Автор неизвестен - Mededworld and amee 2013 conference connect - страница 139

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Take-home messages: The Matrix Analysis Table gives perfect clues to students and curriculum designers about their strength and weakness.

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Does it really matter which language you are educated in? Spillover conclusions of research on efficiency of medical educational programme

Viktor Riklefs (Karaganda State Medical University, Clinical Skills Center, Karaganda, Kazakhstan) Raushan Dosmagambetova (Karaganda State Medical University, Karaganda, Kazakhstan) Alma Muratova (Karaganda State Medical University, Educational Resource Center, Gogol st., 40, Karaganda 100008, Kazakhstan)

Irina Riklefs (Karaganda State Medical University, Educational Resource Center, Karaganda, Kazakhstan) Aida Kasatova (Karaganda State Medical University, Educational Resource Center, Karaganda, Kazakhstan)

Aliya Bukeyeva (Karaganda State Medical University, Educational Resource Center, Karaganda, Kazakhstan)

Background: Influence of lingual differences on the success of medical education is still debated. When our University started researching efficiency of its programme in January 2012, we did not intend to focus on lingual differences. However, language of instruction (Russian or Kazakh) was included as covariate and unexpected results came out. Summary of work: In search for factors influencing success of medical education, 2846 students of Karaganda State Medical University took progress test and were surveyed using Kolb's Learning Style Inventory (KLSI). Progress test served as the main indicator of academic performance. KLSI was used to classify learners into "convergers", "divergers", "accommodators", "assimilators" and assess preference to reflective observation, abstract conceptualisation (AC), active experimentation, and concrete experience. For each respondent, gender, GPA, language of instruction, home region (rural or urban) were also recorded.

Summary of results: We observed higher progress test scores, AC scores and ratio of convergent learning style in students instructed in Russian and coming from urban areas. Multiple regression revealed AC score contribution to better academic performance, and multivariate ANOVA confirmed language of instruction as the most prominent factor for both academic performance and abstract conceptualisation. Conclusions: In our opinion, the limited availability of clinical and basic science sources in Kazakh (in comparison to Russian) inhibits students' desire to logically process and interpret information, reduces knowledge apprehension and decreases academic performance.

Take-home messages: It is best for the countries with a less influential national language to not limit student's medical education to a single language, but stimulate them to learn and communicate in more prominent languages.

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A decade of Web-Based assessments in a medical school: What lies ahead?

Anju Relan (David Geffen School of Medicine at UCLA, Educational Development and Research, 60-051 Center for Health Sciences, UCLA, Los Angeles 90095, United States)

Sally Krasne (David Geffen School of Medicine at UCLA, Physiology, Los Angeles, United States) Katherine Wigan (David Geffen School of Medicine at UCLA, Educational Research and Development, Los Angeles, United States)

Background: Web-Based assessments in medical schools are now commonplace, with the advent of sophisticated learning management systems. We developed an advanced, homegrown web-based assessment environment a decade ago, and have been conducting

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all formative and summative assessments online since then. In this paper we describe the development, implementation and evaluation of web-based assessments, with a look into the future. Summary of work: All formative (weekly) and summative web-based assessments in the first three years of our integrated medical school curriculum are delivered online using a learning management system and standalone assessment software, ExamSoft. Formative assessments employ multiple-choice, open-ended, and USMLE type questions. Students receive brief feedback or elaborate explanations on their responses. Summative assessments are delivered in a controlled, supervised lab environment. Aggregated feedback by tagged keywords is delivered after summative assessments. Automated psychometric information generated is used by faculty to improve robustness of the assessments and improve instruction. We are exploring games and immersive simulations as assessment modalities of the future. Summary of results: Students have consistently rated web-based assessments highly. We have published research which shows the importance of formative assessments in predicting success on summative assessments.

Conclusions: Web-based assessments require considerable team effort among faculty, administration and IT units. However, they offer a host of advantages for the test-takers, instructors and administrators. Competencies tested across the curriculum can be used for institutional accreditation more expeditiously. Take-home messages: Flexible, adaptive environments are now feasible with web-based assessments, which have more to offer with advances in development platforms, and mobile environments of the future.

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Correlation between scores on multiple choice and short essay questionnaires

Rune Standal (Faculty of Medicine, Norwegian University of Science and Technology, IT Division, Postboks 8905, NTNU, Det medisinske fakultet, Trondheim 7491, Norway)

Marite Rygg (Faculty of Medicine, Norwegian University of Science and Technology, Department of Laboratory Medicine, Children's and Women's Health, Trondheim, Norway)

Hilde Grimstad (Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway)

Torstein Vik (Faculty of Medicine, Norwegian University of Science and Technology, Department of Laboratory Medicine, Children's and Women's Health, Trondheim, Norway)

Background: Multiple choice questions (MCQ) are considered the most reliable and valid way of assessing understanding and application of knowledge. Although less reliable and valid, essay questionnaires (EQ) are often used to assess reasoning. We wanted to study how these two examination forms correlate and how

they agree in identifying students who fail the examination.

Summary of work: Results of the end of the fourth year examinations during 2009-12 at the Faculty of Medicine, Norwegian University of Science and Technology were analyzed. At this examination both MCQs and EQs are applied and a sum score is calculated whereby MCQs count 60% and EQs count 40% of the total score (100%). In order to pass the examination a total score of 65% is required.

Summary of results: A total of 459 students completed the written part of the included examinations. The correlation between MCQ and EQ scores was high (Pearson correlation coefficient: 0.62; p<0.001). A total of 38 (8.3%) students failed the examination, and 22

(4.8%) failed on both the MCQ- and the EQ-part.

Moreover, 40 (8.7%) students failed the MCQ part, while 64 (13.9%) failed the EQ part. The agreement between MCQ and EQ on which students should have failed the examination was only fair (Cohen's kappa = 0.35). Conclusions: Our results may be consistent with the notion that EQs are less reliable and valid than MCQs, and that more topics may be tested by MCQs. However, the results may also reflect the possibility that different abilities are tested.

Take-home messages: A variety of examination forms should be applied in high-stake written examinations.

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Perception of students on a Script Concordance Test (SCT) on cardiovascular diseases in an undergraduate medical school

Annick Dermine (KU Leuven, Centre for High Stakes Assessment in Medical Education, Faculty of Medicine KU Leuven, O&N2, bus 400, Herestraat 49, Leuven 3000, Belgium)

Lisa De Jonghe (KU Leuven, Centre for Medical Education

- Faculty of Medicine, Leuven, Belgium)

Inge Fourneau (UZ Leuven, Vascular Surgery, Leuven,

Belgium)

Background: In their 5th year of medical school, students of KU Leuven have a course on cardiovascular diseases. Until today this was partly assessed through SAMCQ and partly by oral examination. Given the importance of assessing clinical reasoning in ill-defined cases in this course, an alternative format was desired. The SCT has these advantages and also measures level of expertise. Therefore, a SCT on cardiovascular diseases was developed. In this study, we evaluate its validity and reliability.

Summary of work: Students took this SCT voluntarily just after the official examination. To demonstrate the validity, we gave participants a survey, questioning some personality traits and students' perception of the SCT in comparison with the official examination. To demonstrate validity and reliability we ran a psychometrical analysis.

Summary of results: 264/418 students participated. This group was comparable with the non-participating (M/F ratio, results on the official exam). With regard to

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personality traits, participants viewed themselves rather cautious (80%), but confident (60%), 88% prefers straightforwardness over vagueness. Regarding the SCT examination: 53% agreed they could demonstrate their insights in the course materials; 86% thought the SCT was 'difficult'. Preliminary item analysis revealed that 80/90 questions showed an item-total correlation >0, 2 and an a of 0,87.

Conclusions: The SCT on cardiovascular diseases provide satisfying psychometric results and students perceive it as a valid alternative, although very difficult. Take-home messages: A SCT can be a valid alternative assessment but must be accompanied with clear test instruction and training before the examination day.

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Is a picture worth a thousand words?

Jane Holland (RCSI, Anatomy, 123 St Stephen's Green, Dublin 2, Ireland)

Robin O'Sullivan (RCSI-Bahrain, Anatomy, Manama, Bahrain)

Richard Arnett (RCSI, Quality Enhancement Office, Dublin, Ireland)

Background: It has previously been suggested that the use of illustrations in MCQs may have variable effects on individual items. This study examines the effect of illustrated questions, as opposed to pure text, to discern if any overall bias between the two formats is detectable.

Summary of work: We reviewed 6 Histology MCQ papers from our Medical Junior Cycle. Classical test theory analysis was performed on all MCQs, which were then divided into two groups, those with associated images and those without. Summary of results: We analysed 195 single best answer MCQs; 100 with associated illustrations, 95 without. The number of students per examination ranged from 277 to 347, with a total of 60,850 student-question interactions. There was no difference in question difficulty between the two groups (0.800 vs. 0.770; p = 0.862, Mann-Whitney-U). The discriminating power of the questions, as measured by point biserial correlation, was also identical (0.315 vs. 0.300; p = 0.939; Independent t-test). Conclusions: We found no overall bias or effect on either item difficulty or discrimination resulting from the addition of illustrations. We suggest that illustrated questions, as with textual vignettes, may test a range of cognitive levels depending on how they are employed.

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European assessments: HERMES (Harmonised Education in Respiratory Medicine for European Specialists) Initiative of the European Respiratory Society (ERS)

Julie-Lyn Noel (European Respiratory Society, Educational Activities, Avenue Sainte-Luce 4, Zurich, Lausanne CH-1003, Switzerland)

Konrad Bloch (University Hospital of Zurich, Pneumology, Zurich, Switzerland)

Background: The ERS provides formative and summative assessments with the European examinations taking place during the annual ERS congress, and in the Netherlands and Russia. 90 multiple choice questions had to be solved within a 3 hour period for this examination.

Summary of work: Rate of participation and their performance in relation to the minimally required score over the period from 2008-2012 for diploma candidates are reviewed. These knowledge-based assessments are run and taken voluntarily by already-qualified respiratory specialists where they receive a European Diploma if successful since 2008. Switzerland uses this examination as the knowledge part of the national exit examination of Switzerland.

Rate of participation for in-training examination and self-assessment is reviewed. These examination goals were introduced in 2010. The examination is an obligatory in-training assessment in the Netherlands. Summary of Results: A yearly increase in participants for the European diploma was observed. A yearly increase in participants for the European diploma was observed. Year (n diploma candidates, success rate: minimum passing score) 2008 (86, 66.3%:59.3%); 2009(74, 64.9%:58.3%); 2010 (87, 54.8%:57.5%); 2011 (101,64.9%:58.1%); 2012 (130, 76.1%:56.2%); Participation numbers for in-training and self-assessment suggests increasing interest. Year (N In-training candidates:N self-assessment

candidates) 2010(61:2); 2011(139:3); 2012 (142:41);

Conclusions: There is an increasing participation in the examination since its introduction. The perceived value of the ERS examinations are based on its links to practice, educational benefit to its users and the attitude and rigour by which it is set up. Take-home messages: More countries are expected to adopt the examination for their training, diplomas and certification with the increasing need of many countries to have ongoing evaluation of medical practitioners. Successful models of collaboration with countries (i.e. Switzerland, Netherlands and Russia) in the use of the examination demonstrate educational, logistical, financial and cultural benefits.

10GG ePosters: Clinical 2

Location: North Hall, PCC 10GG/1

Clinical Outcomes of Type 2 Diabetic Patients attending Academic Siriraj Continuity of Care Clinic

Pochamana Phisalprapa (Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok-noi, Bangkok 10700, Thailand) Chalobol Chalermsri (Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand) Chaiwat Washirasaksiri (Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand) Weerachai Srivanichakorn (Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand) Charoen Chouriyagune (Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand) Denla Pandejpong (Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand)

Background: Many type2 diabetic patients (T2DM) did not receive proper medical care to achieve treatment goals based on clinical practice recommendations. Siriraj Continuity of Care clinic (CC clinic) has been established specifically for medical students and internal medicine residency training purpose since 2006. The training components in the teaching clinic might contribute to overall better outcomes for T2DM comparing to regular service clinics.

Summary of work: We retrospectively reviewed medical records of T2DM who were treated at CC clinic and compared with the patients who treated at service clinics of Siriraj Out-Patient Department (OPD) during

2007 to 2011.

Summary of results: Seven hundred and fifty-seven medical records were reviewed. The 383 patients of CC clinic and the 374 patients of OPD were enrolled. The HbA1c was significantly lower in CC clinic compare with

OPD (7.3% and 7.8%, respectively)(P<.001). The

proportion of patients who received annual diabetic complication assessments were also higher in CC clinic: the percentage of patients who received examinations of the eye, had urine microalbumin checked, had been screened for diabetic foot were 57.1 and 36.7(p<.001), 58.0 and 2.0(p<.001), 81.0 and 36.8(p<.001) in CC clinic and OPD group, respectively. Moreover, there were more patients who received adult health maintenance program including: cancer screening (clinical breast examination, mammography, FOBT and pap smear) and immunization (influenza, diphtheria-tetanus and pneumococcal vaccine) in CC clinic (p<.001). Conclusions: The diabetic patients who were treated in CC clinic had better clinical outcomes as well as received

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better screening and health maintenance program comparing to regular service clinics. Take-home messages: The focus training components in this clinic has played a major role on contributing the preferred clinical performance among medical students and internal medicine residents.

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Classroom to Clinician: An effective method of teaching radiograph interpretation and presentation

Govind Oliver (King's College Hospital, Denmark Hill Campus Teaching Group, Denmark Hill, London SE5 9RS, United Kingdom)

Beverley Yu (King's College Hospital, Denmark Hill Campus Teaching Group, London, United Kingdom) Alice Eldred (King's College Hospital, Denmark Hill Campus Teaching Group, London, United Kingdom) David Hope (King's College Hospital, Denmark Hill Campus Teaching Group, London, United Kingdom) Nadia Muspratt-Tucker (King's College Hospital, Denmark Hill Campus Teaching Group, London, United Kingdom)

Polly Robinson (King's College Hospital, Denmark Hill Campus Teaching Group, London, United Kingdom)

Background: Precise interpretation and presentation of abdominal (AXR) and chest radiographs (CXR) are essential skills to ensure optimal management and outcomes for patients. Whilst radiograph interpretation is taught in the medical curriculum, presentation is a skill often taught anecdotally on the wards. We show that a previously validated method of teaching clinical presentation skills is effective for radiograph teaching. Summary of work: Third year medical students attended CXR (n=39) and AXR (n=38) workshops and were taught a framework for interpretation and presentation. They practiced these skills in small groups. Students completed 3, radiograph interpretation multiple choice questions (MCQs) pre- and post-workshop in addition to scoring their subjective presentation confidence and effectiveness. They also scored their baseline overall personal confidence. Summary of results: Following both workshops, students reported an average increase in presentation confidence by 25% (p<0.05) and effectiveness by 25% (p<0.05). This correlated to an average increase in MCQ performance post-workshop by 36% (p<0.05). Interestingly, students who ranked their baseline confidence as low reported on average a 9% greater increase in presentation confidence and effectiveness compared to their high baseline confidence counterparts. All students indicated these workshops should be integrated into their curriculum. Conclusions: Focused workshops teaching radiograph interpretation early in training can improve both subjective and objective outcomes. This method of teaching may benefit students with low personal confidence in particular.

Take-home messages: Given the positive outcomes, teaching these skills in the medical school curriculum

would be beneficial for student confidence, diagnostic ability and ultimately patient care.

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Comparison of Cardiopulmonary Resuscitation Training program for medical student between integration to anesthesia curriculum and independent separation course

Surisa Siriwong (Medical Education Center, Buriram

Hospital, Anesthesiology, 10/1 Nasatanee Rd. Naimueng

Amphur Mueng, Buriram 31000, Thailand)

Narin Chindavech (Medical Education Center, Buriram

Hospital, Medicine, Buriram, Thailand)

Surasak Aumkaew (Medical Education Center, Buriram

Hospital, Medicine, Buriram, Thailand)

Thanatpong Thienwuttiwong (Medical Education Center,

Buriram Hospital, Medicine, Buriram, Thailand)

Yupin Prawai (Medical Education Center, Buriram

Hospital, Medicine, Buriram, Thailand)

Vitshoon Ruangsuksriwong (Medical Education Center,

Buriram Hospital, Medicine, Buriram, Thailand)

Background: For developing a CPR training course and integrated scenario for learners, we determined the effectiveness of incorporating it into the anesthetic curriculum (IC) compared to independent separation course (IS).

Summary of work: One group of 24 medical students were enrolled in group 1 (IC) compared to 24 student in group 2 (IS). Two adult resuscitation simulation scenarios (Megacode) in which each participant was the code leader to evaluate knowledge and skills, was assessed and reviewed by two instructors independently. Outcomes measurement included basic life support (BLS)/advanced cardiac life support (ACLS) in aspect of ECG analysis, pharmacology, practical application, number of critical actions during Megacode at baseline and after the training program. Summary of results: Baseline students were similar. Total BLS/ACLS knowledge score were higher in IC than

IS group (73.87 vs 54.32, p = 0.000). Students had

moderate confidence level for performing CPR and satisfactory 10-point rating scale for CPR program was 8.75 in both groups (p=1.00). Both groups had knowledge in BLS and all aspects of ACLS significantly (p=0.000). During Megacode both groups received borderline to satisfactory performance by instructors (83.3%). Most common errors during CPR were confirmation of medication administration (83.3%) and misinterpretation of coarse ventricular fibrillation ECG

(79.0%).

Conclusions: Incorporating CPR course had higher examination score than separation course, but confidence to perform CPR and satisfaction for both training programs were not significant. Take-home messages: Incorporating CPR training program into anesthesia curriculum is a more effective teaching method in respect of knowledge score.

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Reasons for choosing vaginal or cesarean birth for themselves or their partners among senior medical students

Roxana Knobel (Universidade Federal de Santa Catarina,

Obstetrics and gynaecology, Florianopolis, Brazil)

Tatiane Watanabe (Universidade Federal de Santa

Catarina, Florianopolis, Brazil)

Guilherme Suchard (Universidade Federal de Santa

Catarina, Florianopolis, Brazil)

Elysa Ribas (Universidade Federal de Santa Catarina,

Florianopolis, Brazil)

Eliana Amaral (Universidade Estadual de Campinas, Tocoginecologia, Campinas, Brazil) Edison Luiz Almeida Tizzot (Universidade Federal do Parana, Faculdade de Medicina, Curitiba, Brazil) (Presenter: Edison Luiz Almeida Tizzot, Universidade Federal do Parana, Tocoginecologia Faculdade de Medicina, Rua Padre Anchieta 2286/804, Bigorrilho -Parana, Curitiba 80730-000, Brazil)

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