Year : 2021 | Volume
: 11 | Issue : 2 | Page : 125--127
Principles of medical education: A review of Book's fifth edition
Medha Anant Joshi
Department of Allied Health Sciences, Faculty of Life and Allied Health Sciences, M.S. Ramaiah University of Applied Sciences, Bangalore; Medical Education Unit and Professor of Pharmacology, International Medical School, MSU, Bangalore campus Bangalore, Karnataka, India
Medha Anant Joshi
Former, Professor and HOD, Allied Health Sciences, Faculty of Life and Allied Health Sciences, M.S. Ramaiah University of Applied Sciences, Bangalore - 560 054, Karnataka
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Joshi MA. Principles of medical education: A review of Book's fifth edition.Int J App Basic Med Res 2021;11:125-127
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Joshi MA. Principles of medical education: A review of Book's fifth edition. Int J App Basic Med Res [serial online] 2021 [cited 2021 Jul 29 ];11:125-127
Available from: https://www.ijabmr.org/text.asp?2021/11/2/125/313310
Editors: Tejinder Singh, Piyush Gupta, Daljit Singh
Published: 2021 (5th ed)
Price: INR 495
With the introduction of Competency-Based Medical Education (CBME) curriculum in 2018–2019, medical educators in India are experimenting with the implementation of new curriculum, with newer student-centered teaching–learning strategies and assessment of learning being given a center stage. Implementing the new curriculum requires rigorous faculty development if the curriculum has to really work. To sustain the faculty development programs conducted by regional and nodal centers across India, there is a need for a comprehensive handbook on various aspects of medical education. This fifth edition of “Principles of Medical Education” by well-known medical educationists and authors of India, Dr. Tejinder Singh, Piyush Gupta, and Daljit Singh, is well timed.
This handbook is published by Jaypee Brothers Medical Publishers (P) Ltd. at a very reasonable cost. The book covers wide-ranging topics that are addressed in 31 chapters. Keeping in mind that the new edition has come out after a gap of 8 years, and the rapid growth of literature in medical education, all the chapters have been thoroughly revised, two chapters have been renamed, and one new chapter on “reflective practice” has been added.
This book is being widely read by educators in the health professions for the past 14 years, since it was first published in 1997, and has served as an excellent resource for young as well as faculty who wish to keep abreast with updates in health professions education.
The basics of teaching–learning, the psychology of learning, improving the retention of what is learned, and expanding on the adult learning section are addressed in the first chapter. In the current CBME curriculum where a lot of stress is placed on self-directed learning, the transformed role of teacher is well explained. Introducing the systems approach right from the first chapter, detailing it in the second chapter, and then connecting it with assessment and CBME in the chapter on innovative teaching methods drive home the importance of this simple, yet significant approach toward medical education. The next chapter on group dynamics makes it very pertinent to handle the newer teaching–learning methods where there is so much of weightage on small-group learning.
There is a lot of misconception regarding the term curriculum, curriculum planning, etc. The chapter on curriculum manages to clarify the concepts, the conceptual framework, and the types of curricula. A few of the approaches described in the literature are explained succinctly just enough to get the concepts clear. Chapter on integrated teaching gives the types of integrated teaching while touching upon the advantages and assessment. I would have liked to see a little more details about the case-based learning (CBL) and problem-based learning (PBL). A table showing the differences in CBL and PBL would have enhanced understanding of these two integrated learning methods which are many a time used erroneously as synonyms.
Domains of learning and learning objectives, the two sections that every health professions educator must be conversant with are well described. Generally, we think of only teachers and students while writing the learning objectives. I especially liked the advantages of learning objectives explained for the major stakeholders (page 38). The differences between objectives, competency, and outcomes are clarified well. The table showing the action verbs in all three domains will be handy when educators start writing the learning objectives.
Time and again the shortcomings of lectures have been discussed in various forums, but we still rely heavily upon this mode of teaching. Hence, why not make it more interactive and meaningful for the learners? The chapter on taking a lecture will definitely give you ideas to make the lectures interactive and memorable. The techniques described to bring in the interactivity are applicable for a large as well as a smaller group. While describing the jigsaw technique, a diagrammatic depiction of the process would have made it easier to follow the technique (page 52). Continuing with the teaching–learning methods, the next chapter touches upon tutorials and small-group discussion. The role of teacher as a facilitator is something that each one of us has to remember while conducting such small-group sessions. The next two chapters that are very much interrelated are on teaching clinical skills. With CBME curriculum in place, teaching and assessing clinical skills are absolutely essential abilities that a medical teacher should be well versed with. The bifurcation of clinical skills into technical and nontechnical and how to teach them using techniques such as active observation, staged approach, or the 1-min preceptor are well written. Another method of teaching clinical skills that I was looking forward to read but did not find a mention in this chapter was SANPPS model, a learner-centered model for outpatient education.
Media in medical education is a very informative chapter, which touches upon the Mayer's theory of multimedia learning and then goes on to explain the principles on how to use multimedia effectively. Computer-based learning, online learning, and web-based learning are the terminologies we all have started using liberally during the COVID-19–induced lockdown teaching sessions. This chapter elucidates to these along with the detailed guidelines for preparing good PowerPoint slices, with a plenty of examples and illustrations.
Next 12 chapters are devoted to an important aspect of the learning cycle, that of assessment. Assessment plays a major role in what is taught and what is learned. In systems approach and in CBME curriculum too, assessment is crucial to ensure that the students learn the skills to attain competence. Hence, it justifies a major part of the book being devoted to various facets of assessment. The chapter on student assessment covers topics such as types of assessments, abilities to be assessed, and the concept of table of specification. A sample table indicating how the weightage is to be assigned would have made the understanding of this not so familiar topic easier to follow. Attributes of a good assessment section of this chapter are very lucid and easy to follow. These psychometric properties are so very essential to understand the subsequent chapters.
Essay questions form a major part of any question paper of medical subject, be it UG or postgraduate (PG) examinations. The chapter on essay questions discusses the advantages, disadvantages, and the ways to write better questions including structured essay questions and modified essay questions. Next comes a chapter on short answer questions (SAQs), which follows the same pattern as the previous chapter and talks about the types of SAQs and guidelines for writing good SAQs followed by the limitations of SAQs.
The chapter on objective-type questions describes in much detail the ways to write different types of multiple-choice questions (MCQs) and to improve the items. This has been done with suitable examples to illustrate each pitfall to be avoided while framing single best answer type. I wish that at least some sample MCQs were of the higher order and not restricted to mere recall level. The author has also included not so commonly used types of objective-type questions. The next chapter on test-item analysis is an essential element when MCQs are part of the question paper; however, most of the times, this aspect is neglected. The importance and calculation of facility values and discrimination index are illustrated in simple and easily understandable steps. Giving the information on software available for analyzing the MCQs might induce the reader to take up the item analysis as a routine posttest activity. The next chapter which is interlinked with previous two chapters on MCQs and item analysis deals with a very useful concept of item banking. When MCQs are used regularly for testing, item banking is an indispensable part of the whole process.
The chapter on oral examination addresses the limitations and the ways and means to overcome them, in a concise manner. The major part of the next chapter on the assessment of practical/clinical skills is devoted to explaining the nuts and bolts of how to conduct an Objective Structured Clinical Examination, and other ways to make the clinical skills assessment more authentic such as using Mini CEX or OSLER are rationalized well. The next two chapters address important issues connected with CBME curriculum that of workplace-based assessment and assessment of noncognitive abilities. Tools available for assessing these are described succinctly. The chapter on continuous assessment discusses a very pertinent notion of assessment for learning, which competencies can be included in continuous internal assessment (CIA) and how a system of CIA can be planned within the regulatory framework.
We are so accustomed to express the achievements of our students in terms of marks that we believe that a student scoring 61 is better than a student who has scored 60 (page 169). The last chapters linked with the assessment go on to burst this myth by discussing the advantages of showing how moving from marks to grades would be advantageous and how we could use it in our day-to-day work. It would have added to the value of the section on assessment if the paradigm of standard setting was introduced to our audience.
The next seven chapters address assorted topics starting with mentoring and coaching. Here the emphasis is that on student–teacher mentoring, I would have liked to see how teacher-to-teacher mentoring is essential and beneficial for both as well as how it can be carried out.
Innovative teaching–learning methods is a renamed chapter, it was called newer methodologies in medical education in the previous edition, is expanded to include eclectic topics such as distance education, PBL, and e-learning. It also covers CBME-related topics such as using appropriate teaching and assessment methods, self-directed learning, and designing electronic learning modules and simulations. Here, newer concepts such as massive open online courses (MOOC) and m-learning are also touched upon. Recognizing the importance of simulations in medical education, this topic deserved a more detailed account or may be a separate chapter addressing all aspects of simulations.
The role “micro-teaching” in faculty improvement is elucidated well, and I feel that this should be a regular feature for PGs and novice teachers.
A critical input for faculty development is teacher evaluation. This is described with various tools available in this chapter. The chapter on reflective writing is a new addition and the need of the hour. If this vital skill has to be taught to the student, as has been mentioned many times in this handbook, the teacher must be familiar with the concept and the process. This chapter gives the right amount of information on this relatively new concept to teach the students. The examples of reflective writings will be very useful while implementing reflective writing in CBME curriculum as this can capture longitudinal development of those noncognitive domains, which are difficult to assess with conventional assessment tools. The last chapter addresses faculty development which explains the changing roles of a teacher and the levels of faculty development.
The book ends with two appendices and bibliography and further reading. The appendix on how to study will help the teacher become a better mentor and last appendix gives a bird's eye view of the theories of learning. If these theories were brought in in the first chapter on teaching–learning, it would have made it more meaningful. Although the bibliography is given at the end, in-text citation would have given an easy access to the literature. A summary at the end of each chapter and a guide for further reading would have added more strength to this handbook.
In an ever-expanding field of medical education, this comprehensive handbook covers many aspects and concepts in a simple language with giving just enough theoretical framework to make the reader understand the basics. Given the shift that is taking place from traditional to CBME curriculum, a chapter on leadership and change management would have added value. Having said that the authors have covered wide range of topics with simple examples and that is what makes this book extremely readable.
I would strongly recommend this book to all healthcare professionals.