Medical education
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Health advocacy is widely accepted as a key element of competency-based education. We examined shifts in the language and description of the role of the health advocate and what these reveal about its interpretation and enactment within the context of medical education. ⋯ This study uncovers shifts in the language of physician advocacy that affect the discourse of health advocacy and expectations placed on physicians and trainees. Being explicit about expectations of the medical profession and individual practitioners may require renewed examination of societal needs. Although this study uses the CanMEDS role of Health Advocate as a specific example, it has implications for the conceptualisation of health advocacy in medicine and medical education globally.
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Increasing numbers of educational institutions in the medical field choose to replace their conventional admissions interviews with a multiple mini-interview (MMI) format because the latter has superior reliability values and reduces interviewer bias. As the MMI format can be adapted to the conditions of each institution, the question of under which circumstances an MMI is most expedient remains unresolved. This article systematically reviews the existing MMI literature to identify the aspects of MMI design that have impact on the reliability, validity and cost-efficiency of the format. ⋯ The MMI literature provides useful recommendations for reliable and cost-efficient MMI designs, but some important aspects have not yet been fully explored. More theory-driven research is needed concerning dimensionality and construct validity, the predictive validity of MMIs other than those of McMaster University, the comparison of station types, and a cost-efficient station development process.
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Recent calls propose the conceptualisation of medical education research as 'an improvement science for complex social interventions'. This involves developing principled, yet contextually grounded, descriptions of health care practice that increase the likelihood of successful intervention. Defining what health professionals should be taught using theoretical perspectives and analytical techniques borrowed from human-centred systems engineering (HCSE) may acknowledge this call by allowing learning objectives and performance assessment criteria to be aligned with the demands of actual work. ⋯ Learning objectives and performance assessment criteria derived from an HCSE perspective target people's attunement to environmental conditions as they strive to enact goal-directed behaviour. Implementing educational interventions from an HCSE perspective should facilitate a sustained positive impact across contexts because theories of person-environment interaction enable principled adaptations of interventions to local circumstances.