Social accountability: the mark of excellence in health professional education by Charles Boelen
Moved from interrogation → an assertion
What is a health professional?
Flexner’s report changed the scope of medical education by introducing a scientific background, especially in education
Medical education should be patriotic (Flexner)
Educating → health professionals → for a strategy → to meet people’s needs (must begin with identifying people’s needs); the 4 layers are not necessarily closely correlated
There are many influences on the process, besides the input we provide in our HEIs
What are people’s needs and values today? What will they be in 20 years time? We’re training professionals for today and tomorrow
Not teaching for health professionals, but change agents
Social accountability: the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region and / or nation they have the mandate to serve. The priority health concerns are to be identified jointly by governments, health care organisations, health professionals and the public”
Priority health concerns:
- quality (ideally, we provide the best to everyone)
- equity (who are the most vulnerable?)
- cost-benefit (resources are fixed and we have to work within them)
- relevance (what are the most relevant problems to address?)
As educators, we can’t achieve the values above on our own, we need to work with others
Functions of a school:
- Education
- Research
- Service
Stakeholders (Boelen, 2000, Towards unity for health, WHO):
- Policy makers
- Health professions
- Academic institutions
- Health managers
- Communities
Social accountability (evaluate impact of commitments)
Social responsiveness (more explicitly aware, use data to drive action)
Social responsibility (awareness)
We should accompany our graduates when they leave our schools
Be critical of the health system
Conceptualisation of professional (role of the school) → production of professional (educational interventions) → usability of professional (society’s satisfaction). Using a commercial model to explore ideas
Pay more attention before beginning training, as well as afterwards
Boelen & Woollard, 2009. The CPU model: conceptualisation-production-usability. Medical Education, 43: 887-894
The concept of social accountability helps us to answer the question: “Why are we doing all of this?”
Global consensus for social accountability of medical schools (www.healthsocialaccountability.org)
A socaily accountable medical shool should:
- respond to current and future health needs
- reorient education, research and service accordingly
- strengthen governance and partnership with other stakeholders
- use evaluation and accreditation to determine impact
Preparing for the future:
- ethics → impact
- democracy → transparency
- globalisation → competition
- public support → synergy
“What is our common purpose?”
Developing enterprising health care professionals. How should we meet the challenge? By Prof. Deborah Murdoch-Eaton
Enterprise:
- making the most of opportunities
- identifying areas for improvement
- developing innovative solutions
- implementing and refining strategies
Health professionals will always work in a business, whether private or public. A business is only as good as it’s employees
Need confidence to implement changes
Reference to “Health professionals for a new century. Frenk et al, The Lancet”
“Provoke” global reforms in all health professions
Core role of universities as social institutions
Need to be effective in an ever-changing environment and knowledge-base
Change in accordance with local needs
Graduate attributes = set of core skills that are not discipline-specific, “meta-skils”
- Communication
- Higher order reasoning
- Critical thinking
- Ability to use technology
Students should not all fit into the “same box”, need to develop those who can lead and innovate
Structured (and repeated) opportunities to practice skills
Incorporate self-reflection and appraisal of own abilities, provide evidence of own learning / experiences
Soft skills:
- teamwork
- creativity
- project planning
- presentation skills
- IT skills
- time management
- networking
- negotiating
- leadership
Be enterprising in teaching style and assessment
Embedding of enterprise:
- strands
- blocks / modules
- extra-curricular
How do we colleagues to collaborate?
What are the persuasive arguments?
Fit for (whose) purpose?
Empower students to help retain them in the country
Need to give guidance and time to think and reflect deeply, not related to “competence-driven outcomes”
Values, cultures and ethics are hard to measure
“new knowledge is regulated by measuring it against exising scholarship through the process of peer review, rather than the extent to which it meets the needs of those external to the field”
Teach students to ask relevant questions, empower them to become change agents
Blackboard training initiative by A Botha
Staff training using Blackboard within institution
(People think that) Blackboard can:
- support good teaching practice
- support learning styles
- encourage collaboration
- keep abreast of learning technologies
Staff were overwhelmed and reported needing extra time for training
Trying to improve quality of people trained, rather than getting numbers through the system
The problem with LMSs is that they don’t take the student into account, the focus is on the lecturer, the content and the course
What is the relationship between activity on the LMS and the throughput?
E-learning: student’s perspective by G Sinombe
Used to increase access to course materials and information, increase contact and participation in courses and enhance variety of learning styles ← blended approach
Courses (reading material, notes, assignments, etc.) uploaded ← not e-learning (by whatever definition you choose to use for “e-learning”)
Student responses differed, some attempted to use, some didn’t try at all
Why do some students not try? Study aimed to determine student perceptions and challenges that impacted on their use
Student responses:
- good tool
- good for slow learners
- enhances communication between lecturer and student
- flexibility in time and place
- easy access to courses
- hard to find unoccupied computer
- network slow, when available
- hard to access off-campus
- helps me to share ideas outside of the classroom
- enhances sharing of ideas
Is “e-learning” necessary? How does it improve performance? This has to be taken in context…what is the context in which you want to use it?
Students’ approaches to learning disciplines in an integrated curriculum by D Manning
How many students achieve pass marks while scoring below the minimum in individual subjects?
In how many disciplines are passing students scoring below the pass mark
Students going into clinical years with substantial gaps in their knowledge
What is going to be done about this?
Is there a need for discipline based subminimums and consideration of logistical solutions
Ready for the catwalk? By what criteria should a new model be judged? By F Cilliers
How does assessment influence learning? Cilliers et al, AHSE, 2010, December
One or more sources of impact, through one or more mechanisms, leading to one or more learning effects
Test the model in a different context to what it was designed for i.e. model developed in theory, then evaluated in clinical practice
“Quality of learning” ← how was this defined?
Interaction with preceptors:
- regular accountability
- personal consequences
- emotional valence
Preparing out of a fear of humiliation, rather than a desire for understanding. Just wanted to “survive” the ward round
“You will learn because you don’t want to continue to live in fear”
“Tyrants” and “teddy bears” ← categories of supervisors
You don’t want to disappoint the “teddy bears”, go out of your way to participate, gather more information
But they are still motivated by others, rather than for themselves. Did any students report a desire for understanding based on what it would mean for their own clinical practice?
“Teddy bears” = scope and safety to ask questions and explore areas of personal interest
Reviewing assessment to promote medical student engagement in basic sciences to cure and care better by C Brand
Curricula are living, self-organising organic systems
“De-load” some of the course content
Threshold concepts = conceptual gateway that opens up previously inaccessible domains
All change begins with conversation
Introduction of a new clinical assessment: did it achieve it’s aim? by L Green-Thompson
Students arrive in the clinical environment unprepared
Introduced an observed examination (mini-CEX) and then evaluated student perceptions of the exam
“Landscape of assessment”
Students reported that the clinical exam was a valuable experience: “a good opportunity to see how far I had come”
“Assessments are theoretical events, rather than clinical events”
Workshop: Making use of adult learning theories by Dr. David Taylor
Theories not mutually exclusive, each have something to recommend them
Instrumental learning theories:
- Behaviourist → stimulus – response (e.g. Skinner)
- Cognitive → mental process not behaviour (e.g. Piaget, constructivism)
- Experiential → behaviour in practice (e.g. Kolb)
Humanistic theories:
- Andragogy → need, readiness, motivation (e.g. Knowles)
- Self-directed learning → what about the social context?
- Transformative learning → disorienting dilemma that drives learning, context, critical reflection (e.g. Mezirow)
Situated cognition (e.g. communities of practice):
- Learning and thinking are social
- Structured by tools available
- Dependant on situation
- Knowing is supported by doing (e.g. Wenger)
How difficult it is to “get into” a new discipline. Need to acquire an understanding of the profession before you can “be in it”
The challenge for a learner is to find out enough about the subject to enable learning
Expectancy valence theory: low expectation of success results in poor motivation for learn, unless rewards are overwhelming → can’t give students tasks that they can’t achieve
- You need to recognise what you already know
- You need to know how the new knowledge fits in
- Dialogue makes it easier
Feedback will drive future learning
What are the responsibilities of the learner and teacher respectively in each phase of a learning cycle?
Dissonance (putting the cat among the pigeons):
- Teacher’s responsibility to challenge student to move outside of their comfort zone
- Learner needs to be open to being challenged, need to identify their own gaps, pre-conceived perspectives impact on worldview
“Critical friendship”
Teachers don’t need to be responsible for the answers, but they need to enable the discovery
Hypotheses that can’t be tested are useless (Poppper)
It’s possible to be critically reflective on your own but feedback is important for error correction → create your own dissonance
Laurillard: feedback is a continuous process that occurs as part of a 2-way dialogue (“conversation”)
“Feedback sandwich” 🙂