Articles

Abstract

Recent calls for educational reform highlight ongoing concerns about the ability of current curricula to equip aspiring health care professionals with the skills for success. Whereas a wide range of proposed solutions attempt to address apparent deficiencies in current educational models, a growing body of literature consistently points to the need to rethink the traditional in-class, lecture-based course model. One such proposal is the flipped classroom, in which content is offloaded for students to learn on their own, and class time is dedicated to engaging students in student-centered learning activities, like problem-based learning and inquiry-oriented strategies.

In 2012, the authors flipped a required first-year pharmaceutics course at the University of North Carolina Eshelman School of Pharmacy. They offloaded all lectures to self-paced online videos and used class time to engage students in active learning exercises. In this article, the authors describe the philosophy and methodology used to redesign the Basic Pharmaceutics II course and outline the research they conducted to investigate the resulting outcomes. This article is intended to serve as a guide to instructors and educational programs seeking to develop, implement, and evaluate innovative and practical strategies to transform students’ learning experience.

As class attendance, students’ learning, and the perceived value of this model all increased following participation in the flipped classroom, the authors conclude that this approach warrants careful consideration as educators aim to enhance learning, improve outcomes, and fully equip students to address 21st-century health care needs.

Abstract
Flipped or inverted classrooms have become increasingly popular, and sometimes controversial, within higher education. Many educators have touted the potential benefits of this model and initial research regarding implementation has been primarily positive. The rationale behind the flipped classroom methodology is to increase student engagement with content, increase and improve faculty contact time with students, and enhance learning. This paper presents a summary of primary literature regarding flipped classrooms, discusses concerns and unanswered questions from both a student and faculty member perspective, and offers recommendations regarding implementation.

Objective

To succinctly summarise five contemporary theories about motivation to learn, articulate key intersections and distinctions among these theories, and identify important considerations for future research.

Results

Motivation has been defined as the process whereby goal-directed activities are initiated and sustained. In expectancy-value theory, motivation is a function of the expectation of success and perceived value. Attribution theory focuses on the causal attributions learners create to explain the results of an activity, and classifies these in terms of their locus, stability and controllability. Social- cognitive theory emphasises self-efficacy as the primary driver of motivated action, and also identifies cues that influence future self-efficacy and support self-regulated learning. Goal orientation theory suggests that learners tend to engage in tasks with concerns about mastering the content (mastery goal, arising from a ‘growth’ mindset regarding intelligence and learning) or about doing better than others or avoiding failure (performance goals, arising from a ‘fixed’ mindset). Finally, self-determination theory proposes that optimal performance results from actions motivated by intrinsic interests or by extrinsic values that have become integrated and internalised. Satisfying basic psychosocial needs of autonomy, competence and relatedness promotes such motivation. Looking across all five theories, we note recurrent themes of competence, value, attributions, and interactions between individuals and the learning context.

Conclusions

To avoid conceptual confusion, and perhaps more importantly to maximise the theory-building potential of their work, researchers must be careful (and precise) in how they define, operationalise and measure different motivational constructs. We suggest that motivation research continue to build theory and extend it to health professions domains, identify key outcomes and outcome measures, and test practical educational applications of the principles thus derived.

Context

Selection methods used by medical schools should reliably identify whether candidates are likely to be successful in medical training and ultimately become competent clinicians. However, there is little consensus regarding methods that reliably evaluate non-academic attributes, and longitudinal studies examining predictors of success after qualification are insufficient. This systematic review synthesises the extant research evidence on the relative strengths of various selection methods. We offer a research agenda and identify key considerations to inform policy and practice in the next 50 years.

Methods

A formalised literature search was conducted for studies published between 1997 and 2015. A total of 194 articles met the inclusion criteria and were appraised in relation to: (i) selection method used; (ii) research question(s) addressed, and (iii) type of study design.

Results

Eight selection methods were identified: (i) aptitude tests; (ii) academic records; (iii) personal statements; (iv) references; (v) situational judgement tests (SJTs); (vi) personality and emotional intelligence assessments; (vii) interviews and multiple mini-interviews (MMIs), and (viii) selection centres (SCs). The evidence relating to each method was reviewed against four evaluation criteria: effectiveness (reliability and validity); procedural issues; acceptability, and cost-effectiveness.

Conclusions

Evidence shows clearly that academic records, MMIs, aptitude tests, SJTs and SCs are more effective selection methods and are generally fairer than traditional interviews, references and personal statements. However, achievement in different selection methods may differentially predict performance at the various stages of medical education and clinical practice. Research into selection has been over-reliant on cross-sectional study designs and has tended to focus on reliability estimates rather than validity as an indicator of quality. A comprehensive framework of outcome criteria should be developed to allow researchers to interpret empirical evidence and compare selection methods fairly. This review highlights gaps in evidence for the combination of selection tools that is most effective and the weighting to be given to each tool.

Dans le cadre d’un dispositif d’évaluation formative et précoce des prérequis à l’entrée des études universitaires, des étudiants de première année ont été amenés à s’auto-évaluer en estimant leur degré de maîtrise de chacun des prérequis testés sur une échelle de trois niveaux spécifiés au préalable. S’inscrivant dans la perspective du feedback « durable », l’auto-évaluation a été introduite dans le dispositif, car elle constitue une étape importante dans un processus visant à développer l’autonomie de l’étudiant, indispensable à sa réussite dans l’enseignement supérieur. Dans ce processus d’auto-évaluation, l’étudiant a d’abord été amené à poser un auto-diagnostic lors de la présentation d’un « Passeport », ce diagnostic étant censé amener l’étudiant à entamer une démarche de régulation par sa participation à des activités de renforcement. Dans cet article, le niveau d’exactitude du comportement d’auto-évaluation des étudiants est d’abord étudié. Les facteurs associés au comportement d’auto-évaluation sont ensuite analysés, en examinant notamment le genre (garçon-fille), le niveau de maîtrise réelle des prérequis, ainsi que la participation aux activités de renforcement. Nous analysons enfin les représentations des étudiants de l’activité même d’auto-évaluation. L’article se termine par une discussion sur les limites de la recherche et par des propositions d’implications pédagogiques.

Dans le cadre d’une formation universitaire initiale en enseignement secondaire, un dispositif de classe inversée a été expérimenté dans un cours portant sur l’évaluation des apprentissages. Structuré selon un mode plutôt traditionnel, le temps de classe était, dans ce cours, principalement consacré aux apprentissages conceptuels tandis que les apprentissages pratiques étaient réalisés en dehors de la classe. À partir de l’hypothèse qu’une pédagogie active et différenciée serait souhaitable pour soutenir les apprentissages procéduraux visés par ce cours, nous avons décidé d’intégrer des capsules d’autoformation en ligne portant sur les concepts, afin de pouvoir davantage accompagner les apprentissages procéduraux des étudiants en classe. Le contexte d’enseignement et d’apprentissage initial a donc été « hybridé » par l’introduction de matériel d’autoapprentissage disponible à distance en mode asynchrone. La problématisation de la situation et l’analyse de l’expérimentation réalisées s’inscrivent dans l’approche Scholarship of Teaching and Learning (SoTL) et le partage d’expertises requises pour le développement du nouveau dispositif de formation s’appuie sur le modèle Technological Pedagogical and Content Knowledge (TPaCK). En vue de bénéficier de cette expérimentation pour enrichir notre enseignement, et considérant la nécessité de recueillir des données probantes et scientifiquement valides pour la viabilité du dispositif de formation du type « classe inversée », notre démarche pédagogique était accompagnée d’une démarche de recherche visant à décrire les modalités d’appropriation des ressources technopédagogiques par les étudiants et à caractériser la dynamique présentielle du point de vue de la formatrice qui a mis à l’essai le dispositif.

The transition from medical student to junior doctor is an important period of change. Research shows junior doctors often experience high levels of stress, and consequently burnout. Understanding how to prepare for the transition may allow individuals who are likely to struggle to be identified and assisted. The aim of this paper is to systematically review the literature on preparedness for practice in newly qualified junior doctors.METHODS: This was a systematic review of literature concerning the transition from student to junior doctor, published in the last 10 years, and that measured or explored one or more factors affecting preparedness.RESULTS: Nine papers were included in this review. These varied in design and methodological quality. Most used survey methodology (n = 7). Six found knowledge and skills, particularly deficiencies in prescribing and practical procedures, relevant in terms of preparedness. Five looked at personal traits, with high levels of neuroticism and low confidence deemed to be important. Medical school and workplace factors, including early clinical experience and shadowing,positively affected preparedness. A lack of senior support proved detrimental. The influence of demographics was inconclusive.DISCUSSION: The studies reviewed indicate that both personal and organizational factors are pertinent to managing the transition from student to junior doctor.Further prospective studies, both qualitative and quantitative, drawing on theories of change, are required to identify what precise factors would make a difference to this transition.