Medical education research at the crossroads.
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Biomedical subjects
Publications and source records attributed to Margery H Davis.
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The Objective Structured Clinical Examination (OSCE) has become an excellent tool to evaluate many elements of a student's clinical skills, especially including communication with the patient (human medicine) or client (veterinary medicine); eliciting clinical information from these conversations; some aspects of the physical examination; and many areas of clinical evaluation and assessment. One key factor is that the examination can be structured to compare different students' abilities.
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A department of medical education is becoming an essential requirement for a medical school. This publication is intended for those wishing to establish or develop a medical education department. It may also prove useful to teachers in medicine by providing information on how such a department can support their activities. This will vary with the local context but the principles are generalizable. Medical education departments are established in response to increased public expectations relating to healthcare, societal trends towards increased accountability, educational developments, increased interest in what to teach and how to educate doctors and the need to train more doctors. The functions of a department of medical education include research, teaching, service provision and career development of the staff. The scope of its activities includes undergraduate and postgraduate education, continuing professional development and continuing medical education. These activities may be extended to other healthcare professions. Flexibility is the key to staffing a department of medical education. Various contractual arrangements, affiliations and support from non-affiliated personnel are needed to provide a multi-professional team with a range of expertise. The precise structure of the department will depend on the individual institution. The name of the department may suggest its position within the university structure. The director provides academic leadership for the department and his/her responsibilities include promotion of staff collaboration, fostering career development of the staff and establishing local, regional and international links. Financial support may come from external funding agencies, government or university sources. Some departments of medical education are financially self-supporting. The department should be closely integrated with the medical school. Support for the department from the dean is an essential factor for sustainability. Several case studies of medical education departments throughout the world are included as examples of the different roles and functions of a department of medical education.
The Dundee Medical School has bean running OSCEs since 1977. In 1995, an integrated systems-based spiral curriculum on the core and options model was introduced. In 1997, outcome-based education was introduced as the basis for instruction, with a task-based educational strategy employed for students in years 4 and 5. This blend of educational strategies was considered in the design of the student assessment process. Assessment instruments, appropriate for use at each of the four levels of Miller's pyramid, were identified and included in the assessment process. The OSCE was used for summative assessment of students at the level of 'shows how' or simulation in years 2, 3 and 4. A year 2 OSCE is described here. Features of the Dundee OSCE are identified, relating to number and length of individual stations, practicalities or assessing a year group of students without student contamination with examination information and the blueprints used to design the examinations. Suggestions made for future development of the OSCE include the OSSE, the Objective Structured Selection Examination, and an exploration of the potential of the OSCE to assess attitudes, personal attributes and professionalism. The need is identified for a platform to debate issues such as should individual medical schools attempt to achieve national test centre standards with their examinations.
In 1995 Dundee medical school introduced an integrated, systems-based spiral curriculum with a number of innovative features. The medical school has now had eight years' experience of the curriculum. This paper describes the changes that have taken place in the curriculum over the eight years. Evidence from internal and external reviews and student examination data are used to identify the lessons learned from implementing the curriculum. The Dundee experience, the approaches to the curriculum described and the conclusions reached are relevant to all with an interest in medical education.
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The move to outcome-based education has been one of the most important trends in health-profession education in recent years. This paper defines outcomes and outcome-based education, describes the development of outcome-based education, identifies several different ways that outcomes have been presented, and discusses the advantages and disadvantages of the outcome-based educational approach. The implementation of outcome-based education at the University of Dundee medical school, Scotland, UK is described as a case study for curriculum planners in veterinary medical education. The lessons learned in Dundee from six years' experience with outcome-based education are identified to aid veterinary medical educators wishing to implement the approach.