Medical Education

"WHAT TO DO WHEN A PATIENT LACKS CAPACITY - The degree and urgency with which to act on findings of impaired capacity depends on multiple factors, including the expected duration of impairment, the severity of the impairment, and the seriousness of the decision. Unless the urgency of a patient's medical condition requires that a substituted decision be made immediately, efforts should be made to identify and correct any reversible causes of the impairment [26]. This is particularly relevant in hospitalized patients with impaired capacity due to delirium. Treatment of the underlying causes of delirium may restore decision-making capacity. Patients with mild to moderate cognitive impairment that is not expected to fluctuate may benefit from more intensive efforts at education to improve understanding of the relevant facts, followed by reassessment of decision-making abilities. A randomized trial found that a memory and organizational aid given to patients with mild stage Alzheimer disease dementia (n = 80) improved performance on understanding, which in turn increased the likelihood of being judged capable of providing informed consent to enroll in a clinical trial [34]. This enhancement was also effective in a randomized trial with middle-aged and older adults with schizophrenia [35]. For patients whose impairments are severe enough that they are judged to lack the capacity to make a decision, there is a clear ethical obligation to seek out a substitute decision maker. Substitute or surrogate decision makers should ideally have been chosen by the patient in advance. In the absence of a designated surrogate, laws may vary in terms of which people can serve in this proxy role and their hierarchy; in general, the order is the spouse, adult children, parents, siblings, and other relatives. (See "Legal aspects in palliative and end of life care", section on 'Surrogate decision makers'.) When making a substituted decision, the proxy should take into consideration

"In conclusion, the BID method, an easily taught approach to surgical instruction, was shown to significantly improve the acquisition of surgical skills during a simulation based skills course. We anticipate this method may provide an ideal framework for time-efficient and effective surgical instruction"

"This study suggest that the described inhibitors of empathy may originate in the hidden curriculum and reinforce each other, creating a greater distance between the physician and the patient, and possibly resulting in decreased empathy. Mastering biomedical knowledge is an important part of the students' ideals of the physician's role, and sometimes objective and distanced ideals may suppress empathy and the students' own emotions. "

"Diagnostic accuracy was moderately associated with higher certainty only when clinical data were consistent. This correlation disappeared when incon sistent data were provided, possi bly reflecting changes in reasoning strategies among diagnostically success ful trainees. The relationship between certainty and diagnostic accuracy is context dependent. Certainty is an unreliable surrogate for diagnostic accuracy."

"Case based learning uses virtual 'trigger' cases to stimulate interest in a particular area of the curriculum. Working in small groups over a two week period, a case is used to think about the knowledge and skills needed and why these might be useful. "

"In the General Medical Council's 2013 national training survey, 13.2% of respondents said that they had been victims of bullying and harassment in their posts, nearly one in five had seen someone else being bullied or harassed, and over a quarter had experienced "undermining" (unfair or belittling treatment)."

"Higher performing students appeared to use the feedback more for positive affirmation than for diagnostic information. Those arguably most in need engaged least. We need to construct feedback after summative assessment in a way that will more effectively engage those students who need the most help."

" how health care has become industrialised, with an emphasis on carrying out mechanical tasks rather than making an emotional connection with patients, often leading to burnout and disillusionment in health care staff. "

"We post challenging hypothetical dilemmas, moderate discussions on potential approaches, and recruit medical education experts to provide their insights. "

"Harvard University Prof. Eric Mazur on difficulties of beginners, teaching each other, and making sense of information

NCSBN conducted a landmark, national, multi-site, longitudinal study of simulation use in prelicensure nursing programs throughout the country.

"The study provides insight as to why supervisors fail to fail the poorly performing student and resident. It also offers suggestions of how to support supervisors, increasing the likelihood that they will provide a valid ITER "

"Feedback is a crucial element in the educational process and it is shown that we are still behind in the optimal use of it; thus, learners need to be taught how to better receive and utilize feedback."

Create your own concept map using a jigsaw puzzle approach

"Participating medical students reported that they perceived narrative medicine to be an important, effective, but counter-culture means of enhancing communication, collaboration, and professional development. The authors contend that these skills are integral to medical practice, consistent with core competencies"

Considering the zones of proximal development model should drive educators to seek out and leverage more structured educational interventions, without which the limitations of learning and self-directed learner growth may be undermining the overall impact of the medical education we create.

"Assessment can be defined as "the process of collecting, synthesizing and interpreting information to aid decision making."1 Key to this process is: Mapping the assessment to the learning objective; and Mapping the assessment instrument to the sophistication of learning being tested."

This paper (a) describes the role feedback plays in formative instructional practices, (b) suggests some evidence-based instructional strategies practitioners can employ to increase opportunities for feedback about their instruction, and (c) recommends ways to enhance the effectiveness of the feedback students receive.

Direct instruction on how to create portfolios