[Should we keep the graduation with distinction in medical school?] / Cum laude in de master geneeskunde.

Historically, medical students can graduate medical school with distinction if they have a high mark on average or excellent performance on a number of rubrics. Recently, one of the Dutch medical schools abolished marks during the clerkships, based on the decision to introduce programmatic assessment. This led to an internal debate about whether or not to keep the option of graduating with distinction. The authors believe firstly that it is difficult to derive a mark from narrative feedback. Secondly, more theoretically, without receiving marks or distinctions, we enable students to focus their attention to the process of learning, allowing mistakes, and uncertainties, instead of showing how good they are in meeting expectations.

Vertical integration in medical education: the broader perspective.

Curricular integration represents collaborations between disciplines to establish a coherent curriculum and has become the dominant recommendation for medical education in the second half of the twentieth century. Vertical integration specifically is the integration between the clinical and basic science parts throughout the program. Vertically integrated curricula present basic sciences imbedded in a clinical context from the start of medical school.The authors briefly discuss vertical integration in relationship with context theory, motivation theory, professional identity formation, transition to practice and the continuum of education and practice. They conclude that vertical integration, rather than horizontal integration, extends far beyond curriculum structure. They consider vertical integration a philosophy of education, with impact on students' maturation and engagement with the profession, and which applies not only to undergraduate education but to the lifelong learning of professionals. The definition of vertical integration as "an educational approach that fosters a gradual increase of learner participation in the professional community through a stepwise increase of knowledge-based engagement in practice with graduated responsibilities in patient care" is more comprehensive than its older conceptualization.

Clinical and basic science teachers' opinions about the required depth of biomedical knowledge for medical students.

The aim of the present study was to investigate whether basic scientists and physicians agree on the required depth of biomedical knowledge of medical students at graduation. A selection of basic science and clinical teachers rated the relevance of biomedical topics for students at graduation, illustrated by 80 example items. The items were derived from ten organ systems and designed at four levels: clinical, organ, cellular and molecular. Respondents were asked to identify for each item to what extent recently graduated medical students should have knowledge about it. In addition, they were asked to indicate whether the content of the item should be included in the medical curriculum. Analysis showed that basic scientists and physicians do not diverge at the clinical level. At the organ, cellular and molecular levels however, basic scientists judge that medical students should have more active knowledge. As expected, basic scientists also indicate that more deep level content should be included. Explanations for this phenomenon will be discussed.

Analysing the concept of context in medical education.

BACKGROUND: There is increasing interest in the role of context in medical education, with the conjecture that learning in a clinical context may be helpful for later recall of knowledge. Although this may be true in a general sense, at a closer look it appears that the notion of context is not well substantiated in the medical education literature and that the concept is not clearly defined. Effects of context on learning appear to depend on type of learning task, the relationship or interaction between the context and the learning material, and motivational features of the context. Context is often implicitly regarded as a uniform concept but conceptual analysis shows that a distinction can be made in several dimensions. RESULTS: In this paper, we identify 3 different dimensions of context: a physical dimension, representing the environmental characteristics; a semantic dimension, reflecting how well the context contributes to the learning task, and a commitment dimension, representing the amount of commitment (in terms of motivation and responsibility) that is generated by the context. On these dimensions, context can be ordered from reduced (providing few cues, little meaning, little commitment) to enriched (many cues, much meaning, high commitment). CONCLUSION: This model can serve a dual purpose: first, to disentangle several aspects of educational contexts (e.g. as high in meaning but low in commitment), and second, to provide a theoretical framework to generate research on the influence of different contexts in education on students' learning.

Validation of core medical knowledge by postgraduates and specialists.

BACKGROUND: Curriculum constructors and teachers must decide on the content and level of objectives and materials included in the medical curriculum. At University Medical Centre Utrecht it was decided to test relatively detailed knowledge at a regular level in study blocks and to design a progress test aimed at the medical core knowledge that every graduating doctor should possess. This study was conducted to validate the level of knowledge tested in this progress test. AIM: We designed a questionnaire to investigate whether postgraduate trainees and experienced specialists agree with item writers on what is required core knowledge. METHODS: Postgraduates and specialists received a questionnaire with 80 items designed to test core knowledge. Respondents were asked to indicate to what extent the items actually represented the core knowledge required of a recently graduated medical student. RESULTS: Of the clinical questions, 82.4% were judged to reflect core knowledge, whereas only 42.4% of the basic science questions were judged to reflect core knowledge. There was a strikingly high correlation on the mean judgements per item of postgraduate trainees versus medical specialists (r = 0.975). CONCLUSION: Many items, written to reflect core knowledge, appear to be judged by postgraduates and clinicians as pertaining to non-core knowledge. Postgraduate trainees appear to be as capable as experienced specialists of making judgements regarding core knowledge. Fewer basic science items are regarded as core knowledge than clinical items. This may suggest that, specifically, basic science teachers do not agree with physicians on what is to be considered medical core knowledge for graduating doctors.

Context-dependent memory in a meaningful environment for medical education: in the classroom and at the bedside.

PURPOSE: Learning-in-context is a much-discussed topic in medical education. Information is said to be better recalled when the learning environment resembles the later retrieval environment. Godden and Baddeley (1975) showed that divers recalled words better when the recall condition matched the original learning environment, i.e. underwater or on land. Though it is unclear whether the findings can be generalized for medical education, medical educators regularly refer to them. We replicated the Godden and Baddeley study in ecologically more valid conditions for medical education and extended it with meaningful subject matter (namely, a patient case description). METHOD: Sixty-three clerks were randomized over four conditions, contrasting a clinical (bedside) with an educational (classroom) environment as both learning and recall conditions. Students were asked to recall a list of words and a patient case in the same environment or in the opposite environment as where they learned it. RESULTS: We failed to find a significant same-context advantage for free recall of the list of words and the patient case propositions. However, there does appear to be a slight tendency towards better recall of the case description when learning took place in the clinical environment. DISCUSSION: In medical education, the context, if conceived as physical surroundings, does not seem to contribute to a same-context advantage. One should be cautious in generalizing the findings of Godden and Baddeley. However, different forms of 'context' other than the physical one used in the Godden and Baddeley study may well enhance learning effects in medical education.