Peer-mentoring experiences in higher education have been largely effective largely effective, however institutions implement them differently. The focus of this program evaluation was a peer-mentoring program at a medical school in the southeastern region of the United States, which had not previously been evaluated. Guided by Kolb's experiential learning theory, the purpose of the evaluation in this study was to examine whether the peer-mentoring experience was perceived as helpful to new students and how students thought the program could be improved. The sequential mixed-method design consisted of a survey of 179 students and interviews of 8 students. A thematic analysis of qualitative data was completed using a constant comparative approach. The qualitative data revealed that students perceived the program as having had a positive effect on their confidence in succeeding in school. They felt more committed to completing school, were more likely to use resources, and reported that peer-mentoring positively affected their learning. The findings also provided recommendations for program refinement related to the selection process, increased opportunities for individual mentoring, systematic documentation for study strategies, and additional group activities. These recommendations were included in the evaluation report. Evaluation results have important implications for positive social change at the local college of medicine that include peer support to ensure retention, facilitated discussion on coping strategies and sources of support, and academic success for students.

UA Open Access Publishing Fund / Introduction: Language and cultural barriers are detriments to quality health care. In acute medical settings, these barriers are more pronounced, which can lead to poor patient outcomes. Materials and methods: We implemented a longitudinal Spanish-language immersion curriculum for emergency medicine (EM) resident physicians. This curriculum includes language and cultural instruction, and is integrated into the weekly EM didactic conference, longitudinal over the entire 3-year residency program. Language proficiency was assessed at baseline and annually on the Interagency Language Roundtable (ILR) scale, via an oral exam conducted by the same trained examiner each time. The objective of the curriculum was improvement of resident language skills to ILR level 1+ by year 3. Significance was evaluated through repeatedmeasures analysis of variance. Results: The curriculum was launched in July 2010 and followed through June 2012 (n=16). After 1 year, 38% had improved over one ILR level, with 50% achieving ILR 1+ or above. After year 2, 100% had improved over one level, with 90% achieving the objective level of ILR 1+. Mean ILR improved significantly from baseline, year 1, and year 2 (F=55, df =1; P,0.001). Conclusion: Implementation of a longitudinal, integrated Spanish-immersion curriculum is feasible and improves language skills in EM residents. The curriculum improved EM-resident language proficiency above the goal in just 2 years. Further studies will focus on the effect of language acquisition on patient care in acute settings

The character of the professional socialization experience is a subject of debate in the literature; one of the primary issues being the relative contributions of trainees to the nature of their socializing experience. As crucial as the clinical education experience is to the educational and professional development of medical students, it has received relatively little attention in the literature on professional socialization of physicians. The goals of this research were to understand, from the students' perspective, the character of the first clinical learning experience in the medical school career of a group of medical students and, given the character of that context, the role of student negotiations in their own education and professional socialization. This study employed a symbolic interactionist framework and the data collection methods of participant observation and unstructured interview. The data collection was conducted over a six-week period during which time the researcher experienced along with a group of six medical students their first clinical learning experience. These students perceived the clinical learning environment to be challenging, complex and frequently too busy to easily accommodate their learning needs. They recognized the enormity of their learning task and of their own incompetence. These were the basic perceptions that prompted the students to negotiate their clinical learning experience. Student negotiations took three basic forms: the creation of new learning opportunities, the manipulation of existing learning resources, and interpretation of events and behaviors. Students' negotiations were constrained by the structure of the education program and the students' own assertiveness. The study's findings indicate that the students were active negotiators of the content and the conduct of their own professional education and professional socialization. Even in the face of overwhelming demands on their intellectual and emotional resources, the students expressed their individual and collective intent for their educational experience. The study findings were similar to those of earlier studies of professional socialization, although new behaviors and behaviors inconsistent with those found in previous research were uncovered. Contributions to the literature on professional socialization and to an understanding of this phenomenon were made through the explanation of these inconsistencies.

Background: Whilst direct-observation, workplace-based (or performance) assessments, sit at the conceptual epitome of assessment within medical education, their overall utility is limited by high-inter-assessor score variability. We conceptualised this issue as one of problematic judgements by assessors. Existing literature and evidence about judgements within performance appraisal and impression formation, as well as the small evolving literature on raters’ cognition within medical education, provided the theoretical context to study assessor’s judgement processes.Methods and Results: In this thesis we present three studies. The first study adopted an exploratory approach to studying assessors’ judgements in direct observation performance assessments, by asking assessors to describe their thoughts whilst assessing standard videoed performances by junior doctors. Comments and follow up interviews were analysed qualitatively using grounded theory principles. Results showed that assessors attributed different levels of salience to different aspects of performances, understood criteria differently (often comparing performance against other trainees) and expressed their judgements in unique narrative language. Consequently assessors’ judgements were comparatively idiosyncratic, or unique.The two subsequent follow up studies used experimental, internet based, experimental designs to further investigate the comparative judgements demonstrated in study 1. In study 2, participants were primed with either good or poor performances prior to watching intermediate (borderline) performances. In study 3 a similar design was employed but participants watched identical performances in either increasing or decreasing levels of proficiency. Collectively, the results of these two studies showed that recent experiences influenced assessors’ judgements, repeatedly showing a contrast effect (performances were scored unduly differently from earlier performances). These effects were greater than participants’ consistent tendency to be either lenient or stringent and occurred at multiple levels of performance. The effect appeared to be robust despite our attempting to reduce participants’ reliance on the immediate context. Moreover, assessors appeared to lack insight into the effect on their judgements.Discussion: Collectively, these results indicate that assessors score variations can be substantially explained by idiosyncrasy in cognitive representations of the judgement task, and susceptibility to contrast effects through comparative judgements. Moreover, assessors appear to be incapable of judging in absolute terms, instead judging normatively. These findings have important implications for theory and practice and suggest numerous further lines of research.

This thesis explores the relationship between physicians’ clinical and educational roles in the context of UK General Practice (GP) education by investigating the experiences of seven GP trainers through an ethnographic approach employing Activity Theory (AT). The Introduction considers the philosophy and structures of GP education and outlines the author’s professional biography to provide context. The Literature Review focusses on the development of medical education as a discrete field and identity formation in medical educators, concluding that: specialist medical educators are a relatively new group; and there is a paucity of knowledge regarding the impact on physicians of occupying dual clinical and educational roles. The thesis then focusses on three Research Questions (RQs), namely: 1. What is the impact of GP trainers’ clinical practice upon their educational work? 2. How does GP trainers’ educational practice influence their clinical work? 3. What are the social contexts for GP trainers’ clinical and educational practice? These questions are addressed within a pragmatic theoretical framework to build up an ethnographic description of the participants’ experiences. Data collection is through semi-structured interviews and observation of video-recorded teaching. Ethical issues associated with the study are discussed in detail, in particular the challenges of “insider” research. Four approaches are used for data analysis: global impressions; word cloud analysis; thematic analysis; and analysis shaped by AT. In answer to RQs 1 and 2, the study finds that GP trainers experience their dual roles as intimately linked, intuitively transferring their skills between their clinical and educational practice. The study also finds that GP trainers reconstruct their professional identities through teaching. With regard to RQ 3, engaging in teaching can lead to internal conflict for GP trainers and tensions with their colleagues, trainees and regulators. These findings are discussed in relation to medical education research methodology and the impact the study on the researcher is explored. The thesis closes by considering the conflicted position the participants occupy, concluding that teaching offers physicians the opportunity to reconstruct their professional identities so they can approach tensions in their practice with a sense of agency and optimism.

Revisión por pares / Conflictos de interés: Graciela Risco de Domínguez integró la Comisión Orgnizadora de la Escuela de Medicina de la UPC, siendo vicerrectora académica de la Universidad. A partir de noviembre de 2011, hasta marzo de 2014 desempeñó el cargo de decana de la Facultad de Ciencias de la Salud, de la cual la Escuela de Medicina forma parte / La educación basada en competencias es una forma de diseñar, desarrollar, entregar y documentar la instrucción en base a los objetivos y resultados que se propone alcanzar, por ello, ha sido recomendada para la formación médica. En este artículo se presenta las etapas del proceso de diseño e implementación del currículo por competencias de una nueva escuela de Medicina en un universidad peruana Se detalla el proceso que se siguió, incluyendo el análisis del contexto, diseño de la misión, del perfil profesional, los contenidos y la organización del currículo, así como la evaluación y recursos para el aprendizaje. Finalmente, se recapitulan los retos y desafíos enfrentados, y las lecciones aprendidas / Competency-based education is a form of designing, developing, delivering and documenting instruction based on a set of objectives and results that have been recommended for medical education. This article describes the steps in the process of designing and implementing a competency-based curriculum at a new medical school in a Peruvian university. We present the process followed including context analysis, mission design, the professional profile, the content and organization of the curriculum as well as the evaluation and resources for the training. Finally, issues and challenges faced, as well as lessons learned are summarized.

Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006-2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to 1) appropriate factor analysis methodology and reporting and 2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize this gap in best practices and subsequently to promote instrument development research that is more consistent through the peer-review process.

The purpose of this study was to improve critical thinking skills in clinical laboratory technologists through the development, implementation, and assessment of a multimodal model targeting critical thinking skills. Clinical laboratory technologists influence patient care through the testing of laboratory samples. Employers of these entry level professionals identified a need for improved critical thinking skills. This quasi-experimental study aimed to design a multimodal critical thinking model, implement the model into the clinical laboratory educational curriculum, and assesses this skill set for students in a pre-test / post-test format. The model was delivered and assessed for 47 clinical laboratory students at the University of Texas M.D. Anderson Cancer Center’s School of Health Professions. Based on numerical results for the Health Science Reasoning Test (HSRT), no significant difference in critical thinking skills was observed for clinical laboratory students before and after the integration of the multimodal model targeting this skill set into the curriculum. For the purpose of this study, critical thinking was defined as the ability to effectively evaluate and interpret data, apply existing knowledge to solve problems in new situations, demonstrate creativity and resourcefulness in learning, and problem solving, and effectively and persuasively communicate findings. Further analysis of the results indicated that junior and community college students were more likely to improve their HSRT scores after completion of the multimodal model than 4-year university and bachelor level students. Findings also suggest a positive relationship between GPA and improved HSRT scores. The amount of time as student spent on each assessment was directly related to success, and an inverse relationship was observed for usage of the model reference material. Further studies are needed to ensure model validity and generalizability of findings. Additionally, HSRT categorical results indicate the need for model modifications to better target the areas of deduction and inference. The online, asynchronous format may benefit from the addition of mandated discussion boards, and requiring assessment and evaluation completion may reduce the effects of lack of effort due to cognitive fatigue observed for this study.

This study was conducted to determine if there was a relationship between targeted funding of research and education and faculty perception of academic freedom at their medical schools. A total of 130 physician and basic sciences faculty from three medical schools assessed academic freedom at their institutions on an academic freedom inventory developed specifically for this study. The lack of a representative sample and the weak explanatory power of the findings limit conclusions that could be drawn. Using multiple regression analysis, the researcher was not able to reject the null for a relationship between targeted funding and academic freedom, using the probability of F statistical test (p>0.05). Other variables included I the study were found to be statistically significant, but the models were generalized considered weak. A statistically significant relationship was found for faculty, who perceived faculty governance and institutional autonomy to be inhibited at their institutions more than their administrators. Collateral track faculty perceived freedom to research to be inhibited, while women and minorities perceived freedom to speak to be inhibited. One unexpected finding was the relationship between being male and being a citizen with a perception that academic freedom was inhibited at their institutions more so than for women and faculty who were not U.S. citizens. These findings were surprising given concern raised in the literature about the treatment of foreign faculty and students after the 9-11 terrorist attacks (AAUP, 2003). Further research is recommended to determine if findings can be replicated with a reliable instrument and a representative sample.

Prescribing medicines is the primary intervention that most doctors offer to influence their patients’ health; however concerns have been expressed about the extent to which graduates are prepared by medical schools to assume prescribing responsibility. Both students and clinical teachers have identified a gap between workplace prescribing demands placed on newly qualified doctors and their preparation for this complex activity during undergraduate training. This study explored the exit-level prescribing performance of final-year students in the Graduate Entry Medical Programme at the University of the Witwatersrand compared with students’ perceptions of their prescribing competence. The results indicated a disparity between students’ competence and confidence. Examination marks showed that 83.6% of students were competent to prescribe according to the graduating standards of the University; however, questionnaire data revealed that 66% of students did not feel that their training had enabled them to prescribe rationally. This inconsistency was explored by analysis of the examination papers according to Bloom’s Revised and the SOLO Taxonomies. It was concluded that students score well on questions which test recall and application of knowledge, but some do not manage questions involving evaluation. Since prescribing is a complex skill that requires evaluative competence, this may explain why, despite high examination scores, students remain insecure. Exploration of the structure of knowledge through a Bernsteinian lens revealed that curricular components including problem-based learning and horizontal integration constrain epistemic access to the structure of rational prescribing knowledge for some students. It is recommended that rational prescribing skills should be taught as a synchronous strand within the curriculum, rather than in the current integrated mode. Learning could also be improved by innovative pedagogies associated with active learning and improved feedback.