Learning,Testing, and the Evaluation of Learning Environments in Medicine: Global Performance Assessment in Medical Education

Changes in the profession of medicine are creating the demand for a substantive reexamination of current practices in medical education. Many of the major issues in addressing this challenge are structural and political rather than scientific; here we address one critical scientific issue that will be important to (though not by itself adequate for) guiding such changes. The factor we address is the development of a global performance assessment: a standardized mechanism to assess individual skills and abilities that can be used to evaluate alternative educational interventions. We discuss the issues involved in developing such a system, and describe a set of principles for defining desired outcomes and developing assessment tools, including (a) wide clinical scope, (b) direct relationship to actual clinical performance, (c) reliability and repeatability, and (d) non-longitudinal measurement. We discuss the role of simulation, reflective practice, and portfolios of work in developing such a system, and argue that whatever form such metrics take, a system of global performance assessment will develop from close collaboration between clinicians and educators with innovative ways of thinking about performance and expertise.     

Field-based teacher education in literacy: preparing teachers in real classroom contexts

For the past two decades, scholars have advocated for reforms in teacher education that emphasize relevant connections between theory and practice in university coursework and focus on clinical experiences. This paper is based on our experiences in designing and implementing an integrated literacy methods course in a field-based teacher education program. We describe issues involved in helping preservice teachers learn to differentiate literacy instruction for diverse learners in urban schools and describe how we use Grossman’s framework of representation, decomposition, and approximation of practice to connect theory and practice. We offer insights about the importance of using recursive cycles of practice and carefully scaffolded learning through attention to different aspects of practice. Initial successes and challenges in implementing field-based literacy education are discussed.     

Acute cardiovascular responses to interval exercise: A systematic review and meta-analysis

ABSTRACT

Interval exercise training is increasingly recommended to improve health and fitness; however, it is not known if cardiovascular risk is different from continuous exercise protocols. This systematic review with meta-analyses assessed the effect of a single bout of interval exercise on cardiovascular responses that indicate risk of cardiac fibrillation and infarction compared to continuous exercise. Electronic databases Medline, CINAHL, Embase, Scopus and Cochrane were searched. Key inclusion criteria were: (1) intervals of the same intensity and duration followed by a recovery period and (2) reporting at least one of blood pressure, heart rate variability, arterial stiffness or function. Cochrane Risk of Bias tool and GRADE approach were used. Meta-analyses found that systolic blood pressure responses to interval exercise did not differ from responses to continuous exercise immediately (MD 8 mmHg [95% CI ?32, 47], p = 0.71) or at 60 min following exercise (MD 0 mmHg [95% CI ?2, 1], p = 0.79). However, reductions in diastolic blood pressure and flow-mediated dilation with interval exercise were observed 10–15 min post-exercise. The available evidence indicates that interval exercise does not convey higher cardiovascular risk than continuous exercise. Further investigation is required to establish the safety of interval exercise for clinical populations.     

Going Where They Are: Intentionally Embedding Librarians in Courses and Measuring the Impact on Student Learning

ABSTRACT

The concept of embedded librarians is a way for academic librarians to be intentionally and strategically inserted in the learning and teaching process through a variety of initiatives. In a mid-size university, in order to better address the research and curricular needs of students and faculty members, librarians became more intentional about embedding themselves in academic departments and online courses. To assess the impact upon student learning, the librarians are working on a pilot project utilizing a variety of methods. This article describes the first phase of this assessment project, a survey of faculty teaching course in which faculty were embedded. Finally, information on next steps to assess the embedded librarian program using student surveys, focus groups, and interviews is presented.     

Uncovering the Evidence: Faculty Perceptions of Distance Library Services

Usage statistics are a regular part of assessment but the lack of context leaves librarians pondering the reasons for fluctuations in use. Through development of an online survey, we examined faculty perceptions, knowledge, and use of distance library services to support online courses. Responses provided much needed context and helped to determine priorities and direction for services. While this survey was a useful marketing tool, results emphasized that the greatest need was for ongoing communication with faculty to increase awareness of services provided.     

Insights into the Integration of Traditional Filipino Arts in Art and Design Education: Voices from the Academe

This article presents the first segment of a qualitative study that explores the feasibility of integrating traditional arts in Philippine art and design education. The views of educators on traditional arts were sought to provide an impetus for the study and a springboard for discussion regarding the relevance of traditional Filipino arts in a predominantly Westernised educational system. The educators’ views and opinions on the central question, ‘Why and how should the study of traditional Filipino arts be integrated in the art and design programme?’ will be used to guide a trial integration of the learning of traditional arts in tertiary art and design classes. They will form part of the multiple perspectives that will be gathered from various sectors throughout the course of research. This phenomenological study, on the whole, seeks to uncover the potentials of traditional arts as a rich resource for learning, particularly for students of art and design.     

Teaching the Mediterranean Diet in Italy

ABSTRACT:  Problem-based learning (PBL) can provide an enhanced appreciation of the relationship between culture and food for students who aspire to become dietitians or nutrition educators; however, large university classes often inhibit the use of PBL. A professor who specializes in research documenting the relationships among food and culture took 17 Canadian university students, many of whom were studying nutrition and food science, to southern Italy where they learned about Mediterranean diets and Italian food culture. PBL was implemented by encouraging students to work together to solve problems, and by the completion of assignments that promoted observation of and interaction with the local culture. Students evaluated the experience positively with majority agreement that the quality of course content was excellent, that knowledge of the subject areas increased, and that the courses challenged students to critically think about issues. Despite a focused effort on PBL in the courses, not all students agreed that the courses helped them to develop the ability to solve real problems in this field. This may have been due to unawareness of dietetic competencies by some students. Many of the assignments used in Italy could be adopted for use in food culture classes in North America, or by postsecondary instructors planning travel study programs in Italy.     

Anatomy as a Model Environment for Acquiring Professional Competencies in Medicine: Experiences at Harvard Medical School

Anatomy education provides students with opportunities to learn structure and function of the human body, to acquire professional competencies such as teamwork, interpersonal skills, self-awareness, and to reflect on and practice medical ethics. The fulfillment of this wide potential can present challenges in courses that are part of an integrated curriculum and shorter than traditional courses. This new reality, together with students' increasing concern about the stresses within medical education, led to efforts at Harvard Medical School to implement practical steps toward an optimal learning environment in anatomy. These were based on core elements of ethical anatomy education and principles of trauma-informed care. Anatomy is conceptualized here as the “first clinical discipline,” with relational interactions between anatomical educators, medical students, and body donors/patients. Essential prerequisites for the implementation of this work were support by the medical school leadership, open partnership between engaged students and faculty, faculty coordination, and peer-teaching. Specific interventions included pre-course faculty development on course philosophy and invitations to students to share their thoughts on anatomy. Student responses were integrated in course introductions, combined with a pre-dissection laboratory visit, an introductory guide, and a module on the history and ethics of anatomy. During the course, team-building activities were scheduled, and self-reflection encouraged, for example, through written exercises, and elective life-body drawing. Students' responses to the interventions were overall positive, but need further evaluation. This first attempt of a systematic implementation of an optimal learning environment in anatomy led to the identification of areas in need of adjustment.