Gudrun Edgren

Comparing the educational environment (as measured by DREEM) at two different stages of curriculum reform

Background: The medical programme at Lund University, Sweden, has undergone curricular reform over several stages, which is still ongoing. Students have been somewhat negative in their evaluations of the education during this time. Aim: To find out how the students perceived the educational climate using the Dundee Ready Education Environment Measure (DREEM), and to compare the findings taken at two given points in time. Method: The DREEM instrument was distributed in semesters 2, 6 and 10 in 2003 and 2005, to a total of 503 students. Results: The students rated their climate as positive. The total DREEM score (145) was somewhat higher than other published results and in the same range as for other reformed curricula. There was hardly any difference between the genders in their perceptions of the climate. Certain items were rated low and became subject of development between the measurements. These items concerned a perceived lack of a support system for stressed students and a lack of feedback and constructive criticism from teachers. Some improvement was detected in 2005. Conclusion: The educational climate was high in a reformed curriculum and could be maintained high during on-going curricular reform. Educational development resulted in better results on some items.

Psychometric evaluation of the Dundee Ready Educational Environment Measure: Swedish version

Background: The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem sparse, for all known versions of the instrument. Aim: The aim was to psychometrically evaluate the Swedish version of the DREEM instrument. Method: A total of 503 students (undergraduate medicine), aged 19–46 years, in semesters 2, 6 and 10 were included in the study. Validity was evaluated through analysis of construct validity and reliability. Results: The instrument had in general both acceptable validity and reliability. Due to a rather poor model fit in the confirmatory factor analysis, an explorative factor analysis was also employed which suggested a new five-factor solution for the instrument. Conclusions: The Swedish version of the DREEM instrument is shown to be valid and reliable, except for the factor structure. The new five-factor solution found in this study is not proven to be a superior measurement model compared with the original, but could be seen as an alternative model to the original, where the strong and weak areas are somewhat more easily identified.

Developing a competence-based core curriculum in biomedical laboratory science: a Delphi study.

In this study the Delphi technique has been used to develop a core curriculum for education of the biomedical scientist. The rapid development in biomedicine and the corresponding changes in methodology in biomedical laboratories demand careful planning of the education of biomedical scientists. The Delphi technique uses an anonymous panel of experts for suggestions and assessments aiming at consensus. Twenty-six experts from different kinds of hospital and university laboratories took part in the investigation. They suggested and assessed necessary competences for a recently graduated biomedical scientist, and if 75% or more of the participants agreed on a competence, it was included in the core curriculum. The final list consisted of 66 competences of varying depth, in three categories. This list contained several generic competences, concerning for example basic laboratory methods, handling of samples, dealing with apparatus and applying relevant rules and laws; basic knowledge in chemistry, preclinical medicine and laboratory methods; and finally attitudes that the panel expected in the recently graduated person. The core was sufficiently restricted to be used in a three-year programme and still leave space for about one year of electives/special study modules. It became rather traditional, e.g. it did not include competences that many recent reports consider important for the future professional.

Conceptions of how a learning or teaching curriculum, workplace culture and agency of individuals shape medical student learning and supervisory practices in the clinical workplace

Abstract The role of workplace supervisors in the clinical education of medical students is currently under debate. However, few studies have addressed how supervisors conceptualize workplace learning and how conceptions relate to current sociocultural workplace learning theory. We explored physician conceptions of: (a) medical student learning in the clinical workplace and (b) how they contribute to student learning. The methodology included a combination of a qualitative, inductive (conventional) and deductive (directed) content analysis approach. The study triangulated two types of interview data from 4 focus group interviews and 34 individual interviews. A total of 55 physicians participated. Three overarching themes emerged from the data: learning as membership, learning as partnership and learning as ownership. The themes described how physician conceptions of learning and supervision were guided by the notions of learning-as-participation and learning-as-acquisition. The clinical workplace was either conceptualized as a context in which student learning is based on a learning curriculum, continuity of participation and partnerships with supervisors, or as a temporary source of knowledge within a teaching curriculum. The process of learning was shaped through the reciprocity between different factors in the workplace context and the agency of students and supervising physicians. A systems-thinking approach merged with the “co-participation” conceptual framework advocated by Billet proved to be useful for analyzing variations in conceptions. The findings suggest that mapping workplace supervisor conceptions of learning can be a valuable starting point for medical schools and educational developers working with changes in clinical educational and faculty development practices.

Twelve tips for constructing problem-based learning cases

Background: One of the key elements for introducing a problem-based learning (PBL) programme is constructing good PBL cases. Good cases should reflect the educational principles of PBL including (a) integration of basic and clinical sciences together with professionalism and psychosocial components, (b) encouragement of discussion of cognitive domains such as identification of problems, generation of hypotheses, construction of an enquiry plan, weighing evidence for and against each hypothesis, interpretation of findings, construction of mechanisms, using evidence to refine the hypothesis and construction of a management plan, (c) encouragement of discussion of cases in small groups with an emphasis on student-centred learning, (d) promotion of collaborative learning and contribution of students to the case discussion and (e) encouragement of teamwork and self-directed learning strategies. Aims and methods: Despite the importance of construction of good PBL cases to the success of a PBL programme, the art of construction of these cases is understudied or described in the literature. Based on our experience in PBL and evidence from literature, we described 12 tips for constructing good PBL cases. Results and conclusions: Constructing good PBL cases is an art that necessitates teamwork and input from several different disciplines. Cases should be constructed using a template reflecting the educational objectives of the programme. This approach will ensure optimum learning outcomes and consistency in the design and delivery of cases.

Portfolio as a method for continuous assessment in an undergraduate health education programme.

A portfolio assessment system has been introduced into a biomedical science programme to promote both continuous learning and deep approaches to learning. Attention has been focused on creating harmony between the assessment system and the PBL curriculum of the programme. Biomedicine and laboratory work are central in the curriculum. The portfolio included evidence of laboratory work, personal reflections and certificates from the PBL tutor. The portfolio was assessed on three occasions over 20 weeks. The grades were ‘pass’ or ‘fail’. The tutor certificate appeared to be a crucial part of the portfolio since a ‘fail’ in this part usually led to an overall ‘fail’. Both students and teachers were concerned about ensuring that enough factual knowledge, as measured by a traditional test, had been achieved. The agreement was good enough for the pass or fail level but some expected differences were found at the detailed level. The course, including the portfolio, was evaluated orally during weekly whole-group meetings and using a questionnaire at the end. The students felt comfortable with the portfolio system and preferred it to a traditional test. The teachers felt that they needed to develop their teacher–student discussion skills and to improve their feedback on the reflections. Peer assessment between students is proposed as a line of action to enhance the credibility of the crucial tutor certificate. The portfolio might be an efficient tool for the students to concentrate their efforts on the most central concepts of medical laboratory work. The model will be developed through further discussions and better consensus among faculty.

Development and psychometric evaluation of the Undergraduate Clinical Education Environment Measure (UCEEM).

Background: There is a paucity of instruments designed to evaluate the multiple dimensions of the workplace as an educational environment for undergraduate medical students. Aim: The aim was to develop and psychometrically evaluate an instrument to measure how undergraduate medical students perceive the clinical workplace environment, based on workplace learning theories and empirical findings. Method: Development of the instrument relied on established standards including theoretical and empirical grounding, systematic item development and expert review at various stages to ensure content validity. Qualitative and quantitative methods were employed using a series of steps from conceptualization through psychometric analysis of scores in a Swedish medical student population. Results: The final result was a 25-item instrument with two overarching dimensions, experiential learning and social participation, and four subscales that coincided well with theory and empirical findings: Opportunities to learn in and through work & quality of supervision; Preparedness for student entry; Workplace interaction patterns & student inclusion; and Equal treatment. Evidence from various sources supported content validity, construct validity and reliability of the instrument. Conclusion: The Undergraduate Clinical Education Environment Measure represents a valid, reliable and feasible multidimensional instrument for evaluation of the clinical workplace as a learning environment for undergraduate medical students. Further validation in different populations using various psychometric methods is needed.

Implementing the Critical Friend Method for Peer Feedback among Teaching Librarians in an Academic Setting

Objective – The role of the academic librarian has become increasingly educative in nature. In this study, the critical friend method was introduced among teaching librarians in an academic setting of medicine and health sciences to ascertain whether this approach could be implemented for feedback on teaching of these librarians as part of their professional development. Methods – We used a single intrinsic case study. Seven teaching librarians and one educator from the faculty of medicine participated, and they all provided and received feedback. These eight teachers worked in pairs, and each of them gave at least one lecture or seminar during the study period. The performance of one teacher and the associated classroom activities were observed by the critical friend and then evaluated and discussed. The outcome and effects of critical friendship were assessed by use of a questionnaire. Results – The present results suggest that use of the critical friend method among teaching academic librarians can have a positive impact by achieving the following: strengthening shared values concerning teaching issues; promoting self-reflection, which can improve teaching; facilitating communication with colleagues; and reducing the sense of “loneliness” in teaching. This conclusion is also supported by the findings of previous studies. Conclusion – The critical friend method described in this study can easily be implemented and developed among teaching librarians, provided that there is support from the organization. This will benefit the individual teaching librarian, as well as the organization at large.

Structured feedback to undergraduate medical students: 3 years' experience of an assessment tool.

Background: There is a paucity of research on the effects of interactive feedback methods and sustained assessment strategies in formative assessment of students in the workplace. Aims: To investigate the outcome of long-term use of an assessment tool. Methods: Retrospective analysis of summarised assessment tools from 3 years of 464 final-year students in general practice. Quantitative data were analysed using non-parametric tests and a multi-level approach. Qualitative data were subjected to content analysis. Results: Students’ main deficiencies in the consultation were in the domains of working diagnoses and management plans; however, supervisors emphasised goals of patient-centred communication and structure of the medical interview. As a group, students underestimated their clinical performance, compared to supervisors’ judgement. Most students were supplied with specific goals, 58% with specific follow-up feedback. The majority of students and supervisors were satisfied with the assessment strategy. Long-term experience with the tool significantly increased the proportion of specific goals and feedback to students, supervisors’ stringency of the assessment, and their satisfaction with the tool. Conclusions: The summarised assessment strategy proved feasible and acceptable with students and supervisors in a continuous attachment with assigned personal supervisors. However, there was room for improvement in supervisors’ provision of specific follow-up feedback.

Students' reflections in a portfolio pilot: highlighting professional issues.

Background: Portfolios are highlighted as potential assessment tools for professional competence. Although students’ self-reflections are considered to be central in the portfolio, the content of reflections in practice-based portfolios is seldom analysed. Aim: To investigate whether students’ reflections include sufficient dimensions of professional competence, notwithstanding a standardized portfolio format, and to evaluate students’ satisfaction with the portfolio. Methods: Thirty-five voluntary final-year medical students piloted a standardized portfolio in a general practice (GP) attachment at Lund University, Sweden. Students’ portfolio reflections were based upon documentary evidence from practice, and aimed to demonstrate students’ learning. The reflections were qualitatively analysed, using a framework approach. Students’ evaluations of the portfolio were subjected to quantitative and qualitative analysis. Results: Among professional issues, an integration of cognitive, affective and practical dimensions in clinical practice was provided by students’ reflections. The findings suggested an emphasis on affective issues, particularly on self-awareness of feelings, attitudes and concerns. In addition, ethical problems, clinical reasoning strategies and future communication skills training were subjects of several reflective commentaries. Students’ reflections on their consultation skills demonstrated their endeavour to achieve structure in the medical interview by negotiation of an agenda for the consultation, keeping the interview on track, and using internal summarizing. The importance of active listening and exploration of patients perspective was also emphasized. In students’ case summaries, illustrating characteristic attributes of GP, the dominating theme was ‘patient-centred care’, including the patient–doctor relationship, holistic modelling and longitudinal continuity. Students were satisfied with the portfolio, but improved instructions were needed. Conclusions: A standardized portfolio in a defined course with a limited timeframe provided ample opportunities for reflections on professional issues. Support by mentors and a final examiner interview contributed to the success of the portfolio with students. The interview also allowed students to deepen their reflections and to receive feedback.