학부의학교육에서 다양한 교육과정과 교육법 설계 접근법의 근거:umbrella review (Med Teach, 2016) [출력완료]

학부의학교육에서 다양한 교육과정과 교육법 설계 접근법의 근거:umbrella review (Med Teach, 2016)

Evidence for curricular and instructional design approaches in undergraduate medical education: An umbrella review

Betty Onyura, Lindsay Baker, Blair Cameron, Farah Friesen & Karen Leslie

의학교육에서 리더나 교수들이 이러한 empirical knowledge 를 교육과정 개발이나 교육법 설계에 적용하지 않고 있다. 이런 것이 교육의 광범위한 영역에서 research-practice gaps 으로 나타난다.

Critically, however, leaders and faculty in medical education may not access or utilize this empirical knowledge to inform their curricular development and instruc- tional design practices (Levinson 2010; Onyura et al. 2014). This echoes concerns across the broader field of education where there are notable research-practice gaps (Spencer et al. 2012).

Umbrella reviews 란 systemic review 수준의 근거를 locating, appraising, and synthesizing 하는 방법이다.

Umbrella reviews (or meta-systematic reviews) are an established method of locating, appraising, and synthesizing systematic review level evidence (Becker & Oxman 2008; Grant & Booth 2009). 

Methods

Eligibility criteria

Search strategies and selection methods

Data abstraction, analysis and synthesis

Assessing the quality of included systematic reviews 

Results

40% 이내에서 행동 변화, 환자 효과, 조직이나 커뮤니티 수준의 성과를 보고했다.

Fewer than 40% of included reviews presented data on behavioural changes (level 3), patient effects (level 4a), and broader organizational (level 4b) and community outcomes (level 4c).

교육과정 설계 접근법

Curricular design approaches

문화간 교류 

Cross-cultural exchanges

문화간 교류란 학생의 모국에서 벗어나서 전체 프로그램이나 elective 와 같은 기간 동안 다른 문화적 맥락에서의 경험을 쌓는 것이다.

Cross-cultural exchanges refer to elective (often) educational experiences completed outside a student’s home country during the course of their program or in a different cultural context within their own country (e.g. experiences in communities populated by continental natives) (Mutchnick et al. 2003).

장점들

• 문화적 역량과 공감 Mutchnick et al. (2003) found consistent evidence that cross cultural experiences enhanced professional development by promoting cultural competence and compassion for patients.
• 자원활용과 공중보건 이슈 In addition, learners developed an increased awareness of resource use, professional practice and public health issues.
• 그 경험을 가치롭게 인식함 Overall, learners valued the learning experience.
• 시야 확장, 자신감, 독립심, 목표설정 It enabled a broadening of perspectives and facilitated increased confi- dence, independence, and realistic goal setting ability.
• 의과대학 매력발산 Having cross-cultural exchanges as a curricular option increased the attractiveness of medical schools to incoming students with many students reporting the exchange option as their primary reason for choosing a particular school.

장점에 대한 또 다른 결과 

Jeffrey et al. (2011) specifically explored international health electives (IHE) and found that

• 자신감 students gained more confidence in certain clinical skills (e.g. history taking, physical examination) than peers who did not complete an IHE.
• 인식 The students also had greater appreciation for the importance of cultural competency, prevention, environmental and public health, as well as the need to provide care to underserviced populations.
• 지식 IHEs promoted knowledge acquisition on trop- ical disease and immigrant health.
• 임상추론능력 It provided opportunities to strengthen existing clinical reasoning, history taking, and diagnostic skills with less emphasis on the use of high-tech instruments or interventions.
• 진로 There was a reported tendency for students who completed IHE to choose primary care specialties (e.g. family medicine, internal medicine), seek employment in low-income clinics or pursue graduate educa- tion in public health (Jeffrey et al. 2011).

 

IHE는 매우 다양해서 어떻게 설계하는 것이 가장 좋은가에 대한 합의가 없다.

It is worth noting that IHEs are highly variable and there is no consensus on how best to design and implement IHE curricula.

조기임상경험

Early clinical and community experience

의과대학생들을 공식 임상실습 시작 전에 임상현장의 사회적 맥락에 orientation시키는 것

Early experience involves the orientation of medical students to the social context of clinical practice before they enter into their formal clinical training (clerkship) years (Dornan et al. 2006).

장점

• 교육 만족 향상 Dornan et al. (2006) found some comparative research that indicated first year medical students who had early experience were more satisfied with their medical education than their peers with less experience.
• 동기부여, 학습에 대한 책임감 Students with early experience developed enhanced learning motivation (Dornan et al. 2006; Yardley et al. 2010) and reported feeling increased responsibility to learn (Yardley et al. 2010).

professional development에 대한 장점

Across reviews, there were positive effects of early experi- ence on students’ professional development, including

• adap- tation to professional roles, teacher-rated maturity (Dornan et al. 2006),
• the identification of role-models,
• understanding of the doctor–patient relationship, and
• role clarity (Yardley et al. 2010).

 

또 다른 장점

• 자기인식, 자신감, 공감 Review findings also illustrated improvements in students’ self-awareness, confidence (Dornan et al. 2006) and empathy for patients (Dornan et al. 2006; Yardley et al. 2010).
• 공감능력이 지속됨 Some research demonstrated that these gains in empathy persisted several years beyond graduation (Dornan et al. 2006).

지식습득

Knowledge gains were reported in several areas, including

• 하는 일의 실제적 관련성 understanding the practical relevance of their work,
• 생활여건과 건강 the link between living conditions and health, and
• 윤리관련 the ethical dimen- sions of patient care (Dornan et al. 2006).

 

기술습득

Skill acquisition was reported with regard to communication, reflection, history taking and physical examination skills (Dornan et al. 2006).

 

전공선택

Early experience also appeared to reinforce medical students’ vocational choice to practice medicine and influence career choices (e.g. working with underserved populations) (Dornan et al. 2006; Yardley et al. 2010).

환자, 지역사회에 대한 영향

Critically, the effects of early experience extended beyond the students themselves.

• Patients were satisfied with the students’ skills and enthusiastic about their role in the learning process (Dornan et al. 2006).
• There were also potential community benefits among populations where students were available to measure blood pressure, deliver oral health, treat trachoma and help manage malnutrition (Dornan et al. 2006).

이러닝

E-learning

만족도 향상
In general, IBL resulted in enhanced student course satisfaction (Cook et al. 2010a) even when compared to printed learning materials (Chumley-Jones et al. 2002).

 

자신감에 대해서는 차이 없음 (=)

There were, however, no significant differences in comparisons of learner confidence between IBL and other educational interventions.

 

지식습득 

Across studies, IBL promoted knowledge acquisition (Cook et al. 2010a) with knowledge gains being either superior (Cook et al. 2010a) or equivalent to gains realized using other educational interventions (Chumley- Jones et al. 2002; Cook et al. 2010a).

 

 

일부 학생들이 학습에 더 오랜 시간 걸림 (=)

However, learning time may have influenced findings as there were some studies where students spent longer studying or participating in IBL interventions (Chumley-Jones et al. 2002; Cook et al. 2010a). 

약간의 향상: 자신감, 성찰적 사고, 임상추론, 임상술기

Blended learning resulted in small improvements in self efficacy, reflective thinking, clinical reasoning, and clinical skills (history taking, reporting, documenting, and patient management) (Rowe et al. 2012).

IPE

Inter-professional education

IPE는 "둘 이상의 전문직 집단의 학생들이 서로에 대해서, 서로로부터, 서로와 함께 배움으로써 효과적인 협력과 health outcome의 향상을 가져오는 것"

IPE refers to‘‘when students from two or more professions learn about,from and with each other to enable effective collaboration and improve health outcomes’’ (WHO 2010, p. 7). 

결과가 혼재되어 있음 ( + / - )

Findings on general learner attitudes toward IPE were mixed.

• 인식, 태도 Although some research reported that IPE was perceived as positive and relevant (Hammick et al. 2007), other research found that improved attitudes toward IPE returned to baseline over time (Lapkin et al. 2013).
• 지식 습득 Although some evidence of knowledge gains as a function of IPE was reported (Lapkin et al. 2013), medical students in uniprofessional groups outperformed those in inter-professional groups on knowledge tests (Lapkin et al. 2013).
• 전문직간 의사소통 While IPE interventions resulted in improvements in inter-professional communication in some research, these gains were comparable to those of control interventions (Lapkin et al. 2013).
• Patient care Finally, there was some evidence to support the improvement of patient care (screening, illness prevention services) through IPE interventions (Hammick et al. 2007). 

포트폴리오

Portfolios

포트폴리오는 학습자의 성취에 대한 정보를 모아놓은 것으로서, personal and professional development을 목적으로, 일부는 비판적 분석과 성찰이 포함됨.

Portfolios are collections of information about a learner’s achievements, assembled with the intension of promoting personal and professional development, in part through a critical analysis and reflection of portfolio contents (McMullanet al. 2003)

전반적으로 personal and professional development의 다양한 측면에 도움이 됨. 그러나 많은 학생들은 종종 포트폴리오를 쓰는 것이 시간이 너무 많이 들어가고 스트레스 받는다고 말함. 또한 학습자들이 포트폴리오에 준비가 잘 안 되어있거나 포트폴리오가 학습자들의 poor commitment를 초래했다고 보고하기도 함.

Overall, learning, portfolios including appear to support various aspects of personal and professional development (Driessen et al. 2007). It is worth noting,however, that many studies report that students often find completion of portfolios to be time-consuming and stressful(Buckley et al. 2009). Studies also reported poor preparation and that introducing portfolios resulted in poor commitment from learners (Driessen et al. 2007).

PBL

Problem-based learning1

PBL은 학생들을 authentic real professional practice problems 에 던져주고 학습을 촉진시키는 것. SDL, reflective inquiry, active learing이 포함된 학생-중심 접근법.

PBL is a pedagogical approach that aims to facilitate student learning by immersing students in authentic real professional practice problems (Barrows 1986; Hung et al. 2008). PBL is a student-centred approach that incorporates SDL, reflective inquiry (Hung et al. 2008) and active learning (Colliver 2000) as learners work in small groups (Srinivasan et al. 2007; Hung et al. 2008).

PBL에 대한 근거는 확정적이지 않다. (+ / -)

Overall, the evidence on PBL is not definitive (Hartling et al. 2010).

• 일부 영역에서는 도움이 된다고 나오나, 학업성취나 지식 습득에 있어서는 상반되는 결과들
  There is evidence to support the efficacy of PBL in improving competence in some domains (e.g. relational skills, clinical performance) and conflicting evidence in domains relating to academic achievement where several studies found knowledge acquisition was lower or equivalent in comparison to traditional teaching methods.

 

다른 평가 전략을 활용할 필요가 있을 것으로 제안하. RCT는 reliable한 방법이 아닐 수 있음.

Review authors suggest that there may be a need to adopt different evaluative strategies to assess the outcomes of PBL (Vernon & Blake 1993). For example, randomized controlled trials (RCTs) may not be a reliable methodology for PBL curricular design research given the lack of standardization or ability to blind students to an intervention (Polyzois et al. 2010).

집중연구

Scholarly concentrations

SC는 일렉티브 혹은 필수 프로그램으로서, 특정 주제에 대한 심화 학습(연구)를 촉진하게끔 하는 프로그램. 전통적인 교육과정에서 제공하는 것을 넘어서는 수준으로 나아감.

SCs are elective or required programs of study designed to promote in-depth study on specified topic areas, going beyond what the conventional curriculum would provide (Bierer & Chen 2010).

 

장점

We identified one review (Bierer & Chen 2010) that examined the impact SCs have on medical students.

• 반응이 좋음 Overall, students reacted favourably to SCs and would undertake SCs again if given the opportunity.
• 시야 넓혀주고, 연구에 대한 이해 도와주고, 지식 향상 Students believed that SCs gave them a broader perspective of patient care, improved understanding of research prin- ciples and enhanced their knowledge.
• 문헌 평가, 과학연구에 관한 글쓰기, 연구의 윤리적 책임에 대한 향상
  Several studies critically showed that SCs improved student ability to conduct evaluate and literature, write scientific studies, ethically responsible research.

그러나 SC가 의무화 되어야 하는가에 대한 근거는 혼재되어 있음 (+ / -)

There were, however, mixed reactions as to whether SCs should be made mandatory.

• Student criticisms of SCs included unwelcome stress, high effort, inadequate structure, and undue focus on lab research.
• Students also expressed concern that SCs detracted from clinical opportunities.

 

진로 선택 관련 영향:

• Finally, participation in SCs was found to influence career choices including choice of clinical specialty and decisions to pursue academic careers.

 

연구에 대한 흥미에 관한 결과는 상반됨 (+ / -)

Interestingly, though some research pointed to SC enhancing research interest, other research found the opposite effect.

 

확실한 결론을 내리기는 어려움

The diversity of articles and variable results prevent definitive conclusions about the value of SCs and the review authors advocate for increased rigour in evaluation designs to demonstrate SCs’ true impact (Bierer & Chen 2010).

자기주도학습 SDL

Self-directed learning

학습 과제가 학습자에 의해서 주도되고, 무엇을 어떻게 배울지 학습자가 결정하는 것

SDL is learning in which the conceptualization and conduct of a learning project are directed by the learner; he/she makes decisions about what to learn and how to learn it (Brookfield 2009).

장점: 최소한 기존 방법만큼은 된다.

However, SDL was  associated with moderate increases in knowledge gains above other approaches; the greatest gains were found when learners chose their own resources. Some evidence suggested that more advanced learners may benefit more from SDL than more novice learners. In general, SDL was found to be at least as effective as traditional learning and perhaps more effective in certain instances (Murad et al. 2010).

교육법 설계 접근법

Instructional design approaches

CBL

Case-based learning

실제 상황 시나리오에 대해서 학생들의 분석적 리뷰와 토론을 통한 교육법. CBL 학습자들은 사전에 준비를 해와서 소그룹으로 퍼실리테이터의 guided inquiry하에 문제를 해결함.

CBL is an instructional approach that involves students’analytic review and discussion of real-life scenarios. CBL learners prepare in advance and work in small groups focused on problem-solving as a facilitator engages them using guided inquiry (Slavin et al. 1995; Srinivasan et al. 2007). 

장점: 반응, 흥미 자극

Thistlethwaite et al. (2012) found that most students’ reactions to CBL were very positive. CBL stimulated learner interest and was perceived to offer a good link between academic content and real-life practice.

 

그러나 학생들은 학습량 부담이 많고, 총괄평가에 적절한지에 대한 의구심

Students,however, had concerns about workloads and whether CBL prepared them adequately for summative assessments.

종합하면, CBL은  장점은 있지만 다른 방법보다 꼭 더 효과적이지는 않을 수도 있음.

Overall, the review illustrates that CBL can be effective in enhancing learning though it may not necessarily be more effective than other teaching approaches(Thistlethwaite et al. 2012). 

개념지도

Concept maps

학습자들이 개념적으로 이해한 내용의 연관성을 시각적으로 표현하는 것

Concept mapping is an instructional strategy that involves having learners integrate knowledge through graphical repre-sentation of their understanding of conceptual linkages (Torreet al. 2013). 

장점 : 문제해결식 시험에서 더 잘했음

There was evidence that students who utilized concept maps performed better on problem-solving examinations than there students given lecture-based instruction.

 

그러나 객관식에서는 차이 없음

However, were no differences between these groups in multiple choice exam performance.

 

lowest cognitive competence인 학생에게 가장 효과가 큼

One study found that concept maps had the most impact on students who came into the study with the lowest cognitive competence(Daley & Torre 2010).

 

새로운 지식을 기존 지식과 연결시키는 것을 도와줌. 교수자가 다른 교육법과 함께 사용하기에 좋은 resource.

Concept maps appear to have a role to play in helping learners link new knowledge to previous knowledge and may be a valuable resource that instructors can integrate with other approaches.

해부실습과 해부시범

Dissection and prosection

해부실습은 학생이 카데바를 해부하는 것. 해부시범은 숙련된 교수자가 설명하면서 해부하는 것

Dissection is an active learning process that involves students cutting a cadaver to examine internal structures (Hasan et al.2010). Prosection involves cadaveric dissection by an experi-enced instructor, who concurrently demonstrates anatomical structures to students.

지식 습득에 관한 결과는 conflicting함

Findings were conflicting with some favouring knowledge acquisition through dissection and others through prosection.

해부실습에 약간 무게가 더 실리나, 더 결론적인 해석은 어려움

Although the findings reflect as light advantage in favour of dissection, a more conclusive interpretation of findings is prohibited by methodological limitations, anatomical including the non-standardized assessment of knowledge (Winkelmann 2007).

교육 게임

Educational games

경험적 학습의 한 형태로서, 학습자들이 구조화된 상황에 놓이고 그들이 학습하는 것에 대해서 경험하고 성찰하게 하는것

Educational games are a form of experiential learning that involve the participation of learners in structured situations that enable them to experience and reflect on what they are learning (Silberman 2007).

롤플레잉 게임은 노인의학 교육을위한 개입으로 효과적이지 않았음

The findings suggest that role-playing games are not effective interventions for geriatric education

지식 습득에 도움됨

The results of the study showed that educational games resulted in improvements in know-ledge, as measured by tests taken shortly after the intervention.

대부분의 연구에서 단기 지식 습득은 더 우월함. 장기 지식 습득에 관한 것은 혼재되어 잇음.

For most studies, short-term knowledge acquisition was found to be either superior or equivalent to didactic lectures. Findings with regard to longer-term knowledge acquisition are mixed. Whereas most studies found superior or equivalent effects when comparing games to didactic learning, one study favoured didactic learning. These findings illustrate the varying situational effectiveness of educational games (Blakely et al. 2009). 

환자 포함

Patient involvement

적극적으로 환자를 involvement시킬 것을 지지하는 설득력있는 rationale들이 있음(질병에 관한 환자의 경험적 지식이 학생 교육에 포함될 수 있다)

There is a persuasive rationale for the active involvement of patients in health professional education, including the fact that patients’ experiential knowledge of illness can be incorporated into student instruction (Towle et al. 2010). 

장점: 긍정적인 학습자 반응. 의사보다 경험많은 환자가 낫다.

Wykurz and Kelly (2002) highlighted positive learner reactions to patient involvement.

 

• Many learners commented on gaining new insights when patients gave them constructive feedback and some even preferred the training they received from experienced patients over the training from doctors (Wykurz & Kelly 2002).

 

단점: 부정적인 학습자 반응. 교수가 가르쳐주는 것이 낫다.

This is in contrast to the findings of Jha et al. (2009) where students in some studies rated faculty teaching as being of better quality and more relevant than teaching by patients. Jha et al. (2009) also highlighted other potentially negative outcomes such as student skepticism about the benefit of patient involvement, or student perceptions of imposing on patients. 

그래도 장점이 많음 

Conversely, there were a myriad of positive effects due to real patient involvement on learners’ perceptions of personal growth and of the quality of the doctor–patient relationship (Jha et al. 2009) along with a deepening respect for patients (Wykurz & Kelly 2002). In addition, several studies reported improvements in clinical skill proficiency and knowledge acquisition including knowledge about the social aspects of disease (Jha et al. 2009) and about patients’ experience of the disease (Wykurz & Kelly 2002).

환자 자신에게도 긍정적 영향이 있음. 

Importantly, patient involvement had a positive effect on patients themselves.

• Patients reported enjoying the process and appreciated the opportunity to share their knowledge and facilitate learning (Wykurz & Kelly 2002). They also reported enhanced disease knowledge, improved perceptions of the doctor–patient relationship (Jha et al. 2009) and feelings of empowerment (Wykurz & Kelly 2002; Jha et al. 2009).

 

 

 

종합하면, 나름의 독특한 장점이 있으나, 환자의 정서적 웰빙 혹은 스테미나, 스트레스 등이 보고되기도 함.

Overall, involving real patients who have first-hand experience of disease in student instruction appears to benefit learners in unique ways, in addition to being cost-effective (Wykurz & Kelly 2002). There were, however, some concerns about patients’ emotional well-being and stamina in some studies, where patients might experience stress when sharing potentially painful issues or undergoing repeated examinations (Wykurz & Kelly 2002). It is important that researchers 

표준화 환자의 효과: 활용하는 것이 가치가 있다.

May et al. (2009) examined the effects of standardized patients on learners.

• Learners consistently rated standardized patients as beneficial, reporting increased confidence and comfort levels, particularly in the areas of communication skills and performance of sensitive examinations.
• Standardized patients also had positive effects on learners’ knowledge and skill and acquisition (e.g. in communication, teamwork,physical examination skills) across studies.

As with real patient involvement, the reviews reveal significant educa-tional value through the use of standardized patients as an instructional tool. 

기술-기반 시뮬레이션

Technology-enabled simulation

시나리오를 실제와 유사하게 연습할 수 있도록 마련된 사람, 기기, 일정조건. 학습자들이 실제 상황에서처럼 반응해야 함

Simulation has been defined as a person, device, or set of conditions that attempt to present practice scenarios authentically and require the learner to respond as he/she would under natural circumstances (McGaghie 1999). Technological advances have opened up new frontiers for simulation technology, allowing medical students to learn and practice clinical skills in controlled environments where patient safety is not at risk (Elley et al. 2012). 

laparoscopic surgery training에 대한 리뷰 세 개

Three reviews examined the use of virtual reality simulators within laparoscopic surgery training

효과성가 확실해보임: 기술적 실수를 줄여줌으로써, 수술의 다른 측면(의사결정)에 더 집중할 수 있게 도와줌

These reviews provided convincing evidence for the efficacy of virtual reality simula-tors in basic laparoscopic training. Simulator training appears to reduce the number of technical mistakes, thus enabling the surgical trainee to concentrate more on other aspects of surgery such as decision making (Ikonen et al. 2012). 

high fidelity simulation 을 사용하는 것의 장점에 대한 근거는 충분하나, 다른 modality보다 우월한지에 대해서는 일관되지 않음.

Overall, there appears to be good evidence to support the use of the high fidelity simulation proffered by computer- ized mannequins in health professional education, however, evidence as to whether it is superior to other modalities is inconsistent.

기술-기반 교육

Technology-enabled teaching

audience response systems (ARS)의 효과

Nelson et al. (2012) reviewed the effects of audience response systems (ARS) on learners.

• 청중과 발표자 상호작용 ARS create interactivity between a presenter and a large audience by providing a platform for audience members to communicate with the presenter.
• 학생들은 ARS를 즐겼고, 자신감 높아짐 Overall, the review found evidence that students generally enjoy using ARSs, and the experience enhanced confidence.
• 학생이 ARS를 얼마나 즐기는가는 교수자에 따라 달라짐. Interestingly, findings indicate that student enjoy- ment of ARS can be teacher-dependent –with ARS favoured with one teacher and traditional lecture format favoured with a different teacher.
• 즉각적, 혹은 장기 지식 습득에 도움 Across studies, use of ARS in lectures resulted in either enhanced or equivalent immediate and long-term knowledge acquisition outcomes in comparison to traditional lectures (Nelson et al. 2012).
• 중립~modest 정도의 효과가 있으며, 교수자에 따라 달라짐 Overall, it appears that there are neutral to modest beneficial effects of ARS use that may be teacher dependent.
• 상호작용적 교육환경 조성에 도움이 됨 ARSs may provide a convenient way for educators to create an interactive teaching environment, particularly in situations where lecturers struggle with student engagement.
• Methodological limitations prohibit drawing of firmer conclusions (Nelson et al. 2012).

Discussion

더 강력한 연구 방법과 연구의 이론적 토대가 필요함

Across reviews, there is a resounding call for greater research methodological rigour and theoretically informed design.

주로 연구들이 Kirkpatrick level 2a and level 2b에 집중하고 있음. 지식은 시험 점수로만, 태도는 자신감으로만 측정하는 경우가 많음. 중요하긴 하나 포괄적으로 반영하지 못할 수도

Our findings highlight that extant research is largely directed at examining a limited set of learning outcomes, focusing predominantly on shifts in knowledge, skills, and attitudes (Kirkpatrick level 2a and level 2b). Often, the singular focus in assessing knowledge acquisition is test performance, while the singular focus in assessing attitudes is on shifts in confidence. While important, these narrow parameters do not reflect the multiple ways in which knowledge is manifested or the huge variability in relevant attitudes experienced by learners.

많은 교육적 인터벤션의 효과는 mixed 되어있다. contextual variabilities and individual differences의 영향도 있음

The review findings highlight that many educational interventions result in mixed effects on learning. Whereas some of this variability is likely attributable to methodological limitations outlined above), some of it must be attributed to contextual variabilities and individual differences. Indeed, the situational variance in the efficacy of educational approaches is worthy of evaluation, and can generate knowledge about how contextual disparities and individual (teacher/learner) differences influence the effectiveness of curricular and instructional design approaches. We contend that the central realist evaluation approach of evaluating ‘‘what works, for whom, under what circumstances, and why’’ (Pawson & Tilley 1997; Ogrinc & Batalden 2009) is highly relevant for evaluating learning outcomes in the complex health professional educa- tion environment.

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Med Teach. 2016 Feb;38(2):150-61. doi: 10.3109/0142159X.2015.1009019. Epub 2015 Sep 4.

Evidence for curricular and instructional design approaches in undergraduate medical education: An umbrellareview.

Onyura B1, Baker L1, Cameron B2, Friesen F1, Leslie K1,3.

Author information

• 1a St. Michael's Hospital , Canada .
• 2b Independent Research Associate , Canada .
• 3c University of Toronto , Canada.

Abstract

INTRODUCTION:

An umbrella review compiles evidence from multiple reviews into a single accessible document. This umbrella review synthesizesevidence from systematic reviews on curricular and instructional design approaches in undergraduate medical education, focusing on learning outcomes.

METHODS:

We conducted bibliographic database searches in Medline, EMBASE and ERIC from database inception to May 2013 inclusive, and digital keyword searches of leading medical education journals. We identified 18,470 abstracts; 467 underwent duplicate full-text scrutiny.

RESULTS:

Thirty-six articles met all eligibility criteria. Articles were abstracted independently by three authors, using a modified Kirkpatrick model for evaluating learning outcomes. Evidence for the effectiveness of diverse educational approaches is reported.

DISCUSSION:

This review maps out empirical knowledge on the efficacy of a broad range of educational approaches in medical education. Critical knowledge gaps, and lapses in methodological rigour, are discussed, providing valuable insight for future research. The findings call attention to the need for adopting evaluative strategies that explore how contextual variabilities and individual (teacher/learner) differences influence efficacy of educational interventions. Additionally, the results underscore that extant empirical evidence does not always provide unequivocal answers about what approaches are most effective. Educators should incorporate best available empirical knowledge with experiential and contextual knowledge.

PMID:

 

25665626

 

[PubMed - in process]