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Background: Patient safety training and education of health-care professionals have neither kept pace with advances in patient safety, nor with workforce requirements. The introduction of patient safety in postgraduate medical education (PGME) is necessary and timely. This research aims to unfold synergies as well as variances regarding patient safety principles among EU countries.
Summary of work: An exploratory field study was conducted combining a semi-structured questionnaire with face-to-face expert interviews. The so-called "CIA-project" was developed in order to adopt a three-dimensional approach, focusing on a) Current situation and trends, b) Importance of developments and desired innovations, and c) Attainability of the desired innovations. The interviews were held among policymakers in eight selected EU countries. Eight variables related to patient safety in PGME were selected to compare existing programmes. Summary of results: Most countries indicate the need for more generalists. Furthermore, all countries indicate increasing necessity of inter-professional medical education and collaborative learning. Additionally, an increasing trend for implementation of standardized evaluations in PGME exists to measure the quality of training groups as well as the safety of the learning environment.
Conclusions: To increase patient safety in PGME, the development of general competences additional to medical knowledge is necessary. Notions of policy makers in the EU show a high degree of conformity concerning this issue.
Take-home messages: PGME programme directors should develop structured competency-based programmes. The common understandings regarding PGME curriculum renovation in EU countries, instigates
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
to further research the potential benefits for an EU policy.
Why do doctors make mistakes? The role of salient distracting clinical features
Silvia Mamede (Erasmus Medical Center, Institute of Medical Education Research, Erasmus MC - Gebouw Rochussenstraat, Gk 745, Burgemeester s'Jacobplein 51, Rotterdam 3015 CA, Netherlands) Tamara Van Gog (Erasmus University Rotterdam, Department of Psychology, Rotterdam, Netherlands) Kees Van den Berge (Erasmus University Rotterdam, Department of Internal Medicine, Rotterdam, Netherlands)
Jan LCM Van Saase (Erasmus Medical Center, Department of Internal Medicine, Rotterdam, Netherlands)
Henk G Schmidt (Erasmus University Rotterdam, Department of Psychology, Rotterdam, Netherlands)
Background: Minimizing diagnostic errors requires understanding the mechanisms underlying flaws in clinical reasoning. This experiment investigated whether salient distracting features (i.e., findings that tend to grab physicians' attention, because they are strongly associated with a particular disease, but are indeed unrelated to the problem) misdirect diagnostic reasoning, causing errors.
Summary of work: Seventy-two internal medicine residents diagnosed 12 clinical cases (6 simple; 6 complex) in 3 different formats: without a salient distracting feature (SDF), with a SDF in the beginning of the case, with a SDF late in the case. In a within-subjects design, each participant solved 2 simple cases and 2 complex cases in each format.
Summary of results: On complex cases, the presence of early-SDF decreased the proportion of correct diagnoses compared both to cases without SDF (0.18 vs 0.43; p<.001) or with late-SDF (0.18 vs 0.36; p<.001). SDFs did not affect performance when they came late in complex cases and on simple cases.
Conclusions: SDFs encountered early in complex cases indeed decreased diagnostic performance. The adverse effect of SDFs was substantial. (Note that the cases with early- or late-SDF were exactly the same except for the SDF location). An explanation may be that when SDFs that strongly point towards a disease are encountered early in a case, the script of that disease becomes highly activated in working memory, blocking access to alternative scripts.
Take-home messages: SDFs present early in a case may misdirect reasoning, and physicians might be aware of the need to overcome their influence to avoid errors.
Feasibility and psychometric properties associated with a 360° Patient Safety Assessment Tool (PSAT360°) to assess medical residents' patient safety skills
Patti McCarthy (Memorial University, Medicine, Room 446, Agnus Cowan Hostel, Faculty of Medicine, Health Science Centre, St. John's A1M0B3, Canada) Vernon Curran (Memorial University, Medicine, St. John's, Canada)
Karla Simmons (Memorial University, Medicine, St. John's, Canada)
Background: Increasing complexity and demands within the health care system are influencing approaches to patient care delivery, patient safety education and assessment. Multisource Feedback (MSF)/360° assessment is an ideal approach to assessing residents' patient safety competence since it provides them with formative feedback on their performance from multiple assessors and highlights areas in need of improvement. Summary of work: This project seeks to develop a valid and reliable MSF/360° tool (PSAT360°) to assess medical trainees' patient safety competence. The work reported here is based on Phases 1 & 2 of an overall 5 phase mixed method study which follows an iterative, sequential mixed method approach. This involved developing and pre-testing the PSAT360°. Subsequent phases will involve pilot-testing the PSAT360° (Phase 3), providing residents with a feedback report (Phase 4) and evaluation (Phase 5).
Summary of results: The design and content of the tool was informed by a systematic literature search, environmental scan, interviews with key experts, focus groups with end users - residents and assessors (program directors, faculty, nurses, allied health professionals). Data was collated from all sources and themes were identified. A tool was drafted and reviewed via Delphi survey with key experts. Conclusions: The majority of participants support a MSF method to assess trainees' patient safety competence. Numerous themes including risk management, disclosure, ethics, communication, collaboration emerged as being central to trainee assessment. It is anticipated that the results of this study will inform future patient safety educational initiatives, including curriculum, instructional methods and faculty development programs.
Embedding Patient Safety into Postgraduate Medical Education: A cross-disciplinary critique
Maria Ahmed (Imperial College London, Department of Surgery and Cancer, Room 504 Wright Fleming Building, London W2 1PG, United Kingdom) Paul Baker (NHS North West, North Western Deanery, Manchester, United Kingdom)
Charles Vincent (Imperial College London, Department of Surgery and Cancer, London, United Kingdom)
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
Sarah Yardley (Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom)
Background: Patient safety is increasingly recognised as an essential theme in contemporary medical education. A huge proliferation of educational interventions in safety has occurred but, analysis of the realities of implementation and attention to the theoretical underpinning of such interventions is often lacking. Summary of work: We developed a patient safety educational programme for all Foundation trainees across the North Western Deanery (n=1000): 'Lessons Learnt: Building a Safer Foundation'. This comprised monthly facilitated case-based discussions of patient safety incidents encountered in the workplace. Evaluation comprised before and after comparison of patient safety knowledge, skills and behaviours using a combination of bespoke and validated tools. Subsequently, we employed cooperative inquiry to critically examine our work, through the lens of socio-cultural experiential learning theories. Summary of results: 'Lessons Learnt' was well-received by trainees who demonstrated significant improvements in safety knowledge, skills and behaviours. Through cooperative inquiry we have identified how reflective practice and experiential learning were enacted in practice. Socio-cultural theories offered insight into the impact of institutional culture on learning about safety. We will discuss implications arising from our analysis which identified gaps between theoretical and in-practice approaches to safety interventions. Conclusions: Educational interventions in safety can benefit from use of socio-cultural experiential learning theories. Cooperative inquiry offers tools to enrich understanding of how interventions are enacted in practice which could inform future approaches to sustainable integration.
Take-home messages: An appreciation of theory is required to advance education in patient safety. Safety experts, educationalists and practitioners should collaborate to ensure sustainable curricular integration which takes into account the complexities of practice.
Exploring deficiencies in the non-technical skills of junior doctors using simulated critical incidents
E Mellanby (University of Edinburgh, Centre for Medical Education, 20 Mayfield Terrace, Edinburgh EH9 1SA, United Kingdom)
V Tallentire (University of Edinburgh, Centre for Medical
Education, Edinburgh, United Kingdom)
J Skinner (University of Edinburgh, Centre for Medical
Education, Edinburgh, United Kingdom)
N Maran (Forth Valley Hospital, Scottish Clinical
Simulation Centre, Larbert, United Kingdom)
Background: Non-technical skills (NTS) such as decisionmaking and team working are cognitive and social skills that combine with technical skills to facilitate safe and effective performance. To improve patient safety we
must equip our healthcare professionals with the appropriate NTS to minimise or mitigate errors. This study aimed to identify the underlying deficiencies in NTS which lead to errors made by junior doctors in acute care.
Summary of work: Following ethical approval, 38 junior doctors participated in authentic simulated critical incidents followed by audio recorded debriefs. Errors have previously been identified using amplification of Reason's generic-error modelling system (GEMS). Each error was reviewed by two researchers to identify whether it was precipitated by a deficiency in NTS. Deficiencies were coded using a prototype NTS taxonomy for junior doctors in acute care by template analysis.
Summary of results: Analysis for this study is currently ongoing. Results will include the proportion of errors attributable to deficiencies in NTS and the categories of NTS that were identified.
Conclusions: Deficiencies in NTS underpin many of the errors made by junior doctors in acute care. Some types of error (according to classification using GEMS) are associated with specific NTS deficiencies, such as the link between rule-based mistakes and prioritisation. Patterns and associations will be explored and discussed.
Take-home messages: NTS are crucial to the care of acutely unwell patients. Identifying deficiencies in NTS using this method can allow us to target the training of appropriate NTS required to reduce error and improve patient outcome.
Specification of an educational intervention in terms of behaviour change techniques
Moira Cruickshank (University of Aberdeen, Health Services Research Unit, Aberdeen, United Kingdom) (Presenter: Jennifer Cleland, University of Aberdeen, Division of Medical and Dental Education, School of Medicine and Dentistry, Foresterhill, Aberdeen AB25 2AZ, United Kingdom)
Background: This study aimed to code a patient safety educational intervention, designed without a theoretical basis, into behaviour change techniques (BCTs) and link these to variables in the Theory of Planned Behaviour
Summary of work: Final-year medical students (n=93) completed TPB-based questionnaires assessing cognitions about two patient safety-related communication behaviours on the first (Time 1) and last (Time 2) days of a 'Professional Practice Block'. The course materials were coded for BCTs and labelled according to Abraham and Michie (2008). BCTs were systematically linked, using a consensus framework (Michie et al., 2008), to underlying TPB variables which were predicted to change between Times 1 and 2. Summary of results: Agreement between coders was adequate (Krippendorff's alpha range 0.65-1.00). Eight BCTs were identified from the course materials, delivered with varying frequency. Attitude was targeted
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
three times; subjective norm, four times; perceived behavioural control, 13 times. All TPB variables changed significantly between Times 1 and 2. Effect sizes: attitude 0.7, subjective norm 0.6, perceived behavioural control (PBC) 1.0, intention .07.
Conclusions: This study demonstrates that interventions that are not explicitly based on theory can be coded reliably into BCTs. This may facilitate the contribution of evaluations of atheoretical interventions to a cumulative evidence base for testing theory. Effect sizes of change in targeted variables were variable. There was also variation in the number of times that each variable was targeted. Thus, a method for specifying intervention intensity is proposed.
Take-home messages: The effect of teaching interventions can be measured using behaviour change theory.
90 Workshop: Progress testing: Implementation of an international consortium
Location: Meeting Room 3.5, PCC
Carlos Fernando Collares (Maastricht University, Educational Development and Research, Universiteitssingel 60 - Room N5.12, Maastricht 6229ER, Netherlands)
CPM van der Vleuten (Maastricht University, Educational Development and Research, Maastricht, Netherlands)
Background: For some years, an international progress test consortium has been carefully prepared. Some concerns, such as content specification, as well as purposes and uses of test scores have been debated, but many issues remain to be addressed thoroughly, such as the impact of cultural aspects and best psychometric practices.
Intended outcomes: To make the international progress test program a useful tool to enhance learning in the health professions worldwide, while following the latest recommendations for large-scale cross-cultural assessments, and thus providing state-of-the-art accuracy for institutional benchmarking. Structure of workshop: Presentation of current developments in the international progress test consortium. Debate about recent scientific evidence with implications in international progress test endeavors. Creation of task groups and formulation of strategic action plans.
Who should attend: Coordinators of progress testing programs and deans or other stakeholders of institutions who are already part of the initiative or that are interested in joining the consortium. Level: Intermediate
9P Course: AMEE-Essential Skills in Medical Education Assessment (ESMEA)
Location: Meeting Room 4.1, PCC
9Q Course: AMEE-Research Essential Skills in Medical Education (RESME)
Location: Meeting Room 4.2, PCC
ABSTRACT BOOK: SESSION 9 TUESDAY 27 AUGUST: 1600-1730
9R Workshop: The future of international student exchanges in health professions education: Identifying
weaknesses and sharing strengths
Location: Meeting Room 2.2, PCC
William Burdick (Foundation for Advancement of International Medical Education and Research, FAIMER Education, 3624 Market Street, 4th Floor, Philadelphia
19104, United States)
Alice McGarvey (Royal College of Surgeons in Ireland, Medicine & Health Sciences, Dublin, Ireland) Agostinho Sousa (IFMSA, Ferney-Voltaire, France)
Background: The purpose of this workshop is to identify challenges and opportunities associated with student exchange in health professions education and identify resources that can be utilized to facilitate and promote these exchanges.
Intended outcomes: Workshop facilitators and participants will examine and suggest resolutions for issues that emerge when implementing international exchange, generating insights from both faculty and student perspectives, and concluding with a summary and evaluations.
Structure of workshop: Workshop participants will be invited to interact to identify issues, solutions, and innovations related to the following: Safety: How do you judge safety? How is student safety maintained once they are abroad? Fairness: How do we ensure a fair exchange between schools? What measures are used to judge the quality of a program? What process facilitates recognition of exchanges? How do you engage schools in international exchange?
Students: How are students selected? How are students best oriented to the experiences they will have during the international exchange? Ethics: What common ethical issues are faced by students and schools during elective exchanges? How are breaches of ethical behavior either during or after the elective managed?
Who should attend: Faculty and students interested in international exchange. Students are highly encouraged to attend. Level: Intermediate
9S Course: AMEE-Essential Skills in Computer Enhanced Learning (ESCEL)
Location: Meeting Room 3.1, PCC
9T Workshop: Narrative Assessment and Evaluation in Competency Based Medical Education: Why more than ever our
Location: Meeting Room 3.2, PCC
Paul Hemmer (Uniformed Services University, Medicine, 4301 Jones Bridge Road, Bethesda 20814, United States) Janice Hanson (University of Colorado, Pediatrics, Aurora, United States)
Marian Govaerts (University of Maastricht, Dept. of Educational Development and Research, Maastricht, Netherlands)
Lindsey Lane (University of Colorado, Pediatrics, Aurora, United States)
Background: With competency-based education, calls have increased for greater use of language based data in assessment; these words that faculty use to describe learners' performance will then be pivotal in developing a descriptive narrative to be used as a source of evidence to judge their progression. However, such descriptive comments may lack specificity, timeliness, or detail that may result from current methods used to solicit such comments (e.g., an impersonal electronic evaluation form) and/or failing to understand the context of the evaluation process. We need to develop and use methods that engage people in assessment as 'qualitative inquiry'.
Intended outcomes: Participants will leave with a plan to implement a process to enhance descriptive evaluation within part, or all, of their educational program.
Structure of workshop: We will provide a brief overview of the problem and describe examples of successful programs of assessment that are built on valuing faculty observations and descriptions, such as "evaluation sessions" (group meetings). Participants will engage in large group discussion and role plays, and small group work to problem solve examples. Using video clips of learner presentations, case discussions or conversations with patients or faculty members, participants will formulate oral feedback, write descriptive comments about learner performance, create written feedback and participate in evaluation discussions about learners with other teachers. Several forms/data collection methods will be used during the workshop, and participants will discuss the strengths and weaknesses of each for different educational programs. Who should attend: Students, faculty, anyone interested in improving the richness of descriptive assessment. Level: Intermediate
9U Workshop: Are you as good an 0SCE
examiner as you think? Location: Meeting Room 3.3, PCC
Ilona Bartman (Medical Council of Canada, Evaluation Bureau, 2283 St. Laurent Blvd., Ottawa K1G 5A2, Canada)
Sydney Smee (Medical Council of Canada, Evaluation Bureau, Ottawa, Canada)
Marguerite Roy (Medical Council of Canada, Research and Development, Ottawa, Canada)
Background: For over 20 years the Medical Council of Canada (MCC) has administered a high stakes OSCE to evaluate candidates for licensure. More recently, the MCC has begun evaluating the raters and providing individualized feedback regarding undesirable tendencies in an effort to minimize rater errors.
Acquire knowledge about extreme rating Develop self-awareness of rating tendencies Reflect on individual rating tendencies Learn what the literature says about OSCE examiners Structure of workshop: Participants will be invited to complete brief self-assessments at the beginning of the workshop to survey assumptions about their scoring tendencies. Then, attendees will rate videos of two OSCE stations. These ratings will be entered into a report application while attendees participate in three presentations/discussions: Overview of the Dove and Hawk phenomenon A summary of research findings demonstrating some of the challenges to effective examiner training The role of self-directed assessment. Attendees will receive aggregate and individual (blinded) graphical feedback that compares group and individual ratings to the answer key. The organizers will review with participants how best to interpret the data. Any participants who wish to discuss their individual feedback may do so within the group or with a facilitator after the workshop. At the end, participants will be asked to complete the self-assessments again as a survey of the immediate impact of the workshop on self-perceptions.
Who should attend: OSCE examiners Level: All levels
9V Workshop: Empathy begins at home: Peer support and student mental health
Location: Room A, Holiday Inn
Andrew Rix (Prepare to Share, Research, 21 Winchester Avenue, Cardiff CF23 9BT, United Kingdom) Andrew Grant (Cardiff University, Institute of Medical Education, Cardiff, United Kingdom)
Background: This workshop is based on research carried out for a study commissioned by the GMC (UK). Evidence from a systematic review of the literature and from qualitative data gathered from medical students via focus groups and narrative interviews was that students in need of support preferred to get help and support from their peers than from their medical school. Peer support schemes are seldom evaluated. Intended outcomes: Understanding different peer support initiatives, how to implement, improve and evaluate them.
Structure of workshop:
Introduction to the literature - 10 minutes Small group work examining examples of peer-led initiatives. Identification of generalizable principles - 30 minutes
Sharing and development of list of core qualities of peer-led initiatives. - 30 minutes Input - Supporting students to evaluate and improve peer led support (without damaging the essential qualities) - 10 Minutes
Discussion: applying evaluation in practise - 10 minutes Who should attend: Students - Medsoc, students union members, welfare and well-being officers Medical school faculty with responsibility for performance and support Level: Intermediate