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      Embracing standardisation and contextualisation in medical education

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          Abstract

          The tensions that emerge between the universal and the local in a global world require continuous negotiation. However, in medical education, standardization and contextual diversity tend to operate as separate philosophies, with little attention to the interplay between them.

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          Most cited references63

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          Informal learning in the workplace

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            Reframing medical education to support professional identity formation.

            Teaching medical professionalism is a fundamental component of medical education. The objective is to ensure that students understand the nature of professionalism and its obligations and internalize the value system of the medical profession. The recent emergence of interest in the medical literature on professional identity formation gives reason to reexamine this objective. The unstated aim of teaching professionalism has been to ensure the development of practitioners who possess a professional identity. The teaching of medical professionalism therefore represents a means to an end.The principles of identity formation that have been articulated in educational psychology and other fields have recently been used to examine the process through which physicians acquire their professional identities. Socialization-with its complex networks of social interaction, role models and mentors, experiential learning, and explicit and tacit knowledge acquisition-influences each learner, causing them to gradually "think, act, and feel like a physician."The authors propose that a principal goal of medical education be the development of a professional identity and that educational strategies be developed to support this new objective. The explicit teaching of professionalism and emphasis on professional behaviors will remain important. However, expanding knowledge of identity formation in medicine and of socialization in the medical environment should lend greater logic and clarity to the educational activities devoted to ensuring that the medical practitioners of the future will possess and demonstrate the qualities of the "good physician."
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              An admissions OSCE: the multiple mini-interview.

              Although health sciences programmes continue to value non-cognitive variables such as interpersonal skills and professionalism, it is not clear that current admissions tools like the personal interview are capable of assessing ability in these domains. Hypothesising that many of the problems with the personal interview might be explained, at least in part, by it being yet another measurement tool that is plagued by context specificity, we have attempted to develop a multiple sample approach to the personal interview. A group of 117 applicants to the undergraduate MD programme at McMaster University participated in a multiple mini-interview (MMI), consisting of 10 short objective structured clinical examination (OSCE)-style stations, in which they were presented with scenarios that required them to discuss a health-related issue (e.g. the use of placebos) with an interviewer, interact with a standardised confederate while an examiner observed the interpersonal skills displayed, or answer traditional interview questions. The reliability of the MMI was observed to be 0.65. Furthermore, the hypothesis that context specificity might reduce the validity of traditional interviews was supported by the finding that the variance component attributable to candidate-station interaction was greater than that attributable to candidate. Both applicants and examiners were positive about the experience and the potential for this protocol. The principles used in developing this new admissions instrument, the flexibility inherent in the multiple mini-interview, and its feasibility and cost-effectiveness are discussed.
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                Author and article information

                Journal
                Medical Education
                Med Educ
                Wiley
                03080110
                October 21 2018
                Affiliations
                [1 ]Department of Family Practice; Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
                [2 ]Department of Pediatrics; Faculty of Medicine; University of British Columbia; Vancouver British Columbia Canada
                [3 ]Department of Community Health Sciences and Director of the Office of Health and Medical Education Scholarship (OHMES); Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
                [4 ]School of Health Professions Education (SHE); Faculty of Health, Medicine and Life Sciences (FHML); Maastricht University; Maastricht the Netherlands
                [5 ]Departments of Clinical Neurological Sciences and Oncology; Schulich School of Medicine and Dentistry; Western University; London Ontario Canada
                Article
                10.1111/medu.13740
                30345527
                1d496e4c-87c9-47ed-9e73-71d3bb38cade
                © 2018

                http://doi.wiley.com/10.1002/tdm_license_1.1

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