Jeffrey Wiseman

Why medical students should learn how to teach

Background: We reviewed the medical-education literature in order to explore the significance and importance of teaching medical students about education principles and teaching skills. Aims: To discuss reasons why formal initiatives aimed at improving teaching skills should be part of the training of all physicians, and how it could begin at the medical-student level. Description: In this article, we propose several reasons that support formal undergraduate medical training in education principles: (1) medical students are future residents and faculty members and will have teaching roles; (2) medical students may become more effective communicators as a result of such training, as teaching is an essential aspect of physician–patient interaction; and (3) medical students with a better understanding of teaching and learning principles may become better learners. We suggest that exposure to teaching principles, skills, and techniques should be done in a sequential manner during the education of a physician, starting in medical school and continuing through postgraduate education and into practice. We outline learning objectives, teaching strategies, and evaluation methods for medical-education components in an undergraduate curriculum. Conclusion: Medical students’ informal teaching activities accompany, facilitate, and complement many important aspects of their medical education. Formally developing medical students’ knowledge, skills, and attitudes in education may further stimulate these aspects.

Multiple mini‐interviews versus traditional interviews: stakeholder acceptability comparison

Context  The McGill University Faculty of Medicine undertook a pilot, simulation‐based multiple mini‐interview (MMI) for medical school applicant selection, which ran simultaneously with traditional unstructured interviews (all applicants underwent both processes). This paper examines major stakeholder (applicants and evaluators) opinions towards the MMI compared with traditional interviews, including perceptions about the feasibility and utility of the MMI.

Scaffolding problem-based learning with CSCL tools

Small-group medical problem-based learning (PBL) was a pioneering form of collaborative learning at the university level. It has traditionally been delivered in face-to-face text-based format. With the advancement of computer technology and progress in CSCL, educational researchers are now exploring how to design digitally-implemented scaffolding tools to facilitate medical PBL. The “deteriorating patient” (DP) role play was created as a medical simulation that extends traditional PBL and can be implemented digitally. We present a case study of classroom usage of the DP role play that examines teacher scaffolding of PBL under two conditions: using a traditional whiteboard (TW) and using an interactive whiteboard (IW). The introduction of the IW technology changed the way that the teacher scaffolded the learning. The IW showed the teacher all the information shared within the various subgroups of a class, broadening the basis for informed classroom scaffolding. The visual records of IW usage demonstrated what students understood and reduced the need to structure the task. This allowed more time for engaging students in challenging situations by increasing the complexity of the problem. Although appropriate scaffolding is still based on the teacher’s domain knowledge and pedagogy experience, technology can help by expanding the scaffolding choices that an instructor can make in a medical training context.

The current state of musculoskeletal clinical skills teaching for preclerkship medical students.

Objective Musculoskeletal (MSK) complaints have high prevalence in primary care practice (12%–20% of visits), yet many trainees and physicians identify themselves as weak in MSK physical examination (PE) skills. As recruitment to MSK specialties lags behind retirement rates, there is a short-age of physicians able to effectively teach this subject. We investigated current practices of Canadian undergraduate medical programs regarding the nature, amount, and source of preclerkship MSK PE clinical skills teaching; and documented the frequency and extent that Patient Partners® in Arthritis (PP®IA) are used in this educational setting. Methods A 2-page self-administered electronic questionnaire combining open- and close-ended questions was developed and piloted. It was distributed by e-mail to all Canadian undergraduate associate-deans and to 16/17 undergraduate MSK course organizers. Results Supervised practice in small groups and the PP®IA are the most prevalent teaching methods. Objective structured clinical examinations are the most prevalent evaluation methods. The average number of hours devoted to teaching these skills is very small compared to the prevalence of MSK complaints in the population. Canadian schools’ preclerkship MSK PE clinical skills teaching is heavily dependent on the contributions of non-MSK specialists. Conclusion The weak link in the Canadian MSK PE educational cycle appears to be the amount of time available for students’ deliberate practice with expert feedback. There is a need for methods to evaluate and further develop MSK PE teaching by non-MSK specialists. This and increased use of PP®IA at the preclerkship level may provide students more time for practice with feedback.

The Deteriorating Patient: a realistic but ‘low-tech’ simulation of emergency decision-making

Y ou are a first-year house officer. At 02:00am you are called to see a 65-year-old man complaining of epigastric discomfort. He has hypertension, atrial fibrillation and was admitted with a diabetic foot ulcer. The ECG is normal. You prescribe antacids. The discomfort persists, the patient becomes sweaty and his blood pressure is dropping. Your supervisor has not returned your call. What would you do next?

Technology-Rich Tools to Support Self-Regulated Learning and Performance in Medicine

Medical students’ metacognitive and self-regulatory behaviors are examined as they diagnose patient cases using BioWorld, a technology rich learning environment. BioWorld offers an authentic problem-based environment where students solve clinical cases and receive expert feedback. We evaluate the effectiveness of key features in BioWorld (the evidence table and visualization maps) to see whether they promote metacognitive monitoring and evaluation. Learning outcomes were assessed through novice/expert comparisons in relation to diagnostic accuracy, confidence, and case summaries. More specifically we examined how diagnostic processes and learning outcomes were refined or improved through practice at solving a series of patient cases. The results suggest that, with practice, medical students became more expert-like in the processes involved in making crucial clinical decisions. The implications of these findings for the design of features embedded within BioWorld that foster key metacognitive and self-regulatory processes are discussed.

The role of regulation in medical student learning in small groups

Computer supported collaborative problem based learning in medicine can lead to high levels of metacognition.High co-regulation in problem based learning co-occurs with levels of Interactive Social Presence.Co-regulatory actions that activate the discussion and metacognitive acts of planning. This study examines the role of regulatory processes in medical students as they learn to deliver bad news to patients in the context of an international web-based problem based learning environment (PBL). In the PBL a medical facilitator and students work together to examine video cases on giving bad news and share their perspectives on what was done effectively and what could be done differently. We examine how regulation occurs within this collaboration. A synchronous computer-supported collaborative learning environment (CSCL) facilitated peer discussion at a distance using a combination of tools that included video-conferencing, chat boxes, and a shared whiteboard to support collaborative engagement. We examine regulation along a continuum, spanning from self- to co-regulation, in situations where medical students learn how to manage their own emotions and adapt their responses to patient reactions. We examine the nature of the discourse between medical students and facilitators to illustrate the conditions in which metacognitive, co-regulation and social emotional activities occur to enhance learning about how to communicate bad news to patients.

The impact of trained patient educators on musculoskeletal clinical skills attainment in pre-clerkship medical students

BackgroundDespite the high burden of musculoskeletal (MSK) diseases, few generalists are comfortable teaching MSK physical examination (PE) skills. Patient Partners® in Arthritis (PP®IA) is a standardized patient educator program that could potentially supplement current MSK PE teaching. This study aims to determine if differences exist in MSK PE skills between non-MSK specialist physician and PP®IA taught students.MethodsPre-clerkship medical students attended 2-hour small group MSK PE teaching by either non-MSK specialist physician tutors or by PP®IA. All students underwent an MSK OSCE and completed retrospective pre-post questionnaires regarding comfort with MSK PE and interest in MSK.Results83 students completed the OSCE (42 PP®IA, 41 physician taught) and 82 completed the questionnaire (42 PP®IA, 40 physician taught). There were no significant differences between groups in OSCE scores. For all questionnaire items, post-session ratings were significantly higher than pre-session ratings for both groups. In exploratory analysis PP®IA students showed significantly greater improvement in 12 of 22 questions including three of five patient-centred learning questions.ConclusionsPP®IA MSK PE teaching is as good as non-MSK specialist physician tutor teaching when measured by a five station OSCE and provide an excellent complementary resource to address current deficits in MSK PE teaching.

Musculoskeletal examination teaching by patients versus physicians: How are they different? Neither better nor worse, but complementary

Background: Musculoskeletal (MSK) complaints comprise 12–20% of primary healthcare; however, practicing physicians’ MSK physical examination (PE) skills are weak. Further, there is a shortage of specialists able to effectively teach this subject. Previous evaluations of patient educators have yielded mixed results. Aims: The aim of this study is to document how teaching by patient educators and physician tutors in MSK PE skills differs. Methods: A qualitative researcher observed, video-recorded, and took notes during preclerkship MSK PE teaching sessions given by patient educators or physician tutors. The researcher identified themes which were evaluated by collective case study methods. Results: Two patient educator and four physician groups were evaluated. The patient educators were more consistent regarding content and style than the physicians. There appeared to be a continuum in teaching organization from patient educator to novice physician tutors to experienced physician tutors. The patient educators consistently covered all major joints (physicians did not); physicians were more likely to request verbalization of actions, relate findings to history, receive questions, and use opportunistic teaching moments. Conclusions: Understanding preclerkship MSK teaching by patient educators compared to physician tutors is necessary for appropriate targeting of the existing Patient Partners® in Arthritis patient educator program and to guide the development of future MSK teaching initiatives.

Twelve tips for conducting a medical education journal club

Background: Journal clubs are active at many universities and they involve many specialties and subspecialties. There is a surprising dearth of journal clubs which deal with articles related to the science of medical education. Aims: In an effort to expose medical educators to the outstanding benefits of medical education journal clubs we have devised a set of twelve tips to success for such clubs. Methods: We conducted a survey of journal club directors at the nine Canadian medical schools known to conduct education journal clubs. We also conducted interviews with all members of the McGill University Centre for Medical Education. Results: Combining the results from these two information sources allowed us to develop an approach to assuring success in medical education journal clubs.