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Summary of work: A prospective investigation (20092013) of assessment of competence in Medicine: Each learning competency was constructed from 1st year. 70 professional skills in Medicine were studied in prospective investigation, as the way they were learned in the course of the career, especially the last three years pondering of 1 to 5 (level 1 minimum and level 5 maximum). Students (n=281), graduates (n=53), professors (n=25) and authorities (n=8). Statistical analysis 2012: For the quantitative analysis of the variables, the normality test was applied. SPSS software version 17 was utilized for all the tests. Summary of results: 1) Students: In 4th year, the learned skills were between level 3 and 4. In 5th year, they were between 4 and 5. In 6th year, almost all students reached the 5th level. 2) Graduates: 45 were applied correctly: level 4 and 5 (84%). 3) Head and assistant professors: n=25. Since 2006, professors have progressively incorporated and applied this pedagogical paradigm in a coordinated and harmonic manner in almost all curriculum subjects: 95% in 2013. Authorities: n= 5. The authority's feedback- in qualitative terms- was consistent with that of the professors. Conclusions: Any student who adopts a learning approach built on professional skills and competencies, a learning task facing towards meaning and understanding, will be developing not only technical skills (know) but also and perhaps more importantly, will develop methodological skills (knowing do), participatory (knowing how to) and personal (how to
Take-home messages: Educational quality can be improved when competence-based learning is applied in undergraduates in the medical career.
Developing a curriculum in disability to help pre-clinical medical students explore world views
Rachel Havyer (Mayo Clinic, Primary Care Internal Medicine, 200 First Street SW, Rochester 55902, United States)
Julie Rogers (Mayo Clinic, Mayo Medical School, Rochester, United States)
Dominic Caruso (Mayo Clinic, Mayo Medical School, Rochester, United States)
C. Christopher Hook (Mayo Clinic, Hematology, Rochester, United States)
Background: Medical education traditionally explores the scientific rather than the social aspects of disability, emphasizing a bias toward normative or curative intent in medicine and further alienating the disability community. A unique pre-clinical curriculum was developed with a focus on the exploration of worldviews, with the purpose of increasing awareness of social aspects of disability and empathy for individuals with disabilities.
Summary of work: Seven hours of curricular time was devoted to exploration of the human experience of disability through interaction with community members. Following this, an ethical discussion contrasted an educational brochure on prenatal genetic testing produced by a medical institution with that of a disability organization. To allow open expression of opinion, electronic reflections were completed and anonymously distributed back to the class. Subsequently, a class discussion ensued regarding the breadth of worldviews and navigating differences that present among patients and colleagues. Summary of results: Forty-seven percent of entering medical students had no personal experience with individuals with disabilities. Students found it helpful to hear the personal perspectives of people with disabilities. Following the review of other students' electronic responses, first year medical students were able to openly discuss how to respectfully and professionally handle opinions that varied from their own.
Conclusions: Pre-clinical medical students commonly lack personal experience with disability. Exposure to the human-experience of disability helps promote empathy and self-exploration of worldview. Take-home messages: Professional development involves self-exploration and empathy. Curriculum to help students understand disability and differing worldviews in society and among colleagues can be easily integrated into curricula and is well-received by students.
Evaluation of physiology teaching in a traditional curriculum in Hungary
Levente Kiss (Semmelweis University, Institute of Human Physiology and Clinical Experimental Research, 37-47 Tuzolto uca, Budapest 1094, Hungary) Tamas Ivanics (Semmelweis University, Institute of Human Physiology and Clinical Experimental Research, Budapest, Hungary)
Background: Physiology teaching in a traditional setting corresponds to a step by step, topic based approach to the material in order to provide the necessary knowledge for the students to apprehend the basics of clinical studies.
Summary of work: Our physiology curriculum comprises regular, weekly series of lectures, lecture consultations and lab activities. Lectures are held for the whole class of 200- 250 people while consultations are conducted for smaller, combined groups of 40-50 students. The lecture material may also be discussed in small groups of approx. 15 students with a dedicated tutor during the lab time when typically various measurements (blood pressure, heart sounds, blood glucose) are taking place. The curriculum is evaluated in detail by the students at the end of each semester using Evasys feedback forms on scales from 1 (worst) to 5 (best) and thoroughly analyzed.
Summary of results: Our traditional teaching method received good scores from the Hungarian and English speaking classes receiving an average value of 4.38 and 3.93 for the lectures, 4.41 and 4.23 for the consultations and 4.54 and 4.55 for the lab practices, respectively. The evaluation also provided scores for every lecturer and tutor and for every lab practice which helped in faculty development.
Conclusions: Students have found our traditional setting of physiology course to be good and useful while also indicated various possible improvements in the curriculum.
Take-home messages: The described traditional physiology curriculum emphasizes the build-up of a firm, structured background exploiting the advantage of a repetition based approach while also facilitates a personal student-tutor relationship.
SESSION 4: Simultaneous Sessions
Monday 26 August: 1400-1530
4A Symposium: How Can Evidence Inform Teaching?
Location: Congress Hall, PCC
Marilyn Hammick (BEME Consultant, UK) (Chair)
Jill Thistlethwaite (University of Queensland, Australia)
Geoff Norman (McMaster University, Canada)
Geoff Wong (UK)
Antonio vaz Carneiro (Portugal)
This symposium follows on from the well-received 'What is evidence?' presentation and discussion at AMEE 2011. It will provide a discussion forum on the role of evidence in health professional education. Presenters will briefly outline from different perspectives the challenges associated with evidence-informed decision-making related to health professional education. A facilitated interactive session with the audience will seek to understand how educational research (primary and secondary) is received by practitioners, how to synthesise and disseminate existing evidence, and the issues associated with the translation of evidence into practice to implement new, or enhance existing, educational initiatives.
4B Symposium: Technology Enhanced
Learning in Regional Networks Focused
on Medical Education Location: Meeting Hall I, PCC
Daniel Schwarz (Masaryk University, Faculty of Medicine, Institute of Biostatistics and Analyses, Czech Republic)
Ladislav Dusek (MEFANET Coordinating Council President, Czech Republic)
Radu Iliescu (University of Medicine and Pharmacy "Gr. T. Popa", Romania)
Oto Osina (Comenius University, Jessenius Faculty of Medicine, Slovakia)
The main goal of the symposium will be an exchange of experience and know-how gained while building and operating a wide range of institutional networks providing the education for physicians and other healthcare professionals. The networks are very often focused on academic medical education. Interesting experience is, however, also expected from professionally oriented groups which implement their educational process in the form of case-based training and electronic remote consilium. A participant of this session can benefit from the presented experience for initiating or upgrading similar network in his/her own region. Furthermore, the participant can also become
more familiar with the tools for technology enhanced learning applied in particular networks and may use selected from them for his/her teaching practice.
4C Symposium: New Trends in Health Sciences Education
Location: Panorama, PCC
Raymond Pavlick (ATStill University School of
Osteopathic Medicine in Arizona, Mesa, USA)
Peter de Jong (Leiden University Medical Center, Leiden,
Amy Wilson-Delfosse (Case Western Reserve University School of Medicine, Cleveland, USA) Aviad Haramati (Georgetown University School of Medicine, Washington DC, USA) (Moderator)
A principal goal of all health professions education is for students to gain a deep understanding of the scientific method, but also to develop the skills and attitudes to apply new knowledge to improve the care of their patients. In recent years, new educational and technological developments have provided opportunities to improve and update science education to a modern and challenging training environment. In this symposium three such trends will be addressed: programs using the flipped classroom approach, advancements in computer technology and innovative case based teaching strategies. The presentations will be followed by a question and answer period and a general discussion.
4D PhD Reports 1
Location: Meeting Hall IV, PCC
The Role of Clinical Documentation and Case Review in Shaping Medical Teaching Teams' Ability to Collaborate in their Provision of Patient
Mark Goldszmidt (Schulich School of Medicine & Dentistry, Centre for Education Research & Innovation, University of Western Ontario, Room 115, Health Sciences Addition, London, Ontario N6A 5C1, Canada) Tim Dornan (Maastricht University, School of Health Education, Maastricht, Netherlands) Jeroen Merrienboer (Maastricht University, School of Health Education, Maastricht, Netherlands) Georges Bordages (University of Illinois at Chicago, Department of Medical Education, Chicago, United
Lorelei Lingard (Schulich School of Medicine & Dentistry, Centre for Education Research & Innovation, London, Canada)
Introduction: The research question was: How does the IMTT genre system influence the team's ability to collectively care for patients? From this emerged two other questions: 1) how do juniors (medical students and first year residents) use the genre system in providing follow-up care? and 2) How does team members' perceived purpose of case review shape the genre?
Methods: Study 1 used multiple case study methodology, with observation and audio-recording of 19 patient cases consisting of admitting case review discussions and chart documents. Participants included 14 medical students, 32 residents, and 10 attending physicians. A constant comparative analytic approach was used to explore patterns that recurred across cases. Study 2 and 3 used constructivist grounded theory methodology and analytic procedures. Study 2 involved observation and field interviews with juniors while they performed patient follow-up. Study 3 involved interviews and focus groups with 24 attending physicians and 20 senior residents. Results: The IMTT genre system facilitated collective care of patients by enabling a phenomenon we called "progressive collaborative refinement" (PCR). PCR refers to the goal, achieved through case and new data review, of collaboratively and progressively refining ideas around the patient's problems and strategies for addressing them. PCR was often threatened by particular features of the genre system: 1) The junior's admission note served as the main document representing the team's thinking; 2) The case review was a verbal genre that did not include a formal verification or modification feature to ensure adequate 'uptake' of evolving concepts by these junior documenters; 3) The genre system lacked a separate, stable, space for maintaining and refining problems and plans; 4) The predominant 'intertextual' reference for each note was the preceding note. Observations of
ABSTRACT BOOK: SESSION 4 MONDAY 26 AUGUST: 1400-1530
junior trainees' provision of follow-up care and faculty and resident interviews confirmed and elaborated our understanding of the PCR phenomenon and the affordances and threats to PCR in the IMTT genre system.
Discussion and Conclusion: Patient care on IMTTs is powerfully shaped by its genre system, which both enables the critical phenomenon of progressive collaborative refinement and threatens it. Identifying the gaps in this genre system offers a foundation for improving both the communication practices themselves and the training we provide novices in using them effectively.
References:  Bernabeo EC, Holtman MC, Ginsburg S, Rosenbaum JR, Holmboe ES. Lost in transition: the experience and impact of frequent changes in the inpatient learning environment. Acad Med 2011; 86(5): 591-8.
 Devitt AJ. Writing genres. Carbondale: Southern Illinois University Press. 2004.
 Miller C. Genre as Social Action. Quarterly Journal of Speech 1984; 70: 151-67.
 Bazerman C, Prior PA. What writing does and how it does it: an introduction to analyzing texts and textual practices. Mahwah, N.J: Lawrence Erlbaum Associates.
Unveiling group processes when students collaborate in small groups: An attempt to increase effectiveness of group learning in higher education
Juliette Hommes (Maastricht University, Faculty of Health Medicine and Life sciences, Educational Research & Development, Postbox 161, Maastricht 6200MD, Netherlands)
Introduction: This PhD thesis focuses on three gaps in the conceptual framework of group learning: the importance of students' learning in the informal context, the influence of time on learning processes in groups and an exploration how students learn and interact across groups. Finally, the authors show how a change in class size enhances group learning. Methods: All research took place in an undergraduate medical curriculum at Maastricht University applying Problem-Based Learning in its programme. Multiple methods were applied, using (longitudinal) social network analysis, mixed methods designs combining repeated measures of the Team Learning and Behaviour Questionnaire (3) and semi-structured individual interviews. A stratified controlled trial divided students of a large class (n=320) into two small subsets (n=50) and one large subset of the remaining students (n=220). Formal and informal learning processes of these students were studied over 22 months. Results: The first study shows that learning in the informal context is a rather important predictor of student learning. The second study elaborates on how groups develop over time, showing development in group learning behaviour, psychological safety, social
cohesion and group potency in each group students were involved in over time. Moreover, interdependence, task cohesion and transactive memory were additional group processes which students valued as important. Convergence of mental models was related to the development of most of the previously mentioned group processes. The third study explored how students learned in the informal context over time, revealing that students developed a personal learning network, unrelated to the formal group they were assigned to by the university. Finally the stratified controlled trial shows that students perceive more positive group learning processes in the formally designed groups. Moreover, this intervention had another long-term effect on group learning: informal learning networks of the students were arranged within the subsets of the class.
Discussion and Conclusion: Groups are complex social systems, dynamic over time. Groups develop within modules, but there is room for improvement to increase effectiveness of learning in groups. Complexity of group learning is clearly illustrated as students learn in the informal context crossing the borders of the formal groups students are involved in, developing a personal network in which learning takes place. The stratified controlled trial furthermore indicates that a simple change of design can facilitate learning in large classes when they seem small.
References: 1. H. Arrow, J. Cook, in Work group learning: understanding, improving & assessing how groups learn in organizations, V. I. Sessa, M. London, Eds. (Lawrence Erlbaum Associates, Taylor & Francis Group, London, 2008), pp. 45-71.
2. S. Decuyper, F. Dochy, P. van den Bossche, Grasping the dynamic complexity of team learning: An integrative model for effective team learning in organisations. Educational research review 5, 111 (2010).
3. P. van den Bossche, W. H. Gijselaers, M. Segers, P. A. Kirschner, Social and cognitive factors driving teamwork in collaborative learning environments: Team learning beliefs and behaviors. Small group research 37, 490
Evaluation and Feedback for Effective Clinical Teaching
Cornelia Fluit (Radboud University Nijmegen Medical Centre, Institute for (Bio) Medical Education, 306 IWOO, Postbus 9101, Nijmegen 6500HB, Netherlands)
Introduction: The research questions were: 1. What are characteristics of good clinical teaching in the clinical workplace and to what extent do existing instruments measure these characteristics? 2. How can we provide feedback effectively? 3. What factors influence the quality of clinical teaching as perceived by residents? Methods: 1. A systematic literature review for describing existing instruments and characteristics of clinical teaching in the workplace. 2. A Delphi study for developing an instrument EFFECT (Evaluation and Feedback for Effective Clinical Teaching), confirmative
factor analyses (CFA) and reliability analyses. 3. Focus group research for evaluating the EFFECT feedback procedure (EFFECT-S). 4. Analyses of data of a longitudinal and a multicenter study by comparing means, t-tests, and multiple regression analyses. Results: None of the existing instruments covered all important aspects of clinical teaching in the workplace; numerous instruments lack a clear theoretical framework and/or lack sufficient validity evidence (3). CFA and reliability analyses of EFFECT yielded an eleven-factor model with a good to excellent fit and good internal consistencies (4). EFFECT-S, including face to face meetings between the clinical teacher and two residents was highly appreciated. A safe evaluation environment and honest feedback were important conditions. Anonymous rating creates a safe evaluation environment for residents, but it impairs safety for supervisors. Some of the clinical teachers showed improvement on the EFFECT scores after one year. Female clinical teachers, clinical supervisors performing assessments, and teachers in affiliated hospitals were rated significantly higher. Residents in their first years of training were more positive about their supervisors. Gender of the residents did not affect the scores, except for the item that specifically asked for the role modeling function.
Discussion and Conclusion: The model of workplace learning is a useful framework for developing an instrument for evaluating clinical teachers. The dialogue between residents and their supervisor stimulates the co-creation of shared knowledge on what the profession is about, a shared understanding of learning in practice and how to optimise this workplace learning in their communities of practice (5). The quality of teaching is not only dependent on individual differences between teachers (gender), but also on environmental factors and characteristics of the resident. References: 1. Billett S. Learning in the Workplace: strategies for effective practice. Crows Nest: Allen & Unwin 2001.
2. Nicol D, Macfarlane-Dick D. 2006. Formative assessment and self-regulated learning: A model and seven principles of good feedback practice. Studies in Higher Education 31(2):199-218.
3. Fluit CR, Bolhuis S, Grol R, Laan R, Wensing M. 2010. Assessing the Quality of Clinical Teachers: A Systematic Review of Content and Quality of Questionnaires for Assessing Clinical Teachers. J Gen Intern Med
4. Fluit CR, Bolhuis S, Grol R, Ham M, Feskens R, Laan R, Wensing M. 2012. Evaluation and feedback for effective clinical teaching in postgraduate medical education: Validation of an assessment instrument incorporating the CanMEDS roles. Med Teach August 2012.
5. Wenger E. Communities of practice: learning, meaning and identity. Cambridge, Cambridge University Press 1998.
Peer Feedback to Enhance Learning?
Rachelle Kamp (Maastricht University, Educational Research & Development, P.O.Box 616, 6200 MD,
Maastricht 6229 ER, Netherlands)
Introduction: This thesis will address the following research questions:
Are students able to evaluate the cognitive, social, and motivational contributions to the tutorial group of their peers and do these contributions predict student achievement?
Under which conditions can a peer rating scale that evaluates students' achievement-related contributions to the tutorial group be used as a PF intervention in order to enhance the quality of these contributions and student achievement?
Methods: A peer rating scale (M-PARS) was developed by selecting cognitive, social, and motivational items. 196 students were evaluated by their peers on these items. Reliability and validity was investigated with a confirmatory factor analysis. Next, 538 students were evaluated with the M-PARS and individual ratings were related to student achievement using structural equation modeling. Students' attitudes towards the effectiveness of PF generated by the M-PARS were investigated with a focus group. In a pre-test (M-PARS), intervention (receiving PF), post-test design (M-PARS and student achievement), PF was combined with reflection and goal setting. Participants were divided into group 1 (PF+individual reflection and goal setting), group 2 (PF+collaborative reflection and goal setting), or group 3 (no PF).