Medical education
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This article reviews and critically evaluates historical and contemporary research on simulation-based medical education (SBME). It also presents and discusses 12 features and best practices of SBME that teachers should know in order to use medical simulation technology to maximum educational benefit. ⋯ Development of and research into SBME have grown and matured over the past 40 years on substantive and methodological grounds. We believe the impact and educational utility of SBME are likely to increase in the future. More thematic programmes of research are needed. Simulation-based medical education is a complex service intervention that needs to be planned and practised with attention to organisational contexts.
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There is a growing literature on diagnostic errors. The consensus of this literature is that most errors are cognitive and result from the application of one or more cognitive biases. Such biased reasoning is usually associated with 'System 1' (non-analytic, pattern recognition) thinking. ⋯ Diagnostic errors are not simply a consequence of cognitive biases or over-reliance on one kind of thinking. They result from multiple causes and are associated with both analytical and non-analytical reasoning. Limited evidence suggests that strategies directed at encouraging both kinds of reasoning will lead to limited gains in accuracy.
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Review
A primer on classical test theory and item response theory for assessments in medical education.
A test score is a number which purportedly reflects a candidate's proficiency in some clearly defined knowledge or skill domain. A test theory model is necessary to help us better understand the relationship that exists between the observed (or actual) score on an examination and the underlying proficiency in the domain, which is generally unobserved. Common test theory models include classical test theory (CTT) and item response theory (IRT). The widespread use of IRT models over the past several decades attests to their importance in the development and analysis of assessments in medical education. Item response theory models are used for a host of purposes, including item analysis, test form assembly and equating. Although helpful in many circumstances, IRT models make fairly strong assumptions and are mathematically much more complex than CTT models. Consequently, there are instances in which it might be more appropriate to use CTT, especially when common assumptions of IRT cannot be readily met, or in more local settings, such as those that may characterise many medical school examinations. ⋯ Classical test theory and IRT are widely used to address measurement-related issues that arise from commonly used assessments in medical education, including multiple-choice examinations, objective structured clinical examinations, ward ratings and workplace evaluations. The present paper provides an introduction to these models and how they can be applied to answer common assessment questions.
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Medical education is as much about the development of a professional identity as it is about knowledge learning. Professional identities are contested and accepted through the synergistic internal-external process of identification that is constituted in and through language and artefacts within specific institutional sites. The ways in which medical students develop their professional identity and subsequently conceptualise their multiple identities has important implications for their own well-being, as well as for the relationships they form with fellow workers and patients. ⋯ Understanding the process through which we develop our identities has profound implications for medical education and entails that we adopt and develop new methods of collecting and analysing data. Embracing this challenge will provide better insights into how we might develop students' learning experiences, facilitating their development of a doctor identity that is more in line with desired policy requirements.