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1.  Combining a leadership course and multi-source feedback has no effect on leadership skills of leaders in postgraduate medical education. An intervention study with a control group 
Background
Leadership courses and multi-source feedback are widely used developmental tools for leaders in health care. On this background we aimed to study the additional effect of a leadership course following a multi-source feedback procedure compared to multi-source feedback alone especially regarding development of leadership skills over time.
Methods
Study participants were consultants responsible for postgraduate medical education at clinical departments. Study design: pre-post measures with an intervention and control group. The intervention was participation in a seven-day leadership course. Scores of multi-source feedback from the consultants responsible for education and respondents (heads of department, consultants and doctors in specialist training) were collected before and one year after the intervention and analysed using Mann-Whitney's U-test and Multivariate analysis of variances.
Results
There were no differences in multi-source feedback scores at one year follow up compared to baseline measurements, either in the intervention or in the control group (p = 0.149).
Conclusion
The study indicates that a leadership course following a MSF procedure compared to MSF alone does not improve leadership skills of consultants responsible for education in clinical departments. Developing leadership skills takes time and the time frame of one year might have been too short to show improvement in leadership skills of consultants responsible for education. Further studies are needed to investigate if other combination of initiatives to develop leadership might have more impact in the clinical setting.
doi:10.1186/1472-6920-9-72
PMCID: PMC2797774  PMID: 20003311
2.  Gender awareness among physicians – the effect of specialty and gender. A study of teachers at a Swedish medical school 
Background
An important goal for medical education today is professional development including gender equality and awareness of gender issues. Are medical teachers prepared for this task? We investigated gender awareness among physician teachers, expressed as their attitudes towards the role of gender in professional relationships, and how it varied with physician gender and specialty. We discuss how this might be related to the gender climate and sex segregation in different specialties.
Method
Questionnaires were sent to all 468 specialists in the clinical departments and in family medicine, who were engaged in educating medical students at a Swedish university. They were asked to rate, on visual analogue scales, the importance of physician and patient gender in consultation, of preceptor and student gender in clinical tutoring and of physician gender in other professional encounters. Differences between family physicians, surgical, and non-surgical hospital doctors, and between women and men were estimated by chi-2 tests and multivariate logistic regression analyses.
Results
The response rate was 65 %. There were differences between specialty groups in all investigated areas mainly due to disparities among men. The odds for a male family physician to assess gender important were three times higher, and for a male non-surgical doctor two times higher when compared to a male surgical doctor. Female teachers assessed gender important to a higher degree than men. Among women there were no significant differences between specialty groups.
Conclusions
There was an interaction between physician teachers' gender and specialty as to whether they identified gender as important in professional relationships. Male physicians, especially from the surgical group, assessed gender important to a significantly lower degree than female physicians. Physicians' degree of gender awareness may, as one of many factors, affect working climate and the distribution of women and men in different specialties. Therefore, to improve working climate and reduce segregation we suggest efforts to increase gender awareness among physicians, for example educational programs where continuous reflections about gender attitudes are encouraged.
doi:10.1186/1472-6920-3-8
PMCID: PMC280661  PMID: 14577837
3.  Changes in postgraduate medical education and training in clinical radiology 
Postgraduate medical education and training in many specialties, including Clinical Radiology, is undergoing major changes. In part this is to ensure that shorter training periods maximise the learning opportunities but it is also to bring medical education in line with broader educational theory. Learning outcomes need to be defined so that there is no doubt what knowledge, skills, attitudes and behaviours are expected of those in training. Curricula should be developed into competency or outcome based models and should state the aims, objectives, content, outcomes and processes of a training programme. They should include a description of the methods of learning, teaching, feedback and supervision. Assessment systems must be matched to the curriculum and must be fair, reliable and valid. Workplace based assessments including the use of multisource feedback need to be developed and validated for use during radiology training. These should be used in a formative and developmental way, although the overall results from a series of such assessments can be used in a more summative way to determine progress to the next phase of training. Formal standard setting processes need to be established for ‘high stakes’ summative assessments such as examinations. In addition the unique skills required of a radiologist in terms of image interpretation, pattern recognition, deduction and diagnosis need to be evaluated in robust, reliable and valid ways. Through a combination of these methods we can be assured that decisions about trainees’ progression through training is fair and standardised and that we are protecting patients by establishing national standards for training, curricula and assessment methods.
doi:10.2349/biij.4.1.e19
PMCID: PMC3097704  PMID: 21614310
Postgraduate; radiology; training; education
4.  Leadership Frames and Perceptions of Effectiveness among Health Information Management Program Directors 
Leadership is important to health science education. For program effectiveness, directors should possess leadership skills to appropriately lead and manage their departments. Therefore, it is important to explore the leadership styles of programs' leaders as health science education is undergoing reform. Program directors of two and four-year health information management programs were surveyed to determine leadership styles. The study examined leadership styles or frames, the number of leadership frames employed by directors, and the relationship between leadership frames and their perceptions of their effectiveness as a manager and as a leader. The study shows that program directors are confident of their human resource and structural skills and less sure of the political and symbolic skills required of leaders. These skills in turn are correlated with their self-perceived effectiveness as managers and leaders. Findings from the study may assist program directors in their career development and expansion of health information management programs as a discipline within the health science field.
As academic health centers receive greater pressure from the Institute of Medicine and accrediting agencies to reform health science education, the question of leadership arises. These centers have taken a leadership role in reforming health professional education by partnering with educational institutions to improve the health of communities.
To achieve health education reform, health sciences educators must apply effective leadership skills.1 College and university leadership is challenged on how to best approach educational reform across health science fields. This article discusses leadership styles employed by program directors of one health science department, health information management, in directing programs for health science education reform.
PMCID: PMC2047298  PMID: 18066358
Leadership frames; health information management; program effectiveness
5.  What is the impact of a national postgraduate medical specialist education reform on the daily clinical training 3.5 years after implementation? A questionnaire survey 
BMC Medical Education  2010;10:46.
Background
Many countries have recently reformed their postgraduate medical education (PGME). New pedagogic initiatives and blueprints have been introduced to improve quality and effectiveness of the education. Yet it is unknown whether these changes improved the daily clinical training. The purpose was to examine the impact of a national PGME reform on the daily clinical training practice.
Methods
The Danish reform included change of content and format of specialist education in line with outcome-based education using the CanMEDS framework. We performed a questionnaire survey among all hospital doctors in the North Denmark Region. The questionnaire included items on educational appraisal meetings, individual learning plans, incorporating training issues into work routines, supervision and feedback, and interpersonal acquaintance. Data were collected before start and 31/2 years later. Mean score values were compared, and response variables were analysed by multiple regression to explore the relation between the ratings and seniority, type of hospital, type of specialty, and effect of attendance to courses in learning and teaching among respondents.
Results
Response rates were 2105/2817 (75%) and 1888/3284 (58%), respectively. We found limited impact on clinical training practice and learning environment. Variances in ratings were hardly affected by type of hospital, whereas belonging to the laboratory specialities compared to other specialties was related to higher ratings concerning all aspects.
Conclusions
The impact on daily clinical training practice of a national PGME reform was limited after 31/2 years. Future initiatives must focus on changing the pedagogical competences of the doctors participating in daily clinical training and on implementation strategies for changing educational culture.
doi:10.1186/1472-6920-10-46
PMCID: PMC2902490  PMID: 20565832
6.  Undergraduate educational environment, perceived preparedness for postgraduate clinical training, and pass rate on the National Medical Licensure Examination in Japan 
BMC Medical Education  2010;10:35.
Background
We investigated the views of newly graduating physicians on their preparedness for postgraduate clinical training, and evaluated the relationship of preparedness with the educational environment and the pass rate on the National Medical Licensure Examination (NMLE).
Methods
Data were obtained from 2429 PGY-1 physicians-in-training (response rate, 36%) using a mailed cross-sectional survey. The Dundee Ready Education Environment Measure (DREEM) inventory was used to assess the learning environment at 80 Japanese medical schools. Preparedness was assessed based on 6 clinical areas related to the Association of American Medical Colleges Graduation Questionnaire.
Results
Only 17% of the physicians-in-training felt prepared in the area of general clinical skills, 29% in basic knowledge of diagnosis and management of common conditions, 48% in communication skills, 19% in skills associated with evidence-based medicine, 54% in professionalism, and 37% in basic skills required for a physical examination. There were substantial differences among the medical schools in the perceived preparedness of their graduates. Significant positive correlations were found between preparedness for all clinical areas and a better educational environment (all p < 0.01), but there were no significant associations between the pass rate on the NMLE and perceived preparedness for any clinical area, as well as pass rate and educational environment (all p > 0.05).
Conclusion
Different educational environments among universities may be partly responsible for the differences in perceived preparedness of medical students for postgraduate clinical training. This study also highlights the poor correlation between self-assessed preparedness for practice and the NMLE.
doi:10.1186/1472-6920-10-35
PMCID: PMC2881012  PMID: 20487536
7.  The educational component of senior house officer posts: differences in the perceptions of consultants and junior doctors. 
Postgraduate Medical Journal  1994;70(821):198-202.
The aims of this study were to elicit general practitioner (GP) trainee's perceptions of the educational structure of their hospital posts, to compare them with those of consultants who had GP trainees as senior house officers (SHOs) in their departments and to examine the use of educational objectives in the hospital component of vocational training for general practice. A confidential postal questionnaire was sent to all the GP trainees (165 doctors) in the hospital component of their vocational training schemes (VTS) for general practice in Trent Region and all the consultants (161 doctors) in Trent who had GP trainees in their SHO posts on that date. Responses were received from 136 trainees (82%) and 134 consultants (83%). Educational objectives were stated as existing in the SHO post by 31 trainees (23%) and by 62 consultants (46%). Of those doctors who said that objectives existed, 19 of the trainees (61%) and 40 of the consultants (65%) said that the objectives were useful. Only nine (29%) of the trainees who stated that educational objectives existed felt that they were being put into practice by senior staff, compared with 41 (66%) of consultants who had made that statement. Of all respondents, 113 trainees (87%) and 100 consultants (77%) agreed or strongly agreed that the use of educational objectives would be beneficial to the trainees. Only 10 (7%) of trainees said that they received no teaching in their current posts. Forty trainees (32%) and 88 consultants (67%) said that teaching took place in protected time. Both groups cited consultants as the member of staff giving the most teaching. Ninety-six consultants (73%) replied that it was possible for GP trainees to obtain study leave, but 102 trainees (75%) either had experienced difficulties in obtaining study leave or had not attempted to obtain study leave. Trainees and consultants differed appreciably in their perceptions of the amount of assessment and feedback which was provided for GP trainees. The use of educational objectives in the hospital component of vocational training was felt to be beneficial by both consultants and GP trainees. Consultants were more likely than trainees to report the use of educational objectives, protected teaching time, GP-orientated teaching, ability of trainees to attend VTS half-day release and the provision of assessment and feedback to trainees.
PMCID: PMC2397854  PMID: 8183753
8.  An exploratory study into the impact and acceptability of formatively used progress testing in postgraduate obstetrics and gynaecology 
Part of recent reforms of postgraduate medical training in the Netherlands is the introduction of formatively intended knowledge testing or progress testing. We previously evaluated the construct validity and reliability of postgraduate progress testing. However, when assessment is intended to be formative, the acceptability of the test (scores) and the educational impact that is achieved are at least as important in the utility of this assessment format. We developed a questionnaire targeted at both educational supervisors and postgraduate trainees, containing questions on general acceptability, educational impact and acceptability of test content. 90 % of trainees and 84 % of educational supervisors completed the questionnaire. The general acceptability of formatively used progress testing is good; however, the self-reported educational impact is limited. Furthermore, trainees query the validity of test content. Formatively intended progress testing is well accepted; however the impact is limited. We discuss the importance of feedback quality and the effect of grading. Furthermore we start a debate on whether, for a genuine effect on learning, formative assessment should have consequences, either by entwining the assessment with the training programme or by linking the assessment to a summative standard.
doi:10.1007/s40037-013-0063-2
PMCID: PMC3722371
Postgraduate; Formative assessment; Progress test; Acceptability; Educational impact
9.  An exploratory study into the impact and acceptability of formatively used progress testing in postgraduate obstetrics and gynaecology 
Part of recent reforms of postgraduate medical training in the Netherlands is the introduction of formatively intended knowledge testing or progress testing. We previously evaluated the construct validity and reliability of postgraduate progress testing. However, when assessment is intended to be formative, the acceptability of the test (scores) and the educational impact that is achieved are at least as important in the utility of this assessment format. We developed a questionnaire targeted at both educational supervisors and postgraduate trainees, containing questions on general acceptability, educational impact and acceptability of test content. 90 % of trainees and 84 % of educational supervisors completed the questionnaire. The general acceptability of formatively used progress testing is good; however, the self-reported educational impact is limited. Furthermore, trainees query the validity of test content. Formatively intended progress testing is well accepted; however the impact is limited. We discuss the importance of feedback quality and the effect of grading. Furthermore we start a debate on whether, for a genuine effect on learning, formative assessment should have consequences, either by entwining the assessment with the training programme or by linking the assessment to a summative standard.
doi:10.1007/s40037-013-0063-2
PMCID: PMC3722371
Postgraduate; Formative assessment; Progress test; Acceptability; Educational impact
10.  Need for enforcement of ethicolegal education – an analysis of the survey of postgraduate clinical trainees 
BMC Medical Ethics  2005;6:8.
Background
The number of medical lawsuits in Japan was between 14 and 21 each year before 1998, but increased to 24 to 35 per year after 1999. There were 210 lawsuits during this 10-year period. There is a need for skills and knowledge related to ethics, which is as fundamental to the practice of medicine as basic sciences or clinical skills. in Japan education in ethics is relatively rare and its importance is not yet recognized. Establishing ethics education using legal precedents, which has already been achieved in Western countries, will be a very important issue in Japan. In the present study, a questionnaire survey was conducted among graduate intern doctors, in order to investigate whether ethics education using precedents might have a positive effect in Japan.
Methods
In 2002, a questionnaire survey entitled Physicians' Clinical Ethics was carried out in a compulsory orientation lecture given to trainees before they started clinical practice in our hospital. The attendees at this lecture were trainees who came from colleges in various districts of Japan. During the lecture, 102 questionnaires were distributed, completed by attendees and collected. The recovery rate was 100%. The questionnaire consisted of 22 questions (in three categories), of which 20 were answered by multiple choices, and the other two were answered by description. The time required to complete the questionnaire was about 10 minutes.
Results
The recovered questionnaires were analyzed using statistical analysis software (SPSS for Windows, Release 10.07J-1/June/2000), in addition to simple statistical analysis. answers using multiple choices for the 20 questions in the questionnaire were input into SPSS. The principal component analysis was performed for each question. As a result, the item that came to the fore was "legal precedent". Since many intern doctors were interested in understanding laws and precedents, learning about ethical considerations through education using precedents might better meet with their needs and interests.
Conclusion
We applied a new method in which the results of principal component analysis and frequencies of answers to other questions were combined. From this we deduced that the precedent education used in Western countries was useful to help doctors acquire ethical sensitivity and was not against their will. A relationship was found between reading precedents and the influence of lawsuits, and it was thought that student participation-type precedent education would be useful for doctors in order to acquire ethical sensitivity.
doi:10.1186/1472-6939-6-8
PMCID: PMC1192799  PMID: 16083505
11.  Postgraduate trainees as simulated patients in psychiatric training: Role players and interviewers perceptions 
Indian Journal of Psychiatry  2010;52(4):350-354.
Background
Teaching skills to enhance competence in clinical settings need to have a focus on learning how to do. This paper describes the subjective experiences and feedback of trainees who participated in a teaching technique using postgraduate trainees as simulated patients.
Materials and Methods
The Objective Structured Clinical Assessment and Feedback was employed for training using trainees as simulated patients and interviewers. This exercise is performed in front of consultants and peers who subsequently provide feedback about the content and process using a structured format. In order to assess the subjective experience of the interviewer and the role players they were requested to provide structured feedback on several aspects. The trainee role player provided feedback on comfort in playing the role, need for further inputs, satisfaction regarding role play, satisfaction with the interview, and the overall effect of the activity. The trainee interviewer gave feedback on his/her level of comfort performing in front of a peer group, being watched, and evaluated in a group.
Results
The feedback forms from 15 sessions were analyzed. Only two of the role players indicated that they felt very uncomfortable while the rest reported comfort. Twelve of the 15 trainees who simulated patients felt they needed more inputs to improve the clarity of the role play; however they all reported feeling satisfied with the role play or interview. The feedback from the interviewers indicated that most were comfortable in all aspects, i.e. conducting the interview, performing in front of a group, being evaluated, and given feedback in front of a group.
Conclusion
The trainees report indicates that those simulating patients need more clarity on their roles and majority had no discomfort performing in front of a group. Interviewers were satisfied and comfortable with all aspects. On the whole, simulated interviews and role plays were found to be an acceptable teaching method by postgraduate psychiatry trainees.
doi:10.4103/0019-5545.74311
PMCID: PMC3025162  PMID: 21267370
Postgraduate training; psychiatry; role plays; simulated patients
12.  How do postgraduate GP trainees regulate their learning and what helps and hinders them? A qualitative study 
BMC Medical Education  2012;12:67.
Background
Self-regulation is essential for professional development. It involves monitoring of performance, identifying domains for improvement, undertaking learning activities, applying newly learned knowledge and skills and self-assessing performance. Since self-assessment alone is ineffective in identifying weaknesses, learners should seek external feedback too. Externally regulated educational interventions, like reflection, learning portfolios, assessments and progress meetings, are increasingly used to scaffold self-regulation.
The aim of this study is to explore how postgraduate trainees regulate their learning in the workplace, how external regulation promotes self-regulation and which elements facilitate or impede self-regulation and learning.
Methods
In a qualitative study with a phenomenologic approach we interviewed first- and third-year GP trainees from two universities in the Netherlands. Twenty-one verbatim transcripts were coded. Through iterative discussion the researchers agreed on the interpretation of the data and saturation was reached.
Results
Trainees used a short and a long self-regulation loop. The short loop took one week at most and was focused on problems that were easy to resolve and needed minor learning activities. The long loop was focused on complex or recurring problems needing multiple and planned longitudinal learning activities. External assessments and formal training affected the long but not the short loop. The supervisor had a facilitating role in both loops. Self-confidence was used to gauge competence.Elements influencing self-regulation were classified into three dimensions: personal (strong motivation to become a good doctor), interpersonal (stimulation from others) and contextual (organizational and educational features).
Conclusions
Trainees did purposefully self-regulate their learning. Learning in the short loop may not be visible to others. Trainees should be encouraged to actively seek and use external feedback in both loops. An important question for further research is which educational interventions might be used to scaffold learning in the short loop. Investing in supervisor quality remains important, since they are close to trainee learning in both loops.
doi:10.1186/1472-6920-12-67
PMCID: PMC3479408  PMID: 22866981
Self-regulation; Workplace-based learning; Postgraduate training; Professional development; Qualitative research methods
13.  The Development, Implementation, and Assessment of an Innovative Faculty Mentoring Leadership Program 
Effective mentoring is an important component of academic success. Few programs exist to both improve the effectiveness of established mentors and cultivate a multi-specialty mentoring community. In 2008, in response to a faculty survey on mentoring, leaders at Brigham and Women’s Hospital developed the Faculty Mentoring Leadership Program (FMLP) as a peer-learning experience for mid-career and senior faculty physician and scientist mentors to enhance their skills and leadership in mentoring and create a supportive community of mentors. A planning group representing key administrative, educational, clinical, and research mentorship constituencies designed the nine-month course.
Participants met monthly for an hour and a half during lunchtime. Two co-facilitators engaged the diverse group of 16 participants in interactive discussions about cases based on the participants’ experiences. While the co-facilitators discussed with the participants the dyadic mentor-mentee relationship, they specifically emphasized the value of engaging multiple mentors and establishing mentoring networks. In response to post-session and post-course (both immediately and after six months) self-assessments, participants reported substantive gains in their mentoring confidence and effectiveness, experienced a renewed sense of enthusiasm for mentoring, and took initial steps to build a diverse network of mentoring relationships.
In this article, the authors describe the rationale, design, implementation, assessment, and ongoing impact of this innovative faculty mentoring leadership program. They also share lessons learned for other institutions that are contemplating developing a similar faculty mentoring program.
doi:10.1097/ACM.0b013e3182712cff
PMCID: PMC3924178  PMID: 23095917
14.  Teachers' ideas versus experts' descriptions of 'the good teacher' in postgraduate medical education: implications for implementation. A qualitative study 
BMC Medical Education  2011;11:42.
Background
When innovations are introduced in medical education, teachers often have to adapt to a new concept of what being a good teacher includes. These new concepts do not necessarily match medical teachers' own, often strong beliefs about what it means to be a good teacher.
Recently, a new competency-based description of the good teacher was developed and introduced in all the Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. We compared the views reflected in the new description with the views of teachers who were required to adopt the new framework.
Methods
Qualitative study. We interviewed teachers in two Departments of Postgraduate Medical Education for Family Physicians in the Netherlands. The transcripts of the interviews were analysed independently by two researchers, who coded and categorised relevant fragments until consensus was reached on six themes. We investigated to what extent these themes matched the new description.
Results
Comparing the teachers' views with the concepts described in the new competency-based framework is like looking into two mirrors that reflect clearly dissimilar images. At least two of the themes we found are important in relation to the implementation of new educational methods: the teachers' identification and organisational culture. The latter plays an important role in the development of teachers' ideas about good teaching.
Conclusions
The main finding of this study is the key role played by the teachers' feelings regarding their professional identity and by the local teaching culture in shaping teachers' views and expectations regarding their work. This suggests that in implementing a new teaching framework and in faculty development programmes, careful attention should be paid to teachers' existing identification model and the culture that fostered it.
doi:10.1186/1472-6920-11-42
PMCID: PMC3163623  PMID: 21711507
15.  Use of a Standardized Patient Exercise to Assess Core Competencies During Fellowship Training 
Background
The Accreditation Council for Graduate Medical Education requires fellows in many specialties to demonstrate attainment of 6 core competencies, yet relatively few validated assessment tools currently exist. We present our initial experience with the design and implementation of a standardized patient (SP) exercise during gastroenterology fellowship that facilitates appraisal of all core clinical competencies.
Methods
Fellows evaluated an SP trained to portray an individual referred for evaluation of abnormal liver tests. The encounters were independently graded by the SP and a faculty preceptor for patient care, professionalism, and interpersonal and communication skills using quantitative checklist tools. Trainees' consultation notes were scored using predefined key elements (medical knowledge) and subjected to a coding audit (systems-based practice). Practice-based learning and improvement was addressed via verbal feedback from the SP and self-assessment of the videotaped encounter.
Results
Six trainees completed the exercise. Second-year fellows received significantly higher scores in medical knowledge (55.0 ± 4.2 [standard deviation], P  =  .05) and patient care skills (19.5 ± 0.7, P  =  .04) by a faculty evaluator as compared with first-year trainees (46.2 ± 2.3 and 14.7 ± 1.5, respectively). Scores correlated by Spearman rank (0.82, P  =  .03) with the results of the Gastroenterology Training Examination. Ratings of the fellows by the SP did not differ by level of training, nor did they correlate with faculty scores. Fellows viewed the exercise favorably, with most indicating they would alter their practice based on the experience.
Conclusions
An SP exercise is an efficient and effective tool for assessing core clinical competencies during fellowship training.
doi:10.4300/JGME-D-09-00001.1
PMCID: PMC2931209  PMID: 21975896
16.  The Legitimacy of Leadership in International Climate Change Negotiations 
Ambio  2012;41(Suppl 1):46-55.
Leadership is an essential ingredient in reaching international agreements and overcoming the collective action problems associated with responding to climate change. In this study, we aim at answering two questions that are crucial for understanding the legitimacy of leadership in international climate change negotiations. Based on the responses of three consecutive surveys distributed at COPs 14–16, we seek first to chart which actors are actually recognized as leaders by climate change negotiation participants. Second, we aim to explain what motivates COP participants to support different actors as leaders. Both these questions are indeed crucial for understanding the role, importance, and legitimacy of leadership in the international climate change regime. Our results show that the leadership landscape in this issue area is fragmented, with no one clear-cut leader, and strongly suggest that it is imperative for any actor seeking recognition as climate change leader to be perceived as being devoted to promoting the common good.
doi:10.1007/s13280-011-0240-7
PMCID: PMC3357891  PMID: 22439154
Climate change; Leadership; Legitimacy; Followers; Views on leadership; COP
17.  Promoting medical students’ reflection on competencies to advance a global health equities curriculum 
BMC Medical Education  2014;14:91.
Background
The move to frame medical education in terms of competencies – the extent to which trainees “can do” a professional responsibility - is congruent with calls for accountability in medical education. However, the focus on competencies might be a poor fit with curricula intended to prepare students for responsibilities not emphasized in traditional medical education. This study examines an innovative approach to the use of potential competency expectations related to advancing global health equity to promote students’ reflections and to inform curriculum development.
Methods
In 2012, 32 medical students were admitted into a newly developed Global Health and Disparities (GHD) Path of Excellence. The GHD program takes the form of mentored co-curricular activities built around defined competencies related to professional development and leadership skills intended to ameliorate health disparities in medically underserved settings, both domestically and globally. Students reviewed the GHD competencies from two perspectives: a) their ability to perform the identified competencies that they perceived themselves as holding as they began the GHD program and b) the extent to which they perceived that their future career would require these responsibilities. For both sets of assessments the response scale ranged from “Strongly Disagree” to “Strongly Agree.” Wilcoxon’s paired T-tests compared individual students’ ordinal rating of their current level of ability to their perceived need for competence that they anticipated their careers would require. Statistical significance was set at p < .01.
Results
Students’ ratings ranged from “strongly disagree” to “strongly agree” that they could perform the defined GHD-related competencies. However, on most competencies, at least 50 % of students indicated that the stated competencies were beyond their present ability level. For each competency, the results of Wilcoxon paired T-tests indicate – at statistically significant levels - that students perceive more need in their careers for GHD-program defined competencies than they currently possess.
Conclusion
This study suggests congruence between student and program perceptions of the scope of practice required for GHD. Students report the need for enhanced skill levels in the careers they anticipate. This approach to formulating and reflecting on competencies will guide the program’s design of learning experiences aligned with students’ career goals.
doi:10.1186/1472-6920-14-91
PMCID: PMC4013808  PMID: 24886229
Global health; Disparities; Medical education; Assessment; Reflection; Curriculum development
18.  Sports medicine and the accident and emergency medicine specialist 
Emergency Medicine Journal : EMJ  2002;19(3):239-241.
Background: Sport and exercise related injuries are responsible for about 5% of the workload in the accident and emergency (A&E) department, yet training in sports medicine is not a compulsory part of the curriculum for Higher Specialist Training.
Aim: To determine how A&E medicine consultants and specialist trainees view their role and skill requirements in relation to sports medicine.
Method: A modified Delphi study, consisting of two rounds of a postal questionnaire. Participants were invited to rate the importance of statements relating to the role and training of the A&E specialist in relation to sports injuries (six statements) and the need for knowledge and understanding of defined skills of importance in sports medicine (16 statements).
Value of research: This provides a consensus of opinion on issues in sport and exercise medicine that have educational implications for A&E specialists, and should be considered in the curriculum for Higher Specialist Training. There is also the potential for improving the health care provision of A&E departments, to the exercising and sporting population.
doi:10.1136/emj.19.3.239
PMCID: PMC1725845  PMID: 11971837
19.  Procedural confidence in hospital based practitioners: implications for the training and practice of doctors at all grades 
Background
Medical doctors routinely undertake a number of practical procedures and these should be performed competently. The UK Postgraduate Medical Education and Training Board (PMETB) curriculum lists the procedures trainees should be competent in. We aimed to describe medical practitioner's confidence in their procedural skills, and to define which practical procedures are important in current medical practice.
Methods
A cross sectional observational study was performed measuring procedural confidence in 181 hospital practitioners at all grades from 2 centres in East Anglia, England.
Results
Both trainees and consultants provide significant service provision. SpR level doctors perform the widest range and the highest median number of procedures per year. Most consultants perform few if any procedures, however some perform a narrow range at high volume. Cumulative confidence for the procedures tested peaks in the SpR grade. Five key procedures (central line insertion, lumbar puncture, pleural aspiration, ascitic aspiration, and intercostal drain insertion) are the most commonly performed, are seen as important generic skills, and correspond to the total number of procedures for which confidence can be maintained. Key determinants of confidence are gender, number of procedures performed in the previous year and total number of procedures performed.
Conclusion
The highest volume of service requirement is for six procedures. The procedural confidence is dependent upon gender, number of procedures performed in the previous year and total number of procedures performed. This has implications for those designing the training curriculum and with regards the move to shorten the duration of training.
doi:10.1186/1472-6920-9-2
PMCID: PMC2651872  PMID: 19138395
20.  Improving the preregistration experience: the New Zealand approach. 
BMJ : British Medical Journal  1994;308(6925):398-400.
There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students' undergraduate training, and the model could have much to offer the United Kingdom. Students take their final examinations at the end of the second clinical year; they spend their final year in a series of eight clinical attachments, during each of which they shadow a preregistration house officer or senior house officer. As trainee interns they are paid 60% of a house officer's salary for their clinical work, which is supervised by the firm's registrars and consultants under the overall responsibility of the head of the academic department. The order of the attachments is determined on educational, not service, grounds, and trainees have to attend educational sessions and pass assessments on each attachment. The trainee internship, funded jointly by the education and health departments, offers a more seamless transition from student to house officer and aims at improving both general medical education and clinical training.
Images
PMCID: PMC2539455  PMID: 8124150
21.  A novel method of assessing quality of postgraduate psychiatry training: experiences from a large training programme 
BMC Medical Education  2013;13:85.
Background
Most assessments of the quality of postgraduate training are based on anonymised questionnaires of trainees. We report a comprehensive assessment of the quality of training at a large postgraduate psychiatry training institute using non-anonymised face-to-face interviews with trainees and their trainers.
Methods
Two consultant psychiatrists interviewed 99 trainees and 109 trainers. Scoring of interview responses was determined by using a pre-defined criteria. Additional comments were recorded as free text. Interviews covered 13 domains, including: Clinical, teaching, research and management opportunities, clinical environment, clinical supervision, adequacy of job description, absence of bullying and job satisfaction. Multiple interview domain scores were combined, generating a ‘Combined’ score for each post.
Results
The interview response rate was 97% for trainers 88% for trainees. There was a significant correlation between trainee and trainer scores for the same interview domains (Pearson’s r = 0.968, p< 0.001). Overall scores were significantly higher for specialist psychiatry posts as compared to general adult psychiatry posts (Two tailed t-test, p < 0.001, 95% CI: -0.398 to −0.132), and significantly higher for liaison psychiatry as compared to other specialist psychiatry posts (t-test: p = 0.038, 95% CI: -0.3901, -0.0118). Job satisfaction scores of year 1 to year 3 core trainees showed a significant increase with increasing seniority (Linear regression coefficient = 0.273, 95% CI: 0.033 to 0.513, ANOVA p= 0.026).
Conclusions
This in-depth examination of the quality of training on a large psychiatry training programme successfully elicited strengths and weakness of our programme. Such an interview scheme could be easily implemented in smaller schemes and may well provide important information to allow for targeted improvement of training. Additionally, trends in quality of training and job satisfaction amongst various psychiatric specialities were identified; specifically speciality posts and liaison posts in psychiatry were revealed to be the most popular with trainees.
doi:10.1186/1472-6920-13-85
PMCID: PMC3695804  PMID: 23768083
Postgraduate Training; Postgraduate Medical Education; Psychiatry Training; Non-anonymised interviews; Non-anonymised feedback; Training quality; Trainees Feedback; Trainer Feedback
22.  Role modeling in medical education. 
Western Journal of Medicine  1994;160(4):335-337.
Role models play an important part in determining how medical trainees mature professionally. Demonstrating clinical skills at the bedside is the most distinctive characteristic of an effective role model. We discuss how role modeling affects professional identity and career choice and offer several suggestions for improving medical education, including the need for leaders to change the educational climate and culture. If implemented, these changes would enhance our ability to provide medical students with positive role models.
PMCID: PMC1022423  PMID: 8023482
23.  The University of Queensland Medical Leadership Program: A Case Study 
The Ochsner Journal  2012;12(4):344-347.
Changes in modern healthcare's provision, complexity, and workforce demands provide a compelling rationale for an increasing emphasis on leadership development at all levels of training within the medical profession. Undergraduate medical education has traditionally focused on the development of clinical acumen with little emphasis on the development of leadership skills or on the operational and systemic issues surrounding healthcare delivery. Incorporating leadership education and competencies presents a number of challenges to medical schools, including defining the subject area, determining the specific skills and knowledge bases that should constitute the basis of the program, and optimizing training to be integrated into the existing clinical curriculum. We present a case study of the Medical Leadership Program at The University of Queensland School of Medicine that runs concurrent to the undergraduate medical degree. We outline the inception of the program, its aims, participant selection, and program components and reflect on the program to date.
PMCID: PMC3527862  PMID: 23267261
Curriculum; leadership; medical education; medical student
24.  Nutrition in medical education: reflections from an initiative at the University of Cambridge 
Landmark reports have confirmed that it is within the core responsibilities of doctors to address nutrition in patient care. There are ongoing concerns that doctors receive insufficient nutrition education during medical training. This paper provides an overview of a medical nutrition education initiative at the University of Cambridge, School of Clinical Medicine, including 1) the approach to medical nutrition education, 2) evaluation of the medical nutrition education initiative, and 3) areas identified for future improvement. The initiative utilizes a vertical, spiral approach during the clinically focused years of the Cambridge undergraduate and graduate medical degrees. It is facilitated by the Nutrition Education Review Group, a group associated with the UK Need for Nutrition Education/Innovation Programme, and informed by the experiences of their previous nutrition education interventions. Three factors were identified as contributing to the success of the nutrition education initiative including the leadership and advocacy skills of the nutrition academic team, the variety of teaching modes, and the multidisciplinary approach to teaching. Opportunities for continuing improvement to the medical nutrition education initiative included a review of evaluation tools, inclusion of nutrition in assessment items, and further alignment of the Cambridge curriculum with the recommended UK medical nutrition education curriculum. This paper is intended to inform other institutions in ongoing efforts in medical nutrition education.
Video abstract
doi:10.2147/JMDH.S59071
PMCID: PMC4038452  PMID: 24899813
undergraduate medical education; nutrition; curriculum
25.  The opinions of postgraduate tutors on continuing education for general practitioners 
The recent big increase in learning opportunities for general practitioners, particularly in postgraduate medical centres, has been accompanied by increasing suspicion that educational activities may not be fulfilling the aims of continuing education, and that there is dissatisfaction with existing courses.
This study took place in the north-western region, and 18 clinical tutors were interviewed using a structured interview schedule.
Very few of the clinical tutors were aware of the existence of the book The Future General Practitioner—Learning and Teaching, and most activities consisted of lectures, lecturers usually being local and regional consultants, with occasional national authorities. Small group teaching rarely occurred, and all the centres had been supplied with videotape equipment.
Most of the tutors had attended a course on audiovisual aids, or a meeting organized by the National Association of Clinical Tutors, but the tutors appeared ill at ease when answering questions about educational aims and objectives, and most tutors were unable to identify an educational objective from a group of statements.
PMCID: PMC2158470  PMID: 859145

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