really good stuff reflection in contemporary health professional education. The portfolio, a collection of evidence demonstrating learning and reflection, is a prevalent assessment tool in both undergraduate and postgraduate medical education. The medical education literature suggests mixed success in the use of portfolios, and previous research has reported that feedback from mentors is a crucial contributor to success. In addition to teachers and peers, who commonly act as mentors, might near-peers, who may be more experienced than peers and more approachable than teachers, be able to support medical students engaged in the portfolio process? Furthermore, can non-medical professionals provide alternative perspectives that stimulate medical students to develop and reflect on the competencies they require to meet societal expectations of medical professionalism? The aim of this study is to bridge the gap in research and investigate the effects of feedback from near-peers and non-medical professionals on medical students’ reflective portfolios. What was tried? From September 2012 to January 2013, all Year 2 medical students (n = 131) taking a required course on medicine and society at National Taiwan University submitted three e-portfolio entries reflecting on their development in key professional competencies, such as humanism and communication. In addition to feedback from teachers and peers, each student was matched to one senior medical student (i.e. near-peer) and one non-medical professional (a category including standardised patients and education researchers) trained to provide feedback. The e-portfolios were scored according to a rubric for reflection.1 At the end of the semester, 81 students completed a questionnaire consisting of 5-point Likert scale-based and openended questions. Research data were analysed using SPSS for Windows V16.0.1 (SPSS Inc., Chicago, IL, USA). The results show that students found the feedback from near-peers and non-medical professionals beneficial. Students agreed that feedback not only helped them in writing their e-portfolios (mean scores: 3.43–3.49; standard deviations [SDs]: 0.77– 0.82), but also enhanced their self-reflection (mean scores: 3.43–3.53; SDs: 0.79–0.92), especially in the case of near-peer feedback. In addition, the perceived effectiveness of near-peer feedback was correlated to portfolio scores (r = 0.23 and r = 0.28; p < 0.05). Answers to the open-ended questions supported the effectiveness of feedback from multiple sources. For instance, students stated: ‘. . .feedback from senior schoolmates helped a tremendous amount’; ‘. . .feedback from near peers and
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non-medical professionals enhanced my understanding of their expectations of medical students’, and ‘. . .receiving feedback from people previously unknown [i.e. a non-medical professional] makes me feel fulfilled.’ What lessons were learned? This study found that feedback from near-peers and non-medical professionals can have a positive impact on medical students’ use of and reflection on their e-portfolios. Near-peer feedback was perceived to be more effective than that given by non-medical professionals. This may reflect the fact that students and their near-peers are of similar ages and backgrounds. Given these impacts, multiple sources of feedback, such as near-peers and non-medical professionals, should be considered when implementing a portfolio system. REFERENCE 1 O’Sullivan P, Aronson L, Chittenden E, Niehaus B, Learman L. Reflective ability rubric and user guide. MedEdPORTAL 2010. http://www.mededportal.org/ pubilication/8133. [Accessed 28 October 2013.] Correspondence: Professor Ming-Jung Ho, Department of Social Medicine, National Taiwan University College of Medicine, No. 1, Ren-Ai Road, Section 1, Taipei 106, Taiwan. Tel: 00 886 910 188399; E-mail: [email protected] doi: 10.1111/medu.12445
Addressing physicians’ poor communication skills in Sri Lanka Avindra Jayawardene & Tony LaDuca What problems were addressed? Deficiencies in the communication skills of health care personnel have been identified as a threat to patient safety. Effective communication in health care settings is dependent on culture, patient expectations and the specific context.1 Although formal communication skills training courses for physicians are being developed worldwide, it is not always true that adequate attention and respect are given to local requirements. The result may be a course that is not fit for purpose. What was tried? The objective of this study was to produce a framework to develop a culturally and contextually relevant communication skills course for doctors in Sri Lanka. Critical incident analysis was used to produce authentic data about real-life experiences to inform course development.
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
really good stuff Five group interviews were conducted with a total of 50 physicians, postgraduate specialists, senior nurses, medical and nursing students and patients. Participants were asked to narrate critical incidents related to deficiencies in communication skills in physicians in which they had been involved or which they had witnessed first-hand. Eighty-one critical incident narrations were recorded and transcribed. They were analysed and grouped according to themes, categories and sub-categories. Communication skills deficiencies were identified from the themes, categories and sub-categories. In-depth analysis of communication gaps, cultural or contextual influences and their medical consequences were identified. One critical incident referred to the failure of a physician to identify the locus of decision making. An individual in need of surgery for a hernia was also at risk for cardiac complications during surgery. The patient felt that his family needed to make the decision, whereas the physician demanded that he make the decision. Another example referred to the fact that ward rounds are usually conducted in English, a language most patients do not understand. One day during discussions at the bedside, the word ‘surgery’ was mentioned causing much unnecessary anxiety and alarm in an elderly female patient. These are two of the incidents narrated which illustrate poor communication with medical consequences. What lessons were learned? Four categories of communication deficiency were developed from the narrated incidents: (i) content omission (8 sub-categories); (ii) inappropriate responses (6 sub-categories); (iii) inappropriate setting (4 sub-categories), and (iv) non-verbal communication issues (6 subcategories). These categories and sub-categories formed an interrelated framework for the content and learning activities of a new communication skills course for Sri Lankan doctors. Critical incident analysis themes provided the content necessary to design a culturally and contextually relevant solution to a significant problem in physician communication in Sri Lanka. The 81 authentic scenarios will also be useful in the teaching process during this course. REFERENCE 1 Ferguson WJ, Candib LM. Culture, language, and the doctor–patient relationship. Fam Med 2002;34 (5):353–61. Correspondence: Dr Avindra Jayawardene, Department of Medical Education, Faculty of Medicine, University of Ruhuna, Tangalle
Rd, Wellmadama, Matara 80000, Sri Lanka. Tel: 00 94 770 530249; E-mail: [email protected] doi: 10.1111/medu.12461
The Concordance of Judgement Learning Tool Amelie Foucault, Serge Dube, Nicolas Fernandez, Robert Gagnon & Bernard Charlin What problems were addressed Ethical decision making is a key aspect of professionalism in medical practice. Yet, medical educators agree that fostering its development is complex, chiefly because there is rarely a single right answer. Students could be prepared to make better ethical decisions early on in their training. Systematic reviews report a variety of methods with which to teach professionalism, most of which are time-consuming and rely heavily on face-to-face contact. Furthermore, as van Mook et al.1 point out, the hidden or informal curriculum is probably one of the main barriers to professionalism development in medical education. What was tried? We implemented the online Concordance of Judgement Learning Tool (CJLT) in our clerkship programme. It briefly describes realistic situations, such as the divulging of prescription error, the breaking of difficult news to patients and caregivers, contexts of physician–patient confidentiality, and the reporting of inappropriate behaviour. For each situation, a series of more or less acceptable behaviours is proposed and students are asked to indicate the degree of appropriateness of each one. Once a student selects his or her decision, the tool provides decisions made by members of an expert panel composed of medical educators identified by students as role models of professionalism. The CJLT’s key feature is the provision of detailed explanations justifying each expert decision. Hence, clerks can think through ethics-related issues, with expert guidance, and make helpful links with their experiences on clinical wards. In this regard, the CJLT represents an efficient learning tool within an environment of limited educational resources. What lessons were learned? Student survey (n = 55) and focus group (n = 8) results about the initial experience confirm our hypothesis: insight into expert ethical decision-making processes involving professionalism favours the development of ethical decision making anchored in critical thinking skills. Because the CJLT is based on ‘concordance’ in which affordance is given to more than one appropriate answer, the CJLT is best suited to learning professionalism. In confronting the student with
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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non-medical professionals enhanced my understanding of their expectations of medical students’, and ‘. . .receiving feedback from people previously unknown [i.e. a non-medical professional] makes me feel fulfilled.’ What lessons were learned? This study found that feedback from near-peers and non-medical professionals can have a positive impact on medical students’ use of and reflection on their e-portfolios. Near-peer feedback was perceived to be more effective than that given by non-medical professionals. This may reflect the fact that students and their near-peers are of similar ages and backgrounds. Given these impacts, multiple sources of feedback, such as near-peers and non-medical professionals, should be considered when implementing a portfolio system. REFERENCE 1 O’Sullivan P, Aronson L, Chittenden E, Niehaus B, Learman L. Reflective ability rubric and user guide. MedEdPORTAL 2010. http://www.mededportal.org/ pubilication/8133. [Accessed 28 October 2013.] Correspondence: Professor Ming-Jung Ho, Department of Social Medicine, National Taiwan University College of Medicine, No. 1, Ren-Ai Road, Section 1, Taipei 106, Taiwan. Tel: 00 886 910 188399; E-mail: [email protected] doi: 10.1111/medu.12445
Addressing physicians’ poor communication skills in Sri Lanka Avindra Jayawardene & Tony LaDuca What problems were addressed? Deficiencies in the communication skills of health care personnel have been identified as a threat to patient safety. Effective communication in health care settings is dependent on culture, patient expectations and the specific context.1 Although formal communication skills training courses for physicians are being developed worldwide, it is not always true that adequate attention and respect are given to local requirements. The result may be a course that is not fit for purpose. What was tried? The objective of this study was to produce a framework to develop a culturally and contextually relevant communication skills course for doctors in Sri Lanka. Critical incident analysis was used to produce authentic data about real-life experiences to inform course development.
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
really good stuff Five group interviews were conducted with a total of 50 physicians, postgraduate specialists, senior nurses, medical and nursing students and patients. Participants were asked to narrate critical incidents related to deficiencies in communication skills in physicians in which they had been involved or which they had witnessed first-hand. Eighty-one critical incident narrations were recorded and transcribed. They were analysed and grouped according to themes, categories and sub-categories. Communication skills deficiencies were identified from the themes, categories and sub-categories. In-depth analysis of communication gaps, cultural or contextual influences and their medical consequences were identified. One critical incident referred to the failure of a physician to identify the locus of decision making. An individual in need of surgery for a hernia was also at risk for cardiac complications during surgery. The patient felt that his family needed to make the decision, whereas the physician demanded that he make the decision. Another example referred to the fact that ward rounds are usually conducted in English, a language most patients do not understand. One day during discussions at the bedside, the word ‘surgery’ was mentioned causing much unnecessary anxiety and alarm in an elderly female patient. These are two of the incidents narrated which illustrate poor communication with medical consequences. What lessons were learned? Four categories of communication deficiency were developed from the narrated incidents: (i) content omission (8 sub-categories); (ii) inappropriate responses (6 sub-categories); (iii) inappropriate setting (4 sub-categories), and (iv) non-verbal communication issues (6 subcategories). These categories and sub-categories formed an interrelated framework for the content and learning activities of a new communication skills course for Sri Lankan doctors. Critical incident analysis themes provided the content necessary to design a culturally and contextually relevant solution to a significant problem in physician communication in Sri Lanka. The 81 authentic scenarios will also be useful in the teaching process during this course. REFERENCE 1 Ferguson WJ, Candib LM. Culture, language, and the doctor–patient relationship. Fam Med 2002;34 (5):353–61. Correspondence: Dr Avindra Jayawardene, Department of Medical Education, Faculty of Medicine, University of Ruhuna, Tangalle
Rd, Wellmadama, Matara 80000, Sri Lanka. Tel: 00 94 770 530249; E-mail: [email protected] doi: 10.1111/medu.12461
The Concordance of Judgement Learning Tool Amelie Foucault, Serge Dube, Nicolas Fernandez, Robert Gagnon & Bernard Charlin What problems were addressed Ethical decision making is a key aspect of professionalism in medical practice. Yet, medical educators agree that fostering its development is complex, chiefly because there is rarely a single right answer. Students could be prepared to make better ethical decisions early on in their training. Systematic reviews report a variety of methods with which to teach professionalism, most of which are time-consuming and rely heavily on face-to-face contact. Furthermore, as van Mook et al.1 point out, the hidden or informal curriculum is probably one of the main barriers to professionalism development in medical education. What was tried? We implemented the online Concordance of Judgement Learning Tool (CJLT) in our clerkship programme. It briefly describes realistic situations, such as the divulging of prescription error, the breaking of difficult news to patients and caregivers, contexts of physician–patient confidentiality, and the reporting of inappropriate behaviour. For each situation, a series of more or less acceptable behaviours is proposed and students are asked to indicate the degree of appropriateness of each one. Once a student selects his or her decision, the tool provides decisions made by members of an expert panel composed of medical educators identified by students as role models of professionalism. The CJLT’s key feature is the provision of detailed explanations justifying each expert decision. Hence, clerks can think through ethics-related issues, with expert guidance, and make helpful links with their experiences on clinical wards. In this regard, the CJLT represents an efficient learning tool within an environment of limited educational resources. What lessons were learned? Student survey (n = 55) and focus group (n = 8) results about the initial experience confirm our hypothesis: insight into expert ethical decision-making processes involving professionalism favours the development of ethical decision making anchored in critical thinking skills. Because the CJLT is based on ‘concordance’ in which affordance is given to more than one appropriate answer, the CJLT is best suited to learning professionalism. In confronting the student with
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
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