Slow down, you move too fast …

cheddar.jpg   Is the fast pace of your life getting you down? Are you looking for ways to s-l-o-w   d-o-w-n?  Well, look no further.  Here are a couple of suggestions:

You can watch Wedginald ripen. Wedginald is a large cheddar cheese, living and ripening at a cheese place in England, courtesy of  West Country Farmhouse Cheesemakers.

You can watch this very, very slow process in real time on a Webcam called cheddarvision.tv.  Currently, Wedginald (the winning name) is 209 days old. If you are more a fast lane kind of person, you can watch a one minute time lapse video showing the first three months of the maturing process on YouTube. (The credits take up a lot of the minute.)

fumulous.jpg  If you prefer, you can watch paint dry, or watch grass grow. Or you can join the Cloud Appreciation Society and hone your cloudspotter skills. (Pictured here is the cloud of the month for July, 2007, a fumulous.) The caption reads:

Cloudspotting is not an activity to be rushed. Most clouds appear to move at a more sedate pace than we do down on the ground and so one has to slow down to watch them develop. It is this requirement to wind down that makes cloud gazing so relaxing. What better expression of the change in pace that comes with a bit of meteorological meditation than this cloud in the shape of a snail, emerging from the fog over Newport in Wales, UK?

I also like last December’s choice, the Altostratus/Altocumulus/Altowhateveritis.

If you feed them, they will come [to medical grand rounds]

jackal1.jpg  Everyone knows that if you feed students, they are more likely to attend your event. Does this also apply to physicians? Apparently, yes, according to a group of  Mayo Clinic researchers who just published in BMC Medical Education this study of attendees at medical grand rounds [free full text]:

Segovis CM, Mueller PS, Rethlefsen ML, Larusso NF, Litin SC, Tefferi A, Habermann TM.  If you feed them, they will come: A prospective study of the effects of complimentary food on attendance and physician attitudes at medical grand rounds at an academic medical center. BMC Med Educ 2007 Jul 12;7(1):22 [Epub ahead of print]

BACKGROUND: Evidence suggests that attendance at medical grand rounds at academic medical centers is waning. The present study examined whether attendance at medical grand rounds increased after providing complimentary food to attendees and also assessed attendee attitudes about complimentary food.
METHODS: In this prospective, before-and-after study, attendance at medical grand rounds was monitored from September 25, 2002, to June 2, 2004, using head counts and electronic card readers. With unrestricted industry (eg, pharmaceutical) financial support, complimentary food was provided to medical grand rounds attendees beginning June 4, 2003. Attendance was compared during the pre-complimentary food and complimentary food periods. Attitudes about the complimentary food were assessed with use of a survey administered to attendees at the conclusion of the study period.
RESULTS: The mean (+/- SD) overall attendance by head counts increased 38.4% from 184.1 +/- 90.4 during the pre-complimentary food period to 254.8 +/- 60.5 during the complimentary food period (P <.001). At the end of the study period, 70.1% of the attendee survey respondents indicated that they were more likely to attend grand rounds because of complimentary food, 53.6% indicated that their attendance increased as a result of complimentary food, and 53.1% indicated that their attendance would decrease if complimentary food was no longer provided. Notably, 80.3% indicated that food was not a distraction, and 81.7% disagreed that industry representatives had influence over medical grand rounds because of their financial support for the food.
CONCLUSIONS: Providing free food may be an effective strategy for increasing attendance at medical grand rounds.    PubMed Record

Micronations: What on earth are they?

sealand.jpg  What is a micronation? According to Wikipedia, micronations, sometimes also referred to as a cybernations, fantasy countries, model countries, and new country projects — are entities that resemble independent nations or states but which are unrecognized by world governments or major international organisations. These nations usually exist only on paper, on the Internet, or in the minds of their creators.

Pictured above is the Principality of SealandThe history of Sealand is a story of a struggle for liberty. Sealand was founded on the principle that any group of people dissatisfied with the oppressive laws and restrictions of existing nation states may declare independence in any place not claimed to be under the jurisdiction of another sovereign entity. The location chosen was Roughs Tower, an island fortress created in World War II by Britain and subsequently abandoned to the jurisdiction of the High Seas. The independence of Sealand was upheld in a 1968 British court decision where the judge held that Roughs Tower stood in international waters and did not fall under the legal jurisdiction of the United Kingdom. This gave birth to Sealand’s national motto of E Mare Libertas, or “From the Sea, Freedom”.

conchflag.jpg  Is the Conch Republic of Key West, Florida (“We seceded where others failed”) a micronation?  The Conch Republic was established by secession of the Florida Keys from the United States of America, on April 23rd, 1982 in response to a United States Border Patrol Blockade setup on highway U.S.1 at Florida City just to the north of the Florida Keys. Read more about the Conch Republic.

Here is another definition of micronations, from micronations. net:
Apart from a few serious secessionist movements, most micronations are essentially nation-state simulations, with varying degrees of seriousness. Unlike role-playing games, micronations have real people who compete for fame, fortune and power, and engage in lively debate and entertainment. Many nations incorporate popular sports and economic simulations.
From this portal you can start a micronation, join a micronation, or communicate with other micronationals. Here is their directory and some sample micronations:

Bobalania (England); Christiania (Copenhagen, probably not a micronation; Wikipedia entry);  British West Florida; Kingdom of Talossa (Lake Michigan area); Kingdom of Biffeche (West Africa); The Republic of Lucastan (in the middle of bloody-damn-all) and on and on …

Find more micronations from Guideall.

AMEE Medical Education Guides

This page last updated December 28, 2007

This Association of Medical Education in Europe (AMEE) is producing a series of medical education guides on key topics in medical education. Below are entries for all but #1-3, which are out of print and temporarily (I hope) unlocatable by yours truly.

The Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine commissioned the writing of extended summaries of 18 of these guides. Links are included below.

Harden RM, Laidlaw JM. AMEE Medical Education Guide # 4: Effective continuing education: The CRISIS Criteria. Med Educ 1992; 26(5):408-422.
Abstract: The need for continuing medical education (CME) is now well recognized. The challenge is to make it effective. CRISIS, an acronymn, stands for the criteria which must be met to produce effective CME programmes: convenience, relevance, individualization, self-assessment, interest, speculation and systematic. CRISIS is a practical tool, based on 15 years of experience in the production and evaluation of CME programmes at the Centre for Medical Education, University of Dundee. The application of the CRISIS criteria to a CME programme will highlight any areas needing improvement and will guide programme producers in the creation of new CME materials. It will also help those responsible for planning CME activities to choose from a range of existing programmes.  PubMed  

Harden RM, Davis MH. AMEE Medical Education Guide # 5: The core curriculum with options or special study modules. Med Teach 1995; 17(2):125-148.
A practical approach to understanding and implementing the core curriculum with options or special study modules – arguably the most important recent development in medical education.   Summary 

Atkins MJ, O’Halloran C. AMEE Medical Education Guide # 6: Evaluating multimedia applications for medical education. Med Teach 1995; 17(2):149-169.
Discusses the evaluation of the usefulness of multimedia materials in medical education. Approaches the issue by looking at the nature of the knowledge that medical professionals are expected to acquire and relating that knowledge to what multimedia applications have to offer. Multimedia applications must also be analyzed for whether they can assist the novice in moving through stages of increasing competence. [ERIC abstract]

Harden RM, Laidlaw JM, Ker JS, Mitchell HE. AMEE Medical Education Guide # 7 Part 1: Task-based learning: An educational strategy for undergraduate, postgraduate and continuing medical education. Med Teach 1996; 18(1):7-13.  Summary 

Harden RM, Laidlaw JM, Ker JS, Mitchell HE. AMEE Medical Education Guide # 7 Part 2: Task-based learning: An educational strategy for undergraduate, postgraduate and continuing medical education. Med Teach 1996; 18(2):91-98.  Summary 

Crosby J. AMEE Medical Education Guide # 8:  Learning in small groups. Med Teach 1996; 18(3):189-202.
Learning in small groups is considered an important education strategy. This guide discusses the reasons for learning in small groups, offers practical and pragmatic guidance on the design and delivery of small group work and details the important role of the facilitator.   Summary 

Gleeson F. AMEE Medical Education Guide # 9: Assessment of clinical competence using the Objective Structured Long Examination Record (OSLER). Med Teach 1997; 19(1):7-14.
Identifies the problems that exist in relation to the long case clinical assessment and provides, through the OSLER, a practical alternative.   Summary

Gale R, Grant J. AMEE Medical Education Guide # 10: Managing change in a medical context: guidelines for action. Med Teach 1997; 19(4):239-249.
This key report is a practical tool which provides an analysis and description of the change process in medical education. There are sections on techniques to apply in analysing the local pathways and barriers to change and on applying the model of the change process in practice. The booklet outlines the ten steps in the management of change.  Summary 

Challis M. AMEE Medical Education Guide # 11 (Revised): Portfolio-based learning and assessment in medical education. Med Teach 1999; 21(4):370-386.
Portfolios are being increasingly used in medical education as a tool for professional development and assessment. This Guide explains what is a portfolio, how to develop one and some ways in which portfolios can be used in formative assessment.

Harden RM. AMEE Medical Education Guide # 12 Part 1:  Multiprofessional Education: Effective multiprofessional education: A three-dimensional perspective. Med Teach 1998; 20(5):402-408.
Multiprofessional education is attracting increasing attention. This Guide is a useful resource for all working in the field of medical education. It provides a practical model for developing a multiprofessional education programme and describes the different approaches and how to make multiprofessional education effective. It also includes information about a survey on conducting multiprofessional education in the UK and important conclusions drawn from this survey. The final part relates to the development of a measurement scale to assess students’ readiness for interprofessional learning.  Summary 

Pirrie A, Wilson V, Harden RM, Elsegood J. AMEE Medical Education Guide # 12 Part 2: Multiprofessional education: Promoting cohesive practice in health care. Med Teach 1998; 20(5):409-416.  Summary 

Collins JP, Harden RM. AMEE Medical Education Guide # 13: The use of real patients, simulated patients and simulators in clinical examinations. Dundee: AMEE, 1999.
In the assessment of clinical competence it is important to observe a candidate interacting with a patient. This guide provides an overview of the different roles of the patient in this encounter. It describes three approaches to patient representations in clinical examinations – the ‘real’ patient, a simulated patient who has undergone training in order to reproduce a particular scenario, and models or simulators, videotape and audiotape and computers used as patient substitutes. The guide presents the advantages and disadvantages of each approach and the factors which you should take into account when you are making an informed decision in your practice. The guide presents a useful continuum between real patients with no training and simulated patients who have been extensively trained to perform the task. An essential guide for all concerned with examining students’ or trainees’ clinical competence.  Summary 

Harden RM, Cosby JR, Davis MH. AMEE Medical Education Guide # 14 Part 1: Outcome-based education: An introduction to outcome-based education. Med Teach 1999; 21(1):7-14.
Abstract: Outcome-based education, a performance-based approach at the cutting edge of curriculum development, offers a powerful and appealing way of reforming and managing medical education. The emphasis is on the product-what sort of doctor will be produced-rather than on the educational process. In outcome-based education the educational outcomes are clearly and unambiguously specified. These determine the curriculum content and its organisation, the teaching methods and strategies, the courses offered, the assessment process, the educational environment and the curriculum timetable.They also provide a framework for curriculum evaluation. A doctor is a unique combination of different kinds of abilities. A three-circle model can be used to present the learning outcomes in medical education, with the tasks to be performed by the doctor in the inner core, the approaches to the performance of the tasks in the middle area, and the growth of the individual and his or her role in the practice of medicine in the outer area. Medical schools need to prepare young doctors to practise in an increasingly complex healthcare scene with changing patient and public expectations, and increasing demands from employing authorities. Outcome-based education offers many advantages as a way of achieving this. It emphasises relevance in the curriculum and accountability, and can provide a clear and unambiguous framework for curriculum planning which has an intuitive appeal. It encourages the teacher and the student to share responsibility for learning and it can guide student assessment and course evaluation. What sort of outcomes should be covered in a curriculum, how should they be assessed and how should outcome-based education be implemented are issues that need to be addressed.

Smith SR, Dollase R. AMEE Medical Education Guide # 14 Part 2: Outcome-based education: Planning, implementing and evaluating a competency-based curriculum. Med Teach 1999; 21(1):15-22.
Abstract: In September, 1996, Brown University School of Medicine inaugurated a new competency-based curriculum, known as MD2000, which defines a comprehensive set of competency requirements that all graduates are expected to attain. The medical students entering in 1996 and thereafter are required to demonstrate mastery in nine abilities as well as a comprehensive knowledge base as a requirement for graduation. Faculty use performance-based methods to determine if students have attained competence. We describe in this article the reasons why we developed the new curriculum, how we planned and structured it, and the significance we anticipate the curricular innovation will have on medical education.  Summary

Ben DM. AMEE Medical Education Guide # 14 Part 3: Outcome-based education: Assessment in outcome-based education. Med Teach 1999; 21(1):23-25.
Abstract: The role of performance assessment in outcomebased education is discussed emphasizing the relationship and interplay between these two related paradigms. Issues of the relevancy of assessment to student learning are highlighted in the context of outcome-based education.The importance of defining assessment premises and the role of institutions in defining their educational philosophy as it pertains to student learning and assessment is also presented. A brief description of implementation guidelines of assessment programs in outcome-based education are presented indicating the key features of such programs.  Summary 

Ross N, Davies D. AMEE Medical Education Guide # 14 Part 4: Outcome-based education: Outcome-based learning and the electronic curriculum at Birmingham Medical School. Med Teach 1999; 21(1):26-31.
Abstract: Outcome-led curricula are increasingly relevant to medical education as Universities seek means to make explicit the criteria against which the success of both the course and the students should be judged. This paper outlines some of the main factors which led the University of Birmingham School of Medicine to develop an outcome-led curriculum for the new undergraduate medical course. Having set the general context, it then describes how the specific structure used by the school for organising integrative learning outcomes both influenced and was influenced by the parallel decision to develop an ‘electronic curriculum’database.The advantages of the electronic curriculum database developed by the School are discussed and examples are given to demonstrate the flexibility with which information can be accessed by students, clinicians and other teachers.  Summary 

Harden RM, Crosby JR, Davis MH, Friedman M. AMEE Medical Education Guide # 14 Part 5: Outcome-based education: From competency to meta-competency: A model for the specification of learning outcomes. Med Teach 1999; 21(6):546-552.
Abstract: Increased attention is being paid to the specification of learning outcomes.This paper provides a framework based on the three-circle model: what the doctor should be able to do (‘doing the right thing’), the approaches to doing it (‘doing the thing right’) and the development of the individual as a professional (‘the right person doing it’).Twelve learning outcomes are specified, and these are further subdivided.The different outcomes have been defined at an appropriate level of generality to allow adaptability to the phases of the curriculum, to the subject matter, to the instructional methodology and to the students’ learning needs. Outcomes in each of the three areas have distinct underlying characteristics.They move from technical competences or intelligences to meta-competences including academic, emotional, analytical, creative and personal intelligences. The Dundee outcome model offers an intuitive, user-friendly and transparent approach to communicating learning outcomes. It encourages a holistic and integrated approach to medical education and helps to avoid tension between vocational and academic perspectives.The framework can be easily adapted to local needs. It emphasizes the relevance and validity of outcomes to medical practice.The model is relevant to all phases of education and can facilitate the continuum between the different phases. It has the potential of facilitating a comparison between different training programmes in medicine and between different professions engaged in health care delivery. professions engaged in health care delivery.

Davis MH, Harden RM. AMEE Medical Education Guide # 15: Problem-based learning: a practical guide. Med Teach 1998; 20(2):317-322.
Abstract: Problem-based learning (PBL) has been widely adopted as an educational strategy. This guide provides an understanding of the principles behind PBLand answers the question: ‘what is PBL?’. It discusses the advantages andproblems associated with PBL. Different approaches are discussed.  Summary 

Harden RM, Laidlaw JM, Hesketh EA. AMEE Medical Education Guide # 16: Study Guides: their use and preparation. Med Teach 1999; 21(3):248-265.
Abstract: Study guides can make a major contribution to learning. This guide provides a short description of the key features of a study guide and how a study guide is different from a textbook. It describes the context in which study guides have become important and the reasons why study guides can help in your educational programme. An account is given of the wide range of components that can go in to make up a study guide. The three functions of a study guide are highlighted in the “study guide triangle”. Practical hints are given on preparing your own study guide. The guide gives examples of good practice in the area.  Summary 

Parsell G, Bligh J. AMEE Medical Education Guide # 17: Writing for journal publication. Med Teach 1999; 21(5):457-468.
Abstract: This guide helps both the novice author and the more experienced writer to plan, organise and write up their findings and reach an appropriate audience as quickly as possible. The guide describes the seven stages in the publication process: forming the original idea, carrying out the research, choosing the journal or publisher, writing the paper and submitting it, rejection, revising and resubmitting, and acceptance. There are few people for whom writing is easy. This guide describes the skills necessary at each stage and how to avoid some of the common pitfalls.

Ben-David MF. AMEE Medical Education Guide # 18: Standard setting in student assessment. Med Teach 2000; 22(2):120-130.
Abstract: Licensure, credentialling and academic institutions are seeking new innovative approaches to the assessment of professional competence. Central to these recent initiatives is the need to determine standards of performance, which separate the competent from the non-competent candidate. Setting standards for performance assessment is a relatively new area of study. Consequently, there is no one recommended approach to setting standards. The goal of this guide is to familiarize the reader with the framework, principles, key concepts and practical considerations of standard setting approaches and to enable the reader to make “educated” choices in selecting the most appropriate standard setting approach for their testing needs.  Summary 

Challis M. AMEE Medical Education Guide # 19: Personal learning plans. Med Teach 2000; 22(3):225-236.
Abstract: The issue of personal learning plans (PLPs), while not new in many educational settings, has recently come to the fore in medical education and professional development. This Guide offers a view on what personal learning plans are, why they are important at the current time, and how they may be approached, developed and evaluated in a range of contexts. It also places the development and history of personal learning plans within an educational rationale that recognises the need for a learners to control their own learning, and for the use of reflection on and in professional practice in order to maximise effective learning.  Summary

Harden RM, Crosby JR. AMEE Medical Education Guide # 20: The good teacher is more than a lecturer – the twelve roles of the teacher. Med Teach 2000; 22(4):334-337.
Abstract: This guide provides an overview of the different roles of the medical teacher in the context of the many changes taking place in medical education. Twelve roles are presented in the model provided. This role model framework is of use in the assessment of the needs for staff to implement a curriculum, in the appointment and promotion of teachers and in the organisation of a staff development programme. Some teachers will have only one role. Most teachers will have several roles. All roles, however, need to be represented in an institution or teaching organisation.  Summary 

Harden RM. AMEEMedical Education Guide # 21: Curriculum mapping: a tool for transparent and authentic teaching and learning. Med Teach 2001; 23(2):123-137.
Abstract: The curriculum is a sophisticated blend of educational strategies, course content, learning outcomes, educational experiences, assessment, the educational environment and the individual students’ learning style, personal timetable and programme of work. Curriculum mapping can help both staff and students by displaying these key elements of the curriculum, and the relationships between them. Students can identify what, when, where and how they can learn. Staff can be clear about their role in the big picture. The scope and sequence of student learning is made explicit, links with assessment are clarified and curriculum planning becomes more effective and efficient. In this way the curriculum is more transparent to all the stakeholders including the teachers, the students, the curriculum developer, the manager, the public and the researcher. The windows through which the curriculum map can be explored may include: (1) the expected learning outcomes; (2) curriculum content or areas of expertise covered; (3) student assessment; (4) learning opportunities; (5) learning location; (6) learning resources; (7) timetable; (8) staff; (9) curriculum management; (10) students. Nine steps are described in the development of a curriculum map and practical suggestions are made as to how curriculum maps can be introduced in practice to the benefit of all concerned. The key to a really effective integrated curriculum is to get teachers to exchange information about what is being taught and to coordinate this so that it reflects the overall goals of the school. This can be achieved through curriculum mapping, which has become an essential tool for the implementation and development of a curriculum. Faced with curricula which are becoming more centralized and less departmentally based, and with curricula including both core and optional elements, the teacher may find that the curriculum map is the glue which holds the curriculum together.  PubMed 

Brown G, Manogue M. AMEE Medical Education Guide # 22: Refreshing lecturing: a guide for lecturers. Med Teach 2001; 23(3):231-244.
Abstract: This guide provides an overview of research on lecturing, a model of the processes of lecturing and suggestions for improving lecturing, learning from lectures and ways of evaluating lectures. Whilst primarily directed at teachers in the healthcare professions, it is equally applicable to all teachers in higher education. Lectures are the most ubiquitous method of teaching so they are an important part of a teacher’s repertoire. Lectures are at least as effective as other methods of teaching at imparting information and explaining. Intention, transmission and output are the basis of a model of lecturing. The key skills of preparing lectures, explaining and varying student activities may be derived from the model. Preparation is based on purposes, content, various structures of lectures and the preparation of audiovisual aids. The essential ingredients of explaining are clarity, interest and persuasion. By varying activities, one can renew attention and develop student learning. Learning from lectures can be improved by teaching students the structure of lectures and methods of listening and note-taking. Student ratings of lectures are useful but over-used and limited ways of evaluating lectures. Equally important is peer review and more important than either student ratings or peer feedback is reflection on the practice of lecturing by individuals and course teams.  PubMed 

Genn JM. AMEE Medical Education Guide # 23 Part 1: Curriculum, environment, climate, quality and change in medical education-a unifying perspective. Med Teach 2001; 23(4):337-344.
Abstract: This paper looks at five focal terms in education – curriculum, environment, climate, quality and change – and the interrelationships and dynamics between and among them. It emphasizes the power and utility of the concept of climate as an operationalization or manifestation of the curriculum and the other three concepts. Ideas pertaining to the theory of climate and its measurement can provide a greater understanding of the medical curriculum. The learning environment is an important determinant of behaviour. Environment is perceived by students and it is perceptions of environment that are related to behaviour. The environment, as perceived, may be designated as climate. It is argued that the climate is the soul and spirit of the medical school environment and curriculum. Students’ experiences of the climate of their medical education environment are related to their achievements, satisfaction and success. Measures of educational climate are reviewed and climate measures for medical education are discussed. These should take account of current trends in medical education and curricula. Measures of the climate may subdivide it into different components giving, for example, a separate assessment of so-called Faculty Press, Student Press, Administration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they have experienced and, second, to report on their ideal or preferred environment. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. In addition to the educational climate of the environment that students inhabit, it is important to consider the organizational climate of the work environment that staff inhabit. This organizational climate is very significant, not only for staff, but for their students, too. The medical school is a learning organization evolving and changing in the illuminative evaluation it makes of its environment and its curriculum through the action research studies of its climate. Considerations of climate in the medical school, along the lines of continuous quality improvement and innovation, are likely to further the medical school as a learning organization with the attendant benefits. Unless medical schools become such learning organizations, their quality of health and their longevity may be threatened.  PubMed 

Genn JM. AMEE Medical Education Guide # 23 Part 2: Curriculum, environment, climate, quality and change in medical education – a unifying perspective. Med Teach 2001; 23(5):445-454.
Abstract: This paper looks at five focal terms in education – curriculum, environment, climate, quality and change – and the interrelationships and dynamics between and among them. It emphasizes the power and utility of the concept of climate as an operationalization or manifestation of the curriculum and the other three concepts. Ideas pertaining to the theory of climate and its measurement can provide a greater understanding of the medical curriculum. The environment is an important determinant of behaviour. Environment is perceived by students and it is perceptions of environment that are related to behaviour. The environment, as perceived, may be designated as climate. It is argued that the climate is the soul and spirit of the medical school environment and curriculum. Students’ experiences of the climate of their medical education environment are related to their achievements, satisfaction and success. Measures of educational climate are reviewed and the possibilities of new climate measures for medical education are discussed. These should take account of current trends in medical education and curricula. Measures of the climate may subdivide it into different components giving, for example, separate assessment of so-called Faculty Press, Student Press, Administration Press and Physical or Material Environmental Press. Climate measures can be used in different modes with the same stakeholders. For example, students may be asked to report, first, their perceptions of the actual environment they have experienced and, second, to report on their ideal or preferred environment. The same climate index can be used with different stakeholders giving, for example, staff and student comparisons. The climate is important for staff as well as for students. The organizational climate that teaching staff experience in the work environment that they inhabit is important for their well-being, and that of their students. The medical school is a learning organization evolving and changing in the illuminative evaluation it makes of its environment and its curriculum through the action research studies of its climate. Considerations of climate in the medical school along the lines of continuous quality improvement and innovation are likely to further the medical school as a learning organization with the attendant benefits. Unless medical schools become such learning organizations their quality of health and their longevity may be threatened.  PubMed 

Friedman BD, Davis MH, Harden RM, Howie PW, Ker J, Pippard MJ. AMEE Medical Education Guide # 24: Portfolios as a method of student assessment. Med Teach 2001; 23(6):535-551.
Abstract: This guide is intended to inform medical teachers about the use of portfolios for student assessment. It provides a background to the topic, reviews the range of assessment purposes for which portfolios have been used, identifies possible portfolio contents and outlines the advantages of portfolio assessment with particular focus on assessing professionalism. The experience of one medical school, the University of Dundee, is presented as a case study. The current state of understanding of the technical, psychometric issues relating to portfolio assessment is clarified. The final part of the paper provides a practical guide for those wishing to design and implement portfolio assessment in their own institutions. Five steps in the portfolio assessment process are identified: documentation, reflection, evaluation, defence and decision. It is concluded that portfolio assessment is an important addition to the assessor’s toolkit. Reasons for using portfolios for assessment purposes include the impact that they have in driving student learning and their ability to measure outcomes such as professionalism that are difficult to assess using traditional methods.  Summary  PubMed 

Shumway JM, Harden RM. AMEE Medical Education Guide # 25: The assessment of learning outcomes for the competent and reflective physician. Med Teach 2003; 25(6):569-584.
Abstract: Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direct what they learn. The second is a move to outcome-based education where the learning outcomes are defined and decisions about the curriculum are based on these. These two trends are closely related. If teachers are to do a better job of assessing their students, they need an understanding of the assessment process, an appreciation of the learning outcomes to be assessed and a recognition of the most appropriate tools to assess each outcome. Assessment tools selected should be valid, reliable, practical and have an appropriate impact on student learning. The preferred assessment tool will vary with the outcome to be assessed. It is likely to be some form of written test, a performance test such as an OSCE in which the student’s competence can be tested in a simulated situation, and a test of the student’s behaviour over time in clinical practice, based on tutors’ reports and students’ portfolios. An assessment profile can be produced for each student which highlights the learning outcomes the student has achieved at the required standard and other outcomes where this is not the case. For educational as well as economic reasons, there should be collaboration across the continuum of education in test development as it relates to the assessment of learning outcomes and in the implementation of a competence-based approach to assessment.
PubMed   Full Text    Summary

Dent JA. AMEE Medical Education Guide # 26: Clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients. Med Teach 2005; 27(4):302-315.
Abstract: Increasing student numbers and changes in healthcare delivery are making inpatient settings less ideal for teaching undergraduate students. As the focus of healthcare provision shifts towards ambulatory care, increasing attention must now be given to developing opportunities for clinical teaching in this setting. This Education Guide describes the opportunities to be made available by introducing clinical teaching into ambulatory care venues not usually used for undergraduate teaching as well as different models for maximizing student/patient interaction in traditional outpatient clinics. In general there has been only a limited development of teaching initiatives in such ambulatory care areas as accident and emergency departments, clinical investigation units, radiology and imaging suites or the departments of professions allied to medicine. Each of these venues provides different resources suitable for clinical teaching and has its own advantages and disadvantages. A variety of models for facilitating student groups in these venues can be used. Practical advice is provided for the clinical tutor about to supervise clinical teaching in any of these ambulatory care settings. In contrast the development of a dedicated Ambulatory Care Teaching Centre allows the use of specific instructional strategies and can focus teaching on specific body systems illustrated by clinical volunteers invited to attend from a ‘bank’ of previous patients with stable clinical conditions. Finally, a teaching programme based on the day surgery unit is described as a way of achieving a variety of educational objectives in a busy resource that may not previously have been used for teaching.  PubMed   Full Text 

Kilminster S, Cottrell D, Grant J, Jolly B. AMEE Medical Education Guide # 27: Effective educational and clinical supervision. Med Teach 2007; 29(1):2-19.
Abstract: This guide reviews what is known about educational and clinical supervision practice through a literature review and a questionnaire survey. It identifies the need for a definition and for explicit guidelines about supervision. There is strong evidence that, whilst supervision is considered to be both important and effective, practice is highly variable. In some cases, there is inadequate coverage and frequency of supervision activities. There is particular concern about lack of supervision for emergency and ‘out of hours work’, failure to formally address under performance, lack of commitment to supervision and finding sufficient time for supervision. There is a need for an effective system to address both poor performance and inadequate supervision.  PubMed 

Davis MH, Karunathilake I, Harden RM. AMEE Medical Education Guide # 28: The development and role of departments of medical education. Med Teach 2005; 27(8):665-675.
Abstract: A department of medical education is becoming an essential requirement for a medical school. This publication is intended for those wishing to establish or develop a medical education department. It may also prove useful to teachers in medicine by providing information on how such a department can support their activities. This will vary with the local context but the principles are generalizable. Medical education departments are established in response to increased public expectations relating to healthcare, societal trends towards increased accountability, educational developments, increased interest in what to teach and how to educate doctors and the need to train more doctors. The functions of a department of medical education include research, teaching, service provision and career development of the staff. The scope of its activities includes undergraduate and postgraduate education, continuing professional development and continuing medical education. These activities may be extended to other healthcare professions. Flexibility is the key to staffing a department of medical education. Various contractual arrangements, affiliations and support from non-affiliated personnel are needed to provide a multi-professional team with a range of expertise. The precise structure of the department will depend on the individual institution. The name of the department may suggest its position within the university structure. The director provides academic leadership for the department and his/her responsibilities include promotion of staff collaboration, fostering career development of the staff and establishing local, regional and international links. Financial support may come from external funding agencies, government or university sources. Some departments of medical education are financially self-supporting. The department should be closely integrated with the medical school. Support for the department from the dean is an essential factor for sustainability. Several case studies of medical education departments throughout the world are included as examples of the different roles and functions of a department of medical education.  PubMed 

Goldie J. AMEE Medical Education Guide # 29: Evaluating educational programmes. Med Teach 2006; 28(3):210-224.
Abstract: Evaluation has become an applied science in its own right in the last 40 years. This guide reviews the history of programme evaluation through its initial concern with methodology, giving way to concern with the context of evaluation practice and into the challenge of fitting evaluation results into highly politicized and decentralized systems. It provides a framework for potential evaluators considering undertaking evaluation. The role of the evaluator; the ethics of evaluation; choosing the questions to be asked; evaluation design, including the dimensions of evaluation and the range of evaluation approaches available to guide evaluators; interpreting and disseminating the findings; and influencing decision making are covered.  PubMed 

Ross MT, Cameron HS. Peer assisted learning: a planning and implementation framework: AMEE Guide no. 30. Med Teach 2007; 29(6):527-545.
Abstract: Much has been written about the benefits and applications of Peer Assisted Learning (PAL) in the literature. Curriculum developers increasingly consider PAL as a vehicle to help undergraduate healthcare students learn to teach; an outcome which has received more attention in the UK since the General Medical Council stated in Tomorrow’s Doctors that medical graduates must ‘Be able to demonstrate appropriate teaching skills’.

This guide is primarily designed to assist curriculum developers, course organisers and educational researchers develop and implement their own PAL initiatives. It is structured around a PAL planning framework consisting of 24 questions. The questions are grouped in threes, around eight themes. Each question is discussed with reference to the PAL literature and other related subjects, and is exemplified by responses from a recent PAL project developed at The University of Edinburgh. Working through the 24 questions, particularly with discussion in a small planning group, will enable readers to efficiently develop their ideas for PAL into comprehensive and practical project plans cognisant of current educational theory, existing PAL literature and the local context.

The framework is particularly suitable for those who want to develop healthcare undergraduate PAL initiatives yet have little or no experience of PAL, as it provides an introduction to the relevant literature field and a step-by-step process for the design and implementation of such projects. It will also be of interest to those with experience of PAL and those seeking a structured framework for planning non-PAL curriculum developments in undergraduate healthcare curricula.

Norcini J, Burch V. Workplace-based assessment as an educational tool: AMEE Guide No. 31. Medical Teacher 2007; 29(9-10):855-871.
Background: There has been concern that trainees are seldom observed, assessed, and given feedback during their workplace-based education. This has led to an increasing interest in a variety of formative assessment methods that require observation and offer the opportunity for feedback.
Aims: To review some of the literature on the efficacy and prevalence of formative feedback, describe the common formative assessment methods, characterize the nature of feedback, examine the effect of faculty development on its quality, and summarize the challenges still faced.
Results: The research literature on formative assessment and feedback suggests that it is a powerful means for changing the behaviour of trainees. Several methods for assessing it have been developed and there is preliminary evidence of their reliability and validity. A variety of factors enhance the efficacy of workplace-based assessment including the provision of feedback that is consistent with the needs of the learner and focused on important aspects of the performance. Faculty plays a critical role and successful implementation requires that they receive training.
Conclusions: There is a need for formative assessment which offers trainees the opportunity for feedback. Several good methods exist and feedback has been shown to have a major influence on learning. The critical role of faculty is highlighted, as is the need for strategies to enhance their participation and training.     

The evolving science of translating research evidence into clinical practice

This editorial was published in the February 2007 issue of Evidence Based Medicine, and again in the May/June 2007 issue of ACP Journal Club. It presents a good overview of evidence dissemination, looking at six models.

Scott IA. The evolving science of translating research evidence into clinical practice. ACP J Club 2007 May-Jun;146(3):A8-11. [subscription required]

Excerpt: Practicing clinicians have to swim in an ocean of clinical research evidence that varies in rigor, consistency, and applicability to the care of individual patients. They are expected to stay up to date, be authoritative, and practice to a high standard. They work in an environment that obliges them to reconcile patient preferences and societal and professional expectations with the need for cost restraint and accountability for quality and safety of care. …What have we learned and what lessons can we apply to minimize the pressure drops in the pipeline from the generation of research evidence to its consistent application in clinical decision making? This editorial looks at 6 models of evidence dissemination that have evolved over the past few decades.:

1. Evidence speaking for itself
2. Evidence as prepackaged “ready-to-go” knowledge
3. Evidence as an industrial commodity
4. Evidence within a framework of systems engineering
5. Evidence within a framework of social innovation
6. Evidence as common property in need of a common language

PubMed Related Articles    

Adverse effects of spinal manipulation: a systematic review

Here is another systematic review from E. Ernst, just published in the July 2007 issue of the Journal of the Royal Society of Medicine:

Ernst E. Adverse effects of spinal manipulation: a systematic review. J R Soc Med 2007; 100(7):330-338.

Objective: To identify adverse effects of spinal manipulation.
Design: Systematic review of papers published since 2001.
Setting: Six electronic databases.
Main outcome measures: Reports of adverse effects published between January 2001 and June 2006. There were no restrictions according to language of publication or research design of the reports. Results The searches identified 32 case reports, four case series, two prospective series, three case-control studies and three surveys. In case reports or case series, more than 200 patients were suspected to have been seriously harmed. The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients. The case-control studies suggested a causal relationship between spinal manipulation and the adverse effect. The survey data indicated that even serious adverse effects are rarely reported in the medical literature.
Conclusions: Spinal manipulation, particularly when performed on the upper spine, is frequently associated with mild to moderate adverse effects. It can also result in serious complications such as vertebral artery dissection followed by stroke. Currently, the incidence of such events is not known. In the interest of patient safety we should reconsider our policy towards the routine use of spinal manipulation.
Full text     PubMed Record
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Writing for Chiropractic Journals

writing.jpg Here is a selection of articles on writing, taken from the chiropractic literature. Included are links to the Index to Chiropractic Literature, as well as links to PubMed, journal records or DOIs.  See also Where should I publish my article? ; Submitting manuscripts to biomedical journals: Common errors and helpful solutions

Budgell B. Commentary: Guidelines to the writing of case studies. JCCA 2008; 52(4):199-204.

Introduction: Case studies are an invaluable record of the clinical practices of a profession. While case studies cannot provide specific guidance for the management of successive patients, they are a record of clinical interactions which help us to frame questions for more rigorously designed clinical studies. Case studies also provide valuable teaching teaching material, demonstrating both classical and unusual presentations which may confront the practitioner. Quite obviously, since the overwhelming majority of clinical interactions occur in the field, not in teaching or research facilities, it falls to the field practitioner to record and pass on their experiences. However, field practitioners generally are not well-practised in writing for publication, and so may hesitate to embark on the task of carrying a case study to publication. These guidelines are intended to assist the relatively novice writer – practitioner or student – in efficiently navigating the relatively easy course to publication of a quality case study. Guidelines are not intended to be proscriptive, and so throughout this document we advise what authors “may” or “should” do, rather than what they “must” do. Authors may decide that the particular circumstances of their case study justify digression from our recommendations.

Green BN, Johnson CD. How to write a case report for publication. J Chiropr Med 2006; 5(2):72-82.

Objective: This paper describes how and why to write a case report for publication in a peer-reviewed journal.
Methods: PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Index to Chiropractic Literature were searched from 2000 through September 2006 using the following search terms: case report, authorship, peer review, and manuscript. Relevant manuscripts were retrieved and the results were used to update a previous narrative overview of the literature.
Discussion: Commensurate with the increased use of evidence-based health care and recent changes in publication requirements, new standards are expected of case reports. Case reports should present new information to the literature and be written succinctly. The types of case reports available are discussed. Steps for preparing a case report are described based upon the current available literature.
Conclusion: Case reports are important contributions to the health sciences literature. Proper preparation of this study design is necessary in order for it to be published. A self-evaluation check sheet for authors is included to assist in the writing process. [Appendix A. Case Report Check Sheet]
ICL Journal Link

Johnson CD, Green BN. Helpful hints: Writing effective letters to the editor [editorial]. J Manipulative Physiol Ther 2006; 29(6):415-416.

Abstract: Letters to the editor serve an important role in postpublication review by maintaining the integrity of evidence. The act of critical appraisal of the literature, an important step of evidence-based practice, may generate letters to the editor. Letters may serve to
(1) identify errors or deficiencies and make a correction to the literature,
(2) point out alternative theories or additional information not contained in the original article,
(3) offer new, additional, or counterevidence to that of the original article, and/or
(4) hold authors and journals accountable for their publications. Through letters, the readership helps to strengthen the evidence base. Recommendations for writing and assessing a letter to the editor are included in this editorial.
ICL DOI Link

Anwar R. How to write a case report. Student BMJ 2004; 12:60-61.
Rahij Anwar and colleagues give advice on the practical details of writing case reports.
Full Text

Gleberzon BJ, Killinger LZ. The journal article cookbook. J Manipulative Physiol Ther 2004; 27(7):481-492.
ICL PubMed Record

Young M. Writing for the peer-reviewed biomedical literature: Part I. The why and the wherefore. Clin Chiropr 2003; 6(3-4):144-150.

Abstract: Within the chiropractic literature, there is under-representation of clinical observation, small-scale trials and pilot studies. This can have an adverse effect in framing the research questions of larger projects. It can also lead to a diminution in the perceived significance of research by clinicians. In many countries, graduate education programmes are seeking to redress this balance by including training in writing for biomedical journals in their content. Continuing professional development portfolios are also increasingly recognizing the importance of such work, both to the professional and to the profession. This two-part article seeks to outline the reasons why clinical papers are important and offer advice as to the best way in which to translate clinical observation and deduction into a publishable format.
ICL DOI Link

Young M. Writing for the peer-reviewed biomedical literature: Part II. The how and the when. Clin Chiropr 2004; 7(2):90-99.

Abstract: Within the chiropractic literature, there is under-representation of clinical observation, small-scale trials and pilot studies. This can have an adverse effect in framing the research questions of larger projects. It can also lead to a diminution in the perceived significance of such research by clinicians. In many countries, graduate education programmes are seeking to redress this balance by including training in writing for biomedical journals. Continuing professional development portfolios are also increasingly recognising the importance of such work, both to the professional and to the profession. This two-part article seeks to outline the reasons why clinical papers are important and offer advice as to the best way in which to translate clinical observation and deduction into a publishable format. This second part deals with the technical aspects of creating a journal submission and the increasingly diverse formats in which submission can be made. Again, emphasis is placed on the formats most appropriate to practicing chiropractors working in a clinical setting.
ICL DOI Link

Green BN, Johnson CD. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Sports Chiropr & Rehabil 2001; 15(1):5-16.

Objective: To describe and discuss the process used to write a narrative review of the literature for publication in a peer-reviewed journal. The JSCR wishes to standardize its publication of narrative overviews of the literature to increase their objectivity.
Background: In the past decade numerous changes in research methodology pertaining to reviews of the literature have occurred. These changes necessitate authors of review articles to be familiar with current standards in the publication process.
Methods: Narrative overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases, hand searches, and authoritative texts.
Discussion: An overview of the use of three types of reviews of the literature is resented. Step by step instructions for how to conduct and write a narrative overview utilizing a ‘best-evidence synthesis’ approach are discussed, starting with appropriate preparatory work and ending with how to create proper illustrations. Several resources for creating reviews of the literature are presented and a narrative overview critical appraisal worksheet is included. A bibliography of other useful reading is presented in an appendix.
Conclusion: Narrative overviews can be a valuable contribution to the literature if prepared properly. New and experienced authors wishing to write a narrative overview should find this article useful in constructing such a paper and carrying out the research process. It is hoped that this article will stimulate scholarly dialog amongst colleagues about this research design and other complex literature review methods.
ICL Full Text

Green BN, Johnson CD. Writing patient case reports for peer-reviewed journals: Secrets of the trade. J Sports Chiropr & Rehabil 2000; 14(3):51-59.

Objective: To describe and discuss the process used to write a case report for publication in a peer-reviewed journal.
Methods: Narrative review of the literature.
Discussion: The importance for case reports is presented as well as the explanation of how to write them in a standardized format. Steps in preparing a case report are described and discussed starting with selecting a title and concluding with preparing appropriate illustrations. Conclusion: Case reports are important contributions to the health sciences literature. Proper preparation of this research design is necessary in order for it to be published in a credible manner.
ICL

Steinecke R. Writing an expert report. J Can Chiropr Assoc 1997; 41(4):237-239.
ICL Full Text

Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research

Here is a new systematic review, just published in the June 2007 issue of the Journal of Alternative & Complementary Medicine (subscription required).

Hawk CF, Khorsan RF, Lisi AJ, Ferrance R, Evans MW. Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med 2007; 13(5):491-512.     PubMed Record

Objectives:
(1) To evaluate the evidence on the effect of chiropractic care, rather than spinal manipulation only, on patients with nonmusculoskeletal conditions; and
(2) to identify shortcomings in the evidence base on this topic, from a Whole Systems Research perspective.
Design: Systematic review.
Methods: Databases included were PubMed, Ovid, Mantis, Index to Chiropractic Literature, and CINAHL. Search restrictions were human subjects, peer-reviewed journal, English language, and publication before May 2005. All randomized controlled trials (RCTs) were evaluated using the Scottish Intercollegiate Guidelines Network (SIGN) and Jadad checklists; a checklist developed from the CONSORT (Consolidated Standards of Reporting Trials) guidelines; and one developed by the authors to evaluate studies in terms of Whole Systems Research (WSR) considerations.
Results: The search yielded 179 papers addressing 50 different nonmusculoskeletal conditions. There were 122 case reports or case series, 47 experimental designs, including 14 RCTs, 9 systematic reviews, and 1 a large cohort study. The 14 RCTs addressed 10 conditions. Six RCTs were rated “high” on the 3 conventional checklists; one of these 6 was rated “high” in terms of WSR considerations.
Conclusions:
(1) Adverse effects should be routinely reported. For the few studies that did report, adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe.
(2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic. Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia.
(3) The RCT design is not necessarily incompatible with WSR. RCTs could improve generalizability by basing protocols on usual practice.
(4) Case reports could contribute more to WSR by increasing their emphasis on patient characteristics and patient-based outcomes.
(5) Chiropractic investigators, practitioners, and funding agencies should increase their attention to observational designs.