Being Edgy in Health Professions Education: Concluding the Philosophy of Science Series

Shaping minds and hearts in medical education: Embedding and implementing a personal and professional development curriculum

This paper explores personal and professional development (PPD) as a key learning domain for the future of medical education and person-centered care. Guided by existing curriculum development models and lessons learned in practice, scenarios from academic and clinical learning environments will guide a theory-driven discussion of concepts and competencies that humanize the practice of medicine, such as emotional intelligence, professional identity formation, lifelong learning and inclusive practice. Factors contributing to contemporary curriculum implementation will be informed by a case study of a PPD program delivered to post-graduate medical students in Australia and propose an action-focused series of next steps to connect past, current and future directions for medical schools and graduates. Through reflections on iterative stages of program development and the incorporation of emerging concepts in PPD, this paper advocates for the true valuing of personal growth and professional development in medical education. If future doctors are to graduate as compassionate, socially informed, and critically reflective practitioners, they need dedicated PPD learning, opportunities to practice and active encouragement to remain curious towards and beyond their own experience.

Legitimation Without Argumentation: An Empirical Discourse Analysis of 'Validity as an Argument' in Assessment

Introduction

Validity is frequently conceptualized in health professions education (HPE) assessment as an argument that supports the interpretation and uses of data. However, previous work has shown that many validity scholars believe argument and argumentation are relatively lacking in HPE. To better understand HPE's discourse around argument and argumentation with regard to assessment validity, the authors explored the discourses present in published HPE manuscripts.

Methods

The authors used a bricolage of critical discourse analysis approaches to understand how the language in influential peer reviewed manuscripts has shaped HPE's understanding of validity arguments and argumentation. The authors used multiple search strategies to develop a final corpus of 39 manuscripts that were seen as influential in how validity arguments are conceptualized within HPE. An analytic framework drawing on prior research on Argumentation Theory was used to code manuscripts before developing themes relevant to the research question.

Results

The authors found that the elaboration of argument and argumentation within HPE's validity discourse is scant, with few components of Argumentation Theory (such as intended audience) existing within the discourse. The validity as an argument discourse was legitimized via authorization (reference to authority), rationalization (reference to institutionalized action), and mythopoesis (narrative building). This legitimation has cemented the validity as an argument discourse in HPE despite minimal exploration of what argument and argumentation are.

Discussion

This study corroborates previous work showing the dearth of argument and argumentation present within HPE's validity discourse. An opportunity exists to use Argumentation Theory in HPE to better develop validation practices that support use of argument.

Quality and constructed knowledge: Truth, paradigms, and the state of the science

CONTEXT AND TRUTH

Education is a social science. Social science knowledge is related to its context of origin. The concept of global 'truth' in education is therefore of limited use when truth is tempered by context. The wider applicability of our knowledge can only be judged if we look at the context in which that knowledge was produced and the assumptions that underpin it. This calls into question the idea that educational research is a quest for global 'truth', although in relation to programme evaluation, truth tied to context is an aim. An analysis is presented of the effects of social construction on research and evaluation processes, on the selection of paradigms, reporting and interpreting findings, and on the ethics of all this.

QUALITY AND IMPROVEMENT

Quality improvement is based on information selected, constructed and interpreted by those who gather, analyse or use it. The strength, and not the weakness, of our knowledge is that it is socially constructed, contextual and of its time. Increasingly looking for our own truth about educational quality, and not importing the truth of others, is crucial to the state of the science. In terms of quality development, using others' findings must be based on informed local judgement. In social science, those judgements are linked to social context and their associated ideologies.

IMPLICATIONS FOR FUTURE WORK

The hallmark of social science is not a narrowing of focus and the search for one truth, but is a broadening of concepts, theories, paradigms, reported experience and method, and an intention for each to tell their own truth well. This will lead to a wealth of diverse views and analysed experience. The science of medical education must seek many truths.

How argumentation theory can inform assessment validity: A critical review

INTRODUCTION

Many health professions education (HPE) scholars frame assessment validity as a form of argumentation in which interpretations and uses of assessment scores must be supported by evidence. However, what are purported to be validity arguments are often merely clusters of evidence without a guiding framework to evaluate, prioritise, or debate their merits. Argumentation theory is a field of study dedicated to understanding the production, analysis, and evaluation of arguments (spoken or written). The aim of this study is to describe argumentation theory, articulating the unique insights it can offer to HPE assessment, and presenting how different argumentation orientations can help reconceptualize the nature of validity in generative ways.

METHODS

The authors followed a five-step critical review process consisting of iterative cycles of focusing, searching, appraising, sampling, and analysing the argumentation theory literature. The authors generated and synthesised a corpus of manuscripts on argumentation orientations deemed to be most applicable to HPE.

RESULTS

We selected two argumentation orientations that we considered particularly constructive for informing HPE assessment validity: New rhetoric and informal logic. In new rhetoric, the goal of argumentation is to persuade, with a focus on an audience's values and standards. Informal logic centres on identifying, structuring, and evaluating arguments in real-world settings, with a variety of normative standards used to evaluate argument validity.

DISCUSSION

Both new rhetoric and informal logic provide philosophical, theoretical, or practical groundings that can advance HPE validity argumentation. New rhetoric's foregrounding of audience aligns with HPE's social imperative to be accountable to specific stakeholders such as the public and learners. Informal logic provides tools for identifying and structuring validity arguments for analysis and evaluation.

The Lifecycle of a Clinical Cadaver: A Practice-Based Ethnography

PhenomenonCadavers have long played an important and complex role in medical education. While research on cadaver-based simulation has largely focused on exploring student attitudes and reactions or measuring improvements in procedural performance, the ethical, philosophical, and experiential aspects of teaching and learning with cadavers are rarely discussed. In this paper, we shed new light on the fascinating philosophical moves in which people engage each and every time they find themselves face to face with a cadaver. ApproachOver a two-year period (2018/19-2019/20), we applied ethnographic methods (137 hours of observation, 24 interviews, and the analysis of 22 documents) to shadow the educational cadaver through the practical stages involved in cadaver-based simulation: 1. cadaver preparation, 2. cadaver-based skill practice with physicians and residents, and 3. interment and memorial services. We used Deleuze and Guattari's concepts of becoming and acts of creation to trace the ontological "lifecycle" of an educational cadaver as embedded within everyday work practices. FindingsWe delineated six sub-phases of the lifecycle, through which the cadaver transformed ontologically from person to donor, body, cadaver, educational cadaver, teacher, and loved one/legacy. These shifts involved a network of bureaucratic, technical, educational, and humanistic practices that shaped the way the cadaver was perceived and acted upon at different moments in the lifecycle. By highlighting, at each phase, 1) the ontological transitions of the cadaver, itself, and 2) the practices, events, settings, and people involved in each of these transitions, we explored questions of "being" as it related to the ontological ambiguity of the cadaver: its conceptualization as both person and tool, simultaneously representing life and death. InsightsEngaging deeply with the philosophical questions of cadaver-based simulation (CBS) helped us conceptualize the lifecycle as a series of meaningful and purposeful acts of becoming. Following the cadaver from program entry to interment allowed us to contemplate how its ontological ambiguity shapes every aspect of cadaver-based simulation. We found that in discussions of fidelity in medical simulation, beyond both the physical and functional, it is possible to conceive of a third type: ontological. The humanness of the cadaver makes CBS a unique, irreplaceable, and inherently philosophical, practice.

Developing experts in health professions education research: knowledge politics and adaptive expertise

The field of health professions education research draws inspiration from many disciplines, creating a dynamic socio-cultural context that is replete with contests over research rigour and quality. These knowledge politics are never definitively resolved. Thus, an important question that any graduate program established within the field has to contend with is what should constitute expertise in HPER. In this paper we explore interrelated contextual, conceptual and procedural dimensions of expertise to substantiate our suggestions for a core curriculum for graduate students in health professions education. We argue that an expert in health professions education research should have both an appreciation of when knowledge politics are relevant to their research process as part of their procedural knowledge and also an awareness of why these politics can affect their work as part of their conceptual knowledge.