“The uncertainty of life” (original) (raw)
Related papers
BMJ, 2020
We read with interest “Medical students need experience not just competence”(1). Dornan et al provides a diagnostic overview of some of shortcomings of medical education in the UK. The shift to competency-based education influenced global reforms in medical education(2) and moved doctors training away from being passive receivers of teaching to experiential learners and driven by inquiry. As mentioned in the article, readiness to practice safely does not mean demonstrably safer practice. This is perhaps linked to how the learning and assessments are organised. There is a lot of focus on the third layer of Miller’s pyramid (“Shows how”) which falls short of the tip of the pyramid where the most important skills of “does” lie(3). The first and second layers are “knows” and “knows how” respectively.
Advances in Health Sciences Education, 2013
We read with much interest the papers and comments recently published in the journal (Whitehead et al. 2011a, b; Malone and Supri 2012; Sherbino et al. 2011), which brought an insightful contribution to the wide debate on pedagogical initiatives pertaining to the concept of competency in medical education. In his editorial comment, Norman (2011) highlights the necessity for questioning the relevance and the limits of the competencybased approach. This is particularly imperative for professional frameworks whose inherent nature suggests that they be implemented and standardized at a national level, as it is the case with the ACGME framework in the United States, the ''The Scottish Doctor'' and the ''Tomorrow's Doctor'' in the United Kingdom and, in particular, the CanMEDS framework in Canada. The latter in particular has a major influence in several countries and is a topic that has been addressed in several published papers. The competency-based approach is generally well understood and accepted as a newly emerging conceptual framework amongst professionals and researchers involved in medical education. We reckon it can offer a very important opportunity to improve health
Vocational thresholds: developing expertise without certainty in general practice medicine
Journal of Primary Health Care
INTRODUCTION This paper argues that particular experiences in the workplace are more important than others and can lead to transformational learning. This may enable practitioners to cross ‘vocational thresholds’ to new ways of being. AIM A notion of ‘vocational thresholds’ is developed, aiming to help build an understanding of the most powerful learning experiences of general practitioners (GPs). Vocational thresholds takes its cue from the idea of ‘threshold concepts’ - concepts that transform perspectives and integrate previously disconnected or hidden knowledge, sometimes in ways that are ‘troublesome’ to previously held beliefs. METHODS The paper is based on a thematic analysis of 57 GPs’ brief written accounts of a particularly powerful learning experience during their development. Accounts were provided in a conference session about an ongoing study of workplace-based structured learning arrangements in the fields of general practice medicine, engineering, and building. FINDI...
Future Healthcare Journal, 2019
capabilities (GPCs) were major drivers for the Joint Royal Colleges of Physicians Training Board (JRCPTB) to develop the new internal medicine curriculum. In particular, the GMC required progression to an outcomes-based curriculum using capabilities in practice. The proof of concept (PoC) study explored the feasibility of using this outcomes-based model of assessment in a UK NHS setting. The learning from the study has enabled us to introduce a novel assessment method into the internal medicine curriculum. The GMC has approved the curriculum and the JRCPTB is implementing the internal medicine curriculum from August 2019.
Varying conceptions of competence: an analysis of how health sciences educators define competence
Medical education, 2012
Medical Education 2012: 46: 357-365 Context Current debate in medical education focuses on the nature of 'competency-based medical education' (CBME) and whether or not it should be adopted. Many medical schools claim to run 'competency-based' curricula, but the structure of their programmes can differ radically. A review of the existing CBME literature reveals that little attention has been paid to defining the concept of competence. A straightforward examination of what is meant by the term 'competence' is noticeably missing from the literature, despite its impact on medical training. Objectives This paper aims to illustrate the varying conceptions of 'competence' by comparing and contrasting definitions provided in the health sciences education literature and discussing their respective impacts on medical education. Methods A systematic review of recent publications in medical education journals published in English and French was conduct...
Sushruta Journal of Health Policy & Opinion
Being a doctor in the 21st Century requires a diverse range of skills, a broad base of knowledge and a suite of professional values and attitudes that enable the clinical practice to be safe, effective and caring. Doctors, irrespective of their speciality, need to be knowledgeable and skilful not just in their area of expertise but also need a range of generic skills and capabilities such as communication, leadership, academic scholarship and research, teaching, quality improvement, advocacy, digital literacy to name a few. These capabilities, all relevant to clinical practice, are assessed routinely in clinical settings. This rich information about trainees, available from their formative assessments, does not inform high-stakes judgements about progression. Instead, these judgements are usually made on the basis of summative examinations conducted in simulated settings. Unfortunately, these summative assessments have consistently delivered results with a large magnitude of the d...
Linking assessment to learning: a new route to quality assurance in medical practice
Medical Education, 2002
Background If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge. Rather a doctor's ongoing learning is a ÔjourneyÕ across a practice lifetime, which involves the doctor as a person, interacting with their patients, other health professionals and the larger societal and community issues. Objectives In this paper, we describe a model of learning and practice that proposes how change occurs, and how assessment links practice performance and learning. We describe how doctors define desired performance, compare actual with desired performance , define educational need and initiate educational action. Method To illustrate the model, we describe how doctor performance varies over time for any one condition, and across conditions. We discuss how doctors perceive and respond to these variations in their performance. The model is also used to illustrate different formative and summative approaches to assessment, and to highlight the aspects of performance these can assess. Conclusions We conclude by exploring the implications of this model for integrated medical services, highlighting the actions and directions that would be required of doctors, medical and professional organisations, universities and other continuing education providers, credentialling bodies and governments.