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Take-home messages: This demonstrates that PAs and clinical assessors generally concur on behaviour assessments. It also appears that inclusion of PA marks are unlikely to disadvantage candidates. We believe a formal framework is required to support this practice.
Patient versus Expert Ratings of Medical Student Performance in a Structured Clinical Examination
Eithne Heffernan (Plymouth University, Peninsula College of Medicine and Dentistry (PCMD), C506 Portland Square, Drake Circus, Plymouth PL4 8AA, United Kingdom)
Thomas Gale (Plymouth University, Peninsula College of Medicine and Dentistry (PCMD), Plymouth, United Kingdom)
Robert Johnson (Plymouth University, Peninsula College of Medicine and Dentistry (PCMD), Plymouth, United Kingdom)
Background: The General Medical Council (UK) has called for more patient and public involvement in the assessment of medical students and practitioners. In the US, standardised patients perform summative assessments of communication skills for the clinical component of the US medical licensing examination. This project aimed to evaluate the reliability of patient ratings of clinical performance in the Integrated
Structured Clinical Examination (ISCE) of the Peninsula College of Medicine and Dentistry (PCMD). This summative assessment requires students to perform a complex combination of skills, including history-taking, communication and examination, in each of its six stations.
Summary of work: Ethics approval was granted by the PCMD Ethics Committee. The communication skills and overall performance of 190 students were rated by patients and clinicians in each station of the 2012 ISCE. The inter-rater reliability of patient-clinician ratings was measured using the Intraclass correlation coefficient
Summary of results: Good inter-rater reliability was found in most stations, particularly those focusing on communication, including 'Communication in Difficult Circumstances' (ICC=.653, p<.001). Some stations showed poor inter-rater reliability, such as 'Endocrine'
Conclusions: Reliability of patient assessments during clinical skills examinations is context dependent. Further work is needed to ascertain which particular domains are reliably assessed by patients. Qualitative analysis of patient feedback and investigations of patient perceptions of the role of assessment are needed to refine patient assessment methods. Take-home messages: Patient ratings of communication skills are a reliable measure of undergraduate clinical performance in certain contexts. More work is needed to investigate the role of patients in the assessment of undergraduate clinical performance.
An Innovative Community Patient Volunteer Program For Teaching Clinical Skills At The Regional Campus Of The University Of Queensland School Of Medicine
Margo Lane (University of Queensland, School of Medicine, Ipswich, Australia)
Geoffrey Mitchell (University of Queensland, School of Medicine, Ipswich, Australia) Philip Towers (University of Queensland, School of Medicine, Ipswich, Australia)
Background: The newly established Ipswich regional campus of the University of Queensland School of Medicine experienced significant difficulty in accessing hospital patients for clinical skills teaching during its initial two years of operation. The innovative Community Patient Volunteer (CPV) program was developed to address this problem. Patient volunteers were recruited from the local community and rostered to attend tutorials on campus. Students practised history taking and physical examination and developed clinical reasoning skills with the assistance of volunteers, under the guidance of their clinician tutor. An evaluation of this program was undertaken.
Summary of work: Questionnaires were disseminated to students, volunteers and tutors from 2010 and 2011. The surveys were designed to explore students' views of the program compared with hospital-based bedside
teaching, volunteers' reflections on their contribution to students' learning, and tutors' perceptions of clinical relevance of CPV.
Summary of results: Students and volunteers reported benefits from participation in the CPV program. Ipswich students' results in Year 2 OSCE in 2010 and 2011 were equal to or better than the Brisbane cohort in the history taking and communication skills stations. Results were the same throughout both cohorts in the physical examination, clinical reasoning and procedural skills stations.
Conclusions: Student learning was not disadvantaged by the use of the CPV program and may have been enhanced. Volunteers reported personal gains from participation.
Take-home messages: The utilization of patients in non-traditional roles in medical education can be mutually beneficial for both students and patient volunteers.
9G Short Communications: Educational Environment
Location: Conference Hall, PCC
Student centered curricular elements are associated with healthier educational environment and lower depressive symptoms in medical students
Eiad AlFaris (King Saud University (KSU), Shaik Hassen alsheik Street, PO Box 2925, Riyadh 11461, Saudi Arabia)
Background: Any curriculum change is essentially an environmental change; therefore there is a need to assess the impact of any change in the curriculum on the students' Educational Environment (EE) and psychological well-being. The objectives of the study were to (i) compare the EE perception of medical students studying in a system based curriculum versus those studying in a traditional curriculum (ii) compare the rate of depressive symptoms among the same students studying in both types of curricula. Summary of work: A cross sectional survey was conducted in a Saudi Medical School from 2007-2011, which transitioned from traditional to system-based curriculum. A bilingual version of the Dundee Ready Educational Environment Measure (DREEM) inventory was used for measuring the EE; the Beck Depression Inventory (BDI II) for screening for depressive symptoms; and a demographic questionnaire. Summary of results: The mean total DREEM score of the EE in the system based curriculum was significantly higher than the traditional curriculum (P<0.01). The effect size was 1.07. The mean total score on the BDI- II inventory for depressive symptoms was 18 among the traditional curriculum students and 15.6 for the system based counterparts and the difference was statistically significant (P=0.004). The effect size was -0.26. Conclusions: The perception of the EE of the students studying in the system based curriculum was significantly healthier than the traditional curriculum students. A higher rate of depressive symptoms was found among the traditional curriculum students than the system based counterparts and the difference was statistically significant (P=0.004). Take-home messages: The current study adds to the advantages of the system based curriculum in terms of healthier EE and emotional well-being.
Validation of the instrument CLES (Clinical Learning Environment and Supervision) for medical students in primary care
Eva Ohman (Centre for Family Medicine, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 12, Huddinge 141 83, Sweden
Hassan Alinaghizadeh (Centre for Family Medicine, Karolinska Institutet, Department of Neurobiology, Care
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
Sciences and Society, Karolinska Institutet, Huddinge, Sweden)
Paivi Kaila (Centre for Family Medicine, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden) Helena Salminen (Centre for Family Medicine, Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden)
Background: The aim of the study was to validate the instrument CLES for medical students in primary care. In a BEME review, the instrument CLES was recommended for evaluation of the clinical learning environment for nursing students and CLES has been validated for evaluation of the clinical learning environment of nursing students at PHCC.
Summary of work: A survey with CLES with 25 items was sent electronically to medical students at Karolinska Institutet. The response rate was 394 out of 1256 medical students. The data was complete with no missing values. Exploratory factor analysis (EFA) based on principal component methods followed by oblique rotation was performed to confirm adequate number of factors in our data.
Summary of results: The items clearly loading to factors indicate that the instrument CLES is validated for use as an evaluation instrument of medical students learning environment in PHCC. The cumulative variance explanation was 0.65, and overall Cronbach's Alpha was 0,95. One item, "The care centre had a clearly defined vision and goals of patient care", moved from the expected factor 4, "Premises of patient care at the primary health care centre", to the unexpected to factor 3 " Leadership style of the leader for the primary health care centre". It may be attributable to that the target group of the item in the original CLES instrument was nursing students who have nursing care as their main subject.
Conclusions: CLES may be regarded as validated for use as an evaluation instrument of medical students' learning environment at PHCC. Take-home messages: CLES is a promising instrument also for medical students.
Medical students and perceptions of their clinical learning environment
Marcus A Henning (University of Auckland, Centre for Medical and Health Sciences Education, Private Bag 92019, Auckland 1142, New Zealand) Ralph Pinnock (The Townsville Hospital, Paediatrics, Townsville, Australia)
Rhys Jones (University of Auckland, Te Kupenga Hauora Maori, Auckland, New Zealand)
Boaz Shulruf (University of New South Wales, Faculty of Medicine, Sydney, Australia)
Susan J Hawken (University of Auckland, Psychological Medicine, Auckland, New Zealand)
Background: Medical students encounter challenging and rewarding learning experiences when early in their clinical training.
Summary of work: To explore whether or not different groups have different perceptions of their learning environment The Dundee Ready Education Environment Measure (DREEM) was administered to 4th and 5th year medical students studying at a New Zealand University. The students were asked to reflect on their recent experience whilst on clinical rotation (medicine, obstetrics and genecology, paediatrics, psychiatry, or surgery).
Summary of results: Preliminary investigations found no difference between rotations and years (4 and 5) in terms of DREEM measures. However, an ethnicity main effect and ethnicity-gender interaction effect were found to be significant. For the main effect, differences were noted for perception of learning and perception of course organisers. For the interaction effect differences were noted for perception of learning and perception of course organisers. Perception of atmosphere was also close to significance (p = .05). Age effects were also noted for perception of learning, academic self-perception and perceptions of atmosphere. Analyses of the means and line graphs revealed that pacific island students tended to responded lower than other groups and in particular pacific island male students in the areas of significance. In addition, older students tended to score lower on the areas of significance. Conclusions: There is evidence to suggest that medical students within different subgroups respond differently to the clinical learning environment. This suggests that the lower scoring students may require more assistance when clinically placed.
Take-home messages: The clinical environment create a diverse learning environment that may impact on students differently and some of the under lying aspects of difference may be identifiable.
Culture matters in successful curriculum change: the influence of national and organisational culture tested with multilevel structural equation modeling
Marielle Jippes (Maastricht University, Dept of Educ Research and Development, Faculty of Health, Medicine and Life sciences, Bilitonkade 73, Utrecht 3531 TK, Netherlands
Erik Driessen (Maastricht University, Dept of Educ
Research and Development, Faculty of Health, Medicine
and Life sciences, Maastricht, Netherlands)
Nick Broers (Maastricht University, Dept of Methodology
and Statistics, Faculty of Health, Medicine and Life
sciences, Maastricht, Netherlands)
Gerard Majoor (Maastricht University, Institute for
Education, Faculty of Health, Medicine and Life sciences,
Wim Gijselaers (Maastricht University, Dept. of
Educational Research and Development, School of
Business and Economics, Maastricht, Netherlands)
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
Cees van der Vleuten (Maastricht University, Dept of Educ Research and Development, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands)
Background: National culture showed to play a role in curriculum change in medical schools, and organisational culture has been similarly implicated in change processes in business organisations. Putting these findings together raises the question of whether and how these two cultural influences may be interconnected and play out in change processes in medical schools. Since this question has remained largely unexplored in the literature, this international comparative study investigated the impact of national and organisational culture on successful curriculum change.
Summary of work: Cross-sectional survey data was collected in medical schools changing (or preparing change of) their curriculum, yielding 991 participants of 131 medical schools in 56 countries. A literature-based conceptual model was developed and tested using multilevel structural equation modeling. National and organisational culture were operationalised using Hofstede's dimensions of culture and Quinn & Spreitzer's competing values framework, respectively. Successful curriculum change was measured using a questionnaire developed to determine Medical schools' Organisational Readiness for curriculum Change (MORC) and measures of change-related behaviour. Summary of results: The initial poor fit of the model was improved by two modifications. In sum, characteristics of national culture affected organisational culture, and direct effects of national and organisational culture characteristics on successful curriculum change were found.
Conclusions: Large differences in readiness for change between and within medical schools were explained by national and organisational culture, respectively, suggesting an impact of both types of culture on successful curriculum change.
Take-home messages: Those contemplating curriculum reform should consider the potential impact of national and organisational culture.
Let me belong - student perceptions of ethnic segregation at medical school
DS Furmedge (University College London Medical School, Academic Centre for Medical Education, Medical School Building, 74 Huntley St, London WC1E 6AU, United Kingdom)
S Vaughan (University of Manchester, Manchester
Medical School, Manchester, United Kingdom)
S Tirodkar (University College London Medical School,
Academic Centre for Medical Education, London, United
J Wollf (University College London Medical School, Academic Centre for Medical Education, London, United Kingdom)
K Woolf (University College London Medical School, Academic Centre for Medical Education, London, United Kingdom)
Background: There is evidence that medical students demonstrate ethnic homophily (segregation) in their social networks. The causes and effects of this phenomenon are not fully understood. Summary of work: 32 one-to-one interviews with students from various ethnic backgrounds at different stages of undergraduate medical training were conducted at one London based UK medical school. They explored thoughts and perceptions about ethnicity within the medical school and the role of clubs and societies in interethnic friendship. Interviews were inductively and deductively thematically analysed using a framework based on Communities of Practice and intergroup contact theories. Summary of results: Emerging themes included: recognised ethnic homophily despite the positive educational effects of diversity; the role of clubs and societies in fostering belonging for students from various ethnic groups and in developing a "medic identity", but also in increasing anxiety at interethnic contact; the positive impact of "enforced" mixing by the medical school in reducing ethnic segregation and widening viewpoints. Feelings of belonging, comfort, and shared common ground were key in developing and maintaining students' communities of practice such as their friendship groups, clubs and societies. This could result in unintended ethnic segregation - itself broken down by "enforced" mixing.
Conclusions: There are a variety of complex reasons for homophily within social networks at medical school but medical schools can have a positive impact, increasing integration through random mixing of teaching groups and clinical firms.
Take-home messages: Medical schools must be aware of issues around segregation and provide an optimal environment to encourage integration.
9H Short Communications: Reflection and Critical Thinking
Location: Club H
Does narrative-based self-reflection, using video recordings of practice, aid professional development? Beyond 'Teacher Coaching'
Ganeshan Ramsamy (Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Medical Education, The Garrod Building, Turner Street, Whitechapel E1 2AD, United Kingdom)
Dane Goodsman (Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Centre for Medical Education, London, United Kingdom)
Anne Hills (Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Institute of Health Sciences Education, London, United Kingdom) Wayne Holland (Cass Business School, Faculty of Management, London, United Kingdom)
Background: Self-reflection is believed to lie at the centre of teachers' professional development, offering a crucial process in enabling new insights and perspectives about practice. Research has emphasised the need to develop a reflective framework for teachers to consider their praxis. To support this notion, our institutions have put in place a Teacher Coaching process, which involves observing teaching through using a real-time narrative methodology. This project aims to build on this, by coupling video technology with narrative self-reflections, so teachers can consider their own practice in real-time from a third person standpoint. Summary of work: This cross-institutional research recruited previously coached clinicians, pre-clinical lecturers and business school lecturers: three from each group. They used the narrative format to self-reflect via video playback of their teaching. Reflective accounts were thematically analysed and teachers were interviewed, to explore opinions about this reflective process.
Summary of results: Thus far, most teachers have supported the Teacher Coaching narrative style and recommended its use, reporting that the experience has improved their teaching. Self-reflection was focused primarily on students' emotional and physical reactions, technical issues and future improvements. Conclusions: By studying different groups of teachers and environments, we examined not only the process, but how broadly it could be applied. We believe this reproducible process has potential implications in aiding teachers' professional development. Take-home messages: The use of technology in facilitating student learning is in the limelight, but we must appreciate that it can also be used to support and train teachers just as effectively.
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
Personal reflection cannot be measured - yet? Psychometric evaluation of the Groningen Reflection Ability Scale
Nina Bjerre Andersen (Aarhus University, Centre for Medical Education, Brendstrupgaardsvej 102, building B, 1st Floor, Ove Gjeddes Gade 5, 3. th, Aarhus N 8200, Denmark)
Lotte O'Neill (Aarhus University, Centre for Medical Education, Aarhus, Denmark)
Line Hvidberg (Aarhus University, The Research Unit for General Practice, Aarhus, Denmark) Lise Gormsen (Aarhus University, Centre for Medical Education, Aarhus, Denmark) Anne Mette M0rcke (Aarhus University, Centre for Medical Education, Aarhus, Denmark)
Background: The use of reflection as a learning approach is increasing in medical education. Personal reflection is used to describe students' ability to critically reflect on own learning and functioning. The Groningen Reflection Ability Scale (GRAS) was developed in The Netherlands in 2007 and is now referred to as an instrument to measure personal reflection. We tested the GRAS scale in a Danish setting and correlated the personal reflection score with other student characteristics.
Summary of work: We translated and adapted GRAS for use in a Danish context (GRAS-DK). GRAS-DK was pilot tested before the primary data collection and the subsequent retest. We tested the psychometric properties of GRAS-DK in terms of test-retest reliability and floor/ceiling effects. Finally, we performed a confirmatory factor analysis to test GRAS-DK against the original factor model.
Summary of results: The GRAS-DK questionnaire was answered by 361 (69%) of 523 invited students. The mean GRAS-DK score was 88 (SD= 11.42).There was a statistically significant difference in GRAS-DK score of 2.58 between male and female students (89.27 vs. 86.70, CI:[0.379; 4.777]). There was no correlation between age, study progression, or extracurricular activities and the GRAS-DK score. The confirmatory factor analysis did not replicate the original three factor model of GRAS and further exploratory factor analysis did not propose an alternative factor model. Conclusions: GRAS in its current form could not be confirmed as a one-dimensional measure of personal reflection. Is personal reflection measurable? Take-home messages: Personal reflection might not be measured easily and we need thorough validation to be able to rely on questionnaire measurements.
Real Time Real Patient: A training model for bridging patient-centered care and reflective practice
Pete Spanos (Louis Stokes Cleveland VA Medical Center, Center of Excellence Primary Care Education, 10701 East Boulevard, Suite 2M680, Cleveland 44106, United States)
Mamta Singh (Louis Stokes Cleveland VA Medical Center, Center of Excellence Primary Care Education, Cleveland,
Sarah Augustine (Louis Stokes Cleveland VA Medical Center, Medicine, Cleveland, United States) Elizabeth Painter (Louis Stokes Cleveland VA Medical Center, Psychology, Cleveland, United States) Renee Lawrence (Louis Stokes Cleveland VA Medical Center, Center of Excellence Primary Care Education, Cleveland, United States)
Background: Reflection is widely recognized as critical for developing mindful practitioners who engage in lifelong learning (Irby, Cooke, 2010). Effective teaching approaches for integrating reflection with development of clinical practice are not as clear, and little is known about whether trainees view such activities as useful or confidence-building.
Summary of work: As one of five Centers of Excellence in Primary Care Education funded to develop new models for training health care professionals, we are piloting a program that provides residents with 4 three-month outpatient blocks and co-learning sessions with nurse practitioner students. Within this overall program, we developed a longitudinal curriculum - "Real Time Real Patient" - that integrates reflection on workplace actions while recognizing the importance of patients as mentors. Resident and nurse practitioner trainees are given portable video cameras to record new and follow up patient encounters (proper consent protocols followed). Trainees then complete summary and reflection forms on the encounters and present their video clips and reflections in a peer and faculty interprofessional group setting. Summary of results: Trainees complete a short evaluation after each session. In Year 1, sessions received an average rating of 4.55 out of 5 (1-5; 5=high) for usefulness and average rating of 4.36 out of 5 for increased confidence. Year 2 sessions have thus far received an average rating of 4.66 for usefulness and 4.62 for increased confidence.