Cover
Foreword to the Third Edition
Preface
Part 1: Foundations
1. 1 Understanding Medical Education
  1. What is Medical Education?
  2. Challenges and Preoccupations
  3. Scholarship and the Pursuit of Excellence
  4. References
2. 2 A Global View of Structures and Trends in Medical Education
  1. Introduction
  2. Medical Education Pathways Worldwide
  3. Purposes and Priorities in Medical Education
  4. Glimpses of the Future
  5. Educational System Factors
  6. Globalisation
  7. Health Care System Factors
  8. Cultural and Societal Factors
  9. Technological Factors
  10. Discussion
  11. Acknowledgements
  12. References
3. 3 The Science of Learning
  1. Introduction
  2. Studying and Measuring Learning
  3. Neural Anatomy and Mechanisms
  4. Memory
  5. Attention and Selection
  6. Cognitive Processing
  7. Strategies for the Novice Learner
  8. Strategies for the Expert Learner
  9. Challenges in Applying Neuroscience and Theory to Practice
  10. Areas for Future Research
  11. Conclusion
  12. References
  13. Further Reading
4. 4 Teaching and Learning in Medical Education
  1. Introduction
  2. Social Cognitive Theory
  3. Reflection and Reflective Practice
  4. Transformative Learning
  5. Self‐directed Learning
  6. Experiential Learning
  7. Situated Learning
  8. Communities of Practice
  9. Constructivism
  10. Socio‐materiality
  11. Adult Learning Principles
  12. Connections
  13. Acknowledgements
  14. References
5. 5 Principles of Curriculum Design
  1. Introduction
  2. What is a Curriculum?
  3. Curriculum Design
  4. Factors that Influence Curriculum Design
  5. Decisions in Curriculum Design
  6. Conclusion
  7. References
  8. Further Reading
6. 6 Instructional Design: Applying Theory to Teaching Practice
  1. Introduction
  2. What is Instructional Design?
  3. What is the Difference between Instructional Design and Curriculum Design?
  4. Why do we need Instructional Design?
  5. Theoretical Concepts Informing Instructional Design
  6. Instructional Design Models Relevant to Health Professions Education
  7. Common Elements and Issues
  8. Design Considerations
  9. Evaluation
  10. Conclusions
  11. Acknowledgement
  12. References
  13. Further Reading
7. 7 Quality in Medical Education
  1. Introduction
  2. Quality Perspectives
  3. Quality Standards
  4. Quality Processes
  5. Quality and Continuing Professional Development
  6. The Quality Cycle
  7. Data Collection
  8. Quality Assurance of Assessment
  9. Acting on Results and Implementing Change
  10. External Accreditation and Benchmarking
  11. Conclusion
  12. References
  13. Further Reading
Part 2: Teaching and Learning
1. 8 Lectures and Large Groups
  1. Introduction
  2. The Lecture in Medical Education
  3. Lectures and Learning
  4. Disruptive Change in Medical Education
  5. From Informing to Involving Students
  6. From Teacher‐centred Instruction to Student‐centred Learning
  7. Implications for Lectures and their Redesign
  8. Large‐group Teaching for Transformative Learning
  9. Strategies to Aid Large‐group Learning
  10. Conclusion
  11. Acknowledgements
  12. References
  13. Further Reading
2. 9 Learning in Small Groups
  1. Introduction
  2. The Learner Experience
  3. What Constitutes a Small Group?
  4. Housekeeping
  5. The Role of the Tutor
  6. Getting Started
  7. Techniques to Use in Small Groups
  8. Case‐based Learning
  9. Problem‐based Learning
  10. Team‐based Learning
  11. Role Play
  12. Clinical Skills Teaching
  13. The Teaching Ward Round
  14. The TOSBA
  15. Balint Groups
  16. Action Learning Set
  17. Group Dynamics
  18. The Interprofessional Group
  19. Dealing with Difficult Group Members
  20. Frequently Asked Questions
  21. Conclusion
  22. References
  23. Further Reading
3. 10 Technology‐enhanced Learning
  1. Introduction
  2. Technology Use in Medical Education
  3. Technologies for Learning
  4. Technologies for Teaching
  5. Technologies for Assessment
  6. Technologies for Managing Medical Education
  7. Technologies as Educational Prostheses
  8. Evaluating and Researching TEL in Medical Education
  9. A Moving Target
  10. Conclusions
  11. References
  12. Further Reading and Resources
4. 11 Simulation in Medical Education
  1. Introduction
  2. Historical Perspectives and Contemporary Applications of Simulation‐based Learning
  3. Contemporary Applications of Medical Simulation
  4. Integrating Theory into Simulation‐based Learning
  5. Simulation‐based Instructional Design
  6. Designing a Simulation Activity
  7. Simulation Fidelity
  8. Limitations and Challenges in Medical Simulation
  9. Conclusions and Future Issues in Medical Simulation
  10. Acknowledgements
  11. References
  12. Further Reading
5. 12 Work‐based Learning
  1. Introduction
  2. The Changing Landscape of Medical Education and Training
  3. Work‐based Learning Throughout a Medical Career
  4. Learning and Work
  5. Theorising Work‐based Learning
  6. Work‐based Learning and the Medical Curriculum
  7. Implications for the Clinical Teacher
  8. Challenges to Work‐based Learning in Medical Education
  9. Leading the Way in Work‐based Learning
  10. Conclusion
  11. Acknowledgements
  12. References
  13. Further Reading and Resources
6. 13 Supervision, Mentoring, and Coaching
  1. Introduction
  2. What does Supervision Mean?
  3. What is Supervision For?
  4. Cases, Contexts, Careers: The Three Domains of Supervision
  5. Types of Supervision
  6. Conceptual Frameworks for Supervision
  7. Common Tensions in Supervision
  8. Raising the Profile of Supervision: Changing the Culture of Medicine
  9. Conclusions
  10. Acknowledgements
  11. References
7. 14 Interprofessional Education
  1. Introduction
  2. Defining Interprofessional Education: The Importance of Pronouns
  3. The Rationale for Interprofessional Education for Collaborative Practice (IPECP)
  4. Can IPE make a Difference? Does it Work?
  5. The Diversity of Interprofessional Education
  6. Designing Effective Interprofessional Education
  7. The Perceived Relevance of the Learning Opportunity
  8. The Perceived Demands of the Learning Context
  9. Learning Spaces
  10. Interprofessional Education and the Curriculum
  11. Curriculum Alignment in an Era of Competency‐based Education
  12. Delivering Effective Interprofessional Education
  13. The Role of Facilitation
  14. Assessment and Interprofessional Education
  15. Conclusion
  16. References
  17. Further Reading
8. 15 Patient Involvement in Medical Education
  1. Introduction
  2. Patients, Users, and Consumers
  3. Context of Patient Involvement
  4. Scope of Patient Involvement
  5. Levels of Patient Involvement
  6. Benefits and Disadvantages
  7. Theoretical Considerations
  8. Principles and Practice
  9. Simulated Patients
  10. Areas for Further Research
  11. Conclusion
  12. Acknowledgements
  13. References
  14. Further Resources
9. 16 Learning Medicine With, From, and Through the Humanities
  1. Part 1: Why the Humanities in Medical Education?
  2. Part 2: How the Humanities are Incorporated in Medical Curricula
  3. Part 3: Searching for Impact: Where is the Evidence for the Humanities?
  4. Conclusion
  5. References
  6. Further Reading
10. 17 The Development of Professional Identity
  1. Introduction
  2. Profession, Professionalism, and Professional Identity
  3. Teaching Medical Professionalism
  4. From Teaching Professionalism to Supporting Professional Identity Formation
  5. Personal and Professional Identity
  6. The Formation of a Professional Identity
  7. Factors Impacting on Socialisation
  8. The Response of Learners to Socialisation
  9. Implications for Medical Education
  10. Conclusion
  11. References
  12. Further Reading
11. 18 Portfolios in Personal and Professional Development
  1. Introduction
  2. Diversity of Portfolios
  3. Portfolios for Monitoring and Planning Development
  4. Portfolios for Assessment
  5. Portfolios to Stimulate Reflection
  6. Conclusions
  7. Acknowledgement
  8. References
  9. Further Reading
12. 19 Continuing Professional Development
  1. Introduction
  2. Self‐directed Learning in Continuing Professional Development
  3. Competencies Across the Continuum of Medical Education
  4. Physician Professional Development and Maintenance of Certification
  5. Team‐based CPD
  6. Conclusion
  7. Acknowledgement
  8. References
Part 3: Assessment and Selection
1. 20 How to Design a Useful Test
  1. Introduction
  2. What is Assessment?
  3. How to Choose the Best Approaches to Assessment
  4. Popular Assessment Instruments
  5. Computers in Assessment
  6. Combining Assessment Methods
  7. Standard Setting
  8. Future Directions
  9. Epilogue
  10. Acknowledgement
  11. References
2. 21 Written Assessment
  1. Introduction
  2. Historical Background
  3. Assessment in the Programme
  4. Knowledge, Reasoning, and Written Assessment
  5. Formats of Written Assessment
  6. Formats using both Selected and Constructed Responses
  7. Computer‐based Written Assessment
  8. Item Analysis
  9. Standard Setting for Written Assessment
  10. Summary
  11. References
3. 22 Workplace Assessment
  1. Introduction
  2. A Framework for Assessment based on Observation
  3. Common Methods
  4. Portfolios
  5. Influence on Learning
  6. Faculty Development
  7. Challenges in Workplace‐based Assessment
  8. Emerging Discourses
  9. Future Research
  10. Conclusion
  11. Acknowledgements
  12. References
  13. Further Reading
4. 23 Structured Assessments of Clinical Competence
  1. Introduction
  2. The Long Case
  3. Objective Structured Long Case Examination Record
  4. Short Cases
  5. Objective Structured Clinical Examinations (OSCEs)
  6. Rationale for the use of OSCEs
  7. Blueprinting
  8. Station Development
  9. Conclusions
  10. Acknowledgement
  11. References
  12. Further Reading
5. 24 Standard Setting Methods in Medical Education
  1. The Need to Make Decisions
  2. Key Considerations in Standard Setting
  3. Norm‐referenced Versus Criterion‐referenced Standards
  4. Test‐centred Methods
  5. Examinee‐centred Methods
  6. Selecting a Criterion‐referenced Standard Setting Method
  7. Gathering Validity Evidence to Support a Cut‐score
  8. Conclusions
  9. Acknowledgement
  10. References
  11. Further Reading
6. 25 Formative Assessment
  1. Introduction
  2. Characteristics of Formative Assessment
  3. Teacher Perspectives
  4. Student Perspectives
  5. Feedback
  6. Formative Assessment in the Curriculum
  7. Conclusions
  8. References
  9. Further Reading
7. 26 Selection into Medical Education and Training
  1. Introduction
  2. Context of Medical Selection
  3. Key Concepts
  4. Selection Methods
  5. Conclusion
  6. References
  7. Further Reading
Part 4: Research and Evaluation
1. 27 Philosophical Research Perspectives and Planning your Research
  1. Introduction
  2. What is Research?
  3. How does Research Differ from Audit, Quality Improvement, and Evaluation?
  4. What is Scholarship?
  5. Theoretical Frameworks in Education and the Social Sciences
  6. Philosophical Perspectives in Research
  7. Reconciling and Combining Research Frameworks
  8. Practical Considerations when Starting Research
  9. Conclusions
  10. References
2. 28 Quantitative Research Methods in Medical Education
  1. Introduction: The Quantitative Paradigm
  2. The Research Question
  3. Research Designs
  4. The Experimental Tradition
  5. The Epidemiological Tradition
  6. The Psychometric Tradition
  7. The Correlational Tradition
  8. Cronbach’s ‘Two Disciplines’
  9. Reviews
  10. Discussion
  11. References
  12. Further Reading
3. 29 Qualitative Research in Medical Education
  1. Introduction: Paradigms and Purposes of Qualitative Research
  2. Qualitative Research Methodologies
  3. Qualitative Research Methods
  4. Ethics, Rigour, and Reflexivity
  5. The Role of Theory
  6. Conclusions
  7. References
  8. Further Reading
4. 30 Programme Evaluation
  1. Introduction
  2. What is Programme Evaluation?
  3. Definitions
  4. Programme Planning and Evaluation
  5. Evaluation or Research?
  6. Theory in Evaluation
  7. Ethics in Programme Evaluation
  8. Evaluation Methods
  9. Data Collection
  10. Promoting the Use of Evaluation Findings
  11. Challenges in Educational Evaluation
  12. Conclusions
  13. Examples of Evaluations in Medical Education
  14. Acknowledgement
  15. References
  16. Further Reading and Resources
5. 31 Knowledge Synthesis
  1. Introduction
  2. What are Knowledge Syntheses?
  3. Why Use Knowledge Syntheses in Health Professions Education?
  4. Types of Knowledge Syntheses
  5. Conducting a Knowledge Synthesis
  6. How to be a Critical Consumer of Knowledge Syntheses?
  7. Conclusions
  8. Acknowledgements
  9. References
  10. Further Reading
Part 5: Faculty and Learners
1. 32 Career Progression and Support
  1. Introduction
  2. Need for Support in Medical Careers
  3. Provision of Effective Careers Support
  4. Specialty Choice
  5. Psychometric Testing
  6. Deciding on a Career in Academic Medicine
  7. Contemporary Developments in Vocational Psychology
  8. Helping Those Whose Career Plans Appear Unrealistic
  9. Other Sources of Careers Support
  10. Leaving Medicine
  11. Conclusions
  12. References
  13. Further Reading
2. 33 Supporting Learner Well‐being
  1. Background: Why the Focus on Learner Well‐being?
  2. Promoting Well‐being: The Role of Education Providers
  3. Future Directions
  4. Acknowledgements
  5. References
  6. Further Reading
3. 34 Managing Remediation
  1. Introduction
  2. Performance and Remediation
  3. From Assessment to Remediation
  4. Principles to Guide Remediation
  5. Getting Started
  6. Where Next?
  7. Digging Deeper
  8. Delivering Remediation
  9. Pitfalls and Problems
  10. Conclusion
  11. References
  12. Further Reading
4. 35 Diversity in Medical Education
  1. Introduction
  2. Perspective and Context
  3. Definitions
  4. Drivers of Diversity Education
  5. Approaches to Diversity Education
  6. Educational Philosophy (Box 35.4)
  7. Content (Box 35.5)
  8. Educational Processes (Box 35.6)
  9. Assessment (Box 35.7)
  10. Evaluation of Diversity Education: Does Diversity Education Work?
  11. Developing Research and Scholarship
  12. How Institutions Address Diversity
  13. Conclusion
  14. References
  15. Further Reading
5. 36 Developing Medical Educators
  1. Introduction
  2. What is a Medical Educator?
  3. What is Faculty Development?
  4. A Curriculum for Staff Development?
  5. How Can We Develop Medical Educators?
  6. Organisational Support and Development
  7. Students and Residents as Teachers
  8. Programme Effectiveness
  9. Theoretical Frameworks to Guide Faculty Development
  10. Designing a Staff Development Programme
  11. Conclusion
  12. Acknowledgements
  13. References
  14. Further Reading and Resources
6. 37 Educational Leadership and Management
  1. Introduction
  2. Leadership and Management
  3. Followership
  4. A Brief History of Leadership
  5. Educational Management and Leadership
  6. Leading Teams
  7. Leading Change
  8. Leading Systems
  9. Setting Direction
  10. Leading for Improvement
  11. Challenges for Health Care Education Leaders
  12. Leadership Development
  13. Conclusion
  14. References
  15. Further Reading
Index
End User License Agreement

List of Illustrations

Chapter 02
1. Figure 2.1 Six routes to unrestricted practice.
2. Figure 2.2 Medical education comparisons by country: phases and duration.
Chapter 03
1. Figure 3.1 Gross anatomy of the human brain (https://commons.wikimedia.org/wiki/File:Figure_35_03_03.png).
2. Figure 3.2 Baddeley's model of working memory.
Chapter 04
1. Figure 4.1 Diagrammatic representation of (a) reciprocal interaction among personal, situational, and behavioural factors; (b) the same factors using a medical education example.
2. Figure 4.2 Seven‐step self‐directed learning model.
3. Figure 4.3 Kolb learning cycle.
4. Figure 4.4 Different forms of virtual communities of practice according to their context of emergence.
Chapter 05
1. Figure 5.1 The curriculum in context.
2. Figure 5.2 Steps and options in curriculum design.
3. Figure 5.3 The curriculum in context.
Chapter 06
1. Figure 6.1 Detailed ADDIE model.
2. Figure 6.2 Focus on: the four component instructional design (4C/ID) model.
3. Figure 6.3 The iterative (small circles) and cyclical (large circle) evaluation process in the ADDIE model.
Chapter 07
1. Figure 7.1 A generic quality improvement cycle.
Chapter 08
1. Figure 8.1 Audience concentration during standard lecture with and without interaction.
2. Figure 8.2 Active involvement of students in a large group interactive lecture.
3. Figure 8.3 Engaging learners though questioning.
Chapter 09
1. Figure 9.1 How jigsaw groups work.
2. Figure 9.2 The ‘Kolb’ cycle (modified).
Chapter 10
1. Figure 10.1 A hierarchy of needs for the use of technology in medical education.
Chapter 11
1. Figure 11.1 Phases in simulation implementation design.
Chapter 13
1. Figure 13.1 The two faces of supervision.
2. Figure 13.2 The learning organisation.
3. Figure 13.3 The three domains of supervision.
4. Figure 13.4 The supervision cycle.
Chapter 16
1. Figure 16.1 Objectification of patients; cartoon by Jordan C. Humphrey [98].
2. Figure 16.2 Student abuse; cartoon by Trey Banbury [98].
Chapter 17
1. Figure 17.1 The role of socialisation in identity formation.
2. Figure 17.2 Factors impacting on socialisation.
3. Figure 17.3 Learner responses to the process of socialisation.
Chapter 18
1. Figure 18.1 Purposes and content of portfolios.
2. Figure 18.2 Example of an Entrustable Professional Activity (EPA).
3. Figure 18.3 A cyclical model of reflection [37].
Chapter 21
1. Figure 21.1 Case courtesy of Dr Andrew Dixon, http://Radiopaedia.org, rID: 9674
Chapter 22
1. Figure 22.1 Miller's pyramid for assessing clinical competence.
2. Figure 22.2 Typical mini‐CEX assessment form.
3. Figure 22.3 Typical OCAT form.
4. Figure 22.4 Typical CbD assessment form.
5. Figure 22.5 The mini‐PAT questionnaire.
Chapter 23
1. Figure 23.1 Example checklist mark sheet for cardiovascular examination.
2. Figure 23.2 Example rating scale mark sheet for cardiovascular examination.
3. Figure 23.3 Example of a floor plan for an Objective Structured Clinical Examination in a large room.
Chapter 24
1. Figure 24.1 Identifying a cut‐score using the contrasting‐groups method.
2. Figure 24.2 Identifying a cut‐score using a Hofstee plot.
Chapter 25
1. Figure 25.1 A model of self‐regulated learning illustrating the relationship between external factors and internal self‐regulation in the student.
2. Figure 25.2 Curriculum module development and review.
Chapter 26
1. Figure 26.1 The process of selection.
Chapter 28
1. Figure 28.1 Pasteur's quadrant.
2. Figure 28.2 Example of a two‐group comparison: e‐learning in brain anatomy [44].
Chapter 29
1. Figure 29.1 Paradigmatic alignment.
Chapter 30
1. Figure 30.1 Kirkpatrick's hierarchy of evaluation.
2. Figure 30.2 The basic components of a logic model.
Chapter 31
1. Figure 31.1 How to conduct a knowledge synthesis.
2. Figure 31.2 A flow diagram depicting the search and inclusion process for a systematic review on training medical students how to locate medical information [59].
Chapter 33
1. Figure 33.1 A diagram conceptualising the learner support system and approaches used by educators.
Chapter 36
1. Figure 36.1 Approaches to faculty development*. *This figure was originally prepared for a chapter on ‘Becoming a Better Teacher: From Intuition to Intent’ [41].
Chapter 37
1. Figure 37.1 Health care Leadership Model.
2. Figure 37.2 Layers of organisational culture [74].
3. Figure 37.3 Leading in complex systems.
4. Figure 37.4 Strategic planning.

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This edition first published 2019
© 2019 The Association for the Study of Medical Education (ASME)

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Library of Congress Cataloging‐in‐Publication Data

Names: Swanwick, Tim, editor. | Forrest, Kirsty, editor. | O’Brien, Bridget C., editor. | Association for the Study of Medical Education, sponsoring body.
Title: Understanding medical education : evidence, theory, and practice / edited by Tim Swanwick, Kirsty Forrest, Bridget C. O’Brien.
Description: 3rd edition. | Hoboken, NJ : Wiley‐Blackwell, 2018. | Includes bibliographical references and index. |
Identifiers: LCCN 2018027439 (print) | LCCN 2018027968 (ebook) | ISBN 9781119373858 (Adobe PDF) | ISBN 9781119373834 (ePub) | ISBN 9781119373827 (pbk.)
Subjects: | MESH: Education, Medical–methods | Education, Medical–organization & administration
Classification: LCC R845 (ebook) | LCC R845 (print) | NLM W 18 | DDC 610.76–dc23
LC record available at https://lccn.loc.gov/2018027439

Cover Design: Wiley
Cover Image: ©Steve Debenport/E+/Getty Images

Contributors

Lindsay Baker
Scientist
Li K Shing Knowledge Institute
Researcher
Centre for Faculty Development
St. Michael’s Hospital
Assistant Professor
Faculty of Medicine
University of Toronto
Toronto, Ontario, Canada

Alexis Battista
Assistant Professor of Medicine
Department of Medicine & F. Edward Hébert School of Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA

Jo Bishop
Associate Dean
Student Affairs and Service Quality
Faculty of Health Sciences and Medicine
Bond University
Gold Coast, Queensland, Australia

Nicole J. Borges
Professor of Neurobiology and Anatomical Sciences
University of Mississippi Medical Center
Jackson, MS, USA

Katharine A. M. Boursicot
Director
Health Professional Assessment Consultancy, Singapore
Singapore

William P. Burdick
Associate Vice President for Education
Foundation for Advancement of International Medical Education and Research (FAIMER)
Clinical Professor of Department of Emergency Medicine
Drexel University College of Medicine
Philadelphia, PA, USA

Craig Campbell
Principal Senior Advisor, Competency‐based Continuing Professional Development
Office of Specialty Education
Royal College of Physicians and Surgeons of Canada
Ottawa, Ontario, Canada

Madeline Carter
Senior Lecturer
Department of Psychology, Faculty of Health and Life Sciences
Northumbria University
Newcastle, UK

Olivia Carter‐Pokras
Professor of Epidemiology and Associate Dean for Diversity and Inclusion
Department of Epidemiology and Biostatistics
School of Public Health
University of Maryland, College Park
College Park, MD, USA

Neville Chiavaroli
Senior Lecturer
Department of Medical Education
Melbourne Medical School
University of Melbourne
Melbourne, Australia

Jennifer Cleland
Professor of Medical Education Research
Centre for Health care Education Research and Innovation
University of Aberdeen
King’s College
Aberdeen, UK

Deborah Cohen
Professor and Director
Student Support
Centre for Psychosocial Research, Occupational and Physician Health
School of Medicine
Cardiff University
Cardiff, UK

Ian Cooper
Language and Communications Specialist
School of Medicine
Cardiff University
Cardiff, UK

Sayra Cristancho
Scientist
Centre for Education Research & Innovation
Assistant Professor
Departments of Surgery and Faculty of Education
Schulich School of Medicine & Dentistry
Western University,
London, Ontario, Canada

Richard L. Cruess
Professor of Surgery
The Centre for Medical Education
McGill University
Montreal, Quebec, Canada

Sylvia R. Cruess
Professor of Medicine
The Centre for Medical Education
McGill University
Montreal, Quebec, Canada

Mary Jane Dalton
Senior Lecturer
School of Medicine and Public Health
University of Newcastle
Callaghan, New South Wales, Australia

Anique B. H. de Bruin
Associate Professor
School of Health Professions Education
Maastricht University
Maastricht, The Netherlands

André F. De Champlain
Chief Research Psychometrician
Research and Development, Medical Council of Canada
Ottawa, Ontario, Canada

Nisha Dogra
Emeritus Professor of Psychiatry Education
Greenwood Institute of Child Health, Department of Neuroscience, Psychology and Behaviour, College of Life Sciences
University of Leicester
Leicester, UK

Erik Driessen
Associate Professor of Medical Education
Department of Educational Development and Research
Faculty of Health, Medicine and Life Sciences
Maastricht University
Maastricht, The Netherlands

Steven J. Durning
Professor and Director
Division of Health Professions Education, Department of Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA

Rachel H. Ellaway
Professor of Medical Education
Department of Community Health Sciences
Co‐DirectorOffice of Health and Medical Education Scholarship
Cumming School of Medicine
University of Calgary
Calgary, Alberta, Canada

Caroline Elton
Director
Career Planning for Doctors and Dentists
London, UK

Kevin W. Eva
Senior Scientist
Centre for Health Education Scholarship
Professor
Director of Education Research & Scholarship
Department of Medicine
University of British Columbia
Vancouver, British Columbia, Canada

Eamonn Ferguson
Professor of Health Psychology
University of Nottingham
Nottingham, UK

Kirsty Forrest
Dean of Medicine
Faculty of Health Sciences and Medicine
Bond University
Gold Coast, QLD, Australia

Della Freeth
Executive Director of Education
Royal College of Physicians
London, UK

Janet Grant
Emerita Professor
The Open University
Honorary Professor
University College London Medical School
Director
CenMEDIC (Centre for Medical Education in Context)
London, UK
Special adviser to the President, World Federation for Medical Education
Ferney‐Voltaire, France

Matthew C. E. Gwee
Medical Educationalist and Chairman
International and Education Programs
Centre for Medical Education, Yong Lo Lin School of Medicine
National University of Singapore, Singapore
Singapore

Graeme Horton
Senior Lecturer
School of Medicine and Public Health
University of Newcastle
Newcastle, New South Wales, Australia

Wendy Hu
Associate Dean
Academic (learning & innovation)
Chair of Medical Education
School of Medicine
Western Sydney University
Penrith, New South Wales, Australia

Chien‐Da Huang
Physician Educator
Chang Gung Medical Education Research Centre (CG‐MERC)
Chang Gung Memorial Hospital
Linkou, Taiwan (ROC)
Deputy Director
Department of Internal Medicine
Associate Professor
Department of Thoracic Medicine and Medical Education
Chang Gung Memorial Hospital
Chang Gung University College of Medicine
Taipei, Taiwan (ROC)

Jan Illing
Professor of Medical Education Research
School of Medical Education
Newcastle University, Newcastle, UK

Dahn Jeong
Research Associate
Office of Continuing Professional Development
Department of Innovation in Medical Education
Faculty of Medicine, University of Ottawa
Ottawa, Ontario, Canada

Brian Jolly
Professor
School of Medicine and Public Health
University of Newcastle
Callaghan, New South Wales, Australia
School of Rural Medicine
University of New England
Armidale, Australia

David M. Kaufman
Professor
Faculty of Education
Associate Member
Faculty of Health Sciences
Associate Member
Department of Gerontology
Simon Fraser University
Burnaby, British Columbia, Canada

Tara J. Kennedy
Developmental Pediatrician and Clinical Leader
Pediatric Autism Rehabilitation Services
Stan Cassidy Centre for Rehabilitation
Fredericton, New Brunswick, Canada

Diane N. Kenwright
Head of Department
Department of Pathology and Molecular Medicine,
University of Otago
Wellington, New Zealand

Simon Kitto
Full Professor
Department of Innovation in Medical Education
Director of Research
Office of Continuing Professional Development
Faculty of Medicine, University of Ottawa
Ottawa, Ontario, Canada
Assistant Professor
Department of Surgery, University of Toronto
Toronto, Ontario, Canada

John Launer
Programme Director for Educational Innovation in Primary Care
(North Central and East London)
Health Education England
London, UK

Lorelei Lingard
Director and Senior Scientist
Centre for Education Research & Innovation
Professor
Department of Medicine
Schulich School of Medicine & Dentistry
Faculty of Education
Western University
London, Ontario, Canada

Bridget Lock
Associate Director of Medical Education
South London Health care NHS Trust
London, UK

Andrew Long
Vice President (Education)
Royal College of Paediatrics and Child Health
Honorary Senior Lecturer
University College London
Consultant Paediatrician
Great Ormond Street Hospital
London, UK

Chris Lovato
Professor
School of Population & Public Health
Director
Evaluation Studies Unit, Faculty of Medicine
University of British Columbia
Vancouver, British Columbia, Canada

Lauren A. Maggio
Associate Professor and Associate Director
Division of Health Professions Education, Department of Medicine
Uniformed Services University of the Health Sciences
Bethesda, MD, USA

Peter McCrorie
Professor of Medical Education
Institute of Medical and Biomedical Education
St George’s University of London
London, UK
Founding Chair and Professor of Medical Education
Department of Medical Education,
University of Nicosia Medical School
Nicosia, Cyprus

Judy McKimm
Professor and Director of Strategic Educational Development
College of Medicine
Swansea University Medical School
Swansea, UK

Lynn Monrouxe
Director
Chang Gung Medical Education Research Centre (CG‐MERC)
Chang Gung Memorial Hospital
Linkou, Taiwan (ROC)

Sandra Monteiro
Assistant Professor
Department of Health Research Methods, Evidence and Impact
McMaster University
Hamilton, Ontario, Canada

Clare Morris
Reader in Medical Education Research and Development
Institute of Health Sciences Education,
Barts and the London School of Medicine and Dentistry
Queen Mary University of London
London, UK

Debra Nestel
Professor of Simulation Education in Health care
Monash University
Clayton, Victoria, Australia
Professor of Surgical Education
Department of Surgery
University of Melbourne
Melbourne, Victoria, Australia

Stella L. Ng
Scientist
The Wilson Centre
Director of Research
Centre for Faculty Development
Arrell Family Chair in Health Professions Teaching
St. Michael’s Hospital
Assistant Professor
Faculty of Medicine
University of Toronto
Toronto, Ontario, Canada

John J. Norcini
President and CEO
Foundation for Advancement of International Medical Education and Research (FAIMER)
Philadelphia, PA, USA

Geoff Norman
Professor Emeritus
Clinical Epidemiology and Biostatistics
McMaster University
Hamilton, Ontario, Canada

Bridget C. O'Brien
Associate Professor
Department of Medicine
Education Researcher
Center for Faculty Educators
University of California
San Francisco, CA, USA

Hirotaka Onishi
Assistant Professor
Department of International Cooperation for Medical Education
International Research Centre for Medical Education
University of Tokyo
Tokyo, Japan

Fiona Patterson
Founding Director
Work Psychology Group
London, UK
Principal Researcher
University of Cambridge
Cambridge, UK

Linda Peterson
Professor and Senior Evaluation Adviser
Retired, Faculty of Medicine
University of British Columbia
Vancouver, British Columbia, Canada

David Price
Senior Vice President
ABMS Research and Education Foundation
American Board of Medical Specialties
Chicago, IL, USA
Professor
Department of Family Medicine,
University of Colorado School of Medicine
Denver, CO, USA

Scott Reeves
Professor
Faculty of Health, Social Care and Education
Kingston University and St. George’s University of London
London, UK

Trudie E. Roberts
Director of Leeds Institute of Medical Education
University of Leeds
Leeds, UK

Melody Rhydderch
GP Training Academic Development Lead
Wales Deanery
Cardiff, UK

Dujeepa D. Samarasekera
Director
Centre for Medical Education, Yong Lo Lin School of Medicine
National University of Singapore, Singapore
Singapore

Maggi Savin‐Baden
Professor of Education
Institute of Education
University of Worcester
Worcester, UK

Lambert W.T. Schuwirth
Strategic Professor for Medical Education
Flinders University
Adelaide, Australia
Professor for Innovative Assessment
Maastricht University, Maastricht
The Netherlands
Professor of Medical Education
Chang Gung University
Taoyuan, Taiwan
Professor of Medicine (Education),
Uniformed Services University for the Health Professions
Bethesda, MD, USA

Matthew Sibbald
Assistant Professor
Department of Medicine
Director
Centre for Simulation‐Based Learning
McMaster University
Hamilton, Ontario, Canada

Linda Snell
Professor of Medicine
Centre for Medical Education and Department of Medicine
McGill University
Montréal, Quebec, Canada

Daisuke Son
Assistant Professor
Department of Medical Education Studies
International Research Centre for Medical Education,
University of Tokyo
Tokyo, Japan

John Spencer
Emeritus Professor of Primary Care and Clinical Education
Newcastle University
Newcastle, UK

Yvonne Steinert
Professor of Family Medicine
Richard and Sylvia Cruess Chair in Medical Education
Director
Centre for Medical Education
Faculty of Medicine
McGill University
Montreal, Quebec, Canada

Tim Swanwick
Dean of Education and Leadership Development
NHS Leadership Academy
Health Education England
London, UK

Jools Symons
Patient & Public Involvement Manager
Faculty of Medicine and Health
Leeds University
Leeds, UK

Olle ten Cate
Professor
Directorate of Education and Training
Utrecht University
Utrecht, The Netherlands
Adjunct Professor of Medicine
University of California
San Francisco, CA, USA

Jill Thistlethwaite
Adjunct Professor
School of Communication
University of Technology
Sydney, Australia

Aliki Thomas
Associate Professor and Research Scientist
Centre for Medical Education
School of Physical and Occupational Therapy
Faculty of Medicine,
McGill University
Montreal, Quebec, Canada

Cees P. M. van der Vleuten
Scientific Director
School of Health Professions Education
University of Maastricht
Maastricht, The Netherlands

Jan van Tartwijk
Professor of Education
Department of Education
Utrecht University
Utrecht, The Netherlands

Claire Vogan
Associate Professor
Swansea University Medical School
Swansea, Wales, UK

Marjo Wijnen‐Meijer
Associate Professor
TUM Medical Education Center
Technical University of Munich
Munich, Germany

Tim Wilkinson
Professor of Medicine and Director of the MB ChB programme
Otago Medical School
University of Otago
Christchurch, New Zealand

Diana F. Wood
Director of Medical Education and Clinical Dean
University of Cambridge School of Clinical Medicine
Cambridge, UK

Zareen Zaidi
Associate Professor
Department of Medicine
University of Florida College of Medicine
Gainesville, FL, USA

Lara Zibarras
Associate Director for Research, Development and Dissemination
Work Psychology Group
Senior Lecturer in Organisational Psychology
City, University of London
London, UK

Foreword to the Third Edition

What can one say about a book that within less than 10 years is its third edition? The need for this new edition reflects that Understanding Medical Education is the authoritative and comprehensive resource in modern medical education practice. To borrow from Parmenides, ‘nothing comes from nothing’ and so it is useful to reflect on both the origins of Understanding Medical Education and how it has evolved through its various iterations. During the early ‘noughties’, the Association for the Study of Medical Education (ASME) approached leading experts in the field of medical education to contribute to a series of standalone monographs on their topics of expertise. These monographs proved incredibly popular, so much so that it became clear that there was a need for a definitive guide to medical education presented, for the first time, in a single core textbook. Having commissioned and edited the original series, Tim Swanwick was invited to take on the gargantuan task of bringing everything together in one place, approaching authors to revise their contributions in light of new research evidence and emerging thinking, and sourcing other well‐known figures and rising stars as contributors. Understanding Medical Education was a cutting‐edge ‘one‐stop shop’ presented in simple language and applicable across the entire spectrum of health professions education. It was an instant ‘hit’, adopted rapidly by medical educators across five continents with translations available in a number of different languages.

Yet nothing stands still. After many centuries of little change, medical education and medicine have shifted dramatically in recent years. Medical practice, society, health care systems, and expectations from patients are changing, and medical education has to also change to keep up. For example, ways of working with patients and colleagues are different. There are changes in how we deliver education and training linked to changing health care practices, particularly fewer opportunities to learn in the workplace because of system changes such as regulated hours for junior doctors. There have been major advances in research and treatments, and hence views of what is good clinical practice. These rapid changes mean that medical education must prepare today's medical students and doctors in training to work in very different ways from those of the past. Best practice in medical curricula, methods of instruction, assessment, and so on have to change and evolve in order to reflect the needs of contemporary medical practice. It is extremely challenging for educators to keep up with the literature, read journal articles and book chapters: the synthesis of the latest, most relevant, and essential material in medical education is if anything more necessary today than it was at the time of the first edition.

The second edition of Understanding Medical Education was published only four years after the first, reflecting the rapidity of change. This third edition, has kept pace with the continuing and hectic evolution of medical education. The content illustrates the journey that medical education has taken over recent years, and hints at the challenges that lie ahead. The content also reflects the responsiveness of the Understanding Medical Education project, a feature which will help those delivering medical education and training reflect on how things have changed since they were in the classroom and clinic, and help them break free of what Whitehead and colleagues have called the ‘carousel of ponies’. This colourful analogy suggests that there are returning themes in medical education, circling round and round in the continual rediscovery of discursive ‘truths’. Getting off this carousel requires both knowledge and reflection. Understanding Medical Education's five sections of Foundations, Teaching and Learning, Assessment and Selection, Research and Evaluation, and Faculty and Learners focus ostensibly on knowledge. Yet running throughout the book is also a strong acknowledgement of the necessity of considered and scholarly reflection on the process of medical education. By this I mean the need to think not just about the ‘what’ or ‘how’ (to assess in the workplace, to introduce portfolios, design a curriculum, etc.) but also the ‘why’ (are we introducing something new, what can we learn from pedagogic shifts, and so on). Understanding Medical Education provides a resource which will help educators reflect on the complexity of medical education, to question discourses and practices in a way which will help them develop as professionals and move medical education ever forwards.

Long‐term fans will also notice that Understanding Medical Education has extended its editorial team. As the current Chair of the Association for the Study of Medical Education (ASME), and the person responsible for commissioning the third edition of UME, I believed it was critically important to ensure that the book explicitly reflected ASME's explicit ‘UK‐based internationally facing’ mission. This mission is reflected in editors, contributors, and readers of ASME's journals, Medical Education and The Clinical Teacher, and our other indispensable resource, Researching Medical Education. In support of this aim, I was delighted to invite Bridget C. O'Brien from the US and Kirsty Forrest from Australia to join Tim Swanwick as co‐editors. Their international collaboration on this edition illustrates the great benefits of working together to share knowledge and networks.

Understanding Medical Education synthesises the latest knowledge, evidence, and best practices in the field. It provides a snapshot of how far we have come as a field. It is the essential resource for established educators and those new to the field. This extensively revised and extended third edition should be on the desk of every medical educator.

Professor Jennifer Cleland
Centre for Health care Education Research and Innovation, University of Aberdeen, Aberdeen, UK
Chair of the Association for the Study of Medical Education

Preface

Understanding Medical Education was launched by the Association for the Study of Medical Education as a series of monographs in September 2006. In 2010 these monographs were brought together into a single textbook, providing a unique and comprehensive guide to the theoretical and academic bases to modern medical education practice.

As well as providing practical guidance for clinicians, teachers, and researchers, Understanding Medical Education is designed to meet the needs of all newcomers to medical education, including those studying at certificate, diploma, or masters level; Understanding Medical Education aims to be both accessible and useful to the reader. The intention is that after reading one of the chapters the reader will not only be better informed about their field of interest, but able to assimilate their new knowledge into their clinical teaching or academic activities.

Following a rigorous process of expert peer review, this third edition sees major updates of all existing chapters and some completely new ones, including contributions on the science of learning, knowledge synthesis, and learner support and well‐being. The third edition also comes with a brand new foreword from Professor Jennifer Cleland, Chair of Medical Education Research at the University of Aberdeen and Chair of Council for the Association for the Study of Medical Education.

Understanding Medical Education remains the first port of call for anyone engaged in medical education as an academic discipline. The book is a unique resource which should prove invaluable for anyone involved in the development of health care professionals, in whatever discipline, wherever they are in the world.

An online edition of the complete book together with individual chapter downloads is available at http://onlinelibrary.wiley.com.

Editors

Tim Swanwick, MA, FRCGP, MA(Ed), FAcadMEd, has a broad range of experience in health care education and is based in London (UK), where he is Dean of Education and Leadership Development for Health Education England and the NHS Leadership Academy. Tim has a variety of academic interests including work‐based learning, faculty development, professional support, academic careers and clinical leadership, and has taught, researched and published widely.

Kirsty Forrest, MBChB, BSc Hons, FRCA, MMEd, FAcadMEd, FANZCA, is based in Gold Coast, Queensland, Australia, as Dean of Medicine at Bond University. She is co‐author and editor of a number of medical textbooks. Kirsty has been involved in educational research and management for many years both at the undergraduate and postgraduate levels and she continues to work clinically as a consultant anaesthetist.

Bridget C. O’Brien, PhD, is an associate professor and education researcher at the University of California, San Francisco, where she supervises doctoral students in the UCSF‐University of Utrecht doctoral program and directs the San Francisco Veterans Affairs Fellowship in Health Professions Education Evaluation and Research. She co‐authored Educating Physicians: A Call for Reform of Medical School and Residency (2010) and has published numerous peer‐reviewed research papers and articles. Her research focuses on workplace learning across the continuum of health professions education.

Association for the Study of Medical Education

The Association for the Study of Medical Education (ASME) was established in 1957 by the UK General Medical Council to promote and conduct research into medical education. ASME's goals are to:

Promote high‐quality research into medical education.
Provide opportunities for developing medical educators.
Disseminate good evidence‐based educational practice.
Inform and advise Governmental and other organisations on medical education matters.
Develop relationships with other organisations and groupings in health care education.

ASME's mission is to meet the needs of teachers, trainers, and learners in medical education by supporting research‐informed best practice across the continuum of medical education.

Acknowledgements

Producing a textbook such as this is a team effort, and thanks must be extended to the ASME Executive and Understanding Medical Education editorial advisory board for their advice and guidance, to the ASME team for their administrative support, and to James Watson and the editorial team at Wiley for helping to make the third edition of Understanding Medical Education such an impressive and attractive volume.

Members of the Editorial Advisory Board include:

Jennifer Cleland

Steven J. Durning

Rachel H. Ellaway

Deborah Gill

Marjan Govaerts

Larry Gruppen

Brian Jolly

Karen Mattick

Lynn Monrouxe

John J. Norcini

William Reid

Charlotte Ringsted

Trudie E. Roberts

Jonathan Sherbino

Linda Snell

Olle ten Cate

Pim Teunissen

Steve Trumble

Sebastian Uijtdehaage

Tim Wilkinson

Understanding Medical Education

EVIDENCE, THEORY, AND PRACTICE