published instrument. Graduates from the PBL curriculum who had not intercalated felt significantly better prepared, less anxious and more confident than equivalent graduates from the systems-based curriculum. Systems-based curriculum graduates who had taken an additional intercalated degree scored as highly in these criteria as the PBL graduates who had not intercalated. Despite these improvements, absolute levels of anxiety remained high and feelings of preparedness and confidence in clinical skills remained poor.     

What is the Net Generation? The challenge for future medical education

The Net Generation is the cohort of young people born between 1982 and 1991 who have grown up in an environment in which they are constantly exposed to computer-based technology. It has been suggested that their methods of learning are different from those of previous generations. In a survey of first-year undergraduate students, we found that a large majority started university with experience of using online systems such as blogs and wikis; furthermore, their attitudes to the possible use of such tools in learning were positive. The Net Generation is a challenge to the way that all universities and medical schools provide teaching and learning. We suggest that all educators of this group of students need to be aware of incoming students' skills and experience and do more to promote their use in the undergraduate curriculum.     

Molecular partners for interaction and cell internalization of cell-penetrating peptides: how identical are they?

Cell-penetrating peptides are short basic peptide sequences that might display amphipathic properties. These positively charged peptides internalize into all cell types, albeit with different efficiency. Cell-penetrating peptides use all routes of pinocytosis to internalize, in addition to direct membrane translocation that requires interaction with lipid membrane domains. These differences in internalization efficiency according to the peptide sequence and cell type suggest that the cell-penetrating peptides interact with different molecular partners at the cell surface. This review will first report on data that describe the molecular interaction of the most popular cell-penetrating peptides (penetratin, Tat and oligoarginine) with carbohydrates and lipids. The second part of the review will be dedicated to cell studies that have reported how cell surface composition influences cell internalization. Discussion will focus on the gap between in vitro and in cellulo studies, and more specifically to which extent the interaction with molecules found in membranes reflect the internalization efficiency of the peptides.     

What can medical educators learn from the Rio 2016 Olympic Games?

Medical Educators face an ongoing challenge in optimizing preparedness for practice for newly qualified doctors. Junior doctors have highlighted specific areas in which they do not feel adequately equipped to undertake their duties, including managing the acutely unwell patient. In these highly stressful, time-critical scenarios it might be assumed that a lack of knowledge underpins these feelings of apprehension from junior medics; however, having studied, trained and passed examinations to demonstrate such knowledge, perhaps other factors should be considered. The recent Olympic Games in Rio demonstrated the impact of sport psychology techniques in allowing athletes to achieve their optimum performance in the face of adversity. The use of mental and behavioral strategies to control feelings of anxiety and low self-efficacy are pivotal for athletes to deliver their best performance under extreme pressure. We consider whether such techniques could improve the preparedness of the newest recruits to the healthcare system, and the impact this could have on patient care. Finally, suggestions for potential research directions within this area are offered to stimulate interest amongst the research community.     

What influences medical school choice?

In this six year study, we asked new students at the University of Liverpool, why they had chosen it. We asked students to tell us what they had considered when they made their decision about Liverpool in a questionnaire at first registration. Ninety-six percent of students in 2001-2002, compared with 66% in 1996-1997, cited the course as most important when choosing a medical school. The type of course offered by medical schools has become important for applicants. The importance of the course for potential students is increasing, but applicants will still consider the whole package: course, students and city when choosing a medical school.     

World conference on medical education: a window on the globalizing world of medical education?

The Association for Medical Education in Europe (AMEE) is a worldwide association for all interested in medical and health professions education (http://www.amee.org). AMEE organizes an annual meeting, the most recent of which (2005) was held in Amsterdam. At this meeting certain countries and regions were better represented than others, while some countries with large populations or a significant role in the history of medical education were almost completely absent from the international scene. At the same time, the themes addressed at the AMEE conference concern issues of international interest, and appear to be leading to internationalization of pedagogical and research methods and policies for educational standards. It is therefore crucial that all parts of the medical education world be well represented. This paper illustrates both the strengths and imbalances of AMEE as a forum for the elaboration of international activities and standards in medical education. Finally, the authors wonder why a tendency to assume international generalizability of concepts and perspectives in medical education is not accompanied by studies that compare and contrast medical education methods, research and values between countries and cultures.