By Georgia Toal, MA
As a medical student and former teacher wishing to delve into the field of medical education, I sifted through the many stellar articles highlighted in the Key Literature in Medical Education (KeyLIME) weekly podcasts. Here is my ‘must-read’ list of articles for students interested in medical education, distributed across some of the most foundational and hot topics in the field.
I suggest the following process:
- Review my ‘Top 10’ list and commentaries below
- Read the published articles
- Listen to the corresponding KeyLIME podcasts
- Ask your mentor to answer any questions that arise
- Then decide: Did Linda, Lara, Jason, and Jon get it right?
Learning Theory
#1. Learning Science as a Potential New Source of Understanding and Improvement for Continuing Education and Continuing Professional Development.
Van Hoof TJ, Doyle TJ. Med Teach. 2018 Sep;40(9):880-885.
- This article is a great place to start for those wanting to enter the field of medical education. Just because someone has been a student for almost two decades does not necessarily make them an expert on learning. Van Hoof and Doyle lay out a clear foundation of the four key aspects that a student can control to improve their own education: distributed learning, retrieval, interleaving, and elaboration—all supplemented with deliberate practice. While the article uses continuing medical education studies as examples, the concepts can be applied more broadly. This is valuable to readers for their own learning and when considering curriculum design for their future classrooms.
Mentorship
#2. Where Philosophy Meets Culture: Exploring How Coaches Conceptualize their Roles.
Watling CJ, LaDonna KA. Med Educ. 2019 May;53(5):467-76.
- While many current papers discuss the benefits of coaching, this paper seeks to eliminate some of the “definitional fuzziness” around coaching. Is it mentoring? A fancy word for feedback? This paper explores three distinct groups: clinician coaches, physicians who coach other activities, and traditional coaches who are not physicians. They found three shared philosophies among these groups, influenced by organizational culture: mutual engagement with a shared orientation towards growth and development, ongoing reflection involving both learners and coaches, and an embrace of failure as a catalyst for learning. Being cognizant of these strategies may help foster a coaching relationship between mentor and mentees.
Instructional Method: Preclinical Classrooms
#3. A Systematic Review of the Effectiveness of Flipped Classrooms in Medical Education.
Chen F, Lui AM, Martinelli SM. Med Educ. 2017. 51(6):585-597.
- The ‘flipped classroom’ methodology continues to be popular in medical education, but what is the data behind it? This systematic review takes a deep dive into flipped classroom research to determine its effectiveness. This article contends that while learner engagement may increase with a flipped classroom, the knowledge and skills learned may not differ from traditional methods. More research is required: how are flipped classrooms best implemented, how much instructor effort is required, etc. This article (and its extensive bibliography) is a great resource if you’re interested in exploring flipped classrooms.
Instructional Method: Clinical Clerkships
#4. Would Socrates Have Actually Used the “Socratic Method” for Clinical Teaching?
Stoddard HA, O’Dell DV. J Gen Intern Med. 2016 Sep;31(9):1092-6.
- This paper outlines the important distinctions between ‘pimping’ and ‘Socratic teaching.’ The core difference between the two methods is the psychological safety of the learner. Pimping belittles the student for a lack of knowledge. The Socratic method utilizes the foundational educational theory of the “zone of proximal development”: the teacher pushes the learner to the boundary of their knowledge so they can expand it and move forward, without pushing so far that they shut down. The act of questioning can be a useful tool to stimulate recall and engage the student in active learning; however, it must be carefully implemented as to not make the student feel as if they are being pimped. This article will make you think about how you question students and provides helpful examples of Socratic questions modified for clinical learning environments.
Assessment
#5. Validity Evidence for Programmatic Assessment in Competency-based Education.
Bok HG, de Jong LH, O’Neill T, Maxey C, Hecker KG. Perspect Med Educ. 2018 Dec;7(6):362-372.
- If you haven’t heard of programmatic assessment, you will be a convert after reading this paper. While the authors may focus on veterinary medicine, they provide strong evidence for how programmatic assessment fits into competency-based education. Traditional models of assessment that work well for other disciplines are failing medical trainees on the wards, as there are not enough different assessors, assessors change frequently over time, direct observation is limited, and the line between formative and summative assessments is blurred. When someone asks if programmatic assessment really makes a difference, forward them this paper.
Feedback
#6. When Assessment Data Are Words: Validity Evidence for Qualitative Educational Assessments.
Cook DA, Kuper A, Hatala R, Ginsburg S. Acad Med. 2016 Oct;91(10):1359-1369.
- Qualitative feedback is helpful for learners, but many educators struggle to solicit valid qualitative feedback ‘data’. In this commentary paper, the authors offer useful summary tables to help make connections between qualitative assessments and validation processes. Concrete examples allow the reader to understand how to implement qualitative assessment while retaining the validity of their previous quantitative assessments. The authors argue for a “methods-neutral” approach to assessment, in which the feedback method should match the purpose of the assessment. Read this paper for the clarity of the frameworks they offer.
Bias
#7. Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training.
Dayal A, O’Connor DM, Qadri U, Arora VM. JAMA Intern Med. 2017 May 1;177(5):651-657.
- Dayal et al.’s paper highlights a disturbing gender gap in residency evaluations, acknowledging the important issue of rater bias. The authors analyzed Accreditation Council for Graduate Medical Education Next Accreditation System milestone evaluations over the course of three years at multiple different institutions. In short, there exists another ceiling for women. Keep this article as an example of the interplay between gender bias and rater bias.
Student Evaluations
#8. Meta-analysis of Faculty’s Teaching Effectiveness: Student Evaluation of Teaching Ratings and Student Learning Are Not Related.
Uttl B, White CA, Gonzalez DW. Stud Educ Evaluation. 2017 Sep 1;54:22-42.
- This article is a bit controversial, as it contradicts the conclusions of many studies of student evaluation of teaching (SET) ratings from the 1980’s. While the long introduction may be tedious to some, I found it helpful in catching me up on what this controversy and debate are all about. The authors expose biases in the previous studies, affected primarily by small sample sizes. They review and reanalyze previous papers, provide a new meta-analysis with additional articles included, and focus on sample size. The KeyLIME podcast summarized my sentiments exactly when they stated, “we should stop calling these data ‘teacher evaluations’…[and] start calling them learner satisfactions.” While SET data is still useful for teacher reflection, they should not be viewed as measurements of learning. After reading this article, you will reconsider the importance of data collection and the quality of data analyses used in medical education.
Duty Hour Policies
#9. Education Outcomes in a Duty-Hour Flexibility Trial in Internal Medicine.
Desai SV, Asch DA, Bellini LM, Chaiyachati KH, Liu M, Sternberg AL, Tonascia J, Yeager AM, Asch JM, Katz JT, et al. N Engl J Med. 2018 Apr 19; 378(16):1494-1508.
- The topic of duty hour restrictions has been debated for many years now. This study was a randomized control trial of flexible duty hours across 63 different internal medicine residency programs in the US. Programs were split into two groups: those adhering to 2011 ACGME duty-hour policies compared to those with flexibility in scheduling. Both groups had a maximum of 80 hours a week, 1 day off every seven days, and in-house call no more frequently than every third night. Differences between the two arms of the study were minimal, and no conclusions could be offered about the impact of duty hours on patient safety. So, these conclusions make me wonder: whose perspective is more important when determining duty hour policies, the educator who wants more time flexibility for their curriculum or the student who is concerned about personal time and well-being?
Becoming a Medical Educator
#10. ‘It was Serendipity’: A Qualitative Study of Academic Careers in Medical Education.
Wendy C. Y. Hu, Jill E. Thistlethwaite, Jennifer Weller, Gisselle Gallego, Joseph Monteith, Geoff J. McColl. Med Educ. 2015 Nov; 49(11): 1124–1136.
- Finally, if you’re still interested in becoming a medical educator, you probably want to know more about what that journey and lifestyle look like. This article leverages interviews from a wide sample of medical school educators. Bourdieu’s Theory of Practice lends a unique perspective to analyze actions and different forms of power. While the KeyLIME hosts may disagree with me about whether this is a ‘must read’ article, I think the aspiring medical educator will be pleased to discover differing definitions of ‘medical educator,’ and the various paths physicians find to this field.
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About the Author:
Georgia Toal, MA is a medical student at Stanford School of Medicine, Stanford, California, USA. This post is the final assignment of a directed reading elective for her Scholarly Concentration in Medical Education.
This work was edited and formatted for International Clinician Educators Blog by her course instructor, Michael A. Gisondi, MD.
The views and opinions expressed in this post are those of the author(s) and do not necessarily reflect the official policy or position of The Royal College of Physicians and Surgeons of Canada. For more details on our site disclaimers, please see our ‘About’ page
