Brian D. Hodges MD, PhD, FRCPC
Perspectives on Learning and Assessment
Scylla and Charybdis: Caught between examination and reflection in medical education
A peculiar disjunction is apparent in the assessment of the health professionals. On one hand there has been an explosion of testing technologies such that health professionals undergo an almost endless series of written and performance examinations during training and practice. They live in what Michel Foucault called the ‘examined society’ in which constant surveillance and testing locates the responsibility for competence externally to individuals. Simultaneously a different discourse about assessment is gaining adherents, one that is tethered to a ‘trinity’ of reflective technologies: self-assessment, self-direction and self-regulation. This approach places the locus for control of competence internally, requiring portfolios and reflective diaries. Both conceptions of assessment have significant advantages but also limitations and even adverse effects. How does the health professional educator navigate between the Scylla of excessive external examination and the Charybdis of naïve reliance on self-assessment?
Brian D. Hodges is Professor in the Faculty of Medicine and Faculty of Education (OISE/UT) at the University of Toronto, the Richard and Elizabeth Currie Chair in Health Professions Education Research at the Wilson Centre for Research in Education and Vice President Education at the University Health Network (Toronto General, Toronto Western Princess Margaret and Toronto Rehab Hospitals). He leads the AMS Phoenix Project: A Call to Caring, an initiative to rebalance the technical and compassionate dimensions of healthcare. www.brianhodges.ca
Brian D. Hodges MD, PhD, FRCPC
Making Teaching and Assessment More Relevant
Cheating in assessments: doing it, detecting it, deterring it
Cheating is commonly defined as breaking the rules to gain advantage. How common is cheating in medical school examinations? It probably occurs more frequently than we would like to think. Why do students do it and how do they justify it when found out? Is cheating more morally wrong in would-be doctors than in other students? Are some types of cheating worse than others? How can we expose this type of deception and how can we deter students from deciding to cheat in assessments. In this presentation I will explore these issues and look at the dilemma posed by medical students and trainee doctors who are academically dishonest.
Trudie E Roberts BSc., MB.ChB, PhD, FRCP, FHEA
Professor David Powis has been a university teacher of, and researcher in, physiology and medical education since 1972. At the University of Newcastle, Australia he has developed a professional interest and worked extensively in the area of medical student selection with the aim of establishing fair principles and appropriate strategy for selecting students for health professional courses. Since 1997 he has worked with Miles Bore and Don Munro to develop and evaluate the Personal Qualities Assessment (www.pqa.net.au) as an instrument for this strategy.
Brian D. Hodges MD, PhD, FRCPC
Doctors, of whatever specialty calling, need specialist medical knowledge and a complementary palette of skills and personality traits if they are to be considered professionally competent. Regardless of the specialty – surgeon or psychiatrist, general practitioner or pathologist - most would agree on which basic skills and traits doctors should have and, equally importantly, on what traits, attitudes, and behaviours that they should not possess. A competency list for a generic medical practitioner would almost certainly include high academic ability, good cognitive skills, and the ability to update and to use academic knowledge appropriately in the course of an increasingly complex professional practice environment. Practitioners should also have well developed decision making skills, professional integrity, high moral standards, and excellent interpersonal skills, in addition to being accomplished and confident communicators who can empathise with patients. They must be able to function professionally when under stress, have a high level of self-control, and not be prone to taking inappropriate risks in a practice setting. Their mental resilience and emotional stability must be high. A capacity to evaluate and reflect on their professional practices is also important. I am not describing here a super being; I am talking about the doctor we would all prefer to attend us when we are sick.
Miriam Friedman Ben David Lecture
Selecting for Personal Suitability
David Powis BSc, PhD
Professor Roberts graduated from Manchester with a degree in Medicine and a BSc in Anatomy. She undertook her early medical training in Manchester and her research at the Paterson Laboratories in Manchester and the Karolinska Institute in Sweden. In 1995 she was appointed Senior Lecturer in Transplant Immunology at the University of Manchester. In 2000 she was appointed Professor of Medical Education and Director of the Medical Education Unit at the University of Leeds. She was awarded a National Teaching Fellowship in 2006. In January 2009 she was appointed Director of the Leeds Institute of Medical Education. She was a council member of the General Medical Council from 2009 until 2012. In 2010 she became Chair of the Association for the Study of Medical Education. She is a council member and Censor for the Royal College of Physicians of London. In September 2013 she will take over as President of the Association for Medical Education in Europe (AMEE). Professor Roberts’s main interests and expertise are in the areas of assessment of competence, professionalism, inter-professional education and transitions in training and education. She is married to a surgeon, has two children and dreams of owning a Subaru WRX.
Medical school training - that four to six year period between school or university and entry to professional practice - can give a future doctor the basic knowledge required, and foster their skills for updating that knowledge to ensure continued academic competence. It can also teach or nurture the development of some of the other skills and attitudes in the competency list. But it is unrealistic to expect that medical education can do it all, particularly if the student is attitudinally unsuited or otherwise ill-equipped in their psychological makeup to meet the expectations of the profession and the community outlined above.
Acceptance of this line of thought must lead us to acknowledge that we should take particular care in selecting medical students - future medical practitioners - basing our choice on a range of criteria that reflect the picture of the generic good doctor. Generally this approach hasn’t been followed. For the past several decades in most countries the main selection criterion has been previous academic achievement moderated sometimes by assessment of motivation, or of some personal qualities by interview or by reading between the lines of a candidate’s application form or a referee’s report. This is not to say that the result has been all bad: most of those who enter medical school graduate as doctors and develop into practitioners who are a credit to the profession and are well regarded by, and of therapeutic value to, their patients. But on the negative side, there have always been a few individuals in every entering class who should not have been accepted into medical school. There are those who during their studies cause their teachers and mentors continual concern for a range of reasons other than academic progress, and those whose psychological resilience is insufficient to meet the demands of medical school training or clinical responsibility. After graduation unsuited and unprofessional doctors are regularly identified by patients - the published ‘restriction to practise’ statistics of the UK General Medical Council, for example, show that many complaints are justified.
In my presentation I will describe techniques and methods that have been used to measure some of the non-academic and non-cognitive qualities mentioned above, and provide empirical data on their reliability, construct validity and, most important, their predictive validity that supports their adoption for the purpose of selecting suitable future health professionals.