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      Knowledge, skills and beetles: respecting the privacy of private experiences in medical education

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          Abstract

          In medical education, we assess knowledge, skills, and a third category usually called values or attitudes. While knowledge and skills can be assessed, this third category consists of ‘beetles’, after the philosopher Wittgenstein’s beetle-in-a-box analogy. The analogy demonstrates that private experiences such as pain and hunger are inaccessible to the public, and that we cannot know whether we all experience them in the same way. In this paper, we claim that unlike knowledge and skills, private experiences of medical learners cannot be objectively measured, assessed, or directly accessed in any way. If we try to do this anyway, we risk reducing them to knowledge and skills—thereby making curriculum design choices based on what can be measured rather than what is valuable education, and rewarding zombie-like student behaviour rather than authentic development. We conclude that we should no longer use the model of representation to assess attitudes, emotions, empathy, and other beetles. This amounts to, first of all, shutting the door on objective assessment and investing in professional subjective assessment. Second, changing the way we define ‘fuzzy concepts’ in medical education, and stimulating conversations about ambiguous terms. Third, we should reframe the way we think of competences and realize only part of professional development lies within our control. Most importantly, we should stop attempting to measure the unmeasurable, as it might have negative consequences.

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          The possibilities of patient-centered medicine.

          É Bálint (1969)
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            Competency-Based Postgraduate Medical Education: Past, Present and Future

            Since the turn of the twenty-first century, competency-based medical education (CBME) has become a dominant approach to postgraduate medical education in many countries. CBME has a history dating back half a century and is rooted in general educational approaches such as outcome-based education and mastery learning. Despite controversies around the terminology and the CBME approach, important national medical regulatory bodies in Canada, the United States, and other countries have embraced CBME. CBME can be characterized as having two distinct features: a focus on specific domains of competence, and a relative independence of time in training, making it an individualized approach that is particularly applicable in workplace training. It is not the length of training that determines a person’s readiness for unsupervised practice, but the attained competence or competencies. This shift in focus makes CBME different from traditional training. In this contribution, definitions of CBME and related concepts are detailed.
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              Assessing empathy development in medical education: a systematic review.

              Empathy in doctor-patient relationships is a familiar topic for medical scholars and a crucial goal for medical educators. Nonetheless, there are persistent disagreements in the research literature concerning how best to evaluate empathy among physicians, and whether empathy declines or increases across medical education. Some researchers have argued that the instruments used to study 'empathy' may not measure anything meaningful to clinical practice or patient satisfaction.
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                Author and article information

                Contributors
                m.veen.1@erasmusmc.nl
                Journal
                Perspect Med Educ
                Perspect Med Educ
                Perspectives on Medical Education
                Bohn Stafleu van Loghum (Houten )
                2212-2761
                2212-277X
                5 February 2020
                5 February 2020
                April 2020
                : 9
                : 2
                : 111-116
                Affiliations
                [1 ]GRID grid.5645.2, ISNI 000000040459992X, Department of General Practice, , Erasmus University Medical Center, ; Rotterdam, The Netherlands
                [2 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Institute of Clinical Sciences, , University of Birmingham, ; Birmingham, UK
                [3 ]GRID grid.12380.38, ISNI 0000 0004 1754 9227, Educational Sciences, Faculty of Behaviour and Movement Sciences, , VU University, ; Amsterdam, The Netherlands
                [4 ]Research in Education, Amsterdam UMC, VUmc School of Medical Sciences, Amsterdam, The Netherlands
                Author information
                http://orcid.org/0000-0003-2550-7193
                Article
                565
                10.1007/s40037-020-00565-5
                7138766
                32026318
                8eac1d8b-1ff0-496c-a4e7-1078eec3c7c7
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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                Eye-Opener
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                © The Author(s) 2020

                Education
                communication,empathy,professionalism,competency based education,philosophy,assessment
                Education
                communication, empathy, professionalism, competency based education, philosophy, assessment

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