Stephen Abrahamson,PhD, ScD,educationist: a stranger in a kind of paradise

This profile of Stephen Abrahamson, Ph.D., Sc.D., is the first of six profiles to appear as part of the Exemplar project focused of six retired medical educators who transformed the field of medical education. The exemplars, all graduate degree recipients in education were interviewed by six senior present-day medical educators using a common protocol designed to elicit career chronology and the significant contributions of educationists to medical education of Dr. Abrahamson's profile was based on an in-depth two-day interview, examination of a comprehensive list of his publications, the history of the Society of the Directors of Research in Medical Education, and unsolicited conversations with several of his colleagues. Dr. Abrahamson began his career teaching high school, later receiving a masters and doctorate degrees, in preparation for a career as a teacher-educator. Through collaboration with Dr. George Miller, Dr. Abrahamson began his career as an educationist in medicine - one who studies the education process and prepares others to become teachers - by teaching medical school faculty about the science of education. Dr. Abrahamson's career was devoted to applying his evidence-based education approach to the newly emerging profession of medical education. An examination of his career shows that he made four vital contributions to medical education - defining the educationist role, serving as a teaching/mentor/network builder/friend to medical educators, curriculum change agent and innovator at USC, and demonstrating and articulating the value of offices of medical education and research in medical education. More broadly, Dr. Abrahamson identified three major contributions made by educationists to the field of medical education: the application of education principles to instructional/assessment innovations (e.g., programmed patients), an evidence-based approach to assessing education, and faculty development/teacher training. Based on his half-century of experience in medical education, Dr. Abrahamson outlined seven lessons for success as an educationist in medicine. This revised version was published online in June 2006 with corrections to the Cover Date.     

Charles W. Dohner,PhD: an evaluator and mentor in medical education

As one of the first generation medical education pioneers, Charles W. Dohner, PhD established the ninth office of medical education at the University of Washington (UW) where he served as chairman from 1967–1996. With a background in education and measurement, he focused his work on evaluation of educational programs and faculty development. The Department of Medical Education went through three distinct stages of development: path finding 1967–1972 focused on developing working relationships with the faculty and clarifying identity, integration into academic affairs 1972–1980, and direct leadership by department faculty 1980–1996. Dohner helped to create and evaluate the WAMI program, a regional medical education program for the states of Washington, Alaska, Montana, and Idaho. He served as a consultant to aspecialty board, the founding president of the Society of Directors of Research in Medical Education, and a frequent consultant in international medical education. Dohner identified three important innovations in medical education: educators in academic medicine, simulations and performance assessment, and community-based medical education. Success factors for professional education include technical competence in education, interpersonal communication and collaboration skills, a plan for personal growth, and use of mentors. Future trends in medical education will involve information technology, professionalism, wellness and complementary medicine, and performance assessment. He has been a passionate spokesman for excellence in medical education and most noted for his roles as an evaluator, program developer, and mentor of academic leaders.This revised version was published online in October 2005 with corrections to the Cover Date.     

Best Evidence Medical Education

There is a need to move from opinion-based education to evidence-based education. Best Evidence Medical Education (BEME) is the implementation, by teachers in their practice, of methods and approaches to education based on the best evidence available. It involves a professional judgement by the teacher about their teaching taking into account a number of factors - the QUESTS dimensions. The Quality of the research evidence available - how reliable is the evidence?, the Utility of the evidence - can the methods be transferred and adopted without modification?, the Extent of the evidence, the Strength of the evidence, the Target or outcomes measured - how valid is the evidence? and the Setting or context - how relevant is the evidence?The evidence available can be graded on each of the six dimensions. In the ideal situation the evidence is high on all six dimensions, but this is rarely found. Usually the evidence may be good in some respects, but poor in others. The teacher has to balance the different dimensions and come to a decision on a course of action based on his or her professional judgement.The QUESTS dimensions highlight a number of tensions with regard to the evidence in medical education: quality v relevance; quality v validity; and utility v the setting or context. The different dimensions reflect the nature of research and innovation. Best Evidence Medical Education encourages a culture or ethos in which decision making takes place in this context.     

Effects of Problem-Based Learning Curricula on Faculty Learning: New Lenses, New Questions

Literature on the impact of problem-based learning (PBL) in medical education has short-changed important questions about the effect of PBL curricula on faculty learning and on faculty knowledge of their subject matter. This paper opens up new questions about the impact of PBL in medical colleges and other health sciences by focusing attention on its effects on faculty learning, on collegial networks in medical colleges, and, consequently, on other scholarly work by faculty. A brief review of research on the effects of PBL on faculty and faculty development is followed by a synthesis of relevant research findings from research on teaching and faculty learning in other disciplines. A new conceptual framework, drawn from the educational paradigms, methods and empirical findings from those other areas of higher education research and research on secondary school teaching, is applied to designing, examining, and evaluating problem-based learning. Viewing faculty as learners prompts a new research agenda including questions such as: What do faculty members learn by participating in integrative, interdisciplinary problem-based learning courses? How? How is that learning related to or integrated with other aspects of their scholarly work?     

Medical Practice as Characterised by Beginning Medical Students

What does medical practice mean to students entering undergraduate medical education? What do these students see as central to the work of a medical doctor? What do they regard as difficult challenges they are likely to face in medical practice? What implications do their perspectives on these questions have for medical education?In the qualitative research study reported in this article, students beginning undergraduate medical education characterised medical practice in a variety of ways. In brief, they characterised medical practice as: (a) helping or saving; (b) diagnosing or treating using required procedures; (c) locating the problem and informing the patient; (d) while diagnosing and treating, interacting in a supportive way; (e) seeking a way forward together; or (f) enabling the patient to better deal with his or her life situation. Some differences based on gender and method of admission to medical education are noted.Implications for medical education include the need to address: variation in characterising medical practice; ways in which medical knowledge and medical care are viewed; non-biomedical aspects as mainstream in the medical curriculum; concerns about difficult human encounters in medical practice; and development of professional identity.     

The impact of early career specialization on licensing requirements and related educational implications

Purpose: It was hypothesized that physicians who pursue early career specialization in their first year of graduate medical education after medical school are likely to experience a decline in their scores on the medical licensing examination. Method: A longitudinal prospective design was used in which 1,927 physicians who graduated from Jefferson Medical College between 1980 and 1991 were studied. Type of first-year graduate training program was the independent variable, and performance on a medical licensing examination (Part III examination of the National Board of Medical Examiners [NBME]) was the dependent variable. Scores on Parts I and II of the NBME taken in medical school, medical school class rank, and gender were the control variables. Results: Findings showed significant differences on Part III scores among physicians in 12 different graduate programs despite statistical adjustments for baseline differences. Physicians in family medicine and emergency medicine programs obtained the highest adjusted Part III scores, followed by physicians in internal medicine and transitional programs. The next group consisted of physicians in pediatrics, obstetrics-gynecology, anesthesiology, and general surgery programs. The group with the lowest Part III scores included physicians in pathology, radiology, and psychiatry. Implications: These findings suggest that students who meet only the minimal standards in medical school should be advised to pursue a broad training program in the first year of graduate medical education to strengthen their general clinical competence as a means to increase their chances of passing licensing examinations.Dr. Gonnella is Dean, senior vice president, professor of medicine, and director of the Center for Research in Medical Education and Health Care. Dr. Hojat is director, Jefferson Longitudinal Study of Medical Students and Graduates at the Center, and is research associate professor, Department of Psychiatry and Human Behavior (DPHB); Dr. Erdmann is associate dean for administration and registrar, and professor, Department of Medicine; Mr. Veloski is director of the medical education division of the Center, and instructor, DPHB, all at Jefferson Medical College, Thomas Jefferson University. Correspondence and requests for reprints should be addressed to Dr. Gonnella, Office of the Dean, Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107.     

Fifty years of medical education research: waves of migration

Medical Education 2011; 45 : 785–791 Context Medical education research has been an academic pursuit for over 50 years, tracing its roots back to the Office of Medical Education at the State University of New York at Buffalo, New York, with George Miller. As the field has matured, the nature of the questions posed and the disciplinary bases of its practitioners have evolved. Methods I identify three chronological ‘generations’ of academics who have contributed to the field, at intervals of roughly 10–15 years. Results Members of the first generation came from diverse and unrelated academic backgrounds and essentially learned their craft on the job. A second generation, emerging in the 1980s and 1990s, consisted of individuals with PhD‐level training in relevant fields such as psychology, psychometrics and sociology, who actively chose a career in health sciences education, often during graduate work. These individuals brought a strong disciplinary orientation to their research. Finally, the proliferation of graduate programmes in medical education means that we are now seeing the evolution of a new type of academic, often a health professional, whose only discipline is medical education. Conclusions I propose that we should strike a balance between seeking to create a separate specialty of medical education and continuing to actively recruit from other academic disciplines. I believe that the strong disciplinary roots of these individuals are a critical element in the continuing growth and progress of medical education research.     

Abraham Lincoln's suit against a medical imposter who assaulted his client

In 1851, A. Lincoln, Esquire represented Edward Jones who charged in a law suit that his attending physician had assaulted him. Jones, also a lawyer, had sharply questioned Dr. Joseph S. Maus about his claims of attendance and graduation from Philadelphia's Jefferson Medical College, an allopathic medical school. Jones claimed that Maus became enraged at his persistent questioning and attacked him. In turn, Maus denied the allegation. He said that he was merely defending himself from Jones' blows with a large cane. Lincoln's legal approach was to argue about the state of medical education and whether Maus had really graduated from Jefferson Medical College. Acting as a peacemaker, he finally arranged to settle the dispute between Jones and Maus out of court.     

Anatomy and embryology in medical education at Cambridge University, 1866-1900

Introduction The teaching of anatomy remains controversial to the present day. This paper explores the arguments over its merits in medical and scientific education at one of the ancient universities. History Medical professors at Cambridge University relied upon the science departments to provide basic scientific instruction, whilst science professors relied upon medical students to make up numbers for their courses. Discussion Human anatomy became a source of contention: did it really educate the mind, or was it simply a dry subject that medical students had to learn by rote? Could the university even cater for professional education?     

Modelling medicine

Context Aristotle's writing on poiesis and techne in general, and his frequent references to medicine in particular, suggest that medicine is instrumental, contingent and procedural. These 3 basic characteristics give rise to three questions: What do doctors do? What affects what they do? How do they do it? Similar questions can be applied to other professions. Objectives This paper sets out a 3‐dimensional model of medicine which addresses these 3 questions. The model can be used to explore general issues in the field such as the nature of general practice, the scope of evidence‐based medicine and the relationship between medicine and cognate professions. It may help to clarify decisions about the scope, sequence and integration of the medical curriculum and it offers a framework for the concrete analysis of clinical situations and decisions. Methods The article is based on conceptual analysis rather than empirical investigation although there are some examples of practical applications of the model. Conclusions Although the headings in the model must be treated as tentative, it offers one way of viewing medicine as a whole. It also offers potential scope for development and use in both initial and continuing medical education. Further work is needed to develop and refine the model for medical education and practice.     

信息化条件下医院医学摄影(像)专业的重要作用

目的:探讨信息化条件下医院医学摄影(像)专业如何适应新的形势任务需求,开展好专业化服务保障工作。方法:对医院医学摄影(像)专业自身特点和所承担的主要任务进行梳理、分析和研究。结果:医学摄影(像)专业工作已同医院医教研工作以及医院全面建设紧密联系。结论:医院医学摄影(像)专业必须创新思维,主动作为,扩展工作和服务范围,配合医院重大工作做好专业化服务保障,搞好医院门户网站建设,担当好"多面手"及"全科医生"。     

Medical education in the later 19th century: the science take-over

Summary. Established in 1858, the General Medical Council was responsible, inter alia, for improving the standard of medical education in Britain. It was agreed on all hands that there were serious deficiencies: there was far too much book-learning and not enough practical knowledge; students graduated who were wholly ignorant of important areas of medicine; there were 19 licensing bodies and the criteria for admission to practise differed widely. Debate continued from 1860 to 1890. A major question was, What sort of education should the student have received before he entered medical school? There were four common answers: (1) he should have received the preliminary education of ‘a well-educated gentleman’; (2) he should know a good deal about everything; (3) he should have a better knowledge of science — but how to define science?; (4) he should have done well at school, never mind what he had studied. A second major question was, How should science and practical instruction be combined in the medical curriculum? Many defended the old and not quite dead apprenticeship system; a practical ‘sandwich course’ was even suggested. The debate ended with the Report of the GMC's Education Committee in 1890, which increased the length of the medical course from 4 years to 5 and brought chemistry, physics and biology into the early years. The amount of clinical work, however, although it was supposed to increase, remained very small.     

Physician executives in managed care: characteristics and job involvement across two career stages.

This paper examines characteristics, job involvement, and career stage differences among 294 physician executives working in managed care settings. The following research questions guide the study: What types of physicians are currently in managerial roles in these settings? What role (if any) does medical career stage play in physician executives' professional and job-related attitudes? What factors are related to physician executives' involvement in their management roles? Several observations are made from the findings. First, contemporary physician executives see management as an exciting alternative career that involves multiple work loyalties, weaker beliefs in traditional professional values, and the sacrifice of significant amounts of clinical for management work. Second, these trends are more pronounced for physician executives at earlier points in their medical careers, although their work loyalties to profession and employing organization are weaker than older physician executives' loyalties. Younger individuals' involvement in management work, more than older individuals' involvement, appears to depend upon the surrounding work climate within the organization. Finally, the amount of time spent by physician executives as clinicians is inversely related to how psychologically attached they are to management, regardless of career stage.     

基层医务人员职业认同、职业规划与工作满意度的关系

目的：探究内蒙古自治区基层医务人员职业认同与工作满意度的关系。方法：采用整群随机抽样方法,在内蒙古自治区的东部、中部和西部地区卫生系统抽取523名基层医务人员为调查对象,运用问卷调查、匿名填写的方法收集资料。结果：内蒙古基层卫生人员的工作满意度平均分为（3.70±0.74）分,工作满意度在民族、学历、职称、年龄方面的差异有统计学意义。基层卫生人员的职业认同平均分为（4.01±0.73）分,不同民族医务人员的职业认同有统计学意义（P〈0.05）,蒙古族医务人员职业认同感高于汉族。职业认同、职业规划和工作满意度呈显著正相关。职业规划在职业认同和工作满意度之间起部分中介作用。结论：改善薪酬和环境,制定有利的职业生涯发展政策,增强医务人员职业认同感,从而提升内蒙古基层医务人员的工作满意度。     

对医学行为的再认识--兼谈医学生人文素质的培养

医学人文在医学行为，医疗活动中占有重要地位，它能够提升医学行为的价值并使医学科学沿着正确的方向发展。医学人文教育是医学教育的重要内容。医学人文精神与医学科学精神融合是社会化医学行为的内在要求。医学职业道德教育是医学人文精神在医疗活动中的具体体现。医学生早期进行系统化的人文课程教育至关重要。     

强化临床医学生人文素质教育的思考

当前我国医学生人文素质教育面临诸多问题,这些问题的产生与当前多元文化的时代背景有着密切联系。对医学生人文精神的渗透是医学生职业道德和现代社会发展的需要。如何让医学生深刻认识到人文素质的重要性,保证今后更好地治病救人,是医学生临床实习中不可缺少的教学内容。     

Major Greenwood (1880–1949): a biographical and bibliographical study

Major Greenwood was the foremost medical statistician of the first half of the 20th century in the UK. Trained in both medicine and statistics, his career extended over 45years during which he published eight books, 23 extensive reports and over 200 papers. His classical education extended to Latin and Greek, and he was fluent in German and French. We provide an overview of his life including family background, training and his career subdivided according to the places where he worked. We describe in particular the key role he played with others in the development of medical statistics within the Medical Research Council, the General Register Office, the Department of Health and the Universities. © 2015 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.     

Leitlinien und Evidenz

Medical child protection comprises different types of involvement of physicians in order to protect children and adolescents from abuse and neglect. This review gives an overview of historical and recent developments in medical child protection. The professional foundation of medical involvement in this field requires a debate on the following questions: Is there evidence for the diagnostic criteria of child abuse and neglect? How far are the principles of evidence-based medicine applicable to the development of guidelines in child protection?     

Making medical education relevant to health care systems

Medical education must be made relevant, and this implies that it must train its students towards the local health care system. If behavioural objectives are defined which must be attained before a student graduates, and before he can function effectively in a health unit, areas which need emphasis are revealed. Communication is a skill which can be left to clinical training: but it is best learned very early in the community, where the student is the supplicant, and not in the hospital where he is dominant. Early community experience can mould a student's attitudes fundamentally and can make him realise the need for work with members of a health team within a health care unit. If education is dogma-centred, and the student is not trained to ask questions early he will not be able to function effectively in any community: modern medical education should be problem-dominated, community-directed and learner-centred. If it is centred on the learner he will become equipped with the ability for independent study and a desire to learn, to improve himself and help other members of the health team throughout his professional career.     

Accreditation of Undergraduate and Graduate Medical Education: How do the Standards Contribute to Quality?

Accreditation organizations such as the Liaison Committee for Medical Education (LCME), the Royal College of Physicians and Surgeons of Canada (RCPSC), and the Accreditation Council for Graduate Medical Education (ACGME) are charged with the difficult task of evaluating the educational quality of medical education programs in North America. Traditionally accreditation includes a more quantitative rather than qualitative judgment of the educational facilities, resources and teaching provided by the programs. The focus is on the educational process but the contributions of these to the outcomes are not at all clear. As medical education moves toward outcome-based education related to a broad and context-based concept of competence, the accreditation paradigm should change accordingly.