Med Ed Briefs

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The Alliance for Clinical Education (ACE) has worked with Teaching & Learning in Medicine to provide these brief reviews.  ACE members review key articles and offer suggestions about how the work can be applied more broadly.  Busy schedules often limit the time to stay current on medical education literature.  Med Ed Briefs is a way to get a sense for what’s being published and entice you to read more!

Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum 

Citation:  Mark R. Tonelli & Robyn Bluhm (2021) Teaching Medical Epistemology within an Evidence-Based Medicine Curriculum, Teaching and Learning in Medicine, 33:1, 98-105, DOI: 10.1080/10401334.2020.1835666. https://www.tandfonline.com/doi/full/10.1080/10401334.2020.1835666

What is this article about?

Don’t shy away from the heady title!  The authors posit that epistemology, the philosophical branch dedicated to understanding knowledge itself, is an underemphasized element of medical education.  They argue that our recent emphasis on evidence-based medicine (EBM) has obscured the value and necessity of integrating clinical experience and underlying knowledge of pathophysiology in making sound clinical decisions.  They suggest that applying a metacognitive approach of applying EBM approaches to EBM itself may deepen learners’ understanding of the necessarily multifaceted nature of clinical medicine, as well as the potential pitfalls of using EBM as a sine qua non approach.  They conclude that teaching learners to think about how they are thinking improves their reasoning and contributes to sound decision-making.

Why should you read the article?

This article walks through defining epistemology, clarifying its value in medical education, and then breaking down a three-tiered approach to integrating its central tenets.  The authors encourage education on different types, levels, and hierarchies of evidence in the preclinical years, evolving to an understanding of how to assess evidence in undergraduate medical education, and culminating in an appreciation of integrating basic scientific knowledge, research findings, and clinical experience in graduate training and beyond.  In a refreshing turn, they emphasize the importance of considering lessons learned from the clinical realm as a valid and essential element of the art of medicine.

How can you use this article?

While the title might be frighteningly philosophical, the take home message is to encourage a much broader education on how to think about what we do and how to incorporate the value of basic sciences, research, and clinical experience into a more comprehensive approach.  They recommend utilizing case-based studies to explore these elements, and we as educators are positioned to benefit from this exercise as well.  Thinking about how we think may allow us to shape learners’ development even further by meting out what parts of our own approaches stem from underlying pathophysiology, from research, and from our experience.  The last of these can be difficult to identify clearly, and by doing so we model a broader, more integrated approach for the next generation to aspire to.

Published 2021-04-06

Review Author:  Corinne A Bazella, M.D.; Associate Professor and Director, Ob/Gyn Clerkship; Case Western Reserve University School of Medicine, Cleveland, OH. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change

Citation: James Dalton, Kimberley Ivory, Paul Macneill, Louise Nash, Jo River, Paul Dwyer, Claire Hooker, David Williams & Karen M. Scott (2020) Verbatim Theater: Prompting Reflection and Discussion about Healthcare Culture as a Means of Promoting Culture Change, Teaching and Learning in Medicine, 32:5, 531-540, DOI: 10.1080/10401334.2020.1768099 https://doi.org/10.1080/10401334.2020.1768099

What is this article about?

This article describes the use of Verbatim Theater (VT) to facilitate awareness and discussion of the hierarchy within the medical education and clinical environments, particularly related to mistreatment of learners and junior health professionals.  In VT, a script is created and performed using only the spoken words of informants for the purpose of attitudinal change.  In Australia, the Sydney Arts and Health Collective recruited and interviewed inter-professional healthcare students to create a play in the VT genre.  A month after performance of the play, open to the lay public, a subset of the audience comprising healthcare students and professionals reflected on training culture and potential for change.  Participants were able to recognize portrayals of their own experiences and propose antidotes to systemic issues, such as harassment and bullying.

Why should you read the article?

This article brings together 3 timely topics of interest to medical educators:  1) addressing trainee mistreatment 2) using the arts and humanities 3) incorporating inter-professional education.  Over the past decade, identification of the longstanding problem of medical student mistreatment has garnered increased attention. Bullying and harassment of trainees is not unique to Australia, and crosses the boundaries of disciplines beyond medicine to nursing and other healthcare disciplines.  Simultaneously, the American Association of Medical Colleges initiatives encourage the integration of the arts in medical education and inter-professional education.  This article describes a specific example of the use of the arts to promote cultural change in healthcare training and the reflection and discussion it generated.

How can you use this article?

As the COVID pandemic shines a spotlight on disparities and systemic racism in society, healthcare and medical education, medical students are eager to participate and lead efforts in reform.  Consider this exemplar of a theatrical genre to create and implement educational experiences integrating the arts to promote attitudinal and social change in your own curriculum.

Published 2021-03-05

Review Author:  Mary Blazek, M.D.; Clinical Associate Professor and Director, Geriatric Psychiatry Clinic; University of Michigan Medical School, Ann Arbor, MI. ACE Member Organization:  Association of Directors of Medical Student Education in Psychiatry

Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students

Citation: Michelle E. Kiger, Caylin Riley, Adrienne Stolfi, Stephanie Morrison, Ann Burke & Tai Lockspeiser. (2020). Use of Individualized Learning Plans to Facilitate Feedback Among Medical Students, Teaching and Learning in Medicine, 32:4, 399-409, DOI: 10.1080/10401334.2020.1713790 https://www.tandfonline.com/doi/abs/10.1080/10401334.2020.1713790

What is this article about?

This article is studying the use of individualized learning plans (ILP) in pediatric clerkships at two different institutions to evaluate if sharing learner ILPs affects the feedback students receive from faculty and resident preceptors.  The authors’ hypothesis was that sharing the learners’ ILP with the preceptor would improve the quality of feedback, would enhance the specificity of the feedback related to the ILP and improve the feedback as perceived by the learner.

Why should you read the article?

This article discusses the feedback loop between faculty/resident preceptors and medical students using ILPs to help promote and strengthen that circular relationship.  As educators, we know that specific timely feedback enables medical students to make behavioral changes that improve their performance.  This article shows how ILPs have the potential to focus preceptor attention to a student’s specific learning goal and plan which could potentially allow students to progress their learning in those specific goals.

Additionally, this study shows that faculty and student engagement and buy in is important when incorporating ILPs into the curriculum. Students who had significant progress on their learning goals found the ILP exercise to be more useful.

How can you use this article?

The learning environment with long term relationships between students and preceptors are situations where ILPs can take advantage of the strong interpersonal relationship between student and teacher. Incorporating preceptors in the process of the student developing their ILP could also be beneficial in helping students form meaningful ILPs and help faculty focus feedback and learner progress.

Published 2021-02-05

Review Author:  Corinne A Bazella, M.D.; Associate Professor and Director, Ob/Gyn Clerkship; Case Western Reserve University School of Medicine, Cleveland, OH. ACE Member Organization:  Association of Professors of Gynecology and Obstetrics

Unpacking Medical Students’ Mixed Engagement in Health Systems Science Education

Citation: Jed D. Gonzalo, Christopher Davis, Britta M. Thompson & Paul Haidet (2020) Unpacking Medical Students’ Mixed Engagement in Health Systems Science Education, Teaching and Learning in Medicine, 32:3, 250-258, DOI: 10.1080/10401334.2019.1704765  https://www.tandfonline.com/doi/full/10.1080/10401334.2019.1704765

What is this article about?

The authors evaluate, qualitatively, one institution’s learner evaluations of an integrated health systems science curriculum. This third pillar to medical education, in addition to the basic and clinical sciences, includes competencies devoted to interprofessional collaboration, population health, and high value care. Any significant change in medical education brings the challenge of faculty and learner buy-in, development of content experts and course leadership, and identification and retention of resources. Exploring learners’ perceptions helps identify challenges and solutions.

Why should you read the article?

This article highlights a central tension in medical education: are we preparing learners to become future physicians, or are we focusing on preparing learners for high-stakes factual examinations? The hidden curriculum creates pressure on the learner to see these non-tested topics as a waste of time. Learners may fail to see these health system sciences competencies as encompassing their professional identities as physicians, and more of a “somebody else’s” problem.

The other important takeaway here is the power of the data we routinely collect to evaluate our curricula. The importance of identifying and understanding the perceptions of the consumers of the curriculum, the learners, is vital to future modifications. This is not the tail wagging the dog; instead harnessing learners’ concerns may aid in highlighting why these competencies are important.

How can you use this article?

While not the main message of the article, the authors highlight the meaningful use of evaluation data in the continuous quality improvement of a curriculum. For an additional pillar of medical education to be successful, both faculty and learners need to buy in and accept it.  Specifically addressing learner perceptions can lead to increased acceptance and engagement in new curricula.

Published 2020-09-24

Review Author:  Scott Graziano, M.D., MS; Professor of Obstetrics & Gynecology and Assistant Dean for for Clinical Development and Third Year Curricular Director for Loyola University Chicago, Stritch School of Medicine, Chicago, IL.  ACE member organization:  Association of Professors of Gynecology and Obstetrics