Feedback mapping - The curricular cornerstone of an "educational alliance".

PURPOSE: The "educational alliance" concept articulates a collaborative framework to facilitate effective feedback through transparency of opportunities aligned with learner stage and intended educational outcomes. Using this framework, we evaluated feedback across a 5 year undergraduate medical program to support embedding a successful learner - teacher "educational alliance". METHOD: A comprehensive mapping exercise used an iterative action research process of source documentary analysis, consultations with key curriculum stakeholders and qualitative analysis. The "educational alliance" model provided a critical lens through which to ensure feedback opportunities aligned with intended learning outcomes and developmental progression. RESULTS: Key information about the type, frequency and timing of feedback opportunities was identified within 188 curricular components. The purpose and intended learning outcomes were mapped, aligning with the stage of learning and with an expectation of supporting learners' capacity for self-regulation. This focus providing clear articulation of feedback opportunities supported the longitudinal developmental curricular review, and facilitated enhanced awareness of dialogic feedback within the "educational alliance". CONCLUSIONS: Explicit alignment of learning intentions between learner and educator is key to forming a successful "educational alliance". The feedback map provides clarity ensuring mutual understanding of intended learning outcomes. The iterative process additionally certified feedback aligned with maturing learner developmental needs across the program

Medical Student Perceptions of Feedback and Feedback Behaviors Within the Context of the “Educational Alliance”

Purpose: Using the "educational alliance" as a conceptual framework, the authors explored medical students' beliefs about feedback and how their feedback behaviors reflect their perceptions. Method: Five focus groups (four to six medical students each) at one UK medical school in 2015 were used to capture and elucidate learners' feedback perceptions and behaviors within the context of the learner-educator relationship. A map of key feedback opportunities across the program was used as a tool for exploring student engagement with the feedback process. Qualitative data were analyzed using an approach based on grounded theory principles. Results: Three learner feedback behaviors emerged: recognizing, using, and seeking feedback. Five core themes influencing these behaviors were generated: learner beliefs, attitudes, and perceptions; relationships; teacher attributes; mode of feedback; and learning culture. Conceptual models illustrating the relationships between the themes and each behavior were developed. Learning culture influenced all three behaviors with a wide context of influences. Conclusions: Ensuring that feedback leads to improved performance requires more than training educators in best practices. The conceptual models support the educational alliance framework and illustrate the context and complexity of learning culture surrounding the educational relationship, learner, and feedback exchange. The educational alliance approach is underpinned by a mutual understanding of purpose and responsibility. Enhancing learners' feedback literacy skills seems to be the key aspect of the educational alliance in need of attention. Empowering learners to recognize, seek, and use feedback received within diverse learning cultures is essential

Effect of curriculum changes to enhance generic skills proficiency of 1st-year medical students

Background. Curriculum review is a dynamic, iterative process, and the effect of change may not always be wholly predictable. At Stellenbosch University, Cape Town, South Africa, revision of the MB,ChB curriculum was undertaken to meet enhanced and changing educational and medical practice, and to provide opportunities to enhance optimal generic skills underpinning effective learning, implemented in 2008. Objective. To determine the extent to which the newly implemented revised curriculum had an effect on experience in necessary generic skills of students in their first year of study. Methods. Students provided annual formal end-of-module evaluation in addition to focus group interviews. Evaluation by teaching staff was conducted by individual in-depth interviews. A validated generic skills questionnaire completed at the end of each academic year monitored the effect on students’ generic learning skills experience. Results. Feedback from these different evaluation methods identified specific needs in the newly implemented revised curriculum, including contextualisation of interventions, unnecessary duplication of content and malalignment of assessment. This led to minor curriculum changes and an educational capacity-building programme. These responsive curriculum changes after evaluation had the intended positive effect on students’ selfreported acquisition of generic learning skills. Conclusion. The objective of the curriculum evaluation was to monitor content output and the acquisition of crucial generic learning skills. Implementation of a revised curriculum combined with ongoing responsive changes aligned with careful multimodality evaluation can ensure that, in addition to scientific knowledge and skills, generic learning skills development of students is facilitated

Self-reported generic learning skills proficiency: another measure of medical school preparedness

Background: Strong generic learning skills may improve academic performance at medical school. Studies evaluating the generic learning skills proficiency of medical students use self-reported data. It is not known whether self-evaluation of discipline-independent skills exhibits the same problems of widely variable accuracy as self-assessment of discipline-related skills. Objective: To investigate whether the self-reported generic learning skills proficiency of medical school entrants was related to three objective measures of performance: pre-university admission aptitude-test scores, information technology (IT) proficiency on entry and early academic performance at university. Methods: This prospective study used a previously validated 31-item questionnaire to document the self-reported proficiency of medical school entrants (2011 - 2013) with regard to 6 categories of generic learning skills: information handling, technical and numeracy, computer, organisational, managing self-learning and presentation skills. The results of the questionnaire were compared with performance in pre-university admission aptitude tests, an IT placement test on entry and end-of-semester 1 examinations (after 6 months at university), which are the basis for promotion to semester 2. Results. A total of 640 of 648 (98.8%) students completed the questionnaire. Self-reported generic learning skills proficiency was found to be significantly related to pre-university admission aptitude test scores (medium effect size), IT proficiency on entry to university (large effect size) and early academic performance at university (small effect size). Academically weak students did not overestimate their skills proficiency. Conclusion. These findings support the opinion that self-reported generic skills proficiency can credibly contribute to determining the academic preparedness of medical school entrants

What can medical educators learn from the Rio 2016 Olympic Games?

Medical Educators face an ongoing challenge in optimising preparedness for practice for newly qualified doctors. Junior doctors have highlighted specific areas in which they do not feel adequately equipped to undertake their duties, including managing the acutely unwell patient. In these highly stressful, time-critical scenarios it might be assumed that a lack of knowledge underpins these feelings of apprehension from junior medics; however, having studied, trained and passed examinations to demonstrate such knowledge, perhaps other factors should be considered. The recent Olympic Games in Rio demonstrated the impact of sport psychology techniques in allowing athletes to achieve their optimum performance in the face of adversity. The use of mental and behavioural strategies to control feelings of anxiety and low self-efficacy are pivotal for athletes to deliver their best performance under extreme pressure. We consider whether such techniques could improve the preparedness of the newest recruits to the healthcare system, and the impact this could have on patient care. Finally, suggestions for potential research directions within this area are offered to stimulate interest amongst the research community

Appreciative inquiry in medical education*

The practice of medicine, and also medical education, typically adopts a problem-solving approach to identify "what is going wrong" with a situation. However, an alternative is Appreciative Inquiry (AI), which adopts a positive and strengths-based approach to identify "what is going well" with a situation. The AI approach can be used for the development and enhancement of the potential of both individuals and organizations. An essential aspect of the AI approach is the generative process, in which a new situation is envisioned and both individual and collective strengths are mobilized to make changes to achieve the valued future situation. The AI approach has been widely used in the world of business and general education, but is has an exciting potential for medical education, including curriculum development, faculty development, supporting learners through academic advising and mentoring, but also for enhancing the teaching and learning of both individuals and groups. This AMEE Guide describes the core principles of AI and their practical application in medical education

Pre-University education curriculum reform and the generic learning skills of medical school entrants: Lessons learned from South Africa

Background: Pre-university education curriculum changes may increase the skills and knowledge gap between secondary (high school) and tertiary (university) education that have been identified as having a major impact on the success of students from underresourced educational backgrounds. This study investigated the impact of extensive pre-university curriculum revision on the generic learning skills of entrants to South African medical schools, which admit students directly from high school. Methods: In this prospective study, students entering four medical schools during 2008-2011 were surveyed to determine their practice of and confidence in information handling, managing own learning, technical and numeracy skills, and computer, organizational, and presentation skills in the 12-month preceding entry. The 2008 entrants were the final cohort of the old secondary school curriculum. The mean levels of practice or confidence of entrants to the four medical schools, during 2008-2011, were compared using analysis of variance. The Bonferroni's test was used for further pair-wise comparison of cohorts of students either entering in different years or different institutions. Results: While entrants at the four medical schools did not demonstrate a consistent or sustained change in their practice of or confidence in each skill category over the period of study, there were some significant differences between entrants at the respective institutions. Furthermore, entrants to one medical school were consistently less confident of their skills, despite more practice. These findings are best accounted for by the long-standing history of inequitably resourced pre-university education in South Africa. Discussion: These findings highlight the need for close monitoring of the impact of pre-university education changes on the learning skill profiles of university entrants, in order to design effective university programs which enable students from diverse backgrounds to participate and adequately meet curricula demands

How do undergraduate medical students perceive social accountability?

Aim: The concept of social accountability within undergraduate training is embedded within the remit of medical schools. Little is known of how medical students perceive social accountability, recognize aspects of their training contributing to the development of this concept and cultivate the underpinning values. Methods: Students nearing graduation were recruited to participate in focus groups designed to explore their perceptions of social accountability, which curricular aspects had contributed to their understanding, and to investigate the implications of individual variations in training. Results: Students expressed limited appreciation of the concept of social accountability and acknowledged little explicit teaching around underpinning core concepts such as awareness of local health needs, advocacy and nurturing of altruism. However, participants recognized numerous aspects of the course and learning initiatives as impacting on their attitudes towards this concept implicitly. Conclusion: This study highlights areas of their undergraduate training that students recognize as having the greatest impact on their development into socially accountable professionals. It poses some significant challenges for health care educators in addressing unintended consequences, including an outcome-driven educational approach, in reducing students’ capacity or willingness to engage in curricular challenges often designed to embed this concept

Modelling neurological diseases in large animals: criteria for model selection and clinical assessment

Issue: The impact of neurological disorders is recognised globally, with one in six people affected in their lifetime and few treatments to slow or halt disease progression. This is due in part to the increasing ageing population, and is confounded by the high failure rate of translation from rodent-derived therapeutics to clinically effective human neurological interventions. Improved translation is demonstrated using higher order mammals with more complex/comparable neuroanatomy. These animals effectually span this translational disparity and increase confidence in factors including routes of administration/dosing and ability to scale, such that potential therapeutics will have successful outcomes when moving to patients. Coupled with advancements in genetic engineering to produce genetically tailored models, livestock are increasingly being used to bridge this translational gap. Approach: In order to aid in standardising characterisation of such models, we provide comprehensive neurological assessment protocols designed to inform on neuroanatomical dysfunction and/or lesion(s) for large animal species. We also describe the applicability of these exams in different large animals to help provide a better understanding of the practicalities of cross species neurological disease modelling. Recommendation: We would encourage the use of these assessments as a reference framework to help standardise neurological clinical scoring of large animal models

What impact does community service learning have on medical students' appreciation of population health?

Objectives: The Bar Ilan Faculty of Medicine places public health as a priority in its medical curriculum, emphasizing its importance by strategically placing the required course as first on entry into medical school. Students are introduced to the importance of population health and community engagement through participatory community learning experiences. This study aims to examine how participatory community teaching methods impact students' understanding and attitudes towards community health. Study design: Mixed quantitative and qualitative design. Methods: 75 first year students completed the required public health course utilizing participatory community methods, including community visits, Team Based Learning, an ethnic forum, and lifestyle medicine. Evaluation comprised skills assessment through project work, analysis of reflective notes and comparison of assessment scores with students in the previous year who experienced a formal lecture-only based curriculum. Results: Students acquired public health skills, including conducting a needs assessment, searching for research evidence and designing an evaluation framework. Reflective notes revealed in-depth understanding not only of course aims, but an appreciation of the social determinants of health and the local community. Test marks indicated public health knowledge reached a comparable standard (83 ± 7.3) to the previous year (85 ± 9.3; P = 0.431). Conclusions: Participatory community learning equips students with public health skills, knowledge, and enhanced understanding of communities. It offers a way to effectively teach public health, while emphasizing the extended role and societal responsibilities of doctors