The problem with solutions

Ajjawi, Rola; Eva, Kevin W.

doi:10.1111/medu.14413

Cited by 12 publications

(3 citation statements)

References 21 publications

(33 reference statements)

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“…The Royal College’s own program evaluation of CBD confirms these findings, taking note of calls to improve the design of e-portfolios [ 39 ]. However, to avoid the quick fixes of ‘solutionism’ [ 26 , 40 ] it is essential to understand that the unintended consequences of technology in this case are more than a problem of workload. Insights from our study support recommendations for enhanced design of technology to improve the quality and accessibility of EPA data for learning.…”

Section: Discussionmentioning

confidence: 99%

Unintended consequences of technology in competency-based education: A qualitative study of lessons learned in an OtoHNS program

Ott,

Apramian,

Cristancho

et al. 2023

Journal of Otolaryngology - Head & Neck Surgery

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Background Formative feedback and entrustment ratings on assessments of entrustable professional activities (EPAs) are intended to support learner self-regulation and inform entrustment decisions in competency-based medical education. Technology platforms have been developed to facilitate these goals, but little is known about their effects on these new assessment practices. This study investigates how users interacted with an e-portfolio in an OtoHNS surgery program transitioning to a Canadian approach to competency-based assessment, Competence by Design. Methods We employed a sociomaterial perspective on technology and grounded theory methods of iterative data collection and analysis to study this OtoHNS program’s use of an e-portfolio for assessment purposes. All residents (n = 14) and competency committee members (n = 7) participated in the study; data included feedback in resident portfolios, observation of use of the e-portfolio in a competency committee meeting, and a focus group with residents to explore how they used the e-portfolio and visualize interfaces that would better meet their needs. Results Use of the e-portfolio to document, access, and interpret assessment data was problematic for both residents and faculty, but the residents faced more challenges. While faculty were slowed in making entrustment decisions, formative assessments were not actionable for residents. Workarounds to these barriers resulted in a “numbers game” residents played to acquire EPAs. Themes prioritized needs for searchable, contextual, visual, and mobile aspects of technology design to support use of assessment data for resident learning. Conclusion Best practices of technology design begin by understanding user needs. Insights from this study support recommendations for improved technology design centred on learner needs to provide OtoHNS residents a more formative experience of competency-based training. Graphical abstract

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Section: Discussionmentioning

confidence: 99%

Unintended consequences of technology in competency-based education: A qualitative study of lessons learned in an OtoHNS program

Ott,

Apramian,

Cristancho

et al. 2023

Journal of Otolaryngology - Head & Neck Surgery

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“…The COVID-19 pandemic unleashed disruptive forces that can create the type of unfreezing that facilitates meaningful change [ 36 ]. Leading medical education journals have been promoting discussions about myths [ 12 ], seeking to accommodate diverse perspectives [ 37 ], and questioning the habit of looking for simple solutions that are intended to address complex problems [ 38 ]. Professional organizations are complexifying by supporting systems-thinking to confront healthcare challenges [ 39 ] and expressing urgency to enhance collaboration within communities [ 40 ].…”

Section: Why We Should Look For Blind Spots In Medical Educationmentioning

confidence: 99%

Blind spots in medical education: how can we envision new possibilities?

et al. 2022

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As human beings, we all have blind spots. Most obvious are our visual blind spots, such as where the optic nerve meets the retina and our inability to see behind us. It can be more difficult to acknowledge our other types of blind spots, like unexamined beliefs, assumptions, or biases. While each individual has blind spots, groups can share blind spots that limit change and innovation or even systematically disadvantage certain other groups. In this article, we provide a definition of blind spots in medical education, and offer examples, including unfamiliarity with the evidence and theory informing medical education, lack of evidence supporting well-accepted and influential practices, significant absences in our scholarly literature, and the failure to engage patients in curriculum development and reform. We argue that actively helping each other see blind spots may allow us to avoid pitfalls and take advantage of new opportunities for advancing medical education scholarship and practice. When we expand our collective field of vision, we can also envision more “adjacent possibilities,” future states near enough to be considered but not so distant as to be unimaginable. For medical education to attend to its blind spots, there needs to be increased participation among all stakeholders and a commitment to acknowledging blind spots even when that may cause discomfort. Ultimately, the better we can see blind spots and imagine new possibilities, the more we will be able to adapt, innovate, and reform medical education to prepare and sustain a physician workforce that serves society’s needs.

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“…In contrast, the COVID-19 pandemic-induced changes in medical education were reactive (Ajjawi & Eva, 2021), global rather than local (Papapanou et al, 2021;Rose, 2020;Wanigasooriya et al, 2021), set against a background of chaos, undertaken with unprecedented speed, and notable for innovation. Many rapid publications described how medical schools and residency/training providers "kept the [educational] show on the road" using technology (e.g., Ajjawi & Eva, 2021) and simulation. The majority of these papers were descriptive, with few providing outcome measures.…”

Section: Introductionmentioning

confidence: 99%

“It’s making me think outside the box at times”: a qualitative study of dynamic capabilities in surgical training

Shah

Walker

et al. 2022

Adv in Health Sci Educ

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Craft specialties such as surgery endured widespread disruption to postgraduate education and training during the pandemic. Despite the expansive literature on rapid adaptations and innovations, generalisability of these descriptions is limited by scarce use of theory-driven methods. In this research, we explored UK surgical trainees’ (n = 46) and consultant surgeons’ (trainers, n = 25) perceptions of how learning in clinical environments changed during a time of extreme uncertainty (2020/2021). Our ultimate goal was to identify new ideas that could shape post-pandemic surgical training. We conducted semi-structured virtual interviews with participants from a range of working/training environments across thirteen Health Boards in Scotland. Initial analysis of interview transcripts was inductive. Dynamic capabilities theory (how effectively an organisation uses its resources to respond to environmental changes) and its micro-foundations (sensing, seizing, reconfiguring) were used for subsequent theory-driven analysis. Findings demonstrate that surgical training responded dynamically and adapted to external and internal environmental uncertainty. Sensing threats and opportunities in the clinical environment prompted trainers’ institutions to seize new ways of working. Learners gained from reconfigured training opportunities (e.g., splitting operative cases between trainees), pan-surgical working (e.g., broader surgical exposure), redeployment (e.g., to medical specialties), collaborative working (working with new colleagues and in new ways) and supervision (shifting to online supervision). Our data foreground the human resource and structural reconfigurations, and technological innovations that effectively maintained surgical training during the pandemic, albeit in different ways. These adaptations and innovations could provide the foundations for enhancing surgical education and training in the post-pandemic era.

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The problem with solutions

Abstract: Ever wondered why academics make things so difficult? Ajjawi and Eva explain with their introduction of the 2021 State of the Science issue and this year's theme of Solution‐ism.

Cited by 12 publications

References 21 publications

Unintended consequences of technology in competency-based education: A qualitative study of lessons learned in an OtoHNS program

Unintended consequences of technology in competency-based education: A qualitative study of lessons learned in an OtoHNS program

Blind spots in medical education: how can we envision new possibilities?

“It’s making me think outside the box at times”: a qualitative study of dynamic capabilities in surgical training

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