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Conclusions: To achieve a satisfactory confidence level for medical externs in performing essential procedures, learning resources should be adequately provided so that each essential procedure is performed in a minimum of 5 to 10 cases.
Take-home messages: To learn to perform essential manual skills with confidence, at least 5 to 10 cases are required for medical students before graduation.
Discovering stigma through recovery teaching
Sarah E Gordon (University of Otago, Wellington, Dept of Psychological Medicine, Wellington, New Zealand) Mark A. Huthwaite (University of Otago, Wellington, Dept of Psychological Medicine, Wellington, New Zealand)
Pete M. Ellis (University of Otago, Wellington, Psychological Medicine, PO Box 7343, Wellington South 6023, New Zealand)
Background: Most English-speaking countries endorse the Recovery Model as central to mental health service delivery. Recovery is supported by: minimising the impact of mental illness through supporting individuals to frame (make sense of the experience) and self-manage; and maximising well-being by supporting individuals to develop a positive identity and valued social roles and relationships. To achieve this, clinicians need to gain the necessary skills, attitudes and knowledge to support recovery. Summary of work: During a quantitative review of the impact of two seminars on recovery, using the Recovery
Attitudes Questionnaire, qualitative observations were informally collated.
Summary of results: Initial openness to recovery concepts prior to a clinical rotation was generally later replaced by scepticism about their clinical application. Clinicians frequently contributed to this change. Students displayed considerable stigma about mental illness and found it hard to identify with patients. These attitudes were openly expressed to the tutor leading the recovery seminars, who openly identified as a mental health consumer, but not in formal assessments with other academic staff.
Conclusions: Students (and clinicians) may use 'professional distance' to avoid being overwhelmed by their own emotional reaction to their work, but this can reinforce stigmatizing attitudes. These are more prevalent in inpatient units. Many inpatient clinical placements may reinforce stigma about mental health consumers and undermine teaching about recovery. Take-home messages: Explicitly explore stigmatizing attitudes - or they will remain invisible. Most mental health services, and recovery, happen in the community - so promote teaching there.
The McGill Illness Narrative Interview as a part of medical intern students' experience in Family Medicine
Daniela Freitas Bastos (Federal University of Rio de Janeiro (UFRJ), Internal Medicine, Rio de Janeiro, Brazil) Caio Faria Maia (Federal University of Rio de Janeiro (UFRJ), Faculty of Medicine, Rio de Janeiro, Brazil) Carolina Cardia Gazineu (Federal University of Rio de Janeiro (UFRJ), Faculty of Medicine, Rio de Janeiro, Brazil)
Alicia Navarro de Souza (Federal University of Rio de Janeiro (UFRJ) - Faculty of Medicine, Psychiatry and Forensic Medicine, Rua Viuva Lacerda 433 apt 202, Rio de Janeiro 22261-050, Brazil)
Background: Considering the tradition of biomedical model and training hospital care, illness experience comprehension by medical students needs to be enhanced. This is particularly valued in primary care, in which people's participation in health promotion and rehabilitation is strategic.
Summary of work: We chose McGill Illness Narrative Interview (MINI) to enable medical intern students to understand illness experience. Eleven students, previously trained, performed 29 MINI in primary care scenario. We conducted semistructured interviews with them before and after eight weeks of Family Medicine internship. Data was examined using thematic content analysis.
Summary of results: Students realized that they became more resourceful applying MINI. However, considering a significant number of patients with difficult compliance, the students believe that they do not adhere to treatment due to inability to handle the information provided about their disease.
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Conclusions: Within current biomedical undergraduate training, after eight weeks listening to experiences of patients, they were not able to modify the ordinary representation of patients' incapacity to understand provided information about their disease, which is the reason they do not comply properly with medical treatment. Appreciation of illness and treatment experience associated with biomedical knowledge about disease have been proved useful, however they are not capable of transforming preconceptions acquired over many years in medical education hegemonic model. Take-home messages: In primary care context, physician-patient relationship tends to reshape favoring illness experience narrated by the patient to the medical doctor. The biomedical model approach, prevalent in medical education, appears insufficient to recognize the complex and multidimensional illness nature.
Patient-centered Medicine - how to learn what we think we already know
Rosa Malena Delbone Faria (Jose do Rosario Vellano University and Federal University of Minas Gerais, Medical Education, Groenlandia, 212/1402, Sion, Belo Horizonte, Minas Gerais 30320060, Brazil) Antonio Carlos de Castro Toledo Jr (Jose do Rosario Vellano University, Medical Education, Belo Horizonte, Brazil)
Alexandre Sampaio Moura (Jose do Rosario Vellano University, Medical Education, Belo Horizonte, Brazil) Jose Roberto Faria (Federal University of Minas Gerais, Internal Medicine, Belo Horizonte, Brazil) Maria Goretti Frota Ribeiro (Foundation for Advancement of International Medical Education and Research, Medical Education, Fortaleza, Brazil) Eliana Amaral (Foundation for Advancement of International Medical Education and Research, Medical Education, Campinas, Brazil)
Background: Patient-centered medicine (PCM) has 4 dimensions: patient as a person; patient empowerment; therapeutic alliance building, and physician as a person. The aim of this study was to assess medical teachers' and students' own perception on patient-centered attitudes, contrasting with patients' perception. Summary of work: In a cross-sectional study, a 20 items self-administered questionnaire (Likert scale) with four PCM domains was developed to evaluate medical teachers' (MT) and students' (MS) perceptions on their skills and attitudes. It had 2 versions, one for MT and MS (self-evaluation), and another for patients. Teachers, students, and patients were paired and data analysis compared percentage of totally agree/agree for each question and general average. All participants signed an informed-consent form before study admission. Summary of results: The final sample had 45 teachers, 93 students and 93 patients. There was a little variation between teachers' and students' self-evaluation (totally agree/agree 95.5% versus 96.6%), and between patients' evaluation of teachers' and students' (totally agree/agree 88.8% versus 87.1%). The difference
between teachers' self-evaluation and patients' evaluation were 6.7 percentage points, and the difference for students was 9.5 percentage points. The largest difference was observed for the "physician as a person" domain, but the domain with a large number of statistical significant differences was "patient empowerment" (6/10 questions). Conclusions: Despite the high scores of patients' evaluations, there were significant differences between self-evaluation and patients' evaluation, mainly in the "patient empowerment" domain, indicating that teachers' and students' attitudes may improve towards a more patient-centered care. Take-home messages: The teacher cannot forget the role model he has.
The McGill Illness Narrative Interview experience of Family Medicine Internship students approaching patients presenting medically unexplained symptoms
Helio Antonio Rocha (University of Rio de Janeiro, Psychiatry Institute, Rua Machado de Assis 31/ 514, Flamengo, Rio de Janeiro 22220060, Brazil) Paula Schettino Rigolon (Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, Brazil) Marcela Gaiotti Marques (Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, Brazil) Alicia Navarro de Souza (Federal University of Rio de Janeiro, Faculty of Medicine, Rio de Janeiro, Brazil)
Background: Patients presenting medically unexplained symptoms (MUS) are frequent at primary care. "Disease-centered" medical education doesn't allow students to achieve enough competence on psychosocial approach demanded by them. MUS brings to clinical practice the complexity of illness experience beyond biomedical model.
Summary of work: The McGill Illness Narrative Interview (MINI) is a semistructured interview schedule to explore illness experience narratives. Students attending Family Medicine Internship were trained and used this guide to address patients with MUS in primary care. Seventeen interviews conducted by interns were recorded and examined using thematic analysis. Summary of results: Interviews lasted on average 40 minutes. Most students negotiated the health problem with their interviewees who elaborated more easily narratives. The ones who didn't negotiate found difficulties to elicit stories. Another difficulty was the attempt to perform anamnesis, in a way abandoning MINI questions. Few students could use interviewees' MINI data for clinical management. Conclusions: The doctor-patient communication is frequently considered a medical skill. The physician must be able to make himself understood and to extract information from patient's disease. The comprehension of illness experience could provide additional information to clinical reasoning. The data suggested that medical students using MINI better understood the psychosocial determinants of disease in these patients.
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
In some cases, it was possible to develop a therapeutic plan beyond medication.
Take-home messages: Patients with MUS represent about 30% of all primary care appointments. "Disease-centered" medical education brings not enough competence on approaching patients. The use of MINI by medical students provide better comprehension on patients illness experience; it may lead to a therapeutic plan beyond medication.
Direct observation study at out-patient setting improve medical students' clinical skill
Chaiwat Washirasaksiri (Faculty of Medicine Siriraj
hospital, Medicine, 2 Prannok road, Siriraj, Bangkok Noi,
2 Bangkok 10700, Thailand)
Varalak Srinonprasert (Faculty of Medicine Siriraj
hospital, Medicine, Bangkok, Thailand)
Praveena Chiowchanwisawakit (Faculty of Medicine
Siriraj hospital, Medicine, Bangkok, Thailand)
Krittiya Korphaisarn (Faculty of Medicine Siriraj hospital,
Medicine, Bangkok, Thailand)
Ranittha Ratanarat (Faculty of Medicine Siriraj hospital, Medicine, Bangkok, Thailand)
Background: Direct observation study (DOS) is the teaching method where a mentor provides direct supervision and gives feedback to the learner in realtime manner. Previous studies showed that DOS improves patient care and trainees' clinical skill but is difficult to implement.
Summary of work: DOS was introduced for the whole class of 5th year medical students throughout the year at out-patient setting department of Medicine, Siriraj Hospital in 2012. DOS sessions were provided during the first few patients' encounters. Students' performance at out-patients clinics were rated for other 8 subsequence sessions. The average score were compared to 5th year students in 2011 (Conventional technique, CT). Summary of results: Two hundred forty six students were supervised in DOS group. Mean score of students received DOS was significantly higher than CT group with score of 8.2 compared to 7.9, respectively (p <0.001). With respect to students' satisfaction, 75% of students rated DOS as a learning method with high to very high benefit.
Conclusions: DOS method improved students' performance with good satisfaction from medical students.
Take-home messages: Direct observation study is feasible to implement for a large group of medical students and leads to better clinical skills. It should be arranged in several essential clinical skills for medical students.
Cross-cultural validation of the Patient-Practitioner Orientation Scale (PPOS)
Claudia Pereira (Federal University of Uberlandia, Anesthesiology, Praga Clarimundo Carneiro, 68, aptp 102, centro Uberlandia 38400-154, Brazil) Helena Paro (Federal University of Uberlandia, Gynecology and Obstetrics, Uberlandia, Brazil) Carlos Silva (Federal University of Uberlandia, Pediatrics, Uberlandia, Brazil)
Background: Patient-centered clinical practice is a holistic concept in which components interact and unite in a unique way in each patient doctor encounter. It has been considered crucial to high-quality health care. In this approach, assessing such attitudes has become increasingly important in the context of health care and medical education. The Patient-Practitioner Orientation Scale (PPOS) is an instrument originally designed to assess physicians', medical students' and patients' attitudes toward their roles in medical care. We aimed to translate, adapt and validate the PPOS for use in Brazil.
Summary of work: The PPOS was translated to Portuguese using a modified Delphi technique. The translated version of the scale was pre-tested in 37 participants. The final version was applied to 360 participants (medical students, residents and patients). Reliability (test-retest and internal consistency) and construct validity (explanatory and confirmatory factor analysis) were assessed.
Summary of results: Only two items did not reach pre-established criteria agreement in Delphi technique. In pre-testing, seven items were modified. Internal consistency and test-retest reliability were adequate. In explanatory factor analysis, one item did not achieve a loading factor, one item was considered factorially complex and two items were inconsistent with a priori factors. Confirmatory factor analysis provided an acceptable adjustment for the observed variables. Conclusions: PPOS Brazilian version (B-PPOS) showed acceptable validity and adequate reliability. Take-home messages: The use of the B-PPOS in national and cross-cultural studies may contribute to the evaluation and monitoring of the attitudes of doctors, medical students and patients toward their professional relationships in research and practice.
Factors affecting CRQ scores of fifth year medical students
Hansa Chairasamee (Faculty of Medicine Ramathibodi Hospital, Mahidol University, Pediatrics, Bangkok 10400, Thailand)
Rungtip Boonsri (Faculty of Medicine Ramathibodi Hospital, Mahidol University, Pediatrics, Bangkok 10400, Thailand)
Samart Pakakasama (Faculty of Pediatrics Ramathibodi Hospital, Mahidol University, Pediatrics, Rama VI Road, Bangkok 10400, Thailand)
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Background: During a 5-week pediatric rotation, the 5th year medical students (MS) had learning experiences at general out patient department (OPD), and in patient department (IPD) including neonatal and general wards. Constructed response question (CRQ) was scheduled at the end of rotation. The harder work in the IPD units may consume time for studying before the exam leading to lower CRQ scores in this group. Therefore, we conducted this study to evaluate whether sequence of learning places affecting CRQ scores or not. Summary of work: Data including gender, grade point average (GPA), last service before the exam (OPD or IPD), and CRQ scores of each MS between 2007 and 2011 was collected. We compared the CRQ scores between OPD and IPD groups. Summary of results: A total of 657 MS (289 M: 368 F) were divided into OPD (319) and IPD (338) groups. The mean CRQ scores of OPD and IPD groups were 267.85 and 263.34 (total of 400), respectively (p<0.001). Female MS did significantly better scores than male MS in both groups. The higher GPA was significantly associated with the greater scores in both groups. The MS within highest GPA (>3.5-4) range had no different mean scores between OPD and IPD groups (289.25 and 289.5, respectively).
Conclusions: Factors associated with greater CRQ scores were female, OPD service before the exam, and high
Take-home messages: Learning place before taking CRQ exam may affect the scores. MS should be advised to study consistently through the rotation.
A pilot study to assess whether patient submitted media data could help educate medical professionals and students about the varying presentations of different conditions within gynaecology
Charlotte Lake (Imperial College London, School of Medicine, London, United Kingdom)
Background: Smartphone photography and other media forms are increasingly being used by patients to demonstrate severity of conditions that may fluctuate or pass by the time of consultation. Students have reported that these images can improve understanding of the varying nature of different conditions. During an obstetrics and gynaecology rotation at Northwick Park Hospital, the use of data from smartphones and other devices for educational purposes was assessed. Summary of work: Two sets of questionnaires were distributed either to patients (n=14) or medical students and doctors (n=18). The questionnaires contained 5 point Likert scales assessing whether smartphones and other media data devices have any role to play in medical education. Further questions addressed current use of smartphones in medical consultations. Summary of results: 92.9% of patients either agreed or strongly agreed that smartphone photography and other media devices could help educate doctors and medical students about the varying natures of different
conditions. 66.7% of doctors or medical students either agreed or strongly agreed that this could be an educational aid. Furthermore, 85.7% of patients indicated that they would consent to their personal images being used for clinical or educational purposes. Conclusions: The majority of patients, medical students and doctors felt that smartphone photography and other media devices could aid education of the varying presentations of conditions within gynaecology. Take-home messages: Smartphone photography and other media devices have the potential to benefit education of medical professionals and students, even within the sensitive setting of gynaecology outpatients.
Encouraging medical students' self-directed learning during paediatric clerkship
Ann-Margrethe Roenholt (Regional Hospital Viborg, Paediatric Department, Heibergs Alle'4 Viborg 8800, Denmark)
Thomas Balslev (Aarhus University, Paediatric department, Aarhus, Denmark)
Background: Self-directed learning is integral to medical professionalism - but how do we best encourage its development in medical students during their paediatric clerkship?
Summary of work: We introduced a compulsory assignment for all medical students. Each of them is required to find an authentic clinical problem and illustrate the result through literature studies and moreover present the results verbally for all the doctors within the department. Through focus group discussions we identified strengths and weakness with this initiative from specialists, residents and medical students' point of view.
Summary of results: All groups revealed that the medical students learned to search for concrete literature prompted by a clinical problem. They got more experience in communicating this new knowledge to and in front of future colleagues. Their self-efficacy beliefs increased when they experienced that other colleagues learned something from their presentation of the results. Some doctors mentioned that often a new side of the concrete problem arose, which encouraged them to do more research of the subject by themselves. The specialists were aware that they play a key role in ensuring a comfortable environment for the students when they give their presentation. The students felt comfortable with the assignment. A few mentioned that the assignment could be time-consuming. Conclusions: Both students and doctors discovered that the students have developed their skills in self-directed learning and strengthen their self-efficacy. A supportive and positive educational environment is however a prerequisite for success.
Take-home messages: Medical students' self-directed learning can be encouraged through an obligatory, structured assignment. The students, residents and staff may benefit.
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
The acceptability of patients towards medical students in Korea
Sung Eun Kim (Chung-Ang, University College of Medicine, Emergency Medicine, 221 Heukseok-Dong Dongjak-Ku, Chung-Ang University Hospital, Seoul 156756, Korea, Republic of (South Korea)) Chan Woong Kim (Chung-Ang University College of Medicine, Emergency Medicine, Seoul, Korea, Republic of (South Korea))
Sang Jin Lee (Chung-Ang University College of Medicine, Emergency Medicine, Seoul, Korea, Republic of (South Korea))
Dong Hoon Lee (Chung-Ang University College of Medicine, Emergency Medicine, Seoul, Korea, Republic of (South Korea))
Background: Bedside teaching is fundamental to medical student education. With increased perception of patients' rights and informed consent, it leads to difficulty in training students if patients decline their involvement and hesitation of students to encounter with patients. This study aimed to explore the acceptability of patients towards medical students during medical visit and to explore possible implications applicable to bedside teaching. Summary of work: 33-questions, self-administered structured questionnaire of 483 who visited the hospital and ordinary person who are not patients were analyzed.
Summary of results: The respondents agreed with history taking(65.1%), observation(60.8%) and examination without physical exposure(56.5%) compared to physical examination with physical exposure. The respondents agreed with neck(68.5%) and abdomen(55.4%) compared to chest, breast, and rectum in physical examination items. They showed higher acceptance of students in the items of measurement of blood pressure(83.6%) and electrocardiogram(71.3%), wound dressing(71.7%) and taking consent(57.9%) compared to drawing of blood, wound repair, splinting, urethral catheterization and spinal tapping in procedure items. Majority of the respondents answered that prior consent is required in all steps of involvement for medical students. Experience and competence level of students and the presence of supervisor were the most important factor in the patients' agreement. In particular, female and younger age of patients appeared to affect the degree of acceptance. Conclusions: The acceptability of patients towards medical students was not high especially in physical examination with physical exposure and invasive procedure. Prior consent for medical student participation could be requested. Take-home messages: We should consider patients' rights and acceptability towards medical students for bedside teaching.
Improving Clerkship Teaching methods using Student Feedback
S J Im (Pusan National University School of Medicine, Medical Education Unit, Yangsan, Korea, Republic of (South Korea))
S Y Beak (Pusan National University School of Medicine, Medical Education Unit, Yangsan, Korea, Republic of (South Korea))
J S Woo (Pusan National University School of Medicine, Medical Education Unit, Yangsan, Korea, Republic of (South Korea))
S Y Lee (Pusan National University School of Medicine, Medical Education Unit, Yangsan, Korea, Republic of (South Korea))
(Presenter: B S Kam, Pusan National University School of Medicine, Medical Education Unit, Pa Ma Ri, Mulkm Eb, Pusan National University School of Medicine, Yangsan 621, Korea, Republic of (South Korea))
Background: Alerting clerkship directors of learners' view from particular content of clerkship is necessary in order to improve teaching skills. For now no feedback system is yet available for this particular setting. Summary of work: Each student in a rotation team having time schedule for a clerkship, learns a lesson. To get to know how much a student learns of this particular content we compare knowledge of student, before and after each clerkship. A checklist of learned content which is to be taught by directors is provided to the system by clerkship directors. Accordingly that would be a memo list for students to be filled up. A web based system schedules the feedback for each student before they get to know their scores. Summary of results: We gathered and evaluated contents for total 200 groups (each of 3 students) and 36 clerkships in two rotation times (2 years). Surprisingly by measuring statistics we saw improvement in clerkship teaching method. We had clerkship in 2009 measured 3.2/5, same clerkship measured at 2010 3.8/5 and year later at 2010 to 4.2/5.