Question storming: The power of Questions-A method to increase options for action in uncertainty.

RATIONALE: Question Storming offers a method that enables one to hold the condition of uncertainty in reflection without the need for resolution. Global interdependencies and unprecedented access to information, social media and multiple forms of communications challenge our ability to see, understand and influence change effectively and efficiently. The tension and need to cope effectively with massive uncertainties cannot be resolved with current methods leading to a necessity for people to seek new ways to transform their understanding and explore new options for action. Problem-solving and facilitation of the past are not flexible or rapid enough to meet the current demands of decision making and action taking in the face of massive uncertainties. As a result, people face 'wicked unsolvable' issues in their personal and professional lives. AIMS AND OBJECTIVES: An international group of scholar-practitioners has adapted and tested an enquiry process. Question Storming-The Power of Questions is based on principles of complex adaptive systems, human systems dynamics, and self-organization. METHOD: A three-step method of inquiry and reflection opens new possibilities. RESULTS AND CONCLUSIONS: Question Storming has helped people see their wicked issues from new perspectives, understand them in useful ways and generate new options for action. This paper introduces Question Storming-the Power of Questions as a practical method for group inquiry in the presence of individual and group uncertainties/wicked issues. The Container, Difference, Exchange (CDE) model and Pattern Logic are presented to explain the paradigm-shifting dynamics experienced by participants, both individuals and members of the group. It concludes with emerging questions for future consideration. Question Storming generates a divergent problem space that decreases constraint and increases degrees of freedom to allow practical exploration of new and often surprising options for action.

Ten Global Challenges in Medical Education: Wicked Issues and Options for Action.

Medical education and the health professions are facing multiple global challenges that are context specific yet are patterned across contexts. These challenges have been described as wicked issues that defy known solutions and are viewed differently by different people. Three simple approaches, inquiry, pattern recognition, and Adaptive Action, are presented as a way forward to tame wicked issues and take informed action.

Wicked Problems in Health Professions Education: Adaptive Action in Action.

This article was migrated. The article was marked as recommended. Each educational institution is different. Every clinical setting is unique. Faculty members - clinical, academic, volunteer - are separated by discipline, history, and professional focus. Students begin at different places and learn in different ways. And yet, we focus on the standardization, rigor, and accountability to competencies and curricula in every facet of health professions' education. The search for consistency and control in such a highly variable system leads inevitably to intractable, wicked problems. Wicked problems are ones that cannot be solved using traditional methods. They are different from traditional problems, in that they are 1) defined differently from multiple perspectives, 2) appear differently in each different context, but follow consistent patterns wherever they appear, and 3) can never be completely solved. Problems that persist for educationalists in health professions meet these criteria and can be classified as "wicked" problems. Rather than solutions to wicked problems, practitioners must choose contextualized, iterative, incremental actions to influence their intractable patterns over time.

Medical educators: How they define themselves - Results of an international web survey.

BACKGROUND: Little is known about medical educators' self-definition. AIMS: The aim of this study is to survey an international community of medical educators focusing on the medical educators' self-definition. METHODS: Within a comprehensive, web-based survey, an open question on the participants' views of how they would define a "medical educator" was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. The free text definitions were analysed using qualitative thematic analysis. RESULTS: Of the, 2200 medical educators invited to participate, 685 (31.1%) provided a definition of a "medical educator". The qualitative analysis of the free text definitions revealed that medical educators defined themselves in 13 roles, primarily as "Professional Expert", "Facilitator", "Information Provider", "Enthusiast", "Faculty Developer", "Mentor", "Undergraduate and Postgraduate Trainer", "Curriculum Developer", "Assessor and Assessment Creator", and "Researcher". CONCLUSIONS: Our survey revealed that medical educators predominantly define themselves as "Professional Experts" and identified 12 further self-defined roles of a medical educator, several of which not to have been reported previously. The results can be used to further the understanding of our professional identity.

Residents' and standardized patients' perspectives on empathy: issues of agreement.

OBJECTIVE: We investigated correlations between residents' scores on the Jefferson Scale of Empathy (JSE), residents' perceptions of their empathy during standardized-patient encounters, and the perceptions of standardized patients. METHODS: Participants were 214 first-year residents in internal medicine or family medicine from 13 residency programs taking standardized patient-based clinical skills assessment in 2011. We analyzed correlations between residents' JSE scores; standardized patients' perspectives on residents' empathy during OSCE encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy; and residents' perspectives on their own empathy, using a modified version of this scale. RESULTS: Residents' JSE scores correlated with their perceptions of their own empathy during encounters but correlated poorly with patients' assessments of resident empathy. CONCLUSION: The poor correlation between residents' and standardized patients' assessments of residents' empathy raises questions about residents' abilities to gauge the effectiveness of their empathic communications. The study also points to a lack of congruence between the assessment of empathy by standardized patients and residents as receivers and conveyors of empathy, respectively. PRACTICE IMPLICATIONS: This study adds to the literature on empathy as a teachable skill set and raises questions about use of OSCEs to assess trainee empathy.

Ethics education in research involving human beings in undergraduate medicine curriculum in Brazil.

INTRODUCTION: The Brazilian national curriculum guidelines for undergraduate medicine courses inspired and influenced the groundwork for knowledge acquisition, skills development and the perception of ethical values in the context of professional conduct. OBJECTIVE: The evaluation of ethics education in research involving human beings in undergraduate medicine curriculum in Brazil, both in courses with active learning processes and in those with traditional lecture learning methodologies. METHODS: Curricula and teaching projects of 175 Brazilian medical schools were analyzed using a retrospective historical and descriptive exploratory cohort study. Thirty one medical schools were excluded from the study because of incomplete information or a refusal to participate. Active research for information from institutional sites and documents was guided by terms based on 69 DeCS/MeSH descriptors. Curriculum information was correlated with educational models of learning such as active learning methodologies, tutorial discussions with integrated curriculum into core modules, and traditional lecture learning methodologies for large classes organized by disciplines and reviewed by occurrence frequency of ethical themes and average hourly load per semester. RESULTS: Ninety-five medical schools used traditional learning methodologies. The ten most frequent ethical themes were: 1--ethics in research (26); 2--ethical procedures and advanced technology (46); 3--ethic-professional conduct (413). Over 80% of schools using active learning methodologies had between 50 and 100 hours of scheduled curriculum time devoted to ethical themes whereas more than 60% of traditional learning methodology schools devoted less than 50 hours in curriculum time to ethical themes. CONCLUSION: The data indicates that medical schools that employ more active learning methodologies provide more attention and time to ethical themes than schools with traditional discipline-based methodologies. Given the importance of ethical issues in contemporary medical education, these findings are significant for curriculum change and modification plans in the future of Brazilian medical education.

Project-based faculty development by international health professions educators: practical strategies.

BACKGROUND: Project design and implementation, applied to real life situations, is emerging as an educational strategy for application of health professions faculty development learning within a supportive environment. AIM: We conducted a retrospective analysis of project evolution to identify common experiences, challenges, and successful strategies of 54 mid-career faculty members from 18 developing countries who attended the Foundation for the Advancement of International Medical Education and Research Institute between 2001 and 2006 and designed, conducted, and evaluated education innovations at their home institutions. METHODS: Chronological analysis of the evolution of 54 projects over the initial 16-18 months of the 2-year Fellowship was based on an iterative qualitative analysis of 324 reports and individual interview transcripts collected over 6 years. RESULTS: Useful skill areas for project implementation included educational methods, leadership and management, and relationships/collaboration. Common challenges included competing responsibilities, lack of protected time, and limited resources. Themes identified with the evolution and success of education innovation projects included leadership and organization, collaboration, personal professional growth, and awareness of the relevant societal context. CONCLUSIONS: Common challenges and success factors in project-based faculty development were identified. Twelve practical strategies to promote successful project-based faculty development emerged that can be generalized for faculty development.

Research in assessment: consensus statement and recommendations from the Ottawa 2010 Conference.

Medical education research in general is a young scientific discipline which is still finding its own position in the scientific range. It is rooted in both the biomedical sciences and the social sciences, each with their own scientific language. A more unique feature of medical education (and assessment) research is that it has to be both locally and internationally relevant. This is not always easy and sometimes leads to purely ideographic descriptions of an assessment procedure with insufficient general lessons or generalised scientific knowledge being generated or vice versa. For medical educational research, a plethora of methodologies is available to cater to many different research questions. This article contains consensus positions and suggestions on various elements of medical education (assessment) research. Overarching is the position that without a good theoretical underpinning and good knowledge of the existing literature, good research and sound conclusions are impossible to produce, and that there is no inherently superior methodology, but that the best methodology is the one most suited to answer the research question unambiguously. Although the positions should not be perceived as dogmas, they should be taken as very serious recommendations. Topics covered are: types of research, theoretical frameworks, designs and methodologies, instrument properties or psychometrics, costs/acceptability, ethics, infrastructure and support.

Expertise, needs and challenges of medical educators: Results of an international web survey.

BACKGROUND: Little is known about how medical educators perceive their own expertise, needs and challenges in relation to medical education. AIM: To survey an international community of medical educators with a focus on: (1) their expertise, (2) their need for training and (3) perceived challenges. METHODS: A web-based survey comprising closed and open free-text questions was sent to 2200 persons on the mailing list of the Association for Medical Education in Europe. RESULTS: Of the 2200 medical educators invited to participate, 860 (39%) from 76 different countries took part in the survey. In general, their reported areas of expertise mainly comprised principles of teaching, communication skills training, stimulation of students in self-directed learning and student assessment. Respondents most often indicated a need for training with respect to development in medical-education-research methodology, computer-based training, curriculum evaluation and curriculum development. In the qualitative analysis of 1836 free-text responses concerning the main challenges faced, respondents referred to a lack of academic recognition, funding, faculty development, time for medical education issues and institutional support. CONCLUSIONS: The results of this survey indicate that medical educators face several challenges, with a particular need for more academic recognition, funding and academic qualifications in medical education.

Complexity and health professions education: a basic glossary.

RATIONALE AND AIMS: The study of health professions education in the context of complexity science and complex adaptive systems involves different concepts and terminology that are likely to be unfamiliar to many health professions educators. A list of selected key terms and definitions from the literature of complexity science is provided to assist readers to navigate familiar territory from a different perspective. TERMS AND CONCEPTS: include agent, attractor, bifurcation, chaos, co-evolution, collective variable, complex adaptive systems, complexity science, deterministic systems, dynamical system, edge of chaos, emergence, equilibrium, far from equilibrium, fuzzy boundaries, linear system, non-linear system, random, self-organization and self-similarity.

Self-organisation, integration and curriculum in the complex world of medical education.

CONTEXT: The world of medical education is more complex than ever and there seems to be no end in sight. Complexity science is particularly relevant as medical education embraces a movement towards more authentic curricula focusing on integration, interactive small-group learning, and early and sustained clinical and community experiences. DISCUSSION: A medical school as a whole, and the expression of its curriculum through the interactions, exchanges and learning that take place within and outside of it, is a complex system. Complexity science, a derivative of the natural sciences, is the study of the dynamics, conditions and consequences of interactions. It addresses the nature of the conditions favourable to change and transformation (learning). CONCLUSIONS: The core process of complexity, self-organisation, requires a system that is open and far from equilibrium, with ill-defined boundaries and a large number of non-linear interactions involving short-loop feedback. In such a system, knowledge does not exist objectively 'out there'; rather, it exists as a result of the exchange between participants, an action that becomes knowing. Understanding is placed between participants rather than being contained in one or the other. Knowledge is not constructed separately in the mind of the knower, but, rather, it emerges; it is co-created during the exchange in an authentic recursive transactive process. Learning and knowing become adaptive responses to continuously evolving circumstances. An approach to curriculum based on self-organisation is characterised as rich, recursive, relational and rigorous and it illuminates how a curriculum can be understood as a complex adaptive system. The perspective of complexity applied to medical education broadens and enriches research questions relevant to health professions education. It focuses our attention onto how we are together as human beings. How we respond to and frame the issues of learning and understanding that challenge contemporary medicine and, by extension, medical education, in a complex and rapidly changing world can have profound effects on the preparedness of tomorrow's health professionals and their impact on society.

Medical students learn over distance using virtual reality simulation.

INTRODUCTION: This article presents the results of a demonstration project that was designed with the goal to determine the feasibility and acceptability of medical students in using distance technology and virtual reality (VR) simulation within a problem-based learning (PBL). METHODS: This pilot project involved students from the Universities of New Mexico and Hawaii and compared (1) control groups consisting of medical students in a tutor-guided PBL session using a text-based case, (2) distance groups using the same text-based case but interacting over distance from multiple sites, (3) groups using a VR simulation scenario integrated into the case without interaction over distance, and (4) combination groups interacting over distance from multiple sites with integration of a VR simulation scenario. RESULTS: The study results suggest that it is possible to successfully conduct a PBL tutorial with medical students from two institutions with the integration VR and distributed distance interaction in combination or independently. The addition of these modalities did not interfere with learning dynamics when compared with traditional tutorial sessions. CONCLUSIONS: These findings suggest the feasibility and acceptability by students in the use of VR simulation integrated into a PBL learning session, as well as multipoint distance technologies that allowed interaction between students and tutors in different locations. The authors believe that these modalities can be applied where students and tutors from different institutions are in separate locations and can be used to support interactive experiential learning in a distributed network or on site and suggest areas for additional research.

Online faculty development for medical educators: experience of a South Asian program.

CONTEXT: India has the highest number of medical schools in the world. Teacher shortages and inadequate training of existing faculty are a major problem. On-line faculty development and learning is a plausible component of developing medical teachers in the essentials of pedagogy. METHODS: An on-line faculty development learning process utilized by Regional Institute Fellows of the Foundation for Advancement of International Medical Education and Research (FAIMER) is described. This faculty development program begins with a face-to-face meeting followed by an 11-month intersession on-line experience, then another face-to-face meeting and a second 11-month intersession on-line experience. During each on-line session, Fellows participate in discussions on topics which they identify based on their learning needs. The on-line program is highly interactive and Fellows and faculty serve as moderators. Discussions have a conversational tone and a semi-structured format which Fellows develop along with the faculty moderator. The participants share their personal and professional experiences and the moderator 'wraps up' with a summary of the learning posted at the end of the month. Faculty facilitate the discussion, sharing appropriate resources and clarifying issues when necessary. CONCLUSIONS: More than the content exchanged, the interpersonal learning environment facilitated effective learning, and rejuvenated the learning experiences and network established during the face-to-face sessions. In view of its cost-effectiveness and the flexible choices it offers, focused, moderated, interactive on-line faculty development and learning needs to be considered seriously as a medium offering opportunities to medical educators and other professionals.