The ways social networks shape reflection on early significant clinical experiences in medical school.

Background: Medical curricula are increasingly providing opportunities to guide reflection for medical students. However, educational approaches are often limited to formalized classroom initiatives where reflection is prescriptive and measurable. There is paucity of literature that explores the personal ways students may experience authentic reflection outside of curricular time. The purpose of this study was to understand how social networks might shape dimensions of reflection. Methods: This study employed a qualitative social network analysis approach with a core sample of seven first year undergraduate medical students who described their relationships with 61 individuals in their networks. Data consisted of participant generated sociograms and individual semi-structured interviews. Results: Many learners struggled to find significant ways to involve their social networks outside of medicine in their new educational experiences. It appeared that some medical students began in-grouping, becoming more socially exclusive. Interestingly, participants emphasized how curricular opportunities such as reflective portfolio sessions were useful for capturing a diversity of perspectives. Conclusions: Our study is one of the first to characterize the social networks inside and outside of medical school that students utilize to discuss and reflect on early significant clinical experiences. Recent commentary in the literature has suggested reflection is diverse and personal in nature and our study offers empirical evidence to demonstrate this. Our insights emphasize the importance of moving from an instrumental approach to an authentic socially situated approach if we wish to cultivate reflective lifelong learning.

Contexte: Les cursus d'études en médecine offrent de plus en plus d'occasions de guider la réflexion des étudiants. Cependant, les approches pédagogiques se limitent souvent à des initiatives formelles en classe où la réflexion est obligatoire et évaluée. Il y a peu d'études scientifiques sur la réflexion personnelle et authentique des étudiants en dehors des cours. Cet article vise à explorer comment les réseaux sociaux peuvent façonner des dimensions de la réflexion. Méthodes: Cette étude est fondée sur une approche qualitative d'analyse des réseaux sociaux avec un échantillon de base de sept étudiants en première année de médecine qui ont décrit leurs relations avec 61 personnes issues de leurs réseaux. Les données sont constituées de sociogrammes créés par les participants et d'entretiens individuels semi-structurés. Résultats: De nombreux apprenants ont eu du mal à trouver une manière de partager leurs nouvelles expériences éducatives de façon significative avec leurs réseaux sociaux extérieurs à la médecine. Le fait que les participants soulignent l'utilité des occasions qu'offre leur programme, comme les séances de réflexion sur le portfolio, pour accéder à une diversité de perspectives est également intéressant à noter. Conclusions: Notre étude est l'une des premières à analyser l'utilisation que font les étudiants en médecine de réseaux sociaux tant l'intérieur qu'à l'extérieur de la faculté pour soutenir leur réflexion sur leurs premières expériences cliniques importantes et pour en discuter. Des publications scientifiques récentes suggèrent que ces réflexions sont personnelles et diversifiées et notre étude en apporte la preuve empirique. Nos observations soulignent l'importance de passer d'une approche instrumentale à une approche authentique et socialement située si nous souhaitons cultiver un apprentissage réflexif tout au long de la vie.

Development of and Preliminary Validity Evidence for the EFeCT Feedback Scoring Tool.

BACKGROUND: Narrative feedback, like verbal feedback, is essential to learning. Regardless of form, all feedback should be of high quality. This is becoming even more important as programs incorporate narrative feedback into the constellation of evidence used for summative decision-making. Continuously improving the quality of narrative feedback requires tools for evaluating it, and time to score. A tool is needed that does not require clinical educator expertise so scoring can be delegated to others. OBJECTIVE: To develop an evidence-based tool to evaluate the quality of documented feedback that could be reliably used by clinical educators and non-experts. METHODS: Following a literature review to identify elements of high-quality feedback, an expert consensus panel developed the scoring tool. Messick's unified concept of construct validity guided the collection of validity evidence throughout development and piloting (2013-2020). RESULTS: The Evaluation of Feedback Captured Tool (EFeCT) contains 5 categories considered to be essential elements of high-quality feedback. Preliminary validity evidence supports content, substantive, and consequential validity facets. Generalizability evidence supports that EFeCT scores assigned to feedback samples show consistent interrater reliability scores between raters across 5 sessions, regardless of level of medical education or clinical expertise (Session 1: n=3, ICC=0.94; Session 2: n=6, ICC=0.90; Session 3: n=5, ICC=0.91; Session 4: n=6, ICC=0.89; Session 5: n=6, ICC=0.92). CONCLUSIONS: There is preliminary validity evidence for the EFeCT as a useful tool for scoring the quality of documented feedback captured on assessment forms. Generalizability evidence indicated comparable EFeCT scores by raters regardless of level of expertise.

Six ways to get a grip on your first health education leadership role.

Entering into health education leadership with clear intentions can help guide a new career. While being asked, or simply considering, an educational leadership position is exciting, it is important to consider your motivation for this position and how this position will mesh with your life and what you want to achieve in this position. In addition, it is important to look to mentors for advice and consider other avenues of professional development. Our six tips provide insight into the consideration, negotiation and selection of a health education leadership career that can yield numerous rewards both personally and professionally.

Pour mieux s'orienter dans une nouvelle carrière, il est utile d'être lucide sur ses intentions lorsqu'on assume pour la première fois un rôle de leadership en éducation médicale. Bien qu'envisager ou se faire proposer un poste de leadership dans le domaine de l'éducation soit en soi palpitant, il est néanmoins essentiel de s'interroger sur sa motivation pour le poste, sur la manière de l'intégrer dans sa vie et sur ce qu'on souhaite réaliser dans cette fonction. En outre, il est important de se faire conseiller par des mentors et d'explorer d'autres possibilités de développement professionnel. Les six conseils qu'on propose touchent à l'examen, à la négociation et au choix d'une carrière de leadership en éducation médicale, qui peut apporter de nombreuses récompenses tant sur le plan personnel que sur le plan professionnel.

Involving users in the refinement of the competency-based achievement system: an innovative approach to competency-based assessment.

BACKGROUND: Competency-based assessment innovations are being implemented to address concerns about the effectiveness of traditional approaches to medical training and the assessment of competence. AIM: Integrating intended users' perspectives during the piloting and refinement process of an innovation is necessary to ensure the innovation meets users' needs. Failure to do so results in no opportunity for users to influence the innovation, nor for developers to assess why an innovation works or does not work in different contexts. METHODS: A qualitative participatory action research approach was used. Sixteen first-year residents participated in three focus groups and two interviews during piloting. Verbatim transcripts were analyzed individually and then across all transcripts using a constant comparison approach. RESULTS: The analysis revealed three key characteristics related to the impact on the residents' acceptance of the innovation as being a worthwhile investment of time and effort: access to frequent, timely, and specific feedback from preceptors. Findings were used to refine the innovation further. CONCLUSION: This study highlights the necessary conditions for assessing the success of implementation of educational innovations. Reciprocal communication between users and developers is vital. This reflects the approaches recommended in the Ottawa Consensus Statement on research in assessment published in Medical Teacher in March 2011.