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Discussion and Conclusion: Clinician teachers are less engaged as teachers than as physicians, while typically clinician teachers with high work engagement as teacher are perceived as better supervisors by residents. This discrepancy leaves room for improvement, meaning that higher teaching performance of clinician teachers could be achieved by improving their work engagement as teacher. In general, job resources, such as job autonomy and performance feedback, benefit work engagement (3). Increasing these factors in practice may facilitate the increase of work engagement and ultimately, teaching performance. Future research will have to show which job resources could be adjusted in the specific context of clinician teachers.
References: 1. van der Leeuw RM, Lombarts KMJMH, Arah OA, Heineman MJ. A systematic review of the effects of residency training on patient outcomes. BMC medicine [Internet]. BioMed Central Ltd; 2012 Jan;10(1):65.
2. Christian MS, Garza AS, Slaughter JE. Work Engagement: a Quantitative Review and Test of Its Relations With Task and Contextual Performance. Personnel Psychology [Internet]. 2011 Mar 17;64(1):89-
3. Bakker AB, Hakanen JJ, Demerouti E, Xanthopoulou D. Job resources boost work engagement, particularly when job demands are high. Journal of Educational Psychology [Internet]. 2007;99(2):274-84.
Exploring talent development environments -inspirations to medical education at doctoral level
Mette Krogh Christensen (Aarhus University, Center of Medical Education, Brendstrupgaardsvej 102, Aarhus N 8200, Denmark)
Ole Lund (Aarhus University, Center of Medical Education, Aarhus, Denmark) Anne Mette M0rcke (Aarhus University, Center of Medical Education, Aarhus, Denmark)
Introduction: Doctoral students may be considered some of our most talented students. In order to maintain high quality in doctoral education we should
ABSTRACT BOOK: SESSION 3 MONDAY 26 AUGUST: 1045-1230
be aware of optimizing the talent development environment in which the students develop their competencies. In this paper we explore the features of a successful talent development environment in Danish doctoral education. Talent development is an extensive and well-established research field. So far, research within this field has mainly focused on sport and other artistic professions and to a minor degree on academic performance. In addition, the focus has been on cognitive skills of individual talents and to a minor degree on institutional conditions and constraints within talent development environments. However, recent studies on talent development in sport recognize 'talent' as a social construction (1) and institutional and environmental features playing a decisive role in talent development (2). Our research question is: do concepts and models for talent development environments in sport apply to medical education at doctoral level? Considering the uniqueness of the two domains (they refer to different overall social fields: education and sport), we presume that they are comparable because they may share some characteristics of successful talent development environments.
Methods: Based on an ecological approach to talent development environments (3) we carried out a pilot case study including field work (10 days of observation) and qualitative interviews with 6 participants (4 doctoral students and 2 supervisors). The case study took place at The Department of Hepatology and Gastroenterology, Aarhus University Hospital in Denmark from December 2012-March 2013. In the analysis of data we use Schein's theory of organizational culture (4) and suggest that a thorough understanding of talent development environments include analysis of the context-specific culture and its effect on the dispositions and behaviours of the talents.
Results: The preliminary results reveals that the talent development environment in this case study and those in sport share a number of common features: an elitist spirit as a way of ascribing meaning to principal activities, a working milieu characterized by continual high-performance achievements, training groups with supportive relationships, proximal role models, and a strong and coherent organization culture. Discussion and Conclusion: This is the first study in Denmark to explore doctoral students' working environments as talent development environments. The results suggest practical implications for fostering and culturing talent development environments in medical education at doctoral level.
References: (1) Christensen MK. "An Eye for Talent": Talent Identification and the "Practical Sense" of Top-Level Soccer Coaches. Sociology of Sport Journal 2009
(2) Barab SA, Plucker JA. Smart people or smart contexts? Cognition, ability, and talent development in an age of situated approaches to knowing and learning. Educational Psychologist 2002;37(3):165-82.
(3) Henriksen K. The Ecology of Talent Development in Sport: A Multiple Case Study of Successful Athletic Talent Development Environments in Scandinavia.
Odense: Syddansk Universitet / University of Southern Denmark; 2010.
(4) Schein EH. Organizational culture. American Psychologist 1990;45(2):109-19.
Evidence of the development of skills in critical reflective writing, in teachers in a science discipline, through use of the "patchwork text" approach
Ayona Silva-Fletcher (The Royal Veterinary College, Veterinary Clinical Sciences, Hawkshead Lane, Hatfield AL9 7TA, United Kingdom)
Hilary May (The Royal Veterinary College, LIVE, Hatfield, United Kingdom)
Kirsty Magnier (The Royal Veterinary College, Veterinary Clinical Sciences, Hatfield, United Kingdom) Stephen May (The Royal Veterinary College, Veterinary Clinical Sciences, Hatfield, United Kingdom)
Introduction: The concepts of 'reflection' and 'reflective practice' are essential for the practising teacher (SchOn 1983) and are used extensively in professional development of teachers (Hatton & Smith 1995). The patchwork text approach (Scoggins & Winter 1999; Winter 2003) involves a series of short reflective pieces, each receiving feedback, culminating in an integrated essay, which is, summatively assessed. This developmental approach is based on students writing patchwork texts at regular intervals and the tutors giving feedback at individual level. Its objective is to achieve deeper reflection, and it is emerging as a popular form of learning and assessment for developing integrated understanding and critical self-analysis (Dalrymple &
The main research question in this study is whether patchwork text can enhance the quality of reflective writing in a postgraduate teacher development programme.
Methods: The PG Certificate in Veterinary Education at the Royal Veterinary College uses the patchwork text approach as one of the main assessment methods. Students submit a "patch" at the end of each of five units in the module: Student Learning (SL), Teaching Methods (TM), Integrated Curriculum (IC), Assessment and Feedback (AF) and a free choice of theme (FC). We analysed the quality of reflective writing in 103 formative essays (800-1000 words each) and 20 integrated essays (2500 words each), from 20 students using criteria developed from those of Hatton & Smith (1994), to identify four levels: descriptive writing, descriptive reflection, dialogic reflection and critical reflection. The word count for each level was recorded to quantify the reflections and a reflective score was calculated for each student.
Results: Students had higher aggregate reflection levels in patches related to SL, TM and FC compared to either AF or IC. The patches related to IC obtained the lowest mean scores. The summative, integrative essays received the highest score. The progress through the formative patches of the five individuals who received
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the highest reflective scores in the summative, integrative essay (top quartile) was compared with the progress of the five individuals who received the lowest scores in the final essay (bottom quartile), by comparing the mean reflective score for their first two patches (SL and TM) with the mean reflective score for the last two (AF and FC). Four out of the five top scoring participants in the summative, integrative essay showed an improvement in their reflective writing between the early and the later essays. In contrast, four out of the five low scoring participants gained lower reflective scores in their last two pieces compared to their first two.
Discussion and Conclusion: The study provides evidence that the quality of reflective writing can be enhanced through the regular, iterative process of reflective writing, which is supported by formative tutor feedback, particularly where the unit deals with a familiar area for the participants (SL, TM, FC), as opposed to one in which they have less experience. Ultimately, this provides evidence that the patchwork text is a suitable formative/summative assessment method for teacher development in the healthcare professions. References: Dalrymple R. & Smith P. (2008) The patchwork text: Enabling discursive writing and reflective practice on a foundation module in work-based learning. Innovations in Education and Teaching International 45, no. 1: 47-54 Hatton N. & Smith D. (1995) Reflection in teacher education: towards definition and implementation. Teaching & Teacher Education, Vol. 11, No. 1, pp. 33-49 Scoggins J. & Winter R. (1999). The patchwork text: A coursework format for education as critical understanding. Teaching in Higher Education 4, no. 4:
Schon, D A (1983) The Reflective Practitioner - How Professionals Think in Action. Jossey-Bass, San Francisco. Winter R. (2003). Contextualising the patchwork text: Addressing problems of coursework assessment in higher education. Innovations in Education and Teaching International 40, no. 2: 112-22.
Evaluation of a pilot program aimed at mobilizing a new generation of physicians in management tasks
Christian Voirol (University of Montreal, Family and Emergency Medicine & Psychology, 1706-350 Boul. de Maisonneuve O., Montreal H3A 0B4, Canada) Marie-Claude Audetat (University of Montreal, Family and Emergency Medicine, Montreal, Canada) Rejean Duplain (University of Montreal, Family and Emergency Medicine, Montreal, Canada) Raynald Gareau (University of Montreal, Family and Emergency Medicine, Montreal, Canada) Julie Lajeunesse (University of Montreal, Family and Emergency Medicine, Montreal, Canada) Marie-France Pelland (University of Montreal, Family and Emergency Medicine, Montreal, Canada)
Introduction: Medical schools often fill their administrative positions for academic and direction needs with faculty members highly skilled in academic fields. However, it is difficult for medical schools to fill the basic needs of academic organisation, and then prepare people for higher positions. Trying to develop those chosen for higher positions (physicians identified as the growing generation of medical leaders), medical schools offer them a plethora of existing training opportunities in the areas of management and leadership. But these initiatives lead to mitigated success. It is therefore necessary to try to understand the underlying causes of this mitigated success. An exploratory research study conducted in 2011 with seven experienced family physicians who occupy or have occupied various management positions, has helped to formulate an hypothesis: for them, there was a considerable difference between their beliefs and representations and the realities that awaited them in management positions. Indeed, the results showed that the majority of these professionals had, and sometimes still have, difficulty in accurately estimating both the management skills required and the abilities and expertise that they actually have, in order to assume their management positions. Therefore, a training program which aims for greater clarity with respect to their chosen career path, would be an essential preliminary step for the mobilization of these physicians. Consequently, a pilot training program of five days spread over a year was developed. This evaluative research tried to verify the following hypothesis: H1: "After five days of a pilot training program, participants will be more aware about their career path aims, about their management skills and abilities, about the management skills, abilities and training required and available, than before the program". Methods: This evaluative research study used a mixed qualitative and quantitative methodology. The conceptual framework was based on the Johari window model. The quantitative analysis used a face validated questionnaire (self-evaluation of their own competencies and of their beliefs on their control on the development of these competencies) completed by the participants before and after the training, and some projects completed during the training. Repeated measures ANOVA have been calculated using Stata 12. The qualitative analysis consisted of thematic analyses of a focus group held with the participants at the end of the training, observation checklists, and some projects completed during the training. These thematic analyses were conducted using Atlas TI.
Results: Whether in terms of the management skills and abilities required, or in terms of their own knowledge, skills and expertise, the program participants reported the extent of the awareness that the pilot program has enabled them to obtain. Repeated-measures ANOVA showed a statistically significative difference (p<0.03) between their self-perceptions before and after the pilot program.
Discussion and Conclusion: The results validate the hypothesis H1. The results also show that the pilot program has allowed these implicated doctors to more
clearly discern what they want and do not want to do in their careers. In doing so, their training choices and their potential involvement in leadership positions should become much more deliberate and coherent.
3F Short Communications: Assessment: OSCE 2 - Implementation
Location: Chamber Hall, PCC 3F/1
Using Tablets for OSCE Exams to Reduce Errors and Optimize Documentation
Jorn Heid (Heidelberg University, International Consortium for Assessment Networks, Im Neuenheimer Feld 346, Heidelberg 69120, Germany) Konstantin Brass (Heidelberg University, International Consortium for Assessment Networks, Heidelberg, Germany)
Achim Hochlehnert (Heidelberg University, International Consortium for Assessment Networks, Heidelberg, Germany)
Andreas Moltner (Heidelberg University, International Consortium for Assessment Networks, Heidelberg, Germany)
Jobst-Hendrik Schulz (Heidelberg University, International Consortium for Assessment Networks, Heidelberg, Germany)
Jana Junger (Heidelberg University, International Consortium for Assessment Networks, Heidelberg, Germany)
Background: Objective Structured Clinical Examination (OSCE) is a form of performance-based testing used to measure candidates' clinical competence. Paper-based checklists are widely used for evaluation of the candidates as they go through a series of stations in which they e.g. treat standardized patients. Therefore a large amount of paper is needed and the results have to be summed over all stations manually. The International Consortium for Assessment Networks (ICAN) is a nonprofit umbrella organization for assessment alliances with different interests and focuses. 48 schools, boards and councils in 6 countries actually using a common platform for preparation, exchange, implementation and evaluation of examinations: the ItemManagementSystem (IMS). Summary of work: To improve the workflow ICAN developed an app, which represents OSCE-stations (stored in IMS) on tablets. QR codes can be used to identify the right stations and the candidates. Several ways of entering comments about the student's judgment are supported: virtual keyboard, finger/pencil, predefined text phrases and voice-recording. After each evaluation a screenshot is automatically stored for neutral documentation. The results could be exported to IMS for analysis or printed via PDF. Summary of results: Several partners are using the app since 2012, reporting an easier, enhanced and smoother workflow. The results will be presented in this session. Conclusions: The usage of tablets eliminates the media gap between designing and performing the exam. It is greatly accepted and offers a transparent documentation which additionally gains more legal certainty.
Take-home messages: Using tablets for OSCE exams the time consumption, the amount of errors and paper can be highly reduced.
The use of OSCEs to assess communication skills in undergraduate medical students: A systematic review of the published literature
Winny Setyonugroho (National University of Ireland Galway, Medical Informatics and Medical Education, Clinical Science Institute, Room 310, Galway, Ireland) Kieran Kennedy (National University of Ireland Galway, Medicine, Galway, Ireland) Thomas Kropmans (National University of Ireland Galway, Medical Informatics and Medical Education, Galway, Ireland)
Background: Assessment of communication skills (CS) is an integral component of modern undergraduate assessment. We report a systematic review of the literature pertaining to the use of OSCEs to assess CS, with a view to comparing assessment methodologies. Summary of work: Research papers describing assessment of medical student CS using OSCEs were identified from Pubmed, Embase, PsycINFO, and the ProQuest Education Databases up to 2012. Studies that did not report empirical validity or reliability values for the CS assessment checklists used, were excluded. Data was extracted by three independent raters. The level of agreement between raters was calculated with respect to 27 domains of CS using Intra Class Correlation Coefficients (ICC).
Summary of results: Of 34 included studies, four reported use of international agreed standards. Overall, rater agreement for reliability and validity of CS was 0.94. Papers were found to focus on generic CS, history taking, doctor-patient communication, interviewing, negotiating treatment, information giving, empathy and 18 sub-domains (ICC -0.12 - 1). Where standardized patients were involved in rating students, they focused mainly on generic CS (31%). Regarding validity and reliability of the different measures used, agreement between raters was 0.44.
Conclusions: Heterogeneity in the assessment of communication skills by OSCEs makes comparison of student competence across institutions or different OSCE settings difficult. Our review demonstrates that studies differ in their use of terminology, in what they report, and that they frequently do not use standardized measurement instruments. Take-home messages: We propose that universal adoption of a standardized CS measurement instrument would allow comparison of student competence across institutions and OSCE settings.
Developing an OSCE curriculum to assess communication skills of residents
Deema Al-Sheikhly (Weill Cornell Medical College in Qatar, Graduate Medical Education, 2 Al-Luqta Street, Doha 24144, Qatar)
Ibrahim Hassan (Hamad Medical Corporation, Internal Medicine, Doha, Qatar)
Lan Sawan (Weill Cornell Medical College in Qatar, Medical Education, Clinical Skills Center, Doha, Qatar) Tasleem Raza (Hamad Medical Corporation, Internal Medicine, Doha, Qatar)
Hassan Mobayed (Hamad Medical Corporation, Internal Medicine, Doha, Qatar)
Dora Stadler (Weill Cornell Medical College in Qatar, Graduate Medical Education, Doha, Qatar)
Background: An Objective Structured Clinical Exam (OSCE) is a performance-based clinical skills assessment tool. As our institution is in the midst of a transition to competency-based education, there was a need to assess residents' communication skills in a standardized setting. We developed an OSCE curriculum to serve as a formative assessment tool targeting communication skills, ethics and professionalism based on the six ACGME core competencies.
Summary of work: We developed a 12 case two-year Standardized Patient (SP) based curriculum for the formative assessment of internal medicine residents. The blueprint addresses core communication topics appropriate to our setting. We created a unified checklist based on the Kalamazoo consensus statement with unique descriptors/scoring rubrics for each case. The cases were piloted to PGY4 residents and efforts to standardize SP scoring ware made through training activities. 66 residents participated in the first OSCE encounter (3 cases each). Residents were assessed by the SPs and completed a self-assessment. Following a debriefing session by the SP, they completed an evaluation on the OSCE encounter. Summary of results: The resident survey indicated that they found the encounters to be practical, the feedback to be useful, and overall a good educational experience. Further formative feedback was incorporated into the residents' midyear evaluation. Conclusions: The current curriculum has been a successful tool for formative assessment and can be further validated and expanded to be used for summative purposes in the future. Take-home messages: Our OSCE curriculum for communications skills assessment is practical, adaptable and transferrable, and can be done on a small scale and in poor resource setting.
ABSTRACT BOOK: SESSION 3 MONDAY 26 AUGUST: 1045-1230
Brief Mindfulness Meditation (BMM) during OSCE to reduce stress and improve performance of medical students
Narin Chindavech (Medication Education Center, Buriram Hospital, Medicine, 488/10 North Bulamdoon, Jira Road, Muang Buriram, Buriram 31000, Thailand) Surasak Aumkaew (Medication Education Center, Buriram Hospital, Medicine, Buriram, Thailand) Yupin Prawai, Prawai (Medication Education Center, Buriram Hospital, Medicine, Buriram, Thailand) Thanatpong Thienwuttiwong (Medication Education Center, Buriram Hospital, Medicine, Buriram, Thailand) Surisa Sririwong (Medication Education Center, Buriram Hospital, Medicine, Buriram, Thailand) Vithoon Ruangsuksriwong (Medication Education Center, Buriram Hospital, Medicine, Buriram, Thailand)
Background: In this era, students may find learning medicine stressful. Mindfulness meditation has been adopted to treat patients with a variety of physical and psychological conditions. Brief mindfulness meditation (BMM) improved the learning experiences. Application of BMM multimedia might reduce stress and improve medical students' inner performance during OSCE. Summary of work: 24 5th year medical students were enrolled during 12 weeks in the medicine department. The students were randomized into 2 groups (n= 12) of each BMM group and control. OSCE was validated for equal level of difficulty in both groups. Outcomes measurement included in pre and post test OSCE score, sympathetic activity by pulse rate, pulse rate variability and self rating anxiety stress score (SRAS). Summary of results: The pulse rate in BMM group was lower than in control group (86.50 vs 98.17, p=0.26). The pulse rate variability in each student decreased in BMM group but with no statistical significance (p=0.31 vs 0.26). BMM group improved OSCE score as compared to the control but with no statistical significance (p=0.05). SRAS in BMM group was lower than in control group (4.50 vs 6.50, p=0.01). Moreover each BMM student reported with decreased SRAS score significantly
(p=0.002 vs 1.00).
Conclusions: BMM decreased stress and anxiety by SRAS during OSCE, significantly. Moreover BMM tended to reduce pulse rate response and variability and improve OSCE score as compared to the control group. Take-home messages: BMM reduced stress, anxiety and might improve the efficiency in medical learning experience.
Listen to the examiner: electronic audio feedback after OSCEs
Christopher Harrison (University of Keele, Medical School, University of Keele, Keele, Staffordshire ST5 5BG, United Kingdom)
Adrian Molyneux (University of Keele, Medical School, Keele, United Kingdom)
Sara Blackwell (University of Keele, Medical School, Keele, United Kingdom)
Val Wass (University of Keele, Medical School, Keele, United Kingdom)
Background: Summative OSCEs gather much data about candidates, but students often receive little feedback to enable them to improve their performance. Electronic audio feedback has shown promise in other educational areas. We aimed to investigate its efficacy as a feedback method in OSCEs.
Summary of work: An electronic OSCE system was designed, comprising (1) an app for iPads allowing examiners to mark in the key consultation skill domains, provide "tick-box" feedback identifying strengths and difficulties, and record voice feedback; (2) a feedback website giving students the opportunity to view / listen in multiple ways to all the feedback captured and compare themselves to the cohort average. Efficacy of the audio feedback was investigated, using focus groups with students and questionnaires with both examiners and students.
Summary of results: Student found the feedback significantly improved, with 71% reporting receiving detailed comments on their work, compared with 30% in the previous year's cohort. They valued the highly personalised, relevant nature of the audio feedback, found it much more useful than written feedback and wanted it applied to workplace learning. Examiners gave audio feedback to all students in 89% cases. Although many found the method easy, lack of time was a factor. Conclusions: Electronic audio feedback provides immediate, personalised and relevant formative feedback to students after a summative OSCE provided enough time is allocated to the process. This method can be transferred to the workplace. Take-home messages: OSCE organisers should harness the opportunities offered by new technology to give students more feedback.
Blueprinting Clerkship OSCEs for Better Data