Lynn V Knight

Is it me or is it them? Factors that influence the passing of underperforming students.

Context  Research has found that clinical assessments do not always accurately reflect medical student performance. Barriers to failing underperformance in students have been identified in other vocational settings. Is ‘failure to fail’ an issue for medical educators in the UK, and, if so, what are its determinants?

High-quality learning: harder to achieve than we think?

Context  High‐quality learning in the context of medical education can be defined by current conceptions of a deep approach to learning and studying, in combination with metacognitive skills such as personal organisation and reflection on learning. Modern undergraduate education aims to provide an environment that will promote high‐quality learning, but this is not as easy to achieve as it might at first seem. Part of the difficulty arises because it is student perceptions of the learning and assessment environment that determine the adopted approach to studying and these are notoriously hard to predict.

Medical educators’ metaphoric talk about their assessment relationships with students: ‘you don’t want to sort of be the one who sticks the knife in them’

Current perspectives in cognitive linguistics highlight the conceptual nature of cognition and how the conceptual metaphors we hold affect ways we think, talk and act. This study examines medical educators’ metaphoric talk to understand ways in which assessment relationships with students are conceptualised in order to understand why educators might ‘fail to fail’ underperformance in medical students. We conducted 10 focus groups with 70 educators at two UK medical schools. The audiotapes were transcribed and analysed using systematic metaphor analysis. The analysis revealed six over‐arching metaphors associated with the target domain of assessment relationships, i.e. assessment relationships as journey, war, sport, parentalism, machine and medicine. While medical educators conceptualised students’ academic failure in relatively innocuous ways (e.g. students’ failure to arrive at their destination; journey), they also conceptualised failure in harmful ways (e.g. students’ death; war). If medical educators hold the concept of assessment relationships as war, it is perhaps unsurprising that they are reluctant to fail students. We discuss these findings in light of existing literature and provide recommendations for designing training sessions through which assessors can address reluctance to fail underperformance. Such faculty development may aid assessors in identifying and using alternative metaphors to conceptualise the assessment relationship.

“From the Heart of My Bottom”: Negotiating Humor in Focus Group Discussions:

Reporting and analyzing interactional data collected during focus groups can be a significant challenge for qualitative health researchers. In this article, the authors explore the use of humor among focus group participants as one area of interaction and negotiation that is methodologically interesting and theoretically insightful. They explore discussions about service user involvement in medical education across eight focus groups consisting of medical educators, medical students, and service users. The findings suggest that humor can be used among focus group participants to maintain solidarity, navigate coping strategies, and negotiate power. Not only is humor useful when exploring new concepts, it can also be an indication of wider views that might not be explicit in an analysis of focus group members’ comments alone. The authors urge qualitative health researchers to examine interactions among focus group participants, and their analysis of humor illustrates how this can be achieved.

The importance of vocational and social aspects of approaches to learning for medical students

Having performed research using approaches to learning and studying inventories and become familiar with the concepts they purport to measure, the authors were concerned that existing inventories might not capture the full range of intentions and motivations for learning that exist within populations of medical students. We used semi-structured interviews to explore the approaches to learning of undergraduate medical students at two time points: in the academic setting (year 2) and subsequently in the clinical setting (year 3). A thematic index was created using a framework analysis approach with the data derived from the academic setting and subsequently applied to and developed by the data derived from the clinical setting. Some themes and sub-themes emerging from the analysis fitted well with the deep, surface and strategic approaches described previously in higher education. Others did not. In particular, the importance of the vocational and social aspects of learning was striking in this sample of students, in both academic and clinical settings, and these would be missed by the majority of existing inventories. This study confirms that existing conceptions of approaches to learning within the higher education literature do not account for the full range of intentions and motivations that exist within medical student populations.

Banning, detection, attribution and reaction: the role of assessors in constructing students’ unprofessional behaviours

Present and Future. Edinburgh: Elsevier 2006;346–8. 5 Holmes OW. The Professor at the Breakfast Table. London: Routledge & Sons 1882;29. 6 Jones AH, Carson RA. Medical humanities at the University of Texas Medical Branch at Galveston, Texas. Acad Med 2003;78:1006–9. 7 Singer P. Strengthening the role of ethics in medical education. CMAJ 2003;168:854–5. 8 Dawkins R. The God Delusion. London: Bantam Press 2006.

Thinking ‘no’ but saying ‘yes’ to student presence in general practice consultations: politeness theory insights

of measurement. Science 1946;103 (67):668–90. 9 Stevens S. Mathematics, measurement and psychoanalysis. In: Stevens SS, ed. Handbook of Experimental Psychology. New York: John Wiley & Sons 1951;1– 49. 10 Likert R, Hayes S. Some Applications of Behavioural Research. Paris: Unesco 1957. 11 Carifio J, Perla R. Ten common misunderstandings, misconceptions, persistent myths and urban legends about Likert scales and Likert response formats and their antidotes. Journal of the Social Sciences 2007;3(3), 106–116.

Revealing implicit understanding through enthymemes: a rhetorical method for the analysis of talk

Background  Everyday talk is characterised by implicit information that the listener is required to infer. We introduce a method of analysis based on theories from semiotics and classical rhetoric that enables the researcher to reveal unspoken beliefs that underlie such talk.

“The stroke is eighty nine”: understanding unprofessional behaviour through physician-authored prose

The unprofessional behaviour of medics is explored through their depiction in two physician-authored books—the novel Bodies and the autobiography Bedside stories: confessions of a junior doctor. Using the Integrative Model of Behavioural Prediction, not only the range and nature of professionalism lapses outlined in these books but also the reasons behind such unprofessional behaviours are examined. The books contained examples of lapses in professionalism outlined in research investigating the unprofessional behaviour of medical students, such as communication violations, objectification of patients and causing harm to patients. More interestingly, various reasons behind lapses in professionalism were found. Most examples of unprofessional behaviour were unintentional acts and therefore due to environmental constraints and skill deficits. Seemingly intentional acts were largely influenced by normative beliefs—that is, people feeling pressurised to act unprofessionally. Further research is needed to examine the depiction of lapses in professionalism in a wider range of physician-authored prose.