PURPOSE: Educational psychology indicates that learning processes can be mapped on three dimensions: cognitive (what to learn), affective or motivational (why learn), and metacognitive regulation (how to learn). In a truly student-centered medical curriculum, all three dimensions should guide curriculum developers in constructing learning environments. The authors explored whether student motivation has guided medical education curriculum developments. METHOD: The authors reviewed the literature on motivation theory related to education and on medical education curriculum development to identify major developments. Using the Learning-Oriented Teaching model as a framework, they evaluated the extent to which motivation theory has guided medical education curriculum developers. RESULTS: Major developments in the field of motivation theory indicate that motivation drives learning and influences students' academic performance, that gender differences exist in motivational mechanisms, and that the focus has shifted from quantity of motivation to quality of motivation and its determinants, and how they stimulate academic motivation. Major developments in medical curricula include the introduction of standardized and regulated medical education as well as problem-based, learner-centered, integrated teaching, outcome-based, and community-based approaches. These curricular changes have been based more on improving students' cognitive processing of content or metacognitive regulation than on stimulating motivation. CONCLUSIONS: Motivational processes may be a substantially undervalued factor in curriculum development. Building curricula to specifically stimulate motivation in students may powerfully influence the outcomes of curricula. The elements essential for stimulating intrinsic motivation in students, including autonomy support, adequate feedback, and emotional support, appear lacking as a primary aim in many curricular plans.

CONTEXT Conceptualisations of self-assessment are changing as its role in professional development comes to be viewed more broadly as needing to be both externally and internally informed through activities that enable access to and the interpretation and integration of data from external sources. Education programmes use various activities to promote learners' reflection and self-direction, yet we know little about how effective these activities are in 'informing' learners' self-assessments. OBJECTIVES This study aimed to increase understanding of the specific ways in which undergraduate and postgraduate learners used learning and assessment activities to inform self-assessments of their clinical performance. METHODS We conducted an international qualitative study using focus groups and drawing on principles of grounded theory. We recruited volunteer participants from three undergraduate and two postgraduate programmes using structured self-assessment activities (e.g. portfolios). We asked learners to describe their perceptions of and experiences with formal and informal activities intended to inform self-assessment. We conducted analysis as a team using a constant comparative process. RESULTS Eighty-five learners (53 undergraduate, 32 postgraduate) participated in 10 focus groups. Two main findings emerged. Firstly, the perceived effectiveness of formal and informal assessment activities in informing self-assessment appeared to be both person- and context-specific. No curricular activities were considered to be generally effective or ineffective. However, the availability of high-quality performance data and standards was thought to increase the effectiveness of an activity in informing self-assessment. Secondly, the fostering and informing of self-assessment was believed to require credible and engaged supervisors. CONCLUSIONS Several contextual and personal conditions consistently influenced learners' perceptions of the extent to which assessment activities were useful in informing self-assessments of performance. Although learners are not guaranteed to be accurate in their perceptions of which factors influence their efforts to improve performance, their perceptions must be taken into account; assessment strategies that are perceived as providing untrustworthy information can be anticipated to have negligible impact.

"Seamless Care" was one of 21 grants awarded by Health Canada to inform policymakers of the effectiveness of interprofessional education in promoting collaborative patient-centred practice among health professionals. The "Seamless Care" model of interprofessional education was designed with input from three Faculties at Dalhousie University (Medicine, Dentistry and Health Professions). The design was grounded in relevant learning theories - Social Cognitive Theory, Self-efficacy, Situated Learning theory and Constructivism. The intervention was informed by principles of active learning, problem-based learning, reflection and role modeling. The primary goal of Seamless Care was to develop students' interprofessional patient-centred collaborative skills through experiential learning. Fourteen student teams, each including one student from medicine, nursing, pharmacy, dentistry and dental hygiene, learned with, from and about each other while they were mentored in the collaborative care of patients transitioning from acute care to the community. Student teams providing collaborative care assisted patients experiencing a chronic illness to become more active in managing their health through development of self-management and decision-making skills. This paper describes the Seamless Care model of interprofessional education and discusses the theoretical underpinnings of this experiential model of interprofessional education designed to extend classroom-based interprofessional education to the clinical setting.

BACKGROUND: Residents are frequently identified by medical students as their most frequent and memorable teachers; residents also teach their peers, junior and senior colleagues, other health professionals, and their patients. Many will teach in their future practice. Developing the skills to become a teacher is an important part of postgraduate education, and warrants a systematic, planned approach that may include many complementary learning opportunities. AIMS: Our purpose is to describe one such approach: a 4-week elective experience in medical education offered to postgraduate learners. METHOD: The paper describes the background and goals for the elective, and the various steps in planning, implementing, and evaluating such a course, drawing on the literature and mining our own experience for examples. Specifically, we address the following: needs assessment; the determination and selection of content, sequence, and teaching and learning methods; the experiential learning opportunities offered; and the emphasis on the participants' developing self-awareness of themselves as teachers, and as part of a community of teachers. RESULTS: The program implementation, program evaluation, and response to feedback received are described. CONCLUSION: A 4-week elective experience in medical education was positively received by participants.

Instructors in the health professions today must acquire knowledge and competencies that go beyond disciplinary expertise. It is now generally accepted that educational training as a teacher is essential to a faculty member's effectiveness as an educator. The educational challenges across the health professions share many similarities. In this article, we draw on the medical education literature and focus on faculty development designed to enhance teaching effectiveness. We first address commonly included faculty development topics, including instructional improvement, organizational development, the development of professional academic skills, and the teaching of specific content areas. We then review a variety of educational approaches and formats that are described in the literature. Included in this discussion are commonly used workshops, seminars, short courses, and fellowships, as well as longitudinal programs, peer coaching, mentorship, self-directed learning, and computer-aided instruction. We also briefly explore learning at work and in communities of practice, and we discuss several frequently encountered challenges in designing and implementing faculty development activities, including motivating colleagues and assessing program effectiveness. We conclude the discussion by presenting a set of guidelines for the design of effective faculty development programs.

Background There is increasing interest in the role of context in medical education, with the conjecture that learning in a clinical context may be helpful for later recall of knowledge. Although this may be true in a general sense, at a closer look it appears that the notion of context is not well substantiated in the medical education literature and that the concept is not clearly defined. Effects of context on learning appear to depend on type of learning task, the relationship or interaction between the context and the learning material, and motivational features of the context. Context is often implicitly regarded as a uniform concept but conceptual analysis shows that a distinction can be made in several dimensions. Results In this paper, we identify 3 different dimensions of context: a physical dimension, representing the environmental characteristics; a semantic dimension, reflecting how well the context contributes to the learning task, and a commitment dimension, representing the amount of commitment (in terms of motivation and responsibility) that is generated by the context. On these dimensions, context can be ordered from reduced (providing few cues, little meaning, little commitment) to enriched (many cues, much meaning, high commitment). Conclusion This model can serve a dual purpose: first, to disentangle several aspects of educational contexts (e.g. as high in meaning but low in commitment), and second, to provide a theoretical framework to generate research on the influence of different contexts in education on students' learning.

Despite the existence of many approaches to understanding learning and change and attempts to incorporate these into continuing education research and practice, the search continues for a comprehensive understanding of how learning is engendered in professional practice and the processes by which learning and change occur. This article considers four broad questions in relation to the practice of continuing education:(1) What can be expected of theory?(2) How does theory relate to the educational practice of those in continuing education and the goals of continuing medical education ?(3) How have practice and theory mutually informed our current understandings?(4) How can theory serve the field more effectively in the future? Broad orientations to understanding learning provide a framework for examining the contributions of theory and practice. The orientations include behaviorist, cognitivist, social learning, humanist, and constructivist; for each, an example is presented. Newer understandings also are introduced. The article concludes by considering reasons as to why theory appears not to have served us better and by offering ways in which those in continuing education can ensure greater usefulness of theory while contributing to its continued development.

BACKGROUND: Professionalism is increasingly emphasised in medical education. Non-cognitive goals, including values, attitudes and skills, remain challenging to define and measure. The purpose of this study was to better understand these goals and their achievement in the MD programme. METHODS: Graduating medical students, faculty preceptors, residents and other health professionals (OHPs) completed a systematically developed mailed survey, rating achievement of 25 attribute statements. Following analyses of means and standard deviations, factor analysis of responses was conducted. Responses were compared across respondent groups. RESULTS: The overall response rate was 50.1%(191/396), comprising 57.5% of the students, 54.1% of the faculty members, 30.9% of the residents and 50% of the OHPs. Five items received mean ratings over 4/5; none were below 3/5. Five factors explained 65% of variance. They were:'Teamwork and interprofessional skills';'Duty and responsibility';'Communication and interpersonal skills';'Professionalism and values', and 'Trustworthiness and ethical behaviour'. The groups differed significantly on 2 factors: Teamwork and interprofessional skills (P < or = 0.0001) and Communication and interpersonal skills (P < or = 0.001). CONCLUSIONS: Important curriculum goals received high mean ratings. Ratings differed significantly across groups, suggesting differing perceptions of the extent to which goals were met. More study is needed to understand the basis of these perceptions.