Janneke M. Frambach

Rethinking the globalisation of problem‐based learning: how culture challenges self‐directed learning

Medical Education 2012: 46: 738–747

AM Last Page: Quality Criteria in Qualitative and Quantitative Research

Acknowledgments: The author would like to thank the following AAMC personnel for reviewing earlier drafts of this Last Page: Karen Mitchell and Cynthia Searcy. Author contact: mkroopnick@aamc.org In the spring of 2015, potential physicians will take the MCAT2015 exam, the newest version of the MCAT exam. The MR5 Committee (the advisory committee for the MCAT2015 exam) redesigned the exam to test the academic competencies* that tomorrow’s physicians will need to know to succeed in medical school. The design is based on survey responses from over 2,700 medical school and baccalaureate faculty members and feedback from expert panelists and participants in over 90 outreach events. The MCAT2015 exam will, like the current exam (the MCAT1991 exam, introduced in 1991), test concepts in the natural sciences, as well as skills in critical analysis and reasoning. Unlike the MCAT1991 exam, the MCAT2015 exam will also cover concepts from the behavioral and social sciences. The table below highlights the features the MCAT2015 exam shares with the MCAT1991 exam, as well as its new features.

Copy but Not Paste: A Literature Review of Crossborder Curriculum Partnerships

Crossborder curriculum partnerships, entailing the transposition of an entire curriculum and the related degree(s) from “home” to “host” institution, are a rather new phenomenon in internationalization in education. The literature describes successful and unsuccessful partnerships, but critical factors for the success or failure of sustainable partnerships remain to be identified. We conducted a narrative literature review to find such factors. Using an iterative approach, we analyzed 39 articles retrieved from Web of Science, Google Scholar, ERIC, PubMed, and PsycInfo and meeting the inclusion criteria. We developed a framework of 13 factors in four domains: students, teachers, curriculum, and soft and hard project management. Simply copy-pasting a curriculum is generally considered to be destined for failure. To overcome challenges, partners should take preventive and affirmative measures across multiple domains. The findings may provide guidance to those considering or engaged in designing, developing, managing, and reviewing a crossborder partnership.

AM Last Page: A Guide to Research Paradigms Relevant to Medical Education

Suggestions for further reading: • Bunniss S, Kelly DR. Research paradigms in medical education research. Med Educ. 2010;44:358-366. • Carter SM, Little M. Justifying knowledge, justifying method, taking action: Epistemologies, methodologies and methods in qualitative research. Qual Health Res. 2007;17:1316-1328. • Illing J. Thinking About Research: Frameworks, Ethics and Scholarship. Edinburgh, UK: Association for the Study of Medical Education; 2007. Research Design Examples include experimental design, ethnography, case study, action research, grounded theory, phenomenology, and discourse analysis. Methods Techniques for data collection include randomized controlled trial, questionnaires, interviews, focus groups, observation, and document analysis. Paradigm

An exploration of crossborder medical curriculum partnerships: Balancing curriculum equivalence and local adaptation

Abstract Context: Worldwide, medical schools have entered into crossborder curriculum partnerships (CCPs) to provide equivalent curricula and learning experiences to groups of geographically separated students. Paradoxically, this process also involves adaptation of curricula to suit local contexts. This study has focused on challenges faced by medical Crossborder curriculum programme directors and strategies they employed to overcome these. Methods: We conducted a qualitative study on six CCPs using document analysis and semi-structured interviews with 13 programme directors from 12 medical schools. Interview transcripts were coded iteratively, followed by cross-case analysis. Results: The challenges faced by CCP programme directors are four-fold, springing from differences in health care systems, legislation and political interference, teaching and learning environments, and partnership. Deliberate strategies, such as intensifying interactions between partners in all academic echelons, can help to overcome these. Partnerships vary in their setup and collaboration strategy. Conclusion: Medical CCPs are challenging though seem feasible. Partnerships with more solid integration of academic operations appear robust in terms of ownership and provide, besides financial, also academic advantages to both institutions. However, more research is needed on the long-term effects on quality of graduates and impact on the host health care system.

Using activity theory to study cultural complexity in medical education

There is a growing need for research on culture, cultural differences and cultural effects of globalization in medical education, but these are complex phenomena to investigate. Socio-cultural activity theory seems a useful framework to study cultural complexity, because it matches current views on culture as a dynamic process situated in a social context, and has been valued in diverse fields for yielding rich understandings of complex issues and key factors involved. This paper explains how activity theory can be used in (cross-)cultural medical education research. We discuss activity theory’s theoretical background and principles, and we show how these can be applied to the cultural research practice by discussing the steps involved in a cross-cultural study that we conducted, from formulating research questions to drawing conclusions. We describe how the activity system, the unit of analysis in activity theory, can serve as an organizing principle to grasp cultural complexity. We end with reflections on the theoretical and practical use of activity theory for cultural research and note that it is not a shortcut to capture cultural complexity: it is a challenge for researchers to determine the boundaries of their study and to analyze and interpret the dynamics of the activity system.

Students’ and junior doctors’ preparedness for the reality of practice in sub-Saharan Africa

Abstract Background: Evidence tailored to sub-Saharan Africa on outcomes of innovations in medical education is needed to encourage and advance their implementation in this region. Aim: To investigate preparedness for practice of students and graduates from an innovative and a conventional medical curriculum in a sub-Saharan African context. Methods: Using mixed methods we compared junior doctors and fifth-year students from two Mozambican medical schools: one with an innovative problem- and community-based curriculum and one with a conventional lecture- and discipline-based curriculum. A questionnaire on professional competencies was administered, semi-structured interviews were conducted, and work diaries were collected. The findings were integrated in a conceptual model. Results: Six areas of tension between global health care ideals and local health care practice emerged from the data that challenged doctors’ motivation and preparedness for practice. Four elements of the innovative curriculum equipped students and graduates with skills, attitudes and competencies to better cope with these tensions. Students and graduates from the innovative curriculum rated significantly higher levels on various competencies and expressed more satisfaction with the curriculum and its usefulness for their work. Conclusion: An innovative problem- and community-based curriculum can improve sub-Saharan African doctors’ motivation and preparedness to tackle the challenges of health care practice in this region.

AM Last Page: Avoiding Five Common Pitfalls of Experimental Research in Medical Education

References: 1. Cook DA, Beckman TJ. Reflections on experimental research in medical education. Adv Health Sci Educ. 2010;15:455–464. 2. Kirk RE. Experimental design. In: Millsap RE, Maydeu-Olivares A. The SAGE Handbook of Quantitative Methods in Psychology. London, UK: SAGE Publications Ltd; 2009. 3. Issa N, Schuller M, Santacaterina S, et al. Applying multimedia design principles enhances learning in medical education. Med Educ. 2011;45:818–826. 4. Cook DA, Thompson WC, Thomas KG, Thomas MR, Pankratz VS. Impact of self-assessment questions and learning styles in Web-based learning: A randomized, controlled, crossover trial. Acad Med. 2006;81:231–238. 5. Hatala RM, Brooks LR, Norman GR. Practice makes perfect: The critical role of mixed practice in the acquisition of ECG interpretation skills. Adv Health Sci Educ. 2003;8:17–26. 6. Mamede S, van Gog T, Moura AS, et al. Reflection as a strategy to foster medical students’ acquisition of diagnostic competence. Med Educ. 2012;46:464–472. 7. Marquard JL, Henneman PL, He Z, Jo J, Fisher DL, Henneman EA. Nurses’ behaviors and visual scanning patterns may reduce patient identification errors. J Exp App. Psychol 2011;17:247–256.

The discomfort of an educator’s critical conscience: the case of problem-based learning and other global industries in medical education

Halman, Baker and Ng’s article [1] on critical consciousness captured our attention as scholars interested in engaging in educational practices that are dynamic and stay responsive to local needs. We expound on ways in which it has made us think about our practice, specifically in the face of globalization in health professions education. We argue that our practice as health professions educators is inextricably linked to a global industry of health professions education, which comes with a potentially discomforting message.

Exporting a Student-Centered Curriculum: A Home Institution's Perspective.

Numerous, mainly Anglo-Saxon, higher education institutions have agreements with foreign providers to deliver their curricula abroad. This trend is gradually making inroads into the medical domain, where foreign institutions undertake to offer their students learning experiences similar to those of the home institution. Not an easy feat, as the national health care contexts differ greatly between institutions. In a bid to export the curriculum, institutions risk compromising their financial resilience and reputation. This article presents an instrumental case study of a home institution’s perspective on the establishment of a cross-border student-centered curriculum partnership. It provides the reader with a practical discourse on dimensions that need to be bridged between home and host contexts, and on new working processes that need to be integrated within the home institution’s existing organizational structure. We describe the advantages and disadvantages based on our experiences with a centralized organizational approach, and advocate for a gradual move toward decentral interfaculty communities of practice.