Principles of Medical Education Daljit Singh, Tejinder Singh, Piyush Gupta
INDEX
ACDEFGIJKLMNOPQRSTVW
A
Adult learning 4
characteristics 4
Assessment 74–82
attributes 77
fairness 119
reliability 80
validity 77
criterion referenced 79
educational impact 81
formative 76, 79
functions 75
integrated 25
internal 76
Miller’s pyramid 82
norm referenced 79
utility 81
C
Case presentation 134
OSCR 135
OSLER 134
Competence 79, 124
Computer-assisted learning 58
Continuous internal assessment(CIA) 76, 144–149
design 147
documentation 148
outcomes 144
quarter model 148
sheet 149
Cronbach’s alpha 81, 112
Curriculum 16–21
components 18
interdependence 18
definition 16
development 20
diseases 21
foundations 17
models 17
planning 17
approaches 19
Kern’s model 21
stages 20
SPICES model 20
types 19
D
Discrimination index 109
Distance education 164
distance teaching 165
processes 164
SIM 165
Distractor efficiency (also see item analysis) 109
Domains of learning 29
affective 29, 31
levels 31
cognitive 29, 30, 84
levels 30
psychomotor 29, 31
levels 31
E
e learning 168
asynchronous 170
characteristics 169
synchronous 170
tools 171
types 170
Educational objectives 27–32
advantages 28, 32
disadvantages 32
framing 38
instructional 28
levels 28
Educational spiral 2, 33
Essay questions 83–87
checklist 86
construction 85
modified 85
structured 84
Extended matching questions 106
F
Facility value 109
Faculty development 183–188
levels 186
training or development 186
Feedback 7
Pendleton’s model 177
Sandwich model 177
G
Grading 150–152
absolute 151
advantages 152
relative 152
types 151
Group dynamics 12–15
group roles 15
groups and teams 12
groups formation 13
groups stages 13
supporting 14, 15
utility 14
I
Information processing 189
Integrated assessment 25, 79
Integrated teaching 22–26
advantages 23
assessment 25
basic and clinical sciences 24
basic sciences 24
CBL 25
early clinical exposure 24
faculty development 26
levels 23
PBL 25
spiral curriculum 25
types 23
Item analysis 108–113
J
Jig saw techniques 42
K
Key feature questions 107
L
Learning 2
adult 4
computer assisted 58
deep 4
domains of 29
experiences 2
factors promoting 3
surface 4
Learning objectives (also see educational objectives) action verbs 38
components 35
qualities 36
writing 35
ABCD 36
Kern 36
Learning opportunities 2
Learning
principles 3
Learning strategic 5
Learning taxonomy 30
Lecture 39–44
interactive 41
jig saw 42
techniques 41
note taking 42
planning 40
pre-lecture assignments 43
utility 40
M
m-learning 172
m-CEX recording form 132
Multiple choice questions (MCQ) 93–106
constructing 103
contextual 104
extended matching 106
K type 105
key features 107
parts 94
types 94
writing 95
Media in medical education 57
Mentoring 153–157
advantages 154
and coaching 154
and counseling 154
contract 156
definition 153
mentor qualities 157
models 155
process 156
skills 156
types 155
Microteaching 174–178
checklists 176
concept 174
cycle 175
feedback 175
Pendleton’s 177
sandwich 177
new 176
technique 174
Miller’s pyramid 82
Mini clinical evaluation exercise (m-CEX) 131
Motivation 158
theories 159
N
Negative discrimination 110
Non cognitive abilities 140–143
assessment 142
peer ratings 143
professionalism 143
Note taking 193
Cornell 193
O
Objective structured clinical examination (OSCE) 123
attributes 124
checklists 79, 128
station 124
types 125
Objective structured practical examination 130
Objectives educational (See also educational objectives) 27
One minute preceptor (OMP) 52–56
components 53
microskills 54
using microskills 56
Oral examinations 117–122
conduct 119
demerits 118
merits 117
structured 120
Overhead projection 70
P
Performance 79
Point biserial correlation 112
PowerPoint presentation 59
animations 67
creating 59
five-step approach 60
PowerPoint toxicosis 161
rule of six 62
slide design 65
Prelecture assignments 43
Problem-based learning 166
taxonomy 167
Projection slides 69
Q
Qualities of medical teacher 5
Question banking 114–116
process 15
R
Reading from books 190
Reflection 194
Reliability 80, 119
threats 81
S
Short answer questions (SAQ) 88–92
completion type 89
open 91
Simulated patients 173
Simulations 172
Specific learning objectives (also see learning objectives) 28
SQ3R 190
Standard error of measurement 112
System 7, 9
closed 7
components 8, 11
open 7
Systems approach 7, 9–11, 34
T
Table of specifications 35, 77
Teacher evaluation 179–182
peer 180
questionnaire 182
self 180
students 181
Teacher roles 183
Teaching 1, 5
Teaching clinical skills 48–51
assessment 50
models 48
observation guides 49
OMP 50
Teaching difficult topics 160
prior knowledge 161
Teaching integrated 22–26
Test analysis 108
Time management 191
Tutorials and small groups 45–47
advantages 46
conducting 46
process 45
V
Validity 77, 119
evidence 77, 79
threats 80
W
Web based learning 72
Workplace-based assessment (WPBA) 136–139
tools 137
case based discussion 138
clinical encounter cards 138
DOPS 138
feedback 139
mPAT 139
portfolios 139
×
Chapter Notes

Save Clear

1Principles of MEDICAL EDUCATION2
3Principles of MEDICAL EDUCATION
Fourth Edition
Tejinder Singh MD DNB MAMS FIMSA FIAP MSc (Health Professions Education) (Maastricht; Hons) MA (Distance Education) PG Dip Higher Education (Gold Medal) Diploma Training and Development (Gold Medal) PG Diploma in Human Resource Management (Gold Medal) Certificate Course Evaluation Methodology and Examinations (AIU) FAIMER Fellow, SIDA Fellow, IFME Fellow, IMSA Fellow Vice Principal (UG) and Professor of Pediatrics Program Director, CMCL-FAIMER Regional Institute Coordinator, MCI Regional Center for Faculty Development Christian Medical College, Ludhiana, Punjab, India Piyush Gupta MD FAMS FIAP Professor of Pediatrics, University College of Medical Sciences, New Delhi, India Editor-in-Chief, Indian Pediatrics Secretary, IAP Education Center Daljit Singh MD DCH MAMS FIMSA FIAP FNNF Diploma in Management (AIMA), FAIMER Fellow Certificate Course Evaluation Methodology and Examinations (AIU) Principal and Professor of Pediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India Visiting Fellow, Royal College of Paediatrics and Child Health (RCPCH), London, UK Forewords CP Bansal DK Srinivas
4
Jaypee Brothers Medical Publishers (P) Ltd.
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd.
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd.
83, Victoria Street, London
SW1H 0HW (UK)
Phone: +44-2031708910
Fax: +02-03-0086180
Email: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc.
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: 507-301-0496
Fax: +507-301-0499
Email: cservice@jphmedical.com
Jaypee Brothers Medical Publishers Ltd.
The Bourse
111, South Independence Mall East
Suite 835, Philadelphia, PA 19106, USA
Phone: + 267-519-9789
Email: joe.rusko@jaypeebrothers.com
Jaypee Brothers Medical Publishers (P) Ltd.
17/1-B, Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
Email: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd.
Shorakhute, Kathmandu
Nepal
Phone: +00977-9841528578
Email: jaypee.nepal@gmail.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2013, Jaypee Brothers Medical Publishers
All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
This book has been published in good faith that the contents provided by the authors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the authors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the authors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.
Principles of Medical Education
First Edition: 1997, Indian Academy of Pediatrics Education Center
Second Edition: 2000, Indian Academy of Pediatrics Education Center
Third Edition: 2009
Fourth Edition: 2013
9789350904091
Printed at
5Dedicated to
Children of the World, Medical students learning to care for them and Medical teachers preparing them for this role
6Foreword
It gives me great pleasure to write the Foreword for Principles of Medical Education (4th edn), a publication of the Indian Academy of Pediatrics.
There have been major changes in our understanding of educational process. Mainly these include the realization that students learn only when they want to learn, they learn by expanding on what they know and that they learn better in context, especially when it comes to skills and attitudes. Similarly, regarding assessment, we now understand that it is only a process of making an estimate of what a student knows and that there are multiple sources of errors in making this estimate. More important than inter-examiner variation, it is the variation between tasks (treating diabetic ketosis is not same as giving dietary advice for diabetes). The best way to make a better estimate is to assess an adequate and representative sample of tasks that a doctor is expected to perform.
Both these require a change in the role of the teacher. He has to be a manager of students’ learning needs rather than being an information dispenser.
The book deals with these issues and brings contemporary educational concepts within easy reach of medical teachers. It also discusses the interventions like early clinical exposure and skills training, which are likely to gain momentum in the coming days with the Medical Council of India (MCI) moving over to the new curriculum model.
I congratulate the Authors, Drs Tejinder Singh, Piyush Gupta and Daljit Singh, who have been widely acknowledged as good academicians, for their excellent work done to bring out this valuable book. The book serves this objective and fills a void in the field of teaching skills. The book certainly will continue to remain as a very prestigious publication of Indian Academy of Pediatrics.
CP Bansal
President IAP 2013
9Foreword
In the last three decades, we have witnessed a surge in the establishment of medical colleges in India. This phenomenon has been compared to ‘mushroom growth’, whether one likes it or not! Recently, to ‘reach targeted doctor population of 1:1000 by 2031’ (vide Vision 2015 document of Medical Council of India) existing colleges have been encouraged to increase number of seats after fulfilling some relaxed norms. There are more than an estimated 36,000 teachers engaged in teaching in the existing medical colleges, notwithstanding the shortage in teaching staff as well as learning resources.
 
REFLECTION
Teaching is a complex skill and art. It requires eagerness, self-discipline, hard work, practice and feedback to make sure that you are on the right track. Even those endowed with inherent talent, must undergo training to improve their performance. Why then, our medical teachers have not realized this? Is it our ego? Do we feel that we have acquired more than one degree that is good enough to teach? How is it that our policymakers, administrators and academicians have not considered training of teachers as important pre-requisite for carrying out their professional tasks?
 
CHANGING SCENARIO IN MEDICAL EDUCATION
There have been burgeoning developments and changes in medical education. For instance, the role of teacher has changed from information giver to facilitator, mentor and creator. The information and communication technology has revolutionized the teaching and learning. The traditional methods of assessment have been challenged leading to rethinking of philosophy, methods and tools of assessment. The focus of student assessment has shifted to the use of multiple-methods for testing a wide gamut of learning outcomes, such as higher cognitive abilities, communication skills, IT skills and professionalism including ethical behavior. Many of the methods lay emphasis on frequent assessment of learning outcomes. Several new methods and tools are now available, the use of which requires special training. Focus is also shifting from competency-based education to outcome-based education and workplace performance assessment. Performance at workplace deals with ‘how people will behave when unobserved in real-life on a day-to-day basis and take effective action in unfamiliar and changing circumstance’ whereas competence is—‘demonstration of knowledge, skills and attitudes required for a task under optimal conditions.’ Competence is necessary, but not sufficient (enough?) for ensuring performance, because in real-life conditions it may not always be optimal.
 
NEED FOR TEACHER TRAINING AND TRAINING MATERIALS
It is, therefore, essential for our teachers not only to be aware of these new developments but also suitably adopt and apply them in their teaching. Equipping medical college teachers to take on these roles through training, therefore, assumes importance.
10The concept of teachers’ training in India started only in late seventies. It gathered pace with Medical Council of India (1999) insisting every medical college to have a medical education unit and recently (2010) making it mandatory, for every teacher undergo at least the basic level training.
The books and other reference materials commonly used in the early years for teacher training were limited to WHO publications on medical education and mimeographed materials from few journals. During mid-90s, a number of useful books rolled out from various corners of India. These included: Medical Education: Principles and Practice (NTTC group, JIPMER, Puducherry, India, 1995), Assessment in Medical Education: Trends and Tools (CMET, AIIMS, New Delhi, 1995), The Art of Teaching Medical Students (MET Cell of Seth GS Medical College, Mumbai, Maharashtra, India), Principles of Medical Education (Tejinder Singh et al., Indian Academy of Pediatrics Education Center, 1997), besides a much-needed Trainer’s Manual by NTTC, Puducherry (1997), India. These books helped many medical teachers across the country not only in enhancing their knowledge but also served as resource material for conducting teacher training programs. However, they can be considered as ‘too little and too few’ if we take into account the enormous expansion in knowledge and the huge volume of target readers including the faculty of medical colleges, dental, nursing, physiotherapy and allied health sciences, who have multiplied over the past few decades and have no access to systematic body of information in health professions’ education.
The paradigm shift in medical education and the proposals made in Vision 2015: Document of Medical Council of India, for reforms and restructuring of medical education have prepared a background, for bringing out a new book-cum-training manual which takes into account and delves into these aspects. That precisely has been done in this revised edition of Principles of Medical Education by Dr Tejinder Singh, Dr Piyush Gupta and Dr Daljit Singh. The book serves this objective and fills a void in this field. Further, the book would be useful to many ‘teachers’ who are not employed in medical colleges—those in private sector teaching DNB students, or ‘teaching’ in conferences/workshops. I wish to congratulate the authors who have made this very valuable contribution to contemporary medical education literature.
DK Srinivas MD
Dean (Retd)
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER)
Puducherry, India
Former Project Officer
National Teacher Training Center (NTTC)
Former Consultant
Rajiv Gandhi University of Health Sciences
Bengaluru, Karnataka, India
11Preface to the Fourth Edition
It is with the sense of happiness and pride that we are writing the preface to the Fourth edition of Principles of Medical Education. It took 9 years for the third edition to be published but has taken only 4 years for the fourth edition to be out. The revision has been necessitated by the rapidly changing medical education scenario in the country and the consequent need for including a number of important concepts in the book.
Like its predecessors, the book covers the areas considered necessary for a medical teacher to be oriented to the art and science of medical education. We have resisted the temptation to put too much of ‘theory’ and tried to keep the discussion simple. However, to satisfy the academic appetite of some readers, a number of references and freely available web resources have been provided at the end. Six new chapters have been added and most other chapters have undergone extensive revisions. The earlier conversational format has been retained.
We are grateful to the medical teachers in India for accepting the earlier editions of the book and we hope that this edition will continue to fulfill their needs. The additions and revisions make the book, a useful training manual and also the resource for basic medical education workshops.
We are open, as usual, to suggestions, criticisms, brickbats (and bouquets!).
January 2013
Tejinder Singh
Piyush Gupta
Daljit Singh
12Preface to the First Edition
The persistent efforts of Pediatricians have finally borne fruits to get the status of a separate subject to pediatrics. This has, however, brought added responsibilities for teachers of pediatrics—that is to ensure that medical graduates are well versed in the care of children.
The quality of end-products of any system of education depends a lot on skills and orientation of the teachers. With this perspective, IAP Education Center has taken the responsibility of orienting teachers of pediatrics to educational technology and pedagogy. This book is a humble attempt to fulfill that mandate.
Written in the format of a self-instructional manual, the book is the outcome of authors’ experience of conducting educational workshops. Many of the examples given in the book have been generated out of these workshops and we do not claim any proprietary over them.
We do hope that the book will make an enjoyable reading and enable teachers to apply many of the educational principles in their day-to-day teaching. Better health care available to children through doctors better trained in this task will be our ultimate reward.
It may also be pointed out that although the book gives examples from the subject of pediatrics only, it will be equally useful for teachers of other subjects also.
We would welcome suggestions and comments to improve the quality of the book.
October 1997
Authors
13
A woodcutter was employed by a timber merchant, who was a very generous employer and offered a good salary and perks.
The woodcutter started his work and was able to fell 20 trees. He was very happy. However, a day later, the number of trees felled came down to 18. There was a progressive decline in the number over next few days.
The woodcutter was feeling very embarrassed since he felt that he was not doing justice to his job. He tried very hard but could not add to the number of trees felled—rather, he was able to cut only 10 trees on tenth day.
He went to his employer to apologize. The employer was very understanding. A bit amused, he asked, “When did you last sharpen your axe?”
The woodcutter appeared puzzled. He said, “Sharpen axe! I have no time. Do not you see I am so busy cutting the trees?”
Abraham Lincoln had rightly said that if he had six hours to cut a tree, he would spend four sharpening his axe.
When did you—as a medical teacher—last sharpen your axe?
14Acknowledgments
We thank the Editor-in-Chief, Indian Pediatrics, for allowing to reproduce freely from their following publications:
  1. Guglani L, Gupta P. Effective PubMed Search. Indian Pediatrics. 2001;38:621-30.
  2. Gupta P, Guglani L, Shah D. Exploring the Power of PowerPoint. Indian Pediatrics. 2002;39:539-48.
  3. Gupta P, Kumhar G, Shah D. Alternative Learning Strategies. Indian Pediatrics. 2003;40:731-41.
15Darkness to Light
O Lord, please protect us both, the teacher and the taught. May our learning be lustrous and revealing. Bestow strength on us so that we may work with mutual reverence and communion. May our learning illumine our minds and may we attain the glory of wisdom. May there be no hostilities between us.