The integration of electronic health records (EHRs) into medical education remains contested despite their widespread use in clinical practice. For medical trainees, this has resulted in idiosyncratic and often ad hoc methods of instruction on EHR use. The purpose of this study was to understand the currently fragmented nature of EHR instruction by examining discourses of EHR use within the medical education literature.
Methods
We conducted a Foucauldian critical discourse analysis to identify discourses of EHRs in the medical education literature. We found our texts through a systematic search of widely cited medical education journals from 2013–2023. Each text was analysed for recurring truth statements—claims framed as self-evidently true and thus not needing supporting evidence—about the role of EHRs in medical education.
Results
We identified three major discourses: (1) EHRs as a clinical skill and competency, emphasising training of physical interactions between learners, patients and computers; (2) EHRs as a system, emphasising the creation and facilitation of networks of people, technologies, institutions and standards; and (3) EHRs as a cognitive process, framed as a method to shape processes like clinical reasoning and bias. Each discourse privileged certain stakeholders over others and served to rationalise educational interventions that could be seen as beneficial in isolation yet were often disjointed in combination.
Conclusions
Competing discourses of EHR use in medical education produce divergent interventions that exacerbate their contested role in contemporary medical education. Identifying different claims for the benefits of EHR use in these settings allows educators to make rational choices between competing educational directions.
{"title":"Competing discourses, contested roles: Electronic health records in medical education","authors":"Daniel Huang, Cynthia Whitehead, Ayelet Kuper","doi":"10.1111/medu.15428","DOIUrl":"10.1111/medu.15428","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The integration of electronic health records (EHRs) into medical education remains contested despite their widespread use in clinical practice. For medical trainees, this has resulted in idiosyncratic and often ad hoc methods of instruction on EHR use. The purpose of this study was to understand the currently fragmented nature of EHR instruction by examining discourses of EHR use within the medical education literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a Foucauldian critical discourse analysis to identify discourses of EHRs in the medical education literature. We found our texts through a systematic search of widely cited medical education journals from 2013–2023. Each text was analysed for recurring truth statements—claims framed as self-evidently true and thus not needing supporting evidence—about the role of EHRs in medical education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified three major discourses: (1) EHRs as a clinical skill and competency, emphasising training of physical interactions between learners, patients and computers; (2) EHRs as a system, emphasising the creation and facilitation of networks of people, technologies, institutions and standards; and (3) EHRs as a cognitive process, framed as a method to shape processes like clinical reasoning and bias. Each discourse privileged certain stakeholders over others and served to rationalise educational interventions that could be seen as beneficial in isolation yet were often disjointed in combination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Competing discourses of EHR use in medical education produce divergent interventions that exacerbate their contested role in contemporary medical education. Identifying different claims for the benefits of EHR use in these settings allows educators to make rational choices between competing educational directions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 12","pages":"1490-1501"},"PeriodicalIF":4.9,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15428","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div> <section> <h3> Background</h3> <p>Feedback is a crucial element in learning. While studies in the field of healthcare professions education have highlighted the process of educators feeding back to learners, relatively little investigation exists on learners feeding back to educators in Asian cultures. Studies show that recipients of effective feedback develop educational skills and reflective practice, but the process of giving feedback seems to have been mainly studied through surveys and questionnaires. Such research offers little to no insights on feedback providers' and recipients' experiences of feedback. To fill the gap, in the context of multi-source feedback, we investigate medical students, residents, and nurses feedback giving to clinical educators (and their receiving of this) following a case presentation training course. We aim to understand the facilitators and inhibitors that encourage and/or prevent feedback provision alongside educators' uptake and reactions.</p> </section> <section> <h3> Methods</h3> <p>We used semi-structured group interviews. Participants comprised five different categories of participants: year-4 medical students (n = 6); residents (n = 5); nurses (n = 4); junior clinical educators (n = 9); senior clinical educators (n = 3). We asked them about their experiences of providing feedback to educators and educators receiving of feedback on their teaching. Group interviews were conducted in the largest healthcare institution in Taiwan. Data were analysed using thematic Framework Analysis and managed in ATLAS.ti 8.0.</p> </section> <section> <h3> Results</h3> <p>We identified two major themes with respective sub-themes: (1) Factors affecting feedback giving (including desire for improvement, feedback content, process of feedback, feedback fears, feedback prevention and medical hierarchy); and (2) Educators' reactions to receiving feedback (including validity of feedback, face-saving and emotional reactions to receiving feedback).</p> </section> <section> <h3> Conclusions</h3> <p>Feedback provision to educators on their teaching, and educators' receiving of this feedback in an Asian culture brings forth issues around medical hierarchy, in-person feedback and face-saving, which have important implications for effective and optimal delivery of feedback. Curricular developers should consider the context of feedback (e.g. anonymously online), facilitating students as active participants for the development of educational quality, and educators' mindful practice when engaging with student feedback.</p>
{"title":"Medical students', residents', and nurses's feedback to clinical educators in Taiwan: A qualitative study","authors":"Chang-Chyi Jenq, Jiun-Ren Lin, Francesca Quattri, Lynn Monrouxe","doi":"10.1111/medu.15429","DOIUrl":"10.1111/medu.15429","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Feedback is a crucial element in learning. While studies in the field of healthcare professions education have highlighted the process of educators feeding back to learners, relatively little investigation exists on learners feeding back to educators in Asian cultures. Studies show that recipients of effective feedback develop educational skills and reflective practice, but the process of giving feedback seems to have been mainly studied through surveys and questionnaires. Such research offers little to no insights on feedback providers' and recipients' experiences of feedback. To fill the gap, in the context of multi-source feedback, we investigate medical students, residents, and nurses feedback giving to clinical educators (and their receiving of this) following a case presentation training course. We aim to understand the facilitators and inhibitors that encourage and/or prevent feedback provision alongside educators' uptake and reactions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used semi-structured group interviews. Participants comprised five different categories of participants: year-4 medical students (n = 6); residents (n = 5); nurses (n = 4); junior clinical educators (n = 9); senior clinical educators (n = 3). We asked them about their experiences of providing feedback to educators and educators receiving of feedback on their teaching. Group interviews were conducted in the largest healthcare institution in Taiwan. Data were analysed using thematic Framework Analysis and managed in ATLAS.ti 8.0.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified two major themes with respective sub-themes: (1) Factors affecting feedback giving (including desire for improvement, feedback content, process of feedback, feedback fears, feedback prevention and medical hierarchy); and (2) Educators' reactions to receiving feedback (including validity of feedback, face-saving and emotional reactions to receiving feedback).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Feedback provision to educators on their teaching, and educators' receiving of this feedback in an Asian culture brings forth issues around medical hierarchy, in-person feedback and face-saving, which have important implications for effective and optimal delivery of feedback. Curricular developers should consider the context of feedback (e.g. anonymously online), facilitating students as active participants for the development of educational quality, and educators' mindful practice when engaging with student feedback.</p>\u0000 ","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 12","pages":"1478-1489"},"PeriodicalIF":4.9,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15429","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heather Nichol, Jennifer Turnnidge, Nancy Dalgarno, Jessica Trier
Introduction
Learning and growth in postgraduate medical education (PGME) often require vulnerability, defined as a state of openness to uncertainty, risk, and emotional exposure. However, vulnerability can threaten a resident's credibility and professional identity. Despite this tension, studies examining vulnerability in PGME are limited. As such, this study aims to explore residents' experiences of vulnerability, including the factors that influence vulnerability in PGME.
Methods
Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Interview transcripts were coded and analysed iteratively. Themes were identified and relationships among themes were examined to develop a theory describing vulnerability in PGME.
Results
Residents characterised vulnerability as a paradox represented by two overarching themes. ‘Experiencing the tensions of vulnerability’ explores the polarities between being a fallible, authentic learner and an infallible, competent professional. ‘Navigating the vulnerability paradox’ outlines the factors influencing the experience of vulnerability and its associated outcomes at the intrapersonal, interpersonal, and systems levels. Residents described needing to have the bandwidth to face the risks and emotional labour of vulnerability. Opportunities to build connections with social agents, including clinical teachers and peers, facilitated vulnerability. The sociocultural context shaped both the experience and outcomes of vulnerability as residents faced the symbolic mask of professionalism.
Conclusion
Residents experience vulnerability as a paradox shaped by intrapersonal, interpersonal, and systems level factors. These findings capture the nuance and complexity of vulnerability in PGME and offer insight into creating supportive learning environments that leverage the benefits of vulnerability while acknowledging its risks. There is a need to translate this understanding into systems-based change to create supportive PGME environments, which value and celebrate vulnerability.
{"title":"Navigating the paradox: Exploring resident experiences of vulnerability","authors":"Heather Nichol, Jennifer Turnnidge, Nancy Dalgarno, Jessica Trier","doi":"10.1111/medu.15426","DOIUrl":"10.1111/medu.15426","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Learning and growth in postgraduate medical education (PGME) often require vulnerability, defined as a state of openness to uncertainty, risk, and emotional exposure. However, vulnerability can threaten a resident's credibility and professional identity. Despite this tension, studies examining vulnerability in PGME are limited. As such, this study aims to explore residents' experiences of vulnerability, including the factors that influence vulnerability in PGME.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Interview transcripts were coded and analysed iteratively. Themes were identified and relationships among themes were examined to develop a theory describing vulnerability in PGME.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Residents characterised vulnerability as a paradox represented by two overarching themes. ‘Experiencing the tensions of vulnerability’ explores the polarities between being a fallible, authentic learner and an infallible, competent professional. ‘Navigating the vulnerability paradox’ outlines the factors influencing the experience of vulnerability and its associated outcomes at the intrapersonal, interpersonal, and systems levels. Residents described needing to <i>have the bandwidth</i> to face the risks and emotional labour of vulnerability. Opportunities to <i>build connections</i> with social agents, including clinical teachers and peers, facilitated vulnerability. The sociocultural context shaped both the experience and outcomes of vulnerability as residents <i>faced the symbolic mask of professionalism</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Residents experience vulnerability as a paradox shaped by intrapersonal, interpersonal, and systems level factors. These findings capture the nuance and complexity of vulnerability in PGME and offer insight into creating supportive learning environments that leverage the benefits of vulnerability while acknowledging its risks. There is a need to translate this understanding into systems-based change to create supportive PGME environments, which value and celebrate vulnerability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 12","pages":"1469-1477"},"PeriodicalIF":4.9,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140958399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anu Kajamaa, Päivikki Lahtinen, Karen Mattick, Rob Bethune
Introduction
In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care; 50% of these are preventable. The aim of this study was to deepen our understanding of disruptions of care processes and how the repairing of disruptions can be sources of stability, learning and change in complex health care settings.
Methods
The organisational interactions associated with disruptions in the standard care processes of 15 surgical patients were followed in a public sector hospital in Finland. The patients and medical professionals were interviewed in situ during the observation of the care processes. An activity-theoretically informed methodological framework was used to identify and analyse disruptions and the associated repair efforts and repair solutions.
Results
Disruptions were frequent and found in all 15 care processes. These related to (1) the patient's worsening physiological state, (2) the equipment used in surgical care, (3) the information flow, (4) delays in the care process and (5) the unclear division of labour within the team. The actors carried out three types of repair efforts (technical, cognitive-emotional and extended collaborative) to overcome the disrupted processes, which usually led to repair solutions that restored stability.
Discussion
The different repair efforts required different kinds of collaboration and learning. Extended collaborative repair was most demanding, providing challenges and opportunities for practice change and expansive learning.
{"title":"Repairing disrupted care processes as sources of stability, learning and change in a Finnish hospital: An activity-theoretical study","authors":"Anu Kajamaa, Päivikki Lahtinen, Karen Mattick, Rob Bethune","doi":"10.1111/medu.15407","DOIUrl":"10.1111/medu.15407","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In high-income countries, it is estimated that one in every 10 patients is harmed while receiving hospital care; 50% of these are preventable. The aim of this study was to deepen our understanding of disruptions of care processes and how the repairing of disruptions can be sources of stability, learning and change in complex health care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The organisational interactions associated with disruptions in the standard care processes of 15 surgical patients were followed in a public sector hospital in Finland. The patients and medical professionals were interviewed in situ during the observation of the care processes. An activity-theoretically informed methodological framework was used to identify and analyse disruptions and the associated repair efforts and repair solutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Disruptions were frequent and found in all 15 care processes. These related to (1) the patient's worsening physiological state, (2) the equipment used in surgical care, (3) the information flow, (4) delays in the care process and (5) the unclear division of labour within the team. The actors carried out three types of repair efforts (technical, cognitive-emotional and extended collaborative) to overcome the disrupted processes, which usually led to repair solutions that restored stability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The different repair efforts required different kinds of collaboration and learning. Extended collaborative repair was most demanding, providing challenges and opportunities for practice change and expansive learning.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 12","pages":"1502-1514"},"PeriodicalIF":4.9,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tim V. Dubé, Annabelle Cumyn, Mariem Fourati, Martine Chamberland, Sharon Hatcher, Michel Landry
Background
Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program.
Methods
We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data.
Results
The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation.
Conclusions
We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.
{"title":"Pathways, journeys and experiences: Integrating curricular activities related to social accountability within an undergraduate medical curriculum","authors":"Tim V. Dubé, Annabelle Cumyn, Mariem Fourati, Martine Chamberland, Sharon Hatcher, Michel Landry","doi":"10.1111/medu.15260","DOIUrl":"10.1111/medu.15260","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Health professions education curricula are undergoing reform towards social accountability (SA), defined as an academic institution's obligation to orient its education, service and research to respond to societal needs. However, little is known about how or which educational experiences transform learners and the processes behind such action. For example, those responsible for the development and implementation of undergraduate medical education (UGME) programs can benefit from a deeper understanding of educational approaches that foster the development of competencies related to SA. The purpose of this paper was to learn from the perspectives of the various partners involved in a program's delivery about what curricular aspects related to SA are expressed in a UGME program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We undertook a qualitative descriptive study at a francophone Canadian university. Through purposive convenience and snowball sampling, we conducted 16 focus groups (virtual) with the following partners: (a) third- and fourth-year medical students, (b) medical teachers, (c) program administrators (e.g., program leadership), (d) community members (e.g., community organisations) and (e) patient partners. We used inductive thematic analysis to interpret the data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The participants' perspectives organised around four key themes including (a) the definition of a future socially accountable physician, (b) socially accountable educational activities and experiences, (c) characteristics of a socially accountable MD program and (d) suggestions for curriculum improvement and implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We extend scholarship about curricular activities related to SA from the perspectives of those involved in teaching and learning. We highlight the relevance of experiential learning, engagement with community members and patient partners and collaborative approaches to curriculum development. Our study provides a snapshot of what are the sequential pathways in fostering SA among medical students and therefore addresses a gap between knowledge and practice regarding what contributes to the implementation of educational approaches related to SA. We emphasise the need for educational innovation and research to develop and align assessment methods with teaching and learning related to SA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 5","pages":"556-565"},"PeriodicalIF":6.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15260","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54229911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>An important lesson from business is that, in times of disruption, distinguishing between your organisation's value proposition and its operational processes is essential. Clearly, the rapid rise of widely available generative artificial intelligence (GenAI) is a time of disruption for medical education. The high workloads and competing pressures that currently afflict many of our educators makes ‘What is the value proposition of medical education?’ a particularly important question.</p><p>Already, learning, teaching, assessment, curriculum design and working practices are being reshaped in response to the emergence of GenAI technologies, and this reshaping is set to expand. It is tempting to change incrementally, making occasional tweaks. However, in doing so, it is easy to neglect what we are trying to achieve. Our response to GenAI should align with our value proposition and not purely react to the threat or challenge we face.</p><p>Deciding upon that response is challenging, in part, because a dissonance exists in medical schools between the espoused value propositions of education and those of assessment. Modern views on education typically promote lifelong learning and competency development, collaboration, professional-identity formation, managing uncertainty, student agency and generation of new and contextualised knowledge. Assessment, in contrast, typically values milestones and mastery, one-time measurement, competition, certainty and linear, predictable and guaranteed outcomes.</p><p>Even before the recent emergence of GenAI, information technologies made this discrepancy clear. Modern medical students have access to vast technological possibilities, including location- and time-independent communication, through which they can contact anyone, anywhere, immediately. This allows them to be connected with communities, perspectives and information sources globally. They can participate in the democratisation of knowledge through creation collaboratives (e.g. wikis, forums). They can not only access resources on almost anything but they can also create them (e.g. instructional videos, diagrams, presentations, podcasts). Where past medical students could only carry small pocket handbooks, nowadays, students can carry whole, easily searchable libraries and knowledge communities within a smart device.</p><p>Such developments have occurred over the course of years, but we have been slow to factor this evolving picture into medical school curricula and assessment. Now, with GenAI, the discord is even starker. Asking students to pass tests, or to produce artefacts, that can also be produced by AI, casts doubt on the relevance of our assessments. In responding, we must return to our assessment's value proposition and focus on producing the kinds of medical graduates needed today, and in the near future, rather than on protecting established assessment processes. For this, we will need a sophisticated view of the human–technology relationship.
{"title":"Rethinking the value proposition of assessment at a time of rapid development in generative artificial intelligence","authors":"Tim Fawns, Lambert Schuwirth","doi":"10.1111/medu.15259","DOIUrl":"10.1111/medu.15259","url":null,"abstract":"<p>An important lesson from business is that, in times of disruption, distinguishing between your organisation's value proposition and its operational processes is essential. Clearly, the rapid rise of widely available generative artificial intelligence (GenAI) is a time of disruption for medical education. The high workloads and competing pressures that currently afflict many of our educators makes ‘What is the value proposition of medical education?’ a particularly important question.</p><p>Already, learning, teaching, assessment, curriculum design and working practices are being reshaped in response to the emergence of GenAI technologies, and this reshaping is set to expand. It is tempting to change incrementally, making occasional tweaks. However, in doing so, it is easy to neglect what we are trying to achieve. Our response to GenAI should align with our value proposition and not purely react to the threat or challenge we face.</p><p>Deciding upon that response is challenging, in part, because a dissonance exists in medical schools between the espoused value propositions of education and those of assessment. Modern views on education typically promote lifelong learning and competency development, collaboration, professional-identity formation, managing uncertainty, student agency and generation of new and contextualised knowledge. Assessment, in contrast, typically values milestones and mastery, one-time measurement, competition, certainty and linear, predictable and guaranteed outcomes.</p><p>Even before the recent emergence of GenAI, information technologies made this discrepancy clear. Modern medical students have access to vast technological possibilities, including location- and time-independent communication, through which they can contact anyone, anywhere, immediately. This allows them to be connected with communities, perspectives and information sources globally. They can participate in the democratisation of knowledge through creation collaboratives (e.g. wikis, forums). They can not only access resources on almost anything but they can also create them (e.g. instructional videos, diagrams, presentations, podcasts). Where past medical students could only carry small pocket handbooks, nowadays, students can carry whole, easily searchable libraries and knowledge communities within a smart device.</p><p>Such developments have occurred over the course of years, but we have been slow to factor this evolving picture into medical school curricula and assessment. Now, with GenAI, the discord is even starker. Asking students to pass tests, or to produce artefacts, that can also be produced by AI, casts doubt on the relevance of our assessments. In responding, we must return to our assessment's value proposition and focus on producing the kinds of medical graduates needed today, and in the near future, rather than on protecting established assessment processes. For this, we will need a sophisticated view of the human–technology relationship.","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"14-16"},"PeriodicalIF":6.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50162111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Highlighting one of the themes from 2024's State of the Science issue, Figueiredo offers insight into the term "Sustainability," describing the concept and pointing out dilemmas and challenges for sustainable development.
{"title":"When I say … sustainability","authors":"Alexandre Medeiros Figueiredo","doi":"10.1111/medu.15258","DOIUrl":"10.1111/medu.15258","url":null,"abstract":"<p>Highlighting one of the themes from 2024's State of the Science issue, Figueiredo offers insight into the term \"Sustainability,\" describing the concept and pointing out dilemmas and challenges for sustainable development.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"23-24"},"PeriodicalIF":6.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50158306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Ten months ago, as of the moment this sentence is being written, ChatGPT was released to the public. Eight months ago, it was reported that over 100 million users had already engaged with the technology.<span><sup>1</sup></span> That same month, 71 days after ChatGPT's release, <i>Medical Education</i> started receiving papers speculating on, and exploring, the potential of this remarkable tool to facilitate better health professional education. The list of eye-popping statistics illustrating its uptake is endless. What will persist in our memories, however, is the lived experience of how quickly discussion about the technology seemed to become omnipresent, whether perusing the academic literature, listening to news reports or engaging in casual conversation with neighbours.</p><p>Most discussions about technology elicit varying degrees of fear and exhilaration. The rapid expansion of the perceived potential of generative artificial intelligence that ChatGPT prompted, however, led people to extremes in both regards. We harbour no doubt that the world has been made better for the development of this technology. At the same time, we do not think there should be any doubt that every action elicits a variety of reactions, some of which will be unintended and some of which will be harmful.</p><p>We cannot have a conversation, therefore, about technological advancement<span><sup>2</sup></span> and the future of health professional education without also having a conversation about sustainability. In that regard, we do not simply mean sustainability of technology itself; rather, we include the need to discuss how one conceptualises sustainability within the context of changing environmental, economic and social considerations that inherently shape health professional education.<span><sup>3</sup></span> There is often a perception that technological developments can foster efficient and sustainable ways to address challenges.<span><sup>4</sup></span> Even if that proves true to a degree, the growing demands on educational infrastructure, students, researchers and the quest for developing knowledge will create a race between development and sustainability that will continue to challenge our healthcare systems.</p><p>As a result, we curated the 2024 edition of the State of the Science series with a dual focus on technology and sustainability. We have titled it ‘Embracing the future’ not to imply that every change will be a good one (although this editorial comes exactly 10 years after a defence of fads that we continue to believe<span><sup>5</sup></span>). Rather, we see the title as a reminder that we have no choice but to grapple with finding the right, context-appropriate, balance between new opportunities and the dangers they create. Subthemes focus on what supports might be enabled and what supports are required for education, assessment, the workforce and education research. Within this array, a wide net is cast by considering topics such as the r
{"title":"Embracing the future: Technological developments and sustainability in health professional education","authors":"Martin Pusic, Paul E. S. Crampton, Kevin W. Eva","doi":"10.1111/medu.15257","DOIUrl":"10.1111/medu.15257","url":null,"abstract":"<p>Ten months ago, as of the moment this sentence is being written, ChatGPT was released to the public. Eight months ago, it was reported that over 100 million users had already engaged with the technology.<span><sup>1</sup></span> That same month, 71 days after ChatGPT's release, <i>Medical Education</i> started receiving papers speculating on, and exploring, the potential of this remarkable tool to facilitate better health professional education. The list of eye-popping statistics illustrating its uptake is endless. What will persist in our memories, however, is the lived experience of how quickly discussion about the technology seemed to become omnipresent, whether perusing the academic literature, listening to news reports or engaging in casual conversation with neighbours.</p><p>Most discussions about technology elicit varying degrees of fear and exhilaration. The rapid expansion of the perceived potential of generative artificial intelligence that ChatGPT prompted, however, led people to extremes in both regards. We harbour no doubt that the world has been made better for the development of this technology. At the same time, we do not think there should be any doubt that every action elicits a variety of reactions, some of which will be unintended and some of which will be harmful.</p><p>We cannot have a conversation, therefore, about technological advancement<span><sup>2</sup></span> and the future of health professional education without also having a conversation about sustainability. In that regard, we do not simply mean sustainability of technology itself; rather, we include the need to discuss how one conceptualises sustainability within the context of changing environmental, economic and social considerations that inherently shape health professional education.<span><sup>3</sup></span> There is often a perception that technological developments can foster efficient and sustainable ways to address challenges.<span><sup>4</sup></span> Even if that proves true to a degree, the growing demands on educational infrastructure, students, researchers and the quest for developing knowledge will create a race between development and sustainability that will continue to challenge our healthcare systems.</p><p>As a result, we curated the 2024 edition of the State of the Science series with a dual focus on technology and sustainability. We have titled it ‘Embracing the future’ not to imply that every change will be a good one (although this editorial comes exactly 10 years after a defence of fads that we continue to believe<span><sup>5</sup></span>). Rather, we see the title as a reminder that we have no choice but to grapple with finding the right, context-appropriate, balance between new opportunities and the dangers they create. Subthemes focus on what supports might be enabled and what supports are required for education, assessment, the workforce and education research. Within this array, a wide net is cast by considering topics such as the r","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"2-4"},"PeriodicalIF":6.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49679250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Highlighting one of the themes from 2024's State of the Science issue, Nageswaran offers insight into the term "Technology," arguing for the importance of balancing tech benefits with human-centric skills.
{"title":"When I say … technology","authors":"Priyanka Nageswaran","doi":"10.1111/medu.15254","DOIUrl":"10.1111/medu.15254","url":null,"abstract":"<p>Highlighting one of the themes from 2024's State of the Science issue, Nageswaran offers insight into the term \"Technology,\" arguing for the importance of balancing tech benefits with human-centric skills.</p>","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"25-26"},"PeriodicalIF":6.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49679251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The sustainability of health professions education (HPE) research is at risk. There are limited resources allocated to HPE research with a failure to align with important changes in HPE and HPE research. Threats to HPE research as described by the three papers in this issue of <i>Medical Education</i> include predominant Eurocentric epistemologies,<span><sup>1</sup></span> universal adoption of ‘god terms’ such as patient outcomes and productivity to drive HPE research<span><sup>2</sup></span> and the lack of theoretical framing coupled with hype and accepted ideology regarding innovation and change in HPE.<span><sup>3</sup></span> Our position is that education leadership can meet the threats to HPE research through examining the changing values underpinning HPE research, engaging with the values of key stakeholders and evolving structures to embrace a values perspective.</p><p>Value as defined by Oxford Languages<span><sup>4</sup></span> is ‘the regard that something is held to deserve; the importance, worth, or usefulness of something’. Leaders must not only make explicit the value in supporting educators and HPE research but also critically examine and reframe values implicitly rooted in our culture and in the structures that support HPE research. These implicit values have a powerful influence on who can successfully do education research, the choice of research methodology, the focus of research, resource allocation and what gets published. Leaders should include and engage with indigenous paradigms of education research as presented by McKivett and Paul<span><sup>1</sup></span> to strengthen the type and appeal of the research undertaken in an institution. They should advocate for values that alter the current emphasis on patient outcomes and productivity that obscure the contributions of educators and their research agenda as suggested by Varpio and Sherbino.<span><sup>2</sup></span> Leaders and HPE researchers should engage in dialogue to make values explicit in funding opportunities to support education research and in criteria for promotion and retention of HPE researchers.</p><p>How can we engage leaders in a values-driven approach to supporting HPE research? Arguably, a ‘god-term’ for leaders in medical institutions is ‘return on investment (ROI)’, and this shapes decision making and resource allocation including investing in HPE educators and research. In our study interviewing leaders in academic medicine and health care,<span><sup>5</sup></span> we explored value factors beyond ROI using the value measurement methodology (VMM) framework with five domains: individual, financial, operational, social/societal and strategic/political. These value factors can be expanded from what we discovered to incorporate contemporary values to sustain HPE research.</p><p>In the individual domain, leaders identified the value factors of career and stature of the individual and their personal and professional growth. Expanding should explicitly i
{"title":"Aligning structures with values to sustain health professions education research","authors":"Ann N. Poncelet, Patricia S. O'Sullivan","doi":"10.1111/medu.15247","DOIUrl":"10.1111/medu.15247","url":null,"abstract":"<p>The sustainability of health professions education (HPE) research is at risk. There are limited resources allocated to HPE research with a failure to align with important changes in HPE and HPE research. Threats to HPE research as described by the three papers in this issue of <i>Medical Education</i> include predominant Eurocentric epistemologies,<span><sup>1</sup></span> universal adoption of ‘god terms’ such as patient outcomes and productivity to drive HPE research<span><sup>2</sup></span> and the lack of theoretical framing coupled with hype and accepted ideology regarding innovation and change in HPE.<span><sup>3</sup></span> Our position is that education leadership can meet the threats to HPE research through examining the changing values underpinning HPE research, engaging with the values of key stakeholders and evolving structures to embrace a values perspective.</p><p>Value as defined by Oxford Languages<span><sup>4</sup></span> is ‘the regard that something is held to deserve; the importance, worth, or usefulness of something’. Leaders must not only make explicit the value in supporting educators and HPE research but also critically examine and reframe values implicitly rooted in our culture and in the structures that support HPE research. These implicit values have a powerful influence on who can successfully do education research, the choice of research methodology, the focus of research, resource allocation and what gets published. Leaders should include and engage with indigenous paradigms of education research as presented by McKivett and Paul<span><sup>1</sup></span> to strengthen the type and appeal of the research undertaken in an institution. They should advocate for values that alter the current emphasis on patient outcomes and productivity that obscure the contributions of educators and their research agenda as suggested by Varpio and Sherbino.<span><sup>2</sup></span> Leaders and HPE researchers should engage in dialogue to make values explicit in funding opportunities to support education research and in criteria for promotion and retention of HPE researchers.</p><p>How can we engage leaders in a values-driven approach to supporting HPE research? Arguably, a ‘god-term’ for leaders in medical institutions is ‘return on investment (ROI)’, and this shapes decision making and resource allocation including investing in HPE educators and research. In our study interviewing leaders in academic medicine and health care,<span><sup>5</sup></span> we explored value factors beyond ROI using the value measurement methodology (VMM) framework with five domains: individual, financial, operational, social/societal and strategic/political. These value factors can be expanded from what we discovered to incorporate contemporary values to sustain HPE research.</p><p>In the individual domain, leaders identified the value factors of career and stature of the individual and their personal and professional growth. Expanding should explicitly i","PeriodicalId":18370,"journal":{"name":"Medical Education","volume":"58 1","pages":"20-22"},"PeriodicalIF":6.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/medu.15247","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49679249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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