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"Wilkinson, Tim"
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Learning to care, caring to learn: the evolving nature of medical education
As Otago Medical School marks its 150th anniversary, this paper reflects on what it means to train doctors for both today and the decades ahead. It traces the school’s evolution from its nineteenth-century foundations through key innovations in curriculum, clinical training and rural health, highlighting the ongoing balance between tradition and change. While early efforts mirrored global trends, Otago has grown into a leader in areas such as assessment, interprofessional education and Indigenous health. This paper explores future challenges including competency-based education, personalised learning and the integration of artificial intelligence, arguing that these developments must be grounded in enduring values: professionalism, teamwork and community engagement. The central task remains unchanged: to train doctors who are not only knowledgeable and skilled, but also compassionate and committed to those they serve.
Journal Article
Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date
This review summarizes the published clinical studies concerning the management of irritable bowel syndrome (IBS) using restriction of Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyols in the diet (low FODMAP diet). In recent years, the data supporting low FODMAP diet for the management of IBS symptoms have emerged, including several randomized controlled trials, case-control studies, and other observational studies. Unlike most dietary manipulations tried in the past to alleviate gastrointestinal symptoms of IBS, all studies on low FODMAP diet have consistently shown symptomatic benefits in the majority of patients with IBS. However, dietary adherence by the patients and clear dietary intervention led by specialized dietitians appear to be vital for the success of the diet. Up to 86% of patients with IBS find improvement in overall gastrointestinal symptoms as well as individual symptoms such as abdominal pain, bloating, constipation, diarrhea, abdominal distention, and flatulence following the diet. FODMAP restriction reduces the osmotic load and gas production in the distal small bowel and the proximal colon, providing symptomatic relief in patients with IBS. Long-term health effects of a low FODMAP diet are not known; however, stringent FODMAP restriction is not recommended owing to risks of inadequate nutrient intake and potential adverse effects from altered gut microbiota. In conclusion, the evidence to date strongly supports the efficacy of a low FODMAP diet in the treatment of IBS. Further studies are required to understand any potential adverse effects of long-term restriction of FODMAPs.
Journal Article
Understanding the gap: a balanced multi-perspective approach to defining essential digital health competencies for medical graduates
Background
Rapid technological advancements have left medical graduates potentially underprepared for the digital healthcare environment. Despite the importance of digital health education, consensus on essential primary medical degree content is lacking. Focusing on core competence domains can address critical skills while minimising additions to an already demanding curriculum. This study identifies the minimum essential digital health competency domains from the perspectives of learners, teachers, and content experts aiming to provide a framework for integrating digital health education into medical curricula.
Methods
We conducted focus groups with students (
n
= 17), and semi-structured interviews with medical educators (
n
= 12) and digital sector experts (
n
= 11) using video conferencing. Participants were recruited using purposive sampling. The data were analysed using framework analysis and inductive thematic analysis to identify common themes.
Results
Four core themes and eleven sub-themes were identified and aggregated into four essential competency domains: “Understand the Local Digital Health Ecosystem and Landscape”, “Safe, Secure and Ethical Information Literacy and Management”, “Proficiency in Digital Health Tools and Associated Technologies” and “Scholarly Research and Evidence-based Practice”. Medical educator and digital sector expert participants provided the greatest source of data for curriculum content consideration. Students demonstrated varying levels of aptitude, confidence, and interest in technology.
Conclusion
Our balanced engagement with learners, educators, and digital health experts enabled the identification of a context-relevant framework for the minimum essential digital health competence domains for graduating medical students. The identification of focused, clinically relevant core competencies makes them amenable to integration into an existing curriculum tailored to local contexts. This approach addresses limitations of restricted curricular space and accommodates varying student interests, confidence and aptitude in technology. The delivery approach should consider a student-centred adaptive modality that takes advantage of advances in artificial intelligence (AI) as an effective pedagogical tool.
Journal Article
Towards a conceptualisation of collaborative decision-making within interprofessional collaborative practice: a concept analysis using scoping review methodology
Background
Collaborative decision-making is a term used when patient care decisions are shared between health workers of different backgrounds. Yet, current definitions of collaborative decision-making do not consistently describe the actions involved in the decision-making process or how the term relates to similar terms. This situation makes learning, teaching, and researching this concept difficult. Therefore, this review aims to clarify the concept of collaborative decision-making within interprofessional collaborative practice.
Methods
Scoping review methodology was used to identify and select relevant literature. Four databases, were searched between Jan 2022 and December 2024 and included peer-reviewed articles that defined, described, or conceptualised collaborative decision-making or related terms. Extracted data were analysed with a concept analysis approach to develop a conceptualisation.
Results
Thirty-seven articles were analysed. Collaborative decision-making was conceptualised as a dynamic and iterative social and cognitive process involving two or more participants from different backgrounds who prioritise their time to discuss and agree on the next steps in patient care. This process includes four core actions: (1) sharing profession specific knowledge and perspectives, (2) integrating knowledge and perspectives to create new and shared knowledge, (3) deliberating over options, and (4) negotiating differences to reach agreement.
Discussion
This conceptualisation clarifies collaborative decision-making as a unifying term for how decisions are shared within interprofessional collaborative practice. It shows that many related terms draw on a common conceptual base. It therefore offers educators a language and framework for making collaborative decision-making explicit to learners and provides researchers with greater conceptual clarity.
Conclusion
This review produced a contemporary conceptualisation of collaborative decision-making for others to use when learning, teaching and researching this key component of interprofessional collaborative practice.
Journal Article
Student progress decision-making in programmatic assessment: can we extrapolate from clinical decision-making and jury decision-making?
Background
Despite much effort in the development of robustness of information provided by individual assessment events, there is less literature on the aggregation of this information to make progression decisions on individual students. With the development of programmatic assessment, aggregation of information from multiple sources is required, and needs to be completed in a robust manner. The issues raised by this progression decision-making have parallels with similar issues in clinical decision-making and jury decision-making.
Main body
Clinical decision-making is used to draw parallels with progression decision-making, in particular the need to aggregate information and the considerations to be made when additional information is needed to make robust decisions. In clinical decision-making, diagnoses can be based on screening tests and diagnostic tests, and the balance of sensitivity and specificity can be applied to progression decision-making. There are risks and consequences associated with clinical decisions, and likewise with progression decisions.
Both clinical decision-making and progression decision-making can be tough. Tough and complex clinical decisions can be improved by making decisions as a group. The biases associated with decision-making can be amplified or attenuated by group processes, and have similar biases to those seen in clinical and progression decision-making.
Jury decision-making is an example of a group making high-stakes decisions when the correct answer is not known, much like progression decision panels. The leadership of both jury and progression panels is important for robust decision-making. Finally, the parallel between a jury’s leniency towards the defendant and the failure to fail phenomenon is considered.
Conclusion
It is suggested that decisions should be made by appropriately selected decision-making panels; educational institutions should have policies, procedures, and practice documentation related to progression decision-making; panels and panellists should be provided with sufficient information; panels and panellists should work to optimise their information synthesis and reduce bias; panellists should reach decisions by consensus; and that the standard of proof should be that student competence needs to be demonstrated.
Journal Article
Career outcomes of students of an intercalated MBChB/PhD : experience from New Zealand
Reports on the career choices and academic accomplishments of MBChB/PhD students at the University of Otago 17 years after the programme’s introduction. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.
Journal Article