Nonrepresentative data pose one of the greatest validity threats in survey research. Samples that are underrepresented and/or overrepresented based on demographic subgroups can introduce bias that distorts both the accuracy and the inferences made about the results. This article discusses the concept of poststratification weighting, a post hoc statistical procedure used to correct for sampling bias in survey research studies. Procedural steps for calculating poststratification weights are presented, and an example involving a simulated cohort of students in a medical school is provided for demonstration purposes. SPSS statistical software coding is presented to help researchers get started with their own calculations of poststratification weights.

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The ability to think critically in an uncertain and complex health-care environment is a paramount skill needed for health profession students to transition to clinical practice. Experts and educators in health profession education have unintentionally created confusion regarding operationalizing critical thinking, clinical reasoning, and clinical decision-making. In the purest form, health profession educators are referencing the cognitive abilities of a clinician to transfer thinking skills from an academic to a clinical setting. The problem with teaching clinical reasoning in health professions is that the ability to transfer knowledge and skill to patient care is often inefficient. Metacognitive awareness provides a theoretical and practical construct to make previously unconscious cognitive processes overt. The benefit of integrating and scaffolding pedagogical practices to emphasize explicit student knowledge and regulation of cognition may benefit health profession educators in teaching future clinicians how to handle cognitively complex problems. Making clinical reasoning overt through metacognitive awareness provides health profession educators a framework which helps to teach and assess cognitive strategies associated with clinical reasoning. Metacognitive awareness operationalizes a complex construct to allow a definitive way for health profession educators to instruct the cognitive system, resulting in enhanced clinical reasoning. Learning the components of metacognitive awareness is essential to a solid foundation for students and faculty. As students receive further instruction and feedback on cognitive strategies, the potential exists to improve metacognitive judgments. Case-based learning, simulated and standardized patient interactions, and experiential learning all provide pedagogical tools to promote metacognitive awareness in health profession students. Through serial assessment of metacognitive awareness, health profession educators may also gain valuable insight into how students develop cognitive strategies for future clinical reasoning. The increased ability to plan and evaluate cognitive processes may aid health profession students and educators in attaining more meaningful thinking for complex problem-solving in clinical practice.

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Change is hard. The flipped classroom, while a powerful and growing force in medical education, is a major change for many health professions' students. Instructors may avoid “flipping” due to anticipated student resistance and poor course evaluations. The business community has developed specific guidelines on how to manage change using the Kubler-Ross death and dying change curve. This article suggests the change curve and related management strategies can and should be applied to flipped classroom scenarios. Action steps are provided for each stage that can help students move from stress and frustration (“I can't learn this way”) to integrated learning as fast as possible, while simultaneously allowing the full advantages of the flipped classroom to be realized.

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The ultimate goal of medical education is to train and prepare aspiring physicians to respond to the health needs of the general population. At present, the medical education system in India relies on a curriculum that is teacher centered and time oriented. Unfortunately, this approach has led to a decline in the competence in recent medical school graduates. A more promising alternative is competency-based medical education (CBME). The implementation of CBME in India could dramatically improve the medical education system and ultimately improve patient outcomes. This article discusses the steps necessary to successfully plan and implement CBME in Indian medical colleges.

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Background: Health professions education is expensive. There has been a growing realization of this cost, and this realization has led many educators to explore new models of health professions education that could be both low cost and high value. This, in turn, has led to a small but growing research base in the field. However, until now, new research and practice has largely proceeded in the absence of theory. Studies of the cost-effectiveness, cost benefit, and cost utility of health professions education have been carried out with little consideration of potential theoretical underpinnings. This article attempts to redress this current shortcoming in the literature. It outlines a number of economic theories that are likely to be most relevant to health professions education. Theories: A number of theories are available that can underpin thinking, research, and practice in the field of cost and value in health professions education. The most relevant theories include human capital theory, signaling or screening theory, the cost-of-production theory of value, the theory of supply and demand, and cost and productivity theory. These different theories offer contrasting approaches to illuminate and understand the complex nature of cost and value in health professions education. However, given the different perspectives of educational stakeholders (e.g., learners, teachers, institutions, and governments), no single theory is likely to address all their contrasting needs. Indeed, some of the theories complement each other (e.g., human capital theory and supply and demand theory) insofar as human capital is a resource that is subject to the forces of supply and demand. Conclusions: Theories that relate to cost and value in health professions education should influence research methodology and practice in this field. In turn, research findings should feed thinking about theory and should enable the development of more profound theoretical underpinnings of research.

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Objectives: The aim of this study is to analyze and describe vignette elements and structure, and resulting difficulty, as a foundation for vignette construction in medical education, and ultimately automated vignette generation. Methods: Sixty-three vignettes representing a variety of disease states were sourced from the Objective Structured Clinical Experiences, published practice literature focused on pharmacy, and other training and assessment environments within the school. Three coders independently coded each vignette to identify underlying elements and structure. A consensus-building process was used by the coders to discuss and reconcile coding differences. Results: The coding process resulted in 36 vignette elements. The most common elements were age (n = 59, 93.6%), gender (n = 57, 90.5%), and medications (n = 54, 85.7%); others included race, medications, and chief complaint. Vignette structures and wording were found to be highly variable, with elements present in different magnitudes (range: 4–18 elements), being used with different descriptors, and given in different sequences. Conclusions: Vignette construction could benefit from further understanding of vignette structures and wording and their influence on the level of difficulty. This undertaking will allow educators to construct better vignettes for teaching and assessment to ensure that student performance accurately represents student knowledge and skills, rather than construct irrelevant variance due to vignette-level inconsistencies in content or structure. The defined elements and structure will also enable a systematic generation of vignettes for further consistency in teaching and assessment.

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Purpose: Medical schools are uniquely positioned to contribute to the changing healthcare climate by increasing diversity in the healthcare workforce and addressing social determinants of health. The purpose of this study was to develop a framework for promoting social mission in medical education and develop case studies of medical schools that exemplify social mission. Materials and Methods: The research team and Advisory Committee first used an iterative process to identify eight core modalities as essential elements in the social mission of medical education. Each modality was supported by a literature review. Six schools were selected for their commitment to enhancing health equity. Interviews and focus groups were then conducted with school leadership, key faculty, students, and residents to learn about the social mission activities of the school and to evaluate the school’s commitment to the eight core modalities. Results: All schools selected for case studies integrated and actively engaged with all eight modalities: school mission, cultivation of the pipeline, student admissions, curricular structure and content, location of clinical experience, tuition management, mentorship, and postgraduate engagement. Each modality was utilized to advance the school’s social mission, demonstrating these modalities as a useful framework for promoting the social mission of medical education. Conclusion: The social mission modalities were developed to provide a tool for institutions to discuss, promote, or measure their social mission. This is ever-more important in the current healthcare climate and should be incorporated not only in medical education but also in all health professions education to build a culture of health.

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Purpose: While clinical reasoning in medicine traditionally values the ultimate goal of providing an accurate diagnosis of disease, insufficient emphasis has been placed on how students' decisions may affect their diagnostic efficiency. This study adds new empirical evidence about what makes students efficient problem-solvers in clinical reasoning. Methods: Seventy-five medical students participated in this study in 2015. The authors compared the differences in clinical reasoning behaviors between high- and low-performing students before they proposed any diagnostic hypothesis. The authors used the Cox proportional-hazards model to explore how certain characteristics of students and essential features of reasoning processes affect the life span of incorrect hypotheses. Results: High-performing students were more prepared than low performers to propose their first hypothesis. The more laboratory tests and hypotheses the medical students had, the longer it took for them to confirm a correct diagnosis. Male students tended to finalize the correct diagnosis earlier than females. There are no differences between the easy and the difficult cases in the aforementioned patterns. Conclusion: This study helps shift the emphasis away from a solitary focus on accuracy to one that considers the importance of diagnostic efficiency. The authors discussed two main take-home messages for physicians.

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Background: Impostor phenomenon (IP), an internal perception of intellectual phoniness despite personal achievements, has been reported and evaluated in a number of professions, including doctors, dentists, pharmacists, and academic faculty. To date, this phenomenon has not been evaluated in the veterinary medicine. Methods: To examine the prevalence of IP in veterinary medicine, we surveyed veterinary students, house officers, and veterinarians at a large college of veterinary medicine. Survey measures included the Clance IP Scale (CIPS) and Young Impostor Scale (YIS). Results: The prevalence of IP in our population was 50%, 68%, and 34%, among students, house officers, and faculty, respectively, based on the responses to the CIPS. The prevalence of IP was 45%, 60%, and 26%, among students, house officers, and faculty, respectively, based on the responses to the YIS. Conclusion: Among veterinary students, house officers and faculty IP are experienced to a similar degree as that reported in other health professions.

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Background: The clinical portion of the education of health professionals occurs through the combined efforts of staff, interns, residents, and faculty in the teaching hospital. Exposure to the clinical environment is an essential element in shaping the emerging medical professional's development as a competent practitioner for their 1^st day of independent practice. Although high value is placed on clinical education by students and educators alike, the expectations of what educational activities will occur, and the value of each to professional development varies. Thus, this study sought to explore the perceptions of students, faculty, and staff in clinical veterinary medical education regarding their expectations about what students would experience during clinical training and how important those experiences are believed to be. Methods: This study utilized survey research methods. Results: The results reveal a complex picture of competing expectations and experiences that differ based on the status of the respondent as a student, veterinary technician, resident, or clinical faculty. Conclusion: Varied perspectives speak to the complexities of clinical education in the authentic environment of the hospital.

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For nearly 1000 years, lecture has been the most frequently used teaching strategy in higher education. Over the past 20 years, there has been increasing pressure to stop lecturing and instead use more active and engaged teaching strategies. An unfortunate result of the attack on the lecture is that faculty members have resisted being told to completely abandon lecturing. This has critically slowed the adoption of more contemporary evidence-based teaching strategies that would likely have advanced student learning beyond where it is today. This article includes four key challenges regarding the “active learning versus lecture” debate. Issues presented address a better understanding of what is meant by “the lecture,” a better understanding of the empirical studies comparing active learning to lecturing, a challenge to the claim that students do not learn well from the lecture, and that the comparison of active learning to lecturing is not an appropriate comparison. The primary position of this paper is that the adoption of contemporary evidence-based strategies designed to advance student learning is much more likely to be accepted and adopted by faculty members if the “active learning versus lecture” position is reframed in favor of an integrated position of combining lecture strategies with more active and engaged learning strategies. This approach would also be more consistent with existing evidence on teaching for deep learning.

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Minimizing the influence of rater errors is a persistent and considerable challenge for educators in the medical and health professions. This article presents a list of 45 common rater errors that assessors and evaluators should be cognizant of while rating performance assessments. Readers are encouraged to examine each rater error type, reflect on the extent to which s/he has previously committed each error, and identify strategies for mitigating and preventing errors in future performance assessment scenarios.

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Background: Pharmacology is perceived as a difficult course by nursing students who find it difficult to retain drug names and complex pharmacokinetic and pharmacodynamics processes. Team-based learning is a student-centered instructional design associated with improved academic outcomes. Purpose: To explore experiences of postgraduate nursing students with team-based learning in clinical pharmacology course. Methods: A descriptive qualitative design comprising of in-depth interviews was used. Study sample comprised of post graduate midwifery nursing students enrolled in clinical pharmacology course conducted with team-based learning. Content analysis following Graneheimian inductive approach was used to yield themes and subthemes. Results: Two themes emerged as 'Learning environment' and 'Intellectual process', comprising of 3-4 subthemes. Students absorbed concepts in a relaxed yet challenging environment. Intellectual process showcased improvements in knowledge retention, grasping concepts, confidence and thinking. Conclusion: Postgraduate midwifery nursing students had positive learning experiences in clinical pharmacology course conducted with team-based learning.

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Background: The use of ultrasound (US) continues to expand in veterinary and human medicine. The purpose of this study was to assess the current practices and potential barriers to the use of US in veterinary small animal general practices. Methods: An electronic survey was administered to approximately 1000 veterinary practitioners in the Southeastern United States. A total of 296 veterinarians completed the survey. Results: Among respondents, 53% reported having an US unit in their practice and 45% reported performing USs more than five times weekly. The most common reasons for not having an US unit were prohibitive cost (27%) and lack of training (27%). In addition, 74% responded that US training for a new graduate was extremely or very important. Conclusions: This study is the first to document the common use of US in small animal general practices and highlights the need for instruction of basic US skills for veterinary students and small animal practitioners.

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Introduction: Job descriptions outline competencies employers consider requisite for success and can be used to inform curriculum design. This paper demonstrates the use of text mining to determine the extent to which key educational outcomes align with job descriptions. Methods: Eighty pharmacist job descriptions containing a total of 12,064 words were text mined using the “bag of words” method. Results: A majority of the 20 most frequent job description words were also present in the pharmacy accreditation standards and American Association of Colleges of Pharmacy entrustable professional activity statements. However, several top 20 words were not, including customer, dispense, department and company. Chi-squared tests revealed text differences between community and health-system pharmacy, including patient, manage, information, and customer, which may have implications for pharmacy schools preparing students for various practice settings. Conclusion: The methodology described here provides a feasible and efficient approach to analyzing current workforce expectations and mapping them to educational outcomes.

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Background: Interprofessional collaborative care has become a preferred model for patient-centered health care, and effective participation in interprofessional teams has emerged as a core expectation of all providers. In response to this change in the healthcare landscape, Leadership Legacy was designed as an extracurricular enrichment opportunity to complement the formal curriculum by enhancing participants' collaboration, leadership, and teamwork skills. This cohort-based interprofessional leadership development program for health profession learners was built on a foundation of leadership theory, specifically emotional intelligence, and the interprofessional education collaborative competencies. Methods: A longitudinal cohort study with a pre- and post-test mixed method design was used to determine changes in students' attitudes, beliefs, and knowledge that resulted from participation in Leadership Legacy. Results: Results of the 2-year study indicate that participation in the program produced learners who reported statistically significant gains in knowledge of educational requirements and scope of practice of other healthcare professionals, satisfaction measures of the experience, interprofessional competencies, and attitudes toward healthcare team and team understanding measures. Conclusions: Together the elements of Leadership Legacy, when viewed through the lens of leadership theory, provide an opportunity whereby interprofessional learners engage in activities designed to increase emotional intelligence and stimulate social change. These same activities also enable future practitioners to develop skills directly related to critical leadership competencies such as conflict management and resolution, effective communication, feedback agility, and project management.

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Introduction: Workplace values are a significant factor in facilitating successful transitions from the classroom to the workforce and in the career development process. Furthermore, employees whose value system aligns with that of their coworkers and leaders report higher rates of job satisfaction. This study sought to determine what current doctor of veterinary medicine (DVM) students' value with respect to intrinsic, extrinsic, and lifestyle factors. Methods: A modified version of the work values checklist was administered to 100 3^rd-year students at a large veterinary school located in the United States. Results: The three values rated most important among participants were “Have fun in your life and at work,” “Feel respected for your work,” and “Gain a sense of achievement.” The three values rated least important were “Be involved in politics,” “Compete with others,” and “Live abroad.” Conclusion: Overall, intrinsic and lifestyle values appear to play a larger role in DVM students' workplace preferences than extrinsic values. Researchers are encouraged to replicate this study at other institutions to determine the extent to which findings from this study are generalizable across the veterinary medical profession.

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Introduction: Early clinical exposure (ECE) is a teaching learning methodology, which fosters the exposure of the medical students to the patients as early as the 1^st year of medical college. A hospital-based educational system provides the exposure to the clinical environment by direct contact with patients, including bedside teaching and applying skills and knowledge. Aim: evaluate the impact of ECE of Omani medical students on their attitude, knowledge, and skills. Methods: A cross-sectional study. A designed questionnaire was sent to more than 500 Omani medical students in Sultan Qaboos University (SQU) and National University (NU). The questionnaire consists two sections. The first section included personal demographic information. The second part included questions to evaluate the quantity and quality of ECE and questions directed toward knowing the current perception of Omani students toward the importance of ECE in terms of developing knowledge and skills. Fifteen questions were asked in the questionnaire. Results: There were a total number of 191 students who participated in this study with a response rate of 44%. The vast majority of them were females represented 73.8. Nearly 63.4% were from SQU and 31.8% were from NU. Sixty-eight percent of the participants are in their 5^th, 6^th, 7^th year, intern, and postintern academic status. There is a significant relationship between getting clinical exposure during preclinical years and fast adaptation in early clinical years with P < 0.05. Conclusion: ECE is a vital part of the preclinical curriculum and should be further enhanced by creating more opportunities to receive clinical and practical training in hospitals.

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Obtaining sufficient survey responses to make course and instructor evaluation results meaningful is a challenge in many, if not most, health professions training programs. This paper describes a series of policy changes that significantly improved data quality at one college of veterinary medicine located in the United States. The steps consisted of minimizing the number of items appearing on the instruments, providing students adequate time and space for completion, clearly explaining the purpose and value of the evaluations, simplifying data collection, collecting verbal feedback, and closing the loop with student participants by informing them of any changes that were made as a result of their feedback. The steps outlined in this model may be easily extended to other health professions programs that involve cohort models, multi-instructor courses and limited resources with respect to time and people.

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The COVID-19 pandemic has had an undeniable effect on medical education, particularly experiential education. Our institution conducted a brief, anonymous survey of nursing, occupational therapy, pharmacy, physical therapy, and physician assistant students engaged in experiential education during the onset of the COVID-19 pandemic to assess diverse student health professionals' perceptions of the pandemic. Based on the survey results, COVID-19 had a significant impact on students, including concerns for mental health and the quality of experiential education. The majority of students considered themselves to be essential workers, citing their need to learn, and a professional responsibility to serve; others expressed concerns of exposure risk to COVID-19 and use of personal protective equipment when supplies may be limited. Students requested increased communication, transparency, and financial support during the hardship of COVID-19. Educators and administrators should strive to address these concerns at their respective institutions, through dedicated resources to communication, mental health, and financial aid.

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Background: Predicting success in the veterinary curriculum with admissions variables is a longstanding interest of veterinary faculty. As linear models have consistently outperformed experts' opinions when making quantitative estimates, integrating them into admissions could both improve the outcome and reduce the burden of the admissions process. Aims and Objectives: To build and test linear models for predicting first year grade point average (GPA) and practice readiness in the Doctor of Veterinary Medicine (DVM) program. Materials and Methods: The authors built and validated models for predicting first year GPA and clinical rotation performance using data from the college's application management system and internal records. Lasso regression was used to select the subset of variables that best predicted both first year GPA and clinical faculty's ratings of practice readiness. Results: Validated models indicated no application variables reliably predicted practice readiness. Only total undergraduate GPA, GRE verbal/quantitate score, reference letter positivity, and number of unexplained course withdrawals reliably predicted first year GPA. Conclusion: Selecting applicants who will be successful in the first year of the veterinary curriculum is an important objective, particularly given the challenges many students face during this part of the veterinary curriculum. The overarching goal of a veterinary curriculum, however, is to produce practice ready veterinarians, thus additional work must be done to improve our ability to identify applicants who will be poised for success upon graduation.

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Training of veterinary students to improve their ability to respond to disaster events that affect livestock and companion animals is an important facet of veterinary education. Just over 10 years ago, the North Carolina (NC) State University College of Veterinary Medicine worked collaboratively with the NC Department of Agriculture and Consumer Service's Emergency Management Program and the University of North Carolina at Chapel Hill Gillings School of Global Public Health, to develop a competency-based Veterinary Credential Responder (VCR) course. This special report reflects on this experience and provides a detailed description of the current VCR course. The 2-week VCR course combines lecture, online, experiential, and group exercises to meet entry-level federal credentialing requirements. Students gain a working knowledge of emergency management, emergency operation plans, and emergency support functions. Over 1000 veterinary students have received the VCR credential making them eligible to participate as deployable members of NC Veterinary Response Corps.

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Background: Serious games have been increasing in popularity within health sciences education. Games can improve learning by increasing students' engagement and by developing their analytical, critical thinking, and teamwork skills. Objective: The objective of this study was to evaluate the efficacy of a board game to teach applied swine antibiotherapy to veterinary students in their clinical year. Methods: Students were quizzed pre- and postclass to evaluate their knowledge retention. An anonymous seven-question survey was given to the students at the end of class to assess their satisfaction with the board game. Results: Students' quiz scores increased by 1.34 points on average between the beginning and end of class (P = 0.03). Students unanimously enjoyed playing the board game and recommended that it continued to be used in the next iteration of the course. Discussion: Using serious gaming proved to be an enjoyable method of reviewing antibiotherapy and applying it to swine clinical cases in this population of veterinary students. Implementing serious gaming in health sciences education requires a time investment for preparation but provides a richer experience for students and faculty alike.

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Background: There is an identified need for practicing veterinarians with a focus on food animal work in the United States. Students at the University of Minnesota College of Veterinary Medicine track by species (food animal, equine, mixed, and small animal) or discipline (research) in the latter part of their training. Identification of life experiences that are associated with students choosing the food animal track would permit the college to better target admissions to meet societal needs. Aims and Objectives: To identify lifestyle characteristics and activities associated with choice of the food animal track and to evaluate how student choice of track varies across their training. Materials and Methods: Students from three consecutive classes were surveyed to identify factors influencing track choice. Fisher's test was used to compare data and Clopper–Pearson “exact” confidence intervals computed. Results: Students who declared interest in the 1st year in small animal, equine, or food animal as a track were highly likely to choose that at their final track later in the curriculum. Eightyfive percent of students in a food animalfocused early admission track chose the food animal track; the remainder chose the mixed track with cattle as one of their species of interest. Students were more likely to choose the food animal track if their undergraduate major was animal science, if they grew up in a rural area, lived on a farm, were in 4H or were in Future Farmers of America, or had shown or worked horses or cattle, or shadowed a large animal veterinarian. Students valued mentoring from within the college and from outside veterinarians. Conclusions: Knowledge of how students choose their tracks will permit the college better to promote admissions of students who are more likely to track food animal and to plan for adequate clinical year experiences for all students.

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Class rank is a commonly used measure to differentiate talent for potential selection in postgraduate training programs (e.g., medical residency, internship, etc.). However, class ranking is a norm-referenced approach in which students are assessed relative to the performance of their peers. This is in juxtaposition to competency-based/standards-based education which is the norm for most all medical training programs. Further, the education literature has repeatedly articulated reasons why differentiating students based on class rank is both inappropriate and detrimental to student learning. Thus, the purpose of this article is to argue for the abolishment of class ranking across all medical and health professions programs.

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