Healthcare Systems Engineering

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Publisher : John Wiley & Sons
ISBN 13 : 1118971108
Total Pages : 432 pages
Book Rating : 4.1/5 (189 download)

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Book Synopsis Healthcare Systems Engineering by : Paul M. Griffin

Download or read book Healthcare Systems Engineering written by Paul M. Griffin and published by John Wiley & Sons. This book was released on 2016-02-25 with total page 432 pages. Available in PDF, EPUB and Kindle. Book excerpt: Apply engineering and design principles to revitalize the healthcare delivery system Healthcare Systems Engineering is the first engineering book to cover this emerging field, offering comprehensive coverage of the healthcare system, healthcare delivery, and healthcare systems modeling. Written by leading industrial engineering authorities and a medical doctor specializing in healthcare delivery systems, this book provides a well-rounded resource for readers of a variety of backgrounds. Examples, case studies, and thoughtful learning activities are used to thoroughly explain the concepts presented, including healthcare systems, delivery, quantification, and design. You'll learn how to approach the healthcare industry as a complex system, and apply relevant design and engineering principles and processes to advance improvements. Written with an eye toward practicality, this book is designed to maximize your understanding and help you quickly apply toward solutions for a variety of healthcare challenges. Healthcare systems engineering is a new and complex interdisciplinary field that has emerged to address the myriad challenges facing the healthcare industry in the wake of reform. This book functions as both an introduction and a reference, giving you the knowledge you need to move toward better healthcare delivery. Understand the healthcare delivery context Use appropriate statistical and quantitative models Improve existing systems and design new ones Apply systems engineering to a variety of healthcare contexts Healthcare systems engineering overlaps with industrial engineering, operations research, and management science, uniting the principles and practices of these fields together in pursuit of optimal healthcare operations. Although collaboration is focused on practitioners, professionals in information technology, policy and administration, public health, and law all play crucial roles in revamping health care systems. Healthcare Systems Engineering is a complete and authoritative reference for stakeholders in any field.

Healthcare Systems Engineering

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Author :
Publisher : John Wiley & Sons
ISBN 13 : 1118971086
Total Pages : 434 pages
Book Rating : 4.1/5 (189 download)

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Book Synopsis Healthcare Systems Engineering by : Paul M. Griffin

Download or read book Healthcare Systems Engineering written by Paul M. Griffin and published by John Wiley & Sons. This book was released on 2016-03-28 with total page 434 pages. Available in PDF, EPUB and Kindle. Book excerpt: Apply engineering and design principles to revitalize the healthcare delivery system Healthcare Systems Engineering is the first engineering book to cover this emerging field, offering comprehensive coverage of the healthcare system, healthcare delivery, and healthcare systems modeling. Written by leading industrial engineering authorities and a medical doctor specializing in healthcare delivery systems, this book provides a well-rounded resource for readers of a variety of backgrounds. Examples, case studies, and thoughtful learning activities are used to thoroughly explain the concepts presented, including healthcare systems, delivery, quantification, and design. You'll learn how to approach the healthcare industry as a complex system, and apply relevant design and engineering principles and processes to advance improvements. Written with an eye toward practicality, this book is designed to maximize your understanding and help you quickly apply toward solutions for a variety of healthcare challenges. Healthcare systems engineering is a new and complex interdisciplinary field that has emerged to address the myriad challenges facing the healthcare industry in the wake of reform. This book functions as both an introduction and a reference, giving you the knowledge you need to move toward better healthcare delivery. Understand the healthcare delivery context Use appropriate statistical and quantitative models Improve existing systems and design new ones Apply systems engineering to a variety of healthcare contexts Healthcare systems engineering overlaps with industrial engineering, operations research, and management science, uniting the principles and practices of these fields together in pursuit of optimal healthcare operations. Although collaboration is focused on practitioners, professionals in information technology, policy and administration, public health, and law all play crucial roles in revamping health care systems. Healthcare Systems Engineering is a complete and authoritative reference for stakeholders in any field.

Engineering a Learning Healthcare System

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Publisher : National Academies Press
ISBN 13 : 0309224772
Total Pages : 340 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Engineering a Learning Healthcare System by : National Academy of Engineering

Download or read book Engineering a Learning Healthcare System written by National Academy of Engineering and published by National Academies Press. This book was released on 2011-06-14 with total page 340 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

Lean Healthcare Systems Engineering for Clinical Environments

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Publisher : CRC Press
ISBN 13 : 1000385701
Total Pages : 129 pages
Book Rating : 4.0/5 (3 download)

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Book Synopsis Lean Healthcare Systems Engineering for Clinical Environments by : Bohdan Oppenheim

Download or read book Lean Healthcare Systems Engineering for Clinical Environments written by Bohdan Oppenheim and published by CRC Press. This book was released on 2021-05-24 with total page 129 pages. Available in PDF, EPUB and Kindle. Book excerpt: It has been almost 20 years since the Institute of Medicine released the seminal report titled, Crossing the Quality Chasm. In it, the IoM identified six domains of care quality (safe, timely, effective, efficient, equitable, and patient-centric) and noted a huge gap between the current state and the desired state. Although this report received a great deal of attention, sadly there has been little progress in these areas. In the U.S., healthcare still has huge disparities, is inefficient, and is fragmented with delays in care that are often unsafe. Most U.S. citizens are expected to suffer from a diagnostic error sometime during their lifetime, not receive a large fraction of recommended care, and pay for one of the most expensive systems in the world. Much has been written about quality improvement over the years but many prominent quality and safety experts. Yet progress has been slow. Some have called on the healthcare professions to look outside of healthcare to other industries using examples in nuclear power and airlines for safety, the hotel and entertainment industry for a ‘customer’ focus, and the automotive industry, particularly Toyota for efficiency (Lean). This book by Dr. Oppenheim on lean healthcare systems engineering (LHSE) is a fresh approach that brings forth concepts that systems engineers have used in huge national defense projects. What’s unique in this book is that these powerful system engineering tools are modified to be able to address smaller sized healthcare problems that still involve similar problems in fragmentation and poor communication and coordination. This book is an invaluable reference for a new powerful process named Lean Healthcare Systems Engineering (LHSE) for managing workflow and care improvement projects in all clinical environments. The book applies to ambulatory clinics and hospitals of all types including operating rooms, emergency departments, and ancillary departments, clinical and imaging laboratories, pharmacies, and population health. The book presents a generic rigorous but not mathematical step-by-step process of integrated healthcare, systems engineering and Lean. The book also contains the first major product created with the LHSE process, namely tabularized summaries of representative projects in healthcare delivery applications, called Lean Enablers for Healthcare Projects. Each full-page enabler table lists the challenges and wastes, powerful improvement goals, risks, and expected benefits, and some useful descriptions of the healthcare system of interest. The book provides user-friendly solutions to major problems in healthcare delivery operations in all clinical environments, addressing fragmentation, wastes, wrong incentives, ad-hoc and stove-piped management, lack of optimized processes, hierarchy gradient, lack of systems thinking, “blaming and shaming culture”, burnout of providers and many others.

Handbook of Healthcare Delivery Systems

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Publisher : CRC Press
ISBN 13 : 1439803625
Total Pages : 798 pages
Book Rating : 4.4/5 (398 download)

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Book Synopsis Handbook of Healthcare Delivery Systems by : Yuehwern Yih

Download or read book Handbook of Healthcare Delivery Systems written by Yuehwern Yih and published by CRC Press. This book was released on 2016-04-19 with total page 798 pages. Available in PDF, EPUB and Kindle. Book excerpt: With rapidly rising healthcare costs directly impacting the economy and quality of life, resolving improvement challenges in areas such as safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity has become paramount. Using a system engineering perspective, Handbook of Healthcare Delivery Systems offers theoretical foundation

Understanding and Managing the Complexity of Healthcare

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Publisher : MIT Press
ISBN 13 : 0262027518
Total Pages : 297 pages
Book Rating : 4.2/5 (62 download)

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Book Synopsis Understanding and Managing the Complexity of Healthcare by : William B. Rouse

Download or read book Understanding and Managing the Complexity of Healthcare written by William B. Rouse and published by MIT Press. This book was released on 2014-07-03 with total page 297 pages. Available in PDF, EPUB and Kindle. Book excerpt: An argument that understanding healthcare delivery as a complex adaptive system will help us design a system that yields better health outcomes. Breakthroughs in medical science, innovations in medical technologies, and improvements in clinical practices occur today at an increasingly rapid rate. Yet because of a fragmented healthcare delivery system, many Americans are unable to benefit from these developments. How can we design a system that can provide high-quality, affordable healthcare for everyone? In this book, William Rouse and Nicoleta Serban introduce concepts, principles, models, and methods for understanding, and improving, healthcare delivery. Approaching the topic from the perspectives of engineering and statistics, they argue that understanding healthcare delivery as a complex adaptive system will help us design a system that is more efficient, effective, and equitable. The authors use multilevel simulation models as a quantitative tool for evaluating alternate ways of organizing healthcare delivery. They employ this approach, for example, in their discussions of affordability, a prevention and wellness program, chronic disease management, and primary care accessibility for children in the Medicaid program. They also consider possible benefits from a range of technologies, including electronic health records and telemedicine; data mining as an alternative to randomized trials; conceptual and analytical methodologies that address the complexity of the healthcare system; and how these principles, models, and methods can enable transformational change.

Building a Better Delivery System

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Publisher : National Academies Press
ISBN 13 : 030909643X
Total Pages : 277 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Building a Better Delivery System by : Institute of Medicine

Download or read book Building a Better Delivery System written by Institute of Medicine and published by National Academies Press. This book was released on 2005-10-20 with total page 277 pages. Available in PDF, EPUB and Kindle. Book excerpt: In a joint effort between the National Academy of Engineering and the Institute of Medicine, this books attempts to bridge the knowledge/awareness divide separating health care professionals from their potential partners in systems engineering and related disciplines. The goal of this partnership is to transform the U.S. health care sector from an underperforming conglomerate of independent entities (individual practitioners, small group practices, clinics, hospitals, pharmacies, community health centers et. al.) into a high performance "system" in which every participating unit recognizes its dependence and influence on every other unit. By providing both a framework and action plan for a systems approach to health care delivery based on a partnership between engineers and health care professionals, Building a Better Delivery System describes opportunities and challenges to harness the power of systems-engineering tools, information technologies and complementary knowledge in social sciences, cognitive sciences and business/management to advance the U.S. health care system.

Handbook of Industrial and Systems Engineering

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Publisher : CRC Press
ISBN 13 : 1420038346
Total Pages : 766 pages
Book Rating : 4.4/5 (2 download)

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Book Synopsis Handbook of Industrial and Systems Engineering by : Adedeji B. Badiru

Download or read book Handbook of Industrial and Systems Engineering written by Adedeji B. Badiru and published by CRC Press. This book was released on 2005-12-15 with total page 766 pages. Available in PDF, EPUB and Kindle. Book excerpt: Responding to the demand by researchers and practitioners for a comprehensive reference, Handbook of Industrial and Systems Engineering offers full and easy access to a wide range of industrial and systems engineering tools and techniques in a concise format. Providing state of the art coverage from more than 40 contributing authors, many of whom a

M-Health

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Publisher : Springer Science & Business Media
ISBN 13 : 0387265597
Total Pages : 619 pages
Book Rating : 4.3/5 (872 download)

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Book Synopsis M-Health by : Robert Istepanian

Download or read book M-Health written by Robert Istepanian and published by Springer Science & Business Media. This book was released on 2007-01-04 with total page 619 pages. Available in PDF, EPUB and Kindle. Book excerpt: M-health can be defined as the ‘emerging mobile communications and network technologies for healthcare systems.' This book paves the path toward understanding the future of m-health technologies and services and also introducing the impact of mobility on existing e-health and commercial telemedical systems. M-Health: Emerging Mobile Health Systems presents a new and forward-looking source of information that explores the present and future trends in the applications of current and emerging wireless communication and network technologies for different healthcare scenaria. It also provides a discovery path on the synergies between the 2.5G and 3G systems and other relevant computing and information technologies and how they prescribe the way for the next generation of m-health services. The book contains 47 chapters, arranged in five thematic sections: Introduction to Mobile M-health Systems, Smart Mobile Applications for Health Professionals, Signal, Image, and Video Compression for M-health Applications, Emergency Health Care Systems and Services, Echography Systems and Services, and Remote and Home Monitoring. This book is intended for all those working in the field of information technologies in biomedicine, as well as for people working in future applications of wireless communications and wireless telemedical systems. It provides different levels of material to researchers, computing engineers, and medical practitioners interested in emerging e-health systems. This book will be a useful reference for all the readers in this important and growing field of research, and will contribute to the roadmap of future m-health systems and improve the development of effective healthcare delivery systems.

Healthcare Management Engineering: What Does This Fancy Term Really Mean?

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Publisher : Springer Science & Business Media
ISBN 13 : 1461420687
Total Pages : 138 pages
Book Rating : 4.4/5 (614 download)

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Book Synopsis Healthcare Management Engineering: What Does This Fancy Term Really Mean? by : Alexander Kolker

Download or read book Healthcare Management Engineering: What Does This Fancy Term Really Mean? written by Alexander Kolker and published by Springer Science & Business Media. This book was released on 2011-12-02 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Briefs Series book illustrates in depth a concept of healthcare management engineering and its domain for hospital and clinic operations. Predictive and analytic decision-making power of management engineering methodology is systematically compared to traditional management reasoning by applying both side by side to analyze 26 concrete operational management problems adapted from hospital and clinic practice. The problem types include: clinic, bed and operating rooms capacity; patient flow; staffing and scheduling; resource allocation and optimization; forecasting of patient volumes and seasonal variability; business intelligence and data mining; and game theory application for allocating cost savings between cooperating providers. Detailed examples of applications are provided for quantitative methods such as discrete event simulation, queuing analytic theory, linear and probabilistic optimization, forecasting of a time series, principal component decomposition of a data set and cluster analysis, and the Shapley value for fair gain sharing between cooperating participants. A summary of some fundamental management engineering principles is provided. The goal of the book is to help to bridge the gap in mutual understanding and communication between management engineering professionals and hospital and clinic administrators. The book is intended primarily for hospital/clinic leadership who are in charge of making managerial decisions. This book can also serve as a compendium of introductory problems/projects for graduate students in Healthcare Management and Administration, as well as for MBA programs with an emphasis in Healthcare.

Prognostics and Health Management of Engineering Systems

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Publisher : Springer
ISBN 13 : 3319447424
Total Pages : 347 pages
Book Rating : 4.3/5 (194 download)

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Book Synopsis Prognostics and Health Management of Engineering Systems by : Nam-Ho Kim

Download or read book Prognostics and Health Management of Engineering Systems written by Nam-Ho Kim and published by Springer. This book was released on 2016-10-24 with total page 347 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book introduces the methods for predicting the future behavior of a system’s health and the remaining useful life to determine an appropriate maintenance schedule. The authors introduce the history, industrial applications, algorithms, and benefits and challenges of PHM (Prognostics and Health Management) to help readers understand this highly interdisciplinary engineering approach that incorporates sensing technologies, physics of failure, machine learning, modern statistics, and reliability engineering. It is ideal for beginners because it introduces various prognostics algorithms and explains their attributes, pros and cons in terms of model definition, model parameter estimation, and ability to handle noise and bias in data, allowing readers to select the appropriate methods for their fields of application.Among the many topics discussed in-depth are:• Prognostics tutorials using least-squares• Bayesian inference and parameter estimation• Physics-based prognostics algorithms including nonlinear least squares, Bayesian method, and particle filter• Data-driven prognostics algorithms including Gaussian process regression and neural network• Comparison of different prognostics algorithms divThe authors also present several applications of prognostics in practical engineering systems, including wear in a revolute joint, fatigue crack growth in a panel, prognostics using accelerated life test data, fatigue damage in bearings, and more. Prognostics tutorials with a Matlab code using simple examples are provided, along with a companion website that presents Matlab programs for different algorithms as well as measurement data. Each chapter contains a comprehensive set of exercise problems, some of which require Matlab programs, making this an ideal book for graduate students in mechanical, civil, aerospace, electrical, and industrial engineering and engineering mechanics, as well as researchers and maintenance engineers in the above fields.

Systems Engineering

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Publisher : Pearson Education
ISBN 13 : 9780130950857
Total Pages : 392 pages
Book Rating : 4.9/5 (58 download)

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Book Synopsis Systems Engineering by : Richard Stevens

Download or read book Systems Engineering written by Richard Stevens and published by Pearson Education. This book was released on 1998 with total page 392 pages. Available in PDF, EPUB and Kindle. Book excerpt: In an age of shrinking development cycles, it is harder than ever to bring the right product to market at the right time. Good product, especially complex products, is underpinned by good systems, and systems engineering itself is recognised as the key tool to product development. This book covers the principles of systems design in an easy to read format. The authors have decades of practical industrial experience, and the material is ideal for industrial project teams. For academic courses, the book acts as a component for graduate and undergraduate engineering studies, particularly those on systems engineering. It covers how to handle requirements, architectural design, integration and verification, starting from the perspective of a simple linear lifecycle. The book then gradually introduces recent work on the complexity of real world systems, with issues such as multi-level systems, and iterative development. There is also coverage of the impact of systems engineering at the organsational level.

Proceedings of the International Conference on Health Care Systems Engineering

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Publisher : Springer Science & Business Media
ISBN 13 : 3319018485
Total Pages : 313 pages
Book Rating : 4.3/5 (19 download)

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Book Synopsis Proceedings of the International Conference on Health Care Systems Engineering by : Andrea Matta

Download or read book Proceedings of the International Conference on Health Care Systems Engineering written by Andrea Matta and published by Springer Science & Business Media. This book was released on 2013-11-20 with total page 313 pages. Available in PDF, EPUB and Kindle. Book excerpt: The International Conference on Health Care Systems Engineering (HCSE) provided a timely opportunity to discuss statistical analysis and operations management issues in health care delivery systems. The conference took place in Milan between May 22nd and 24th, 2013. Scientists and practitioners discussed new ideas, methods and technologies for improving the operation of health care organizations. The event and this resulting volume emphasize research in the field of health care systems engineering developed in close collaboration with clinicians.​ Topics applicable to researchers and practitioners include: hospital drug logistics, operating theatres, modelling and simulation in patient care and healthcare organizations, home care services.

Architecture and Principles of Systems Engineering

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Publisher : CRC Press
ISBN 13 : 1420072544
Total Pages : 498 pages
Book Rating : 4.4/5 (2 download)

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Book Synopsis Architecture and Principles of Systems Engineering by : Charles Dickerson

Download or read book Architecture and Principles of Systems Engineering written by Charles Dickerson and published by CRC Press. This book was released on 2016-04-19 with total page 498 pages. Available in PDF, EPUB and Kindle. Book excerpt: The rapid evolution of technical capabilities in the systems engineering (SE) community requires constant clarification of how to answer the following questions: What is Systems Architecture? How does it relate to Systems Engineering? What is the role of a Systems Architect? How should Systems Architecture be practiced?A perpetual reassessment of c

Service Systems Engineering and Management

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Publisher : CRC Press
ISBN 13 : 149872308X
Total Pages : 453 pages
Book Rating : 4.4/5 (987 download)

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Book Synopsis Service Systems Engineering and Management by : A. Ravi Ravindran

Download or read book Service Systems Engineering and Management written by A. Ravi Ravindran and published by CRC Press. This book was released on 2018-04-18 with total page 453 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recipient of the 2019 IISE Institute of Industrial and Systems Engineers Joint Publishers Book-of-the-Year Award This is a comprehensive textbook on service systems engineering and management. It emphasizes the use of engineering principles to the design and operation of service enterprises. Service systems engineering relies on mathematical models and methods to solve problems in the service industries. This textbook covers state-of-the-art concepts, models and solution methods important in the design, control, operations and management of service enterprises. Service Systems Engineering and Management begins with a basic overview of service industries and their importance in today’s economy. Special challenges in managing services, namely, perishability, intangibility, proximity and simultaneity are discussed. Quality of service metrics and methods for measuring them are then discussed. Evaluating the design and operation of service systems frequently involves the conflicting criteria of cost and customer service. This textbook presents two approaches to evaluate the performance of service systems – Multiple Criteria Decision Making and Data Envelopment Analysis. The textbook then discusses several topics in service systems engineering and management – supply chain optimization, warehousing and distribution, modern portfolio theory, revenue management, retail engineering, health systems engineering and financial services. Features: Stresses quantitative models and methods in service systems engineering and management Includes chapters on design and evaluation of service systems, supply chain engineering, warehousing and distribution, financial engineering, healthcare systems, retail engineering and revenue management Bridges theory and practice Contains end-of-chapter problems, case studies, illustrative examples, and real-world applications Service Systems Engineering and Management is primarily addressed to those who are interested in learning how to apply operations research models and methods for managing service enterprises. This textbook is well suited for industrial engineering students interested in service systems applications and MBA students in elective courses in operations management, logistics and supply chain management that emphasize quantitative analysis.

Machine Learning and Knowledge Discovery for Engineering Systems Health Management

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Publisher : CRC Press
ISBN 13 : 1439841799
Total Pages : 489 pages
Book Rating : 4.4/5 (398 download)

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Book Synopsis Machine Learning and Knowledge Discovery for Engineering Systems Health Management by : Ashok N. Srivastava

Download or read book Machine Learning and Knowledge Discovery for Engineering Systems Health Management written by Ashok N. Srivastava and published by CRC Press. This book was released on 2016-04-19 with total page 489 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume presents state-of-the-art tools and techniques for automatically detecting, diagnosing, and predicting the effects of adverse events in an engineered system. It emphasizes the importance of these techniques in managing the intricate interactions within and between engineering systems to maintain a high degree of reliability. Reflecting the interdisciplinary nature of the field, the book explains how the fundamental algorithms and methods of both physics-based and data-driven approaches effectively address systems health management in application areas such as data centers, aircraft, and software systems.

Health Systems Science E-Book

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Author :
Publisher : Elsevier Health Sciences
ISBN 13 : 0702070378
Total Pages : 238 pages
Book Rating : 4.7/5 (2 download)

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Book Synopsis Health Systems Science E-Book by : Richard E. Hawkins

Download or read book Health Systems Science E-Book written by Richard E. Hawkins and published by Elsevier Health Sciences. This book was released on 2016-11-30 with total page 238 pages. Available in PDF, EPUB and Kindle. Book excerpt: Developed by the American Medical Association’s Accelerating Change in Medical Education Consortium, Health Systems Science is the first text that focuses on providing a fundamental understanding of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. Along with basic and clinical science, Health Systems Science (HSS) is rapidly becoming a crucial "third pillar" of medical science, requiring a practical, standardized curriculum with an emphasis on understanding the role of human factors, systems engineering, leadership, and patient improvement strategies that will help transform the future of health care and ensure greater patient safety. Complete coverage of the evolving field of HSS includes patient safety, quality improvement, evidence-based medicine, value in health care, interprofessional teamwork, stewardship of health care resources, population management, clinical informatics, care coordination, leadership, and health care financing/reform. Patient improvement strategies incorporates checklists, information technology, team training, and more. A consistent chapter template provides clear coverage of each topic, including Learning Objectives, Chapter Outline, Core Chapter Content, Summary, Questions for Reflection, and Annotated Bibliography and References. Highly relevant content applicable to today’s evolving health care delivery written by experts in key, emerging areas of HSS. Developed in partnership with the AMA’s Accelerating Change in Medical Education Consortium, at the forefront of change and innovation in medical education.