ANZCA Educators Program (AEP): Program modules

Keywords: confidence gap; gender bias; medical education; teaching; unconscious bias.

Abstract
Background: Adult learning theories play a pivotal role in the design and implementation of education programs, including healthcare professional programs. There is a variation in the use of theories in healthcare professional education programs and this is may be in part due to a lack of understanding of the range of learning theories available and paucity of specific, in-context examples, to help educators in considering alternative theories relevant to their teaching setting. This article seeks to synthesize key learning theories applicable in the learning and teaching of healthcare professionals and to provide examples of their use in context.

Method and results: A literature review was conducted in 2015 and 2016 using PubMed, Scopus, Web of Science, and ERIC academic databases. Search terms used identified a range of relevant literature about learning theories, and their utilization in different healthcare professional education programs. The findings were synthesized and presented in a table format, illustrating the learning theory, specific examples from health and medical education, and a very brief critique of the theory.

Outcome: The literature synthesis provides a quick and easy-to-use summary of key theories and examples of their use to help healthcare professional educators access a wider range of learning theories to inform their instructional strategies, learning objectives, and evaluation approaches. This will ultimately result in educational program enhancement and improvement in student learning experiences.

The assertion that first, there was pedagogy and then came andragogy, is simultaneously true and misleading. What is pedagogy? What is andragogy? Which preceded the other? And what, if anything, does any of this have to do with medical education? In this article, we will explore the answers to these questions, review the historical bases for the pedagogical and andragogical paradigms, and discuss learning theories and their relevancy to teaching and
learning in medicine.

Abstract
The traditional unstructured apprenticeship model of teaching is still prevalent despite evidence that a more deliberate approach to teaching is likely to enhance learning. No deliberate teaching tool has been designed for or evaluated in clinical anaesthesiology. This pilot study aims to measure the effect of a deliberate teaching tool on the operating theatre educational environment in clinical anaesthesiology. We used a literature review to identify desirable teaching practices in clinical anaesthesiology, to design the Concise Regular Assessment and Feedback for Teaching and learning (CRAFT) framework. The CRAFT framework was piloted as an 'intention-to-treat' pre-post interventional study, over a four-week period in two sites. The operating theatre educational environment score improved from 73.8 ± 12.4 to 78.8 ± 15.0 (mean ± SD, p = 0.002), with statistically significant improvements observed in three of the four educational environment domains. Differences in the degree of improvement were observed between study sites (p = 0.271) and participant gender (p = 0.069). Female learners found the intervention more feasible (p = 0.073) and acceptable (p = 0.015) than their male peers. An adequately powered multi-centre study is planned to determine if these effects can be observed in different training regions and to investigate underlying factors in the educational experience of female and male learners.

Abstract
Teaching with real patients in the clinical setting lies at the heart of health professional education, providing an essential component to clinical training. This is true of all the health disciplines - particularly medicine, nursing, dentistry, physiotherapy, and dietetics. Clinical tutorials orientate students to the culture and social aspects of the healthcare environment, and shape their professional values as they prepare for practice. These patient-based tutorials introduce students to the clinical environment in a supervised and structured manner, providing opportunities to participate in communication skills, history taking, physical examination, clinical reasoning, diagnosis and management. It is only through participation that new practices are learnt, and progressively, new tasks are undertaken. The aim of this paper is to provide health professional students and early career health professionals involved in peer and near peer teaching, with an overview of approaches and key tips for teaching in the clinical setting. Although there are many competencies developed by students in the clinical setting, our tips for teaching focus on the domains of medical knowledge, interpersonal and communication skills, and professionalism.

Abstract
Feedback can improve students' learning and performance on clinical placements, yet students are often dissatisfied with the process. Attempts to improve feedback frequently focus on faculty development programs without addressing learners' capabilities to engage with feedback. For feedback to be effective, students need to understand its processes and to translate this into practice. Developing student feedback literacy may enhance feedback engagement and, therefore, learning outcomes. This qualitative interview study aimed to problematise student feedback literacy in the healthcare setting, from the learner's perspective. Before commencing placements, 105 healthcare students at an Australian teaching hospital participated in a feedback literacy program. After their placements, 27 students engaged in semi-structured interviews to explore their feedback experiences. Informed by workplace learning theory, interview transcripts were analysed using the framework method of qualitative analysis. Students reported reframing feedback as a process they could initiate and engage in, rather one they were subjected to. When they took an intentional stance, students noted that feedback conversations generated plans for improvement which they were enacting. However, students had to work hard against orthodox feedback expectations and habits in healthcare. They privileged intraprofessional supervisor feedback over interprofessional practitioners, patients, or peers. Findings suggest that student engagement with feedback can be augmented with focussed retraining. However, further research examining the structural and cultural influences on students' capacity to be active in workplace feedback is warranted.

Abstract
Background Teaching during patient care is an important competency for faculty. Little is known about anesthesiology resident preferences for teaching by anesthesiology faculty in the operating room (OR). If the behaviors and characteristics of anesthesia teaching in the OR that are most valued by residents were identified, faculty could incorporate that best practice to teach residents during OR cases. The objective of this phenomenological study was to interview anesthesiology residents to determine what they perceive the best faculty teachers are doing in the OR to educate residents. Methods Thirty randomly selected anesthesiology residents (10 in each post-graduate year class) were interviewed using a semi-structured approach with a predetermined question: "Based on your experiences as a resident, when you think about the best-attending teachers in the OR, what are the best-attending teachers doing in the OR to teach that other faculty maybe are not doing?" Interviews were recorded, transcribed, converted into codes, and grouped into themes derived from the cognitive apprenticeship framework, which includes content, teaching methods, sequencing, and social characteristics. Results Resident responses were separated into a total of 134 answers, with similar answers grouped into one of 27 different codes. The most commonly mentioned codes were: autonomy - step back and let resident work through (mentioned by 13 residents), reasoning - explain why attending does things (12), context - teach something relevant to the case (8), commitment - take time to teach (8), literature - bring relevant papers (8), prior knowledge - assess the baseline level (7), flexibility - be open to trying different approaches (7), focus on just a few learning points (6), reflection - ask resident questions (6), provide real-time feedback (6), teach back - ask residents to explain what they were taught in their own words (5), belonging - facilitate communication with the OR team (5), psychological safety - be open and approachable (5), equanimity - stay calm and collected (5), select proper timing for instruction when the resident is not occupied with patient care (5), visualization - use graphs or diagrams (5), and specify learning goals ahead of time (5). Conclusion The best practice for OR teaching, as perceived by anesthesia residents, includes social characteristics, such as context, commitment, psychological safety, equanimity, and proper timing, as well as teaching methods, such as autonomy, reasoning, literature, prior knowledge, flexibility, reflection, real-time feedback, and teach back. Further studies can determine if training anesthesiology faculty to incorporate these elements increases the caliber of daily teaching in the OR.

Abstract
A structured approach is critical to the success of any small group teaching session; preparation and planning are key elements in ensuring the session is systematic and effective. Learning activities guide and engage students towards the achievement of agreed learning outcomes. This paper introduces the central concepts of planning and preparing a small group teaching session. It provides an overview of key theoretical principles in lesson planning, delivery, and how to provide effective feedback in this setting.

ABSTRACT
An interactive teaching method is a form of learning and communicative activity, which focuses on students’ needs and allows them to actively participate in the learning process. With the introduction of competency based medical education (CBME), new teaching methods have been introduced to ensure the attainment of competencies by medical graduates. Research shows that interactive activity in class is an effective teaching learning method. There are many studies which have reported that students prefer interactive lectures based on active learning principles. Despite this, it has been found that many students do not engage with active learning exercise, which is probably due to the reason that among students, there is an already established culture of teaching and learning. The interactive lectures need to be designed after exploring student expectations, feedback, and experiences. Faculty members too have their own skepticism about the use of innovative methods in their teaching. These challenges need to be addressed for successful implementation of CBME based curriculum in medical education. With this review, we present the experiences about the use of interactive teaching methods in the field of medical education and also point out various barriers and challenges on the path of its execution.

Abstract
Introduction: Workplace-based assessments (WBAs) are used in competency-based training programs to facilitate learning and inform decisions on trainees’ progression. Competency in assessing WBAs is generally assumed; how assessors develop these skills remains largely unknown. This study explored how novice assessors acquire WBA skills to generate insights to inform future faculty development.

Methods: We conducted seven semi-structured interviews with provisional fellows, who are final-year trainees of the Australian and New Zealand College of Anaesthetists. Provisional fellows assess junior trainees as part of their preparation for consultant practice. We used constructivist grounded theory methods to analyse their experience of learning to perform WBAs.

Results: Participants primarily learned WBA skills through experiential learning and self-reflection on their practice. They developed practical skills to accommodate WBA into clinical practice, including finding time to facilitate WBAs and selecting appropriate cases. Simultaneously, participants developed expertise in the critical aspects of the assessment, particularly learning to determine the standard required of trainees and improving their feedback skills. This learning engendered an increased appreciation of the purpose of WBA, helped participants develop their clinical expertise and prompted them to envision themselves in the consultant role. Participants felt underprepared for their assessor role and appreciated access to the “safety net” ongoing supervision provided.

Conclusion: This study provides valuable insights into what is learned in becoming a WBA assessor and how it is learned. These insights could inform future faculty development initiatives to help improve graduating consultants’ development in this important area of consultant practice.

Abstract
Background: The current, so-called "Millennial" generation of learners is frequently characterized as having deep understanding of, and appreciation for, technology and social connectedness. This generation of learners has also been molded by a unique set of cultural influences that are essential for medical educators to consider in all aspects of their teaching, including curriculum design, student assessment, and interactions between faculty and learners.

Aim: The following tips outline an approach to facilitating learning of our current generation of medical trainees.

Method: The method is based on the available literature and the authors' experiences with Millennial Learners in medical training.

Results: The 12 tips provide detailed approaches and specific strategies for understanding and engaging Millennial Learners and enhancing their learning.

Conclusion: With an increased understanding of the characteristics of the current generation of medical trainees, faculty will be better able to facilitate learning and optimize interactions with Millennial Learners.

Abstract
Mobile technologies (including handheld and wearable devices) have the potential to enhance learning activities from basic medical undergraduate education through residency and beyond. In order to use these technologies successfully, medical educators need to be aware of the underpinning socio-theoretical concepts that influence their usage, the pre-clinical and clinical educational environment in which the educational activities occur, and the practical possibilities and limitations of their usage. This Guide builds upon the previous AMEE Guide to e-Learning in medical education by providing medical teachers with conceptual frameworks and practical examples of using mobile technologies in medical education. The goal is to help medical teachers to use these concepts and technologies at all levels of medical education to improve the education of medical and healthcare personnel, and ultimately contribute to improved patient healthcare. This Guide begins by reviewing some of the technological changes that have occurred in recent years, and then examines the theoretical basis (both social and educational) for understanding mobile technology usage. From there, the Guide progresses through a hierarchy of institutional, teacher and learner needs, identifying issues, problems and solutions for the effective use of mobile technology in medical education. This Guide ends with a brief look to the future.

Abstract
The use of information technology to support the educational mission of academic medical centers is nearly universal; however, the scope and methods employed vary greatly (Souza et al. 2008 ). This article reviews the methods, processes, and specific techniques needed to conceive, develop, implement, and assess technology-based educational programs across healthcare disciplines. We discuss the core concepts, structure, and techniques that enable growth, productivity, and sustainability within an academic setting. Herein are specific keys to success with examples including project selection, theory-based design, the technology development process, implementation, and evaluation that can lead to broad participation and positive learning outcomes. Most importantly, this article shares methods to involve students, faculty, and stakeholders in technology design and the development process that fosters a sustainable culture of educational innovation.

Abstract
Simulation training is an essential educational strategy for health care systems to improve patient safety. The strength of simulation training is its suitability for multidisciplinary team training. There is good evidence that simulation training improves provider and team self-efficacy and competence on manikins. There is also good evidence that procedural simulation improves actual operational performance in clinical settings. However, no evidence yet shows that crew resource management training through simulation, despite its promise, improves team operational performance at the bedside. Also, no evidence to date proves that simulation training actually improves patient outcome. Even so, confidence is growing in the validity of medical simulation as the training tool of the future. The use of medical simulation will continue to grow in the context of multidisciplinary team training for patient safety.

Abstract
Background: Due to the increasing complexity of medical education and practice, the preparation of healthcare professionals for leadership roles and responsibilities has become increasingly important. To date, the literature on faculty development designed to promote leadership in medical education has not been reviewed in a systematic fashion.

Aim: The objective of this review is to synthesize the existing evidence that addresses the following question: 'What are the effects of faculty development interventions designed to improve leadership abilities on the knowledge, attitudes, and skills of faculty members in medicine and on the institutions in which they work?'

Search strategy: The search, which covered the period 1980-2009, included six databases (Medline, EMBASE, CINAHL, Web of Science, ERIC, and ABI/Inform) and used the following keywords: faculty development; in-service training; doctor; medic; physician; faculty; leadership; management; administration; executive; and change agent. Hand searches were also conducted, and expert recommendations were solicited.

Inclusion and exclusion criteria: Articles with a focus on faculty development to improve leadership, targeting basic science and clinical faculty members, were reviewed. All study designs that included outcome data beyond participant satisfaction were examined. From an initial 687 unique records, 48 articles met the review criteria in three broad categories: (1) reports in which leadership was the primary focus of the intervention; (2) reports in which leadership was a component of a broader focus on educational development; and (3) reports in which leadership was a component of a broader focus on academic career development.

Data extraction: Data were extracted by three coders using the standardized Best Evidence Medical Education coding sheet adapted for our use. One reviewer coded all of the articles, and two reviewers each coded half of the dataset. Coding differences were resolved through discussion.

Data synthesis: Data were synthesized using Kirkpatrick's four levels of educational outcomes. Findings were grouped by intervention type and level of outcome.

Results: Forty-eight articles described 41 studies of 35 different interventions. The majority of the interventions targeted clinical faculty members and included workshops, short courses, fellowships, and other longitudinal programs. The majority of studies were quantitative in nature, though five studies used a qualitative design, and 12 studies used mixed methods. All quantitative studies were quasi-experimental and most employed a single group design; only two studies had a comparison group. Qualitative study designs were typically not specified. The majority of evaluation data, primarily collected post-intervention, consisted of participants' responses to questionnaires and interviews. KEY POINTS AND SUMMARY OF OUTCOMES: Despite methodological limitations, the faculty development literature tends to support the following outcomes: ▪ High satisfaction with faculty development programs. Participants consistently found programs to be useful and of both personal and professional benefit. They also valued the practical relevance and applicability of the instructional methods used. ▪ A change in attitudes toward organizational contexts and leadership roles. Participants reported positive changes in attitudes toward their own organizations as well as their leadership capabilities. Some reported an increased awareness of--and commitment to--their institution's vision and challenges, whereas others reported greater self-awareness of personal strengths and limitations, increased motivation, and confidence in their leadership roles. A greater sense of community and appreciation of the benefits of networking were also identified. ▪ Gains in knowledge and skills. Participants reported increased knowledge of leadership concepts, principles, and strategies (e.g., leadership styles and strategic planning), gains in specific leadership skills (e.g., personal effectiveness and conflict resolution), and increased awareness of leadership roles in academic settings. ▪ Changes in leadership behavior. Self-perceived changes in leadership behavior were consistently reported and included a change in leadership styles, the application of new skills to the workplace (e.g., departmental reorganization and team building), the adoption of new leadership roles and responsibilities, and the creation of new collaborations and networks. Observed changes primarily suggested new leadership positions. ▪ Limited changes in organizational practice. Although not frequently examined, changes in organizational practice included the implementation of specific educational innovations, an increased emphasis on educational scholarship, and the establishment of collegial networks. ▪ Key features of faculty development. Features contributing to positive outcomes included the use of: multiple instructional methods within single interventions; experiential learning and reflective practice; individual and group projects; peer support and the development of communities of practice; mentorship; and institutional support. ▪ Avenues for future development: Moving forward, faculty development programs should: ground their work in a theoretical framework; articulate their definition of leadership; consider the role of context; explore the value of extended programs and follow-up sessions; and promote the use of alternative practices including narrative approaches, peer coaching, and team development. METHODOLOGICAL ISSUES: More rigorous and diverse research designs are needed to capture the complexity of interventions in this area. Varied methods of assessment, utilizing multiple data sources to tap changes at the interpersonal and organizational level should be explored, as should the maintenance of change over time. Process-oriented studies, comparing different faculty development strategies and clarifying the process of change through faculty development, should also become a priority.

Conclusion: Participants value leadership development activities and report changes in attitudes, knowledge, skills and behavior. Moreover, despite methodological limitations, certain program characteristics seem to be associated with positive outcomes. Further research is required to explore these associations and document changes at both the individual and organizational level.

Abstract
In any evaluation system of medical trainees there is an underlying set of assumptions about what is to be evaluated (i.e., which goals reflect the values of the system or institution), what kind of observations or assessments are useful to allow judgments 1 ; and how these are to be analyzed and compared to a standard of what is to be achieved by the learner. These assumptions can be conventionalized into a framework for evaluation. Frameworks encompass, or "frame," a group of ideas or categories to reflect the educational goals against which a trainee's level of competence or progress is gauged. Different frameworks provide different ways of looking at the practice of medicine and have different purposes. In the first place, frameworks should enable educators to determine to what extent trainees are ready for advancement, that is, whether the desired competence has been attained. They should provide both a valid mental model of competence and also terms to describe successful performance, either at the end of training or as milestones during the curriculum. Consequently, such frameworks drive learning by providing learners with a guide for what is expected. Frameworks should also enhance consistency and reliability of ratings across staff and settings. Finally, they determine the content of, and resources needed for, rater training to achieve consistency of use. This is especially important in clinical rotations, in which reliable assessments have been most difficult to achieve. Because the limitations of workplace-based assessment have persisted despite the use of traditional frameworks (such as those based on knowledge, skills, and attitudes), this Guide will explore the assumptions and characteristics of traditional and newer frameworks. In this AMEE Guide, we make a distinction between analytic, synthetic, and developmental frameworks. Analytic frameworks deconstruct competence into individual pieces, to evaluate each separately. Synthetic frameworks attempt to view competence holistically, focusing evaluation on the performance in real-world activities. Developmental frameworks focus on stages of, or milestones, in the progression toward competence. Most frameworks have one predominant perspective; some have a hybrid nature.

Abstract
Background: The organisation of specialist training is complex and involves many clinical departments. The position of consultants responsible for education (CRE) in specialist training at department level is poorly defined in the literature.

Aims: The aim of the study was to explore expectations of stakeholders concerning the role and position of a CRE in specialist training.

Method: The role and position of the CRE was explored using focus group and semi-structured individual interviews.

Results: Knowledge of tasks and responsibilities was limited in all stakeholders except among CREs. The expectations of stakeholders to the CRE varied according to their position in the hospital hierarchy. In general terms the CRE was expected to assume overall responsibility for specialist training, promote a positive educational climate and secure quality of specialist training along with numerous administrative tasks. All interviewees expressed a wish for a strong leader at the same time they did not consider the position of the CRE influential.

Conclusion: Along with improved information about the role of the CRE, formal education, proper job-descriptions and clear leadership in the organisation concerning specialist training might increase the influence and power of CREs.