Which social accountability competencies make a good physician? A qualitative investigation of the patient perspective on social accountability.

OBJECTIVE: Social accountability is an emerging theme in health care education. In previous literature, the perspectives of patients regarding the competencies that they think are required for physicians to demonstrate in this domain are scarce. This study aims to get insight into the competencies in the domain of social accountability that, according to patients, should be demonstrated by physicians. METHODS: Online semi-structured interviews with 18 patients in the Netherlands were conducted as part of an exploratory qualitative study. Snowballing and convenience sampling techniques were used to recruit participants. The grounded theory method was used to qualitatively analyze the interviews. RESULTS AND CONCLUSION: Patients identified five competencies of a physician in the domain of social accountability: (1) Taking patient's characteristics into account and tailoring care to the individual patient, (2) Taking the broader community into account, (3) Balancing between care for the individual patient versus concern for society, (4) Providing guidance to patients in the navigation within the health system, and (5) Taking climate impact into account. Patients stated that the importance of these competencies are dependent on the specialism. PRACTICE IMPLICATIONS: The formulated competencies can be used to better align medical education focussing on social accountability to the expectations of patients.

Opening the black box of team-based learning (TBL): A study of verbal interactions in online application sessions.

CONTEXT: In team-based learning (TBL), an instructional strategy that encourages in-depth team discussion and deep learning, interactions in terms of sharing, co-construction, constructive conflict and procedural interactions are important. Since TBL has also been applied online in recent years, the question is whether these interactions are sufficiently present in an online setting. AIM: Gain insight into the nature and extent of these types of interactions in online TBL application sessions and to what extent these vary between teams and sessions. METHODS: We made audiovisual recordings of 12 TBL teams in two online application sessions during assignments. Transcripts were coded and analyzed using a framework derived. RESULTS: Teams spent more than 85% of their time on all four types of interactions in both sessions. The largest proportion of time was spent on sharing and co-construction. Constructive conflict occurred to a limited extent. We observed variation in proportion of time spent on and the distribution of the four types of interactions between teams and sessions. DISCUSSION: All interactions important for achieving deep learning occurred in online TBL application sessions. However, the effective use of these types of interaction should not be left to chance.

An evidence-based roadmap to integrate planetary health education into the medical curriculum.

The urgency for action on climate change is regarded as the defining issue of our time. Planetary health education prepares future healthcare professionals to promote the health of the planet, including sustainable healthcare. This has potential benefits for the healthcare system, patients, community, and the environment. However, many educators are not confident in explaining and inspiring students and many deans and educational staff report challenges when integrating planetary health into education. The roadmap presented in this paper uses evidence from medical education literature to support medical schools with implementing this type of education. The roadmap can be used as a guide for educators, university leadership, and policy-makers in the design of planetary health education.

Team-based learning (TBL): Each phase matters! An empirical study to explore the importance of each phase of TBL.

CONTEXT: In Team Based Learning (TBL), it is, based on theory, assumed that knowledge development in each phase contributes to the subsequent phase and to learning performance. However, there is no empirical evidence for this assumption. AIM: In order to find support for the relation between TBL and the underlying theory, we determined to what extent each phase of TBL is associated with the knowledge development in the next phase and with the total learning performance. METHODS: We measured the scientific concepts recalled by 56 second-year undergraduate medical students before TBL, after each of the three phases and after TBL. We used multivariate regression analysis to determine the statistical association between the phases as well as the total learning performance. RESULTS: Results showed that in each phase, students produced new concepts in addition to those previously recalled. Regression models showed statistically significant explained variance ranging from 0.19 to 0.26, between the three phases and the total learning performance. DISCUSSION: Each phase of the TBL is significantly associated with knowledge development in the subsequent phase and with the total learning performance, and therefore matters. This study contributes to the scientific underpinning of TBL and offers leads to more elaborate research and interventions to improve TBL.

Enhancing the effectiveness of flipped classroom in health science education: a state-of-the-art review.

BACKGROUND: In a flipped classroom, students acquire knowledge before class and deepen and apply this knowledge during class. This way, lower-order learning goals are achieved before class and higher-order skills are reached during class. This study aims to provide an overview of the factors that contribute to the effectiveness of the flipped classroom and how these factors can be stimulated. The effectiveness of the flipped classroom is conceptualized in this study as test scores, the achievement of higher learning goals, and student perceptions. METHODS: A state-of-the-art review was conducted. The databases MEDLINE, PsycINFO, PubMed, Web of Science, and Scopus were consulted. The timeframe is 2016 till 2020. The studies were qualitatively analyzed according to the grounded theory method. RESULTS: After screening the studies based on the inclusion-and exclusion criteria, 88 studies were included in this review. The qualitative analysis of these studies revealed six main factors that affect the effectiveness of the flipped classroom: student characteristics, teacher characteristics, implementation, task characteristics, out-of-class activities, and in-class activities. Mediating factors are, amongst other factors, the learner's level of self-regulated learning, teacher's role and motivation, assessment approach, and guidance during self-study by means of prompts or feedback. These factors can be positively stimulated by structuring the learning process and focusing the teacher training on competencies and learning-and teaching approaches that are essential for the flipped classroom. CONCLUSION: This paper provides insight into the factors that contribute to the effectiveness of the flipped classroom and how these factors could be stimulated. In order to stimulate the effectiveness of the flipped classroom, the positively and negatively affecting factors and mediating factors should be taken into account in the design of the flipped classroom. The interventions mentioned in this paper could also be used to enhance the effectiveness.

Dealing with emotions: medical undergraduates' preferences in sharing their experiences.

CONTEXT: Patient care evokes emotional responses such as uncertainty, grief and pride in medical students. There is a need for opportunities to share and express such emotions because they influence students' professional development and well-being. There is a trend towards introducing mentor programmes into medical curricula. It remains unknown whether students are willing and able to share their emotional experiences within this formal setting. We set out to explore how medical students share their emotional experiences and why. METHODS: We used thematic analysis, including purposeful sampling, parallel processes of data collection and constant comparative analysis, maintaining an audit trail for validation purposes. The study had a constructivist, interactional design and used Goffman's dramaturgical theory as an interpretive framework. Nineteen students participated in individual, semi-structured interviews. RESULTS: Participants' narratives revealed a preference for sharing emotional experiences away from people who might expect them to uphold formal behaviour. They deliberately decided with whom to share their emotional experiences. Participants had a preference to talk to fellow students working in the same department, or family and friends outside medical school. CONCLUSIONS: Participants found it difficult to uphold behaviours that they thought patients, preceptors or the organisation expected of them as future doctors. In adjusting their behaviour to meet those expectations, they became attuned to how to best present themselves based on the people present. This influenced how they chose which emotional experiences to share with whom.

International survey of veterinarians to assess the importance of competencies in professional practice and education.

OBJECTIVE: To determine the perceived importance of specific competencies in professional veterinary practice and education among veterinarians in several countries. DESIGN: Survey-based prospective study. SAMPLE: 1,137 veterinarians in 10 countries. PROCEDURES: Veterinarians were invited via email to participate in the study. A framework of 18 competencies grouped into 7 domains (veterinary expertise, communication, collaboration, entrepreneurship, health and welfare, scholarship, and personal development) was used. Respondents rated the importance of each competency for veterinary professional practice and for veterinary education by use of a 9-point Likert scale in an online questionnaire. Quantitative statistical analyses were performed to assess the data. RESULTS: All described competencies were perceived as having importance (with overall mean ratings [all countries] ≥ 6.45/9) for professional practice and education. Competencies related to veterinary expertise had the highest ratings (overall mean, 8.33/9 for both professional practice and education). For the veterinary expertise, entrepreneurship, and scholarship domains, substantial differences (determined on the basis of statistical significance and effect size) were found in importance ratings among veterinarians in different countries. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated a general consensus regarding the importance of specific types of competencies in veterinary professional practice and education. Further research into the definition of competencies essential for veterinary professionals is needed to help inform an international dialogue on the subject.

Evaluating clinical teachers with the Maastricht clinical teaching questionnaire: how much 'teacher' is in student ratings?

BACKGROUND: Students are a popular source of data to evaluate the performance of clinical teachers. Instruments to obtain student evaluations must have proven validity. One aspect of validity that often remains underexposed is the possibility of effects of between-student differences and teacher and student characteristics not directly related to teaching performance. AIM: The authors examined the occurrence of such effects, using multilevel analysis to analyse data from the Maastricht clinical teaching questionnaire (MCTQ), a validated evaluation instrument, in a veterinary curriculum. METHODS: The 15-item MCTQ covers five domains. The authors used multilevel analysis to divide the variance in the domain scores in components related to, respectively, teachers and students. They estimated subsequent models to explore how the MCTQ scores are dependent on teacher and student characteristics. RESULTS: Significant amounts of variance in student ratings were due to between-teacher differences, particularly for learning climate, modelling and coaching. The effects of teacher and student characteristics were mostly non-significant or small. CONCLUSION: Large portions of variance in MCTQ scores were due to differences between teachers, while the contribution of student and teacher characteristics was negligible. The results support the validity of student ratings obtained with the MCTQ for evaluating teacher performance.

Developing an online professional network for veterinary education: the NOVICE project.

An online professional network for veterinarians, veterinary students, veterinary educationalists, and ICT (Information and Communication Technology) educationalists is being developed under the EU (European Union) Lifelong Learning Programme. The network uses Web 2.0, a term used to describe the new, more interactive version of the Internet, and includes tools such as wikis, blogs, and discussion boards. Focus groups conducted with qualified and student veterinarians within the project's five founding countries (The Netherlands, Germany, United Kingdom, Hungary, Romania) demonstrated that online professional communities can be valuable for accessing information and establishing contacts. Online networks have the potential to overcome common challenges to face-to-face communities-such as distance, cost, and timing-but they have their own drawbacks, such as security and professionalism issues. The Network Of Veterinary ICt in Education (NOVICE) was developed using Elgg, an open-source, free social networking platform, after several software options had been considered. NOVICE aims to promote the understanding of Web 2.0, confidence to use social software tools, and participation in an online community. Therefore, the Web site contains help sections, Frequently Asked Questions, and access to support from ICT experts. Five months after the network's launch (and just over one year into the project) 515 members from 28 countries had registered. Further research will include analysis of a core group's activities, which will inform ongoing support for and development of informal, lifelong learning in a veterinary context.

Peer group reflection helps clinical teachers to critically reflect on their teaching.

BACKGROUND: Student evaluations can help clinical teachers to reflect on their teaching skills and find ways to improve their teaching. Studies have shown that the mere presentation of student evaluations is not a sufficient incentive for teachers to critically reflect on their teaching. AIM: We evaluated and compared the effectiveness of two feedback facilitation strategies that were identical except for a peer reflection meeting. METHOD: In this study, 54 clinical teachers were randomly assigned to two feedback strategies. In one strategy, a peer reflection was added as an additional step. All teachers completed a questionnaire evaluating the strategy that they had experienced. We analysed the reflection reports and the evaluation questionnaire. RESULTS: Both strategies stimulated teachers to reflect on feedback and formulate alternative actions for their teaching practice. The teachers who had participated in the peer reflection meeting showed deeper critical reflection and more concrete plans to change their teaching. All feedback strategies were considered effective by the majority of the teachers. CONCLUSIONS: Strategies with student feedback and self-assessment stimulated reflection on teaching and helped clinical teachers to formulate plans for improvement. A peer reflection meeting seemed to enhance reflection quality. Further research should establish whether it can have lasting effects on teaching quality.

Students' and teachers' perceived and actual verbal interactions in seminar groups.

OBJECTIVES: This study set out to examine how much time students and teachers devote to different learning-oriented interactions during seminar sessions and students' and teachers' perceptions about the occurrence and desirability of these interactions. METHODS: Students and teachers participating in eight seminar group sessions in Year 4 of an undergraduate veterinary curriculum completed an 11-item questionnaire which asked them to rate, on a 5-point Likert scale, the frequency of occurrence and level of desirability of three learning-oriented types of interaction: exploratory questioning; cumulative reasoning, and handling of conflict about knowledge. The questionnaire also invited positive and negative responses to aspects of group interactions and an overall mark (1-10) for the seminars and group interactions. Four group sessions were video-recorded and analysed using a coding scheme. The amount of time devoted to the different interactions was calculated. RESULTS: Both students and teachers gave scores of 3.0-3.5 for frequency of occurrence of exploratory questioning and cumulative reasoning and < 3.0 for occurrence of handling of conflict about knowledge. The desired occurrences of all interaction types were significantly higher than the actual occurrences according to students and teachers. Teachers were responsible for the majority of the interactions (93%). The percentages of session time devoted to teacher-centred cumulative reasoning, exploratory questioning and handling of conflict about knowledge were 65.8%, 15.6% and 3.1%, respectively. CONCLUSIONS: Group interactions in seminar groups are dominated by the posing of questions by teachers to students. The moderate occurrence of group interactions as perceived by students and teachers may be explained by the inadequate preparation of teachers and students to stimulate group interactions.