The student is key: A realist review of educational interventions to develop analytical and non‐analytical clinical reasoning ability

Dual-process and dual-system theories in both cognitive and social psychology have been subjected to a number of recently published criticisms. However, they have been attacked as a category, incorrectly assuming there is a generic version that applies to all. We identify and respond to 5 main lines of argument made by such critics. We agree that some of these arguments have force against some of the theories in the literature but believe them to be overstated. We argue that the dual-processing distinction is supported by much recent evidence in cognitive science. Our preferred theoretical approach is one in which rapid autonomous processes (Type 1) are assumed to yield default responses unless intervened on by distinctive higher order reasoning processes (Type 2). What defines the difference is that Type 2 processing supports hypothetical thinking and load heavily on working memory. © The Author(s) 2013.

Although competency-based medical education (CBME) has attracted renewed interest in recent years among educators and policy-makers in the health care professions, there is little agreement on many aspects of this paradigm. We convened a unique partnership - the International CBME Collaborators - to examine conceptual issues and current debates in CBME. We engaged in a multi-stage group process and held a consensus conference with the aim of reviewing the scholarly literature of competency-based medical education, identifying controversies in need of clarification, proposing definitions and concepts that could be useful to educators across many jurisdictions, and exploring future directions for this approach to preparing health professionals. In this paper, we describe the evolution of CBME from the outcomes movement in the 20th century to a renewed approach that, focused on accountability and curricular outcomes and organized around competencies, promotes greater learner-centredness and de-emphasizes time-based curricular design. In this paradigm, competence and related terms are redefined to emphasize their multi-dimensional, dynamic, developmental, and contextual nature. CBME therefore has significant implications for the planning of medical curricula and will have an important impact in reshaping the enterprise of medical education. We elaborate on this emerging CBME approach and its related concepts, and invite medical educators everywhere to enter into further dialogue about the promise and the potential perils of competency-based medical curricula for the 21st century.