Academic Psychiatry 26:216-218, September 2002
© 2002 Academic Psychiatry
Educational Abstracts
Richard Tiberius, Ph.D.
Dr. Tiberius is on the faculty of the Department of Psychiatry, University of Toronto.
Key Words: Service-Learning • Professsionalism • Educational Abstracts
The UCLA Higher Education Service-Learning Clearinghouse. http: / / www.gseis.ucla.edu / slc / index.html
I have not reviewed a website before in this column, but it is time to begin. Increasingly professionals are seeking information from the Internet. The Clearinghouse is a website sponsored by the Higher Education Research Institute, which is in the Graduate School of Education and Information Studies at The University of California, Los Angeles. This site is designed to provide resources, tips, and links to other sites that offer information on service-learning in higher education. What is service-learning and what does it have to do with teaching in psychiatry? According to the Clearinghouse website,
Service-learning is a form of experiential learning in which students and faculty collaborate with communities to address problems and issues, simultaneously gaining knowledge and skills and advancing personal development. There is an equal emphasis on helping communities and providing valid learning experience to students. Service-learning requires that faculty members be actively engaged as teacher/mentors with students. Students learn new knowledge and skills that contribute to their education. Students have the opportunity to reflect critically upon their experiences. The service provided meets a need identified by the community to be served. Those receiving the service have significant involvement and control over the activities engaged in by students and faculty.
Does this sound familiar to anyone? Most of medical education, from clerkship on, is a kind of service-learning. Higher education is rediscovering what medicine and other cognitive apprenticeships have been doing for centuries. On the other hand, the early years of medical education have not traditionally included much experiential learning. This situation is changing with the institution of problem-based learning, community-based learning, and other strategies for early introduction of patient contact. In psychiatry, innovations for the early introduction of patient care include the "Medical Students Psychotherapy Scheme" developed in London by Peter Shoenberg and David Sturgeon. We have a similar program at the University of Toronto, directed by Solomon Shapiro.
The reason I want to bring this Internet resource to your attention now is that service-learning has become a hot topic in higher education, and psychiatric educators who are introducing service-learning in the early years of medical education can learn from the new literature. What can we learn? First, we can find many sites that are designed to help us develop service-learning programs. The oldest such site devoted to service-learning is Service-Learning (Colorado): The Home of Service Learning on the World Wide Web, at http://csf.colorado.edu/sl/. Next, we can find studies that have evaluated service-learning programs. These are listed on the Clearinghouse website. The good news to be found there is that service-learning has been shown to enhance achievement across a wide variety of disciplines; to have a positive impact on personal, social and cognitive outcomes; to improve the student–faculty interaction; to enhance students' beliefs in their personal efficacy; and to be a possible predictor of their further professional development. On the Clearinghouse website we can also find discussion groups, workshops, model programs, and course syllabi.
Arnold L: Assessing professional behavior: yesterday, today and tomorrow. Academic Medicine 2002; 77(6):502–515
Professionalism is a hot topic today with a fast-growing literature. I recommend this article to anyone who seeks a painless and efficient introduction to the literature on the assessment of professionalism. The article is based on the literature published over the last 30 years, most of it peer reviewed. Dr. Arnold defines the concept of professionalism, reviews the key approaches to assessing it, and suggests ways to strengthen the measurement properties of these approaches.
Arnold concludes that more research is needed into measurement tools that are focused on professional behaviors as expressions of value conflicts, to determine if these will produce more valid and reliable instruments. She suggests that such tools might be especially suited to identifying "routine" lapses into unprofessional behavior. She suggests that what physicians need to learn, and thus what should be assessed, may vary with career stage. She asks whether we should teach medical students only a subset of the elements of professional behavior—those that are most applicable to their student role—or whether we should teach the other elements as well, under the assumption that the socialization should anticipate the need. Another developmental question that she asks is whether different learning levels should be matched to students, residents, and practitioners. Should students be held responsible only for knowledge, residents for knowledge and competence, and practitioners for all three?
Finally, Arnold discusses how the environment could support or sabotage the assessment of professional behavior. She argues that if we are to develop valid and reliable measures of professionalism, we must consider the institutional stance toward professional behavior and the conditions under which the assessment is administered. For example, the so-called hidden or informal curriculum is a component of the institutional stance that has a huge influence on professional values. She names the following conditions of assessment as potential biasing factors in assessment: the hesitance of students to render evaluations; the purpose of the assessment (formative or summative); the breadth of the assessment; types of people involved; and confidentiality issues.
Van Dalen J, Gubbels H, Engel C, Mfenyana K: Effective poster design. Education for Health 2002; 15(1):79–83
Poster sessions present a problem for me, the same problem I encounter at craft shows. I need to ascertain very quickly whether I am interested in the topic, because after the poster's author or the craftsperson has begun talking to me, it's too late. I am far too polite to cut them off. This dilemma is fresh in my mind since I have just returned from a medical education conference in which there was the usual poster session. The authors, most of whom I knew, were standing in front of their posters eagerly anticipating customers. Moving from poster to poster, I found none whose theme I could discern without reading the fine print. And each time I read the fine print, the author engaged me. I politely endured many discussions about posters that were irrelevant to my work and consequently missed others because I ran out of time.
When I got back to my office, the latest issue of Education for Health was on my desk, containing, as it always does, its "practical advice" column. I once wrote one of these columns myself. This one on effective poster design is short enough to read in five minutes, or give to your residents without apology. The main message of the article is contained in the first two sentences of the abstract: "A poster is an abstract. The mistake most frequently made is to put too much information on your poster." They also reproduce two examples of posters that won awards at an international conference.
Wenger EC, Snyder WM: Communities of practice: the organizational frontier. Harvard Business Review, January-February 2000, pp 139–145
Wenger E: Communities of Practice: Learning, Meaning and Identity. Cambridge, UK, Cambridge University Press, 1998
The concept of communities of practice is one that is gradually working its way through institutions of higher education. Etienne Wenger's 1998 book has already caused a major stir in intellectual circles within the business community. A short time ago organizations focused on team building. Today companies are beginning to think in terms of communities of practice as vehicles for the creation of identity and innovations. Although the language and context of the literature on communities of practice is clearly aimed at business, higher education and health care institutions should not ignore these ideas. If you would like to begin with a quick overview of the concepts rather than an entire book, see the article (2000) that Wenger wrote with Snyder in Harvard Business Review.
Communities of practice are "groups of people informally bound together by shared expertise and passion for a joint enterprise—engineers engaged in deep-water drilling for example, consultants who specialize in strategic marketing, or frontline managers in charge of check processing at a large commercial bank" (2000, p. 139). People in communities of practice interact informally to find innovative ways of solving their problems. Because of the informal, spontaneous nature of these communities, they are not easily fostered by the kind of direct control typical of business culture. In fact, they cannot be mandated. They can only be fostered or nurtured. In contrast to business culture, the informal, collegial culture of medical education is ideally suited to the formation of communities of practice. Indeed, academic communities of practice have existed for centuries.
Most of us already belong to groups that have voluntarily organized themselves around a common passion. Some of these groups likely manifest the defining characteristics of a community of practice—the group selects its own leaders, it sets its own agenda, and the members are self-selected. If these communities are self-organizing, why do we need to study them? The answer is that while they cannot be mandated, they can be cultivated. Wenger and Snyder offer several ways that managers can cultivate them. Translating these into language familiar to psychiatric educators, they would look like this:
- Identify potential communities of practice that will enhance the mission statement of the university and the strategic plan of the Faculty of Medicine or Department of Psychiatry.
- Provide the infrastructure that will support such communities and enable them to apply their expertise effectively.
- Use nontraditional methods to assess the value of the Department's communities of practice.
Let's take a hypothetical example to see how these methods work. The facilitator must identify a domain of interest that might serve to integrate a potential community of practice. One such potential community may consist of the psychiatrists in your department who are interested in resident supervision. The coordinator then invites the group to a meeting to discuss ways that they can interact for their mutual benefit and the enhancement of the practice of supervision. Next, the coordinator must provide an infrastructure. The authors note that communities of practice are vulnerable because they lack the legitimacy conferred by budgets and institutional credit. To remedy this, the departmental promotion system can be modified to recognize the contributions of such communities and give academic credit to members of the communities. The communities of practice, in recognition of their contribution to the department, can be provided with convenient locations to meet, refreshments, parking, a list server, or secretarial help in arranging meetings and keeping track of ideas. And the coordinators might be paid for their work.
Finally, the coordinator must seek nontraditional methods of measuring the value of communities of practice. Communities of practice are not likely to produce publications or win grants. Their contributions will be indirect and delayed. A great idea that influences research or educational practice may have been spawned in a meeting of the community, but no one may be aware of its origin. Wenger and Snyder suggest systematically gathering evidence through the use of qualitative measurements of assessment such as listening to the members' stories.
At the end of their article the authors speculate that in five to ten years, "communities of practice may be as common to discussions about organization as business units and teams are today." Maybe they are optimistic when it comes to business, but my hunch is that their prediction will become true within the academic world.
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