Developing research skills in medical students: AMEE Guide No. 69

This Guide has been written to provide guidance for individuals involved in curriculum design who wish to develop research skills and foster the attributes in medical undergraduates that help develop research. The Guide will provoke debate on an important subject, and although written specifically with undergraduate medical education in mind, we hope that it will be of interest to all those involved with other health professionals' education. Initially, the Guide describes why research skills and its related attributes are important to those pursuing a medical career. It also explores the reasons why research skills and an ethos of research should be instilled into professionals of the future. The Guide also tries to define what these skills and attributes should be for medical students and lays out the case for providing opportunities to develop research expertise in the undergraduate curriculum. Potential methods to encourage the development of research-related attributes are explored as are some suggestions as to how research skills could be taught and assessed within already busy curricula. This publication also discusses the real and potential barriers to developing research skills in undergraduate students, and suggests strategies to overcome or circumvent these. Whilst we anticipate that this Guide will appeal to all levels of expertise in terms of student research, we hope that, through the use of case studies, we will provide practical advice to those currently developing this area within their curriculum.     

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.     

A model for communication skills assessment across the undergraduate curriculum

Physicians' interpersonal and communication skills have a significant impact on patient care and correlate with improved healthcare outcomes. Some studies suggest, however, that communication skills decline during the four years of medical school. Regulatory and other medical organizations, recognizing the importance of interpersonal and communication skills in the practice of medicine, now require competence in communication skills. Two challenges exist: to select a framework of interpersonal and communication skills to teach across undergraduate medical education, and to develop and implement a uniform model for the assessment of these skills. The authors describe a process and model for developing and institutionalizing the assessment of communication skills across the undergraduate curriculum. Consensus was built regarding communication skill competencies by working with course leaders and examination directors, a uniform framework of competencies was selected to both teach and assess communication skills, and the framework was implemented across the Harvard Medical School undergraduate curriculum. The authors adapted an assessment framework based on the Bayer-Fetzer Kalamazoo Consensus Statement adapted a patient and added and satisfaction tool to bring patients' perspectives into the assessment of the learners. The core communication competencies and evaluation instruments were implemented in school-wide courses and assessment exercises including the first-year Patient-Doctor I Clinical Assessment, second-year Objective Structured Clinical Exam (OSCE), third-year Patient-Doctor III Clinical Assessment, fourth-year Comprehensive Clinical Practice Examination and the Core Medicine Clerkships. Faculty were offered workshops and interactive web-based teaching to become familiar with the framework, and students used the framework with repeated opportunities for faculty feedback on these skills. A model is offered for educational leaders and others who are involved in designing assessment in communication skills. By presenting an approach for implementation, the authors hope to provide guidance for the successful integration of communication skills assessment in undergraduate medical education.     

Teaching diversity to medical undergraduates: Curriculum development,delivery and assessment. AMEE GUIDE No. 103

The aim of this Guide is to support teacher with the responsibility of designing, delivering and/or assessing diversity education. Although, the focus is on medical education, the guidance is relevant to all healthcare professionals. The Guide begins by providing an overview of the definitions used and the principles that underpin the teaching of diversity as advocated by Diversity and Medicine in Health (DIMAH). Following an outline of these principles we highlight the difference between equality and diversity education. The Guide then covers diversity education throughout the educational process from the philosophical stance of educators and how this influences the approaches used through to curriculum development, delivery and assessment. Appendices contain practical examples from across the UK, covering lesson plans and specific exercises to deliver teaching. Although, diversity education remains variable and fragmented there is now some momentum to ensure that the principles of good educational practice are applied to diversity education. The nature of this topic means that there are a range of different professions and medical disciplines involved which leads to a great necessity for greater collaboration and sharing of effective practice.     

Self-perceived attitudes and skills of cultural competence: a comparison of family medicine and internal medicine residents

This study surveyed resident perceptions of competent cross-cultural doctor-patient communication as a step toward developing an integrative primary care cross-cultural curriculum. Respondents were 57 first-, second- and third-year residents in family medicine (FA) and internal medicine (IMA) who completed a questionnaire assessing cross-cultural attitudes and skills relevant to clinical practice. As a group, residents endorsed the relevance of culturally competent communication to patient care, perceived themselves to be fairly competent in the use of culturally competent communication technique, used such techniques frequently, and generally found them to be quite helpful. FM residents rated culturally competent communication as significantly more relevant, themselves as more competent, and culturally competent communication techniques as more helpful than did IM residents. Over half the residents in both specialties tended to identify as serious cross-cultural problems those that focused on perceived patient shortcomings.     

Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic

Abstract

The COVID-19 pandemic has disrupted healthcare systems around the world, impacting how we deliver medical education. The normal day-to-day routines have been altered for a number of reasons, including changes to scheduled training rotations, physical distancing requirements, trainee redeployment, and heightened level of concern. Medical educators will likely need to adapt their programs to maximize learning, maintain effective care delivery, and ensure competent graduates. Along with a continued focus on learner/faculty wellness, medical educators will have to optimize existing training experiences, adapt those that are no longer viable, employ new technologies, and be flexible when assessing competencies. These practical tips offer guidance on how to adapt medical education programs within the constraints of the pandemic landscape, stressing the need for communication, innovation, collaboration, flexibility, and planning within the era of competency-based medical education.     

Mobile technologies in medical education: AMEE Guide No. 105

Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.     

Transferable skills of incoming medical students and their development over the first academic year: The United Arab Emirates experience

Increasingly, it is being recognised in higher and medical education that learners should be adequately prepared for the unpredictable nature of professional practice. Several generic or transferable skills or capabilities (e.g., communication, information handling) that will enable graduates to function in an ever-changing professional world have been identified. Using a validated inventory comprising six categories of transferable skills, three cohorts of incoming male and female medical students at a Gulf university documented their level of practice and confidence for 31 skills. The exercise was repeated a year later. New medical students identified computer and organisational skills and the ability to manage their learning as strengths, but scores for technical and numeracy, information handling and presentation and communication skills suggested that learners generally required guidance. A year later, despite considerable self-reported information handling and communication skills development, learners generally did not consider themselves self-sufficient. A significant gender difference emerged, with incoming males reporting less experience and confidence in many skills. This gap was reduced but did not disappear over the first academic year. An audit such as this may be useful for identifying individual skills levels as well as providing insight into shortcomings in the academic programme in terms of opportunities for transferable skills development.     

e-Learning in medical education Guide 32 Part 2: Technology, management and design

With e-learning now part of the medical education mainstream, both educational and practical technical and informatics skills have become an essential part of the medical teacher's portfolio. The Guide is intended to help teachers develop their skills in working in the new online educational environments, and to ensure that they appreciate the wider changes and developments that accompany this 'information revolution'. The Guide is divided into two parts, of which this is the second. The first part introduced the basic concepts of e-learning, e-teaching, and e-assessment, the day-to-day issues of e-learning, looking both at theoretical concepts and practical implementation issues. This second part covers topics such as practical knowledge of the forms of technology used in e-learning, the behaviours of teachers and learners in online environments and the design of e-learning content and activities. It also deals with broader concepts of the politics and psychology of e-learning, as well as many of its ethical, legal and economical dimensions, and it ends with a review of emerging forms and directions in e-learning in medical education.     

Developing performance-based medical school assessment programs in resource-limited environments

While the use of performance-based assessments in medical schools is widespread, there are unique issues associated with developing and establishing simulated clinical examinations when resources are limited. The faculty at the National University of Cuyo (NUC) in Mendoza, Argentina, has successfully implemented an OSCE as part of the medical school graduation requirements. This paper provides an overview of the issues faced by NUC faculty in setting up a standardized patient (SP)-based assessment with only limited resources, and contrasts their experiences with those of other groups, including certification and licensure bodies who have implemented similar types of assessments. Despite their novelty and a lack of technological, staffing, and budgetary resources, with adequate planning, an emphasis on faculty involvement, quality case development, local SP recruitment and training activities, educational programs focused on assessment, and flexibility in creating a physical space to conduct the exam, an effective program for assessing the clinical skills of medical students can be realized.     

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.     

A systemic framework for the progress test: Strengths, constraints and issues: AMEE Guide No. 71

There has been increasing use and significance of progress testing in medical education. It is used in many ways and with several formats to reflect the variety of curricula and assessment purposes. These developments have occurred alongside a recognised sensitivity for error variance inherent in multiple choice tests from which challenges to its validity and reliability have arisen. This Guide presents a generic, systemic framework to help identify and explore improvements in the quality and defensibility of progress test data. The framework draws on the combined experience of the Dutch consortium, an individual medical school in the United Kingdom, and the bulk of the progress test literature to date. It embeds progress testing as a quality-controlled assessment tool for improving learning, teaching and the demonstration of educational standards. The paper describes strengths, highlights constraints and explores issues for improvement. These may assist in the establishment of potential or new progress testing in medical education programmes. They can also guide the evaluation and improvement of existing programmes.     

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.     

Nurses in medical education: A unique opportunity

Medical students are expected to learn certain procedural skills in addition to clinical skills, such as assessment and decision making. There is much literature that shows proficiency in procedural skills translated to improved outcomes and cost-saving. Given the time constraints placed by increasing clinical demands, physicians have less time to work with students in teaching technical skills. There is a unique opportunity to utilize nurses in clinical clerkships to teach procedural skills. A dedicated nurse educator can provide a consistent curriculum, work with learners to achieve proficiency, and provide measurable outcomes. Future research should explore the role played by nurses in medical education and the comparison of instructional effectiveness.     

Integrating professionalism into the curriculum: AMEE Guide No. 61

Professional values and behaviours are intrinsic to all medical practice, yet remain one of the most difficult subjects to integrate explicitly into a curriculum. Professionalism for the twenty-first century raises challenges not only to adapting the course to changing societal values but also for instilling skills of ongoing self-directed continuous development in trainees for future revalidation. This Guide is based on the contemporary available literature and focuses on instilling Professionalism positively into both undergraduate and postgraduate training deliberately avoiding the more negative aspects of Fitness to Practise. The literature on Professionalism is extensive. An evidence-based approach has been taken throughout. We have selected only some of the available publications to offer practical advice. Comprehensive reviews are available elsewhere (van Mook et al. 2009a-g). This Guide takes a structured stepwise approach and sequentially addresses: (i) agreeing an institutional definition, (ii) structuring the curriculum to integrate learning across all years, (iii) suggesting learning models, (iv) harnessing the impact of the formal, informal and hidden curricula and (v) assessing the learning. Finally, a few well-evaluated case studies for both teaching and assessment have been selected to illustrate our recommendations.     

AMEE Guide No. 27: Effective educational and clinical supervision

Background: This guide reviews what is known about educational and clinical supervision practice through a literature review and a questionnaire survey. It identifies the need for a definition and for explicit guidelines on supervision. There is strong evidence that, whilst supervision is considered to be both important and effective, practice is highly variable. In some cases, there is inadequate coverage and frequency of supervision activities. There is particular concern about lack of supervision for emergency and 'out of hours work', failure to formally address under-performance, lack of commitment to supervision and finding sufficient time for supervision. There is a need for an effective system to address both poor performance and inadequate supervision. Supervision is defined, in this guide as: 'The provision of guidance and feedback on matters of personal, professional and educational development in the context of a trainee's experience of providing safe and appropriate patient care.' A framework for effective supervision is provided: (1) Effective supervision should be offered in context; supervisors must be aware of local postgraduate training bodies' and institutions' requirements; (2) Direct supervision with trainee and supervisor working together and observing each other positively affects patient outcome and trainee development; (3) Constructive feedback is essential and should be frequent; (4) Supervision should be structured and there should be regular timetabled meetings. The content of supervision meetings should be agreed and learning objectives determined at the beginning of the supervisory relationship. Supervision contracts can be useful tools and should include detail regarding frequency, duration and content of supervision; appraisal and assessment; learning objectives and any specific requirements; (5) Supervision should include clinical management; teaching and research; management and administration; pastoral care; interpersonal skills; personal development; reflection; (6) The quality of the supervisory relationship strongly affects the effectiveness of supervision. Specific aspects include continuity over time in the supervisory relationship, that the supervisees control the product of supervision (there is some suggestion that supervision is only effective when this is the case) and that there is some reflection by both participants. The relationship is partly influenced by the supervisor's commitment to teaching as well as both the attitudes and commitment of supervisor and trainee; (7) Training for supervisors needs to include some of the following: understanding teaching; assessment; counselling skills; appraisal; feedback; careers advice; interpersonal skills. Supervisors (and trainees) need to understand that: (1) helpful supervisory behaviours include giving direct guidance on clinical work, linking theory and practice, engaging in joint problem-solving and offering feedback, reassurance and providing role models; (2) ineffective supervisory behaviours include rigidity; low empathy; failure to offer support; failure to follow supervisees' concerns; not teaching; being indirect and intolerant and emphasizing evaluation and negative aspects; (3) in addition to supervisory skills, effective supervisors need to have good interpersonal skills, good teaching skills and be clinically competent and knowledgeable.     

'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.     

Twelve tips for just in time teaching of communication skills for difficult conversations in the clinical setting

The ability to communicate well with patients and other members of the healthcare team is a vital skill for physicians to have, but one that is often not emphasized in medical education. Learners of all levels can obtain and develop good communication skills regardless of their natural ability in this area, and the clinical setting represents an underutilized resource to accomplish this task. With this in mind, we have reviewed the growing body of literature on the subject and organized our findings into twelve tips to help educators capitalize on these missed opportunities. While our emphasis is helping learners with difficult discussions, these tips can be easily adapted to any other clinical encounter requiring clear communication. Teaching effective communication skills in the clinical setting requires some extra time, but the steps outlined should not take more than a few minutes to complete. Taking the time to develop these skills in our learners will make a significant difference not only their lives but also their patients and their families.