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Background: Quality improvement is one of the core contents in business schools and business administration programs. Nowadays, practice-based learning and improvement is listed as one of 6 competency domains for graduate medical education.
To introduce the concept early in medical training is important.
Summary of work: We have conducted a quality improvement program (known as A to A+) for 4 years for medical students of year 1 or 2. The program is composed of 8 interactive lectures and 8 weeks of small group tutorials. The lectures cover the aspects of principle of priority setting, time management, PDCA (plan-do-check-action) theory, SWOT (strength-weakness-opportunity-threat) analysis, quality management, learning theory, research quality and patient care quality. Students are then assigned into small groups with tutors. They can practice applying knowledge learned on a self-determined project to demonstrate the improvement in quality. Summary of results: This program has been listed in the top 3 most popular courses in our university since its launch. Students gave positive feedbacks on the effectiveness of learning, including the improvement of academic marks or extracurricular activities. Over 20 projects have been introduced through the program in the 4 years.
Conclusions: Quality management concepts are important in modern medical education. The key concepts of quality management can be effectively taught through interactive lectures and small group tutorials.
Take-home messages: Quality improvement concept is a core element in competency of medical education. Introducing the learning early in medical education is beneficial for both academic achievement and extracurricular activity success. Long term follow-up is mandatory to prove its effectiveness in future clinical practices.
Factors associated with knowledge and attitude towards palliative and end of life care in medical students in Thailand
Saranya Prathaithep (Sanpasitthiprasong Hospital, Medicine, 285 Satholamark Road, Sansook District, Varinchamrab, Ubon Ratchathani 34190, Thailand) Parinya Chamnan (Sanpasitthiprasong Hospital, Social Medicine, Ubon Ratchathani, Thailand)
Background: Palliative and end of life care recently has been taught in clinical year medical students in Sanpasitthiprasong hospital. The present study aimed to examine the theoretical knowledge and attitude in palliative and end of life care among clinical year medical students, and to examine factors associated with their knowledge and attitude. Summary of work: 79 4th-6th year medical students were invited to answer the self-administered questionnaire, which included information on students' characteristics, experience caring relatives who were dying, theoretical knowledge and attitude towards palliative and end of life care. Experience of caring of their dying relatives was presented in percentages. Median (interquartile range, IQR) knowledge and attitude scores, and high score was defined as more
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than 80% of total score. Factors associated with the knowledge and attitude was examined using logistic regression.
Summary of results: The median age (IQR) of the students was 23.5 (23.0-24.5) years, with 42% being male. 29 students (37%) reported having cared for their relatives who were dying. The median knowledge score (IQR) was 4 (3-5) out of 8. The median attitude score (IQR) was 38 (34-40) out of 50. Eight students (10.1%) and 28 students (35.4%) had high knowledge and attitude scores respectively. Having had dying relatives and experience of caring for the relatives who were dying were not associated with the knowledge and attitude (p > 0.05).
Conclusions: Students' knowledge in palliative and end of life care was moderate, while their attitude was fairly good. The experience of caring for the relatives who were dying was not linked to students' knowledge and attitude. The highest scores observed in Year 4 might be explained by the fact that interactive class and community based learning for palliative and end of life care was mainly in Year 4.
Take-home messages: Palliative and end of life care should be included in formal curriculum.
Clinical Ethics at the Ward: Discussing End-of-Life Decisions with Residents and Students in a Brazilian University Hospital
Marcelo Schweller (UNICAMP, Emergency, Campinas, Brazil)
Diego Ribeiro (UNICAMP, Emergency, Campinas, Brazil) Daniel Franci (UNICAMP, Emergency, Campinas, Brazil) Thiago Santos (UNICAMP, Emergency, Campinas, Brazil) Flavio Sa (UNICAMP, Clinical Ethics, Campinas, Brazil) Marco Antonio Carvalho Filho (UNICAMP, Emergency, Campinas, Brazil)
Background: The increasing life expectancy of the population carries a higher prevalence of chronic-degenerative diseases and neoplasms, which imposes the need for the doctor to deal with issues related to death and with end-of-life care. Undergraduate medical students and residents have little experience with these issues, which amplifies personal difficulties related to the theme.
Summary of work: Undergraduate medical students and residents of an intensive care unit and an internal medicine ward of a Brazilian university hospital participated in a weekly meeting of clinical ethics, during 1 month, throughout the year of 2012. At each meeting, they presented one of their actual clinical cases, with issues related to terminal illness. The group discussed the cases following a script of clinical ethics that covers the clinical situation, the patient's point of view, the quality of life and legal aspects, searching for conclusions and decisions. Participants were encouraged to give their opinion and share with the group their feelings brought by the case, which often occurred in an intense and emotional way.
Summary of results: Students and residents showed increased awareness about the need to deepen the knowledge and understanding of patients and their families. Over the weeks, they have shown greater serenity to discuss the issue and make decisions related to terminal illness.
Conclusions: Issues related to terminal illness and palliative care have great importance in day-to-day medical practice and there is a need for students and residents to discuss and reflect about it. Take-home messages: The medical curriculum should include specific time for the discussion of end-of-life care.
Poor pain management: Education failure or unchangeable attitudes?
Emma Casely (Hillingdon Hospital, Anaesthetics, Pield Heath Road, Uxbridge, London UB8 3NN, United Kingdom)
Helen Laycock (Imperial College, Anaesthetics, Pain Management and Intensive Care, London, United Kingdom)
Rosada Davey (Imperial College, Anaesthetics, Pain Management and Intensive Care, London, United Kingdom)
Carsten Bantel (Imperial College, Anaesthetics, Pain Management and Intensive Care, London, United Kingdom)
Background: Junior doctors are first responders to acute pain in hospital, yet suboptimal management is widespread (Helfand and Freeman 2009). Is inadequate treatment a consequence of educational failure or inbuilt attitudes that are unaltered by experience and training?
Summary of work: Thematic analysis (Kruger and Casey 2000) of two scripted focus groups, discussing acute pain management. a) Doctors within 6 months of graduation (n=7) b) Medical students, recently completed first clinical placement (n=7). Summary of results: Three common themes emerged. HELPLESSNESS - Repeated expression of helplessness in managing patients in pain. PAIN VALIDITY - The "deserving" versus "undeserving" patient, with some types of pain perceived as more "valid". A suggestion it is socially preferable not to complain about pain. POOR KNOWLEDGE - Of drugs, dosing and practicalities of administration. Only small differences in understanding between groups, with experiential learning identified as influential. Differences; Medical students expected a habituation to seeing patients in pain would develop with time, but had major concerns regarding opioid addiction. Junior doctors expressed feelings of irritation towards patients in pain, an acceptance of the inevitability of treatment failure and insight into seeing pain as a low clinical priority. Conclusions: Attitudes to pain management are not fixed and appear to develop, hardening with training. Large gaps in knowledge may contribute to this, themes of helplessness and social constructs of pain validity.
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Both knowledge and attitudes regarding pain management evolve and are prime targets for educational intervention.
Take-home messages: Pain management education at undergraduate and postgraduate level should address knowledge and attitudes if it is to impact on patient care.
Pharmacokinetics: The preferable way to teach it for Generation Z medical students: Experience from Thammasat University
Nuchanart Suealek (Faculty of Medicine, Thammasat University, Preclinical Science, Rangsit Campus, Klonglaung, Pathumthani 12120, Thailand) Panadda Rojpibulstit (Faculty of Medicine, Thammasat University, Preclinical Science, Pathumthani, Thailand)
Background: Medical students now are the internet "Generation Z", with the over-dependence on technology prefer learning by exploring using their own paths, and dislike the lecture class. However, for the subject that is difficult to understand, such as pharmacokinetics, it is hard to say what teaching methods they choose. Thus, this study aims to evaluate which method of learning Generation Z medical students prefer in difficult topics such as pharmacokinetics.
Summary of work: After completing the course containing the lecture and the clinical scenario of pharmacokinetics, the second year medical students were assigned to complete questionnaires to evaluate the learning experiences in pharmacokinetic study including a lecture, self-study from internet worldwide, textbook reading and small group learning using five rating scales. Data were analyzed using mean ± SD and one-way ANOVA.
Summary of results: From the response data (88% response rate), mean score of the lecture, small group learning, reading textbooks and self-study from internet worldwide were 4.17 ± 0.76, 3.58 ± 0.78, 3.36 ± 0.99, and 2.74 ± 1.14, respectively. Interestingly, the more clearly preferable learning experiences was lecture
Conclusions: Although Generation Z medical students favor learning from internet worldwide, they also prefer the lecture for more insight in the difficult topic. However, small group learning and reading textbooks were also needed for more effective learning especially in problem solving.
Take-home messages: Lectures for Generation Z medical students should be integrated with the clinical correlation to encourage their critical thinking skills.
Ability to extract embedded information from guidelines in relation to calculating drug doses
Katy Harries (University of KwaZulu-Natal, Division of Pharmacology, College of Health Sciences, Private Bag 7, Congella, Durban 4013, South Africa)
Julia Botha (University of KwaZulu Natal, Division of Pharmacology, College of Health Sciences, Durban, South Africa)
Background: For medics, dosing involves extracting quantities embedded in standard treatment guidelines. We compared first year student ability using these with their ability where information was not embedded. Summary of work: After 10 hours of training, 178 students were given ten practical dosage calculations. Of those 10, four questions were embedded. Ability was compared between the embedded and non-embedded calculations. The influence of home language and school leaving maths score was also investigated, using Epi-Info (version 3.5.3) to perform statistical testing. Summary of results: Students achieved on average 34% and 57% for the embedded and non- embedded questions respectively (p<0.001). The two worst answered questions were embedded, with only 7% and 25% getting them right. None of the four best-answered were embedded. The worst answered question, concerning oral paediatric digoxin, involved several steps: manipulating a decimal quantity (0.01mg/kg), dividing the daily dose then rounding off. Non- English mother-tongue speakers achieved a lower mean total score than their counterparts (4 vs. 6 correct answers, p<0.001).While the risk of failing both kinds was significantly higher for non-English students (p<0.01), it fell from 2.5 to 1.7 between the non-embedded and embedded questions. For the 136 students who wrote the school mathematics examination , school mathematics ability predicted ability to do non-embedded type questions to a greater extent than embedded -type questions (r2 = 0.17 vs. 0.10). Conclusions: Despite training, students battle with embedded-type questions, Surprisingly, English as a home language provided less advantage for calculating embedded questions.
Take-home messages: Students need support to develop extraction of embedded quantities.
Evaluation of session in pharmacology: Autobiography of drugs: A learning experience
Anuradha Joshi (Pramukh Swami Medical College, Pharmacology, House no 5/6, ShriVihar Society, Lamvel Bakrol Road, VVN, Anand 388001, India)
Background: Student-centred activities have been developed in Pharmacology teaching for medical students to make teaching more interesting and relevant. This study reports on students' perception of new form of teaching learning method in Pharmacology i.e. "Autobiography of Drugs". Summary of work: Study participants were Second M.B.B.S. students. In one session, 4 Autobiographies were displayed in relation to Pharmacokinetics, Pharmacodynamics, Pharmacotherapeutics, and Pharmacovigilance of particular drug. Subsequently students were supposed to identify the name of drug/drug group. Next session of 60 minutes includes
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evaluation of module in terms of quality, content, usefulness (on 5 Point Likert Scale). Data was analysed using SPSS version 15.1 and applying Z test. Summary of results: It was reported that new module on "Autobiography of Drugs" was a positive learning experience.
Conclusions: Various studies seem to demonstrate that activation of prior knowledge and recall of information with help of innovations in teaching can lead to conceptual change in the way students learn. Active Learning Modules of this type attempt to minimize rote learning and passive learning in large or small classroom setting and can be an effective form of teaching and learning activity. It can be used in traditional course as a complement to lectures, and be a part of integrated curricula.
Take-home messages: Learning can be improved by ability to create significant learning environment, in form of innovative teaching modules.
Integrated learning of modern and applied Thai traditional medicine by peer teaching Orawan Lekskulchai (Thammasat University, Obstetrics and Gynecology, Klong 1, Klong Luang, Patumtani 12120, Thailand)
Background: To promote Thai traditional medicine and standard Thai herbal products to Asian harmonization, the policy of Ministry of Public Health (Thailand) is focusing on increasing utilization of Thai herbal medicine for treatment of various diseases instead of importing drugs from aboard. However, most of physicians may not have good attitude and knowledge in applying Thai medicine and could not have good collaborations with Thai medical doctors. Thus, this study aims to improve the attitude and knowledge of Applied Thai medicine to medical students.
Summary of work: Fifteen sixth year medical students and 15 fourth year applied. Thai medical students were recruited and divided into 5 groups. Each group was assigned to take care of a postpartum woman who was 24-48 hours after normal delivery with no complications. The students in each group had to discuss and teach each other in the topic of postpartum care. Pre and post knowledge tests and training evaluation model by Kirkpatrick was used. All the patients were asked to complete a short questionnaire regarding their satisfaction from the combined treatment. Summary of results: All modern and applied Thai medical students were satisfied with this protocol. They all improved their knowledge especially the modern medical students that reported improving their attitude about applied Thai medicine and gaining confidence in working with applied Thai medical staff. Above all, the patients reported great satisfaction from the combined treatment.
Conclusions: The peer learning among students from two different courses could help improve their knowledge and attitude which may promote their good collaborations in the future.
Meeting recommendations to prepare future doctors for obesity management with patients
Jo Hart (University of Manchester, Manchester Medical School, Stopford Building, Oxford Rd, Manchester M13 9PT, United Kingdom)
Anna Chisholm (University of Manchester, School of Psychological Sciences, Manchester, United Kingdom) Sarah Peters (University of Manchester, School of Psychological Sciences, Manchester, United Kingdom) Karen Mann (Dalhousie University and University of Manchester, Division of Medical Education, Halifax, Canada)
Mark Perry (University of Manchester, Manchester Medical School, Manchester, United Kingdom)
Background: In response to the global obesity epidemic, clinical guidelines now encourage doctors to facilitate healthy diets and physical activity with patients. Accordingly, the UK's General Medical Council recommends that medical students graduate with competencies in discussing obesity and behaviour change with patients. Behaviour change is challenging and complex and an evidence base identifying theory-linked techniques to support patients with this exists. Research suggests however, that training fails to prepare doctors to tackle obesity with patients, and there is little evidence indicating effective medical education in this area.
Summary of work: GP trainees delivered theory-based obesity management education to 4th and 5th year medical students (n=34). It provided students with a practical behaviour change toolkit to use with patients in practice. Pre- and post-intervention questionnaires assessed students' communication skills and intentions to discuss obesity with future patients. Content analysis of students' written feedback and fidelity analysis of audio-recorded sessions enabled explorations about acceptability and feasibility of the session. Summary of results: Students' were more likely, post-intervention, to 1) report intentions to discuss obesity with patients and 2) use effective communication skills. The intervention was highly valued by students and delivered consistently by tutors. Conclusions: Behaviour change education for medical students may increase obesity management intentions and skills. This education was acceptable Take-home messages: The evidence-base identifying behaviour change techniques can usefully inform medical education. Specifically, it may help in preparing future doctors for discussing obesity management with patients.
8EE Posters: The Teacher and Staff Development
Location: Terrace 1, PCC
Factors Related to Medical Teacher Burnout: An In Depth Interview
Wallapa Bunpromma (Khonkaen Medical Education Center, CPIRD, Ministry of Public Health; Psychiatry, 5456 Khon Kaen Hospital, Psychiatric Department, Srichan Road, Muang District, Khon Kaen 40000, Thailand)
Background: Medical teacher burnout consists of 3 dimensions; emotional exhaustion, depersonalization and personal accomplishment. High levels of burnout in three dimensions were found among staff in the Internal Medicine and Surgery Department. This study aimed to explore factors related to medical teacher burnout. Summary of work: A qualitative study was conducted. Modified Maslash Burnout Inventory (MBI) questionnaire comprising three components of burnout questions was used for screening among medical teachers. Then, 13 staff (9 Medicine, 4 Surgeons) were selected for in depth interview and also assessing data triangulation by asking the same questions in different participants included burnout and not burnout teachers. Summary of results: Factors associated with burnout among staff in Medicine included preference of service to teaching, low self-esteem regarding medical knowledge, high workload and expectation towards medical students. Factors relating to burnout among surgeons were lack of support from the Head of Department and high expectation towards students. Conclusions: The shared factor that affected burnout was high expectation towards students. Internal factors such as service preference, low self-esteem were detected as well as external factors such as workload and lack of support from superior. Both personal factors and external factors of medical staff were related to medical teachers' burnout. However, the external factors were found affect to affect staff burnout more. Take-home messages: External factors are major causes of medical teachers' burnout, thus the solution should be well organized.
Development of a Multi-Source Feedback System to Assess the Effectiveness of Postgraduate Clinical Supervision
Mayen Egbe (Royal Bolton Hospital NHS Foundation Trust, Medicine, Minerva Road, Bolton BL4 0JR, United Kingdom)
Madawa Chandratilake (University of Dundee, Centre for Medical Education, Dundee, United Kingdom) Paul Baker (North West Deanery, Foundation School, Manchester, United Kingdom)
Background: With increasing public awareness of patient safety issues in health care, the quality
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assurance of medical training comes under the spotlight. Central to this is good clinical supervision, and, the need for a Multi-Source Feedback tool to assess its effectiveness. This work describes the development of a Multi-Source Feedback tool to assess the effectiveness of clinical supervision.
Summary of work: A with 25 item questionnaire with four-point Likert scale and an "unable to assess" category was developed as a self and peer assessment tool to assess clinical supervisors. Items addressed key competencies of the trainer's role relating to credibility, education knowledge, interest in training, supervision and training style and technical ability. Feasibility, validity, reliability, underlying correlations and agreements were explored.
Summary of results: 24 self-assessments, and 196 peer assessments (trainees = 107, fellow trainers = 89) were available. There was an 80% response rate. Questionnaire completion time for self-assessments was six minutes and nine minutes for peer assessments. Rating scores ranged between 3-4. Comparatively few items had high percentages of "unable to assess". Independent t-testing and an agreement plot suggested no significant differences in the trainee and fellow trainer scores. Principal component factor analysis identified six factors accounting for 68% of the total variance. There was high internal consistency reliability with Cronbach's a 0.93.
Conclusions: Psychometric analyses suggested that the Multi-Source Feedback questionnaire was an effective way to assess the role of the clinical supervisor with satisfactory reliability, validity, and feasibility. Take-home messages: Multi-Source Feedback can be used to reliably assess the effectiveness of clinical supervision.
A voluntary, university-wide, peer-observation program: factors influencing implementation and faculty participation
Adrienne Dolberry (Ross University School of Medicine, Center for Teaching and Learning, Portsmouth, Dominica)
Orla O'Donoghue (Ross University School of Medicine, Department of Anatomy, 630 US Highway 1, Suite 500, North Brunswick 08902, United States) Jyotsna Pandey (Ross University School of Medicine, Department of Pathology, Portsmouth, Dominica) Claire Joseph (Ross University School of Medicine, Academic Director of Faculty Affairs, Portsmouth, Dominica)
Background: Peer observation is an activity for faculty to review and provide constructive feedback on activities related to teaching. Guidance is required to develop a scholarly yet safe environment for faculty to participate and communicate their teaching practices. The purpose of this study was to survey faculty on the implementation and usefulness of a voluntary peer-observation program for Ross University School of Medicine educators.