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PURPOSE: To explore and describe the highly cited articles' themes of research in medical education and to provide an insight into and reflection on which the elites of medical education society invested their energies from 2009 to 2018. METHODS: An in-depth content analysis as a research technique for the objective, systematic, and quantitative description of the manifest content of communication was used to quantitatively assess subject interests, methods, and other characteristics associated with citation of published studies in medical education research. Meaning units were compacted and coded with labels and categories in two phases. RESULTS: Among a variety of topics, methods, and strategies, 764 codes, 24 descriptive themes, and seven categories were extracted from the content analysis as the most prominent. Categories of medical education research were: modern technologies updating in medical education; learner performance improvement; sociological aspects of medical education; clinical reasoning; research methodology concerns of medical education; instructional design educational models; and professional aspects of medical education. CONCLUSIONS: Commitment to continuous revision of educational emphasis and concerns on technological, sociological, and methodological concerns were the most repeated components of the highly cited articles that were ascertained through increased structure course designs and instructional strategies of the flipped classrooms to realize clinical reasoning and performance improvement.[Box: see text].

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With increased interest in the use of entrustable professional activities (EPAs) in undergraduate and postgraduate medical education, comes questions about their implications for curriculum development and assessment. This paper addresses some of those questions, discussed at a symposium of the 2017 conference of AMEE, by presenting the components of an EPA, describing their importance and application, identifying their implications for assessment, and pinpointing some of challenges they pose in undergraduate and postgraduate settings. It defines entrustment, describes the three levels of trust, and presents trainee and supervisor factors that influence it as well as perceived benefits, and risks. Two aspects of EPAs have implications for assessment: units of professional practice and decisions based on entrustment, which impact an assessment's blueprint, test methods, scores, and standards. In an undergraduate setting EPAs have great appeal, but work is needed to identify and develop a robust assessment system for core EPAs. At the postgraduate level, there is tension between the granularity of the competencies and the integrated nature of the EPAs. Even though work remains, EPAs offer an important step in the evolution of competency-based education.

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The provision of self-regulated learning (SRL) enhanced feedback on performing clinical skills and making a clinical diagnosis recognizes the importance of feedback on the use of key SRL processes. In contrast to the broader concept of self-directed learning, SRL has a specific focus on the individual learner's approach to achieve a task, including their planning, self-monitoring, and future adaptations. The key SRL processes can be identified using structured microanalysis during the clinical task and feedback to the learner using the tips outlined in this article. It is essential that SRL enhanced feedback is integrated with best practice on providing feedback to ensure that its potential is achieved.

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Introduction: In 2010, the Ottawa Conference produced a set of consensus criteria for good assessment. These were well received and since then the working group monitored their use. As part of the 2010 report, it was recommended that consideration be given in the future to preparing similar criteria for systems of assessment. Recent developments in the field suggest that it would be timely to undertake that task and so the working group was reconvened, with changes in membership to reflect broad global representation.Methods: Consideration was given to whether the initially proposed criteria continued to be appropriate for single assessments and the group believed that they were. Consequently, we reiterate the criteria that apply to individual assessments and duplicate relevant portions of the 2010 report.Results and discussion: This paper also presents a new set of criteria that apply to systems of assessment and, recognizing the challenges of implementation, offers several issues for further consideration. Among these issues are the increasing diversity of candidates and programs, the importance of legal defensibility in high stakes assessments, globalization and the interest in portable recognition of medical training, and the interest among employers and patients in how medical education is delivered and how progression decisions are made.

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Whether ultrasound (US) should be incorporated into a medical undergraduate curriculum remains a matter of debate within the medical education arena. There are clear potential benefits to its early introduction particularly with respect to the study of living anatomy and physiology in addition to the learning of clinical skills and procedures required for the graduate clinical practice. However, this needs to be balanced against what is perceived as an added value in addition to financial and time constraints which may potentially lead to the sacrifice of other aspects of the curriculum. Several medical schools have already reported their experiences of teaching US either as a standalone course or as a fully integrated vertical curriculum. This article describes and discusses the initial experience of a UK medical school that has taken the steps to develop its own pragmatic vertical US curriculum based on clinical endpoints with the intent of using US to enhance the learning experience of students and equipping them with the skills required for the safe practice as a junior doctor.

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Research indicates the importance and usefulness of feedback, yet with the shift of medical curricula toward competencies, feedback is not well understood in this context. This paper attempts to identify how feedback fits within a competency-based curriculum. After careful consideration of the literature, the following conclusions are drawn: (1) Because feedback is predicated on assessment, the assessment should be designed to optimize and prevent inaccuracies in feedback; (2) Giving qualitative feedback in the form of a conversation would lend credibility to the feedback, address emotional obstacles and create a context in which feedback is comfortable; (3) Quantitative feedback in the form of individualized data could fulfill the demand for more feedback, help students devise strategies on how to improve, allow students to compare themselves to their peers, recognizing that big data have limitations; and (4) Faculty development needs to incorporate and promote cultural and systems changes with regard to feedback. A better understanding of the role of feedback in competency-based education could result in more efficient learning for students.

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Ensuring medical graduates are competent is of central importance to a number of stakeholders including medical schools, faculty, regulators, employers, students and last but not least patients and their carers. Consequently, assessment of competence is one of the main areas of focus for medical education. Recognising the significance of excellence in student assessment the ASPIRE Board identified this as one of the initial themes. The aim of the ASPIRE initiative is to encourage and reward excellence. In this article the process of agreeing the criteria for excellence in assessment is described along with examples from successful applications

Garantizar que los graduados de medicina sean competentes es una cuestión de vital importancia para las diversas partes interesadas, facultades de medicina, profesorado, autoridades reguladoras, proveedores de servicios, estudiantes y por último pero no por ello menos importante, los pacientes y sus cuidadores. En consecuencia, la evaluación de competencias supone una de las principales áreas de atención para la educación médica. Para los responsables de ASPIRE, una de las prioridades iniciales fue reconocer el significado de la excelencia en la evaluación del estudiante. El objetivo de la iniciativa ASPIRE es estimular y premiar la excelencia. En este artículo se describe el proceso empleado para acordar los criterios de reconocimiento de excelencia en evaluación junto con ejemplos que proceden de facultades premiadas

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Fitness to practice decisions are often based on a student's digression from the regulations, with limited exploration of the reasoning behind the student's behavior. However, behavior is underpinned by complex, "hidden" variables, including an individual's attitudes and social norms. Examining hidden determinants of professionalism, such as context, interpersonal relationships, social norms, and local cultures, then allows medical educators to develop a richer understanding of unprofessional behavior.In this article, the authors propose the use of the theory of planned behavior (TPB) as a framework to help evaluate unprofessional behavior in students. The TPB is a deliberative processing model that explains how an individual's behavior is underpinned by his or her cognitions, with behavior being primarily dependent on the intention to perform the behavior (behavioral intention). Intention, in turn, is determined by three variables: attitude, subjective norm, and perceived behavioral control.To understand the practical use of the TPB, the authors present four complex, anonymized case studies in which they employed the TPB to help deal with serious professionalism lapses among medical students. The outcomes of these cases as well as the student and program director perspectives, all explained via the TPB variables, are presented. The strengths and limitations of the TPB are discussed.

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CONTEXT: As a contribution to this special issue commemorating the journal's 50th volume, this paper seeks to explore directions for national licensing examinations (NLEs) in medicine. Increases in the numbers of new medical schools and the mobility of doctors across national borders mean that NLEs are becoming even more important to ensuring physician competence. OBJECTIVES: The purpose of this paper is to explore the use of NLEs in the future in the context of global changes in medical education and health care delivery. METHODS: Because the literature related to NLEs is so large, we have not attempted a comprehensive review, but have focused instead on a small number of topics on which we think we have something useful to say. The paper is organised around five predicted trends for NLEs. DISCUSSION: The first section discusses reasons why we think the use of NLEs will increase in the coming years. The second section discusses the ongoing problem of content specificity and its implications for the design of NLEs. The third section examines the evolution of large-scale, standardised cognitive assessments in NLEs and suggests some future directions. Reflecting the fact that NLEs are, increasingly, attempting to assess more than just knowledge, the fourth section addresses the future of large-scale clinical skills assessments in NLEs, predicting both increases in their use and some shifts in the nature of the stations used. The fifth section discusses workplace-based assessments, predicting increases in their use for formative assessment and identifying some limitations in their direct application in NLEs. The concluding section discusses the cost of NLEs and indulges in some further speculations about their evolution.

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This paper presents perspectives and controversies surrounding the use of milestones to assess competency in outcomes-based medical education. Global perspectives (Canada, Europe, and the United States) and developments supporting their rationales are discussed. In Canada, there is a significant movement away from conceptualizing competency based on time, and a move toward demonstration of specific competencies. The success of this movement may require complex (rather than reductionist) milestones that reflect students' progression through complexity and context and a method to narrate their journey. European countries (United Kingdom, France, and Germany) have stressed the complexity associated with time and milestones for medical students to truly achieve competence. To meet the changing demands of medicine, they view time as actually providing students with knowledge and exposure to achieve various milestones. In the United States, milestones are based on sampling throughout professional development to initiate lifelong learning. However, the use of milestones may not imply overall competence (reductionism). Milestones must be developed alongside outcomes-based curriculum with use of faculty and competency committees. The perspectives outlined in this paper underscore emerging challenges for implementing outcomes-based medical education and call for new conceptualizations of competence.

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