Introduction : Reflection and reflective practice is of increasing importance in medical education curricula. The aim of this review is to summarise the literature published around facilitating reflection in a medical course, and to answer the question : W0 hat is the current evidence regarding learning and development moments across the medical curriculum in developing students' reflective practice? Methods : A review of the literature was undertaken using defined databases and the search terms 'medical students', 'medical education', 'reflection', 'reflect*' and 'medicine'. The search was limited to peer-reviewed published material in English and between the years 2001 and 2011, and included research, reviews and opinion pieces. Results : Thirty-six relevant articles were found, identifying enhancing factors and barriers to effectively teaching reflective practice within medical curricula, relating to: The breadth of the meaning of reflection; facilitating reflection by medical educators; using written or web-based portfolios to facilitate reflection; and assessing the reflective work of students. Discussion : A variety of reflective purposes was found in this literature review. Evidence indicates that, if students are unclear as to the purpose of reflection and do not see educators modelling reflective behaviours, they are likely to undervalue this important skill regardless of the associated learning and development opportunities embedded in the curriculum.

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Context : There is growing interest worldwide in social accountability for medical and other health professional schools. Attempts have been made to apply the concept primarily to educational reform initiatives with limited concern towards transforming an entire institution to commit and assess its education, research and service delivery missions to better meet priority health needs in society for an efficient, equitable an sustainable health system. Methods : In this paper, we clarify the concept of social accountability in relation to responsibility and responsiveness by providing practical examples of its application; and we expand on a previously described conceptual model of social accountability (the CPU model), by further delineating the parameters composing the model and providing examples on how to translate them into meaningful indicators. Discussion : The clarification of concepts of social responsibility, responsiveness and accountability and the examples provided in designing indicators may help medical schools and other health professional schools in crafting their own benchmarks to assess progress towards social accountability within the context of their particular environment.

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Introduction: Multiple choice questions (MCQs) are one of the most frequently used written assessments particularly when there is a large body of material to be tested and a large number of students to be assessed. MCQ examinations have manageable logistics, are easy to administer, can be scored rapidly and difficulty indices and the discriminatory value of each item can be easily calculated, facilitating standard application. Methods of ensuring quality assurance are essential when assessment is used for the purposes of certification. Methods: Developing MCQs requires a concerted effort from curriculum planners, content experts, course coordinators and medical educators. This article aims at outlining a stepwise approach towards ensuring quality assurance in written assessments in an integrated curriculum from aligning assessment with the learning to ensuring banking of good quality MCQs. Discussion: Coordinated efforts and a stepwise approach towards item development, coupled with focused faculty development exercises, is a cost-effective means of developing a huge 'Question Data Bank' of valid and reliable test items which can serve as a National Resource for the Professional Regulatory Councils in the country for their Licensure Examination.

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Introduction: The objective of the study was to describe and assess a brief curricular intervention designed to help medical students adopt active learning strategies. Methods: Based on student interest, we created a one-hour workshop that focused on seven microskills of learning and presented it to our medical students during their Obstetrics and Gynecology clerkship. The workshop utilized a modified version of the "Five-Step 'Microskills' Model of Clinical Teaching" first described by Neher in 1992 and paralleled the model our residents are taught as part of their "Resident-as-Teacher" curriculum. Students were surveyed at various time points following the workshop to evaluate the perceived usefuness, value, and durability of the skills taught. Results: Immediate postworkshop feedback was favorable with 93% of students expecting to use the skills taught. At the end of the rotation, students reported a significant increase in usage of each microskill via a retrospective pre/postquestionnaire. While response rates at 1, 3, and 6 months after the rotation were moderate, the majority of the students responding stated that they had utilized the microskills. Conclusions: In its pilot year, the Microskills of Learning workshop was a beneficial addition to our clinical clerkship curriculum. By utilizing a parallel curriculum to that of our residents, the workshop mutually enhanced the educational process by encouraging teachers and learners to speak the same language.

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Introduction: In India, as in some other neighboring Asian countries, students and teachers are generally unaware of the differences in the learning styles among learners, which can handicap students with learning styles alien to the common teaching/learning modality within the institution. This study aims to find out whether making students aware of their learning styles and then using the Appreciative Inquiry approach to help them discover learning strategies that worked for them and others with similar learning styles within the institution made them perceive that this experience improved their learning and performance in exams. Methods: The visual, auditory, read-write, and kinesthetic (VARK) inventory of learning styles questionnaire was administered to all 100 first-year medical students of the Father Muller's Medical College in Mangalore India to make them aware of their individual learning styles. An Appreciate Inquiry intervention was administered to 62 student volunteers who were counseled about the different learning styles and their adaptive strategies. Pre and post intervention change in student's perception about usefulness of knowing learning styles on their learning, learning behavior, and performance in examinations was collected from the students using a prevalidated questionnaire. Results: Post intervention mean scores showed a significant change (P < 0.0001) in student's self-perceptions about usefulness of knowing one's learning style and discovering strategies that worked within the institutional environment. There was agreement among students that the intervention helped them become more confident in learning (84%), facilitating learning in general (100%), and in understanding concepts (100%). However, only 29% of the students agreed that the intervention has brought about their capability improvement in application of learning and 31% felt it improved their performance in exams. Discussion : Appreciate Inquiry was perceived as useful in helping students discover learning strategies that work for different individual learning styles and sharing them within the group helped students choose strategies to help overcome the handicap presented by the school's teaching methods.

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Introduction: The General Medical Council of the UK, advocates that by the end of their undergraduate course, medical students should be proficient in communicating with patients. However, the attitude of some medical students toward formal training in communication skills seems lukewarm. Although several studies on assessing attitudes of medical students on learning communication skills have been carried out in Europe and America, Asian studies are very few and literature in the Sri Lankan context is lacking. To explore the attitudes of first to fourth year medical students of the Faculty of Medicine, University of Peradeniya (FOMUP), Sri Lanka on learning communication skills and to identify possible factors that may influence student attitudes. Methods: A total of 675 students from year 1 to 4 of the FOMUP were asked to complete a modified version of the Communication Skills Attitude Scale. Items of its positive attitude scale (PAS) were analyzed together while negative items were considered individually. Results: Response rates ranged from 70% to 98% for the various year groups. There were no significant differences between the PAS for males and females and for those exposed to formal training and those who were not. The junior students scored significantly higher on the PAS than seniors. Most students of all the groups disagreed with the item "I don't see why I should learn communication skills". Approximately one-quarter of the students of each group endorsed the statement "Nobody is going to fail their medical degree for having poor communication skills". Out of the students who have undergone formal communication training, almost one-third agreed that they find it difficult to take communication skills learning seriously. Discussion: Although medical students seem to have realized the importance of communication skills training for the practice of medicine, a significant minority have reservations on attending such sessions. Sri Lanka faculty will need to make a concerted effort to change this attitude through improving teaching and assessment strategies.

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Introduction : The rise of complementary and alternative medicine (CAM) professions has taken place alongside an increase in public use of CAM therapies. Some actions have been taken to establish educational standards, often focusing on educating competent professionals to ensure citizens' freedom to make choices for their own healthcare while at the same time ensuring their safety. However, in professions like homeopathy that are unregulated in most European countries, it is not clear what it means to be a competent homeopath. The aim of this study was to investigate educators' views on what a competent homeopath is and what they require in their education. Methods : This was a qualitative study based on grounded theory methodology involving telephone interviews with 17 educators from different schools in 10 European countries. It used constant/simultaneous comparison and analysis to develop categories and properties of educational needs and theoretical constructs and to describe behaviour and social processes. The main questions asked of subjects were "What do you think is necessary in order to educate and train a competent homeopath?" and "How would you define a competent homeopath?" Results : The educators defined a competent homeopath as a professional who, through her knowledge and skills together with an awareness of her bounds of competence, is able to help her patients in the best way possible. This is achieved through the processes of study and self-development, and is supported by a set of basic resources. Becoming and being a competent homeopath is underpinned by a set of basic attitudes. These attitudes include course providers and teachers being student-centred, and students and homeopaths being patient-centred. Openness on the part of students is important to learn and develop themselves, on the part of homeopaths when treating patients, and for teachers when working with students. Practitioners have a responsibility towards their patients and themselves, course providers and teachers have responsibility for providing students with effective and appropriate teaching and learning opportunities, and students have responsibility for their own learning and development. Discussion : According to homeopathy educators' understanding, basic resources and processes contribute to the development of a competent homeopath, who possesses certain knowledge and skills, all underpinned by a set of basic attitudes.

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Introduction: Interprofessional teamwork is essential for effective delivery of health care to all patients, particularly the vulnerable and underserved. This brief communication describes a pilot interprofessional learning experience designed to introduce medicine and pharmacy students to critical health issues affecting at-risk, vulnerable patients and helping students learn the value of functioning effectively in interprofessional teams. Methods: With reflective practice as an overarching principle, readings, writing assignments, a community-based immersion experience, discussion seminars, and presentations were organized to cultivate students' insights into key issues impacting the health and well-being of vulnerable patients. A written program evaluation form was used to gather students' feedback about this learning experience. Results: Participating students evaluated this learning experience positively. Both quantitative and qualitative input indicated the usefulness of this learning experience in stimulating learners' thinking and helping them learn to work collaboratively with peers from another discipline to understand and address health issues for at-risk, vulnerable patients within their community. Discussion: This pilot educational activity helped medicine and pharmacy students learn the value of functioning effectively in interprofessional teams. Given the importance of interprofessional teamwork and the increasing need to respond to the health needs of underserved populations, integrating interprofessional learning experiences in health professions training is highly relevant, feasible, and critically needed.

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Context: Studies in medical expertise have shown that the medical knowledge of physicians is organized in a way that is easily retrievable when they encounter patients. These knowledge structures, called illness scripts, contain various pieces of information, including signs, symptoms, and enabling conditions, concerning a given disease. Illness script research has principally focused on understanding how physicians make diagnoses, while patient management has received much less attention. Although the work on diagnostics has taught us many things about the nature of medical expertise, focusing solely on this aspect provides only a narrow perspective on the subject, resulting in an incomplete depiction of medical experts. The goal of the present study was to experimentally determine how management knowledge plays a role in the development of illness scripts and developing expertise. Materials and Methods: Medical students, interns, and residents were instructed to think aloud while reading a case with either a diagnostic or management focus. The recall protocols were examined in terms of illness script components, as well as diagnostic and management accuracy. Findings: Both residents and interns were sensitive to the focus and generated significantly more management-items when thinking about management than when they were asked to diagnose a clinical case. They also provided more management items than medical students in management-focus. The performance of interns was superficially similar to that of residents in terms of management proportion, but with respect to both diagnostic and management accuracy they resembled medical students. Medical students, in contrast, were very persistent and insensitive to the focus. Conclusions: Medical expertise could be characterized by the emergence of illness scripts that are rich in terms of management knowledge. Illness scripts can generally be applied to any medical encounter that includes diagnosis and management, and expertise research should be extended to cover both domains.

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Introduction: To improve the viewing of the video-projected structured clinical examination (ViPSCE), we developed a computerized version; the computer-based clinical examination (CCE). This was used to assess medical students' higher knowledge and problem solving skills in surgery. We present how we did this, test score descriptive statistics, and the students' evaluation of the CCE. Methods: A CCE in surgery was administered to assess a class of 43 final year medical students at the end of their surgical clerkship. Like the ViPSCE, the exam was delivered as a slide show, using a PowerPoint computer program. However, instead of projecting it onto a screen, each student used a computer. There were 20 slides containing either still photos or short video clips of clinical situations in surgery. The students answered by hand writing on the exam papers. At the end, they completed evaluation forms. The exam papers were corrected manually. Test score descriptive statistics were calculated and correlated with the students' scores in other exams in surgery. Results: Administration of the CCE was straightforward. The test scores were normally distributed (mean = median = 4.9). They correlated significantly with the total scores obtained by the students in surgery (r = 0.68), and with each of the other exam modalities in surgery, such as the multiple choice and structured essay questions. Acceptability of the CCE to the students was high and they recommended the use of the CCE in other departments. Discussion: CCE is feasible and popular with students. It inherits the validity and reliability of the ViPSCE with the added advantage of improving the viewing of the slides.

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Introduction: In view of increasing demand for reforms in medical education in India, it is important to generate evidence through education research to increase the relevance and improve the quality of medical education. Education research is still at a nascent stage in India for a number of reasons. This study elicited health professions educators' views about the dearth of education research in Southeast Asia and what is needed to improve it. Methods: Qualitative content analysis of an interactive, online discussion on 'education research' between PSG-FAIMER Regional Institute fellows and faculty was carried out. Results and Discussion: Forty-four health professionals exchanged approximately 492 email messages during the discussion. One main concern expressed within the group was that the medical curriculum was not in tune with the health care needs of the society and reforms in the curriculum should be based on research. Most fellows felt that their work in education research was not appreciated in their schools. Participants felt that education research was done for altruistic reasons and only by self-motivated faculty. Participants also said that regulatory bodies were not concerned about the quality of education and its related research. Measures that could improve education research also emerged during the discussions. Interactive online discussions elicited important issues about education research in India. Participants noted that there is no recognition or rewards to encourage faculty to conduct education research. They also said that there is need to educate faculty about changes elsewhere in medical education and to make them more aware of education research generally.

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Introduction: The "Open Space Technology" (OST) is an innovative group process introduced by Harrison Owen in 1997. There is some evidence for its effectiveness in education quality improvement. However, its application in higher education has not been reported. Our objective was to apply a modified OST as a quality improvement tool in a postgraduate training quality improvement program at a university hospital in Argentina. Methods: OST is a method in which a program's participants propose and discuss topics of their interest with an aim that had been defined for them by coordinators. After proposing and writing down themes important to improving the quality of their postgraduate training, residents were divided into small groups to discuss the suggested topics for 90 minutes. They then reconvened in the large group and presented the conclusions of their small group discussions. Results: Thirty-six percent of residents (75/208) participated in one of the two OST sessions. Topics suggested by participants were similar in both sessions: (1) work hours, (2) work conditions, (3) residency curriculum, (4) residents' duties, (5) salaries, (6) professional burnout, (7) patient care load, and (8) interdisciplinary activities. Discussion: In only four hours, residents were able to share their concerns and proposals for improving the quality of their residencies with their faculty. Most of the topics they suggested were subsequently included in the program's quality improvement agenda.

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