Medical education
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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.
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The script concordance test for clinical reasoning: re-examining its utility and potential weakness.
The script concordance test (SCT) assesses clinical reasoning under conditions of uncertainty. Relatively little information exists on Z-score (standard deviation [SD]) cut-offs for distinguishing more experienced from less experienced trainees, and whether scores depend on factual knowledge. Additionally, a recent review highlighted the finding that the SCT is potentially weakened by the fact that the mere avoidance of extreme responses may greatly increase test scores. ⋯ The SCT was able to differentiate between test subjects of varying levels of competence, and results were not associated with medical knowledge. However, the test was vulnerable to responses that intentionally avoided extreme values. Increasing the proportion of questions with extreme modal answers may attenuate the effect of candidates exploiting the test weakness related to extreme responses.
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Shame and guilt are subjective emotional responses that occur in response to negative events such as the making of mistakes or an experience of mistreatment, and have been studied extensively in the field of psychology. Despite their potentially damaging effects and ubiquitous presence in everyday life, very little has been written about the impact of shame and guilt in medical education. ⋯ The authors conclude with recommendations for research on shame and guilt and their influence on the experience of the medical learner. This critical research plus enhanced recognition of shame and guilt will allow teachers and institutions to further cultivate the engaged, empathetic and shame-resilient learners they strive to create.