Preparing leaders in health professions education.

In the past 15 years, the number of Master's degree programs in Health Professions Education (MHPE) has grown from 7 to 121 programs worldwide. New MHPE programs continue to be developed each year, due to increased demand for individuals with specialized knowledge concerning how to best educate future health professionals. During the 2012 Association of Medical Education in Europe (AMEE) meeting in Lyon, France, a symposium was organized to explore the reasons for the proliferation of MHPE programs worldwide. In particular, the issues explored included the need for such programs, their outcomes in developing education leaders and scholars in HPE, and facilitators, barriers and models for initiating such programs. This paper synthesizes the discussion during this symposium. Some of the reasons for enrolling in a Master's degree program in HPE include the formal credential, knowledge of a number of theories and frameworks, new approaches to problems and ways of thinking, the mentored project, and networking and working with faculty and students. The uniqueness of being a trainee in an MHPE program is the immersion in the medical education environment and the assimilation of a new approach to scholarship and a new approach to leadership.

The educational theory basis of team-based learning.

BACKGROUND: Health care providers require the ability to use critical thinking skills and work effectively in a team as a part of an overall set of competencies. Therefore, educational programs should use appropriate methods based in educational theory to effectively graduate learners with these abilities. Team-based learning (TBL) is a method that has been introduced in healthcare education to foster critical thinking skills while students work in high functioning teams. AIMS: This article will show how TBL follows the principles of constructivist learning theory. METHOD: The principles of constructivist learning theory are discussed in relation to the teaching method of team-based learning. The effectiveness of TBL in healthcare education is then reviewed. RESULTS: TBL is learner centered with the teacher acting as an expert facilitator and also provides students with opportunities to expose inconsistencies between their current understandings and new experiences thus stimulating development of new personal mental frameworks built upon previous knowledge. The learning is active using relevant problems and group interaction. Teamwork skills are strengthened by focused reflection on new experiences during the group sessions and on teamwork success by providing feedback to group members. CONCLUSION: Since these aspects are all essential components of constructivist educational theory, TBL is solidly grounded in the theory and is a promising method to strengthen healthcare education.

Targeting educational interventions to clinician's stage of change.

This before-after mixed-method study assessed the effect of a diabetes education and self-efficacy training workshop on clinician knowledge, intention and self-efficacy. This workshop demonstrated and narrowed a knowledge gap but did not change intention or self-efficacy. Neither the intervention nor the measured outcomes were targeted to clinicians' stage of change.

A theory-based curriculum design for remediation of residents' communication skills.

PROBLEM: Residents requiring remediation are often deficient in communication skills, namely clinical interviewing skills. Residents have to digest large amounts of knowledge, and then apply it in a clinical interview. The patient-centered approach, as demonstrated in the Calgary-Cambridge model and Martin's Map, can be difficult to teach. Before implementing a remediation curriculum, the theoretical educational underpinnings must be sound; curriculum evaluation is often expensive. Before establishing metrics for curriculum evaluation, a starting point is to perform a mental experiment to test theoretical adherence. METHODS: This article describes an experiential remedial curriculum for communication skills. Educational theories of Kolb, Knowles, Bandura, and Bloom are used to design the curriculum into theory-based design components. CONCLUSIONS: Kolb's experiential cycle models the natural sequence of experiencing, teaching, and learning interviewing skills. A curriculum structured around this cycle has multiple intercalations with the above educational theories. The design is strengthened by appropriately timed use of education strategies such as learning contracts, taped interviews, simulations, structured reflection, and teacher role modeling. Importantly, it also models the form of the clinical interview format desired. Through understanding and application of contemporary educational theories, a program to remediate interviewing skills can increase its potential for success.

Integrating teaching into the busy resident schedule: a learner-centered approach to raise efficiency (L-CARE) in clinical teaching.

BACKGROUND: Clinical teachers are sometimes challenged by residents who seem too busy to concentrate on their learning. In such situations, teachers must be aware to diagnose underlying problems in learners and to effectively help them maximize learning while minimizing time and energy requirements. OBJECTIVE: To develop a learner-centered model to improve efficiency of clinical teaching. METHODS: We reviewed the literature on educational diagnosis, self-directed learning, and effective/efficient teaching to put together a new model. RESULTS: The Learner-Centered Approach to Raise Efficiency (L-CARE) in Clinical Teaching is inspired from the well-known patient-centered clinical method. Using the L-CARE in clinical teaching involves: (1) addressing the learners' feelings regarding their environment as well as patient care and study issues, which provides a good learning climate facilitating educational diagnosis and management of issues that could impair learning; (2) establishing a learning contract (expectations); (3) sharing resources and strategies (ideas) that should be effective without wasting time or energy; (4) self-assessment and constructive feedback (impact). These steps are grounded in self-directed learning theory to improve motivation and ensure that learners concentrate on their own needs to promote learning efficiency. CONCLUSION: The L-CARE model integrates educational diagnosis principles, self-directed learning theory, and efficient teaching strategies to improve efficiency of clinical teaching.

The feasibility of an electronic reflective practice exercise among physiotherapy students.

BACKGROUND: Reflective practice is a skill that serves as a model for continuous learning. Like any skill, reflective practice can be improved and health professional curricula should include opportunities to develop these skills. The clinical component of health professional curriculum is a natural component where reflective practice skills can be developed. Electronic means will help students and faculty stay in contact during clinical internships. AIMS: The purpose of this study was to evaluate the feasibility of an electronic reflective practice exercise during a clinical internship and explore the potential trends on students' reflective practice skills and self-directed learning readiness. METHODS: We used a prospective pre-post intervention design in a cohort of physiotherapy students to examine feasibility and explore trends. Faculty also rated the depth of reflection papers. In addition, students completed a reflective practice exercise questionnaire and the self-directed learning readiness scale (SDLRS) was completed pre- and post-internship. RESULTS: All 84 students completed the reflective practice questionnaire. Sixty-six students consented to complete the questionnaire and 17 consented to complete the SDLRS pre- and post-internship. It took an average of 7 min for faculty to review each student's reflection and there were no significant electronic difficulties encountered. Initial reflection papers were rated at a descriptive (23%), descriptive-analytical (28%) or analytical level (33%). Eighty-six percent of students rated faculty feedback as helpful and 92% rated peer feedback as helpful. Almost all students (97%) students reported that they followed through on some or all of the items on their reflective practice learning plans. The SDLRS significantly improved with the exercise (mean difference 6.8 +/- 9.9; p < 0.05). CONCLUSIONS: This electronic reflective practice exercise during the physiotherapy students' clinical internship was feasible and demonstrated trends to positively impact the learners' skills and self-directed learning readiness.

Continuing Medical Education Strategy for Primary Health Care Physicians in Oman: Lessons to be learnt.

INTRODUCTION: Continuing medical education (CME) is important for professional development, to improve doctors' clinical performance that ultimately influences the quality of the health outcomes. In the presence of an increasing number of family physicians serve in the primary health care system upon graduation in Oman make us to consider the meta-cognition of the leaner and engaged them in learning process. The purpose of this paper is to examine ways of improving the continuing education methods for the physicians. OBJECTIVE: To assess the preferred method of continuing education for primary health care physicians. METHODS: We conducted a program evaluation among a group of general physicians who were involved in some of the activities in continuing education at end of their program in the Muscat region health centres in Oman. The main outcome measure was to study the preferred method for CME. RESULTS: The majority of the participants believe that continuing medical education improves their practice. In addition, the finding suggests that small group learning and combination of methods are the preferred methods of continuing education for primary health care physicians. CONCLUSION: Interactive small group learning is shown to be more effective to achieve the learning objectives and ultimately improve practice. Practice-based small group learning is the method we recommended.

Adapting an Effective Counseling Model from Patient-centered Care to Improve Motivation in Clinical Training Programs.

The value of establishing a patient-centered relationship within the context of the clinical encounter is well documented. The learner-centered method of medical education parallels the patient-centered clinical method; therefore, it should be explored as a method for teaching in the context of the learning encounter. In Japan and other Asian countries, rotations through services not related to the learner's chosen medical specialty are mandatory parts of the medical internship. Participation and effort in these rotations are often met with resistance from learners and are a common problem for medical educators. We adapted the counseling method for patients based on patient-centered methods such as motivational interviewing and solution-focused therapy to address this common problem. We show one case of a medical resident who lost his motivation to learn during his training. A resident has many kinds of mental and physical stress. One such problem arises from the gap between what they want to do and what they have to do. Strategies from motivational interviewing and solution-focused therapy were adapted to successfully resolve a common teaching problem in Japan. A physician teacher (preceptor) helped this resident solve the issue for himself instead of arguing in favor of change. The positive aspects of the counseling method were based on patient-centered medicine and proved useful and effective in counseling for medical residents. We may take the lessons learned from using patient-centered counseling methods to further develop a clear and systematic process of counseling methods for residents to conduct learner-centered medical education.

An evidence-based model of effective self-assessment for directing professional learning.

An innovative model for conducting meaningful self-assessments is presented to help oral health care professionals efficiently determine what to learn with the goal of remaining competent. A review and analysis of the literature drawing from several databases was conducted to develop the model. Through this process, we identified four key categories: prerequisite competencies, process, applications, and tools that are suggested to occur within a supportive environment to carry out valid self-assessments and to positively influence learning choices and practice improvements.

Hidden curriculum in continuing medical education.

In developing curricula for undergraduate and graduate medical education, educators have become increasingly aware of an interweaving of the formal, informal, and hidden curricula and their influences on the outcomes of teaching and learning. But, to date, there is little in the literature about the hidden curriculum of medical practice, which takes place after graduation and certification. This article initiates that discussion with influences of the hidden curriculum on the actions physicians take or do not take in caring for patients. Hafferty's framework of institutional policies, evaluation activities, resource-allocation decisions, and institutional slang, along with our knowledge of health services research and the continuing medical education (CME) research literature, suggests that there is a hidden and powerful curriculum that affects physician performance. Determining whether the hidden curriculum conflicts with the messages that we are delivering through formal CME (courses, clinical practice guidelines, peer review journals) may contribute to improving our impact on physician performance.