Saturday, 6 October 2012

PhD proposal in medical education

The illustrated guide to a PhD

12 Tips for studying medical education at the doctoral level (uncorrected final version pdf)

               12 Tips for studying medical education at the doctoral level (Medical Teacher, 2009)

Doctoral programs in HPE (Medical Teacher, 2013)

        Writing a PhD Proposal (Maastricht)

        EdD (NIE)

        PhD, EdD (IOE, London)

        Fellowship in Medical Education (Chicago)

        Doctor of Education (Harvard)
Choosing the right research advisor

How to get the most out of scientific conferences

How to get all-important teaching experience

Reflections on Mastery Training in Diagnostic Radiology

1. What are the indicators of mastery? (learning objectives)

      a. literature

Brettle, Barry & Smith, 2007

Jasinski, 2004

Kundel, Nodine, Conant & Weinstein, 2007


Wood, 1999

      b. survey / interview teaching staff (open or structured) - group discussion, questionnaire 
            i. open ended question (what are the indicators you would use to assess mastery?
                     list 3 or 5 indicators you would use to assess mastery?)
            ii. rank these in order of usefulness / impact
            iii. why did you select these indicators? (open ended discussion)

            iv. some examples - knowledge base, years of experience, ability to recognize unusual 
                      presentations, accuracy, completeness, speed, efficiency of search strategy,    
                      effectiveness, confidence, error rates

2. How could this be assessed? (for each area / topic)

     a. with plain film cases
            i. how many are required?
            ii. what spectrum of cases / complexity of cases is required?

     b. with cross sectional imaging
            i. accurate selection of key images
            ii. accurate description of key features on these key images
            iii. speed and confidence in screening all images and identifying key images

3. How can we train for mastery?

      a. role of "deliberate practice" (systematic case review, increasing complexity, with expert
          guidance / feedback)

      b. role of background reading / reflection on day to day clinical experience ("ad hoc" 
          case review)

4. What is the role of "key images"?

Reiner & Siegel, 2006

Gaillard, 2010

Dang et. al., 2009

5. What is the role of case repositories?

a. literature

Scarsbrook, Foley, Perriss & Graham, 2005

Yang & Lim, 2006

b. use in the continuum of training 

            i. undergraduate - exemplar case
            ii. residency and fellowship - mastery training
            iii. CPD

How radiology experts think - and value of online case repositories 

1. expertise in radiology is directly correlated with experience

2. case experience should be cumulative

3. case experience should include the full spectrum of the presentation of any given diagnosis

4. case experience should include material of increasing complexity

5. increasing complexity involves the review of cases showing typical, then less typical, less easily detectable features, with less associated features, or more confounding associated features, or more than one pathology, and progressively less or contradictory additional information

6. the radiology task is a simple three step process - see, recognize, diagnose

7. this requires perceptual learning or pattern recognition, categorical learning or the ability to list key features, and diagnostic reasoning or the ability to correlate with the clinical setting

8. experts use rapid holistic perception linked to experience, which are mental schemas or representations of the key features of a wide range of pathology

9. experts use rapid 200msec big picture perception to generate the most likely hypothesis, which then drives the deliberate search for key features

10. experts rapidly decide on whether a radiograph or scan is normal, or has a likely abnormality, and then use visual search and reasoning to confirm the diagnosis

11. online case repositories can accelerate the development of expertise, by widening the case experience of radiologists, beyond that of individual day to day direct experience, efficiently and effectively

12. the key is to use case material in a deliberate way (deliberate practice)

Cognitive apprenticeship

1. Developing into an expert radiologist involves mastering a set of complex task skills.

2. This includes "running the service" - prescribing the optimal imaging technique to address the clinical problem, protocolling the study, modifying the study "in real time" to take into account (unexpected) findings during the radiological examination, and interacting with technical and clinical staff to both optimize the examination, and convey the relevant radiological information that will facilitate clinical management of the patient.

3. The cognitive aspects of making a radiological diagnosis involve the "see, recognize, and diagnose" three step process described above.

4. The role of the trainee resident or fellow in radiology requires a combination of focus, application, sustained effort, and dedication to learn; coupled with a high level of professional responsibility and commitment to learning and practicing the craft of radiology.

5. Ultimately, learning requires active application of effort - learning by doing, with feedback on performance. Passive observation does not lead to true learning or the functional ability to perform in better ways. A combination of reflection, and repeated attempts to apply knowledge and skills is required to "learn" anything. This is an active process. Increasing expertise is acquired by "deliberate practice" 

6. The role of the instructor in radiology is to "coach", guide and facilitate this learning process in a positive way.

7. An example of a systematic positive coaching paradigm comes from coaching in sports, where the players or learners are reminded that they have total control over three aspects of performance - effort, learning from experience, and response to mistakes - ELM framework

8. A useful way of thinking about the trainee - instructor interaction is to reflect on the idea of "cognitive apprenticeship" 

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