A Practical Guide for Medical Teachers

John Dent; Ronald M Harden; Dan Hunt

BOOK

A Practical Guide for Medical Teachers

John Dent | Ronald M Harden | Dan Hunt

(2017)

Additional Information

Book Details

ISBN: 978-0-7020-6893-5
Edition: 5
Language: English
Pages: 428
Subjects: Medicine: general issues
Clinical & internal medicine
Medical study & revision guides & reference material

Abstract

The Fifth Edition of the highly praised Practical Guide for Medical Teachers provides a bridge between the theoretical aspects of medical education and the delivery of enthusiastic and effective teaching in basic science and clinical medicine. Healthcare professionals are committed teachers and this book is an essential guide to help them maximise their performance.

This highly regarded book recognises the importance of educational skills in the delivery of quality teaching in medicine.

The contents offer valuable insights into all important aspects of medical education today.

A leading educationalist from the USA joins the book’s editorial team.

The continual emergence of new topics is recognised in this new edition with nine new chapters: The role of patients as teachers and assessors; Medical humanities; Decision-making; Alternative medicine; Global awareness; Education at a time of ubiquitous information; Programmative assessment; Student engagement; and Social accountability.

An enlarged group of authors from more than 15 countries provides both an international perspective and a multi-professional approach to topics of interest to all healthcare teachers.

Section Title	Page	Action	Price
Front Cover	cover
Inside Front Cover	ifc1
A Practical Guide for Medical Teachers	i
Copyright Page	iv
Table Of Contents	v
Foreword	ix
Preface	xi
Contributors	xii
1 Curriculum Development	1
1 New horizons in medical education	2
Integration of information	2
Changing learning situations	3
An authentic curriculum	3
Students and student engagement	3
Summary	3
References	3
2 Curriculum planning and development	4
Introduction	4
What is a curriculum?	4
Identifying the need	4
Establishing the learning outcomes	5
Agreeing on the content	5
Experience as core content	6
Organizing the content	6
Deciding the educational strategy	7
Student-centred learning	7
Problem-based learning (PBL)	7
Integration and interprofessional learning	7
Community-based learning	7
Electives	8
Systematic approach	8
Choosing the teaching methods	8
Preparing the assessment	9
Communication about the curriculum	9
Promoting an appropriate educational or learning environment	10
Managing the curriculum	10
Summary	11
References	11
3 The undergraduate curriculum	13
Introduction	13
Forces shaping the curriculum	14
Critical components of the undergraduate medical education programme as they relate to the continuum of medical education	16
Summary	18
References	18
4 Postgraduate medical education	20
Introduction	20
Functions of PGME and postgraduate trainees in a healthcare system	20
Transitions in PGME	21
Admissions and matching	21
Transition from junior resident to senior resident	21
Transition from PGME to practice	21
Models of PGME	21
The role of internships or foundational training	22
Setting for training	22
Responsibility for curricular development and management	22
Post-certification training	22
Teaching, learning and assessment in PGME	22
External assessment in PGME: summative, certification	24
PGME quality, accreditation and CQI	24
Controversies in PGME	25
The debate about generalism versus specialism in PGME	25
The challenge of resident duty hours	25
Training clinical supervisors: faculty development	26
The future of PGME	26
Summary	26
References	26
5 Continuing professional development	28
Background	28
How clinicians learn	28
Recognizing an opportunity for improvement	28
Searching for resources for learning	29
Engaging in learning	29
Considering prior knowledge and experience of clinician participants	30
Focusing on outcomes important to clinician participants	30
Respond positively to the expectations of clinician participants	31
Interactivity with multiple methods and multiple exposures	31
Longer sessions	32
Supportive learning environment	32
Trying out what was learned	32
Incorporating what was learned	32
Assessment and evaluation	33
Summary	33
References	33
6 The hidden curriculum	35
Historical context	35
Definitions and metaphors	36
Definitions	36
Metaphors	37
Applications: exploring/assessing the hidden curriculum	37
Student mistreatment: a case study in applying the HC lens	39
Summary	40
References	40
2 Learning Situations	43
7 Lectures	44
Lectures in medical teaching	44
Pros and cons of lectures as a primary learning event	44
Learning in a lecture environment	44
Attention in lecture	45
Fostering engagement	45
Promoting retention	46
Organizing a lecture	46
Teaching materials	47
Audiovisuals	47
Audience response system (ARS)	47
Lecture recordings	47
Active learning in the lecture hall	48
Embedded methods	48
Note check	48
Low stakes writing assignment	49
Think-pair-share	49
Buzz groups	49
Games	49
The flipped classroom	49
Out-of-class homework	49
Developing the activity	50
Running the session	50
Evaluation	50
Summary	51
References	51
8 Learning in small groups	52
What is a small group?	52
When to use small groups?	53
What format of small-group teaching?	54
What type of instructional methods?	54
How to effectively conduct a small-group teaching session	54
Preparing for the small-group session	54
Leading the small-group session	55
Conditions for an effective session	55
Evaluating (assessing) the small-group session	56
Evaluation of small-group teaching and participation	56
Summary	57
Further information	57
9 Learning with patients	58
Introduction	58
The ‘learning triad’	58
Patients	59
Students	59
Tutors	59
Appropriate knowledge	59
Appropriate skills	60
Appropriate attitudes	60
Educational strategies for bedside teaching	60
Strategies for inpatients	60
Cox’s cycle	60
MiPLAN	61
Strategies for outpatients	61
Learner-centred approach	61
Microskills for students	61
Educational strategies applicable to all clinical settings	61
Outcome-based education	61
Time-efficient strategies for learning and performance	62
Structured logbooks	62
Task-based learning	63
Problem-based learning	63
Study guides	63
Case studies	63
Hospital ward opportunities – models for managing learning in the ward	63
Apprenticeship/shadowing a junior doctor model	63
Grand rounds	63
Business ward round	63
Teaching ward round	63
Clinical conference	64
Training ward	64
Ambulatory care opportunities	64
when should ambulatory care teaching be provided?	64
Traditional venues	64
Sitting-in model	64
Apprenticeship/parallel consultation model	64
Report-back model	64
Grandstand model	64
Breakout model	64
Supervising model	64
Additional venues	64
Innovative venues	65
Ambulatory care teaching centre (ACTC)	65
Integrated ambulatory care programme	65
Assessment of bedside learning	65
Staff development	65
Summary	66
References	66
10 Learning in the community	68
Introduction	68
What is community-based medical education?	68
Goals of CBME	69
Preclinical aims	69
Clinical aims	69
To learn about general practice/ family medicine	69
To learn about a particular specialty other than general practice/family medicine	69
To learn about primary care	70
To learn multiple disciplines concurrently	70
Practical principles for successful CBME	71
The clinician–patient relationship	71
The university–health service relationship	72
The government–community relationship	73
The personal–professional relationship	74
Summary	74
References	75
Further reading	75
11 Learning in rural and remote locations	76
Introduction	76
Before the learner arrives	77
Program support and preceptor preparation	77
A well-prepared physician’s office and staff	77
Main preceptor/rural medical teacher and engaged colleagues	78
Helpful hospital and healthcare organizations	78
Community partnerships	78
The first day	78
During the rotation	79
Observation/demonstration/feedback	80
Assessment and wrap-up	81
Troubled and troubling learners	82
Summary	82
Acknowledgements	82
References	82
12 Learning in longitudinal integrated clerkships	84
Introduction	84
Definition	84
History	85
Rationale	86
Learning imperatives	86
Professional imperatives	87
Health system imperatives	87
Societal imperatives	87
Model types	87
Generalist model LICs	88
Multi-specialty ‘streams’ model LICs	88
Strengths of LICs	88
For individual students, doctors, and patients	88
For organisations	89
For communities	89
Challenges of LICs	90
For the individual students and faculty	90
For organisations	90
For communities	90
Future visions	90
Summary	90
References	91
13 Learning in a simulated environment	92
Introduction	92
Background	92
Simulation as design	93
Simulated patients	93
Simulated patient methodology and trends in medical education	94
Fundamental concepts in simulated patient methodology	94
Discourses of clinical competence	94
Scope of SP practice	94
Hybrid simulations	95
Patients’ voices	95
Qualities of simulated patients	95
Supporting simulated patients in role portrayal and feedback	96
Simulation technology	96
Physical models	97
Virtual reality simulators	97
Hybrid simulators	97
Current and future trends	98
Simulation in the twenty-first century	98
Summary	99
References	99
Further reading and resources	100
14 Distance education	101
Before you begin …	101
Introduction to the course	101
Learning activities	102
Objectives	102
Contents	102
What is distance learning?	103
Technology and distance learning	104
Feedback	105
Technology	105
Print	105
The structure of a distance learning text	105
Feedback	106
Providing students with feedback on learning	107
Blending different elements of the course	107
Managing clinical attachments by distance learning	108
Feedback	108
The student’s learning experience	109
Managing distance learning	109
Development of distance learning courses (Table 14.11)	110
Quality assurance in distance learning	111
Feedback	111
Conclusion	111
References	111
Further reading	112
3 Educational Strategies and Technologies	113
15 Outcome-based education	114
A move from process to product	114
The trend towards OBE	114
Why the move to OBE?	115
Attention to quality of care and neglected areas of competence	115
The problem of information overload	115
Assessment of the learner’s progress and the continuum of education	115
Student-centred and individualized learning	116
Accountability	116
Implementation of OBE	116
Learning outcomes and instructional objectives	116
Outcome frameworks	117
Selecting or preparing an outcome framework	117
Implementing OBE	118
An outcome-based curriculum	119
Myths about OBE	120
Summary	120
References	120
16 Integrated learning	122
Introduction	122
Some definitions	122
Rationale for integrated learning	123
Strategies for integrated learning	123
Barriers to integrated learning	125
Integrated student assessment	126
Summary	127
References	127
17 Interprofessional education	128
Definitions	128
History	128
The rationale for IPE	128
Curriculum development	129
Learning activities	130
Assessment	130
Post-qualification	131
Impact and effectiveness of IPE	131
Faculty development for IPE	132
Overcoming challenges	132
Summary	132
References	133
18 Problem-based learning	134
Perspectives in problem-based learning	134
Problem-based learning format	134
Creating PBL courses: a systems perspective	134
Writing PBL cases	135
Running PBL small groups	136
Faculty as tutor	136
Evaluating PBL session outcomes	137
PBL controversies	137
Outcomes of PBL courses	137
Reasons to consider using a PBL approach	137
General disadvantages of small-group learning	138
Specific disadvantages of PBL as a learning format	138
Issues with PBL as an educational methodology	138
Matching learning objectives with educational methodology	138
Extraneous load	138
Variable session experiences	138
Scaffolding	139
Resource use	139
Issues with students	139
Small-group dysfunction	139
Student preparation	139
Evaluation and outcomes	139
Issues with tutors	139
Active learning beyond the PBL format – expanding the educator toolbox	139
Summary	140
Reference	141
Further reading	141
19 Team-based learning	143
What is team-based learning?	143
How does TBL work?	143
Students’ perspective	143
TBL recurring steps	143
Step 1 – advance assignment	143
Out-of-class/individual	143
Step 2 – iRAT – individual readiness assurance test	143
In-class/individual	143
Step 3 – tRAT – team readiness assurance test	143
In-class/team	143
Step 4 – instructor clarification review	144
In-class/instructor	144
Step 5 – team application – tAPP	145
In-class/team	145
Step 3A and/or 6 – appeal	145
In-class/out-of-class/team	145
TBL nonrecurring steps	145
Orientation	145
Out-of-class/in-class/individual/team	145
Peer evaluation	145
Out-of-class/individual	145
What does a TBL session look like?	145
What are the ingredients for a successful TBL module?	146
Instructor’s perspective	146
TBL recurring steps	146
Step 1 – situational factors and learning goals	146
Step 2 – tAPP – team application	147
Step 3 – iRAT/tRAT – individual readiness assurance test/team readiness assurance test	147
Step 4 – advance assignment	148
Step 5 – instructor clarification review	148
Step 6 – appeal	148
TBL nonrecurring steps	148
Team formation	148
Orientation	148
Peer evaluation	148
Why does TBL work?	148
Accountability	148
Immediate feedback	148
Solving authentic problems	148
Engagement with course content	148
Learning to work collaboratively	148
What can go wrong with TBL?	148
Is TBL worth the effort?	150
One instructor; same message	150
One classroom; no spreading around or finding more faculty	150
In-class meetings; all happens in the classroom	150
Individual accountability; no social loafing	150
Simultaneous reporting; no presentations	150
Instructor clarification; immediate feedback	150
Naturally functional teams; no teamwork instruction	150
Self-directed and lifelong learning	150
Summary	151
References	151
Online resources	151
20 Using digital technologies	152
Introduction	152
The digital technology repertoire	152
Using technology in medical education	153
Why use digital technology?	153
Exponential connectivity and integration	154
Accelerating speed of action and response	154
Defeating geography and temporality	154
Observation	154
Technology and instructional design	154
Who are your learners and what learning processes work best for them?	155
What are the learning and performance contexts you are working with?	155
What content will be involved, how should it be structured and sequenced?	155
What instructional and non-instructional strategies should you use?	155
What media and delivery systems will you use?	156
How will you actually conduct the design processes?	156
Mobile technologies	156
Preparing for e-health	157
Hidden curriculum and digital technologies	157
Digital professionalism	159
The role of the medical e-teacher	159
Summary	160
References	160
Further reading	161
21 Instructional design	162
Introduction	162
The ADDIE model	162
The universe of ID models	163
Outcomes-based models	163
Whole-task models	164
Examples of ID models	165
Cognitive load theory	165
Nine events of instruction	166
Four-component instructional design (4C/ID)	166
Summary	168
References	168
4 Curriculum Themes	171
22 Basic sciences and curriculum outcomes	172
Introduction	172
The changing medical curriculum	172
Authentic learning in basic science courses	173
The active learning environment	174
Use of reflective practice, critical thinking and clinical reasoning	174
Innovations in teaching basic sciences	175
Basic science integration throughout the curriculum	176
Nontraditional discipline-independent skills	176
Leadership	176
Teamwork	176
Professionalism	176
Communication skills	176
Student well-being	176
Assessment of discipline-independent skills	177
Learning basic science outside curricular structure	177
Summary	177
References	178
23 Social and behavioural sciences in medical school curricula	180
Introduction	180
Why are the social and behavioural sciences important in medicine?	180
What topics should be included in the curriculum?	181
Biological mediators of SBS factors and health	181
Social and cultural determinants of health, illness and disease	182
Patient behaviour	182
The experience of illness	182
Physician–patient interactions	182
Physician role and behaviour	182
Health policy and economics	183
Where and when should SBS be presented in the curriculum?	183
Discipline-specific curricula	183
Multidisciplinary	183
Interdisciplinary	183
Who should do the teaching design and delivery?	184
How can SBS be learnt, taught and assessed?	184
Assessment	185
How do we implement an SBS curriculum?	186
Summary	186
References	186
Further reading	187
24 Clinical communication	188
Introduction	188
Using role play	188
Rationale	188
Formats for role play	189
Conducting a role play session	190
The wider context	190
Other aspects of spoken communication	190
Medical records	191
Communication and HI-FIDELITY simulation	191
Communication between colleagues	191
Reading and writing	192
Language, culture and the international medical graduate (IMG)	192
Professionalism	193
Assessment	193
Conclusion	193
References	193
Relevant websites	194
Teaching resources available online	194
Support for the international doctor	194
25 Ethics and attitudes	195
Introduction	195
Critical challenges	195
Challenge 1: the changing doctor–patient relationship	195
Challenge 2: cultural pluralism	196
Challenge 3: the power of the hidden curriculum	196
Undergraduate education	197
Organizing undergraduate ethics education	197
National University of Singapore Yong Loo Lin School of Medicine (NUS YLLSoM)	197
David Geffen School of Medicine at UCLA (DGSOM)	199
Assessment of ethical and professional attitudes	200
Fitting outcomes and innovative methods	200
Assessment: some difficulties	200
The special nature of attitudes	201
Consistent expectations	201
Summary: effecting culture shift	201
References	201
26 Professionalism	203
Introduction	203
Defining professionalism	203
Setting expectation: agreeing a framework for professionalism	204
Developing a culture of professionalism: role modelling and the hidden curriculum	205
Digital professionalism	206
Educating faculty on social media	207
Building in guidance on the use of social media	207
Assessing professionalism	207
Summary	208
References	208
27 Evidence-based medicine	210
Introduction	210
Approaches to teaching EBM	211
Building-block approach	211
Whole-task approach	211
Integration with other courses and content	211
Clinical integration	211
Computer assisted and online learning approach	212
Timing of EBM	212
EBM instructors	212
Learning resources for EBM	213
EBM assessment	213
Future directions for EBM teaching	213
Summary	214
References	214
28 Patient safety and quality of care	215
Introduction	215
Introduction to patient safety, the tragedy of preventable harm	216
New competencies and patient safety	216
Reporting and learning from adverse events and close calls	216
Establishing the just culture	216
Teamwork skills and a deeper understanding of human factors	217
Introduction to health care quality	218
Teaching healthcare quality and patient safety	218
A continuum of physician professional development in quality and safety	218
Strategies for teaching quality and safety	219
Assessment and evaluation	220
Challenges that are somewhat unique to establishing a patient safety and healthcare quality educational programme	220
Summary	220
References	220
29 Medical humanities	222
Introduction	222
What are the medical humanities?	222
How do the medical humanities contribute to medical education?	223
Preparation for medical practice	223
Perspective and personal development	223
Bring balance to the medical curriculum	224
What educational approaches are useful in medical humanities?	224
Curriculum structure	224
Framework	224
Outcomes-based approach to student learning (OBASL)	225
Assessment	225
Integration	225
Compulsory or elective	226
Content and delivery	226
Narrative based	226
Arts based	227
E-learning	227
Experiential learning	227
Mindful practice	227
Historical visits	227
Service learning	227
What are some practical considerations and challenges?	227
Teachers	227
Sustainability	228
Changing role of doctors	228
Cross-cultural and linguistic issues	228
Realities of practice	229
Summary	229
Acknowledgement	229
References	229
30 Integrative medicine in the training of physicians	230
Introduction	230
Integrative medicine in undergraduate medical education	230
Pre-clinical years	231
Experiential learning	231
Clinical years	231
Clerkships	231
Clinical pearls toolkit	231
Interprofessional standardized patient exam	232
Fourth-year advanced electives	232
Integrative medicine in graduate medical education	233
Residency	233
Fellowship	234
Summary	234
References	235
31 Global awareness	236
Introduction	236
The rationale for global awareness	236
Understanding the global health agenda for medical education	237
Integrating activities and resources for global awareness	238
Global health training starts by understanding local health issues	239
Assessment	240
Preparing students for international experiences and electives	241
Faculty development for global awareness	241
Ethical issues and international electives	242
Summary	242
References	242
32 Medical education in an era of ubiquitous information	243
Ubiquitous information	243
Data, information, knowledge	243
Healthcare in the digital age (and biomedical knowledge in the cloud)	244
Electronic health records	244
Learning health systems	244
Biomedical knowledge in the cloud	244
Aids to clinical reasoning and decision making	245
The digital native learner	245
Three key competencies at a time of ubiquitous information and educational strategies to support the digital learner	245
Metacognition and sensing gaps in one’s knowledge	245
Metacognition	246
Confidence calibration	246
Demonstration and assessment of metacognition	246
Information retrieval and the ability to form an appropriate question	247
Foundational, advanced and specialized medical knowledge	247
Framing an appropriate clinical question	248
Assessment of information retrieval and analysis	248
Evaluating and weighing evidence to make decisions; recognizing patients and interprofessional colleagues as additional sources of information	248
Assessment of uncertainty/shared decision making	249
Summary	249
References	249
5 Assessment	251
33 Concepts in assessment including standard setting	252
Measurement theories	252
Classical Test Theory (CTT)	252
Generalizability Theory (GT)	252
Item Response Theory (IRT)	253
Types of assessment	253
Formative assessment	253
Summative assessment	253
Diagnostic assessment	253
Qualities of a good assessment	254
Validity theory	254
Score interpretation	255
Norm-referenced score interpretation	255
Criterion-referenced score interpretation	255
Score equivalence	255
Standards	256
Relative standards	256
Absolute standards	256
Blueprints	256
Self-assessment	257
Objective versus subjective assessments	257
All assessment requires judgement	258
Summary	258
References	258
34 Written assessments	260
Introduction	260
Question format	260
Quality control of items	261
Response formats	261
Short-answer open-ended questions	261
Description	261
When to use and when not to use	261
Tips for item construction	261
Essay questions	262
Description	262
When to use and when not to use	262
Tips for item construction	262
True–false questions	263
6 Staff	305
40 Staff development	306
Introduction	306
Common practices and challenges	306
Key content areas	306
Educational formats	307
Decentralized activities	307
Self-directed learning	307
Peer coaching	308
Online learning	308
Mentorship	308
Learning in the workplace	309
Frequently encountered challenges	309
Programme effectiveness	310
Designing a staff development programme	310
Understand the institutional/organizational culture	310
Determine appropriate goals and priorities	310
Conduct needs assessments to ensure relevant programming	310
Develop different programmes to accommodate diverse needs	311
Incorporate principles of adult learning and instructional design	311
Offer a diversity of educational methods	311
Promote ‘buy in’ and market effectively	312
Work to overcome commonly encountered challenges	312
Prepare staff developers	312
Evaluate – and demonstrate – effectiveness	312
Summary	313
References	313
41 Academic standards and scholarship	315
Introduction	315
Double standard: research, patient care and teaching	315
Professionalizing teaching	316
Broadening the definition of scholarship	316
Criteria for scholarship in teaching and education	316
Recognizing and evaluating a scholarly approach to teaching and educational scholarship	317
Increasing support for a scholarly approach to teaching and educational scholarship	317
Leadership: promoting the scholarship of teaching	318
Adaptive action: leadership for scholarship	319
Summary	320
References	321
7 Students	323
42 Student selection	324
Introduction	324
Why select?	324
Selection of students by the medical school	324
Selection by applicants of medicine as a career	324
Implicit selection of the medical schools by applicants	324
Explicit selection of medical schools by applicants	324
Selection for a particular academic curriculum	325
Selection by staff for staff	325
The limits of selection	325
Which are the canonical traits in selection?	325
Intellectual ability	325
Learning style and motivation	326
Communicative ability	326
Personality	326
Surrogates for selection	326
Methods and process of selection	327
Assessing methods of selection	327
Different methods of selection	327
Open admissions and lotteries	327
Administrative methods	327
Assessment of application forms	327
Biographical data (biodata)	328
Referees’ reports	328
Interviewing	328
Multiple mini-interviews (MMIs)	328
Psychometric testing	328
Situational judgement tests	328
Assessment centres	329
The costs of selection	329
Routine monitoring of selection	329
Widening access	329
Studying selection and learning from research	329
Evidence-based medicine and the scientific study of selection	329
Summary	330
References	330
43 Student support	332
Supporting student learning	334
Enhancing study and learning skills	334
Providing support for knowledge deficits	334
Monitoring student performance	334
Supporting student mental and physical wellbeing	335
Mentoring	335
Supporting health and wellness	335
Providing health and psychological services	336
Providing other support services	336
Supporting student career choice	336
Providing financial aid services and counselling	337
Creating a comprehensive student services system	337
Identifying and maintaining adequate resources	337
Overcoming student resistance	337
Summary	338
References	338
44 Student engagement in learning	339
Expertise	339
Mastery	340
Addressing our expert blind spot and developing student mastery	341
Contextual learning and thinking	342
Strategies for developing medical students’ contextual thinking	342
Student engagement in the management of the learning environment	343
Summary	344
References	344
45 Peer-assisted learning	345
Introduction	345
Defining PAL	345
PAL and collaborative learning	346
Theoretical basis for PAL	346
Cognitive factors: challenge and support	346
Communication factors	346
Affective and social factors	346
Organizational factors and the PAL process	347
Evidence for PAL	347
Advantages for tutors	347
Advantages for tutees	347
Advantages for the institution	348
Potential disadvantages and concerns about PAL	348
Components and choices in PAL	348
Background	349
Aims	349
Tutors	349
Tutees	349
Interaction	349
Evaluation	350
Institution	350
Realization	350
Applications and examples of PAL in healthcare education	350
Skills training in shoulder ultrasound (Knobe et al. 2010, Germany)	350
Online formative assessment and feedback in clinical examination (O’Donovan & Maruthappu, 2015, United Kingdom and Malaysia)	350
Researching and developing an undergraduate mental health curriculum (Furmedge et al., 2014)	351
Conclusions	351
Summary	352
References	352
8 Medical School	353
46 Understanding medical school leadership	354
Where and how decisions are influenced in complex organizations	354
Top-down decisions	354
Matrix-model decisions	355
Venn diagram decisions	355
Relationships with the medical school departments	356
Relationships with the clinical learning sites	357
Relationship with the graduate medical education programmes	357
Relationship with the research institutes and research centres	357
Relationships with the parent university administration	357
Summary	358
References	358
47 Medical education leadership	359
Introduction	359
The ‘leadership triad’	359
Our current understanding of medical education leadership	360
Leadership theory and practice	361
Personal qualities and attributes	361
Leadership is context dependent	363
Leading groups and teams	364
A systems perspective	364
Summary	365
References	365
Additional reading	367
48 The medical teacher and social accountability	368
Introduction	368
The concept of social accountability of medical schools	368
Medical teachers and social accountability	369
Medical teachers comprehensive roles in socially accountable medical schools	370
Practical examples of medical teacher social accountability	371
Research	373
Summary	374
References	374
Further reading	375
49 The educational environment	376
Introduction	376
What is the educational environment?	376
The person level	377
The group level	378
Learner–learner interactions	378
Learner–faculty interactions	378
Learner–patient/staff interactions	379
The organization level	379
Physical factors	379
Cultural factors	379
The community and society levels	380
How is the educational environment measured?	380
Teaching with the educational environment in mind	380
Addressing student mistreatment	380
Curriculum change and the educational environment	381
Faculty behaviours	381
The effect of the educational environment on faculty	382
Time and space	382
Community building	382
Summary	383
References	383
50 Medical education research	384
Quantitative and qualitative research	385
Mixed-methods research	387
Reflection	387
Building capacity	388
Funding	389
Summary	389
References	389
Index	391
A	391
B	392
C	392
D	394
E	394
F	395
G	395
H	396
I	396
J	397
K	397
L	397
M	398
N	399
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A Practical Guide for Medical Teachers

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