What works in medical education?

1. What works in medical education? Angel Centeno, MD, PhD SIMEC 2012 Riyadh

2. What works? What does this mean? • Better grades • Better residency places • More primary care practitioners • Highest number of publications • Better individual health • Better public health indicators • …

3. Different categories/ levels Individual level • Students • Feedback • Active learning • Faculty members • Faculty development Institutional level • School´s mission Social level • Context

4. 1: Feedback

5. Students receiving feedback (Isaacson et al)

6. The critical elements Descriptive Credible Specific Possibility of change Clear Timely Selective Respectful Positive climate Action plan

7. The KSS method Keep Stop Start

8. What is missing…?: Characteristics of the recipient • Confident • Previous successful experiences with feedback • Readiness to receive it • Consistency with self perceptions Eva et al (2012)

9. What is missing…?: promotion of reflection For feedback to improve practice, the facilitation of reflection may be of equal importance to the provision of effective feedback Sargeant et al (2009)

10. The KSSR method Keep Stop Start Reflect

11. 2: Active learning

12. Active learning Learner engages in some activity manual (skills) intellectual (knowledge) To: acquire competences or to apply them in practice, or to develop professional and professional growth Wagenaar et al

13. Active learning Redundancy: all learning is active Most learning, regardless of the curriculum is a solitary activity; to that extent most learning is active. (Norman 2004) The learning that leads to knowledge is taking place around, under and beside the curriculum, not as part of it. (Norman, Schmidt, 2000)

14. Active learning is not: • Self directed learning • PBL • Small group learning

15. Learn by doing • Skills Learn by thinking • Synthesize • Paraphrase • Categorize • Elaborate • Integrate • Evaluate Learn by observing • Observation may be active

16. Findings on active learning Active learning increases knowledge measured by standard tests It is maintained in the medium term It decreases with long time It is not perceived to be effective It is perceived of lower value than traditional “didactic“ teaching Haidet et al 2004

17. Faculty development

18. Faculty development Is it useful? Does it make a difference?

19. Key features of effective faculty development use of experiential learning, provision of feedback, effective peer and colleague relationships, well-designed interventions following principles of teaching and learning, use of a diversity of educational methods Steinert et al

20. What they did not mention Longitudinal long term experiences Personal involvement / transformation High level impact Armstrong et al, Burdick et al

21. The institutions: mission

22. The institutions: explicit mission Recognition of a long–term implicit contract between the medical school and the society it serves (Lewkonia)

23. Lack of specificity of missions declared The triad: Education, research and clinical service • “The mission of the school is threefold: the training of physicians, the search for new knowledge and the care for the sick…” The words: • Excellence, innovation, humanitarian, compassionate, life long learning, quality, …

24. Specific missions: two examples “Central to our mission is the preparation of health professionals and scientists who can ... adapt to change and initiate change, and collaborate within interdisciplinary teams” “…will be responsive to the health needs of he communities of northern Australia and the school will be a leader in the four areas of rural and remote health, indigenous health and tropical medicine for Australia and for the wider Asia-Pacific region”

25. Context

26. Three dimensional model of context Physical dimension Cognitive/ semantic dimension Affective dimension Koens et al 2005

27. Three dimensional model of context Physical dimension Cognitive/ semantic dimension Affective dimension What is missing? • The Cultural dimension

28. Lack of recognition of, and adaptation to context is a powerful obstacle to success for any educational program

29. So, whatworks? Feedback • Takingcare of recipientscharacteristics, and promotingreflection Active learning • Recognizingthatwhatstudentdoesisthemostimportant variable in learning Facultydevelopment • Longitudinal, longterm and transformationalprograms are themosteffective Medical schoolmission • Theexplicit, specific and sharedmissionfacilitatessuccess Context • Identifyspecific social characteristics and be critical of externalprogramsbeforeadoptingthem

30. Thank you acenteno@cas.austral.edu.ar