Barbara Joyce

Epistemic cognition in medical education: a literature review.

Objective To review the research literature on epistemic cognition in medical education. Methods We conducted database searches using keywords related to epistemic cognition and medical education or practice. In duplicate, authors selected and reviewed empirical studies with a central focus on epistemic cognition and participant samples including medical students or physicians. Independent thematic analysis and consensus procedures were used to identify major findings about epistemic cognition and implications for research and medical education. Results Twenty-seven articles were selected. Themes from the findings of selected studies included developmental frameworks of epistemic cognition revealing simple epistemological positions of medical learners, increasing epistemological sophistication with experience, relationships between epistemic cognition and context, patterns in epistemic orientations to clinical practice, and reactions to ambiguity and uncertainty. Many studies identified the need for new instruments and methodologies to study epistemic cognition in medical education settings and its relationship to clinical outcomes. Relationships between epistemological beliefs and humanistic patient care and influences of medical education practices were commonly cited implications for medical education. Conclusions Epistemic cognition is conceptualized and operationalized in a variety of ways in the medical research literature. Advancing theoretical frameworks and developing new methodological approaches to examine epistemic cognition are important areas for future research. Also, examination of the relationship between the contexts of medical learning and practice and epistemic cognition has potential for improving medical education. This work also establishes a need for further investigation into the implications of epistemic cognition for humanistic orientations and ultimately for patient care.

Curriculum Design for Competency-Based Education in Orthopaedics

This chapter provides program directors and faculty with a systematic, stepwise process to create competency-based curricula for rotations or educational experiences. Creating competency-based program goals, rotation goals, and objectives can be daunting, but important tasks, which focus trainees and faculty on content and educational outcomes pertinent to the rotational experience. As the surgical world becomes more subspecialized, residency training and, therefore, the curriculum must remain an inclusive, encompassing teaching of principles that will sustain the surgeon through his/her future. New surgeons will have to adjust to increases in knowledge and technology, as well as develop the ability to “think on their feet.” The process for writing rotational curriculum and curriculum for educational experiences, such as a simulation course, should follow the principles and process described below. Backward design is an instructional design model that may offer some solutions to program directors charged with writing competency-based rotation curricula or curricula for educational experiences. Backward design principles begin with identifying educational outcomes and working backwards to design curriculum.