Neville Chiavaroli

Knowing how we know: an epistemological rationale for the medical humanities

Although their inclusion in medical curricula internationally is increasing, the medical humanities still face challenges to their role and place in the curriculum. Justifications supporting the inclusion of humanities content, methods and perspectives in medical curricula have generally been proposed along instrumental, intrinsic and critical lines. However, recent literature in the field has turned to ‘ways of knowing’ as representing an alternative, essentially epistemological, perspective on the matter. This involves the claim that the medical humanities align with and promote characteristic ways of understanding and practising medicine, which are not adequately represented in traditional disciplinary frameworks.

When Majority Doesn't Rule: The Use of Discrimination Indices to Improve the Quality of MCQs.

Abstract This paper outlines the use of item analysis to assist examiners in evaluating the quality and validity of their MCQ exam questions. The generation of item analysis, particularly discrimination index, has long been established practice in professional testing and credentialing organisations and some disciplines in tertiary education, but its use appears to be inconsistent among Bioscience departments. We argue that generating some form of discrimination index is an essential part of the validation of exams, in particular to help identify errors in scoring, to identify potentially flawed questions, or to confirm the validity of challenging questions. We demonstrate each of these uses through examples drawn from first year Biology exams, with interpretations of the questions in the light of post-examination item analysis.

How clinical reasoning is taught and learned: Cultural perspectives from the University of Melbourne and Universitas Indonesia.

BackgroundThe majority of schools in the Asia-Pacific region have adopted medical curricula based on western pedagogy. However to date there has been minimal exploration of the influence of the culture of learning on the teaching and learning process. This paper explores this issue in relation to clinical reasoning.MethodA comparative case study was conducted in 2 medical schools in Australia (University of Melbourne) and Asia (Universitas Indonesia). It involved assessment of medical students’ attitudes to clinical reasoning through administration of the Diagnostic Thinking Inventory (DTI), followed by qualitative interviews which explored related cultural issues. A total of 11 student focus group discussions (45 students) and 24 individual medical teacher interviews were conducted, followed by thematic analysis.ResultsStudents from Universitas Indonesia were found to score lower on the Flexibility in Thinking subscale of the DTI. Qualitative data analysis based on Hofstede’s theoretical constructs concerning the culture of learning also highlighted clear differences in relation to attitudes to authority and uncertainty avoidance, with potential impacts on attitudes to teaching and learning of clinical reasoning in undergraduate medical education.ConclusionsDifferent attitudes to teaching and learning clinical reasoning reflecting western and Asian cultures of learning were identified in this study. The potential impact of cultural differences should be understood when planning how clinical reasoning can be best taught and learned in the changing global contexts of medical education, especially when the western medical education approach is implemented in Asian contexts.

Attitudes and Barriers to Evidence-Based Practice in Optometry Educators

Purpose Evidence-based practice (EBP) is an essential component of good quality, patient-centered health care. This requires practitioners to acquire EBP skills and knowledge during undergraduate and continuing education. Evidence-based practice education exists in a range of health care disciplines, including optometry. Evidence-based practice education, however, depends on relevant skills and knowledge in educators. Courses and workshops exist for the development of EBP teaching skills in some areas of health care but not in optometry. Here, we describe a pilot workshop designed to enhance the teaching of EBP and to investigate the perspectives of optometric educators on EBP including their attitudes and perceived barriers to EBP and its teaching. Methods Twenty-seven optometric educators including 8 facilitators participated. Of these, 14 were academics (including the 8 facilitators) and 13 were practitioners. Evidence-based practice attitudes were assessed using the Evidence-Based Practice Attitude Scale-50 with appropriate modifications for optometry. Workshop design incorporated strategies to trigger discussion among participants. A nominal group technique was used to identify, prioritize, and reach consensus on barriers to EBP. Results Although some participants expressed reservations about EBP, a common understanding of the contemporary definition of EBP emerged in educators. Thirty-five barriers to EBP were identified; “time” was selected in the top five barriers by most participants and attracted the highest total score, well above any other barrier (negative attitude to EBP, volume of evidence, integration with clinical practice, and lack of lifelong learning mind-set). Attitudes toward EBP were generally positive and negatively correlated with age and time since graduation, respectively. Conclusions A group of optometrists and academics new to implementing education in EBP displayed positive attitudes to EBP but considered that its application and teaching could be significantly hindered by a lack of time to access and appraise the large volume of available research evidence in the field of eye care.

The Medical Humanities and the Perils of Curricular Integration

The advent of integration as a feature of contemporary medical curricula can be seen as an advantage for the medical humanities in that it provides a clear implementation strategy for the inclusion of medical humanities content and/or perspectives, while also making its relevance to medical education more apparent. This paper discusses an example of integration of humanities content into a graduate medical course, raises questions about the desirability of an exclusively integrated approach, and argues for the value of retaining a discrete and coherent disciplinary presence for the medical humanities in medical curricula.

Tensions in post-examination feedback: information for learning versus potential for harm

Self‐regulation is recognised as being a requisite skill for professional practice This study is part of a programme of research designed to explore efficient methods of feedback that improve medical students’ ability to self‐regulate their learning. Our aim was to clarify how students respond to different forms and content of written feedback and to explore the impact on study behaviour and knowledge acquisition.

When I say … phronesis

In Ancient Greece, there existed several different terms for ways of knowing and acting in the world. Commonly referred to as the ‘intellectual virtues’, many of these terms appear in modern English, either as borrowed words, such as nous (intelligence or common sense) and praxis (critical reflective practice [as recently discussed in this series by Ng and Wright]), or by providing roots from which we form words about knowledge and its activities, such as technical/technique (art/skill, from techne), philosophy (love of wisdom, from sophia) and epistemology (from episteme, knowledge/science). Several other related terms remain obscure in everyday English, including gnome (good sense), synesis (understanding) and the subject of this article, phronesis – a form of practical knowing.

Improving visual observation skills through the arts to aid radiographic interpretation in veterinary practice: A pilot study

Radiographic interpretation is a perceptual and cognitive skill. Recently core veterinary radiology textbooks have focused on the cognitive (i.e., the clinical aspects of radiographic interpretation) rather than the features of visual observation that improve identification of abnormalities. As a result, the skill of visual observation is underemphasized and thus often underdeveloped by trainees. The study of the arts in medical education has been used to train and improve visual observation and empathy. The use of the arts to improve visual observation skills in Veterinary Science has not been previously described. Objectives of this pilot study were to adapt the existing Visual Arts in Health Education Program for medical and dental students at the University of Melbourne, Australia to third year Doctor of Veterinary Medicine students and evaluate their perceptions regarding the programs effects on visual observation skills and confidence with respect to radiographic interpretation. This adaptation took the form of a single seminar given to third year Doctor of Veterinary Medicine students. Following the seminar, students reported an improved approach to radiographic interpretation and felt they had gained skills which would assist them throughout their career. In the year following the seminar, written reports of the students who attended the seminar were compared with reports from a matched cohort of students who did not attend the seminar. This demonstrated increased identification of abnormalities and greater description of the abnormalities identified. Findings indicated that explicit training in visual observation may be a valuable adjunct to the radiology training of Doctor of Veterinary Medicine students.

The principles of problem-based learning are more important than the method

The Medical Journal of Australia ISSN: 0025729X 4 November 2013 199 9 588-590 ©The Medical Journal of Australia 2013 www.mja.com.au For Debate (Manuscript Invitation Only) behaviourist, cognitivist, huma constructivist perspectives, all o more generic psychological ap outlines of PBL were fundame and Tamblyn, for example, prese i g theory4), it has come to be theories, and most meaningfully proposes that adults make m Active discovery in small groups remains essential to the learning experience