Medical education
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Many medical schools are currently undergoing curriculum reform. When considering the means by which students will be evaluated in a revised curriculum, the need to reduce the prevalences of depression and anxiety associated with academic stress must be weighed against the importance of academic outcomes. Pass/fail evaluation, as compared with tiered grading, is commonly presented as a means to adequately assess student performance while minimising stress and anxiety. The purpose of this literature review was to determine the impact of pass/fail grading on medical student well-being and academic outcomes. ⋯ Student well-being is enhanced and objective academic performance is not adversely affected by a pass/fail evaluation system, but students' ability to obtain a desired residency programme may be hindered by individual programme directors' preferences for tiered grading systems. There is an overall paucity of literature on this topic and additional study is needed.
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Training future doctors to develop an appropriate professional persona is an important goal of medical student education and residency training. Most medical education research paradigms on professionalism have focused largely on lapses (e.g. yelling as an example of communication failure) and tend to emphasise behaviour that should be avoided. The assumption is that, if left unchecked, students will see these negative behaviours exhibited by their role models and possibly emulate them, allowing the potential reinforcement of the inappropriate behaviours. ⋯ Year 3 medical students in the USA reported observing very positive, exemplary health care provider interactions that were diverse in focus. Themes were identified regarding the OR team members' interactions with patients (calm, communication, comforting), with one another (teamwork, respect) and with the medical students (teaching). This classification of exemplary OR behaviour contributes to our understanding of how professional behaviour is viewed and potentially emulated by medical students on surgical rotations.
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Prior work has found that a doctor's clinical reasoning performance varies on a case-by-case (situation) basis; this is often referred to as 'context specificity'. To explore the influence of context on diagnostic and therapeutic clinical reasoning, we constructed a series of videotapes to which doctors were asked to respond, modifying different contextual factors (patient, doctor, setting). We explored how these contextual factors, as displayed by videotape encounters, may have influenced the clinical reasoning of board-certified internists (experts). Our purpose was to clarify the influence of context on reasoning, to build upon education theory and to generate implications for education practice. ⋯ Our unified model is consistent with the tenets of cognitive load, situated cognition and ecological psychology theories. A number of potentially modifiable influences on clinical reasoning were identified. Implications for doctor training and practice are discussed.