Conversation Kickstarter #MedEdJ: Revisiting PBL

This is a guest blog post provided by e-Council member Robert Cooney, MD, MSMedEd, RDMS, FAAEM, FACEP.

As Medical Education celebrates the publication of 50 volumes, it is fascinating to look back through the archives and revisit the articles that made an impact over the course of the journals publication history. One such article is “Essentials of problem-based learning,” published in 1989. The article remains the most cited article from the 1987 to 1991 time period.

In this months’ edition of Medical Education, Gerald Koh revisits the article. As an early career clinician educator, I find the history of problem-based learning fascinating. My own experience with problem-based learning during my education was extremely limited. Our curriculum revolved largely around the traditional model of didactic-based teaching with skills sessions for anatomy, histology, microbiology, and history and physical examination. It was not until I was actually in my clinical years that I was exposed to problem-based learning.

As Koh points out, “the impetus for PBL arose from the common observation that medical students entering the clinical years appeared often to be devoid of knowledge which they could be presumed to have possessed earlier.” While present in 1989, this problem remains pervasive within medical education. Unfortunately, this was not a problem that could be solved solely by the use of a new teaching method or philosophy.  We are now bearing witness to even more novel solutions to the problem, such as the implementation of longitudinal integrated curricula.

It is also interesting to note that in the original article Walton and Matthews described some of the key barriers to the implementation of problem-based learning. The need for coordination between educators and clinicians, the hours of preparation needed for successful course of study, and the significant differences in reimbursement between clinicians with an educational mission versus those with a clinical mission are as relevant today as they were in 1989. Also fascinating is the fact that Ernest Boyer published his seminal report, Scholarship Reconsidered in 1990. The issues defined by a Walton and Matthews above were being debated within academia in general. In redefining scholarship, Boyer’s work gave rise to the role of Clinician-Educator that I enjoy today.

The final take away from Walton and Matthews article is to need to be cautious with the adoption of new teaching methodologies. “One of the errors to readily made by those initiating a change to PBL is to discard other methods of teaching which for certain objectives to be attained are more appropriate.” After the adoption of PBL, several schools initiated this teaching methodology as their sole method of curriculum delivery only to later reintroduce tried-and-true teaching methods. This is a lesson for any of us in medical education. We teach and learn in an environment that is constantly changing. The introduction of new teaching tools seems to occur almost daily. The ubiquity of computers and the ease-of-use of cloud-based technologies has given rise to several forms of “blended learning.” These new tools hold significant promise, but like PBL, we need to be deliberate with our curriculum design in order to most appropriately match you are teaching methodology to the desired educational outcomes.

Walton and Matthews made a lasting and significant impact with their article in 1989. While focused on problem-based learning, the issues identified are as relevant today as they were 25 years ago. Their lessons learned from the implementation of problem-based learning are applicable not only to their chosen philosophy but to any current educational endeavor.

Do you want to be the next eEditor for Medical Education and The Clinical Teacher?

Medical Education and The Clinical Teacher are seeking applications for the role of eEditor, deadline 31st May 2016. The position is due to start from the beginning of August.

Further information (including instructions on how to apply) is available here and the job description is posted below.

Medical Education and The Clinical Teacher E-Editor
Role Description

1. Reporting and appraisal

A Board of Management, with equal representation from ASME and Wiley, oversees the
performance of Medical Education and The Clinical Teacher. The E-Editor reports to the Editors of Medical Education and The Clinical Teacher, who in turn report to the Board of Management.

An annual appraisal meeting between the E-Editor and the journals’ Editors will take place at ASME’s Annual Scientific Meeting. Plans and targets agreed at the appraisal will be forwarded to the Board of Management for approval.

2. Overall aim(s) of the E-Editor role

– Increasing usage of journals
– Raising profile of journals
– Adding value to content and helping readers to engage with it (i.e. communicating about
journal content in accessible and credible way)
– Generating discussion

3. Main responsibilities of the E-Editor role


– Strategic planning with editors and rest of team
– Liaising with editors regarding papers/news to be highlighted
– Day to day activities to increase usage and profile of journals
– Measuring and reporting on success of activities
– Monitoring relevant developments in websites, blogs, social media and discussing with team
– Create and maintain a network of individuals who will provide support to the electronic
dissemination of information about the journals (currently the e-Council)


– writing blog posts – 1 a month
– inviting blog posts – 2 a month
– moderating comments

#MedEdJVJC summary is here!

Please check out the link below for the summary of the fantastic Virtual Journal Club held last month that discussed humanism in medical education. Feel free to continue the discussions on Twitter using #MedEdJVJC.

Thank you to all the VJC participants for their engagement, and see you all next time!

Self-assessment and programmatic assessment: Is self- regulation one of the keys to its success?

The following is a guest post by Helen Wozniak, Academic Director e-Learning and Evaluation at Flinders University. 

In its 50th year celebrations the journal Medical Education is revisiting highly cited articles and publishing a comment piece that links “old” ideas to current medical education themes. It is not surprising that assessment has been a focus in the last 3 issues – “Peer and self-assessment” in March, “Assessment of clinical competence with the OSCE” in April, and “The effect of assessment and examinations on learning” in May. This blog post considers the theme of self-assessment.

With the recognition that we need sustainable assessment practices that are fit for an educated society and also promote lifelong learning (Boud, 2000), new trends in assessment are emerging. Programmatic assessment is one such development (Van Der Vleuten, Schuwrith, 2005). It embeds many of the fundamental elements of assessment that are conducive to student learning: such as; a learner centred focus on capturing evidence; providing opportunities for learners to reflect on their progress; provision of feedback; and aggregating multiple sources of data. Inherent in this learner-driven approach to the assessment process is the need to for learners to engage in self-assessment of their learning and progress (Langendyk, 2006).

Linn et al (1975) when discussing peer and self-assessment, highlighted the importance of students managing their learning process, a core requirement for programmatic assessment. Passi and Southgate who revisit the original paper note that enabling students to “take charge of their own learning”, is still an issue today (2016, p.267). It has been suggested that one of the underpinning skills needed to enable effective self-assessment is the development of self-regulatory behaviours (Brydges & Butler, 2012). Self-regulation refers to a student’s ability to monitor, adapt and change one’s learning approaches to improve their situation and achieve their goals (Zimmerman, 1990), yet learners are rarely taught how to develop their self-regulatory behaviours (Winne, 2014). If students have limited insight about their learning and progress, this will impact their ability to engage in self- assessment. Consequently they may not recognise the need to seek out assistance and proactively manage their learning environment. All of these factors may impact their engagement and successful implementation of a programmatic assessment for learning approach.

Questions for you to consider and post a comment are as follows:

  1. What is your experience of learner’s engaging in self-assessment of their learning? What hinders this process, what enhances this process?
  2. How self-regulated are your learners? How do they acquire self-regulatory behaviours?
  3. What can we do as educators to develop self-regulatory skills in our learners?


Boud, D. (2000). Sustainable assessment: Rethinking assessment for the learning society. Studies in Continuing Education, 22(2), 151-167. Doi:10.1080/713695728

Brydges, R. & Butler, D. (2012). A reflective analysis of medical education research on self-regulation in learning and practice. Medical Education, 46(1), 71-79. doi:10.1111/j.1365-2923.2011.04100.x

Lanendyk, V (2006). Not knowing that they do not know: self-assessment accuracy of third year medical students. Medical Education, 40(2), 173-179. doi:10.1111/j.1365-2929.2005.02372.x

Linn, B.S., Arostegui, M. & Zeppa, R. (1975) Performance rating scale for peer and self assessment. British Journal of Medical Education, 9(2):98–101. doi:10.1111/j.1365-2923.1975.tb01902.x

Passi, V., & Southgate, L. (2016). Revisiting “Performance rating scale for peer and self assessment”. Medical Education, 50(3), 267-270. doi:10.1111/medu.12798

Van Der Vleuten, C. P. M., & Schuwirth, L. W. T. (2005). Assessing professional competence: from methods to programmes. Medical Education, 39(3), 309-317. doi: 10.1111/j.1365-2929.2005.02094.x

Winne, P. H. (2014). Issues in researching self-regulated learning as patterns of events. Metacognition and Learning, 9(2), 229-237. doi:10.1007/s11409-014-9113-3

Zimmerman, B. J. (1990). Self-regulated learning and academic achievement: An overview. Educational Psychologist, 25(1), 3-17. doi:10.1207/s15326985ep2501_2

A date for your diaries: The Medical Education Virtual Journal Club (#MedEdJVJC)

On April 6th we will be running a 24 hour Twitter-based virtual journal club (VJC) discussing the special March edition of Medical Education that focused on humanism in medical education. This issue of the journal has been made FREE to access for a short period of time around the VJC.

How the Virtual Journal Club will work:

The over-riding aim is to facilitate discussion about the issues addressed within this journal edition. Similar to previous journal clubs, we at Medical Education invite you, the participants, to discuss the questions below in the blog comments in order to get the discussion going prior to the event itself. You can simply ‘comment’ on this post.

The VJC will begin via Twitter at 14:00 BST on 6 April 2016, and run for 24 hours. During that time a number of the edition’s contributing authors will be checking the discussion thread periodically in order to respond and discuss further. The Twitter hashtag for the discussion will be #MedEdJVJC – include it in all your tweets to join the discussion, or simply follow the hashtag to see the conversation as it evolves. You can either discuss your own/other peoples’ answers to the questions below, or just pose any questions you may have to the author or the discussion participants.

We hope to see you online on the 6th. If you’re unable to make the VJC then feel free to catch up/join in with the discussion afterwards; just search #MedEdJVJC on Twitter. We will also be posting a summary of the Twitter discussion back to this blog for further comments.


  1. In the medical education programs that you are familiar with, how are arts and humanities-based teaching methods used? What knowledge and learning outcomes do they address? Is this form of teaching part of the required curriculum or is it offered in supplementary courses?
  2. How can we make the rich variety in form and function of medical humanities teaching visible so that we can make more thoughtful decisions about how to assess these methods?
  3. How can we best measure effects of process-oriented medical humanities teaching when dominant research methodologies and curriculum contexts seem to privilege content-oriented use?
  4. Do you see paying more attention to the underlying assumptions of teaching with and through the arts and humanities as a way to move forward in providing requested evidence?

Purple Sticker Pilot Project #3: Perspectives on peer mentoring and peer tutoring in medical education

What follows is the third in a series of posts that form the conclusion of the Purple Sticker Pilot Project, an initiative designed to highlight hot topics of discussion at the 2015 ASME Annual Scientific Meeting and continue the conversation after the event. This blog is a guest post by Dr Helen Watson, Lecturer in Biomedical Sciences at the University of Exeter Medical School; it follows on from the presentation that she and Timo Tolppa  delivered at the conference. You will then find a number of links to related journal articles from Medical Education and The Clinical Teacher that provide a basis for further reading around the topic. These articles are all free to access for the next month. Please have a look through the blog and related articles then share your thoughts, either in the comments section below or on Twitter (#ASMEpspp) – make sure to mention our Twitter account in your tweet: @mededuceeditor.

The General Medical Council (GMC) states in “Tomorrow’s Doctors” that medical graduates must be able to “function effectively as a mentor and teacher”1. The concept of mentorship is as old as education itself, but here I will discuss how it has changed and adapted to new trends and challenges in medical education.

At the 2015 ASME Annual Scientific Meeting we presented a summary and evaluation of a student led, near-peer mentoring scheme which has been running for two years at the Peninsula College of Medicine and Dentistry (PCMD) in Devon and Cornwall, UK2. The Peninsula student body faces several specific challenges, which this mentoring scheme helped address. PCMD split into the University of Exeter Medical School (UEMS) and the Plymouth University Peninsula Schools of Medicine and Dentistry (PUPSMD) in 2012, with students in 2013 entering one of these new schools. Therefore, for the last few years we have been teaching the remaining PCMD students as well as the new students in UEMS and PUPSMD. Another challenge facing students in Peninsula is the large geographical spread of our campuses over North and South Devon and Cornwall, with students in PCMD moving sites between year two and three as well as between year four and five. Problem based learning (PBL) is central to our curriculum, something which first year students are unlikely to have met in their education to date. In addition, our integrated curriculum requires students to be in a professional setting right from their first year. The near-peer mentoring scheme was set up by Peninsula Student Parliament to support all students and to address some of these challenges. There was some staff input into the training sessions and the evaluation but this was initiated by the students.

The undergraduate PCMD near-peer mentoring initiative was piloted in 2013-14 and then rolled out across all five years of study and all three campuses (Exeter, Plymouth and Truro) the following year. The scheme worked by pairing mentees with a mentor in the year above, resulting in very near-peer mentoring. The rationale was that this closeness in experience would help the mentee to gain valuable insights from the mentor who had only just been in the very same situation. The following evaluation and discussion refers to the roll-out of the scheme rather than the pilot. Mentors were recruited early in the academic year. 228 undergraduate students volunteered to be mentors and attended training sessions led by the student mentoring committee with talks from university counsellors, pastoral and academic tutors. Mentors were put into pairs and each pair allocated four mentees. This grouping allowed students to further provide peer support but also introduced flexibility so that the mentees could swap mentors, and vice versa, if they felt the relationship was not productive. 436 mentees were involved in the scheme, over all five years and all three campuses. A total of 664 undergraduate students were involved in the scheme during the first full implementation which makes it, to our knowledge, the largest initiative of this type to be used in medical education so far.

There was a mid-year meeting held for all mentors where they were able to share ideas and give feedback to the committee. This helped the students to clarify their role and to take new ideas to their mentees. The scheme was evaluated at the end of the academic year. Out of those that responded to the survey, all mentors had been in touch with all of their mentees by email or Facebook. Only 6% of mentors met none of their students face to face and 77% of mentors enjoyed being a mentor. 34% of mentees enjoyed having a mentor and 19% neither enjoyed nor disliked having a mentor. These lower numbers have likely resulted from those students who did not meet their mentors and perhaps did not see the need for the relationship. Some mentors commented that it was hard to arrange meetings with all of their mentees. Despite this, 100% of eligible mentors and 78% of mentees said they wanted to engage with the scheme the following year. As the mentoring was organised and led by the students with no demand for specific topics to be explored, we carried out a thorough evaluation of the scheme to find out more about what they were discussing when they met or exchanged emails.

The nature of the meetings was informal, with many of the students saying they had met over coffee or in the pub. In terms of the topic of conversation, assessments were identified by 49% of mentees and 47% of mentors. The structure of the year ahead for the mentees was discussed often, perhaps unsurprisingly as the curriculum and types of session vary considerably over the five year course. Personal issues and work life balance were less commonly discussed, with academic issues being most commonly explored. There were many positive comments from students in the evaluation, see figure 1 for some examples.

Positive outcomes for students

“Sense of community”

“Advice from a student perspective”

“Nice to have support moving into 3rd year in a new locality”

Positive outcomes for mentors

“It has been nice to get to know students in the year below and put our ‘wisdom’ into use and pass it on. The feeling of ‘paying it back’.”

“Being an older role model for peers. Communication & reflection on own experiences”

“Got more confidence in my own skills and knowledge”

Figure 1 – positive outcomes of the PCMD scheme from the end of year evaluation

We also asked students about the skills they thought they had accrued from the scheme. Mentees cited increased confidence, reduction in stress and an increase in clinical skills and medical knowledge as key benefits. The mentors felt they had improved their networking, teaching and organisational skills. Importantly, some mentors arranged extra activities for their mentees including tours of the hospital, bedside teaching and involvement with audits. Our near-peer mentoring scheme is just one example of how mentoring can support students through the many challenges of medical education. I will now explore some other methods of implementing mentoring and peer tutoring in other institutions, before discussing some common themes and questions.

Salerno-Kennedy et al have used peer tutoring as part of their graduate medical programme at University College Cork, Ireland3. This scheme is more focussed on teaching than mentoring but it makes use of fairly near peer relationships. Fourth year medical students tutored more junior students with medical educators alongside. Interestingly, the tutors were paid for their time. This may affect the dynamic of the relationship and the motivation of the tutors, although the authors say that the tutors were motivated by wanting to help fellow students and a desire to further their own teaching skills. The training in this tutoring scheme was given by LTHE trained medical educators and is described in detail in the paper. It is appropriately very much angled at preparing the students to be teachers, rather than mentors. The evaluation demonstrated the benefits of the thorough training, as the junior students found their student tutors to be very well prepared.

Another scheme, this time at the University of Iowa Carver College of Medicine, USA, has been introduced to support students through the pre-clinical to clinical transition. Brauer et al used a student initiated near-peer shadowing scheme where 62 pre-clinical students were given the opportunity to shadow 34 clinical student teachers over a four week period during their final pre-clinical semester4. Over 90% of pre-clinical students reported that they felt more aware of what their role in a hospital team would be and what would be expected of them. This pre-clinical to clinical transition is a challenging one and seems to be a particularly useful point to introduce peer support.

Doumouras et al have used peer tutoring between senior and junior medical undergraduates at Queen’s University in Ontario, Canada5. Again, this is more of a tutoring scheme than a mentoring scheme but, like ours, it relied on near-peer relationships with first and second years being taught by third and fourth years. 70 junior medical students and 15 senior medical students were involved in a two year programme. The outcomes seemed very positive for both junior and senior students. Increased confidence was seen in both sets of students, for the juniors feeling more confident in the hospital setting, and for the seniors in teaching in that setting. Unlike the Cork tutoring scheme above3, students in Ontario had no specific training in teaching but the preparation they needed to do was communicated to them in advance. The junior medical students found these sessions useful and a unique experience, reporting a high regard for the senior student teachers.

Saunders et al have initiated an interdisciplinary peer-assisted learning programme at the University of Edinburgh, UK6. Rather than using near-peer relationships, this scheme delivered training in specific skills to an interdisciplinary group of fourth year medical students and nursing students. These sessions were developed and delivered by medical and nursing students with guidance from teaching staff. The students were encouraged to work together and were asked to answer questions which related to the careers of both doctors and nurses. Students reported increased confidence in the specific skills taught and, crucially, also said they had a better awareness of the role of the other discipline. The authors of this paper encourage their readers to try using this type of teaching for different topics in order to improve interdisciplinary working in the clinical environment.

I have explored a range of mentoring and tutoring schemes here, each implemented in a different way. Although the aims of the initiatives differ, with some being focussed towards teaching and others on mentoring, the wider benefits seem to be shared amongst them all. Overwhelmingly positively, all of the schemes described here report mutual benefit for both sides of the mentoring or tutoring relationship. Another common theme is increased confidence amongst students in various domains. Possibly the benefit of near-peer mentoring and tutoring is that there is less pressure on students from senior teaching staff, allowing them to take more risks in raising difficult questions or discussing areas where they have a lack of knowledge.

The question of what is the best gap between mentor and mentee is an interesting one. Our very near-peer scheme helped students solve problems which were very specific to their point of study, for example what a particular assessment involved or how the curriculum is laid out. It might be that a bigger gap, for example between pre-clinical and clinical students, or students and junior doctors, may change the topics of conversation if the scheme was left flexible as ours was. It would be easy to imagine that a more junior student talking to a junior doctor may ask more about, for example, the doctor’s experience of particular situations or what was expected of them in the hospital rather than what would be in their next exam. In addition, regarding the hidden curriculum, what students or mentees might learn about values or how to behave from a junior doctor mentor is likely to be quite different from the cues they may pick up from a student just one year ahead of them.

Something which differs significantly between these papers is the level of training provided to students. The scheme at the University of Cork provided students with thorough teacher training, whereas in Ontario the students were required to take the initiative a little more in terms of preparing themselves to teach3,5. Our scheme included a training day at the beginning of the scheme and a mid-year meeting to address any issues that had arisen during the intervening period. These sessions were student led and very flexible to allow discussion. Despite our lack of rigorous training in comparison to Cork, our students still felt that they developed important skills. The need for training may depend on what the students are asked to deliver, for example formal teaching versus informal mentoring.

Transitional periods seem to be eased by the introduction of mentoring initiatives. The pre-clinical students in the Iowa scheme showed an impressive increase in awareness of what was required in the clinical setting they were about to find themselves in4. Similarly, our students remarked that their mentors helped them through the transition to a new geographical location as they moved from year two to year three. Mentees from all years said that they discussed what the following year would entail, indicating that mentoring also helps with smaller transitions for example between year three and four. We could extend this so that the mentee receives support from their mentor before they move to a new locality as well as when they arrive.

Peer mentoring and tutoring schemes, such as those discussed here, have wide reaching benefits for both the mentee or student and the mentor or teacher. Although there is a variation in the amount and types of training received prior to the schemes, the increase in confidence, skills and knowledge is a common factor, as is the mutually beneficial nature of these relationships. The use of these schemes seems particularly important during periods of transition and also to enhance interdisciplinary practice in medicine6. In my opinion, one of the most impressive factors of these schemes is the ability of students to initiate and drive them forward. In the case of our scheme and also that devised by Brauer et al in Iowa4, the schemes can be entirely student driven with minimal input from staff and minimal or no need for resources from the institution. Hopefully these case studies of mentoring and tutoring schemes will inspire you to try them yourselves, or to build on your existing structures and continue the conversation.


  1. General Medical Council, Tomorrow’s Doctors outcomes and standards for undergraduate medical education. (2009).
  2. Tolppa, T., Watson, H. R. in Annual Scientific Meeting of ASME (Edinburgh, 2015).
  3. Salerno-Kennedy, R., Henn, P. & O’Flynn, S. Implementing peer tutoring in a graduate medical education programme. The clinical teacher 7, 83-89, doi:10.1111/j.1743-498X.2010.00354.x (2010).
  4. Brauer, D. G., Axelson, R., Emrich, J., Rowat, J. & Stafford, H. A. Enhanced clinical preparation using near-peer shadowing. Med Educ 48, 1116, doi:10.1111/medu.12589 (2014).
  5. Doumouras, A., Rush, R., Campbell, A. & Taylor, D. Peer-assisted bedside teaching rounds. The clinical teacher 12, 197-202, doi:10.1111/tct.12296 (2015).
  6. Saunders, C. et al. The experience of interdisciplinary peer-assisted learning (PAL). The clinical teacher 9, 398-402, doi:10.1111/j.1743-498X.2012.00568.x (2012).

Further Reading 

Brauer, D. G., Axelson, R., Emrich, J., Rowat, J. and Stafford, H. A. (2014), Enhanced clinical preparation using near-peer shadowing. Medical Education, 48: 1116. doi: 10.1111/medu.12589

Doumouras, A., Rush, R., Campbell, A. and Taylor, D. (2015), Peer-assisted bedside teaching rounds. The Clinical Teacher, 12: 197–202. doi: 10.1111/tct.12296

Salerno-Kennedy, R., Henn, P. and O’Flynn, S. (2010), Implementing peer tutoring in a graduate medical education programme. The Clinical Teacher, 7: 83–89. doi: 10.1111/j.1743-498X.2010.00354.x

Saunders, C., Smith, A., Watson, H., Nimmo, A., Morrison, M., Fawcett, T., Tocher, J. and Ross, M. (2012), The experience of interdisciplinary peer-assisted learning (PAL). The Clinical Teacher, 9: 398–402. doi: 10.1111/j.1743-498X.2012.00568.x


Purple Sticker Pilot Project: A Fourth Wave for IPE and IPE Research?

This post is the continuation of a conversation that started at the ASME Annual Scientific Meeting 2015. The Purple Sticker Pilot Project is an initiative designed to highlight hot topics at the meeting and facilitate continued online discussion after the event; this post was one such hot topic. It has prompted the following guest blog by Dr Paradis (@ep_qc) and Dr Whitehead (@cynthiarw29); their affiliations and contact information can be found at the end of the post. 

Please join in the conversation! You can either comment on this blog or tweet; the Purple Sticker Pilot Project hashtag is #ASMEpspp and the blog editor twitter handle is @mededuceeditor.

Educational interventions and innovations are not neutral, and they do not emerge out of thin air. Instead, they are the result of a political process that happens in a particular social space and at a particular time.

Interprofessional education is such an educational intervention, and it has a rich but under-appreciated history that is ready for greater social scientific study (Michalec & Hafferty, 2015). In Canada, we could divide this history into three waves. The first, in the 1960s, aimed to better manage the workforce at a time when a nursing shortage seemed unavoidable and the looming Medicare reforms created uncertainty around physicians’ roles. The second, renewal wave, in the late 1990s, also promised better workforce management, and focused on the roles and scopes of health professionals. This wave was built upon the idea that if students from different professions discussed their professional roles and scopes, the understanding of these roles and scopes would naturally lead to integrated and higher-quality care.

The current, third wave of IPE rides the coattails of the patient safety movement and suggests that IPE will help curb errors, improve patient outcomes and satisfaction, and prepare clinicians for the needs of our complex healthcare system and the complicated needs of our aging patients.

For many years, now, our community has teased out the strengths and limitations of IPE as a solution to problems of teamwork in healthcare. Key findings include:

  • Limited evidence of IPE’s impact on collaborative practice (Reeves et al., 2008), and the WHO’s recent conditional support of IPE (World Health Organization, 2013);
  • Physicians’ paradoxical support for IPE, since it is an intervention that purportedly gives greater power and voice to clinicians from other professions (Whitehead, 2007);
  • Continued hierarchical relationships among clinicians (Burford et al., 2013; Long et al., 2006) and the continued salience of professional identities in clinical care (Burford, 2012);
  • IPE’s silence about the structural changes required to flatten professional hierarchies (Kuper & Whitehead, 2012);
  • The insufficiency of individual-level solutions to solve problems of system complexity, role ambiguity, and differing professional viewpoints on cases (Lingard et al., 2012);
  • Varied strategies used by professional groups to maintain their dominance over others (in the case of physicians), and carve out a space for their own professional practice (Baker et al., 2011).

In light of these findings, we would like to propose a fourth wave of IPE and of IPE research, one that is much more aware and attuned to power struggles at the systemic (i.e. in the system of professions) and relational (i.e. between individuals) levels. As we argued in our recent article in Medical Education, (Paradis & Whitehead, 2015), if IPE continues to ignore the structural, organizational and cultural issues that plague interpersonal relationships in healthcare, it will continue to wrongly place the onus for system change on learners, and try to solve a social problem by changing individuals.

We look forward to your thoughts and to continuing this conversation!


Baker, L., Egan-Lee, E., Martimianakis, M., & Reeves, S. (2011). Relationships of power: Implications for interprofessional education & practice. Journal of Interprofessional Care, 25, 98-104.

Burford, B. (2012). Group processes in medical education: Learning from social identity theory. Medical education, 46, 143-152.

Burford, B., Morrow, G., Morrison, J., Baldauf, B., Spencer, J., Johnson, N., et al. (2013). Newly qualified doctors’ perceptions of informal learning from nurses: implications for interprofessional education and practice. Journal of Interprofessional Care, 27, 394-400.

Kuper, A., & Whitehead, C. (2012). The paradox of interprofessional education: IPE as a mechanism of maintaining physician power? Journal of Interprofessional Care, 26, 347-349.

Lingard, L., McDougall, A., Levstik, M., Chandok, N., Spafford, M.M., & Schryer, C. (2012). Representing complexity well: A story about teamwork, with implications for how we teach collaboration. Medical education, 46, 869-877.

Long, D., Forsyth, R., Iedema, R., & Carroll, K. (2006). The (im)possibilities of clinical democracy. Health Sociology Review, 15, 506-519.

Michalec, B., & Hafferty, F.W. (2015). Role theory and the practice of interprofessional education: A critical appraisal and a call to sociologists. Social Theory & Health, 13, 180–201.

Paradis, E., & Whitehead, C.R. (2015). Louder than words: Power and conflict in interprofessional education articles, 1954-2013. Medical education, 49, 399-407.

Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Hammick, M., et al. (2008). Interprofessional education: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews, 1, Art. No.: CD002213.

Whitehead, C. (2007). The doctor dilemma in interprofessional education and care: How and why will physicians collaborate? Medical education, 41, 1010-1016.

World Health Organization. (2013). Transforming and scaling up health professionals’ education and training: World Health Organization guidelines. Geneva, Switzerland

Elise Paradis, PhD.                                                                                              Assistant Professor, Leslie Dan Faculty of Pharmacy and Department of Anesthesia, Faculty of Medicine, University of Toronto                                                               Scientist, The Wilson Centre for Research in Education      

Cynthia R. Whitehead, MD, PhD                                                                          Director and Scientist, Wilson Centre for Research in Education                                    Vice President Education, Women’s College Hospital                                            Associate Professor, Department of Family and Community Medicine, Faculty of Medicine, University of Toronto                                                                                                     BMO Financial Group Chair in Health Professions Education Research at University Health Network

Purple Sticker Pilot Project #2: Patient and Public Involvement in medical student selection

What follows is the second in a series of posts that form the conclusion of the Purple Sticker Pilot Project, an initiative designed to highlight hot topics of discussion at the 2015 ASME Annual Scientific Meeting and continue the conversation after the event. This blog post contains the second of three abstracts for presentations that generated extensive discussion and engagement at the conference; you will then find a number of links to related journal articles from Medical Education and The Clinical Teacher that provide a basis for further reading around the topic. These articles are all free to access for the next month. Please have a look through the blog and related articles then share your thoughts, either in the comments section below or on Twitter (#ASMEpspp) – make sure to mention our Twitter account in your tweet: @mededuceeditor.

Introducing Patient and Public Involvement to the selection of medical students, quality processes and governance of a Medical School

H Clifford, P Coventry, A Hassell                                                                            Contact: H Clifford, Community and Public Engagement Officer, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG

Background and Purpose

The General Medical Council have produced a supplementary guidance document1 to Tomorrow’s Doctors2 to further detail how Medical Schools should engage with patients and the public. The document acknowledges public involvement is challenging especially within governance but nonetheless involvement in this area has the greatest potential for constructive input influencing strategic decisions1. Challenges include the risk of tokenistic involvement1, ensuring that individuals have the required expertise and confidence to deal with technical content and wide ranging issues whilst still being representative of the patient population1. This presentation outlines Keele University School of Medicine’s experiences in introducing Patient and Public Involvement.

Achievements and Challenges

The recruitment process resulted in over 60 expressions of interest and was supported by role outlines and skills profiles. Interested applicants were interviewed in a semi-formal interview setting by a small panel of faculty. 38 successful applicants were taken forward and completed a training program to prepare them for their role.

Lay members sit on 12 School committees including student disciplinary panels. Challenges have included helping lay members to be involved in committees with technical content or large membership. Nonetheless the addition of lay membership on student disciplinary panels has been particularly positive.

Additional public involvement has included using ‘lay interviewers’ of prospective medical students and including lay members on Service Increment for Teaching (SIFT) visits. A Patient and Public Involvement (PPI) Group has been established to consult the public on issues within medical education (selection, professionalism, the future doctor). Feedback from lay participants has indicated that this forum is an effective way for participants to give their patient/public view and to influence the development of medical education (100% agree).

A future challenge is to balance training and support requirements with the risk of members becoming ‘non lay’. Ensuring that our group of lay members reflects the local patient population is key. Helping lay members to meet the technical knowledge demands of some committees and of future activities will also be a priority

Evaluation and Quality Monitoring

Results from questionnaires and focus groups giving a lay, faculty and student perspective on our current and future public involvement, including their views on the impact and challenges of public involvement, will be presented. Lay member views on what they think we should be doing, why they got involved and what they get out of it have been considered.


  1. General Medical Council. Patient and public involvement in undergraduate medical education. London: GMC; 2011
  2. General Medical Council. Tomorrow’s Doctors. London: GMC; 2009

Related articles

Girotti JA, Park YS and Tekian A. Ensuring a fair and equitable selection of students to serve society’s health care needs. Medical Education 2015; 49: 84–92 doi:10.1111/medu.12506

Razack S, Hodges B, Steinert Y and Maguire M. Seeking inclusion in an exclusive process: discourses of medical school student selection Medical Education 2015; 49: 36–47 doi: 10.1111/medu.12547

Towle A and Godolphin W. Patients as teachers: promoting their authentic and autonomous voices. The Clinical Teacher 2015; 12: 149–154. doi: 10.1111/tct.12400

Conversation Kickstarter #ClinTeach: Changing undergraduate attitudes to mental illness

This is a guest post by Dr Peter Cull, Emergency Department Consultant, Mental Health lead and Undergraduate Medical Education lead at the Royal Derby Hospital Emergency Department.

Bharathy et. al. recently published a fascinating paper in The Clinical Teacher; it is set amidst the background of a global problem of stigma towards mental illness. The article highlights that targeted efforts to counter this stigma include the promotion of positive attitudes and behaviours among medical undergraduates towards people with psychiatric illness.1

Although the research was conducted in Malaysia, a country with its own specific religio-cultural beliefs around the causation of mental illness,2 the premise of the paper is widely applicable. Mental health problems are far more common than generally realised; in the studied class of 30 students, for example, it is likely that at least 3 will have mental health problems. Statistically 1 in 10 young people and 1 in 4 adults will suffer a mental health problem in any given year. Of those, 9 out of 10 will experience stigma and discrimination.3

Given the high incidence of mental illness, the importance of positively shaping medical students’ views of sufferers cannot be overstated and any techniques that can help improve perceptions must be beneficial. It is unfortunate that students can only gain this experience from NGO/voluntary sector services and that the ‘normality’ of people with mental illness is not conveyed in current undergraduate teaching.

Do we spend too long in psychiatric placements concentrating on psychotic illnesses, rather than understanding the breadth of mental illness in the wider community?

The stigma of mental illness is probably contributory to this; until society is willing to talk about mental illness and people are willing to share their experiences then we will not be able to reflect on that ‘normality’. This core theme probably helps explain the first theme of ‘joyful participation’. Students were not expecting laughter and joy, because they weren’t expecting normality.

It does beg the question – what were they expecting?

The third theme that was mentioned is the understanding of these support groups and how important they are. ‘Chat and connect’ is just one example that was used. Students stated they were more likely to refer patients and recommend these groups. Perhaps funding could be increased by inviting some politicians and commissioners along to the same groups…

Undoubtedly the research as described has had a positive impact on these students and raised their awareness of mental health and the positive non-pharmacological interventions available. The authors have highlighted that they do not know the long-term impact on the students and whether those first impressions will change their future practice in any way. Whether this study has done enough to convince medical schools that programmes such as this would be beneficial, and how you could organise these on a large scale, it is difficult to say.

However, considering the scale of the problem of mental illness and the impact it has on all of our lives, anything which can help to reduce the associated stigma and improve understanding of these common illnesses justifies further consideration.


  1. Bharathy, A., Foo, P.-L. and Russell, V. (2016), Changing undergraduate attitudes to mental illness. The Clinical Teacher, 13: 58–62. doi: 10.1111/tct.12372
  2. Razali SM , Najib MA. Help- seeking pathways among Malay psychiatric patients . Int J Soc Psychiatry 2000;46: 281 – 289.
  3. Time to Change (2016) Available at: (Accessed: 08/02/2016)