Автор неизвестен - Mededworld and amee 2013 conference connect - страница 115

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Rungniran Praditsuwan (Faculty of Medicine Siriraj Hospital, Mahidol University, Medicine, Bangkok, Thailand)

Background: Breaking bad news is an important clinical task, which can result in emotional stress of both the patients and the physicians. In addition, the physician-patient relationship could be compromised if the counseling has not been done properly. Currently, a two-day communication skills training for the first year medicine residents has been established. However, the efficacy of this training program has not been evaluated previously.

Summary of work: The standardized patients' encounters were video-recorded and assessed by 3 blinded, independent raters using the adapted breaking bad news schedule (BAS) at 2 weeks prior- and 8 weeks after the communication training program. Primary outcome was the difference of pre- and post- training BAS scores.

Summary of results: Twenty-eight residents were enrolled to the study. The median age was 28 years (range 26-30). The mean post-training BAS scores were significantly improved in 4 out of 5 domains of the BAS, including breaking the news (P= <.001), eliciting concerns (P= <.001), information giving (P=<.001) and general consideration (P=<.001). Setting the scene was the only domain of the BAS, which had no statistical difference of pre- and post-training score (P=0.07). Interestingly, while eliciting concern was the domain with the lowest pre-training scores, it was the domain, which the residents obtained the highest percentage change of the pre- and post- training scores.

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

Conclusions: The communication skills training program in breaking bad news was effective in improving the breaking bad news skills for the first year medicine residents.

9Z/10

Medical students' non-technical skills awareness - Breaking bad news

Nelson Albuquerque (University of Beira Interior, Faculty of Health Sciences, Santo Amaro Street, n.48, Oliveira do Bairro 3770-058, Portugal)

Ricardo Tjeng (University of Beira Interior, Faculty of Health Sciences, Covilha, Portugal) Luis Patrao (University of Beira Interior, Faculty of Health Sciences, Covilha, Portugal)

Background: Medicine teaching has suffered large changes over the years, undergoing the stage where it only consisted in text recitation, the stage when it focused on the practical teaching and the stage where the focus was on a solid scientific pre-medical training. Nowadays, combined with science, the need to emphasize other skills arose such as non-technical skills' (NTS) training. These are specially beneficial in areas where events are rapidly developing, such as situational awareness, communication and teamwork. Training linked to NTS, such as knowing how to communicate bad news, should be an object of study and assessment. Summary of work: Knowing if medical students feel prepared to deal with this particular NTS (bad news communication), identifying experience, different behaviours, action patterns, and use of SPIKE protocol related to this issue is important. A questionnaire with open and closed questions will be sent to all medical students from the 6-year course of the Faculty of Health Science, University of Beira Interior (Covilha - Portugal). SPSS will be used for statistical analysis. Summary of results: Survey application and data analysis are scheduled for April and May 2013. Conclusions: Communication of bad news is an important medical skill, however, it is a difficult task even for experienced physicians. It is important to know future doctors' perceptions about this NTS, in order to create strategies to better prepare them. Take-home messages: Better knowledge of medical students NTS awareness, specially in breaking bad news can help improve learning methodologies.

9Z/11

Non-verbal communication in a medical school -an example from Northern Sweden

Aria Lehti (Family Medicine, Dept of Public Health and Clinical Medicine, Family Medicine, Morkullev.9, Umea 90187, Sweden)

Karin Seijsing (Family Medicine, Dept of Public Health and Clinical Medicine, Umea, Sweden)

Background: The relationship between a patient and a doctor is always power asymmetric. Studies have shown

that power is constituted by doctors and patients through verbal and non-verbal communication. Summary of work: To explore how non-verbal communication can influence the patient-doctor relationship medical students in Umea have pre-clinical training individually and in groups. Afterwards students sum up their experiences in written reflections. At first every student practices how voice and verbal communication are influenced by body balance and breathing. After theoretical insight into non-verbal communication students carry out a doctor-patient consultation. Half of the group acts as doctors. They are asked to go out of the room and are introduced to come back and show with bodily communication that they are totally uninterested in their student patients. The training continues with a doctor-patient consultation in a group of 7-9 students and a senior doctor as a discussion leader. One by one the students act as a doctor and as a patient while the other students are observers, focusing on doctor's and patient's agenda, non-verbal communication and power relations. Summary of results: In the written reports afterwards many students have stressed that training non-verbal communication is important for establishing and maintaining a trustful relationship between patients and doctors. To meet or act as an uninterested doctor, caused embodied discomfort and feelings of power or subordination.

Conclusions: Further the reports have established that training non-verbal communication skills is one way to increase students' self-reflection capacity. Take-home messages: Teaching non-verbal communication is important in training consultation

skills.

9Z/12

Communication and consideration: Anamnesis Groups as an effective way of teaching reflective skills

Josephine Buchwald (RWTH Aachen, c/o Fachschaft Medizin; Pauwelsstrafie 30, Aachen 52074, Germany) Elisabeth Dinter (RWTH, Aachen, Germany) Janna-Lina Kerth (RWTH, Aachen, Germany)

Background: Following the change in German approbation regulations, training in patient-doctor communication became mandatory for future physicians. Reflection on one's communicational skills and attitudes is a crucial part of successful long-term relationships between doctor and patient. In German speaking countries, a peer-teaching concept addressing those skills has been established for over forty years: Anamnesis Groups.

Summary of work: In most medical schools, Anamnesis Groups are a facultative addition to the core curriculum. A small group of medical and psychology students meets once a week and one participant takes a patient's detailed history. Afterwards, the group gives feedback and discusses different aspects of the patient-"doctor" relationship as well as the conversation itself and some theoretical background on communication. In Aachen,

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

participants fill in a questionnaire before and after participation. Amongst others it enquires about the element the students benefitted from most and a self-assessment of their reflective competence on a five-point Likert scale.

Summary of results: Participants benefitted from all elements with a slight emphasis on discussion and their own history taking. We could find an increase in the self-assessed skills on reflection regarding communication patterns.

Conclusions: Anamnesis Groups can significantly contribute to an improvement in reflective skills in future physicians. Not only the experience of taking a patient's history, but also watching others do so and reviewing it encourages students to actively think about the process of communication and the effects it has on others.

Take-home messages: Anamnesis Groups as a form of peer teaching are an effective way of teaching communication and reflective skills.

9Z/13

Attitudes and Performances regarding Communication Skills among Year-Sixth Medical Students

Jiratha Budkaew (Khon Kaen Medical Education Center, Social Medicine, Khon Kaen Hospital, Srichan Road, Muang Khon Kaen District, Khon Kaen 40000, Thailand)

Background: Communication skills are considered medically necessary and vital for medical professionalism. Khon Kaen Medical Education Center has provided communication skills training for medical students since 2009. This study sought to determine students' current attitudes and performances in communication skills and examine factors related to these features in sixth year medical students. Summary of work: An analytic cross-sectional study using a self-administered questionnaire (Cronbach's alpha = 0.82) was conducted to assess attitudes toward communication skills among 49 sixth year medical students. Additionally, 5 stations of ethical OSCE were also tested to assess their performances related to communication skills. Data were presented in median values and also categorized into good, moderate, and poor. Their associated factors were examined using Fisher's exact test.

Summary of results: Approximately two-third of medical students had a good attitude (69.37%), particularly about the necessary communication skills that medical students should learn as well as applying these important skills in their future careers. Only, slightly one-third had good performances (28.57%) in communication skills. Of note, they had limited performances in three aspects including listening and asking questions, making therapeutic relationships, and summarizing and closing communication. However, a statistically significant association was found between the mean attitude scores and performance scores (p=

0.038).

Conclusions: Students' attitudes and performances in communication with patients were good and associated. Their performances in three contents should be improved.

Take-home messages: Students' experiences with communication skills training during the clinical years are likely to shape their interaction with patients throughout their career.

9Z/14

Developing communication skills with GP trainees: the REAM approach

Rachel Elliott (Wessex School of General Practice, Wessex Deanery, UK, GP Education Department, Portsmouth, United Kingdom)

Samantha Scallan (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Mailpoint 10, Southampton University Hospital Trust, Tremona Road, Southampton SO16 6YD, United Kingdom) Alex MacDonald (Wessex School of General Practice, Wessex Deanery, UK, GP Education Department, Portsmouth, United Kingdom)

Background: Communication skills development is one of the cornerstones of training for general practice. The subtleties of communication in the consultation can be an area with which trainees struggle. Increasing emphasis on the assessment of the consulting skills of trainees using simulation and role-play throughout training, has seen GP educators seeking to develop activities to focus on consulting skills early in training. Summary of work: The aim of this work was to design a teaching activity around communication skills which would raise the awareness of trainees to their approach to consulting in order to help them tune into the areas they needed to develop. GP trainees (ST1-3, n 76) attended a simulated consultation circuit comprising cases written by RE. Although reflecting clinical cases and played out as such in role play, the scenarios were non-medical in their subject matter. This was intended to help the trainees focus on the process rather than the content of the 'cases.' Trainees were scored using the RCGP marking scheme and they received written feedback on their performance. Summary of results: Trainees in ST1/2 valued the opportunity to role play the problem solving element of the consultation and demonstrated use of a consultation model to structure their approach. ST3 trainees felt that the lack of clinical content made the cases less valuable for their stage of learning. Conclusions: The REAM approach to role playing case scenarios offers educators a diagnostic tool to explore consultation skills with trainees in the early years, a means to explore process over content. It is, however, less relevant and valuable to trainees in their final year.

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

9Z/15

Communication Skills Training for Foundation Year 2 Doctors

Marwa Salman (Medway Maritime Hospital, Anaesthetics, 2 Biscayne avenue, 901 Michigan building, London E14 9QT, United Kingdom) Manisha Shah (Medway Maritime Hospital, Anaesthetics, Kent, United Kingdom) Antonia Benton (Medway Maritime Hospital, Anaesthetics, Kent, United Kingdom)

Background: The 2-year Foundation programme in the UK aims to ensure that newly qualified doctors develop their clinical and professional skills in readiness for more advanced training. Foundation year (FY) 2 doctors take on an increasing responsibility for patient care and are expected to demonstrate an ability for effective communication in increasingly challenging circumstances.

Summary of work: We conducted a survey to evaluate the communication skills training received by FY2 doctors at Medway and Lewisham Hospitals, and the impact this has had on their performance. We received 23 responses.

Summary of results: All respondents rated communication skills in medical practice as 'very important' with 78% strongly agreeing that ineffective communication skills contributed to errors in healthcare. Ninety six percent of respondents had received formal training on aspects of communication as medical students, but only 52% had such training during their FY1 year. Despite that, 30% said they have encountered a situation which they felt required communication skills beyond their training or competence. When asked to rate the various methods of delivery of training, simulation was rated as the most effective by the majority of respondents (65%).

Conclusions: Further emphasis should be placed on non­technical skills (NTS) training for junior doctors. Simulation is an effective teaching tool and should be utilized to this purpose.

Take-home messages: The integration of both technical and NTS like communication and decision-making facilitates successful task performance. NTS training for FY2 doctors should be tailored to fulfill the requirements set in the Foundation programme curriculum and to achieve the desired outcomes of Foundation training.

9Z/16

Peer assisted learning is effective for teaching communication and history taking skills

Georgina KP Choi (University of Sheffield, Academic Unit of Medical Education, Sheffield, United Kingdom) Jonathan C Brooke (University of Sheffield, Academic Unit of Medical Education, Sheffield, United Kingdom) Michelle Marshall (University of Sheffield, Academic Unit of Medical Education, 85 Wilkinson Street, Sheffield

S10 2GJ, United Kingdom)

Background: Peer Assisted Learning (PAL) is a validated educational tool, often used to supplement formal teaching. This study evaluated the effectiveness of PAL for first-year medical students with particular regard to the development of their communication and history taking skills.

Summary of work: 410 first-year students were divided into small groups and allocated a peer-tutor in the clinical phase of the medical course. Tutors delivered teaching on communication and history taking skills and supervised the tutees in practice. An interactive session using electronic keypads was conducted to evaluate the peer-led sessions. 4-point Likert scales were used to quantify responses. University Research Ethics Committee approval was obtained. Summary of results: 91% of tutees considered PAL to be a useful supplement to formal teaching. 89% believed the scheme highlighted areas where they could improve their history taking skills. The PAL scheme enabled 88% to improve their confidence with history taking. 83% improved their appreciation of psychosocial impacts, and 95% of tutees reported an improvement in their communication skills. Additionally, 67% were more confident in suggesting differential diagnoses and 87% improved their ability to suggest management plans. Conclusions: This is the first study to demonstrate that PAL schemes improve the confidence and ability of medical students in developing an appreciation of the history taking process, as well as improving their communication skills.

Take-home messages: PAL is beneficial for first-year medical students in improving their basic clinical competencies, including history taking and communication 9AA Posters: Selection: Undergraduate and Postgraduate

Location: Terrace 2, PCC

9AA/1

Cognitive and non-cognitive features of first year medical students: impact of gender on selection?

Milena Abbiati (University of Geneva, UDREM, 1, Michel

Servet, Geneva 1211, Switzerland)

Anne Baroffio (University of Geneva, UDREM, Geneva,

Switzerland)

Nicolas Kramar (University of Lausanne, Natural Science, Lausanne, Switzerland)

Margaret Gerbase (University of Geneva, UDREM, Geneva, Switzerland)

Background: Switzerland, like other Western countries, faces an insufficient number of medical students graduating each year, to meet aging population needs. However, selection for medical studies is severe and based mostly on MCQ scores, thus ignoring non-cognitive features particularly relevant for selecting 'good' doctors. Contribution of non-cognitive features to optimize selection of medical students has not been fully investigated.

Summary of work: to establish first-year medical students' cognitive and non-cognitive profiles; - to compare how such profiles features contribute to success by gender and in three different selection environments. Method: We assessed first-year medical (N=180), psychology (N=150) and sciences (N=160) students on personality traits (NEO), learning approaches (SPQ-R) and professional motivations and collected high-school final grade (HSG), first-year exam grades (FYG) and socio-demographic data. T scores were used to compare students' personality with a general reference population; multivariate linear regressions were run to analyze how gender, NEO, SPQ-R and HSG contribute to FYG, and ANOVAs to compare medical, psychology and sciences students. Summary of results: Medical students showed high extraversion (90-percentile) and low agreeableness (30-percentile). Regression model (r2=0.301, p=0.001) differed by gender (p=0.02). Men's HSG, SPQ-deep motive, NEO-openness (positive) and NEO-agreeableness (negative) significantly contributed to FYG. Women's HSG only did. Comparison with other students will be presented at the conference. Conclusions: Medical school students present specific profiles. Whereas cognitive ability influenced all medical students' MCQ first-year exam score, non-cognitive traits impacted men's success only. Take-home messages: Taking into account non-cognitive measures to a cognitive test might better equilibrate gender selection for medical school and thus better fulfill societal public health needs.

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

9AA/2

Dare to Doctor: An Access to Medicine Summer School

Daniel Wilkins (University of Bristol, Great Western Hospital Academy, Marlborough Road, Swindon SN3 6BB, United Kingdom)

Amy Hawkins (University of Bristol, Great Western Hospital Academy, Swindon, United Kingdom) Kevin Jones (University of Bristol, Great Western Hospital Academy, Swindon, United Kingdom)

Background: Access to medicine summer schools are a commonly used, but under studied widening access initiative in the United Kingdom, aimed at school students from lower social classes, who lack self confidence and underestimate their chances of success in applying for a place at medical school. Summary of work: The University of Bristol's Swindon Academy ran Dare to Doctor, an access to medicine summer school. Each student (N=24) completed a questionnaire before and after the summer school. They were questioned on their commitment to medicine and their chances of success. The questionnaire used a 5-point scale from strongly disagree to strongly agree, with space for free-text responses. Students also completed an evaluation questionnaire. The aim of this study was to investigate the role of access to medicine summer schools as a widening access tool. Summary of results: After the summer school students rated themselves as better prepared for interviews (Mean 4.10 vs 2.90, P<0.001) and personal statement writing (4.20 vs 3.20, P<0.001). Before and after the summer school all students felt strongly committed to medicine. Student evaluation was overwhelmingly positive. Most found clinical shadowing to be most enjoyable (81%), and mock interviews most useful

(86%).

Conclusions: After Dare to Doctor students felt more confident in facing interviews and personal statement writing, and found the experience useful and enjoyable. However only students already strongly committed to medicine attended.

Take-home messages: Access to medicine summer schools is successful in boosting the confidence of the committed few who attend them, but a more proactive outreach is needed to target a wider audience.

9AA/3

Research in action: using Q sort to support widening participation in medicine

Qasim Ashraf (University of Manchester, School of Medicine, ATR4, Education and Research Centre, University Hospital South Manchester, Manchester M23 9LT, United Kingdom)

Akhil Lakhani (University of Manchester, School of Medicine, Manchester, United Kingdom) Elspeth Hill (Maastricht University, School of Health Professions Education, Maastricht, Netherlands) Suzanne Vaughan (University of Manchester, School of Medicine, Manchester, United Kingdom)

Andy Brass (University of Manchester, School of Computer Science, Manchester, United Kingdom)

Background: Diversity in medical education has positive implications for students, staff, patients and wider society. Individuals from underrepresented groups often have negative perceptions about medical school and their ability to fit in or succeed. To achieve diversity in medicine, young people need opportunities to learn about the attributes and achievements required for a place at medical school, and to challenge negative stereotypes.

Summary of work: This innovative, interdisciplinary project uses Q sort, a statement sorting task, to stimulate discussion around young people's perceptions of medical students and medicine whilst collecting data to contribute to the widening participation (WP) literature. We report on the initial findings from twenty groups of school pupils aged 11-17 and five groups of medical students.

Summary of results: Quantitative analysis revealed certain attributes to be universally perceived as necessary for success in medical education. There were, however, differences between groups and between pupils and medical students. Observational data provides further insight into negative preconceptions, oppositional identities and school cultures, and how they can be challenged. We provide a model for other programmes to utilise and adapt. Conclusions: By undertaking this research during our WP sessions we can ensure our activities are needs-led and evidence-based.

Take-home messages: Q sort is a successful way to stimulate discussion, challenge preconceptions and direct the right information and support to young people underrepresented in medicine.

9AA/4

Admission criteria and diversity in medical school

LD O'Neill (Aarhus University, Center for Medical Education, Brendstrupgardsvej 102, B., Aarhus N 8200 N, Denmark)

MC Vonsild (University of Southern Denmark, Unit for

Education Development, Odense, Denmark)

B Wallstedt (University of Southern Denmark, SDU

Universitetspsedagogik, Odense, Denmark)

T Dornan (Maastricht University, Department of

Educational Development and Research, Maastricht,

Netherlands)

Background: The underrepresentation of students from lower socioeconomic backgrounds in medical education is an important social issue. There is currently little evidence about whether changes in admission strategy could increase the diversity of medical students. Denmark introduced an "attribute-based" admission track to make it easier for students, who may not be eligible for admission through the "grade-based" track, to be admitted on the basis of attributes other than academic performance. The aim of this research was to examine whether there were significant differences in

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

the social composition of students admitted via the two tracks between the years 2002-2007. Summary of work: This prospective cohort study included 1074 Danish medical students admitted between the years 2002-2007 to the University of Southern Denmark (USD) medical school. Of these, 454 were admitted by grade-based selection and 620 were selected on attributes other than grades. To explore the social mix of the two tracks, we obtained information on social indices associated with educational attainment in Denmark (ethnic origin, father's education, mother's education, parenthood, parents live together, parent on benefit).

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