Robbert Duvivier

CRITERIA FOR GOOD ASSESSMENT: CONSENSUS STATEMENT AND RECOMMENDATIONS FROM THE OTTAWA 2010 CONFERENCE

In this article, we outline criteria for good assessment that include: (1) validity or coherence, (2) reproducibility or consistency, (3) equivalence, (4) feasibility, (5) educational effect, (6) catalytic effect, and (7) acceptability. Many of the criteria have been described before and we continue to support their importance here. However, we place particular emphasis on the catalytic effect of the assessment, which is whether the assessment provides results and feedback in a fashion that creates, enhances, and supports education. These criteria do not apply equally well to all situations. Consequently, we discuss how the purpose of the test (summative versus formative) and the perspectives of stakeholders (examinees, patients, teachers-educational institutions, healthcare system, and regulators) influence the importance of the criteria. Finally, we offer a series of practice points as well as next steps that should be taken with the criteria. Specifically, we recommend that the criteria be expanded or modified to take account of: (1) the perspectives of patients and the public, (2) the intimate relationship between assessment, feedback, and continued learning, (3) systems of assessment, and (4) accreditation systems.

Students' views on the use of real patients and simulated patients in undergraduate medical education.

Purpose To determine students’ views about the strengths and weaknesses of real patient interactions as opposed to simulated patient (SP) interactions in the undergraduate medical curriculum in order to evaluate how their strengths can be optimally used and weaknesses remedied. Method Five focus-group interviews were conducted among fourth- and fifth-year medical students at Maastricht University in 2007, using a preestablished interview guide. The interviews were recorded, transcribed, and analyzed using qualitative methods. Results In general, the 38 participants considered real patient encounters more instructive and more authentic than SP encounters. However, students identified several strengths of SP encounters compared with real patient encounters. For example, SP interactions were helpful in preparing students for real patient interactions (particularly with regard to communication skills and self-confidence), in the teaching of “intimate” physical examination skills, such as gynecological examination skills, and in giving constructive feedback on communication skills. In contrast to what we had anticipated, taking a time-out was considered easier in real patient interactions. Conclusions Both real patient interactions and SP interactions are considered indispensable to undergraduate medical education. Each encounter has unique strengths and weaknesses from the perspectives of students. On the basis of strengths and weaknesses that were identified, suggestions were made for the use of real patients and SPs in undergraduate medical education.

Teacher perceptions of desired qualities, competencies and strategies for clinical skills teachers

Introduction: Clinical skills centres (or Skillslabs) prepare students for patient-encounters. Evidence on teaching skills in these centres is lacking. What teaching skills do teachers view as effective in supporting the acquisition of physical examination skills in undergraduate medical training? Method: Structured interviews of 10 teachers (1/3 of staff of Maastricht University, Skillslab) were conducted. Selection was based on even representation of age, years teaching experience, gender and previous experience at Maastricht University. A topic grid was used to ensure comparability. Interviews (average 70 min, range 33–95 min) were recorded and transcripts were analyzed independently by two researchers. Results: Teaching skills identified include the ability to adapt content of the training, level of depth and teaching method according to the needs of any particular group. Thorough comprehension of students’ context (level of knowledge, prior experience and insight in the curriculum) is considered helpful. Explicitly inviting students to ask questions and providing relevant literature is seen to stimulate learning. Providing constructive feedback is essential, as is linking physical examination skills training to clinical situations. The ideal attitude includes appropriate dress and behaviour, as well as the use of humour. Affinity for teaching is regarded as the most important reason to work as a teacher. Conclusion: Desired characteristics for undergraduate skills teachers resemble findings in other teaching roles. Affinity for teaching and flexibility in teaching methods are novel findings.

Problem-based learning (PBL): getting the most out of your students - their roles and responsibilities: AMEE Guide No. 84.

This Guide discusses the considerable literature on the merits or shortcomings of Problem-based learning (PBL), and the factors that promote or inhibit it, when seen through the eyes of the student. It seems to be the case that PBL works best when students and faculty understand the various factors that influence learning and are aware of their roles; this Guide deals with each of the main issues in turn. One of the most important concepts to recognise is that students and Faculty share the responsibility for learning and there are several factors that can influence its success. They include student motivation for PBL and the various ways in which they respond to being immersed in the process. As faculty, we also need to consider the way in which the learning environment supports the students develop the habit of life-long learning, and the skills and attitudes that will help them become competent reflective practitioners. Each of these elements place responsibilities upon the student, but also upon the Faculty and learning community they are joining. Although all of the authors work in a European setting, where PBL is used extensively as a learning strategy in many medical schools, the lessons learned we suggest, apply more widely, and several of the important factors apply to any form of curriculum. This Guide follows on from a previous review in the AMEE Guides in Medical education series, which provided an overview of PBL and attempts to emphasise the key role that students have in mastering their subject through PBL. This should render the business of being a student a little less mystifying, and help faculty to see how they can help their students acquire the independence and mastery that they will need.

Student views on the effective teaching of physical examination skills: a qualitative study

Objectives  The lack of published studies into effective skills teaching in clinical skills centres inspired this study of student views of the teaching behaviours of skills teachers.

Overview of the world's medical schools: an update

That few data are available on the characteristics of medical schools or on trends within medical education internationally constitutes a major challenge when developing strategies to address physician workforce shortages. Quality and up‐to‐date information is needed to improve health and education policy planning.

Universal health coverage and the post-2015 agenda.

A high-level meeting on March 5–6 in Botswana is the culmination of 6 months of discussion on the post-2015 development agenda for health. The hosts (Governments of Botswana and Sweden, with UNICEF and WHO) and participants are challenged to review the sub missions to the global consultation on health and to consider an aspirational, inclusive, and yet politically palatable vision for human health after the Millennium Development Goals (MDGs) expire in 2015. Their report will be submitted to the UN Secretary General’s high-level panel of eminent persons and the fi ndings considered in the panel’s publication in May, 2013. That report will go to an even higher high-level meeting at the UN General Assembly in September, 2013. The consultation has generated countless blogs, opinions, reports, and tweets. Yet, surprisingly, only 94 papers are posted on the offi cial consultation site, and there are only 19 responses to its synthesis paper. By contrast, the consultation on addres sing inequalities received 179 papers and 61 comments on its synthesis. The Botswana meeting might well conclude that the consultation has been open and inclusive, and that the synthesis paper is a fair refl ection of submissions (it is), but there is something missing: a consensus. Con vergence is apparent: learn from evidence and experience, the unfi nished agenda of the MDGs, measure accountability and results, and address equity—with universal health coverage the solution for many. But, a unifying vision or a “yes, we can” dream, is not yet there. However, is the governance process and the new support for universal health coverage (UHC) the emperor’s new clothes in global health—described elsewhere as “old wine in a new bottle”—and will a high, higher, and even higher governance process capture the needs of men, women, and children who are seeking quality care from local health workers? The evidence exists on what is required in the world we want. More than 100 global health experts presented this evidence in 2004 through a Joint Learning Initiative. Their conclusion: the only route to achieve the health MDGs is through the health worker. The same is true for UHC and post-2015, only this time with deeper consideration of effective coverage—ie, the dif ference between the theoretical coverage implied by the availability of the workforce and the actual coverage resulting from the quality of the workforce. This is the grand challenge on human resources for health for all countries. Could the Botswana consensus therefore be the concept of “just health”, with health workers at its core?

Twelve tips for medical curriculum design from a cognitive load theory perspective

Abstract During their course, medical students have to become proficient in a variety of competencies. For each of these competencies, educational design can use cognitive load theory to consider three dimensions: task fidelity: from literature (lowest) through simulated patients (medium) to real patients (highest); task complexity: the number of information elements in a learning task; and instructional support: from worked examples (highest) through completion tasks (medium) to autonomous task performance (lowest). One should integrate any competency into a medical curriculum such that training in that competency facilitates the students’ journey that starts from high instructional support on low-complexity low-fidelity learning tasks all the way to high-complexity tasks in high-fidelity environments carried out autonomously. This article presents twelve tips on using cognitive load theory or, more specifically, a set of four tips for each of task fidelity, task complexity, and instructional support, to achieve that aim.

Health professionals for the 21st century: a students' view.

1 Flexner A. Medical education in the United States and Canada: a report to the Carnegie Foundation for the advancement of teaching. 1910. http://www.archive.org/details/medicaleducation00fl exiala (accessed Oct 28, 2010). 2 Frenk J, Chen L, Bhutta ZA, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; published online Nov 29. DOI:10.1016/S0140-6736(10)61854-5. 3 Bhutta ZA, Chen L, Cohen J, et al. Education of health professionals for the 21st century: a global independent commission. Lancet 2010; 375: 1137–38. 4 Chen L, Evans T, Anand S, et al. Human resources for health: overcoming the crisis. Lancet 2004; 364: 1984–90.

Medical education in global health: student initiatives in the Netherlands.

As students ourselves we, along with many of our peers, believe that all medical undergraduates should learn about health and health care from a global perspective. Brewer et al. rightly remark that global health issues should form essential components of learning for all students, not just for an interested few. This argument has been made before, most notably in your journal by Edwards et al., who proved that elective courses on global health issues preach to the converted.