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This symposium will confront the implicit assumption that "measurement" is preferable to "description" when assessing and evaluating learners in medical education. Symposium presenters will discuss why written narrative descriptions of learners' performance may provide a more useful and valid foundation for assessment and evaluation than Likert-scale ratings and percentage scores from observation checklists and examinations. Presentations will also address practical approaches to eliciting useful narratives and explore the challenges of changing a culture of evaluation that has relied on numbers for most evaluation data. Participants will be invited into the lively conversation about the issues that emerge.

10B Symposium: Becoming a doctor: the

importance of on-the-job learning

Location: Meeting Hall I, PCC

Trudie Roberts (Leeds Institute of Medical Education, University of Leeds, UK)

Cees van der Vleuten (Maastricht University, the Netherlands) and colleagues

A substantial portion of medical education takes place in the clinical workplace. Recent research offers new insights into the possibilities and limitations of on-the-job learning. Experts from various parts of the world will share their insights and discuss important topics in this type of learning, such as feedback, assessment and mentoring. The panel of speakers and the audience will engage in a discussion of the possibilities and limitations of learning on the job.

10C Short Communications: Games and eLearning

Location: Panorama, PCC 10C/1

Serious gaming: The development of an interactive computer game for learning chest drain insertion

Juan D Hernandez (Universidad de los Andes, Facultad

de Medicina, Anatomy, Carrera 1 No 18 A 10 Edificio Q

Oficina 806, Bogota 11001000, Colombia)

Nicolas Mendoza (Universidad de los Andes, Systems

Engineering, Bogota, Colombia)

David Delgadillo (Universidad de los Andes, Facultad de

Medicina, Bogota, Colombia)

Pablo Figueroa (Universidad de los Andes, Systems

Engineering, Bogota, Colombia)

Background: Working hour restrictions, reduced patient contact and exposure to procedures, diminish students' chances to acquire experience in tube thoracostomy (chest drain insertion). Chest drain insertion (CDI) is a frequent intervention junior doctors and interns are required to perform in some countries. Existing simulators are mannequins only for the surgical procedure itself, with limited practice of all steps and without aspects around preparation and care, which are competencies involved. A computer-based, interactive simulator could give a significant initial knowledge in CDI, before students perform the procedure. We present the process of creation of a serious game to teach a basic surgical procedure. Summary of work: To create an attractive and engaging game to teach CDI, the process was: define the procedure steps (expert); interview residents, interns and students to find difficulties and expectations in the learning process of CDI; creation of an algorithm around milestones of CDI. Once these elements were defined, a software environment and imaging design was developed.

Summary of results: Students and experts have shown interest. Current development has provided initial images and an environment to place the game in an interactive context, including these steps: diagnostic, equipment and patient preparation, intervention performance and patient care afterwards. Usability tests for initial designs are in process. Conclusions: Learning outcomes should guide the creation of the game contents, steps and rewards. Students show interest in learning using a familiar environment. The challenge is to make it enjoyable. Take-home messages: Games represent alternative methods of teaching using attractive environments that promote repetition and construction of increasingly complex learning.

ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015

10C/2

Game for training in primary health care took place in a 3D virtual city

Alessandra Dahmer (Federal University of Health Sciences, Education Information and Health, Porto Alegre, Brazil)

Maria Eugenia Pinto (Federal University of Health Sciences, Department of Public Health, Porto Alegre, Brazil)

Gabriele Dias (Federal University of Health Sciences, Education Information and Health, Porto Alegre, Brazil) Rodrigo Tubelo (Federal University of Rio Grande do Sul, Department of Public Health, Sarmento Leite, 245, Jose Affonso Ely, 52, Porto Alegre 91787810, Brazil)

Background: Teaching methodologies have usually used new technologies in order to improve the quality of learning. The UFCSPA/UNASUS developed a game, based on the clinic of the Primary Health Care, in order to help in the permanent process of education of health professionals.

Summary of work: The aim of this study was the development of a game using simulation of the clinical cases which took place in a PHC clinic in order to contribute to the learning process of health professionalss. The use of a virtual fictitious city in 3D (Santa Fe), located in the Brazilian countryside, made in the Software Google Sketchup Pro 8, was part of the creation process of the Game. Clinical cases made in the XMind 2012 tool were adapted for the participation of different professions that are on the course (physicians, nurses, dentists). E_Adventure was the tool used in the development of the game.

Summary of results: The transformation of a fictitious city for the third dimension was able to simulate with reality a Brazilian countryside. The development of the game showed the interactivity of the student with the virtual city, emphasizing the learning in an entertainment way.

Conclusions: The creation of a game took place in a virtual city, simulating the routine of the physicians, nurses and dentists and allowed the transmission of knowledge in a longitudinal and interactive way. Take-home messages: The creation of a serious game is an important advance for the qualification of the course offered to the health professionals.

10C/3

Medical students repurpose and evaluate serious games, e-OSCEs and virtual patients

Eleni Dafli (Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece)

Panagiotis Bamidis (Aristotle University of Thessaloniki, School of Medicine, PO Box 323, Thessaloniki 54124, Greece)

Background: Contemporary medical education exhibits a wide variety of learning resources. Serious games, OSCEs in electronic format and virtual patients are some

examples of modern learning content items used in the community of medical education. Summary of work: During the last few academic years, representative samples of the previously mentioned types of learning content items were designed and implemented in the educational activities of Aristotle University of Thessaloniki. They were widely used, re­used and repurposed from medical students, as an attempt to update the medical curriculum. The final step of the procedure was the students' evaluation of the three types of learning resources. Summary of results: Medical students, randomly divided in three groups, used and reused, repurposed and evaluated: 1) a serious game, 2) an e-OSCE and 3) a serious game, among all these that are used in the medical curriculum of AUTH. The SUS score questionnaire was used as an evaluation tool of the usability of these three different systems and open ended questions were used complementary in the final evaluation process.

Conclusions: The results of the evaluation demonstrate that medical students are attracted to modern types of learning resources. The usability of all of the three systems was graded with a high usability score and students showed a great willing of involvement in the re-design and implementation process. Take-home messages: Serious games, e-OSCEs or virtual patients? Every interactive type of modern learning resources presents a great challenge for students; to play, train, repurpose and reuse.

10C/4

Assessment of Psychiatry Clinical Simulation Teaching Modules by Student Surveys

Martin Klapheke (University of Central Florida College of

Medicine, Clinical Sciences, 6850 Lake Nona Blvd,

Orlando, Florida 32827, United States)

Adriana Foster (Georgia Regents University, Psychiatry,

Augusta, Georgia, United States)

Teresa Johnson (University of Central Florida College of

Medicine, Medical Education, Orlando, Florida, United

States)

Background: A Clinical Simulation Initiative by the Association of Directors of Medical Student Educators in Psychiatry has developed a free database of online psychiatry teaching modules that include videos of simulated patient cases. We now aim to obtain preliminary data on student satisfaction and the modules' impact on students' confidence in disorder-specific knowledge, diagnosis, and treatment, and assess the internal consistency of the student surveys evaluating module quality and effectiveness. Summary of work: Surveys used in a 2011-12 pilot study were revised based on statistician and focus group feedback. Survey items include educational value, general feedback, and student confidence in disorder-specific knowledge, diagnosis, and treatment. Rating items are measured on a 5-point Likert-type scale, where 1=Strongly Disagree and 5=Strongly Agree. Comparisons between pre- and post-module student

ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015

confidence ratings were assessed using non-parametric Wilcoxon signed rank tests.

Summary of results: Preliminary 2012-13 data (bipolar disorder, N=75; personality disorders, N=44; dementia, N=37) yielded mean student ratings of 3.9-4.6 on items measuring module quality and effectiveness. All student confidence ratings were significantly higher post-module as compared to pre-module for all modules (p<0.001). Five of the six pre- and post-module student surveys demonstrated moderate to strong internal consistency (Cronbach's alpha=0.71-0.93).

Conclusions: Initial data from the larger, ongoing 2012­13 study generally support the reliability of the survey instruments, and demonstrate student satisfaction with the modules and positive impact on students' confidence in disorder-specific knowledge, diagnosis, and treatment.

Take-home messages: Preliminary results are promising for: 1) student satisfaction and confidence in knowledge gained with these clinical simulation teaching modules, and 2) internal consistency of these survey instruments, which could be adapted to collect feedback about similar teaching tools.

10C/5

The Prescribing Optimalization Method In The E-Learning Environment Pscribe Is An Effective Method For Medical Students' Education On Pharmacotherapy

CJPW (Karen) Keijsers (UMC Utrecht, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, Utrecht, Netherlands) ABD van Doorn (University of Groningen, Dept. of Pharmacotherapy and Pharmaceutical Care, Groningen, Netherlands)

A van Kalles (UMC Utrecht, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, Internal post B05.256, Utrecht 3508 GA, Netherlands)

DJ de Wildt (UMC Utrecht, Neurosciences and

Pharmacology, Utrecht, Netherlands)

JRBJ Brouwers (UMC Utrecht, Department of Geriatric

Medicine and Expertise Centre Pharmacotherapy in Old

Persons, Utrecht, Netherlands)

PAF Jansen (UMC Utrecht, Department of Geriatric

Medicine and Expertise Centre Pharmacotherapy in Old

Persons, Utrecht, Netherlands)

Background: Although junior doctors feel unprepared for prescribing, evidence based medical education on the topic is lacking. The Prescribing Optimalization Method (POM) is proven to be effective to review polypharmacy by general physicians. Aim: to study the effectiveness of the POM in final year medical students in the e-learning environment Pscribe. Summary of work: In a multicenter randomized pre- and posttest design the POM was studied. All were asked to optimize the pharmacotherapy for two cases. All students optimized the first case without any method. For the second case half of the students were randomized for the POM, half for the control group.

Within the intervention group half received a non-e-learning variant, half received the e-learning program Pscribe. The medication lists as proposed by the students were compared with consensus from an expert panel. The control and intervention group as well as the e-learning and non-e-learning group were compared with a repeated measurement linear model with t-test as post-hoc analyses.

Summary of results: 103 students were included: 51 from Utrecht, 52 from Amsterdam (68% female, median age 25 (23-40). With use of the POM pharmacotherapy improved: 33% more correct decisions (p 0.00) and 30% less potentially harmful decisions (p 0.00). No differences were found between the e-learning and non­e-learning group.

Conclusions: Use of the POM increases correct decisions and significant decreases potentially harmful decisions. Above, the method was proven to be effective without instruction and can therefore be easily implemented in pharmacotherapy education of medical students. Take-home messages: The POM is effective in medical students' education without instructions.

10C/6

Malnutrition eLearning and social media join forces to build global malnutrition management capacity

Sunhea Choi (University of Southampton, Faculty of Medicine, Southampton, United Kingdom) Trevor Pickup (University of Southampton, Faculty of Medicine, MP 820, Level B, Faculty of Medicine, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom)

Background: Technological advances, particularly the Internet, have revolutionised medical education globally, increasing access to learning/training opportunities that were not available previously. Challenges are students and health professionals identifying credible and effective learning resources and educational institutions raising awareness about their resources among potential users. Summary of work: The University of Southampton and International Malnutrition Task Force developed a high quality eLearning course, Malnutrition eLearning, to meet the global demands for malnutrition management capacity building among students and health professionals. After failing to achieve a large-scale uptake of the course, a social media campaign was launched in October 2012. To evaluate the course and Social Media campaign, a questionnaire and assessment of user enrolment records were conducted. Summary of results: From October 2012 to February 2013 1,771 people from 121 countries, ranging from doctors, nutritionists, academics, government staff to students, enrolled on the course. Healthcare professionals' enrolment for their Continuing Professional Development (CPD) was far greater than students', although student numbers increased gradually. 141 from 38 countries participated in the questionnaire. 92% found the course helpful or very

ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015

helpful. 55% became aware of it through LinkedIn and Facebook (38%) and Google (17%). Conclusions: Malnutrition eLearning, promoted by Social Media, has enabled health professionals, working across a range of roles globally, to get malnutrition management training. eLearning and Social Media together showed potential to achieve global health improvement, contributing to health professionals' CPD. Take-home messages: eLearning can make significant impact on global capacity building, and Social Media is a powerful method, bringing users and available training together, outperforming other communication methods.

10D Short Communications: Empathy

Location: Meeting Hall IV, PCC

10D/1

Empathy perception and skills differ among medical students: results from a cross-sectional comparative study

Margaret W Gerbase (University of Geneva, Faculty of Medicine, Unit of Development and Research in Medical Education, 1, rue Michel-Servet, Geneva 1211, Switzerland)

Milena Abbiati (University of Geneva, Faculty of Medicine, Unit of Development and Research in Medical Education, Geneva, Switzerland) Nu Viet Vu (University of Geneva, Faculty of Medicine, Unit of Development and Research in Medical Education, Geneva, Switzerland)

Anne Baroffio (University of Geneva, Faculty of Medicine, Unit of Development and Research in Medical Education, Geneva, Switzerland)

Background: Empathy is a recognized key ability for medical practice. Early development of empathy skills during medical studies strengthens this ability. However, the relationship between valuing empathy and being empathic is unknown. Aims: compare perception and skills of empathy among 1st-year medical students, and analyze contributions of personal characteristics, learning approaches and stress coping to empathy. Summary of work: 180 students completed validated questionnaires assessing empathy perception (Jefferson Scale of Empathy, JSE) and empathy skills (Empathy Quotient, EQ); standardized questionnaires assessed personality (Big Five NEO), learning approaches (SPQ) and stress coping (CISS). Pearson's correlations compared JSE and EQ scores. Multivariate linear regressions analyzed students' characteristics related to

JSE or EQ.

Summary of results: Correlation between JSE and EQ was 0.404 (p<0.0001). Overall, scores were 108.6±10.4 (78% of JSE max score=140) and 51.2±5.6 (64% of EQ max score=80) with significant gender differences. Regression models (r2=0.291 for JSE and r2=0.364 for EQ) showed that gender, NEO-openness and NEO-agreeableness (positive), and NEO-neuroticism (negative) correlated similarly and significantly with JSE and EQ. Stress coping by emotion (p=0.025) and distraction (p=0.045) correlated with JSE, whereas social direction (p=0.004) with EQ. No significant correlations were found between empathy scores and learning approaches (surface or deep). Gender specificities partly explaining the observed results will be presented. Conclusions: First-year medical students had fair scores on perceived empathy, but lower scores on empathy skills. Correlation between JSE and EQ was moderate, underlining differences between instruments which merit to be taken into account when assessing students' empathy capacity.

Take-home messages: Perceived empathy value is higher than empathy skills among junior medical students.

ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015

10D/2

Variation of empathy in a cohort of medical students and the relationship with their value profiles. Andres Bello University, Vina del Mar,

Chile

Peter Mc Coll (Universidad Andres Bello, Escuela de Medicina, Calle Llay Llay 1726, Vina del Mar 2520613,

Chile)

Hernan Borja (Universidad Andres Bello, Escuela de

Medicina, Vina del Mar, Chile)

Alberto Caro (Universidad Andres Bello, Escuela de

Medicina, Vina del Mar, Chile)

Gabriel Perat (Universidad Andres Bello, Escuela de

Medicina, Vina del Mar, Chile)

Camila Perez de Arce (Universidad Andres Bello, Escuela de Medicina, Vina del Mar, Chile)

Background: Empathy is one of the main features that a physician must develop.

Summary of work: Objective: To compare the level of empathic orientation that 3rd year medical students have in the beginning and by the end of a clinical course. To establish whether the value profile is in correlation with the level of empathic orientation or not. A cohort study was performed, 32 third-year medical students (18 males and 14 females). In the beginning of the investigation empathic orientation was measured by utilizing Jefferson scale and the value profile was established by using Schwartz's value inventory. At the end of the course, after 4 months, Jefferson scale was applied again. To analyze the data, Student's t-test was used as well as Pearson correlation. Summary of results: There was a slight diminution in global empathy and more specifically in "compassionate care" component. On the other hand, there was a slight increase in perspective taking and "standing in the patient's shoes", though these differences were not significant statistically (p>0.05). Women showed means that were slightly higher than men's in global measurement and in all three components, even though these differences were not statistically significant either

(p>0.05).

Conclusions: In this study group, no significant changes in the empathic orientation were found. There were neither differences in gender nor correlation with the value profile.

Take-home messages: It is necessary to continue carrying out this study after the 4th or 5th year of medicine studies is finished, using Jefferson scale to verify whether these tendencies that were found become significant in the long term.

10D/3

"It is good to be a doctor": preserving empathy through a positive look into the practice of medicine

Marcelo Schweller (UNICAMP, Emergency, Rua Quatorze de Dezembro, 404, apt 52, Campinas 13015­130, Brazil)

Eloisa Celeri (UNICAMP, Psychiatry, Campinas, Brazil) Marco Antonio Carvalho Filho (UNICAMP, Emergency, Campinas, Brazil)

Background: Recent studies have demonstrated that undergraduate medical students typically undergo a loss of empathy during medical school. The hidden curriculum, embodied mainly by negative role models, can be held liable for the contrast between medicine as imagined by the student and the reality he or she encounters and experiences.

Summary of work: Sixty-five first-year medical students of 2012 participated in a curricular course with weekly meetings over the course of 4 months. Several activities were proposed, with the aim of introducing students to the reality of medical practice and the doctor-patient relationship; these included conversations with patients and experienced physicians, supervised visits to the emergency room and intensive care unit with selected physicians, and theatrical performances portraying caricatures of inadequate consultations. Students' empathy levels were evaluated by the Jefferson Scale of Physician Empathy (JSPE) before and after the curricular course.

Summary of results: The pretest JSPE scores were 119.4 and increased to 123.0 after the intervention (p<0.001). The increase was greater (9.4 points) among students with lower initial JSPE scores, while students with higher initial scores had more modest increases (1.4 points). Conclusions: These results suggest that early curricular interventions could prevent loss of empathy through a positive introduction to the reality of medical practice. Take-home messages: Activities that present the students with a positive view of the practice of medicine and offer interaction with positive role models should be inserted early into the medical school curriculum.

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