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Maureen Doyle-Scharff (Pfizer, Inc., Medical Education Group, New York, United States)
Background: Continuing medical education and continuing professional development (CME/CPD) are being challenged to show results. Despite a considerable amount of research and some limited advances, it is unclear if CME/CPD is routinely delivering the outcomes that society, organized medicine, and health care institutions expect: improved performance of physicians and other health professionals. There has been an increased focus on measuring outcomes but this has not been accompanied by an equally important emphasis on educational planning for results. Desired outcomes just don't happen; they must be planned for. Van Merrienboer and Kirschner have recently published a book entitled Ten Steps to Complex Learning which describes an evidence-based approach to educational planning that could provide what CME/CPD needs to create the desired outcomes. At the annual meeting of the Global Alliance for Medical Education (GAME) in June 2013, attendees participated in active learning modules to use the new Ten Steps model to plan an educational activity to help clinicians achieve desired outcomes in managing patients with diabetes. Intended outcomes: After participating in this workshop, attendees should be able to describe and discuss:
The ten steps approach to instructional design The relationship between educational planning and outcomes
Strategies to focus educational planning on outcomes in
their educational practice
Structure of workshop: Instructional plan: The
workshop will have four parts:
Summary of the GAME workshop and its results.
A small group inquiry-based exercise to examine the
relationship between educational planning and
Discussion: sharing the results and developing a consensus.
Constructing an action plan.
Who should attend: educators, deans, department chairs, faculty in academic institutions and medical associations, and other educators, clinicians and researchers interested in educational design and its relationship to achieving desired outcomes. Level: Intermediate
ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015
10Y Workshop: Train the trainer in team with meta-simulation: different faculty roles and major pedagogical components during high fidelity simulation
Location: Meeting Room 4.3, PCC
Fremen Chih-Chen Chou (China Medical University Hospital, Department of Education and Department of Emergency Medicine, #2, Yu-de Rd. North District Taichung 40447, Taiwan)
Chih-Wei Yang (National Taiwan University Hospital, Department of Medical Education and Department of Emergency Medicine, Taipei, Taiwan) Cheng-Ting Hsiao (Chang Gung Memorial Hospital Chiayi Branch, Department of Education and Department of Emergency Medicine, Chiayi County, Taiwan)
Yi-Ju Fu (China Medical University Hospital, Department of Education, Taichung, Taiwan)
Background: Faculty development has been recognized as a crucial factor for the success of high fidelity simulation (HFS) training. Moreover, multi-disciplinary teamwork of faculties responsible for different aspects of tasks during HFS is the key to optimal operation of a HFS session. However, comprehensive faculty team training focusing on tasks of different faculty roles is currently lacking. Through facilitated discussion and meta-simulation, our workshop intends to identify the different faculty roles and major pedagogical components during a HFS session. Intended outcomes: Participants are able to: 1. Identify the needs of different faculty roles in HFS; 2. Point out the major pedagogical components that constitute an effective HFS; 3. Discuss how the different faculty roles work collaboratively on those pedagogical components to achieve the learning objectives. Structure of workshop: 1. Introduction of workshop, organizers and participants (10 min); 2. Activity I (10 min): Ask participants buzz group to generate the possible faculty roles and the course structure of HFS according to their experiences; 3. Introduction of each role in a faculty team and the pedagogical components of HFS training (20 min); 4. Activity II, Meta-simulation (35min): Participants experience a HFS and metacognitively reflect on the faculty roles and their collaboration on the pedagogical components of the course with the provided observation tool; 5. Reflection, discussion and summary (15min). Who should attend: Participants with interest in HFS, especially who want to improve the effectiveness of their HFS course or who have the needs to develop faculty team and course structure. Level: Intermediate
10Z Posters: Postgraduate Education 2
Location: South Hall, PCC
Complications During Cataract Surgery Learning Curve Performed by Ophthalmology Residents
Sakchai Vongkittirux (Thammasat University Hospital, Ophthalmology, Khlong Luang, Pathumthani 12120, Thailand)
Background: Phacoemulsification is one of the most commonly performed cataract surgical procedures of ophthalmologists which needs well-trained surgical skills and aims to have zero complications as much as possible eg. ruptured posterior capsule. In-training ophthalmology residents started cataract surgery training in the third year which was inevitably vulnerable to a lot of serious complications. However, as time goes by, it holds true that their phacoemulsification learning curves were gradually improved and finally completed. Summary of work: The data of all consecutively attempted phacoemulsifications with intraocular lens implantations performed at the Department of Ophthalmology, Thammasat University from 2010 to 2011, total 1,262 cases, were retrospectively reviewed and reported in the annual seminar of the department. The cataract surgery complications using phacoemulsification technique of third-year ophthalmology residents and skilful faculty staffs were compared.
Summary of results: Incidence of phacoemulsification intraoperative complications performed by third-year ophthalmology residents was 5.36 % (9/168) which is higher than that of faculty 1.83 % (20/1,094). The odds that the eyes in the resident group would have an intraoperative complication were 3 times the odds that the eyes in the faculty staff group would have such complication (odd ratio 3.04, 95% confidential interval (CI) = 1.36 - 6.79). Nevertheless, residents' complications were successively decreased whereas they gained more experience.
Conclusions: Meticulous processes of cataract surgery training will help decrease the possible complications of this procedure and continuously prosper the ability of the trainees.
Take-home messages: Customizing of the teaching pattern to suit the learning objectives will help develop residents' skill during training.
How do surgical trainees engage in self-directed learning in the workplace?
Harsheet Sethi (Imperial College London, Surgery and Cancer, London, United Kingdom) SFSmith (Imperial College London, National Heart and Lung Institute, London W2 1BL, United Kingdom)
Background: This exploratory study aims to generate a deeper understanding about learning strategies
ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015
employed by surgical trainees, their engagement in self-directed learning and perceptions about self-assessment.
Summary of work: A qualitative study based on grounded theory using digitally recorded in-depth semi-structured interviews with nine surgical trainees (ST3-8) within the Yorkshire rotation. Theoretical sampling was used to identify putative interviewees. The interview transcripts were coded and analysed using a constant comparative approach in an attempt to reach saturation.
Summary of results: The emerging themes reached saturation. Trainees were motivated to learn for extrinsically set milestones such as exams, intrinsically to feel competent and most importantly for problem solving. Most trainees emphasised 'learning by doing', although acquisition of theoretical knowledge was considered important. Trainees planned their route towards a consultant position in collaboration with their mentor and deanery. They found work-based assessments cumbersome and rating scales of little value, preferring timely face-to-face feedback from trainers trained to provide constructive feedback. Most people are reflective learners but prefer private reflection to formal reflective writing; they equated self-assessment to reflection-on-action, using peer performance as a yard stick to measure their own ability.
Conclusions: Central themes emerging from this pilot study were learning by doing, self and peer assessment and feedback. These will be explored further with a larger sample, via the medium of a questionnaire. This may modify our approach to and suggest improvements for the current assessment system. Take-home messages: Trainees use critical reflection for self and peer assessment and crave graded supervision with constructive feedback from appropriately trained trainers.
Design and implementation of performance improvement programs for orthopedic trauma surgeons
Michael Cunningham (AO Foundation, AO Education Institute, Stettbachstrasse 6, Zurich 8600, Switzerland) Claude Martin Jr (AOTrauma, Education, Zurich, Switzerland) (Presenter: Urs Ruetschi - AO Foundation, Zurich, Switzerland)
Background: The design and implementation of performance improvement programs (PIPs) has not been fully explored with surgeons who manage fractures and related musculoskeletal injuries. Clinical experts identified two areas in imaging where performance could be further optimized to improve patient care: intraoperative views of hip fractures and appropriate use of MRI. This research asked if effective PIPs can be designed for surgeons in the area of orthopedic trauma.
Summary of work: A 3-step process was defined and implemented for two PIPs: 1) design, administration,
and analysis of a needs analysis (online set of questions and simulated cases); 2) design and delivery of a focused educational intervention; and 3) analysis of a set of post-intervention questions.
Summary of results: Needs analyses were completed by 98 surgeons and residents globally for intraoperative imaging and by 361 for MRI. Educational needs were confirmed for both topics, and differences based on level of experience and country of practice were detected. Targeted educational interventions were delivered to address these specific gaps. Post-intervention survey data from the MRI webinar showed that many surgeons intended to make improvements in their clinical practice as a result of participation. Conclusions: The needs analysis process successfully identified educational needs and performance gaps on several specific topics. By following a backward planning process, our educational interventions were appropriately developed to address these specific needs and gaps.
Take-home messages: Combining online needs analyses with targeted educational interventions delivered using appropriate methods is an effective method of conducting PIPs with surgeons.
Defining a learning curve for open appendicectomy
Hamid Abboudi (William Harvey Hospital, General Surgery, Ashford, United Kingdom) Satish Babu (William Harvey Hospital, General Surgery, Ashford, United Kingdom)
Uthishtran Sreedaran (Perth Royal Infirmary, Acute Medical Unit, Taymount Terrace, Perth PH1 1NX, United Kingdom)
Pradeep Basnyat (William Harvey Hospital, General Surgery, Ashford, United Kingdom)
Background: A learning curve defines an improvement in performance over time. Surgical trainees often lack defined end points with regards to procedural competence. Our aim was to examine a junior surgical trainee's open appendicectomy learning curve and hopefully guide curriculum developers. Summary of work: Case notes and theatre records of open appendicectomies conducted by a single trainee from December 2011-April 2012 were reviewed. Summary of results: A total of 26 open appendicectomies were performed. Operative times ranged from 20 - 91 minutes (mean 58). The length of stay ranged from 0 to 7 post-operative days (mean 1.5). Of the 26 appendices removed, 4 were histologically normal, 3 were reported as enterobius vermicularis and 19 as acute appendicitis. 2 major morbidities occurred at the early stages of the learning curve. One patient required reoperation to drain an infected collection. There were no readmissions to the same hospital and no mortalities.
Conclusions: No significant reduction in operative time was observed. This may suggest that this trainee requires more than 26 cases to overcome the learning
ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015
curve. Alternatively, the results may reflect the trainee receiving progressively less assistance from supervisors. Numerous factors including case mix, characteristics of the surgeon and composition of the surgical team could influence learning curves.
Take-home messages: After 26 cases, the learning curve was not clearly established for this trainee. Defining learning curves for procedures could guide developing surgeons during their training. The learning curve for open appendicectomy may require more cases prior to competence.
Developing an adolescent medicine curriculum: confidence verses practice of pediatric residents in Thailand
Rosawan Sripanidkulchai Areemit (Khon Kaen University, Department of Pediatrics, Faculty of Medicine, 123 Mitrapap Road, Muang Khon Kaen, Khon Kaen 40002, Thailand)
Wirote Areekul (Phramongkutklao College of Medicine, Department of Military and Community Medicine, Bangkok, Thailand)
Boonying Manaboriboon (Mahidol University,
Department of Pediatrics, Faculty of Medicine Siriraj
Hospital, Bangkok, Thailand)
Supinya In-Iw (Mahidol University, Department of
Pediatrics, Faculty of Medicine Siriraj Hospital, Bangkok,
Jiraporn Arunakul (Mahidol University, Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand)
Background: Confidentiality, privacy and psychosocial assessments are important aspects of adolescent health care. In order to develop a proper curriculum for adolescent medicine rotations, the authors aim to assess pediatric residents' confidence level and frequency of providing health care for adolescents. Summary of work: This is a prospective descriptive study. Participants were a group of pediatric residents from multiple institutions throughout Thailand who agreed to complete a self-reported questionnaire. They were asked to use a scale of 1 (not confident, never) to 4 (most confident, always) to rate their level of confidence and frequency of in providing health care to adolescents. Issues assessed were chosen from health supervision guidelines pertinent to adolescent health care.
Summary of results: Forty-five residents completed the questionnaire, the majority (95.6%) were in their last year of training. Most (73.33%) had experience in providing care to adolescents. Adolescents comprised 11.91% of the patients seen.
Residents were most confident about BMI (95.56%) and blood pressure assessment (95.56%). Issues that they were least confident about were: game & internet addiction (71.11%) and mood disorders (66.67%). Issues that they most frequently practiced were: blood pressure (86.76%), plotting weight and height on growth curves (86.76%) and growth assessment (86.76%). Issues that were least frequently practiced were assessment
for: risk of pregnancy (75.56%) and cervical dysplasia
Conclusions: Pediatric residents were more confident and more frequently provided health care to adolescents on physical rather than psychosocial issues. Take-home messages: In Thailand, an adolescent medicine curriculum which focuses on comprehensive health care with an emphasis on psychosocial issues is recommended.
Procedural skills in pediatric residency and in practice
Meera Rayar (University of Toronto, Pediatric Hematology and Oncology, Toronto, Canada) Stephanie Kay (McMaster University, Pediatrics, 1200 Main Street West, Hamilton L8S 4L8, Canada) Andrea Hunter (McMaster University, Pediatrics, Hamilton, Canada)
Rahim Valani (McMaster University, Pediatrics, Hamilto, Canada)
Background: Procedural skills are an integral part of pediatric residency training programs in Canada. It is uncertain which skills practicing pediatricians consider important in practice versus the comfort level of residents for these procedural skills. Summary of work: This prospective survey was undertaken at a single academic institution. Residents and general pediatricians were surveyed on how often they performed procedures listed by the Royal College of Physicians of Canada training objectives. Participants were also asked to rate their confidence level in performing each skill, along with their perception of which skills were necessary for pediatrics practice. Summary of results: Thirty seven participants completed the survey (22 residents, 15 staff). 14 residents were in their first two years of training. All staff physicians had community practices, over 90% also had academic appointments. 100% of residents and practitioners identified neonatal and pediatric resuscitation skills as essential to practice though used this skill set less than 5 times in the last year. Competence in all other non-resuscitation procedures were rated as either useful or important, but not essential to general pediatrics. The emphasis placed on a skill was not predictably related to the frequency they were performed. Residents uniformly described less confidence in performing all procedures than attending physicians.
Conclusions: This study shows that despite limited training and exposure to a skill, residents are able to distinguish which procedural skills are important to the practice of general pediatrics. Take-home messages: There remains a need for continued exposure to essential skills in practice, even if limited in opportunity, to continue to build confidence in implementation.
ABSTRACT BOOK: SESSION 10 WEDNESDAY 28 AUGUST: 0830-1015
Published articles based on pediatric residency training research theses
Somchit Jaruratanasirikul (Prince of Songkla University, Department of Pediatrics, Faculty of medicine, Prince of Songkla University, Hat Yai 90110, Thailand) Wassana Khotchasing (Prince of Songkla University, Pediatrics, Hat Yai, Thailand)
Background: Since 1985, the Department of Pediatrics of the Faculty of Medicine/Songklanagarind Hospital, Prince of Songkla University, has been approved by the Royal College of Pediatricians of Thailand (RCPT) as one of the Thai university hospitals qualified for pediatric residency training, with 3-6 residents/year during 19852003 and 6-10 residents/year since 2004. According to RCPT requirements, each pediatric resident is required to complete a full thesis prior to their final Thai Pediatric Board Examination.
Summary of work: Objectives: To determine the percentage of published articles based on residents' theses in medical journals and how long after the residents finished their residency training this publishing occurred.
Method: PubMed, Scopus, Web of Science, and the Thai journal database were searched for the names of our pediatric residents. Faculty researchers who had supervised the residents during their training were asked to confirm whether the residents had published their work.
Summary of results: Of the total 130 residents' theses during the 24-year period (1985-2012), 34 (26.2%) were published as articles in a medical journal: 8 (23.5%) in a Thai medical journal, 8 (23.5%) in a regional English journal, and 18 (53.0%) in an international journal. The median timings from when the residents finished their training program to the time their articles were published were 16, 20.5 and 21 months for Thai journals, regional journals and international journals, respectively.
Conclusions: About 25% of the residents' theses during the pediatric training were published as articles in the medical journals.
Take-home messages: More published articles based on residents' theses are expected in the future.
The third year anesthesiology residents' knowledge regarding pediatric postoperative pain management
Jirawadee Seehanoo (Khon Kaen University, Anesthesiology, Khon Kaen, Thailand) Somboon Thienthong (Khon Kaen University, Anesthesiology, 324/126 Ban Siriporn, Mitraparb Road, Tambol Sila, Amphur Muang, Khon Kaen Province 40000, Thailand)
Wimonrat Sriraj (Khon Kaen University, Anesthesiology, Khon Kaen, Thailand)
Suwannee Suraseranivongse (Mahidol University, Anesthesiology, Bangkok, Thailand)
Allen Finley (Dalhousie University, Anesthesiology, Halifax, Canada)
Background: An evidence of residents' knowledge is needed for improving the training program. Objective of the study is to assess the third year anesthesiology residents' knowledge about pediatric postoperative pain management.
Summary of work: The pediatric postoperative pain management was surveyed. The questionnaire has 35 questions divided to 17 multiple choice questions and 18 true or false questions to cover 2 domains; 1) use of age-appropriate pediatric pain assessment (10 questions) and 2) pediatric pain treatment (25 questions). Minimal passing level of the questionnaire rated before starting the survey was 76.2 percent. Participants were sixty-two 3rd year anesthesiology residents from 6 training centers across Thailand.
Summary of results: The response rate was 95.2 percent. Seventy-one percent of participants reported that they had learned about pediatric pain treatment. Of those, 55.9% rated their remaining knowledge at median level. The proportion of correct score was 67.7 percent (mean 23.7 + 2.9 SD) which was lower than the minimal passing level. The highest score was 29 (82.9%) and the lowest score was 16 (45.7%). For pain assessment domain; the mean proportion of correct score was 65% with highest and lowest scores at 90% and 40%. For pain treatment domain; the mean proportion of correct score was 68.8% with highest and the lowest score at 88% and 44%. There were 3 questions from the first domain and 5 questions from the second domain that less than 50 percent of participants had correct answer. Conclusions: Pain education is provided during Anesthesiology training programs in Thailand and the third year anesthesiology residents' knowledge about pediatric postoperative pain management needs to be improved.