Medical education
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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.
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Randomized Controlled Trial
Authenticity of instruction and student performance: a prospective randomised trial.
This study aimed to investigate the relationship between the authenticity of instructional formats and outcome measures within a pre-clerkship clinical reasoning course. ⋯ Increasing the authenticity of instructional formats does not appear to significantly improve clinical reasoning performance in a pre-clerkship course. Medical educators should balance increases in authenticity with factors such as cognitive load, subject area and learner experience when designing new instructional formats.
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Review Historical Article
Looking back to the future: a message for a new generation of medical educators.
Many changes in medical education have occurred during the author's 50-year career in the field. The aim of this paper is to describe 10 lessons worth recording for others engaged in the training of health care professionals. ⋯ The following lessons have been learned. (i) People are important as role models and collaborators. (ii) Innovation in medical education is a complex process and research findings can easily be misinterpreted. (iii) Nudges, interventions that encourage rather than mandate change, are valuable. (iv) Students are important players in planning, delivering and evaluating a curriculum. Each student has different needs and aspirations. They are the 'digital natives'. (v) Offer stakeholders practical solutions to problems that can be implemented. (vi) There is always something to learn outside one's own practice. Go to a conference or read a journal in a related field. (vii) Time spent recording one's work and publishing reports based on it is rewarding. (viii) Learn from history. We don't need to keep reinventing the wheel. (ix) Obtain independent funding. (x) Finally, and most importantly, have fun. Working in medical education can be exciting, fulfilling and hugely enjoyable.
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The occupational health literature has long been dominated by stress-related topics. A more contemporary perspective suggests using a positive approach in the form of a health model focused on what is right with people, such as feelings of well-being and satisfaction. ⋯ This study identified EI as a factor in understanding doctors' work-related issues. Given the multi-dimensional nature of EI, refinement of the definition of EI and the construct validity of EI as rated by others require further examination.
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Non-conscious stereotyping and prejudice contribute to racial and ethnic disparities in health care. Contemporary training in cultural competence is insufficient to reduce these problems because even educated, culturally sensitive, egalitarian individuals can activate and use their biases without being aware they are doing so. However, these problems can be reduced by workshops and learning modules that focus on the psychology of non-conscious bias. THE PSYCHOLOGY OF NON-CONSCIOUS BIAS: Research in social psychology shows that over time stereotypes and prejudices become invisible to those who rely on them. Automatic categorisation of an individual as a member of a social group can unconsciously trigger the thoughts (stereotypes) and feelings (prejudices) associated with that group, even if these reactions are explicitly denied and rejected. This implies that, when activated, implicit negative attitudes and stereotypes shape how medical professionals evaluate and interact with minority group patients. This creates differential diagnosis and treatment, makes minority group patients uncomfortable and discourages them from seeking or complying with treatment. ⋯ Workshops or other learning modules that help medical professionals learn about non-conscious processes can provide them with skills that reduce bias when they interact with minority group patients. Examples of such skills in action include automatically activating egalitarian goals, looking for common identities and counter-stereotypical information, and taking the perspective of the minority group patient.