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Take-home messages: Consequently, for the MCCQEII, there appears to be little empirical evidence to support the use of complex scoring approaches. As an added benefit, adopting a simplified scoring model would ease the efforts required by our medical experts to develop these weights.
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Effects of changing from checklist to rating scale scoring for OSCEs
Katharine Boursicot (St George's University of London, Centre for Medical and Healthcare Education, PHSE, 6th Floor Hunter Wing, SGUL, Cranmer Terrace, London SW17 0RE, United Kingdom) David Swanson (NBME, Philadelphia, United States) Kate Johnson (SGUL, London, United Kingdom) David Oliveira (SGUL, London, United Kingdom) Kevin Hayes (SGUL, London, United Kingdom)
Background: Originally, OSCEs were scored on checklists tailored to station content. This approach has been criticized for rewarding thoroughness and trivializing the skills assessed, and some have moved to use of multi-item rating scales to better capture students' increasing clinical expertise. Summary of work: OSCE station scoring for the SGUL MBBS course was changed to rating scales for the clinical years from 2011. This study examined the impact on mean scores, pass marks, and pass rates. Summary of results: On a percentage-of-possible-points scale, mean scores declined from 70.4% in 2010 (checklists) to 66.4% in 2011 (ratings); passmarks set using (identical) borderline regression methods declined from 57.4% to 46.3%; mean differences between scores and passmarks increased from 13.0% to 20.2%; and pass rates increased from 96.7% to 99.7%. Reproducibility of total scores was lower for rating scales than checklists due primarily to larger differences in the stringency of examiners marking the same station. Interestingly, the reproducibility of global ratings used in standard setting was also lower in 2011 than 2010. Conclusions: The change from checklists to rating scales did not result in the expected improvement in the reproducibility of total scores and pass rates dropped to almost 0, raising questions about the utility of ratings (or our implementation of them.) Take-home messages: Further investigation into the use of checklists and rating scales for scoring OSCE stations is merited. A blend of methods may be warranted to aid in standard setting and reducing variation in examiner stringency.
2G Short Communications: Curriculum Planning
Location: Conference Hall, PCC
Comparing a spaced format of an emergency medicine block course with a compressed format in their impact on students' test scores in a key-feature test
Jan Breckwoldt (University of Zurich, Deanery of Medicine, Pestalozzistr. 3/5, Zurich 8091, Switzerland) Jan R Ludwig (Charite - Medical University of Berlin, Dieter Scheffner Center for Medical Education, Berlin, Germany)
Harm Peters (Charite - Medical University of Berlin, Dieter Scheffner Center for Medical Education, Berlin, Germany)
Background: Spacing of teaching sessions may provide the learner with more opportunities to elaborate and process learning contents. Hence, distributing a certain amount of teaching hours over a longer time period (spaced format) may result in better learning than delivering the same amount within a shorter time period (compressed format). We wanted to evaluate this effect for an emergency medicine block course (EM-BC) on students' procedural knowledge.
Summary of work: In the fifth year of an undergraduate medical curriculum an EM-BC of 26 teaching hours was delivered either within 3 days, or 4.5 days. At the end of the course students' procedural knowledge was assessed by a specifically developed video-based electronic key-feature test.
Summary of results: From 191 eligible students 156 data sets could be completely evaluated, 54 students from the spaced version, and 102 students from the compressed version. Socio-demographic characteristics and drop out rates were similar between groups. In the key-feature-test with a possible maximum score of 22 points students from the spaced format reached a median of 15 points (13-16; 25.-75. percentile), and students from the compressed format reached 13.5 points (12-15); Cronbach's alpha was 0.63. The observed difference was 8.5% of the median test score, being highly significant (p = 0.002) at a moderate effect size
(Cohens d = 0.53).
Conclusions: A spaced distribution of teaching hours resulted in a moderate increase of procedural knowledge if compared to a compressed distribution. Take-home messages: Spacing of teaching units may produce moderate gains in cognitive learning.
Comparison of medical students' learning approaches in a traditional versus integrated lecture-based curricula
Anne Baroffio (University of Geneva Faculty of Medicine, Unit for Development and Research in Medical
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Education, Medical Center, 1 rue Michel Servet, Geneva 4 1211, Switzerland)
Milena Abbiati (University of Geneva Faculty of Medicine, Unit for Development and Research in Medical Education, Geneva, Switzerland) Margaret W Gerbase (University of Geneva Faculty of Medicine, Unit for Development and Research in Medical Education, Geneva, Switzerland) Marie-Paule Gustin Paultre (University Lyon 1, Department of Public Health, Institute of Pharmacy, Lyon, France)
Background: Students' learning approaches can be influenced by the teaching and assessment characteristics of curricula. In many European countries, political constraints oblige medical schools to select students during the first study year. Because of the large number of students, the teaching environments are often lecture-based and assessments anchored on factual knowledge through highly selective MCQ tests. This could impact the deep learning approach necessary to develop clinical reasoning.
Summary of work: We compared first-year students' learning approaches in two French-speaking learning environments (Geneva G and Lyon L), offering similar teaching (lectures) and assessment (MCQ) formats, but displaying different curriculum organization (G thematic integrated modules vs L traditional). The study process questionnaire (R-SPQ) was administered to 1947 first-year medical students (1654 in L, 293 in Geneva). Multivariate general linear models were conducted to compare deep-(DA) and surface-(SA) approaches to learning in both environments.
Summary of results: Compared to L-students (DA 2.91, SA 2.49 on a scale of 5), G-students used deeper and less surface approaches (DA 3.20, SA 2.35, p<0.001). L-students focused more on the target (L 3.37, G 3.26, p<0.05) and applied more rote learning (L 2.36, G 2.01,
Conclusions: Despite lecture-based and MCQ-assessed, an integrated curriculum seems to favor students' deep learning approaches, compared to a traditional curriculum.
Take-home messages: An integrated selection-year curriculum might partly compensate the potentially detrimental influence of lecture-based teaching and factual assessment on students' approaches to learning.
Effectiveness of Integrated Curriculum at a Public Medical College of Kashmir: A Participatory Action Research Report
Muhammad Saeed (AJKMC, Medical Education, AJK Medical College, Muzaffarabad-AJK, Pakistan, MZD
Muhammad Iqbal Khan (AJKMC, Surgery, Muzaffarabad, Pakistan)
Sarmud Latif Awan (AJKMC, Anatomy, Muzaffarabad, Pakistan)
Syed Sajid Shah (AJKMC, Pathology, Muzaffarabad, Pakistan)
Ziyad Afzal Kayani (AJKMC, Surgery, Muzaffarabad, Pakistan)
Mohsin Shakil (AJKMC, Urology, Muzaffarabad, Pakistan)
Background: AJK Medical College is the 1st public sector medical college in Pakistan to adopt an outcome based integrated undergraduate curriculum. To contextualize the training of future physicians and make Basic Health Sciences (BHS) instruction more relevant to the clinical practice; AJKMC introduced integrated, system-based Modular curriculum at undergraduate level. The authors are the members of Curriculum Committee, involved in iterative loops of participatory action research, mandated to refine the dynamic curriculum through informed decisions based on local experience. Summary of work: Six Modules of 1st Year MBBS class were indigenously conceptualized, developed, delivered and evaluated in year 2012 by multidisciplinary teams. The learning outcomes were explicitly defined in respective study guide of Module, which included theme-based core contents; learning outcomes; Teaching & learning strategies; TOS, Tools of assessment; time table; student support & troubleshooting mechanisms. The Study Guides of each module provided road map to faculty and students' learning. Each module was assessed by written assessment and integrated practical examination (IPA-an integrated 17 station OSPE). All modules were evaluated by a focus group and a pilot tested semi-structured questionnaire, administered to voluntary participants among faculty and students of class of 2016. Summary of results: Triangulation of quantitative & qualitative data revealed positive perceptions of students & faculty about integrated curriculum. The response rate of voluntary participants was 98%. 96% students validated the teaching strategies and 92% perceived the assessment valid, fair and reliable. 95% strongly agreed to continue the integrated curriculum
Conclusions: Integrated curriculum enhanced students' motivation for self-directed life-long learning. Take-home messages: Integrated curriculum can be implemented in a resource constrained environment; however, it demands a strong institutional leadership role.
"Being a doctor here is a misery". How to train doctors for the reality of practice in Sub-Saharan Africa
Janneke Frambach (Maastricht University, Department of Educational Development and Research, P.O. Box 616, Maastricht 6200 MD, Netherlands) Beatriz Manuel (Eduardo Mondlane University, Community Health Department, Maputo, Mozambique) Cees van der Vleuten (Maastricht University, Department of Educational Development and Research, Maastricht, Netherlands)
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Erik Driessen (Maastricht University, Department of Educational Development and Research, Maastricht, Netherlands)
Background: Sub-Saharan African health care faces a heavy disease burden and radical physician shortages. Scaling up the quantity and quality of doctors is urgently needed. A factor affecting quality of doctors is the curriculum, but evidence on outcomes of curricular innovations in Sub-Saharan Africa is lacking. Summary of work: We investigated how graduates and fifth-year students from an innovative medical curriculum (problem- and community-based), compared with a conventional curriculum (lecture- and discipline-based), in a Sub-Saharan African context (Mozambique) felt their education (had) prepared them for practice. We administered a questionnaire (n=157), conducted semi-structured interviews (n=20), and collected diaries
Summary of results: We identified six tensions between local Mozambican reality and 'ideal' medical practice, which heavily challenged doctors' motivation and preparedness for work. Four elements of the innovative curriculum equipped participants with skills and competencies that helped balancing between these tensions, which increased motivation and preparedness for practice (mainly medium to large effect sizes). Conclusions: Our results suggest that problem- and community-based curricula may hold special promise for Sub-Saharan Africa, as our effect sizes are unmatched in studies conducted elsewhere. The challenges faced in a Sub-Saharan African context seem of such magnitude, however, that medical school alone seems unable to fully prepare doctors.
Take-home messages: Curricular innovation in Sub-Saharan Africa helps doctors - perhaps more than elsewhere - to tackle local challenges, but is not enough on its own. Joint effort by relevant stakeholders is needed to improve health care systems and medical education in this region.
Application of efficient instruction of medical curriculum across multiple geographic locations in times of limited resources
Ruth Ballweg (University of Washington School of Medicine, MEDEX Northwest Division of Physician Assistant Studies, Seattle, United States) David Talford (Idaho State University, Physician Assistant Studies, Idaho State University - Meridian Health Science Center, 1311 East Central Drive, Meridian
83642, United States)
Jared Papa (Idaho State University, Physician Assistant
Studies , Meridian, United States)
Linda Vorvick (University of Washington School of
Medicine, MEDEX Northwest Division of Physician
Assistant Studies, Seattle, United States)
Chad Harbal (Idaho State University, Physician Assistant
Studies, Pocatello, United States)
Background: The global prevalence of economic crisis, limited resources and underserved populations calls for new means of delivering efficient yet effective medical education. Medical educators are challenged with allocating restricted assets to produce a more resourceful and beneficial education system. Summary of work: Two University Physician Assistant programs efficiently implement their medical curriculum across distant geographical teaching sites through varied approaches, which will be compared and contrasted. Summary of results: The University of Washington delivers an asynchronous standardized curricula, in combination with synchronous examinations across its distant campuses. This approach draws on local provider lecturers at each satellite site. The result is an integration of the program with the local medical community and additional clinical sites. Idaho State University synchronously delivers its standardized curricula utilizing distance technology to link distant campuses to create a single virtual classroom. Both programs use technology, and online learning management systems to implement their program's curriculum. Distance education technologies offer alternatives for medical education to respond to converging information and communication trends. Likewise, the engagement of the local medical community in the educational process facilitates the integration of the medical program, with its students, into the local community.
Conclusions: With either approach a single university can bridge their curricula, pedagogy and organizational structure across geographically distinct campuses more efficiently. Performance outcomes and student satisfaction surveys have shown no statistically significant differences between sites. Take-home messages: Limitation of resources and a need to train more providers to meet the needs of society requires innovation and the leveraging of technology to drive efficient delivery of medical education.
Curriculum design: The "English garden" model
Valentin Muntean ("Iuliu Hatieganu" University of Medicine and Pharmacy, Surgery, 14C Trifoiului Street, 18 Republicii Street, Cluj-Napoca 400478, Romania)
Background: Classic English cottage garden evokes a natural feeling, looking as if no planning was necessary to create their beauty.
Summary of work: When designing an English garden three steps should be followed. Summary of results: The first step is to select three to four main colors to create continuity within the garden. The three main longitudinal themes of our curriculum are basic sciences, clinical skills and clinical presentations / examination objectives. Although free flowing, English gardens do need a certain amount of structure. The structure of our curriculum is provided by study guides, personal learning plans, learning portfolios, mentoring and peer review. A third important
ingredient in an English garden is the "accessories" or in other words, the structures or the "whimsy": a gate, a bench or a water feature. In our curriculum the "accessories" are provided by the authentic activity in the communities of practice the learner is exposed during the training period.
Conclusions: The "English garden" model for curriculum design refers to the active involvement of learners in authentic activities within specific communities of practice, and is based on our cultural background and available teaching staff and infrastructure. Take-home messages: Our curriculum is grounded on the theories of cognitive apprenticeship and situated learning.
2H: Short Communications: Curriculum:
Community Oriented Medical Education Location: Club H, PCC
The Impact of Integrated Public Health Teaching among Final-Year Medical Students
Janne Pitkaniemi (University of Helsinki, Department of Public Health, Helsinki, Finland) Ossi Rahkonen (University of Helsinki, Department of Public Health, Helsinki, Finland)
Heikki S. Vuorinen (University of Helsinki, Department of Public Health, PO Box 41 (Mannerheimintie 172), Helsinki FI-00014 University of Helsinki, Finland)
Background: Department of Public Health reformed its curriculum for the final-year medical students in the autumn 2012 by focusing on prevention and integrating teaching of theory oriented topics such as health promotion, epidemiology and biometrics and everyday work oriented topics such as occupational health and healthcare organization. Our aim was to study how this change affected attitudes of medical students on public health, prevention, epidemiology and biostatistics. Summary of work: Questionnaires were collected in the beginning of the final-year public health teaching and in the end of teaching period of four months. Response rates were respectively 50% and 75% (total number of students 123). The sixteen questions included several statements about the attitudes towards teaching and topics graded by a 5-point Likert scale. A statistically significant change in the responses was tested by individual transitions between baseline and follow-up response.
Summary of results: Significant changes were observed in students' improved understanding of the basic concepts of epidemiology and biostatistics and in the opinion about the ability to use AUDIT (Alcohol Use Disorders Identification Test) much better (p<0.001). A better understanding of sources of error and uncertainty in scientific studies was achieved (p=0.002) as well as increased interest in epidemiology and biostatistics. Medical undergraduate students also changed their opinion in favor of a more tight border control as a mean for better control of the use of alcohol, drugs and tobacco (p=0.03, linear by linear). Conclusions: The new integrated public health curriculum was able to change short term attitudes on public health among the final-year medical students.
Defining and measuring quality in community-based medical education: Developing an adaptable audit tool
Emma Scott (University of Liverpool, Community Studies Unit, Room 2.27 Cedar House, Ashton Street, Liverpool
L69 3GE, United Kingdom)
Omnia Allam (University of Liverpool, School of Medicine, Liverpool, United Kingdom)
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Sian Alexander-White (University of Liverpool, Community Studies Unit, Liverpool, United Kingdom)
Background: There has been a shift towards undergraduate education in the community following the GMC recommendations in Tomorrows Doctors. The University of Liverpool's MBChB Community Studies Unit programme has over 200 practices that host medical students however the quality of these placements are not comprehensively audited. The literature review revealed a gap in both research and practice in this area.
Summary of work: This piece of work defines the standards of a good quality community medicine placement for undergraduates. The data was collected using a combination of focus groups and semi-structured on-to-one interviews. Transcripts were analysed to produce a cumulative and collective representation of the stakeholders' opinion. A single analyst approach employed a variant of Thematic Content Analysis. The resulting Quality Toolkit can assess quality of community placements for medical undergraduates.
Summary of results: The results yielded a simple yet multi-dimension audit tool, which is currently being validated. The feedback produced is useful to reassure and congratulate good practice and suggest improvements in areas of weakness. Although this tool was produced from the stakeholders at the University of Liverpool, the intension is to share good practice; with minimal adaptations this tool could be used to audit community placements hosting students from Universities throughout the UK and internationally. Conclusions: Ensuring consistent quality of placements for undergraduates requires an evidenced-based, holistic approach. This work proposes an adaptable, practical and useful way to ensure this. Take-home messages: An adaptable tool to holistically and consistently assess the quality of community placements for medical undergraduates at the University of Liverpool.
The outstanding features of Community based learning (CBL) of Chiang Mai University (CMU)
Wuttipong Siriwittayakorn (Chiang Mai University, Faculty of Medicine, 66/1 Tippanet, Haiya, 110 Intawaroros, Sriphum, Muang Chiang Mai, Chiang Mai 50100, Thailand)
Volaluck Supajatura (Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand)
Background: 21th Century medical education prefers doctor with a community orientation. Community health management is the unavoidable responsibility of every doctor. Medical curriculum with CBL is necessary. The medicine course of CMU included CBL in 2nd-5th year level of the 6th year curriculum.
Summary of work: In the 2nd year, Med-students study epidemiology, community research, and start experience in community surveys. In 3rd year, Med-
Students visit villages and find out the common health problems. They learn team working, analyzing information, and problem solving. 4th year med-student spend a month in rural area hospitals. They have opportunities to treat patients and study primary health care and referral system. Fortunately, it's the time that they have chance to work with community health personnel. Interestingly, Med-students in 5th year approach community research, make manuscript and poster presentation reports to Faculty. The valuable data and solutions are sent back to the relevant authorities and hospitals for health promotions. Summary of results: In the five years of experience, Med-students learn much not only health problems and research, but also health policy and organization. Importantly, they have ability in communication skills, learning by doing, self-directed learning and cross-cultural understanding. They achieve volunteering, creative thinking and social mind. Together, these abilities mold them to work and adapt to great changes in society effectively.
Conclusions: The doctor is a key person who could change global health; therefore they have to fulfil their experience during study MD.
Take-home messages: Family and Community Medicine is the most essential subject for Med-students to become a doctor in global medicine.