Biomedical subjects
R M Harden
Publications and source records attributed to R M Harden.
Trends and the future of postgraduate medical education.
Where is the present flurry of activity in medical education leading and what sort of future is envisaged? This paper looks at trends in postgraduate medical education. Four themes and two trends for each theme have been identified. The themes are: the postgraduate medical curriculum, the application of learning technologies, assessment of competence, and professionalism in medical education. The trends are: outcome based education and a unitary approach to medical education; the use of simulators and e-learning; competency and performance based assessment, and portfolios and self assessment; and training the trainer and best evidence medical education. Any limitations in implementing change will likely result from a lack of imagination in those planning postgraduate medical education and their ability to bring about the necessary changes. To avoid a growing gap developing between what is possible educationally and what is delivered, it is clear that we need a new paradigm for postgraduate medical education.
Applying learning outcomes to dental education.
Increasing emphasis is being placed in dentistry, as in other areas, on outcome-based education and on the specification of learning outcomes. An earlier paper by the same authors described the adaptation for dentistry of Harden's medical three-circle model to specify learning outcomes. This paper shows how learning outcomes can be applied in dental education, in particular in the areas of student selection, curriculum planning, teaching, learning and assessment.
The specification of learning outcomes in dentistry.
Increasing emphasis is being placed in dentistry, as in other areas, on outcome-based education and on the specification of learning outcomes. This paper describes the adaptation for dentistry of the medical three circle model as described by Harden to specify learning outcomes. The model offers an effective and user-friendly format based on the three dimensions of the work of a dentist. What the dentist is able to do ('doing the right thing'), how the dentist approaches their practice ('doing the thing right'), and the dentist as a professional ('the right person doing it'). The model also facilitates curriculum and examination planning, reconciles tensions between vocational and academic education and is readily understood and accepted by students and teachers.
"On Track"--an educational resource to support dental SHO training.
This paper describes the development, implementation and evaluation of an educational resource, "On Track", designed to support dental SHOs throughout their time in post, thereby helping them gain optimum benefit from this important stage in their early postgraduate training. The need for such a resource was highlighted by a previous study undertaken by the paper's key authors with SHOs and their trainers in a UK dental school. Among several areas of change identified by both trainers and trainees were the needs to develop the SHO experience into more than an apprenticeship by improving the trainer/trainee relationship, and to encourage trainee-centred learning and self-appraisal. The key aims of "On Track" were therefore to define the outcomes of SHO training, to facilitate the relationship between SHO and educational supervisor (trainer), and to encourage the SHO in reflective learning and self-appraisal."On Track" was subject to developmental testing with both trainers and trainees to ensure that it could achieve these aims and the resultant resource is described, along with its implementation and evaluation. "On Track" met with mixed success and the reasons behind this and conclusions drawn for the introduction of any future similar resources are outlined.
Exit learning outcomes for the PRHO year: an evidence base for informed decisions.
OBJECTIVE: To evaluate potential learning outcomes for pre-registration house officer (PRHO) training and develop an evidence base for informed decision making. DESIGN AND SETTING: A 2-stage Delphi process was employed to establish the opinions of Scottish stakeholders with regard to learning outcomes for the PRHO year. PARTICIPANTS: Doctors involved in the provision of PRHO training, including deans, postgraduate tutors and general practitioners (GPs) with trainees, were invited to participate in the study. MAIN OUTCOME MEASURES: Respondents rated a range of outcomes according to which they believed should be included or excluded from the PRHO training year. RESULTS: Learning outcomes identified for PRHOs were grouped under the 12-domain framework of the 3-circle model: 'What the doctor can do', 'How they approach their practice' and 'Their professionalism'. Based on the consensus opinions gained in the Delphi study, the ratings were classified into priority groupings. Priority 1 contained 45 of the original 81 learning outcomes, representing each area of the 3-circle model, with emphasis on the domains of clinical skills, patient investigation/management, communication, appropriate attitudes and personal development. Health promotion and disease prevention was the only domain not represented at priority 1. Priority 2 contained 24 outcomes with emphasis on the understanding of clinical skills, patient management and personal development. Priority 3 contained 12 outcomes indicating a lack of emphasis for some outcomes, particularly the role of the doctor and health promotion. CONCLUSION: Consensus on the learning outcomes for PRHO training has been achieved, providing an evidence base for curriculum planning. The relative priority assigned to these outcomes can facilitate the use of the evidence. This evidence base should be referred to when reviewing any PRHO training programme.
In our opinion: The First Five Years--A framework for Dental Undergraduate Education.
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The Physick Garden: an interview with R M Harden.
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Adoption and integration of simulation-based learning technologies into the curriculum of a UK Undergraduate Education Programme.
CONTEXT: At a time of significant changes in medical education world-wide, the international dimensions and global issues relating to the application of new learning technologies have been recognised. OBJECTIVE: The aim of this paper is to describe the adoption and integration within the curriculum in one United Kingdom (UK) medical school of 'Harvey', the Cardiology Patient Simulator, and the UMedic multimedia computer-based cardiology curriculum - resources developed in a medical school in the USA. PARTICIPANTS: The integration of the resources into the curriculum is described by 3 teachers actively involved in the cardiology curriculum of the UK medical school and 3 teachers associated with the development of resources in the USA. ASPECTS CONSIDERED: The review considers the adoption of Harvey and UMedic in the UK in programmes in relation to: curricular issues, training needs, learning outcomes, curriculum content and sequences of content, educational strategies, teaching and learning methods, assessment, communication about the curriculum and management of the curriculum. CONCLUSIONS: Learning resources, in the form of simulators and computer-based learning modules, developed in one country can be successfully adopted and implemented in another. Facets that facilitated the adoption included close liaison between the developers of the resources in the USA and the implementers in the UK, and careful and systematic planning including in-depth integration of the simulation-based resources into the required curriculum rather than their relegation to a peripheral ad hoc position. The successful use of simulators such as Harvey requires the presence of a 'champion', a clinician educator and a supporting administrative staff who ensure the simulator's appropriate use.
New doctors' perceptions of their educational development during their first year of postgraduate training.
The General Medical Council (GMC) in the UK describes a wide range of competences in which the new medical graduate should develop during the first postgraduate year. New graduates are known as pre-registration house officers (PRHOs). In this study, semi-structured open interviews with PRHOs approaching the end of their first postgraduate year were used to explore the trainees' perceptions of their development. After the interview their views on the importance given in their experience to the GMC's competences were explored though a questionnaire. Most noticeable from the interview data was the PRHOs'emphasis in the development of generic skills required of working in the 'real world'--skills such as communication, team working and the ability to cope with responsibility. In some outcomes, their noticeable progression, e.g. communication, or lack of progression, e.g. health promotion, reflected their views on the importance given. With other outcomes there was a paradox, e.g. practical skills were rated highly but were not noticeably developed; the role of the doctor was noticeably developed but was not highly rated. Overall the PRHOs developed most strongly in the 'professionalism' domain with not all the skills in the 'tasks' domain being similarly developed. This study helps to define the benefits and opportunities of the PRHO year, as currently perceived by the trainees, and should be of interest to those involved in the planning and delivery of postgraduate training.
Standards and medical education.
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AMEE Guide No. 25: The assessment of learning outcomes for the competent and reflective physician.
Two important features of contemporary medical education are recognized. The first is an emphasis on assessment as a tool to ensure quality in training programmes, to motivate students and to direct what they learn. The second is a move to outcome-based education where the learning outcomes are defined and decisions about the curriculum are based on these. These two trends are closely related. If teachers are to do a better job of assessing their students, they need an understanding of the assessment process, an appreciation of the learning outcomes to be assessed and a recognition of the most appropriate tools to assess each outcome. Assessment tools selected should be valid, reliable, practical and have an appropriate impact on student learning. The preferred assessment tool will vary with the outcome to be assessed. It is likely to be some form of written test, a performance test such as an OSCE in which the student's competence can be tested in a simulated situation, and a test of the student's behaviour over time in clinical practice, based on tutors' reports and students' portfolios. An assessment profile can be produced for each student which highlights the learning outcomes the student has achieved at the required standard and other outcomes where this is not the case. For educational as well as economic reasons, there should be collaboration across the continuum of education in test development as it relates to the assessment of learning outcomes and in the implementation of a competence-based approach to assessment.
UK recommendations on undergraduate medical education and the Flying Wallendas.
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Myths and e-learning.
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