Автор неизвестен - Mededworld and amee 2013 conference connect - страница 111

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pursue GP careers (OR 0 to 0.17 [0.07-0.36]). In the CIS,

from 46 articles, 3 themes emerged; the decision to undertake an iBScs; the educational experience (intellectual growth and financial costs); finally, the iBSc ramifications: improved employment prospects and the potential for "better" doctors. This review identifies key educational outcomes and areas of uncertainty as well as contextual data about these courses. Conclusions: These findings could have implications for a variety of international enrichment programmes. Take-home messages: IBScs may improve UG performance, increase the likelihood of academic careers, and a reduced likelihood of following a GP career. They help students to develop reflexivity and key skills, critical appraisal and research.

9J/4

Teaching evidence-based medicine to undergraduate medical students: A systematic review and meta-analysis

Seyed-Foad Ahmadi (University of California, Irvine, Public Health, Irvine, United States)

ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730

Emad Ahmadi (Harvard Medical School, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, United States)

(Presenter: Hamid Baradaran, Iran University of Medical Sciences, Center for Educational Research in Medical Sciences, Hemmat Highway, Tehran 141765376, Iran)

Background: Despite the various methods of widespread teaching of evidence-based medicine (EBM) to medical students, the relevant literature has not been appropriately synthesized. Therefore the aim of this study is to do a systematic review to measure the effect of teaching EBM to medical students on EBM knowledge, attitudes, skills and behaviors. Summary of work: We searched MEDLINE, SCOPUS, Web of science, ERIC, CINAHL, and Current Controlled Trials up to May 2011; we also performed backward and forward reference checking of included and relevant studies. Two reviewers independently extracted data and assessed study quality.

Summary of results: We found 10111 potential studies, of which 27 were included in the review: I. 6 studies examined the effect of integrated methods, of which 5 were low quality; the other one used no validated instrument; II. A strong study found problem-based learning less effective compared to usual teaching; III. 6 studies examined e-learning, of which 5 had high or acceptable quality and linked e-learning to improved knowledge, attitudes and skills; IV. 12 studies evaluated the effect of seminars, workshops and short courses, of which 11 were low quality, and the other one lacked a validated instrument again; V. Two studies with high or moderate quality linked complex interventions to improved knowledge and attitudes; VI. No included study assessed the long-term effects. Conclusions: Evidence supports the use of e-learning as a complement for usual teaching; however, we have to further examine integrated teaching methods, problem-based learning, and short courses and instructions; in addition, we should focus on long-term assessments using high-quality instruments. Take-home messages: Using of e-learning as an effective complement of usual teaching. Assessing long-term higher-order mastery of EBM, using high-quality instruments, and further focusing on properly designed methods, using mode of practicing EBM, and student educators should be considered in the future studies.

9J/5

Examining the effectiveness of the methods used to develop research skills in medical education -A systematic review proposal

Simon Guild (University of St Andrews, School of

Medicine, St Andrews, United Kingdom)

Jon Issberner (University of St Andrews, School of

Medicine, St Andrews, United Kingdom)

Vicki Cormie (University of St Andrews, Library, St

Andrews, United Kingdom)

Alun Hughes (University of St Andrews, School of

Medicine, St Andrews, United Kingdom)

Gerard Browne (University of St Andrews, School of Medicine, Medical and Biological Sciences Building, North Haugh, St Andrews KY16 9TF, United Kingdom) Anita Laidlaw (University of St Andrews, School of Medicine, St Andrews, United Kingdom) Rachel Davis (University of St Andrews, School of Medicine, St Andrews, United Kingdom)

Background: Training in research skills and the development of research skills is required to ensure that doctors are competent both as future practitioners and clinical or basic science investigators. There is a substantial literature on how to develop and inculcate research skills in medical students (Laidlaw et al, AMEE guide No. 69, 2012, Medical Teacher 34: 754-771). Summary of work: This review will look at the effectiveness of the methods and approaches in the field to successfully teach and develop critical thinking and research skills in medical students. Summary of results: 1. Is there a body of research available on the topic of teaching research skills in undergraduate medical education? 2. What teaching methods have been found to be effective in this field? 3. How has this effectiveness been evaluated? 4. Does the literature show when (and how) critical appraisal is taught? 5. Does the literature have a specific focus on generic skills in critical appraisal and thinking? Conclusions: Although there is evidence related to the promotion of research skills in medical students there has not been a systematic review and synthesis of the literature to date.

Take-home messages: Research skills and attributes in the wider sense are viewed as important if not essential for producing competent and effective doctors.

9J/6

A Best Evidence in Medical Education (BEME) Systematic Review: The integration of theoretical and clinical knowledge in undergraduate medical education

Klara Bolander Laksov (Karolinska Institutet, Stockholm, Sweden)

Anna Josephson (Karolinska Institutet, Stockholm, Sweden)

Background: The problem of transfer of knowledge from basic science to clinical practice has been a challenge for teachers and medical schools for over a century. Numerous initiatives to facilitate for students to integrate theoretical basic science knowledge with clinical knowledge have been taken - some at course or module level, others at programmatic level. This systematic review aims to explore the best evidence concerning integration of theoretical and clinical knowledge, to guide further initiatives of integration in the construction of professional competence. Summary of work: After a comprehensive literature search, two reviewers completed title screening, fulltext review and quality assessment of studies in health professions settings. A coding sheet was constructed and piloted on 11 articles. A candidate theory was

constructed as a way of making explicit the underlying (latent) conceptions of integration and the manifestation of these in a range of efforts to integrate theoretical and clinical knowledge in undergraduate medical education. Three pairs of reviewers were in the process of coding in the middle of March. Summary of results: To be reported at the conference.

9K Short Communications: Simulated

Patients

Location: Club B, PCC

9K/1

Pre-clinical medical students' integration of communication and procedural skills in a simulated patient consultation

Ina Treadwell (University of Limpopo (Medunsa Campus), Skills Centre, PO Box 151, MEDUNSA, Pretoria 0204, South Africa)

Background: Performing a consultation involves two sets of skills - psychomotor and clinical communication skills. Although indivisible in practice, these skills are usually taught separately. Scenario-based assessments were done to determine junior medical students' ability, according to assessors and themselves, to integrate communication and procedural skills they've mastered separately since their first year of study. Summary of work: A mixed method study was done using a population sample of 3rd year medical students (N=251) at Medunsa in 2012, randomly allocated to one of eight 15 minute OSCE stations. Students assessed and reflected on their own performance using a checklist comprising items on procedural steps and communication attributes. The assessors' and self-assessment scores were compared and themes were developed from the qualitative analysis of the reflections.

Summary of results: The mean scores for communication skills (assessors=51%; students=54%) were significantly lower (p=<0.0001) than the scores for procedural skills (assessors=71%; students=69%). Compared to the assessors the students overrated their communication scores significantly (p=0.04). Students (97%) have learned in spite of stress caused by time constraints and being observed. To them the encounters felt real due to the use of simulated patients and they became aware of their shortcomings, especially in communicating with the patient. They expressed a need for similar experiences to further enhance their confidence and communication skills prior to clinical practice in 4th year. Conclusions: Students reported problems with integrating communication skills with procedural skills but still overrated their competency. Take-home messages: Integrating communication skills in clinical training at all levels of medical education is essential.

9K/2

Simulated patients' views of professional identity formation in medical students

Michelle McLean (Bond University, Faculty of Health Sciences & Medicine, Gold Coast 4229, Queensland, Australia)

Patricia Johnson (Bond University, Faculty of Health Sciences & Medicine, Gold Coast, Australia)

ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730

Patricia Green (Bond University, Faculty of Health Sciences & Medicine, Gold Coast) Sally Sargeant (Bond University, Faculty of Health Sciences & Medicine, Gold Coast, Australia)

Background: Research on medical students' professional identity formation traditionally reflects students' perspectives. As students interact with many teachers during their studies, the perspectives of these instructors should also be canvassed. Summary of work: Students and their instructors (e.g. simulated patients (SPs), registered nurses, problem-based learning facilitators) from an undergraduate Australian medical programme were interviewed to gain different perspectives on students' professional identity formation. SPs are used extensively in Years 1-3 for communication skills training and physical examinations. SPs encounter students in Years 4 and 5 during OSCEs and when they return for skills training. Summary of results: SPs (mostly > 45 years) viewed preclinical students as doctors in training, treating them as such. Preclinical students, however, did not generally live up to SPs' expectations in terms of dress and sometimes demeanour. Almost all SPs remarked on students' transformations following patient contact. In their opinion, exposure to patients was a key event in professional identity formation. Conclusions: SPs, with whom students interact in their early medical studies, can contribute to our understanding of students' socialisation into the medical profession.

Take-home messages: Canvassing the views of the different instructors of medical students with regard to professional identity formation offers a 360 degree perspective of how and when this might happen.

9K/3

Resuscitating the Simulated/Standardised Patient (SP) through Authentication

Louise Schweickerdt-Alker (University of Limpopo (Medunsa Campus), Skills Centre, PO Box 197, Garankuwa 0204, South Africa)

Background: Delivering authentic portrayals for Simulated/Standardised Patients (SPs) is chore. The question arises how to train the SPs to deliver the portrayals authentically if the scenarios supplied and the time allocated for preparation do not suffice. Summary of work: Following a few basic steps in order to create an inner thought process enables the SP to give life to the person behind the patient. It offers the SP something to tap from in order to portray an authentic patient with energy and focus. This process need not take up more time than the reviewing of the scenario does.

Summary of results: The SPs are enabled to deliver authentic portrayals with more energy and focus. Their verbal and non-verbal communication becomes congruent, expressions of feelings become real and they portray characters with more depth. The creation of a

person behind the patient breathes life into the SP's portrayal.

Conclusions: The effect of creating a three dimensional person behind the patient enables the SP to deliver an authentic portrayal which is believable, alive and real. It enables them to react authentically in the moment no matter what they are challenged with. Creating authentic portrayals is possible even given a basic scenario and with short training sessions. Take-home messages: Creating authentic SP portrayals is chore and is possible within a short span of time even when given the most basic scenarios.

9K/4

Lay person-led pelvic examination training: A Randomised Controlled Trial

SK Chequer (Barts and the London School of Medicine

and Dentistry, Queen Mary University of London,

Medical Education, 27 Lindley Street, Whitechapel,

London E1 3AZ, United Kingdom)

A Braddy (Barts and the London School of Medicine and

Dentistry, Queen Mary University of London, Medical

Education, London, United Kingdom)

JMN Duffy (Barts and the London School of Medicine and

Dentistry, Queen Mary University of London, Blizard

Institute, Women's Health Research Unit, London, United

Kingdom)

Khalid Khan (Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Blizard Institute, Women's Health Research Unit, London, United Kingdom)

AM Cushing (Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Institute of Health Sciences, Centre for medical education, London, United Kingdom)

Background: Performing intimate examinations well is challenging due to the required combination of technical, interpersonal, and communication skills. Established training methods are associated with poor training outcomes. Gynaecological Teaching Associates (GTAs) are trained laywomen who work in pairs to teach the pelvic examination, one acting as a patient, and one acting as the instructor. Several low methodological quality studies have evaluated GTA training with promising results.

Summary of work: This is the first high quality randomised control trial (RCT) aligned with CONSORT guidelines evaluating GTA training. 4th year medical students with no prior experience of pelvic examination training were invited to participate within the study. Students were randomly allocated by computer generated random sequence, communicated within sealed opaque envelopes, to intervention (GTA training and routine clinician-led training) or control (routine clinician-led training only). The study is powered to demonstrate a 10% improvement in the primary outcome measure of technical competence. Other outcome measures evaluated included interpersonal and communication skills, student anxiety and

ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730

confidence. Investigators responsible for outcome assessment were blinded to participant allocations. Summary of results: 77 students have agreed to participate within the study. Preliminary results will be available for presentation at the conference. Conclusions: The results will form the basis for an exciting presentation and lively debate about the role of GTA training in undergraduate education. Take-home messages: Educational studies should aim to be RCTs paying careful attention to CONSORT guidelines to provide the high quality evidence required to plan the delivery of medical education.

9K/5

Simulated patient methodology across three continents: A qualitative interview-based study

Debra Nestel (Monash University, School of Rural Health, Northways Road, Churchill 3842, Australia) Shane Pritchard (Monash University, HealthPEER, Clayton, Australia)

Felicity Blackstock (Latrobe University, Physiotherapy, Bundoora, Australia)

Jenny Keating (Monash University, Physiotherapy, Frankston, Australia)

Katherine Bowman (University of Manchester, School of Medicine, Manchester, United Kingdom)

Background: There has been a growth in simulated patient (SP) literature demonstrating significant variation in the values and practices of SPs. Even basic nomenclature is varied. We sought the views of experts in SP methodology across three continents to gain insight into contemporary SP practices. Summary of work: Experts in SP methodology were identified through relevant professional associations and peer reviewed publications for individual interviews. Semi-structured telephone interviews were audio-recorded and transcribed. Transcripts were analyzed independently using thematic analysis. Summary of results: Sixteen transcripts were analyzed from two male and fourteen female interviewees based in Europe (n=6), Australasia (n=4) and North America (n=6). There was little consensus on the key elements of recruitment, role development, training methods, program management, and providing feedback to learners. There was general agreement that there is inadequate training and resources available for SP educators. SP educators reported that expertise is often developed in isolation and experientially, and that there is no clear career path.

Conclusions: Beliefs and practices of SP expert educators vary. Efforts to collaborate across SP programs may encourage a shift to establishing more consistent and enhanced SP practices. Take-home messages: Although there are similarities in SP methodology internationally, SP practices seem highly contextualised. The internationalization of practices may help to enhance SP practices.

9K/6

English is not my first languageTraining English-speaking SPs to develop English communication skills

Ruri Ashida (Tokyo Medical University, English Department, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160­8402, Japan)

Christine D Kuramoto (Kyushu University, Department of Medical Education, Fukuoka, Japan)

Background: Development of English communication skills is indispensable for medical students whose first language is not English. However, despite many years of English study, most students become doctors without having any experience of interviewing an English-speaking patient. One survey shows that 25.4% of hospitals in Japan basically do not accept patients who cannot speak Japanese. Medical interviews practiced through classroom role-plays do not prepare students to perform adequately in real practice. Summary of work: We trained English-speaking SPs. Twenty-four first year students and 10 fourth-year students from 2 universities in Tokyo participated in the study. Semi-structured questionnaires were administered to measure the effects. The SPs were trained to be available for all universities across Japan. Summary of results: Students were very nervous about their first English interview with a non-Japanese patient but perceived that they could understand the patient better (67.6%) and make themselves understood better (61.8%) than they had initially thought. Many were motivated to improve their English communication skills (79.4%). Some cultural differences, such as shaking hands, were noted and their appropriateness was discussed. Interviews with SPs were successful in providing most students with a positive experience, enabling them to feel that interviewing patients in English is feasible and that they can improve with further practice.

Conclusions: The SPs gave students authentic experiences of interviewing non-Japanese patients in English, and helped develop confidence in communicating in English.

Take-home messages: English speaking SPs should be involved in medical education to cultivate doctors capable of practicing in the global setting.

9L Short Communications: Interprofessional Education:

Postgraduate

Location: Club C, PCC

9L/1

Impact of interprofessional education (IPE) on primary care practice

Heather Bell (Queen's University, Belfast, NICPLD, School of Pharmacy, Riddel Hall, 185 Stranmillis Road, Belfast

BT9 5EE, United Kingdom)

Crist'm Ryan (Queen's University, Belfast, School of Pharmacy, Belfast, United Kingdom) Maeve McQuillan (Queen's University, Belfast, School of Pharmacy, Belfast, United Kingdom) Colin Adair (Queen's University, Belfast, School of Pharmacy, Belfast, United Kingdom)

Background: IPE workshops for GPs, nurses and pharmacists have run for 3 years, in which participants work in mixed groups to ensure interprofessional interactivity. While participants have previously reported a positive learning experience, there was a need to evaluate the impact on practice, specifically professional relationships and patient benefit. Summary of work: A questionnaire was developed, piloted and distributed online to the 605 healthcare professionals who had participated in the programme. The areas in the questionnaire addressed attitudes, relationships and patient care linked to IPE. Responses to questions on attitudes and relationships were measured using Likert scales, where 1=strongly disagree, 5=strongly agree.

Summary of results: 375 questionnaires were completed (response rate 62%). 71.6% reported that their participation in IPE had led to patient benefit and that they now adopted a more holistic approach to patient management (median 4 (IQR 4-5)). Respondents reported they had changed how they practised as a result of IPE (median 4 (IQR 4-5)), with the changes consistent across professional groups (Kruskal-Wallis p=0.123). While participants reported that IPE improved collaboration and communication across the team (median 4 (IQR 3-4)), pharmacists and nurses were more likely to report these benefits than GPs (Kruskal-Wallis

p=0.013).

Conclusions: This study demonstrates that primary care practitioners believe IPE leads to better collaboration and communication between the professions and improved patient care. In addition, a more holistic approach to patient care is adopted. Take-home messages: Practitioners perceive interprofessional learning that is actively managed as having a positive impact on practice and patient care.

ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730

9L/2

A Home Visit Curriculum to Foster Interprofessional Collaboration and Improve Care Coordination for High-Risk Patients in the SF Veteran's Affairs Center of Excellence in Primary Care Education

Shalini Patel (University of California San Francisco/San Francisco VA, Medicine, San Francisco, United States) Rebecca Shunk (University of California San Francisco/San Francisco VA, Medicine, San Francisco,

United States)

Bridget O'Brien (University of California San Francisco/San Francisco VA, Medicine, San Francisco,

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