Online learning, antiracism, clinical reasoning, and IPE

Conditions that enable learning in medical education

Developing competencies in medical education involves designing conditions that support learners’ participation and practice alongside instructional content. Constraints on participation arising from work, caregiving, and place of residence are linked to how education is delivered. Preconceptions about background or gender affect whether learners feel respected. Practicing clinical reasoning involves interpreting patient information and revising judgments. Learning across healthcare professions requires collaboration between departments and universities.

Expanding learning opportunities as the starting point for online education

The editorial on online learning considers the circumstances of adult learners who face barriers to education before discussing technology or programs. Expanding educational opportunities for non-traditional learners is also the central concern of Learning at the back door: reflections on non-traditional learning in the lifespan, which provides the editorial’s starting point. The educational significance of online learning lies in expanding opportunities for participation among learners who find it difficult to attend classes because of work, caregiving, or distance.

Medical education has traditionally centered its curricula on medical school classrooms and patient care in clinics or wards. The editorial suggests that it has therefore faced less pressure than other educational fields to design teaching and learning for learners who have difficulty coming to campus. The editorial frames the rapid introduction of online learning during the COVID-19 pandemic as an opportunity to re-examine learner-centered educational environments and the instructor’s role. Accumulated theories and experience in online and distance education can inform instructional design following an emergency transition to remote classes.

The contribution from Indiana University examines the changing roles of learners and instructors, as well as flexible learning, from the perspective of Instructional System Technology. The contribution from Pusan National University College of Medicine addresses social accountability and mental health alongside clinical clerkships and student assessment. The contribution from Wonkwang University College of Medicine considers applications of emerging technology and empirical findings on its effects. Survey research by the research team at Yonsei University College of Medicine describes instructors’ experiences of the transition to online learning, their satisfaction with it, and their faculty development needs.

Antiracism and educational environments that support professional identity

The book review on antiracism connects How to Be an Antiracist, published by One World in 2019, with a humanistic approach to educational environments in medical education. Prompted by an online keynote speech at the Association of American Medical Colleges conference, the review discusses the personal growth and changes in identity detailed in the book alongside its analysis of history, society, and policy. Its central concern is the mindset that assigns “false hierarchies of human value,” together with the power and policies that sustain them. The review explains how generalizing individual characteristics to an entire group, or requiring minoritized groups to assimilate into the dominant group’s values, can also occur in educational environments.

Examples include ranking learners’ prospects of becoming excellent doctors by college entrance exam scores, alma mater, or family background. Other examples include a culture that dictates the appearance of female faculty and medical students, and curricula in which the vast majority of patient cases involving HIV and sexually transmitted infections feature sexual minorities. Antiracism involves educators reflecting on their own thinking while working to change educational environments and policies that rank people by their perceived human value. In a socially and psychologically safe educational environment, medical students can express diverse personal identities and an authentic sense of self while learning and developing professional identities.

The CCC curriculum for repeating and comparing clinical reasoning

The review of educational materials for clinical reasoning describes the structure and learning procedures of Critical Clinical Competencies (CCC) for Clinical Reasoning Practice, produced by the Southern Illinois University School of Medicine. The material was published in July 2018, and the access date recorded in the original text is November 2023. The review introduces this freely available program, drawing on the reviewer’s experience as a member of the development team. The design is grounded in deliberate practice. The CCC curriculum combines 1 primary patient case and 3 supplementary patient cases for each of the 12 major symptoms to create 48 diagnostic cases, providing a total of 144 diagnostic cases across 3 training years.

After receiving the patient’s name, age, sex, main symptoms, and vital signs, learners list differential diagnoses and justify their choices in writing. In an abdominal pain case, learners watch videos of approaches from different specialties, including emergency medicine, family medicine, obstetrics and gynecology, and pediatrics. Each time patient information is added, learners first write a differential diagnosis and its rationale, then observe the expert’s reasoning. This sequence provides repeated opportunities to compare and revise their own judgments. The initial history, review of systems, and physical examination findings are provided sequentially. Learners are guided toward a final diagnosis by the time they receive the physical examination findings. Test and laboratory findings are intended to confirm the diagnosis.

After completing the main cases, learners work through 3 mini cases that alter one or two pieces of information while retaining the same chief complaint. These cases allow learners to compare how reasoning changes when a patient with abdominal pain is of a different sex, has a high fever, or is a child. The curriculum is guided by compare & contrast—examining the same diagnosis across different symptoms and patient conditions, and comparing different diagnoses for the same symptom. Spaced learning also guides the curriculum. Because the material was developed in the context of United States healthcare services, specifically primary care, its use in Korean curricula requires consideration of differences in language and culture.

Inter-institutional collaboration to sustain interprofessional education

The editorial on interprofessional education (IPE) examines structures for sustaining IPE, drawing on discussions and implementation efforts in Korea following the first IPE special issue of the Korean Medical Education Review in 2017. It considers patients’ increasingly diverse and complex healthcare needs in relation to curricula centered on disease diagnosis and the separation of healthcare professions that developed after the “Flexner Report.” Interprofessional collaboration is needed to provide specialized healthcare services to patients, but IPE remains peripheral in educational settings. The special issue brings together experiences of developing and running programs to identify conditions that support the establishment of IPE curricula.

The first of the three articles compares domestic and international cases, summarizing educational needs encountered in healthcare settings and difficulties in running programs. The second article, a literature review, examines how interprofessional education associations abroad are organized and how they relate to medical school accreditation organizations. It describes a system that supports instructors’ individual efforts and bottom-up initiatives. The third article presents a case of collaboration between the Chung-Ang University College of Medicine and the Sungshin Women’s University College of Nursing. Collaboration with other universities makes IPE possible when a single university does not have all the necessary healthcare departments.

Reading notes

Research spanning HRD and medical education can examine faculty development, the design of educational materials, and approaches to managing inter-institutional collaboration alongside changes in learner competencies. Research on case-based learning in the CCC curriculum can examine records of revised judgments alongside access logs and satisfaction. Research on interprofessional education can analyze the collaboration between departments and universities that makes joint programs possible.

References

Han, H. (2021). Medical education in the era of online learning: Challenges and opportunities. Korean Medical Education Review, 23(3), 145–146. https://doi.org/10.17496/kmer.2021.23.3.145

Han, H. (2021). How to be an antiracist. Korean Medical Education Review, 23(2), 139–140. https://doi.org/10.17496/kmer.2021.23.2.139

Han, H. (2024). Critical Clinical Competencies (CCC) curriculum for clinical reasoning skills development. Korean Medical Education Review, 26(1), 79–80. https://doi.org/10.17496/kmer.24.005

Han, H. (2024). Interprofessional education in Korean medical education: From individual efforts to structural collaboration. Korean Medical Education Review, 26(2), 81–82. https://doi.org/10.17496/kmer.24.022