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The article offers information on various medical workshops offered by different publication companies and universities which include the workshop on how to create a good research paper, workshop on understanding the methods in research, and a question and answer workshop on the development of Multiple Mini Interview (MMI) format.

Context The impact of academic scholarship has traditionally been measured using citation-based metrics. However, citations may not be the only measure of impact. In recent years, other platforms (e.g. Twitter) have provided new tools for promoting scholarship to both academic and non-academic audiences. Alternative metrics (altmetrics) can capture non-traditional dissemination data such as attention generated on social media platforms. Objectives The aims of this exploratory study were to characterise the relationships among altmetrics, access counts and citations in an international and pre-eminent medical education journal, and to clarify the roles of these metrics in assessing the impact of medical education academic scholarship. Methods A database study was performed (September 2015) for all papers published in Medical Education in 2012 ( n = 236) and 2013 ( n = 246). Citation, altmetric and access ( HTML views and PDF downloads) data were obtained from Scopus, the Altmetric Bookmarklet tool and the journal Medical Education, respectively. Pearson coefficients ( r-values) between metrics of interest were then determined. Results Twitter and Mendeley (an academic bibliography tool) were the only altmetric-tracked platforms frequently (> 50%) utilised in the dissemination of articles. Altmetric scores (composite measures of all online attention) were driven by Twitter mentions. For short and full-length articles in 2012 and 2013, both access counts and citation counts were most strongly correlated with one another, as well as with Mendeley downloads. By comparison, Twitter metrics and altmetric scores demonstrated weak to moderate correlations with both access and citation counts. Conclusions Whereas most altmetrics showed limited correlations with readership (access counts) and impact (citations), Mendeley downloads correlated strongly with both readership and impact indices for articles published in the journal Medical Education and may therefore have potential use that is complementary to that of citations in assessment of the impact of medical education scholarship. [ABSTRACT FROM AUTHOR]

To evaluate the effect of a compulsory evidence-based medicine (EBM) seminar in critical appraisal skills and the overall acceptance of compulsory EBM seminars for Year 3 medical undergraduate students. Small group seminars by peer teaching were conducted for up to 23 undergraduates. Knowledge and skills in EBM before and after the compulsory seminars were evaluated by 2 different sets of 20 questions. To apply knowledge, each undergraduate had to analyse an individual paper case using the principles of EBM. Undergraduates gave anonymous feedback using separate evaluation sheets at the end of the seminar. Main outcome variables were changes in knowledge and skills. A total of 132 Year 3 undergraduates at the University of Frankfurt participated in a compulsory EBM seminar during the academic half-year 2003/04 as part of their regular curriculum. Complete datasets were available for evaluation from 124 undergraduates (94%). The seminars led to an overall increase in knowledge (question paper score increase from 2.37 to 7.48, 99% CI 6.61–8.36, or 216%). Transfer of knowledge into a paper case scenario was generally good, with a mean score of 49.5 (SD 5.24) out of 55 points. Feedback indicated good overall acceptance of the seminars, with a median of 2 (score range from 1 = excellent to 6 = failed). Trained medical students are effective and well accepted EBM trainers in compulsory undergraduate seminars. [ABSTRACT FROM AUTHOR]

An abstract of the article "Video or Paper for Delivery of Problem-Based Learning Cases?" by Najia K. Ghanchi et al. is presented.

Context The development of clinical reasoning ( CR) in students has traditionally been left to clinical rotations, which, however, often offer limited practice and suboptimal supervision. Medical schools begin to address these limitations by organising pre-clinical CR courses. The purpose of this paper is to review the variety of approaches employed in the teaching of CR and to present a proposal to improve these practices. Methods We conducted a narrative review of the literature on teaching CR. To that end, we searched PubMed and Web of Science for papers published until June 2014. Additional publications were identified in the references cited in the initial papers. We used theoretical considerations to characterise approaches and noted empirical findings, when available. Results Of the 48 reviewed papers, only 24 reported empirical findings. The approaches to teaching CR were shown to vary on two dimensions. The first pertains to the way the case information is presented. The case is either unfolded to students gradually - the 'serial-cue' approach - or is presented in a 'whole-case' format. The second dimension concerns the purpose of the exercise: is its aim to help students acquire or apply knowledge, or is its purpose to teach students a way of thinking? The most prevalent approach is the serial-cue approach, perhaps because it tries to directly simulate the diagnostic activities of doctors. Evidence supporting its effectiveness is, however, lacking. There is some empirical evidence that whole-case, knowledge-oriented approaches contribute to the improvement of students' CR. However, thinking process-oriented approaches were shown to be largely ineffective. Conclusions Based on research on how expertise develops in medicine, we argue that students in different phases of their training may benefit from different approaches to the teaching of CR. [ABSTRACT FROM AUTHOR]

Context The inclusion of interprofessional education opportunities in clinical placements for pre-registration learners has recently been proposed as a strategy to enhance graduates' skills in collaborative practice. Objectives A realist review was undertaken to ascertain the contexts, mechanisms and outcomes of formal interprofessional clinical workplace learning. Methods Initial scoping was carried out, after which Ovid MEDLINE, CINAHL and EMBASE were searched from 2005 to April 2016 to identify formal interprofessional workplace educational interventions involving pre-registration learners. Papers reporting studies conducted in dedicated training wards were excluded, leaving a total of 30 papers to be included in the review. Results Several educational formats that combined students from medicine, nursing, pharmacy and allied health professions were identified. These included: the use of engagement by student teams with a real patient through interview as the basis for discussion and reflection; the use of case studies through which student teams work to promote discussion; structured workshops; ward rounds, and shadowing. Meaningful interprofessional student discussion and reflection comprised the mechanism by which the outcome of learners acquiring knowledge of the roles of other professions and teamwork skills was achieved. The mechanism of dialogue during an interaction with a real patient allowed the patient to provide his or her perspective and contributed to an awareness of the patient's perspective in health care practice. Medication- or safety-focused interprofessional tasks contributed to improved safety awareness. In the absence of trained facilitators or in the context of negative role-modelling, programmes were less successful. Conclusions In the design of workplace education initiatives, curriculum decisions should take into consideration the contexts of the initiatives and the mechanisms for achieving the education-related outcomes of interest. [ABSTRACT FROM AUTHOR]

Objectives This paper reviews why and how theories of agency can be used as analytical lenses to help health professions education ( HPE) scholars address our community's wicked problems. Wicked problems are those that resist clear problem statements, defy traditional analysis approaches, and refuse definitive resolution (e.g. student remediation, assessments of professionalism, etc.). We illustrate how theories of agency can provide new insights into such challenges by examining the application of these theories to one particular wicked problem in HPE: interprofessional education ( IPE). Methods After searching the HPE literature and finding that theories of agency had received little attention, we borrowed techniques from narrative literature reviews to search databases indexing a broad scope of disciplines (i.e. ERIC, Web of Science, Scopus, MEDLINE and PubMed) for publications (1994-2014) that: (i) examined agency, or (ii) incorporated an agency-informed analytical perspective. The lead author identified the theories of agency used in these articles, and reviewed the texts on agency cited therein and the original sources of each theory. We identified 10 theories of agency that we considered to be applicable to HPE's wicked problems. To select a subset of theories for presentation in this paper, we discussed each theory in relation to some of HPE's wicked problems. Through debate and reflection, we unanimously agreed on the applicability of a subset of theories for illuminating HPE's wicked problems. This subset is described in this paper. Results We present four theories of agency: Butler's post-structural formulation; Giddens' sociological formulation; cultural historical activity theory's formulation, and Bandura's social cognitive psychology formulation. We introduce each theory and apply each to the challenges of engaging in IPE. Conclusions Theories of agency can inform HPE scholarship in novel and generative ways. Each theory offers new insights into the roots of wicked problems and means for contending with them. [ABSTRACT FROM AUTHOR]

Context Thirty years ago, it was suggested in the Edinburgh Declaration that medical school applicants should be selected not only on academic, but also on non-academic, attributes. The main rationale behind extending medical school selection procedures with the evaluation of (non-academic) personal qualities is that this will lead to the selection of students who will perform better as a doctor than those who are selected on the basis of academic measures only. A second rationale is the expectation that this will lead to a representative health workforce as a result of reduced adverse impact. The aims of this paper are (i) to describe what can be learned about the use of selection criteria other than grades from over 15 years of Dutch experience and (ii) to summarise current knowledge on the issue of adverse impact in relation to non-grades-based selection. Methods A narrative review was undertaken of the (published) evidence that has resulted from non-grades-based school-specific selection procedures in the Netherlands and from recent explorations of the effect of the use of non-grades-based selection criteria on student diversity. Results The Dutch evidence is grouped into five key themes: the effect of participation in voluntary selection procedures, the assessment of pre-university extracurricular activities, the use of work samples, Dutch experiences with situational judgement tests and the effects of changing circumstances. This is followed by several lessons learned for medical schools that aim to increase their student diversity. Conclusion Over the last 30 years, important steps towards reliable and valid methods for measuring non-academic abilities have been taken. The current paper describes several lessons that can be learned from the steps taken in the Dutch context. The importance of sharing evidence gathered around the globe and building on this evidence to reach our goal of predicting who will be a good doctor is acknowledged. [ABSTRACT FROM AUTHOR]

Context In 1988, the World Federation of Medical Education called for reform in medical education, publishing 12 recommendations. The sixth recommendation of this Edinburgh Declaration was to 'complement instruction about the management of patients with increased emphasis on promotion of health and prevention of disease'. Thirty years on, this paper reports an exploration of what has changed since then. Methods Several search strategies were used, including websites of medical standards organisations, and formal searches of Pub Med and Google Scholar using key words such as 'medical education standards', 'health promotion', 'illness prevention', 'effectiveness' and 'assessment'. As these searches produced more descriptive than evidence-based papers, the exploration widened to follow evolving discussions about changing emphases in medical education relevant to public health. Results Health promotion and illness prevention are in the undergraduate medical education standards of the more influential regulators. There is little evidence of the impact of this inclusion on graduate outcomes and later medical practice, although 'differently educated' doctors may have contributed to the success of broader public health strategies achieved through reorganisation of health care, media campaigns and legislation changes. There is greater success in postgraduate specialty training of general practitioners and public health doctors. The discussion about public health interventions and the roles of doctors has moved on to topics such as patient safety, the health of doctors, global health and planetary health. Conclusions The inclusion of health promotion and illness prevention strategies in undergraduate curricula varied considerably, but was strongest in programmes claiming social accountability and responding to medical education standards of the more influential regulators. However, the contribution of medical education to improvements in health care and the health of populations is difficult to measure. It may be timely to revisit the purpose and practicality of broadening the scope of undergraduate medical curricula in public health medicine. [ABSTRACT FROM AUTHOR]

Context The arts and humanities are gradually gaining a foothold in health professions education as a means of supporting the development of future clinicians who are compassionate, critical and reflexive thinkers, while also strengthening clinical skills and practices that emphasise patient-centredness, collaboration and interprofessional practices. Assignments that tap into trainee creativity are increasingly used both to prepare learners for the demands of clinical work and to understand the personal and professional challenges learners face in these contexts. Health professions educators need methods for interpreting these creations in order to understand each learner's expressions. This paper describes two theoretical frameworks that can be used to understand trainees' unique learning experiences as they are expressed in arts- and humanities-based creations. Methods The authors introduce the philosophical underpinnings and interpretation procedures of two theoretical frameworks that enable educators to 'hear' and 'see' the multilayered expressions embedded within arts- and humanities-based student creations: Gilligan's Listening Guide and Kress and van Leeuwen's approach to visual rhetoric. To illustrate how these frameworks can be used, the authors apply them to two creative summaries that learners made as part of a humanities-informed, interprofessional education intervention that took place in a non-acute-care teaching hospital. The interpretations of two creative summaries, a poem and a pair of paintings, highlight how applying these theoretical frameworks can offer important insights into learners' experiences. Conclusions This cross-cutting edge paper describes how the Listening Guide and visual rhetoric can help health professions educators listen to and read the arts- and humanities-based creative expressions made by learners. Insights gained from these interpretations can advance the understanding of students' personal experiences in different learning environments and can inform curriculum development. [ABSTRACT FROM AUTHOR]

IntroductionThis paper reports on a teaching strategy designed to support first year undergraduate medical students from non-English speaking backgrounds in a behavioural science course taught at an Australian university. MethodThe strategy is described, as is the language profile of students from two successive cohorts who participated in the teaching programme. The effectiveness of the intervention in improving students’ academic performance is explored, as gauged by summative assessment and student perceptions. ConclusionsFindings suggest that students disadvantaged by difficulties with language and/or knowledge of Australian culture were able to perform at least as well as other students on a number of summative criteria. Non-English speaking background students perceived the behavioural science course to be difficult, and indicated that they found the teaching support offered to them to be useful. The methodological difficulties and limitations involved in the evaluation of a teaching programme such as this are discussed and the conclusions that can be validly drawn are considered. [ABSTRACT FROM AUTHOR]

Context: The prevalence of depressive symptoms among medical students has been found to be higher than among other students because of their longer studying time, higher workload and larger financial burden. Despite the availability of reviews examining this, some have focused solely on one country, whereas others used databases containing papers of solely one language; therefore, the results from reviews might not be comprehensive. Against this background, this overview aims to synthesise the results from all the published systematic reviews of depression among medical students, in order to provide a more accurate result. Methods: A systematic search was conducted of online databases for published systematic reviews or meta‐analyses examining the prevalence of depressive symptoms among medical students. The findings of individual studies included in these reviews were extracted and then combined with a random‐effects model. Subgroup analysis was conducted by regions. Results: A total of 10 studies were selected in this overview, involving 249 primary studies and 162 450 medical students. MEDLINE was the most popular database used in these studies. The overlapping of primary studies in these reviews was appreciably high, except for three studies that focused on specific countries. The overall pooled prevalence was 27.0% (95% CI, 24.7–29.5%). Significant subgroup differences were detected (p < 0.001). The pooled prevalence among studies in the Western Pacific Region was the lowest, 18.9% (95% CI, 11.7–29.0%), whereas that in Africa (40.9%) was the highest (95% CI, 28.8–54.4%). The top five significant factors associated with depressive symptoms were: (i) year of study; (ii) gender; (iii) personal issues; (iv) family relations or issues, and (v) health status. Conclusions: Depression affected around a quarter of medical students in general and 40.9% of students in Africa. It is suggested that medical schools and health authorities should introduce preventive measures to curb the high prevalence of depressive symptoms. How depressed are your medical students? In this review of reviews, examining data from over 162,000 students, Tam, Lo, and Pacheco report the factors most associated with depressive symptoms. [ABSTRACT FROM AUTHOR]

Context Gender sensitivity is a crucial factor in the provision of quality health care. This paper explores acquired gendered values and attitudes among medical students through an analysis of the hidden curriculum that exists within formal medical classes and informal learning. Methods Discourse analysis was adopted as the research method. Data were collected from the Bulletin Board System ( BBS), which represented an essential communication platform among students in Taiwan before the era of Facebook. The study examined 197 gender-related postings on the BBS boards of nine of 11 universities with a medical department in Taiwan, over a period of 10 years from 2000 to 2010. Results The five distinctive characteristics of the hidden curriculum were as follows: (i) gendered stereotypes of physiological knowledge; (ii) biased treatment of women; (iii) stereotyped gender-based division of labour; (iv) sexual harassment and a hostile environment, and (v) ridiculing of lesbian, gay, bisexual and transgender ( LGBT) people. Both teachers and students co-produced a heterosexual masculine culture and sexism, including 'benevolent sexism' and 'hostile sexism'. As a result, the self-esteem and learning opportunities of female and LGBT students have been eroded. Conclusions The paper explores gender dynamics in the context of a hidden curriculum in which heterosexual masculinity and stereotyped sexism are prevalent as norms. Both teachers and students, whether through formal medical classes or informal extracurricular interactive activities, are noted to contribute to the consolidation of such norms. The study tentatively suggests three strategies for integrating gender into medical education: (i) by separating physiological knowledge from gender stereotyping in teaching; (ii) by highlighting the importance of gender sensitivity in the language used within and outside the classroom by teachers and students, and (iii) by broadening the horizons of both teachers and students by recounting examples of the lived experiences of those who have been excluded and discriminated against, particularly members of LGBT and other minorities. [ABSTRACT FROM AUTHOR]

Context The author describes a career in which he combined clinical surgery with the formal study of medical education. In the 1980s, when the author embarked on this career track, it was an uncommon pathway. Over the last 30 years there has been an exponential increase in the number of individuals who have made medical education their principal academic focus. This paper provides examples from the author's personal story and lessons derived from that experience. Process The author outlines his experience of attaining formal training in education and concludes that this training was a foundational element in his pursuit of a career in health education research. The author describes his involvement in the transition from paper and pencil-based tests to performance-based testing in high-stakes examinations. He describes the development of a research centre in health professions education and the establishment of a simulation centre. The author's experiences in the development of an examination intended to measure technical skills, in the adoption of surgical safety checklists and in the elaboration of a programme in competency-based education are discussed. Discussion The author describes several of the lessons learned in the course of his career in medical education. He argues that successful enterprises in scholarship in medicine are almost invariably the product of interdisciplinarity. He describes the power of a joint venture between a university and an academic hospital. He argues that the geographical footprint of an emerging centre is critical. He discusses the importance of graduate studentship in an emerging discipline and enterprise. [ABSTRACT FROM AUTHOR]

Objectives This study was intended to determine if previously identified educational benefits of the Harvard Medical School ( HMS) Cambridge Integrated Clerkship ( CIC) endure over time. Methods The authors' earlier work compared the 27 graduates in the first three cohorts of students undertaking the CIC with a comparison group of 45 traditionally trained HMS students; CIC graduates emerged from their clerkship year with a higher degree of patient-centredness and felt more prepared to deal with numerous domains of patient care. Between April and July 2011, at 4-6 years post-clerkship, the authors asked these original study cohorts to complete an electronic survey which included measures used in the original study. The authors also reviewed data from the National Residency Match Program to compare career paths in the two groups. Results The response rate was 62% (42/68). The immediate post-clerkship finding that CIC students held more patient-centred attitudes was sustained over time (p < 0.035). Reflecting retrospectively on their clerkship experiences, CIC graduates continued to report that their clerkship year had better prepared them in a wide variety of domains. Graduates of the CIC attained awards and published papers at the same rates as peers, and were more likely to engage in health advocacy work. Both groups chose a wide range of residency programmes. Among those expressing a preference, no CIC graduates said they would choose a traditional clerkship, but 6 (27%) of the traditionally trained graduates said they would choose a longitudinal integrated clerkship. Conclusions This paper indicates that benefits of longitudinal integrated clerkship training are sustained over time across multiple domains. [ABSTRACT FROM AUTHOR]

Context Health care organisations are increasingly conceptualised as complex, indivisible entities made up of web-like networks of staff that connect to each other in changeable ways. This study draws on the theoretical framework of activity theory and the concept of knotworking to illustrate how health professionals improvise collaboratively to negotiate everyday challenges and contribute positively to patients' health priorities. Objectives The aim of this paper is to contribute to evolving ideas about collective learning, change and improvement in secondary care by exploring how health professionals work and learn together and how this compares with earlier findings from primary care. Methods This study applied a constructionist methodology within the research paradigm of interpretivism. Qualitative data were gathered through 26 hours of observations and 17 field interviews within the natural environment of a working hospital over a 3-month period. The research site encompassed a medical receiving ward, a chronic ward, an out-patient clinic and the connecting corridors. Staff participants included a range of clinical, nursing, ancillary and clerical staff. Results The study found a recurring pattern of spontaneous team forming and interprofessional shared learning to respond to care needs within the hospital as they arise. These are presented in four analytical themes: motion, flux and the unpredictability of 'team spirit'; adaptive, responsive learning through seeing, doing and asking questions; the collective learning gap between doctors and other staff; and frustration, compassion and the desire for improvement. Conclusions Health care professionals in the hospital setting both create and experience complex inclusion and exclusion behaviours that define who is empowered to act with professional authority in any given moment of care. This paper discusses issues of power, the particular exclusion of doctors from interprofessional knotworking, and the greater emphasis on questions as the pivotal aspect of shared collective learning when compared with primary care. [ABSTRACT FROM AUTHOR]

Context The delivery of undergraduate clinical education in underserved areas is increasing in various contexts across the world in response to local workforce needs. A collective understanding of the impact of these placements is lacking. Previous reviews have often taken a positivist approach by only looking at outcome measures. This review addresses the question: What are the strengths and weaknesses for medical students and supervisors of community placements in underserved areas? Methods A systematic literature review was carried out by database searching, citation searching, pearl growing, reference list checking and use of own literature. The databases included MEDLINE, EMBASE, PsycINFO, Web of Science and ERIC. The search terms used were combinations and variations of four key concepts exploring general practitioner (GP) primary care, medical students, placements and location characteristics. The papers were analysed using a textual narrative synthesis. Findings The initial search identified 4923 results. After the removal of duplicates and the screening of titles and abstracts, 185 met the inclusion criteria. These full articles were obtained and assessed for their relevance to the research question; 54 were then included in the final review. Four main categories were identified: student performance, student perceptions, career pathways and supervisor experiences. Conclusions This review reflects the emergent qualitative data as well as the quantitative data used to assess initiatives. Underserved area placements have produced many beneficial implications for students, supervisors and the community. There is a growing amount of evidence regarding rural, underserved areas, but little in relation to inner city, deprived areas, and none in the UK. [ABSTRACT FROM AUTHOR]

Introduction Many doctors, across grades and specialities, supervise or advise students and juniors undertaking elective placements. Electives form part of medical curricula on a worldwide scale. The Medical Schools Council ( MSC) Electives Committee in the UK identified a gap in the current literature in relation to provision of comprehensive recommendations for the design and management of undergraduate elective programmes. Electives afford many known benefits for medical and other health care students, but the context, and risks (impacting potentially on patient, public and student well-being) are usually different from those associated with 'home' clinical placements. Aim The aim is to share experiences and good practice within UK Medical Schools, and inform and inspire others involved with similar programmes across the globe. Method This paper reports the results of the formation of a sub-group to draft a set of recommendations, drawing on the reported experiences of academic elective leads across all UK schools, and including input from the MSC, and the student group Medsin (to capture the learner voice). The final document was the result of a national consultative process of four iterations. The end document was approved at school level, e.g. by curriculum committee, by each of the participating schools. Recommendations The recommendations consolidate the experiences of 30 participating UK medical schools. The consultation process generated 17 pre-departure recommendations, seven during elective recommendations, 11 post elective recommendations and a further four recommendations relating to infectious disease. Conclusion We believe developing elective programmes using collective recommendations will provide a basis for a safer and more structured approach to a medical elective without losing the uniqueness and creative experiences valued by participants. Issues relating to undergraduates leaving their home school to experience medicine in a new context or country replicate across sites, so many recommendations will be transferable internationally. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "What is the role of e-learning? Looking past the hype" by D.A. Cook and M.M. Triola published in issue 48:930-7 of a 2014 edition of the periodical.

The introduction of graduate entry medical courses requires attention to models of decision-making and change. Much of the educational literature describes change as either centralised or decentralised with the latter claimed to be more effective. Recently Fullan has argued for the importance of an ongoing culture of change. This paper examines the change culture of two medical schools adopting graduate entry courses; Flinders University in South Australia and St George's Hospital Medical School, London.Comparative case study was used. Key informants were interviewed and documents and records analysed. Data were cross-checked and categorised to generate models of change.There were four components of the change culture at Flinders but they were not sufficient on their own to generate change. The process was triggered by a significant external event. The nature of the change was also important. The descriptive model developed suggested a complex interplay of factors rather than attributing the success of the change to the change mechanisms adopted alone. The model was tested for explanatory potential at St George's. The culture there was described as both‘macro-innovative’ and‘micro-conservative’. External events were also important but they exerted a positive force. A more centralised approach was adopted.The models developed represent change as‘dynamic, complex and open’ rather than a simple centralised or decentralised dichotomy. While some of the elements of a change culture were evident at both schools there were longer term questions of sustainability. This has implications for development of all programmes but particularly for graduate entry schools. [ABSTRACT FROM AUTHOR]

Context Many individual- and job-related factors are known to influence medical careers decision making. Previous research has extensively studied medical trainees' (residents') and students' views of the factors that are important. However, how trainees and students trade off these factors at times of important careers-related decision making is under-researched. Information about trade-offs is crucial to the development of effective policies to enhance the recruitment and retention of junior doctors. Objectives Our aim was to investigate the strength of UK medical students' preferences for the characteristics of training posts in terms of monetary value. Methods We distributed a paper questionnaire that included a discrete choice experiment ( DCE) to final-year medical students in six diverse medical schools across the UK. The main outcome measure was the monetary value of training post characteristics, based on willingness to forgo and willingness to accept extra income for a change in each job characteristic calculated from regression coefficients. Results A total of 810 medical students answered the questionnaire. The presence of good working conditions was by far the most influential characteristic of a training position. Medical students consider that, as newly graduated doctors, they will require compensation of an additional 43.68% above average earnings to move from a post with excellent working conditions to one with poor working conditions. Female students value excellent working conditions more highly than male students, whereas older medical students value them less highly than younger students. Conclusions Students on the point of completing medical school and starting postgraduate training value good working conditions significantly more than they value desirable geographical location, unit reputation, familiarity with the unit or opportunities for partners or spouses. This intelligence can be used to address the crisis in workforce staffing that has developed in the UK and opens up fruitful areas for future research across contexts and in terms of examining stated preferences versus actual career-related behaviour. [ABSTRACT FROM AUTHOR]

Context Patient care activity has recently increased without a proportionate rise in workforce numbers, impacting negatively on health care workplace learning. Health care professionals are prepared in part by spending time in clinical practice, and for medical staff this constitutes a contribution to service. Although stakeholders have identified the balance between health care professional education and patient care as a key priority for medical education research, there have been very few reviews to date on this important topic. Methods We conducted a realist synthesis of the UK literature from 1998 to answer two research questions. (1) What are the key workplace interventions designed to help achieve a balance between health care professional education and patient care delivery? (2) In what ways do interventions enable or inhibit this balance within the health care workplace, for whom and in what contexts? We followed Pawson's five stages of realist review: clarifying scope, searching for evidence, assessment of quality, data extraction and data synthesis. Results The most common interventions identified for balancing health care professional education and patient care delivery were ward round teaching, protected learning time and continuous professional development. The most common positive outcomes were simultaneous improvements in learning and patient care or improved learning or improved patient care. The most common contexts in which interventions were effective were primary care, postgraduate trainee, nurse and allied health professional contexts. By far the most common mechanisms through which interventions worked were organisational funding, workload management and support. Conclusion Our novel findings extend existing literature in this emerging area of health care education research. We provide recommendations for the development of educational policy and practice at the individual, interpersonal and organisational levels and call for more research using realist approaches to evaluate the increasing range of complex interventions to help balance health care professional education and patient care delivery. [ABSTRACT FROM AUTHOR]

Context There are inconsistent claims made about the effectiveness of the flipped classroom ( FC) in medical education; however, the quality of the empirical evidence used to back up these claims is not evident. The aims of this review are to examine the scope and quality of studies on the FC teaching approach in medical education and to assess the effects of FCs on medical learning. Methods A literature search was conducted using the major electronic databases in 2016. Peer-reviewed papers were screened and reviewed according to explicit inclusion criteria. The scope and quality of all resultant studies were evaluated. Studies identified as using controlled designs were further synthesised to assess the effects of FCs on learning. Results A total of 118 articles were obtained. Full texts of 82 articles were reviewed. Nine of the included 46 articles used a controlled design when examining the effects of the FC. There were generally positive perceptions of the FC approach. However, the effects of FCs on changes in knowledge and skills were less conclusive as the effect sizes ranged from d = −0.27 to 1.21, with a median of 0.08. The varying direction and magnitude of the effect sizes, together with their 95% confidence interval, which contained zero, suggested the lack of strong evidence for the effectiveness of FCs in promoting knowledge acquisition above and beyond the traditional learning methods. Conclusions There has been a recent increase of research rigor and variety in measures of effectiveness in studies on the FC in medical education. The FC is a promising teaching approach to increase learners' motivation and engagement. More solid evidence on its effect on changes in knowledge and skills are warranted. Further studies should also examine the long-term effects of FCs with regard to knowledge retention and transfer of knowledge to professional practice and patient care. [ABSTRACT FROM AUTHOR]

Context Being able to accurately monitor learning activities is a key element in self-regulated learning in all settings, including medical schools. Yet students' ability to monitor their progress is often limited, leading to inefficient use of study time. Interventions that improve the accuracy of students' monitoring can optimise self-regulated learning, leading to higher achievement. This paper reviews findings from cognitive psychology and explores potential applications in medical education, as well as areas for future research. Cognitive Psychology Effective monitoring depends on students' ability to generate information ('cues') that accurately reflects their knowledge and skills. The ability of these 'cues' to predict achievement is referred to as 'cue diagnosticity'. Interventions that improve the ability of students to elicit predictive cues typically fall into two categories: (i) self-generation of cues and (ii) generation of cues that is delayed after self-study. Providing feedback and support is useful when cues are predictive but may be too complex to be readily used. Application to Medical Education Limited evidence exists about interventions to improve the accuracy of self-monitoring among medical students or trainees. Developing interventions that foster use of predictive cues can enhance the accuracy of self-monitoring, thereby improving self-study and clinical reasoning. First, insight should be gained into the characteristics of predictive cues used by medical students and trainees. Next, predictive cue prompts should be designed and tested to improve monitoring and regulation of learning. Finally, the use of predictive cues should be explored in relation to teaching and learning clinical reasoning. Conclusions Improving self-regulated learning is important to help medical students and trainees efficiently acquire knowledge and skills necessary for clinical practice. Interventions that help students generate and use predictive cues hold the promise of improved self-regulated learning and achievement. This framework is applicable to learning in several areas, including the development of clinical reasoning. [ABSTRACT FROM AUTHOR]

Context An increasing number of medical schools around the world are implementing longitudinal integrated clerkships ( LICs). The University of Alberta's third-year LIC admits a small group of each class. Those not in the LIC undertake a rotation-based clerkship ( RBC). All students have a fourth-year RBC. Meaningful participation in patient care and guidance have been identified as affordances for work-based learning. Methods This qualitative study is part of an ongoing research programme conducted in a hermeneutic phenomenological frame. The overarching research question is: What is the lived experience of integrated community clerkship ( ICC) students in their clerkships? This paper focuses on an emic question, that is, one arising from the analysis, which was: What was the experience of ICC students in their transitioning to the fourth year? One-to-one reflective conversations with LIC students when they were at the end of their fourth year were the source of the material analysed. Transcripts were first analysed by each researcher and then co-analysed with an emphasis on overall meaning. Results are from conversations with 33 students from the first five LIC cohorts. Socio-cultural learning theory was used as an interpretive framework. Results This study identifies that the length and nature of placements led to continuity relationships for students with patients and teachers and meaningful participation in patient care. These are an interwoven set of affordances that facilitate learning in the ICC. Participants described the loss of these affordances in the RBC, resulting in diminished confidence, disruption of the learning trajectory and a re-forming of identity. Conclusion It is important for all medical schools with LICs followed by RBCs to consider the differences between these two clerkships as experienced by students in order to determine how best to support students as they navigate through both. Medical educators need to examine all of their clerkships to identify the affordances that support learning. [ABSTRACT FROM AUTHOR]

Context We teach judgement in pieces; that is, we talk about each aspect separately (patient, plan, resources, technique, etc.). We also let trainees figure out how to put the pieces together. In complex situations, this might be problematic. Using data from a drawing-based study on surgeons' experiences with complex situations, we explore the notion of 'problem definition' in real-world clinical judgement using the theoretical lens of systems engineering. Methods 'Emergence', the sensitising concept for analysis, is rooted in two key systems premises: that person and context are inseparable and that what emerges is an act of choice. Via a 'gallery walk' we used these premises to perform analysis on individual drawings as well as cross-comparisons of multiple drawings. Our focus was to understand similarities and differences among the vantage points used by multiple surgeons. Results In this paper we challenge two assumptions from current models of clinical judgement: that experts hold a fixed and static definition of the problem and that consequently the focus of the expert's work is on solving the problem. Each situation described by our participants revealed different but complementary perspectives of what a surgical problem might come to be: from concerns about ensuring standard of care, to balancing personal emotions versus care choices, to coordinating resources, and to maintaining control while in the midst of personality clashes. Conclusion We suggest that it is only at the situation and system level, not at the individual level, that we are able to appreciate the nuances of defining the problem when experts make judgements during real-world complex situations. [ABSTRACT FROM AUTHOR]

The article offers a reflection on the article "Performance Rating Scale for Peer and Self Assessment" by Bernard S. Linn, Martin Arostegui, and Robert Zeppa" originally published in the periodical in 1975. It examines the motivation of the authors in developing peer and self-assessment guidelines for medical students, noting their belief in students ability for self-directed learning. The psychological aspects of self-assessment are also discussed.

Context There exists a disparity between the views of physicians and the views of their patients on end-of-life decisions. However, the timing of when the end-of-life preferences of physicians and non-medically-trained individuals diverge is currently unknown. The objective of this paper is to characterise how preferences for medical interventions change throughout medical education and residency or fellowship training when confronted with scenarios of critical or terminal illness. Methods This is a single-centre cross-sectional study that enrolled medical students at Sidney Kimmel Medical College and residents and fellows at Thomas Jefferson University Hospital. Through an online survey we determined the preferences of medical trainees for specific interventions throughout medical training when presented with different clinical scenarios. Interventions were organised into three categories: standard, intermediate and aggressive. We analysed responses to questions regarding different scenarios in separate repeated measures logistic regression models. The probability of declining medical interventions was modelled, and significant predictors of refusal of interventions were identified. Results Years of training was a significant predictor of declining interventions for several scenarios. When faced with permanent physical disability, increased years of training led to a higher rate of refusal of intermediate ( OR = 1.14 [1.02-1.28], p = 0.02) and aggressive interventions ( OR = 1.15 [1.03-1.28], p = 0.01). For the scenario of terminal illness with associated physical disability, years of training significantly influenced refusal of intermediate ( OR = 1.14 [1.04-1.26], p = 0.006) and aggressive ( OR = 1.20 [1.08-1.34], p = 0.001) interventions. For the scenario of permanent cognitive impairment, increased years of training led to a higher rate of refusal of standard ( OR = 1.14 [1.01-1.29], p = 0.03), intermediate ( OR = 1.30 [1.13-1.50], p < 0.001) and aggressive ( OR = 1.38 [1.14-1.66], p = 0.001) interventions. Conclusion Changes in end-of-life preferences occur throughout medical training. Years of training influenced the likelihood of declining medical interventions when faced with scenarios of terminal illness and physical or cognitive disability. [ABSTRACT FROM AUTHOR]

Context This paper describes the transition processes experienced by Year 3 medical students during their longitudinal integrated clerkship ( LIC). The authors conceptualise the stages that encompass the transition through a LIC. Objectives The purpose of this study was to understand the perspectives of 12 Northern Ontario School of Medicine ( NOSM) Year 3 medical students about their transition process. Methods Data were collected longitudinally through three conversational interviews with each of these students, occurring before, during and after the clerkship. The authors used a guided walk methodology to explore students' everyday lives and elicit insights about the transition process, prompted by the locations and clinical settings in which the clerkship occurred. Results Participants identified three interconnected stages in the transition process: (i) shifting from classroom to clinical learning; (ii) dealing with disorientation and restoring balance, and (iii) seeing oneself as a physician. Interview data provided evidence for the adaptive strategies the participants developed in response to these stages. Conclusions Based on these findings, the transition process during a LIC can be characterised as one of entering the unfamiliar, with few forewarnings about the changes, of experiencing moments of confusion and burnout, and of eventual gains in confidence and competence in the clinical roles of a physician. Recommendations are made regarding future research opportunities to further scholarship on transitions. [ABSTRACT FROM AUTHOR]

Context Although reflection is considered a significant component of medical education and practice, the literature does not provide a consensual definition or model for it. Because reflection has taken on multiple meanings, it remains difficult to operationalise. A standard definition and model are needed to improve the development of practical applications of reflection. Objectives This study was conducted in order to identify, explore and analyse the most influential conceptualisations of reflection, and to develop a new theory-informed and unified definition and model of reflection. Methods A systematic review was conducted to identify the 15 most cited authors in papers on reflection published during the period from 2008 to 2012. The authors' definitions and models were extracted. An exploratory thematic analysis was carried out and identified seven initial categories. Categories were clustered and reworded to develop an integrative definition and model of reflection, which feature core components that define reflection and extrinsic elements that influence instances of reflection. Results Following our review and analysis, five core components of reflection and two extrinsic elements were identified as characteristics of the reflective thinking process. Reflection is defined as the process of engaging the self (S) in attentive, critical, exploratory and iterative ( ACEI) interactions with one's thoughts and actions ( TA), and their underlying conceptual frame ( CF), with a view to changing them and a view on the change itself ( VC). Our conceptual model consists of the defining core components, supplemented with the extrinsic elements that influence reflection. Conclusions This article presents a new theory-informed, five-component definition and model of reflection. We believe these have advantages over previous models in terms of helping to guide the further study, learning, assessment and teaching of reflection. [ABSTRACT FROM AUTHOR]

Context The purpose of this paper is to provide a critical analysis of a mobile research method, the guided walk, and its potential suitability in medical education research. Methods The Northern Ontario School of Medicine's ( NOSM) longitudinal integrated clerkship served as the research context in which the guided walk method was used to explore the lived experiences of 12 Year 3 medical students undertaking their clerkship in one of eight different communities across Northern Ontario, Canada. Informed by the social constructivist research paradigm, the guided walk method was employed to answer the research question: how do Year 3 medical students at NOSM describe their clerkship experiences as encountered in their placement and living contexts? Through an inductive thematic analysis of the data, the findings provided a rich description of the guided walk from the participants' and the researcher's perspectives. Results There were significant advantages to using the guided walk rather than other types of qualitative research approaches. The guided walk made it easier for participants to take part in the study, provided context-rich research interactions, and led to serendipitous encounters for both participants and the first author. There were also challenges and limitations associated with the guided walk method. For example, this method carries inherent challenges with reference to the safeguarding of confidentiality and anonymity for both participants and those encountered during the walk. Conclusions The guided walk method is promising within medical education, particularly for researchers seeking to gain participants' stories in the contexts to which they refer. This method may be appropriate for use in medical education research in areas such as the evaluation and assessment of a student's clinical decision-making skills and competency development, as well as the consolidation of strategies to manage ethical and professional dilemmas. [ABSTRACT FROM AUTHOR]

Context During clerkships, teaching and learning in day-to-day activities occur in many moments of interaction among doctors, patients, peers and other co-workers. How people talk with one another influences their identity, their position and what they are allowed to do. This paper focuses on the opportunities and challenges of such moments of interaction between doctors and students during a clerkship characterised by short supervisory relationships. Methods This study was conducted in a 10-week internal medicine clerkship. Nine students and 10 doctors who worked with these nine students participated by regularly describing moments of interaction, using dictaphones. We performed critical discourse analysis of material sourced from a total of 184 audio diary entries and seven student debriefing interviews to reveal how participants discursively shaped the way they could think, speak and conduct themselves. Results The ways in which doctors and students posed and answered questions represented a recurrent and influential feature in the diaries. This Question and Answer dynamic revealed six discourses of Basic Learning Need, Care and Attention, Power Game, Exchange of Currency, Distance, and Equality and Reciprocity. These discourses and the interplay among them revealed both students' and doctors' frameworks of needs and expectations in a culturally defined power structure. The interplay among the discourses reflected the ways in which doctor-student interactions afforded meaningful contributions to their medical or educational practice such as in the exchange of authentic professional or personal experience. Conclusions By purposefully bringing power structures to the surface, we have addressed the complexity of learning and teaching as it occurs in day-to-day moments of interaction in a clerkship with little continuity in supervision. Both doctors and students should be supported to reflect critically on how they contribute to supervisory relationships with reference to, for example, the ways in which they ask or answer questions. [ABSTRACT FROM AUTHOR]

Objectives Medical education research is thriving. In recent decades, numbers of journals and publications have increased enormously, as have the number and size of medical education meetings around the world. The aim of this paper is to shed some light on the origins of this success. My central argument is that dialogue between education practice (and its teachers) and education research (and its researchers) is indispensable. Reflections To illustrate how I have come to this perspective, I discuss two crucial developments of personal import to myself. The first is the development of assessment theory informed by both research findings and insights emerging from implementations conducted in collaboration with teachers and learners. The second is the establishment of a department of education that includes many members from the medical domain. Conclusions Medical education is thriving because it is shaped and nourished within a community of practice of collaborating teachers, practitioners and researchers. This obviates the threat of a fissure between education research and education practice. The values of this community of practice - inclusiveness, openness, supportiveness, nurture and mentorship - are key elements for its sustainability. In pacing the development of our research in a manner that maintains this synergy, we should be mindful of the zone of proximal development of our community of practice. [ABSTRACT FROM AUTHOR]

Context Despite a growing and influential literature, 'professionalism' remains conceptually unclear. A recent review identified three discourses of professionalism in the literature: the individual; the interpersonal, and the societal-institutional. Although all have credibility and empirical support, there are tensions among them. Objectives This paper considers how these discourses reflect the views of professionalism as they are expressed by students and educator-practitioners in three health care professions, and their implications for education. Methods Twenty focus groups were carried out with 112 participants, comprising trainee and educator paramedics, occupational therapists and podiatrists. The focus group discussions addressed participants' definitions of professionalism, the sources of their perceptions, examples of professional and unprofessional behaviour, and the point at which participants felt one became 'a professional'. Results Analysis found views of professionalism were complex, and varied within and between the professional groups. Participants' descriptions of professionalism related to the three discourses. Individual references were to beliefs or fundamental values formed early in life, and to professional identity, with professionalism as an aspect of the self. Interpersonal references indicated the definition of 'professional' behaviour is dependent on contextual factors, with the meta-skill of selecting an appropriate approach being fundamental. Societal-institutional references related to societal expectations, to organisational cultures (including management support), and to local work-group norms. These different views overlapped and combined in different ways, creating a complex picture of professionalism as something highly individual, but constrained or enabled by context. Professionalism is grown, not made. Conclusions The conceptual complexity identified in the findings suggests that the use of 'professionalism' as a descriptor, despite its vernacular accessibility, may be problematic in educational applications in which greater precision is necessary. It may be better to assume that 'professionalism' as a discrete construct does not exist per se, and to focus instead on specific skills, including the ability to identify appropriate behaviour, and the organisational requirements necessary to support those skills. [ABSTRACT FROM AUTHOR]

Context This paper explores how structured feedback and other features of workplace-based assessment ( WBA) impact on medical students' learning in the context of an evaluation of a workplace-based performance assessment: the teamwork mini-clinical evaluation exercise ( T- MEX). The T- MEX enables observation-based measurement of and feedback on the behaviours required to collaborate effectively as a junior doctor within the health care team. The instrument is based on the mini-clinical evaluation exercise (mini- CEX) format and focuses on clinical encounters such as consultations with medical and allied health professionals, discharge plan preparation, handovers and team meetings. Methods The assessment was implemented during a 6-week period in 2010 with 25 medical students during their final clinical rotation. Content analysis was conducted on the written feedback provided by 23 assessors and the written reflections and action plans proposed by the 25 student participants (in 88 T- MEX forms). Semi-structured interviews with seven assessors and three focus groups with 14 student participants were conducted and the educational impact was explored through thematic analysis. Results The study enabled the identification of features of WBA that promote the development of collaborative competencies. The focus of the assessment on clinical encounters and behaviours important for collaboration provided opportunities for students to engage with the health care team and highlighted the role of teamwork in these encounters. The focus on specific behaviours and a stage-appropriate response scale helped students identify learning goals and facilitated the provision of focused feedback. Incorporating these features within an established format helped students and supervisors to engage with the instrument. Extending the format to include structured reflection enabled students to self-evaluate and develop plans for improvement. Conclusions The findings illuminate the mechanisms by which WBA facilitates learning. The educational features highlighted include effectively structured feedback processes, support for situated learning, a positive backwash (facilitation of learning through preparation for the assessment), and facilitation of informed self-assessment. [ABSTRACT FROM AUTHOR]

Context In current debates about professional practice and education, increasing emphasis is placed on understanding learning as a process of ongoing participation rather than one of acquiring knowledge and skills. However, although this socio-cultural view is important and useful, issues have emerged in studies of practice-based learning that point to certain oversights. Methods Three issues are described here: (i) the limited attention paid to the importance of materiality - objects, technologies, nature, etc. - in questions of learning; (ii) the human-centric view of practice that fails to note the relations among social and material forces, and (iii) the conflicts between ideals of evidence-based standardised models and the sociomaterial contingencies of clinical practice. Discussion It is argued here that a socio-material approach to practice and learning offers important insights for medical education. This view is in line with a growing field of research in the materiality of everyday life, which embraces wide-ranging families of theory that can be only briefly mentioned in this short paper. The main premise they share is that social and material forces, culture, nature and technology, are enmeshed in everyday practice. Objects and humans act upon one another in ways that mutually transform their characteristics and activity. Examples from research in medical practice show how materials actively influence clinical practice, how learning itself is a material matter, how protocols are in fact temporary sociomaterial achievements, and how practices form unique and sometimes conflicting sociomaterial worlds, with diverse diagnostic and treatment approaches for the same thing. Conclusions This discussion concludes with implications for learning in practice. What is required is a shift from an emphasis on acquiring knowledge to participating more wisely in particular situations. This focus is on learning how to attune to minor material fluctuations and surprises, how to track one's own and others' effects on 'intra-actions' and emerging effects, and how to improvise solutions. [ABSTRACT FROM AUTHOR]

Context The accreditation of medical school programmes and the licensing and revalidation (or recertification) of doctors are thought to be important for ensuring the quality of health care. Whereas regulation of the medical profession is mandated in most jurisdictions around the world, the processes by which doctors become licensed, and maintain their licences, are quite varied. With respect to educational programmes, there has been a recent push to expand accreditation activities. Here too, the quality standards on which medical schools are judged can vary from one region to another. Objectives Given the perceived importance placed by the public and other stakeholders on oversight in medicine, both at the medical school and individual practitioner levels, it is important to document and discuss the regulatory practices employed throughout the world. Methods This paper describes current issues in regulation, provides a brief summary of research in the field, and discusses the need for further investigations to better quantify relationships among regulatory activities and improved patient outcomes. Discussion Although there is some evidence to support the value of medical school accreditation, the direct impact of this quality assurance initiative on patient care is not yet known. For both licensure and revalidation, some investigations have linked specific processes to quality indicators; however, additional evaluations should be conducted across the medical education and practice continuum to better elucidate the relationships among regulatory activities and patient outcomes. More importantly, the value of accreditation, licensure and revalidation programmes around the world, including the effectiveness of specific protocols employed in these diverse systems, needs to be better quantified and disseminated. [ABSTRACT FROM AUTHOR]

Context Basic science teaching in undergraduate medical education faces several challenges. One prominent discussion is focused on the relevance of biomedical knowledge to the development and integration of clinical knowledge. Although the value of basic science knowledge is generally emphasised, theoretical positions on the relative role of this knowledge and the optimal approach to its instruction differ. The present paper addresses whether and to what extent biomedical knowledge is related to the development of clinical knowledge. Methods We analysed repeated-measures data for performances on basic science and clinical knowledge assessments. A sample of 598 medical students on a traditional curriculum participated in the study. The entire study covered a developmental phase of 2 years of medical education. Structural equation modelling was used to analyse the temporal relationship between biomedical knowledge and the acquisition of clinical knowledge. Results At the point at which formal basic science education ends and clinical training begins, students show the highest levels of biomedical knowledge. The present data suggest a decline in basic science knowledge that is complemented by a growth in clinical knowledge. Statistical comparison of several structural equation models revealed that the model to best explain the data specified unidirectional relationships between earlier states of biomedical knowledge and subsequent changes in clinical knowledge. However, the parameter estimates indicate that this association is negative. Discussion Our analysis suggests a negative relationship between earlier levels of basic science knowledge and subsequent gains in clinical knowledge. We discuss the limitations of the present study, such as the educational context in which it was conducted and its non-experimental nature. Although the present results do not necessarily contradict the relevance of basic sciences, we speculate on mechanisms that might be related to our findings. We conclude that our results hint at possibly critical issues in basic science education that have been rarely addressed thus far. [ABSTRACT FROM AUTHOR]

Introduction Health care professionals work and learn in complex environments. Some are able to continue learning from their practice and the challenges it presents, whereas others refrain from investing more effort when faced with setbacks. This paper discusses a social cognitive model of motivation that helps to explain the different kinds of behaviour that emerge when individuals are confronted with challenges. Self-theories Self-theories (people's theories on what competence is and means for the self) play a major role in establishing the goals people set for themselves, the emotions they experience and the meanings they attach to situations. These self-views are often not explicitly articulated and are therefore called 'implicit' ('self-') theories. Social cognitive research suggests there are two distinct ways of thinking about one's personal attributes: entity theorists view a trait as a fixed, concrete internal entity, whereas incremental theorists instead believe a trait to be something malleable that can be developed or cultivated through effort. Holding an entity theory leads one to set performance goals and to harbour concerns about performing well and making a good impression. Holding an incremental theory tends to lead one to set learning goals, and to focus less on performance and more on spending time and effort in determining which strategies work. Discussion The current literature on self-theories is used to explore the relevance of these theories in medical education in three contexts: (i) it is argued that, in order to support lifelong learning, both individual and organisational efforts fit best with an incremental outlook on professional development; (ii) if it is to move forward in the domain of feedback-seeking behaviour, medical education might benefit from a better understanding of the interactions among self-theories, feedback behaviour, and the pervading role of organisational culture, and (iii) the impact of self-theories on assessors' evaluations of performance. [ABSTRACT FROM AUTHOR]

An abstract of the article "Exploring meaningful and truly integrative changes: a call to arms for medical education," by J. D. Gonzalo and colleagues is presented.

Context The Bologna Declaration of 1999 has led to the initiation of profound changes within the European Higher Education Area. Methods This paper gives an overview of the Bologna Process, reviews the developments within European dental education that have arisen as a result of the Process, and describes the impact of the continuation of the Process on health science education in the UK. Conclusions The Bologna Process has led to the establishment of the European Higher Education Area, which is committed to implementing a series of action lines by 2010. Currently, we are just over halfway to 2010, and the importance of UK higher education institutions engaging with the Bologna Process is stressed. [ABSTRACT FROM AUTHOR]

An opinion piece is presented in which the authors discuss an article in the issue on attitudes expressed by Taiwanese medical students towards gender in their online discussions. Topics discussed include the so-called hidden curriculum in medical education, institutional culture at medical schools, and the ways in which discourses of gender impact who has power in a social context.

Skills examinations use a cut-off score of 50% to separate good and bad performing students. However, a fixed cut-off score is only associated with students ability to pass exams. The difficulty of the exam or variability between examiners in marking student's performance is not being taken into account. The Online Marking Tool incorporates various Global Rating Scales (GRS) marking professional competence as Pass, Borderline, Fail, Good and Excellent. Borderline Regression Analysis is used to determine a flexible cut-off score. The Online Marking Tool contains of an OSCE Management Tool to plan and execute Objective Structured Clinical Examinations (OSCE), a OSCE station bank and a Result Analysis tool including a fully-fledged Borderline Regression Analysis pack (Excel export pack). Individual (blinded) scores at item level are correlated with the GRS of Fail, Borderline, Pass, Good and Excellent or variations of this GRS (Borderline Fail and Borderline Pass; Fail, Borderline, Pass). Borderline Group Average, the average mean score of those students being marked as 'Borderline' is compared with Borderline Regression Method 1 and 2 (Borderline Fail e.g. Pass) to determine a flexible cut-off score. Twelve prestigious universities are currently using this unique online marking tool for clinical skills assessments. Over 200 OSCE were successfully administered and analysed using this software solution. Costs of the labour intense paper trail of regular OSCE are reduced by 70% and the error reduction in the paper trail is reduced by 30%. Approximately 19% more students fail after introducing Borderline Regression Analysis, together with a minimum amount of stations that need to be passed. [ABSTRACT FROM AUTHOR]

In this article the author reflects on the role of feedback in learning and achievement and on cultural-historical activity theory (CHAT), which suggests that people are shaped by social and cultural contexts. A discussion of reports in the issue, including one by Vivekananda-Schmidt et al. on a large database containing free-text comments provided by assessors in a multi-source feedback process, one by Leeuw on feedback and one by Chou et al. on feedback to medical students, is presented.

In this article the authors discuss identity formation in medical students and the articles "Reflections: An Inquiry Into Medical Students’ Professional Identity Formation" by A. Wong and K. Trollope-Kumar and "Even Now it Makes Me Angry’: Health Care Students’ Professionalism Dilemma Narratives" by L. V. Monrouxe, C. E. Rees, R. Endacott et al. within the issue. They are supportive of several points raised in both papers and of providing mentoring to medical students to reduce the stresses that are associated with medical education and a career in medicine.

An abstract of the article "The effect of assessments and examinations on the learning of medical students," by David Newble and K. Jaeger is presented.