Principles of Medical Education Daljit Singh, Tejinder Singh, Piyush Gupta
INDEX
A
Academic honesty 167
Acceptable performance 146
Adult learners, characteristics of 6
Adult learning 6
Advanced course 224
Affective domain 35
Affective skills 163
Animations 76
Assessment 8192
attributes of assessment 85
assessment for learning 83, 165
assessment of learning 83, 225
assessment of performance 91
assessment terminology 91
authentic assessment 91
checklist-based assessment 91
competency 91
competency-based assessment 92
criterion-referenced assessment 91
educational impact of assessment 89
formative assessment 91
functions of assessment 82
global ratings 91
integrated assessment 91
internal assessment 32, 63, 84, 153, 163, 226
Miller pyramid 90, 152
norm-referenced assessment 91
programmatic assessment 92
reliability 91
summative assessment 91
test 91
tool 91
types of assessment 83, 84
utility of assessment 89, 136
validity 85
B
Backward planning 24 (Also See Competency-based education)
Basic sciences 29, 30
Bedside teaching, problems with 64
Blended learning 199
Bloom's level of cognition, matching questions to 95
Bloom's taxonomy 94
Blueprinting 41, 130
Bookmarking 198 (Also See e-learning)
Bringing interactivity in lectures 50
C
Case-based discussions 154, 156
Case presentation 149
OSLER 149
CBD (See Case-based discussions)
Charts and photographs 142
Chart simulated recall 154
Clinical case presentation 149
Clinical competence, components of 138
Clinical encounter cards 153
Clinical judgment 147, 148
Clinical skills 59
assessment of 137
range of 140
Clinical work sampling 153
Coaching 174
and mentoring 173
Cognitive domain 35
Cognitivism 233
Communication 33, 34, 60, 73
skills 36, 132, 142, 145, 160
Competence 91
Competency 91, 164, 190
descriptors of 148
statements 44
Competency-based
approach 24
assessment 192, 193
comparison with conventional
competency 190
medical education 24, 190, 191
models of 190
planning competency-based curriculum 192
teaching for competencies 192
Complex learning 93
Constructivism 233
Contemporary learner 185
Content, categorization of 9
Continuing medical education 201
Continuous internal assessment 163, 164, 193 (Also See Internal assessment)
features of 164
function of 166
issues surrounding 166
role of 166
Conventional and competency-based curricula, comparison of 191
Cornell note taking 231
Cost-effective methods 47
Counseling 174
skills 147, 148
Course-based websites 79
Creativity 159
Critical incident method 44
Cronbach's alpha 88, 127
Curricula, formulation of 185
Curricular components 22
Curricular foundations 21
Curricular obesity 26
Curricular ossification 26
Curriculitis 26
Curriculo-sclerosis 26
Curriculum 20
approaches to curriculum planning 23
backward planning 24
competency based 24
learner centered 23
problem solving 23
subject centered 23
components of curriculum 22
curriculum mapping 26
diseases of curriculum 26
foundations of curriculum 21
hidden curriculum 24
Kern's method 25
SPICES model 24
types of curriculum 26
Zais model 21
D
Decision-making 60
Delivering lecture 49, 54
Developing teachers 32
Diagnostic teaching 164
Difficult topics 181
Direct responsibility model 61
Discrimination index 107, 123, 129
Discussions, case-based 157
Distance education 184, 185
advantages of 187
compliments 185
concept of 185
processes 185
SIM 186
student support 187
teaching 187
Distractor efficiency 124 (Also See Item analysis)
DOPS 154, 156
Driving effect of assessment 6
Dynamic faculty development 224
E
Early clinical exposure 30
Education changing trends in education 221
conventional mode of 184
education spiral 39
reflections in education 214
Educational process 81
Educational system 14
Educational feedback, models of providing 207
Pendleton's approach 207
sandwich model 207
Educational objective (See Learning objectives)
Education spiral 39
Effective teaching 8
E-learning (See Electronic learning)
Electronic learning 197
asynchronous learning 198
synchronous learning 199
tools used for electronic learning 200
types of electronic learning 199
use of electronic learning 203
Electronic mail 78
E-mail (See Electronic mail)
Engagement triggers 50
Ensuring equal participation 18
Entrustable professional activities 192
Essay questions 93, 94
improving 97
marking 97
modified 95
structured 94
traditional 93
Ethics 34
Examination stress 86
Expectancy theory 180
Experiential learning 223, 233
F
Face-to-face teaching 185
Facility value 123, 129
Factual knowledge 90
Faculty development 32, 197, 220, 222, 223, 225
levels of 223
purpose of 220
Feasibility 89
Feedback, sources of 211
Flipped classroom 52
Flowchart of OSCE 141 (Also See OSCE)
From marks to grades 169
advantages 170, 172
grades 170
problem 169
types of grading 170
absolute 171
relative 171
G
Good assessment, attributes of 85 (Also See Assessment)
Group 16
dynamics 15
formation of 19
members of 56
potential 18
processes, management of 19
roles 18
stages of formation 16, 17
supporting groups 17
H
Hawthorne effect 212
Humanistic qualities/professionalism 147, 148
Hypertext 79, 200
I
Improving retention 4
Indian medical graduate 191
Individual encounters, observation of 154
Information processing 228
Institutional objectives (See Learning objectives)
Interactive lectures 50
concept maps 51
jigsaw technique 51
muddiest point 51
pre-lecture assignments 51
techniques 50
think-pare-share 50
Integrated teaching 27
advantages 28
assessment 31
case based learning 31
early clinical exposure 29
faculty development 32
interdisciplinary 30
levels 29
problem-based learning 31
spiral curriculum 31, 200
types 29
Internal assessment 84, 163
continuous 164
diagnostic teaching 164
documentation of 168
features of 164
formative or summative 166
MCI regulations on 168
Quarter model 167
role of 166
Internet 78
applications of 79
revolution 80
Interpersonal skills 167
Item analysis 122127
discrimination index 123
distractor efficiency 124
facility value 123
indices, range of 124
negative discrimination 124
preparing for 123
steps 123
utility of 125
J
Jigsaw technique 51
K
Key feature test 121
Knowledge 33
application of 28
assessment of 99
domains of 35
recall of 28
retention of 28
L
Laboratory data interpretation 142
Learner-centered approach 23
Learning 2, 3, 36
active learning 5, 56, 76, 198
adult learning 6
assessment for learning 83, 165
case-based learning 30, 31
computer-aided learning 200
computer-assisted learning 73
cumulative learning 5
deep learning 7, 28
domains of learning 33
facilitation of learning 69, 220
feedback and learning 6
formative assessment and learning 6
happening, chances of 216
higher domains of learning 94
improving learning 5
learning in context 188
learning needs, managing 179
learning opportunities 2
learning strategies 7
managers of learning 222
principles of learning 4
psychology of learning 3
resources, creation of 220
self-directed learning 193
sequential learning 4
spiral learning 2
surface learning 7
theories of learning 233
types of learning 7
web-based learning 78
Learning objectives 26, 37, 38, 190
ABCD technique 43
action verbs for writing 46
advantages of 38, 45
disadvantages of 45
domains of learning 41
elements of 42
Kern's method 43
levels 38
Mager's approach 42
qualities of 43
relation to competency 40
SLO 39
sources of 44
table of specifications 41
Learning outcomes 165
Lecture
A-V Aids 48
delivery of 49
interactive 50
note taking 53, 230
Cornell note taking system 230
planning for 48
prelecture assignments 52, 182, 187
utility 48
Life-long learner 194
Logbooks 153, 154
Long-term memory 3, 227
M
Managing time 229
Massive online open courses 79, 186
types of 201
MCQs (See Multiple-choice questions)
Meaningful learning 28
Media in medical education (See Multimedia)
Medical curricula, problem-based 189
Medical teacher, emerging roles of 222
Memory, management of 232
Mentoring 173, 174, 177
advantages of 175
definition 173
for self-directed learning 196
limitations of 175
models of 175
process of 176
skill for 176
types of 175
Mentors, qualities of 177
Metacognition 215
Microteaching 204, 206, 208
checklists 206
concept 204
cycle 205
feedback during 205
session, transcript from 209
technique 205
version 3 208
Miller pyramid 90
Mini peer assessment tool 154
Mini-CEX (See Mini clinical evaluation exercise)
Mini-clinical evaluation exercise 146
recording form 147
feedback during 146
M-learning 202
Modified essay question (See Essay questions)
MOOCs (See Massive open online courses)
Motivating students 179
Motivation, common theories of 180
Muddiest point 51 (Also See Interactive lectures)
Multimedia 71, 198
dual channel assumption 70
instructional design theory 75
learning, assumptions 70
Limited-capacity assumption 70
Meyer's theory 78
principles 71
Multiple low-stakes assessments 86
Multiple-choice questions 99, 106
checklist for writing 117
contextual 118
cover the options test 109
distractor 106
extended matching 120
key 106
key feature questions 121
K type questions 118
stem 106
writing good questions 107
Multisource feedback 153
N
Negative discrimination 124, 126 (Also See Item analysis)
Non-cognitive abilities 159
assessment of 158
peer ratings 161
professionalism 161
Norming 17 (Also See Group dynamics)
Note taking 53, 230
O
Objective questions 105
extended matching questions 120
key feature questions 121
K-type questions 118
MCQs 106
Multiple approach type 118
selection type 106
supply type 106
varieties of 106
Objective structured clinical examination 85, 137, 151, 160
checklists 139
designing stations 139
flowchart 141
limitations 145
planning 141
reliability of 138
skills tested 142
station 139, 160
types of stations 139
Objective structured long case record 149
Objective structured practical examination 135, 145
Observation guides 61 (Also See Teaching clinical skills)
Offline materials 200
One-minute preceptor 64, 65
bedside teaching 65
microskills 66
model 62, 66
rationale 65
utility 67
Online reading resources 200
Oral examination 132, 134
attributes of 134
conducting 133
demerits of 133
formats of 136
merits of 132
structured 135
Organization/efficiency 148
Organizational development 225
OSCE (See Objective structured clinical examination)
OSPE (See Objective structured practical examination)
Overall clinical competence 147, 148
Overhead projector 205
P
PBL (See Problem-based learning)
Peer evaluation 211
Peer ratings 161
Pendleton's model 207
Personal digital assistants 202
Peyton approach 62
Physical examination 60, 141, 142, 147
Point biserial correlation 127
Poor lectures, students’ perception of 49
Poor memory 227
Portfolios 155
PowerPoint 73
animations 76, 198
creating 74
five step approach 74
presentation 76, 199
rule of six 75
slide design 199
slides 77
toxicosis 183
Practical examination, suggested format 145
Practical tips for effective lecture 54
Pre-lecture assignments 52, 182
Prior knowledge 182
Problem-based learning 31, 188, 189
rationale of 188
advantages of 189
collaborators 190
process of 188
variants of 189
Problem-solving 23
Procedural skills 62
Professional relationship 173
Professionalism 34, 161
assessment during internal assessment 167
assessment during m-CEX 147
assessment using PMEX 162
Program evaluation 83
Q
Qualities of medical teacher 8
Question banking 128, 130
advantages 130
item cards 129
process 129
R
Reading from books 228
Reflections 214
assessment of 219
concept of 214
feedback, and learning 155
how to write 216
Kolb's framework 215
metacognition and 215
portfolios and 155
process of 215
WPBA and 156
Reflective cycle 215
Reflective writing 214
advantages 216
process 216
Relation-assertion type questions 106
Reliability 87
Revisiting basic sciences 31
Routine performance, feedback on 154
S
Sample student feedback format 213
Sample teacher self-evaluation format 212
Sandwich model 207 (Also See Feedback)
Selection type tests 99
Self-directed learning 185, 193, 195
advantages of 196
assessment for 196
challenge for 197
implementing 195
issues with 196
process of 195
readiness for 194
skills for 196
steps in 194
Self-improvement 211
Self-instructional materials 186
production of 185, 186
Sequential learning 4
Short answer questions 99, 100
advantages of 102
disadvantages of 102
completion types 100
one best response types 101
open types 102
types of 100
writing good questions 102
Simulated patients 63, 203
Simulations 202, 203
Single best answer 106 (Also See Objective type questions)
Situated learning 234
Small group discussion 55, 56
Social learning theory 233
Soft learning skills 152
Spatial distance 186
Specific learning objectives (See Learning objectives)
Specifications, table of 41, 107
Spiral curriculum 31, 200
Split attention, principle of 71
Split-half 88
method 126
reliability 88
SQ3R technique 228, 229
Strategic learning 7
Strengthening motivation 181
Structured essay questions 94
Structured oral examinations 135
Student assessment 26, 81 (Also See Assessment)
Student feedback 212
Student ratings of teachers 212
Student learning 12
assessment of 220
diagnosis of 65
Students with language problems 176
Student-support services 187
Study skills 159
Studying with friends 230
Subject matter, listing of 20
categorization of content 9
core components 9
Subject-centered approach 23 (Also See Curriculum)
Supply type tests 99
Supported curriculum 24
Supporting group processes 17
Synchronous learning 199
System 9, 12
Systems approach 9, 10, 12, 22, 25, 40, 82
application of 13
backward planning 13
concept of 10
input-process-output model 10
to instruction 12
T
Table of specifications 41, 84, 85, 107, 130
Taking lecture 47
Tasks, core dimensions of 180
Teacher 173
evaluation 211
implication for 180
qualities of 8
role of 2, 220
Teacher evaluation 211
Teaching 7
aims 1
efficiency of teaching 144
purpose of teaching 7
session 65
teaching approaches 221
teaching clinical skills 59, 60
teaching difficult topics 181
teaching for competencies 192
teaching in context 182
teaching skills 204
Teaching-learning methods 184
Team 16
Teamwork, leadership 164
Technical clinical skills 59, 61, 228
observation guides 61
OMP 64
Teaching difficult topics 181
Technology 221
non-availability of 203
Telnet 79
Test analysis 126
Cronbach's alpha 127
point biserial correlation 127
reliability of the test 126
split half method 127
Tested curriculum 24
Test-retest reliability 88
Threats
to reliability 88
to validity 87
Time management 229
Traditional essay 93
limitations of 94
Traditional long case 149 (Also See Long case)
Training 223
Training medical students 59, 62
Tutorial 55
active learning 56
U
Unitary concept 87 (Also See Validity)
Unobserved procedure station 139, 144 (Also See OSCE)
Utility of assessment 74, 172
V
Validity 85, 91, 103 (Also See Assessment)
aspects of 86
characteristics of 86
types of 86
content 86
construct 86
criterion related 86
threats to, 87
unitary concept 87
W
Web-based learning 78
Work experience, documentation of 153
Working memory 4
Workplace-based assessment 151
authenticity 153
rationale for 152
tools for 153, 156
case based discussions 154
clinical encounter cards 153
DOPS 154, 156
feedback 146
mPAT 154
portfolios 155, 157
World-wide-web 79
WPBA (See Workplace- based assessment)
Writing notes during lectures 54
Writing objectives 41, 42 (Also See Learning objectives)
Z
Zais model 21 (Also See Curriculum)
×
Chapter Notes

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Principles of MEDICAL EDUCATION
Principles of MEDICAL EDUCATION
Fifth 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 Professor Department of Pediatrics and Medical Education SGRD Institute of Medical Sciences and Research Amritsar, Punjab, India Piyush Gupta MD FAMS FIAP FNNF FAAP Professor and Head Department of Pediatrics University College of Medical Sciences, New Delhi, India Daljit Singh MD DCH FIAP FNNF FAMS FIMSA Diploma in Management (AIMA), FAIMER Fellow Certificate Course Evaluation Methodology and Examinations (AIU) Vice-Chancellor Sri Guru Ram Das University of Health Sciences Amritsar, Punjab, India Foreword Janet Grant
Jaypee Brothers Medical Publishers (P) Ltd
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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
Fifth Edition: 2021
9789390281411
Printed at
Teach a student and you impact a life; Train a teacher and you impact generations of lives.
Hassezmusings
Foreword
The new edition of this handbook, Principles of Medical Education, is timely. Medical education in India is in the throes of fundamental change; from the promise of new regulation to the definition of a new curriculum with a new structure, new ideas about how students should enter medical school, new ideas about how they should learn, new areas of content and new assessment-based methods of progression.
As with any such sweeping educational innovation, it is not without its controversies. The apparent underlying intention to address the variability in quality of medical education seems laudable. Perhaps there was also a feeling that trying ideas that have been used elsewhere might improve medical education in India. While a number of guidelines for practice and planning have been provided, it is important to consider the development of a contextual curriculum as well as the new disability competences in foundation. These might appear in the next edition of this handbook.
It might be difficult to keep up with such a fast-moving landscape. And every teacher and educational leader will be expected to change their practice and planning in one way or another to meet the new demands. This book will help. It is a handbook that skilfully summarizes the salient points of many current concepts. I must congratulate the authors who have managed to be wonderfully clear in presenting the essence of each topic in a very few words. That makes this resource highly accessible.
Although the techniques detailed in the chapters are not supported by in-text citations, I can understand why this handbook has chosen this non-academic style. Medical education does not change as a result of a new and convincing evidence base. Medical education is a social science, and as such, it tends to change on the basis of social trends rather than evidence. In education, some ideas are integrated into practice simply as a political or regulatory imperative. Educational change is often based on current values and argument rather than evidence.
So, putting the risk of plagiarism aside, I hope that this approach liberates the reader to be critical, to question and to read around each topic. And then to reach your own conclusions about the contextual usefulness of the ideas so clearly presented. The essence of social science is critique.
On the other hand, I know that when there is the need to change, then a pithy summary can offer reassuring guidance. And as an introduction to the breadth of medical education, this handbook also sets out a lot of the terrain and explains terminology and basic concepts very well. It is a faithful presentation of some dominant ideas in medical education. Coming from the part of the world where most of these ideas originated, I know that what is said and what is done are often very different. As an educational psychologist, my personal bugbear is adult learning: that it continues to be touted as a theory is a mystery to me. It is an idea that has no evidence base, and did not arise from the context of professional training. And that is where your own critique and reflection come in.
Looking towards the future, I believe that such critique and reflection will lead to a book that includes theories and techniques that have been born in India, alongside those that were invented elsewhere. The richness of educational philosophy, values and practice in India should surely have given rise to new ideas that those of us from other parts should consider.
I am pleased to see the focus on assessment in this book. Although trends change in this field too, and the current trends seem to be towards more holistic approaches, there are clear, and possibly largely uncontentious, procedures for the development of examinations that must be followed. Nonetheless, even ideas such as workplace-based assessment have been driven by ideas of feedback, rather than by applying the rules of valid and reliable measures. And in that, as in all education, the principle of feasibility is fundamental.
I wonder whether, given the turbulent and exciting times in medical education in India, a chapter on management might not have been useful: managing the curriculum, managing resources, managing change. I have always believed that much of the success of education in practice is in its management rather than its rhetoric.
So in reading this wonderful resource, keep thinking and asking questions. I congratulate the authors for their ability to present complex ideas so succinctly and economically. This is neither an instruction manual, nor is it an academic treatise; it is a concise introduction to the current landscape of medical education. You will find yourself asking questions: and that is what should happen in this area of social science.
Janet Grant
Honorary Professor, University College London Medical School
Professor Emeritus, Department of Education in Medicine, The Open University, UK
Special Adviser to the President, World Federation for Medical Education
Senior Scholar, Department of Medical Education, University of Illinois Chicago College of Medicine
Adjunct Visiting Professor, Manipal Centre for Professional and Personal Development Manipal University, Karnataka, India
Director, Centre for Medical Education in Context [CenMEDIC] & FAIMER Centre for Distance Learning
Preface
We are happy to present the fifth edition of the book, Principles of Medical Education. The edition has been revised with some deletions and many additions. The driver for change has been the ongoing curriculum change in India to competency-based education and the book presents topics useful to teachers for delivery of this curricular model. Most of the chapters have been updated to address the contemporary curricular change, but we have retained the basic nature of the material and its conversational style. We have added in the Further Reading, a number of publications which we have published on competency-based medical education and related aspects. Most of these are free access papers and we do hope that interested readers will read them for a detailed and more theoretical coverage.
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 and advanced medical education workshops.
We are open, as usual, to suggestions, criticisms, brickbats (and bouquets!).
Tejinder Singh
Piyush Gupta
Daljit Singh