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Take-home messages: Mobile learning media such as smartphone apps are well received by students and constitute a suitable new medium for teaching and learning in undergraduate medical training of pharmacology.
9D AMEE Fringe 2
Location: Meeting Hall IV, PCC
The Friday afternoon tutorial... a picture is worth of a thousand words!
V Vassiliou (Royal Brompton, Cardiology, Cambridge, United Kingdom)
E Ntatsaki (UCL Medical School, Medical Education, London, United Kingdom)
As tutors of medicine we often discussed how best to optimize teaching and learning. How to engage the students and how to ensure that they remember a bit of every tutorial, lecture or clinical session. But how can difficult topics such as neurology be understood and remembered? And more importantly, how to do this on a Friday afternoon? How to convince all 30 students to come, engage, enjoy and remember? We tried to put ourselves in their shoes... what would we have liked to see? Definitely, not the Krebs Cycle... not on a Friday afternoon and possibly not ever! But pictures? Videos? Maybe!
We based therefore our tutorials on pictures.. But these were not random pictures.. Sylvester Stallone looks masculine, but how many know that he actually has congenital Bell's palsy? And what is Bell's palsy? And how do you distinguish it from stroke? Risk factors for stroke? Compare Obelix and Asterix. who is most at risk? Is diabetes a risk factor? And does the Bond girl Halle Berry have type 1 or type 2 diabetes? And how do you treat diabetes? And could stroke give you Parkinson Disease? Remember Michael J.Fox? Mohammed Ali? Do they have Parkinson Disease? Or not? And having discussed a variety of pathology corresponding to the theme of the week what best way to end the day with a related episode from House MD, or Scrubbs or Gray's Anatomy? With complementary popcorn? But pausing and discussing the pathology?
We enjoyed running these sessions. Feedback suggests that the students enjoyed it too and learned. even on a Friday afternoon! We would welcome the opportunity to give you a snapshot of how we did it!
Metaphors and artefacts in medical education -using creativity as a paradigm for reflection
Eleana Ntatsaki (UCL, ACME, Holborn Union Building, Archway Campus, Highgate Hill, London N19 5LW, United Kingdom))
V Vassiliou (Royal Brompton Hospital, Cardiology, London, United Kingdom)
Linda Jones (University of Bedfordshire, Education, Bedford, United Kingdom)
The notion of "reflection" in deeply embedded within the current medical education vocabulary having been initially introduced by Dewey, further expanded by Schon and established as a key component of Kolb's
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
cycle of experiential learning in the 70s. Similarly the use of metaphors in humanities (arts, music, and literature) is certainly not an innovation. However, combining those two elements as part of a creative reflective process when developing as a learner or as a medical educator, may prove innovative and may certainly produce some interesting and potentially colourful results.
As part of my professional development as a medical educator, I explored the concept of informal learning and the use of humanities in medical education. I chose to use an artefact as a metaphor for my understanding of informal learning in the form of a created tangible object and utilise different levels and layers of metaphors to capture my own reflections and learning through this process.
The artefact itself is a composition with coloured coffee capsules, pieces of string and a wooden round base. Although interpretation of art (or artefacts) lies within the eyes of the individual, the original intention and reason for its creation lies within the mind and heart of its creator. This artefact is presented with the aid of pictures that illustrate the process of creating it and is accompanied by a personal narrative analysing, decomposing and re-illuminating my perception of the artefact from two different metaphor angles. There may be many more ways to interpret this artefact, and also many more stories and connections to be made and reflections to be triggered. Feel free to come to AMEE Fringe to explore them further.
Choose Your Own Medical Adventure
Jamie Newman (Mayo, Hospital, Medicine, 200 1st St
SW, Rochester 55902, United States)
Andy Herber (Mayo, Rochester, United States)
There are many ways to make a continuing medical education (CME) course more interesting, though sadly they are not often used. Some courses use patient-based scenarios as a starting point for academic discussion. Stem questions and Audience Response Systems can enhance audience interactivity during CME events. The authors have taken this one step further by using video clips for both the Stem and Answer, developed for a CME event for Nurse Practitioner/Physician Assistant Hospitalists. By allowing the audience to vote, the attendees can actually see the outcome of their choice. But what happens when the audience chooses the incorrect answer? What horrible events and unexpected outcomes will develop? Only the Fringe knows for sure.
Staff? Faculty? No, Staffulty!
Heather Haseley (Northwestern University Feinberg School of Medicine, Center for Education in Medicine, 303 E. Chicago Avenue, Ward Building, Chicago, IL
60611, United States
Paul Pribaz (Northwestern University Feinberg School of Medicine, Center for Education in Medicine, Chicago,
Faculty are the subject matter experts. They practice clinically, teach and do research. Staff deal with all the administrative nonsense, like finances, human resources, technology, facilities, legal, strategic planning, blah, blah, blah. But what happens when this traditional model no longer fits? What happens when you are short on budget and need an administratively savvy technology expert, content expert, researcher, and teacher all rolled into one? Enter the "staffulty": the individual who lives in the gray area between staff and faculty, who is equally as comfortable with curriculum development as with a spreadsheet, and who has multiple scholarly achievements but still is responsible for the annual budget projections. Staffulty are those indispensible administrators who not only understand medical education but also engage directly with it. Using quiz show questions and facilitated ranting, we aim to encourage a discussion surrounding the multitude of questions surrounding this elusive species, such as: How does one become an expert staffulty spotter? What special powers do staffulty possess? Is the presence of staffulty a good thing for medical education? How do we train, promote, and reward staffulty?
Reflection on using artistic creativity in medical teaching and learning
Nataiie Beausoleil (Memorial University, Division of Community Health & Humanities, Faculty of Medicine, Health Sciences Centre, Memorial University, St. John's, NL A1B3V6, Canada)
In this presentation I will reflect on my journey as a social scientist and artist working in a medical school and my attempts to integrate artistic creativity and experiential learning in the curriculum. I will discuss the potential for creativity and the use of artistic skills in the new medical curriculum being developed in my institution, the medical school in Newfoundland and Labrador, a Canadian province rich in artistic tradition and creativity. I will explore avenues for enhancing creativity in teaching and opening learning to students' artistic creativity. Through this examination of artistic creativity in teaching and learning I aim to expand knowledge on a range of dimensions of health professionals' identity and links with the broader community. My project also contributes to current discussions of learning/teaching medicine as practices relevant to both art and science. Finally, I ponder the possibilities for a changed academia given my personal experience of a profound disjuncture between my life as an academic and my life as an artist.
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
Narrative and film
George Zaharias (Victorian Metropolitan Alliance General Practice Training, Educational Enhancement, 15 Cato St, Hawthorn 3122, Australia)
Much has been written about "narrative" and the importance of "the patient's story" which invariably provides valuable insights for the clinician and assists them in better managing the patient. It is not difficult to convince experienced clinicians of the value of narrative medicine. With medical students and vocational trainees however, who are more focused on amassing facts and making a diagnosis, it is more difficult to teach the value of narrative let alone its practice. Film is a powerful medium whose value in medical education is possibly not widely recognized. Partly because of this but also because in medical education there is scepticism about its benefits, film isn't often used and it is generally left to those with a "bent for the
This presentation will engage participants in a brief discussion of a clinical scenario and will then demonstrate through the use of film: (1) the relevance and importance of narrative in clinical practice; (2) the usefulness and the power of film in medical education; (3) the simplicity of using film in medical education.
9E PhD Reports 3
Location: Meeting Hall V, PCC
The influence of vertically integrated curricula on readiness for clinical practice
Marjo Wijnen-Meijer (University Medical Center Utrecht, Center for Research and Development of Education, HB 4.05, PO Box 85500, Utrecht 2508 GA, Netherlands)
Introduction: The main goal of the thesis was to determine whether a vertically integrated (VI) curriculum enhances the transition to postgraduate training.
Methods: A variety of studies and methods was used to address the research questions. We conducted questionnaire studies among medical trainees, from either a traditional or a VI curriculum, and among supervisors to gather information about their perceptions regarding graduates' readiness for practice. In addition, we conducted design-based research to develop an authentic assessment procedure for the assessment of readiness for clinical practice. Next we used this procedure to evaluate graduates' readiness for practice in Germany and the Netherlands. Results: The results indicate that graduates who followed VI curricula make their definite choice for a specialization at an earlier stage and need less time and fewer applications to obtain positions for postgraduate training programs. In addition, VI graduates find themselves better prepared for clinical work and postgraduate training . Also the results of a questionnaire study among supervisors of postgraduate training programs show differences in performance between the two groups of medical graduates. Graduates from a VI curriculum appear more capable to work independently, to solve medical problems, to manage unfamiliar medical situations, to prioritize their tasks, to collaborate with other people, to estimate when supervision is needed and to reflect on their activities . Consequently, we designed an authentic assessment procedure for medical near-graduates in the role of beginning residents on a very busy day. Near-graduates from either a VI or a non- VI curriculum participated in this assessment. In this study, we found only few differences in the assessment scores between the two groups. The most important finding is that candidates from a VI curriculum get better scores on the facet that we labeled as 'active professional development' which includes 'reflection' and 'asking for feedback'.
Discussion and Conclusion: The international nature of the studies had strengths and limitations that will be discussed. Further research needs to focus on the actual performance in clinical practice of trainees from different curricula.
References: 1. Cave J, Goldacre M, Lambert T, Woolf K, Jones A, Dacre J. Newly qualified doctors' views about whether their medical school had trained them well: questionnaire surveys. BMC Med Educ 2007; 7(38): 1-6.
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2. Chittenden EH, Henry D, Saxena V, Loeser H, O'Sullivan P. Transitional clerkship: an experiental course based on workplace learning theory. Acad Med
2009; 84: 872-876.
3. Ten Cate O. Medical Education in the Netherlands.
Med Teach 2007; 28: 752-757.
4. Wijnen-Meijer M, Ten Cate OTJ, Van der Schaaf M, Borleffs JCC. Vertical Integration in medical school: effect on the transition to postgraduate training. Med Educ 2010; 44: 272-279.
5. Wijnen-Meijer M, Ten Cate O, Van der Schaaf M, Harendza S. Graduates from vertically integrated curricula. Clin Teach (accepted for publication). Communications: eLearning iPads and Mobile Technology
Filling a gap in post-graduate communication skills teaching: a faculty development project
Noelle Junod Perron (Geneva University Hospitals, Division of Primary Care Medicine, 4 rue Gabrielle Perret-Gentil, Geneva 1211, Switzerland)
Introduction: How effective is a training program for clinical supervisors on how to teach patient communication skills to residents in clinical practice? Methods: First, a needs assessment was conducted through several focus groups among clinical supervisors and residents of both inpatient and outpatient settings. Second, a pretest-posttest controlled study was carried out in which clinical supervisors attended a program in teaching communication skills tailored to their needs over a period of 6-9 months in which communication and teaching skills were trained simultaneously. Outcomes measures were the number and type of communication skills identified by clinical supervisors on three videotaped clinical encounters, the number of communication skills discussed in an interactive way and observed use of feedback skills during three objective structured teaching encounters. Finally, skill transfer was explored through semi-structured interviews among 26 trained clinical supervisors 3 to 6 months after training.
Results: The needs assessment was used to design the training program. 48 clinical supervisors participated (28 in the intervention group and 20 in the control group). Training had no impact on clinical supervisors' ability to identify poor or good communication skills used by residents but had positive effects on the number of communication skills taught in an interactive way to residents (effect sizes 1.36-1.77). In addition, trained participants significantly improved their feedback skills during the structured teaching encounters (effect sizes 0.93-4.94) (2). Finally, factors facilitating transfer included work characteristics such as opportunities to practice, involvement in teaching activities, supportive institutional and a positive learning climate. Participants who reported teaching communication skills in practice were generally involved in structured communication skills teaching.
Discussion and Conclusion: A training program on how to teach communication skills is feasible, appreciated and effective in that it changes perceptions and behaviors and helps shift a paradigm change from a teacher centered to a more learner centered approach. References: 1. van den Eertwegh V, van Dulmen S, van Dalen J, Scherpbier AJ, van der Vleuten CP. Learning in context: Identifying gaps in research on the transfer of medical communication skills to the clinical workplace. Patient Educ Couns 2012.
2. Junod Perron N, Nendaz M, Louis-Simonet M, Sommer J, Gut A, Baroffio A, et al. Effectiveness of a training program in supervisors' ability to provide feedback on residents' communication skills. Adv Health Sci Educ Theory Pract 2012.
3. De Rijdt C, Stes A, van der Vleuten CP. Influencing variables and moderators of transfer of learning to the workplace within the area of staff development in higher education: research review. Educational Research Review 2012; Available online 7 June 2012.
4. O'Sullivan PS, Irby DM. Reframing research on faculty
development. Acad Med 2011;86(4):421-8. 9E/3
Fostering cognitive presence in higher education through the authentic design, delivery, and evaluation of an online learning resource: A mixed methods study
Douglas Archibald (University of Ottawa, Family Medicine, 43 Bruyere St., Room 369y, Ottawa K1Y 0A6, Canada)
Introduction: The purpose of this mixed methods sequential explanatory study was to explore cognitive presence and the learning experiences of participants using an online learning resource in higher education research methods courses. Through examination of the relationships between three elements in an online CoI the researcher was able to gain further insight into whether higher levels of cognitive presence can be reached in an online environment. Specifically, the researcher explored the effects of the design of the online learning resource, his direct instruction and facilitation of the discussions (teaching presence) and the extent of the development of the interpersonal relationships among users (social presence) on predicting critical thinking among users (cognitive presence). Furthermore, with regard to the examination of the CoI, the researcher wanted to determine the ability of social and teaching presence to predict cognitive presence after controlling for several additional variables (i.e., self-directed learning readiness, prior online learning experience, and prior collaborative learning experience). Methods: In the first quantitative phase of the study, data were collected from 189 consenting participants in 10 research methods courses in education and health education programs, via three online surveys and course discussion transcripts. Various relational and comparative statistical techniques were used to analyse the survey data, including multiple regression, t-tests,
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
ANOVAs, CHAID, and content analysis. Based on the results of the first phase, the interview protocol was developed and participants were selected for the interviews. In the second, qualitative phase of the study, 25 participants from the various research method courses were selected to explore the results from the quantitative phase in more detail. Results: The quantitative results indicated that both social and teaching presence had a strong positive relationship with cognitive presence and that learners generally perceived to have a positive learning experience using the online resource. The qualitative findings helped elaborate the significant quantitative results and were organised into the following themes: making connections, multiple perspectives, resource design, being a self-directed learner, learning strategies, learning preferences, and barriers to cognitive presence. Discussion and Conclusion: This study provided an enhanced understanding of cognitive presence from adults engaged in online learning, which may affect educational practice.
References: 1. Archibald, D. (2010). Fostering the development of cognitive presence: Initial findings using the community of inquiry survey instrument. The Internet and Higher Education, 13(1-2), 73-74.
2. Creswell, J. W., & Plano Clark, V. L. (2010). Designing
and conducting mixed methods research (2nd ed.). Thousand Oaks, CA: Sage.
3. Garrison, D. R., Anderson, T., & Archer, W. (2010).The first decade of the community of inquiry framework: A retrospective. The Internet and Higher Education, 13(1-
Learning to diagnose using patient video cases in paediatrics. Perceptive and cognitive processes
Thomas Balslev (Aarhus University, Centre of Medical Education, Brendstrupgaardsvej 102, Aarhus N 8200, Denmark)
Introduction: Our group wished to clarify how adding a patient video case (PVC) might enhance the cognitive processes and sharing of cognition, and to identify efficient interactive uses of PVCs. We also aimed to illuminate the perceptive and cognitive processes of clinicians with varying duration of experience. In a final study visual guidance in PVCs was explored. Methods: In the first two studies, a randomized, controlled before-and-after design was used (1,2). One group analysed a videocase, the other analysed a text case. The verbal interaction was audio recorded and the clauses analysed. A stimulated recall procedure was used to obtain an in-depth analysis (2). A stepwise, interactive teaching approach with PVCs was applied to identify methods useful to help non-experts learn from experts (3). Next, we examined visual expertise in detail (4). We used eye tracking to examine the perceptive processes and a concomitant think aloud procedure to examine the cognitive processes during analysis of PVCs. In the final, randomized study (5) we examined the
effect of two types of visual modelling in teaching videos: "circle" or "spotlight".
Results: We identified improved learning processes (1) and improved sharing of knowledge (2) among participants analysing the video case compared to the text case. Participation in small group discussions and subsequent listening to an expert's think-aloud were particularly effective approaches (3). Experienced clinicians used more time looking at relevant areas, and less time searching other areas (4). Learners taught by "spotlight" teaching videos were faster and more focused in their visual search when subsequently analysing test videos (5).
Discussion and Conclusion: This series of studies widens the understanding of the perceptive and cognitive processes in clinicians working with authentic PVCs in paediatric neurology. In some of the studies, only a limited number of PVCs were used. References: (1) Balslev T, de Grave WS, Muijtjens AM, Scherpbier AJ. Comparison of text and video cases in a postgraduate problem-based learning format. Med
Educ. 2005 Nov;39(11):1086-92.
(2) Balslev T, W. de Grave, A.M.M. Muijtjens, B. Eika, A.J.J.A. Scherpbier. The development of shared cognition in paediatric residents analysing a patient video versus a paper patient case. Advances in the
Health Professions Education. 2009;14(4):557-565
(3) Balslev T, de Grave W, Muijtjens A, Scherpbier A. Enhancing diagnostic accuracy among non-experts by use of video-cases. Pediatrics 2010;125(3):e570-6
(4) Balslev T, Jarodzka H, Holmqvist K, de Grave W, Muijtjens AMM, Eika B, van Merri§nboer J, Scherpbier AJJA. Visual expertise in paediatric neurology. Eur J
Paediatr Neurol 2012;161(2):161-6
(5) Jarodzka H, Balslev T, Holmqvist K, Scheiter K, Nystrom M, Eika B, Gerjets P. Conveying clinical reasoning based on visual observation via eye-movement modelling examples. Instructional Science.
9F Short Communications: Patients as Partners
Location: Chamber Hall, PCC 9F/1
Actively engaging adolescents with chronic diseases in medical education: what do they think their contribution might be?
Marie-Paule Morin (CHU Sainte-Justine, Pediatric Rheumatology, 3175 Chemin cote Sainte-Catherine, Montreal H3T1C5, Canada) Tina Martimianakis (The Hospital for Sick Children, Department of Paediatrics, Toronto, Canada) Rayfel Schneider (The Hospital for Sick Children, Pediatric Rheumatology, Toronto, Canada) Maria Mylopoulos (The Hospital for Sick Children, Learning Institute, Toronto, Canada)
Background: The unique expertise of patients with chronic diseases is increasingly recognized. While a number of patient partners (also referred as patient educators) programs have been developed in the adult population, little is known about how adolescents with chronic conditions could actively be engaged in medical education.
Summary of work: The main aim of the study was to explore and develop a detailed understanding of teens' perspective about their potential contributions as patient partners. Using a qualitative approach, seventeen individual semi-structured interviews were conducted with adolescents living with chronic arthritis. A thematic analysis of the transcripts was realized using a constant comparative approach. Summary of results: Motivational factors for teens' involvement, main barriers for engagement and preferred patient partners program's structural components were identified. Beyond teaching components of physical exam, adolescents brought to light other competencies, such as teaching of communication skills, they valued as important elements to incorporate in the educational program. Conclusions: Our work demonstrates that adolescents express a strong desire to be engaged as patient partners and manifest a clear understanding of what their potential and unique contributions to the teaching might be.
Take-home messages: This study represents the first step toward the development of a patient-centered educational program actively and effectively involving teens as teachers in medical education.
The role of patients as assessors in medical examinations
Michele Kigozi (Kings College Hospital, Anaesthesia and Critical Care, London, United Kingdom) James Hollands, Kings College University, London, United Kingdom)
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
Stephanie Strachan (Kings College Hospital, Critical Care, Denmark Hill, London SE5 9RS, United Kingdom)
Background: Shifts in relationships between doctors, learners and patients have resulted in more active patient roles in medical education, with the evolution of 'patient assessors' (PA's) raising questions as to the validity and reproducibility of patient assessments of doctors. Here, we report on an observational study of untrained 'real patient' ('RPs') assessments of final year medical students' objective structured clinical examinations (OSCE's).
Summary of work: Data was collected prospectively. Assessment of candidates' behaviour was with an ordinal scale describing highly professional candidates with good communication skills through to poorly performing candidates.
Summary of results: 1567 sets of RP data were compared with 288 sets of simulated patient ('SP') data demonstrating average marks of: (mean ± SD) 5.7 ± 1.13 for RP's and 4.8 ± 1.08 for SPs with no statistically significant differences between 'trained' and 'untrained' assessments. Analysis of an individual OSCE station demonstrated a significant effect of group, with RP and SP mean ranks of 214.8 and 153.4 respectively (p < 0.0001, Mann Whitney U-test). If PA assessments were included, 60 candidates (3.23%) would have had their result changed from a fail to a pass and 12(0.65%) would have received a pass not a fail on these stations. Conclusions: PAs can 'triangulate' examiner assessments and assess specific areas (e.g non-technical skills). Whilst a credible source of feedback, patients may not always assess objectively.