Evaluation - the educational context

Evaluation comes in many shapes and sizes. It can be as simple and as grounded in day to day work as a clinical teacher refl ecting on a lost teaching opportunity and wondering how to do it better next time or as complex, top down and politically charged as a major government led evaluation of use of teaching funds with the subtext of re-allocating them. Despite these multiple spectra of scale, perceived ownership, fi nancial and political implications, the underlying principles of evaluation are remarkably consistent. To evaluate well, it needs to be clear who is evaluating what and why. From this will come notions of how it needs to be done to ensure the evaluation is meaningful and useful. This paper seeks to illustrate what evaluation is, why it matters, where to start if you want to do it and how to deal with evaluation that is external and imposed

Maximising learning opportunities in handover

Handing over responsibility for patients has always been part of medical practice. Definitions emphasise transfer of responsibility to ensure patient safety and the available literature tends to follow this line (see box 1). Handover is much more than this, however. It is a key event where teams meet, have the opportunity to communicate, support each other and learn. This paper considers different ways of maximising learning opportunities in handover, with particular emphasis on the strengths and challenges of the paediatric environment. Alongside review of the best available evidence, many of the ideas discussed were generated from working with a group of 65 experienced paediatricians with particular experience and interest in medical education as part of the Royal College of Paediatrics and Child Health Paediatric Educators Programme. Formal handover has increased in importance and been embedded in practice with the transition from “on-calls” to “full-shift” rotas in an effort to comply with the European Working Time Directive1 in the United Kingdom (UK). Departments responsible for acute patient care have had to incorporate two or three handover sessions into every day to ensure patient problems and management plans are appreciated by the incoming medical team

Continuing professional development : putting the learner back at the centre

Continuing professional development (CPD) is changing. Once seen as flexible on the basis of personal choice and mainly consisting of conferences and lecture style meetings, it is now much more likely to be specified, mandatory and linked to specific regulatory or quality improvement activities. This may not be well aligned with how adult professionals learn best and the evidence of resulting change in practice is limited. Also there is a danger of losing out on serendipity in learning by pushing experienced professionals into focusing excessively on mandatory activities that seem to be increasingly ‘ticking the box’. However, the previous impression of flexibility may have hidden poor education practice. This paper defines CPD and asks whether there are problems with CPD. It looks at how adults are thought to learn and places this in the context of current practice. It considers practical models of how to deal with a series of common challenges met by those who provide and undertake CPD

Warwick Medical School : A four dimensional curriculum

Medical curricula vary hugely across the world. Notions of horizontal and vertical integration and spiral curricula are present in many modern curricula although true integration happens to a varying degree. By seeing the development of a curriculum as fundamentally about integration, rather than as a process of seeking to integrate separate elements, we have developed a program that prepares students well for the complexities and rate of change of practice. The risks inherent in bringing forward the point at which learners need to deal with such substantive and fundamental complexity produces challenges. Such challenges are ones that our students have shown they can not only deal with, they are often better equipped than faculty to provide solutions for themselves, their peers and those who follow them. We present the three dimensions of integration in the Warwick Medical School curriculum and note the fourth dimension provided by our students, being student led teaching and support far beyond what is normally found in medical courses

Design, validation and dissemination of an undergraduate assessment tool using SimMan® in simulated medical emergencies

Background: Increasingly, medical students are being taught acute medicine using whole-body simulator manikins. Aim: We aimed to design, validate and make widely available two simple assessment tools to be used with Laerdal SimMan (R) for final year students. Methods: We designed two scenarios with criterion-based checklists focused on assessment and management of two medical emergencies. Members of faculty critiqued the assessments for face validity and checklists revised. We assessed three groups of different experience levels: Foundation Year 2 doctors, third and final year medical students. Differences between groups were analysed, and internal consistency and interrater reliability calculated. A generalisability analysis was conducted using scenario and rater as facets in design. Results: A maximum of two items were removed from either checklist following the initial survey. Significantly different scores for three groups of experience for both scenarios were reported (p0.90). Internal consistency was poor (alpha<50.5). Generalizability study results suggest that four cases would provide reliable discrimination between final year students. Conclusions: These assessments proved easy to administer and we have gone some way to demonstrating construct validity and reliability. We have made the material available on a simulator website to enable others to reproduce these assessments

Predicting success in graduate entry medical students undertaking a graduate entry medical program (GEM)

Background: Success in undergraduate medical courses in the UK can be predicted by school exit examination (A level) grades. There are no documented predictors of success in UK graduate entry medicine (GEM) courses. This study looks at the examination performance of GEM students to identify factors which may predict success; of particular interest was A level score. Methods: Data was collected for students graduating in 2004, 2005 and 2006, including demographic details (age and gender), details of previous academic achievement (A level total score and prior degree) and examination results at several points during the degree course. Results: Study group comprised 285 students. Statistical analyses identified no significant variables when looking at clinical examinations. Analysis of pass/fail data for written examinations showed no relationship with A level score. However, both percentage data for the final written examination and the analysis of the award of honours showed A level scores of AAB or higher were associated with better performance (p < 0.001). Discussion: A prime objective of introducing GEM programs was to diversify admissions to medical school. In trying to achieve this, medical schools have changed selection criteria. The findings in this study justify this by proving that A level score was not associated with success in either clinical examinations or passing written examinations. Despite this, very high achievements at A level do predict high achievement during medical school. Conclusions: This study shows that selecting graduate medical students with the basic requirement of an upper-second class honours degree is justifiable and does not disadvantage students who may not have achieved high scores in school leaver examinations

How and why children instigate talk in pediatric allergy consultations : a conversation analytic account

Involving children in their healthcare encounter is a national and international priority. While existing research has examined the ways in which children are recruited to participate in the consultation, no work has examined whether and how children instigate talk, and the extent to which their contributions are successful. This paper presents a conversation analysis of a selection of 10 out of 30 video recordings in which children aged 4–10 years instigate talk during consultations they attend with their parents/carers at a UK pediatric clinic. The analysis reveals for the first time that children do successfully instigate talk without being asked or selected in 22 episodes during their consultation with the doctor. Children most frequently address their parent/carer (16/22). They capitalize on specific contexts within the consultation to instigate talk, for example: history-taking questions about what they ate or how they reacted (10/22); or discussions surrounding the child's feelings or sensations following the skin-prick testing (7/22) - aspects of experience to which they have access. Children's non-solicited talk necessarily occurs when they are not currently active participators and children engage in extra interactional work including various verbal strategies (summons and prosodic variations) and non-verbal resources (tapping and gaze) to break into the interaction. The benefits of their contributions include the opportunity to affirm the child's role as a legitimate contributor, and the potential for additional medically-relevant information to arise which could enrich the clinical process. Our analysis shows that the previously overlooked phenomenon of children instigating talk, although not common, can play a crucial role in the consultation. We suggest that strategies to increase such involvement have the potential to augment the healthcare process. Our findings offer a critical baseline for the introduction of new consultations models, such as digital appointments, which may exclude some children completely

The impact of COVID-19 on medical education and medical students. How and when can they return to placements?

This article was migrated. The article was marked as recommended. The defining feature of 2020 will be the early and mid-stages of the covid-19 pandemic, declared by the World Health Organisation on 11th March. Rapid worldwide exponential spread continues and by 15 April, more than 1 900 000 cases and 123 000 deaths had been reported worldwide (WHO, 2020). Health services have coped to varying degrees. One common feature has been the withdrawal of routine care (Iacobucci, 2020a) and 'non-essential' staff including learners, although many have returned to undertake care roles. As the likely timeframe for stabilisation of health services becomes clearer, certainly in the United Kingdom (UK) (Iacobucci, 2020b), medical educators need to rapidly get the teaching of the next generation of health care workers back on track if they are to enter health services as confident and competent practitioners in 2020 and 2021. Although a 'whole world' experience, the effects of covid-19 sit in national contexts. We detail the issues for the UK in re-starting and re-inventing medical education, noting that the principles, if not necessarily the detail, will be common across the world

Health Impact Assessment in New South Wales & Health in All Policies in South Australia: differences, similarities and connections

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Policy decisions made within all sectors have the potential to influence population health and equity. Recognition of this provides impetus for the health sector to engage with other sectors to facilitate the development of policies that recognise, and aim to improve, population outcomes. This paper compares the approaches implemented to facilitate such engagement in two Australian jurisdictions. These are Health Impact Assessment (HIA) in New South Wales (NSW) and Health in All Policies (HiAP) in South Australia (SA). Methods: The comparisons presented in this paper emerged through collaborative activities between stakeholders in both jurisdictions, including critical reflection on HIA and HiAP practice, joint participation in a workshop, and the preparation of a discussion paper written to inform a conference plenary session. The plenary provided an opportunity for the incorporation of additional insights from policy practitioners and academics. Results: Comparison of the approaches indicates that their overall intent is similar. Differences exist, however, in the underpinning principles, technical processes and tactical strategies applied. These differences appear to stem mainly from the organisational positioning of the work in each state and the extent to which each approach is linked to government systems. Conclusions: The alignment of the HiAP approach with the systems of the SA Government increases the likelihood of influence within the policy cycle. However, the political priorities and sensitivities of the SA Government limit the scope of HiAP work. The implementation of the HIA approach from outside government in NSW means greater freedom to collaborate with a range of partners and to assess policy issues in any area, regardless of government priorities. However, the comparative distance of HIA from NSW Government systems may reduce the potential for impact on government policy. The diversity in the technical and tactical strategies that are applied within each approach provides insight into how the approaches have been tailored to suit the particular contexts in which they have been implemented. Keywords: Health in all policies, Health impact assessment, Healthy public polic