Автор неизвестен - Mededworld and amee 2013 conference connect - страница 41

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Improving Residents' Perceived Abilities as Teachers using Simulation

Farhan Bhanji (McGill University, Royal College of Physicians and Surgeons of Canada, Centre for Medical Education, 4286 rue Joliette, Montreal H1X 3L5, Canada) Linda Snell (McGill University, Royal College of Physicians and Surgeons of Canada, Centre for Medical Education, Montreal, Canada)

Background: Residents, interns and junior doctors play a significant teaching role for junior colleagues and medical students. However few receive training in

ABSTRACT BOOK: SESSION 4 MONDAY 26 AUGUST: 1400-1530

teaching and most are left to 'figure it out' on their own. Simulation-based education provides an authentic and safe learning environment but has infrequently been used to improve residents' teaching skills. Summary of work: We implemented a simulation-based, academic half-day to improve residents' teaching skills at McGill University, Canada. Faculty included expert clinician-teachers and residents with expertise in education. We evaluated the overall value of the program and residents' perceived learning using the retrospective pre-post survey questionnaire with a 5-point Likert-scale (1='not at all', 5='to a large extent'). Summary of results: 53/80 participants completed a post-workshop questionnaire, indicating the program met their learning needs (4.1/5), there was adequate opportunity for practice/participation (4.5/5) and they would recommend the program to colleagues (4.4/5). The mean of all retrospective pre-scores was 3.3 and post-scores was 4.0.

Conclusions: Residents believed the workshop prepared them to identify their role as teacher and be comfortable with it, describe important concepts in education and apply them to their teaching and reflect on their practice as teachers. Simulation may be a valuable strategy to help residents engage in their roles as teachers and to improve their perceived teaching abilities. Further research should address if this improves their teaching abilities in practice. Take-home messages: Well designed simulation-based Resident-as-Teacher Programs are well received and can help residents improve their perceived teaching abilities.

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Impact of a rotation in medical education on the development of a teacher identity for senior residents of Universite de Montreal

Genevieve Gregoire (Universite de Montreal, medecine, Montreal, Canada)

Suzanne Laurin (Universite de Montreal, Medecine familiale et medecine d'urgence, Montreal, Canada) Marie-Claude Audetat (Universite de Montreal, Medecine familiale et medecine d'urgence, Pavillon Roger-Gaudry bureau Y- 201-3, 2900, boul. Edouard-Montpetit, Montreal H3T 1J4, Canada)

Background: Senior residents, even though they teach junior residents and clerks and have received a basic medical education formation, see themselves as physicians. The medical education centre of the Faculty of Medicine of Universite de Montreal has developed a four weeks elective Medical education rotation for senior residents who intend to practice in a teaching hospital. We were interested to know if and how such a rotation could affect the construction of a professional teaching identity for the senior residents. Summary of work: The conceptual framework was based on Susan Starr's model and the 7 themes described as part of the teacher identity: intrinsic satisfaction, knowledge and skill about teaching, belonging to a community of teachers, receiving rewards for teaching, believing that being a doctor means being

a teacher, feeling a responsibility to teach, and sharing clinical expertise. Exploratory research using qualitative and quantitative methodology was conducted. We conducted focus groups to collect data about opinions, beliefs and attitudes about teaching. A short questionnaire was delivered and three focus groups were conducted with the five residents before, at the end and six months after the rotation. On the basis of the verbatim responses, a thematic analysis was conducted using Atlas TI software. Summary of results: Indicators of the development of professional identity as teachers were identified. We also highlighted other elements that illustrate the development of this professional identity, such as the integration and the appropriate use of educational concepts and vocabulary, the development of a reflective process and the transfer of some concepts and educational competencies in other contexts. Conclusions: Participation in a medical education rotation fosters the construction of a teacher identity among senior residents.

Take-home messages: Understanding how residents think about their teaching role and identity could help Medical schools to recruit and prepare physicians to be better and more involved teachers.

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A faculty-facilitated near-peer teaching programme: an effective way of teaching undergraduate medical students

Xinyi Du (Princess Alexandra Hospital, Foundation Programme, Harlow, United Kingdom) Muhammad Kebreya (Princess Alexandra Hospital, Foundation Programme, Harlow, United Kingdom) Sreekanth Sakthibalan (Princess Alexandra Hospital, Foundation Programme, Harlow, United Kingdom) Andrew Peetamsingh (Princess Alexandra Hospital, Foundation Programme, Harlow, United Kingdom) Frances Hiscock (Princess Alexandra Hospital, Foundation Programme, Harlow, United Kingdom) Peter Bishop (Princess Alexandra Hospital, Education, Intensive Care Unit, Harlow, United Kingdom)

Background: Senior residents, even though they teach junior residents and clerks and have received a basic medical education formation, see themselves as physicians. The medical education centre of the Faculty of Medicine of Universite de Montreal has developed a four weeks elective Medical education rotation for senior residents who intend to practice in a teaching hospital. We were interested to know if and how such a rotation could affect the construction of a professional teaching identity for the senior residents. Summary of work: The conceptual framework was based on Susan Starr's model and the 7 themes described as part of the teacher identity: intrinsic satisfaction, knowledge and skill about teaching, belonging to a community of teachers, receiving rewards for teaching, believing that being a doctor means being a teacher, feeling a responsibility to teach, and sharing clinical expertise. Exploratory research using qualitative

ABSTRACT BOOK: SESSION 4 MONDAY 26 AUGUST: 1400-1530

and quantitative methodology was conducted. We conducted focus groups to collect data about opinions, beliefs and attitudes about teaching. A short questionnaire was delivered and three focus groups were conducted with the five residents before, at the end and six months after the rotation. On the basis of the verbatim responses, a thematic analysis was conducted using Atlas TI software. Summary of results: Indicators of the development of professional identity as teachers were identified. We also highlighted other elements that illustrate the development of this professional identity, such as the integration and the appropriate use of educational concepts and vocabulary, the development of a reflective process and the transfer of some concepts and educational competencies in other contexts. Conclusions: Participation in a medical education rotation fosters the construction of a teacher identity among senior residents.

Take-home messages: Understanding how residents think about their teaching role and identity could help Medical schools to recruit and prepare physicians to be better and more involved teachers.

4J/5

The Development of an Objective Structured Teaching Examination for Foundation Doctors

Jo Sophia Phillips (University of Manchester, Wythenshawe Hospital (UHSM), Southmoor Road, Wythenshawe, Manchester M23 9LT, United Kingdom) Lucie Marie Theresa Byrne-Davis (University of Manchester & UHSM Academy, Manchester Medical School, Manchester, United Kingdom) Gerard John Byrne (University of Manchester & UHSM Academy, Faculty of Medical and Human Sciences, Manchester, United Kingdom)

Background: Teaching is an important role of doctors. Junior doctors in the UK often teach basic clinical skills to medical students. In the UK there is no formal programme for teaching doctors to teach or to assess their teaching abilities. We aimed to devise a feasible and reliable teaching assessment. Summary of work: US Objective Structured Teaching Examination (OSTE) stations were reviewed and found to be unfeasible for use with UK junior doctors. An expert panel created six shorter stations. We ran an OSTE in which junior doctors taught, and were assessed by, medical students. We collected evidence regarding the feasibility, validity and reliability of our OSTE. Summary of results: The majority of students were able to complete mark sheets easily. Three markers reported that the doctors found it difficult to close the teaching session. Simple linear regressions of checklist to global scores ranged from 0.29 to 0.91. Internal consistency reliability was 0.682 (Cronbach's alpha). Doctors reported that the experience was beneficial. Conclusions: Overall the OSTE was feasible and acceptable to doctors and students. There is evidence of validity in four stations with moderate associations of checklist and global scores. The internal consistency

reliability was moderate to high: good for a small sample size. The OSTE was feasible, acceptable, valid and reliable in this small study of foundation doctors teaching medical students.

Take-home messages: We need to train and assess doctors in teaching clinical skills. The OSTE is a promising way of doing this.

4J/6

Improving resident teaching through clinical case conference presentations in Japan

Jeffrey G Wong (Medical University of South Carolina, Internal Medicine, 135 Cannon Street, Suite 403K,

Charleston 29425, United States)

Masataka Gunshin (The University of Tokyo, Department of Emergency Medicine, Tokyo, Japan) Daisuke Son (The University of Tokyo, International Research Center for Medical Education, Tokyo, Japan)

Background: At the University of Tokyo School of Medicine, interactive clinical case conference discussions, hosted by clinical teaching faculty, are an increasingly popular teaching methodology for improving the clinical reasoning skills of medical students and junior residents. We wanted to investigate whether or not mentoring senior residents to take on a formal teaching role in this conference could improve their confidence in their abilities to teach. Summary of work: From November 2012 through March 2013, seven 1-hour clinical case conferences were presented. For each conference, a power point presentation of an actual patient was chosen and prepared by the teaching resident. Mentored by one author experienced in clinical education (JGW), the residents were encouraged to construct their presentations in a fashion that would encourage active audience participation and would emphasize concrete learning goals for the conference participants. Conferences were presented in both English and Japanese using translation. Outcomes were measured using a 5-point Likert-type retrospective pre-post-survey asking the residents to self-evaluate specific teaching skills and also their overall abilities to teach before and after their presentations. Descriptive comparisons between pre- and post-test scores were assessed using the student t-test.

Summary of results: All teaching residents found the mentored presentations valuable. Survey results demonstrated statistically significant improvement in self-assessed teaching skills for organizing and presenting the material as well as recognizing and expressing key learning points. Conclusions: We were able to demonstrate improvement in the residents' self-evaluated teaching ability following a brief mentored educational intervention.

Take-home messages: Mentoring residents on effective presentation skills may improve a program's educational quality.

4K Short Communications: Education Management

Location: Club B, PCC

4K/1

Overview of the world's medical schools

RJ Duvivier (Foundation for Advancement of International Medical Education and Research FAIMER, 3624 Market Street, Philadelphia, United States) J Boulet (Foundation for Advancement of International Medical Education and Research FAIMER, Philadelphia,

United States)

A Opalek (Foundation for Advancement of International Medical Education and Research FAIMER, Philadelphia,

United States)

Background: There has been increasing interest in strategic investment in medical education worldwide. Simultaneously, some regions have seen rapid expansion of the number of medical schools. However, little data is available on the status of medical schools or trends within medical education internationally which is a major challenge when developing strategies to address shortages in physician workforce. Summary of work: We used publicly available data from the International Medical Education Directory and Avicenna Directories. We sought additional information by sending a semi-structured questionnaire to a selection of medical schools. Whenever there was incongruence between sources, we contacted Ministry of Health, National Agency for Accreditation or similar bodies. Additionally, we identified key informants for country-level specific information. We used descriptive statistics to analyze current medical school data by country.

Summary of results: There are currently over 2500 medical schools worldwide, with the largest numbers in India (296), Brazil (182), USA (166), China (145) and Pakistan (86). Of 193 independent states, 64 have no medical school while 53 have only 1. Regionally, the number of schools per 1 million population differ greatly with the Caribbean having 1 school per 0.65 million population, Americas 1/1.2M, Oceania 1/1.3M, Europe

1/1.8M, Asia 1/3.5M, and Africa 1/5M.

Conclusions: Combining medical school locations with population figures and physician density provides insight in geographical distribution of training programs. Take-home messages: The total number and distribution of medical schools around the world is not well matched with existing physician numbers and distribution, and there is a particular misbalance in Caribbean and Africa.

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Government role in medical education in Brazil

Miriam Graciano (Unifenas, Public Health, Rua Maria Jose de Carvalho, 72, Rod MG179 Km0 Campus Universitario Sala 602, Alfenas 37130-000, Brazil) Helena Chini (Unifenas, Physiology, Alfenas, Brazil)

ABSTRACT BOOK: SESSION 4 MONDAY 26 AUGUST: 1400-1530

Patricia Oliveira (Unifenas, Public Health, Pogos de Caldas, Brazil)

Eliana Amaral (Unicamp, Obstetrics and Gynecology, Campinas, Brazil)

Jaqueline Barboza (Unifenas, Medical Psychology, Alfenas, Brazil)

Silvana Novais (Unifenas, Public Health, Alfenas, Brazil)

Background: The educational system should not be left out of planning of the National Health System. University autonomy should not distance it from the social responsibility of education. It is understood, in Brazil, that the Government should develop policies that induce universities to fulfill their social function (Ceccim, Feuerwerker, 2004).

Summary of work: In 2005, The Pro-Health Program (Reorientation of Vocational Training in Health), led us to propose a community-based learning. This approach starts from the first semester of the medical course, with the following modules: Policies and Health Practices in Community, Surveillance and Health Education, Maternal and child Care, Clinical and Psychosocial Anamnesis, and Therapeutical Assistance. Summary of results: One Commission to Integrate Service and Medical School was founded; students began to collaborate with health teams, developing functions together and not just doing passive observation; three guidelines for practical activities for students in the early years were produced according to national primary health policy. The Pro-Health Program reinforces the processes of changes developed in Brazil since 2001. The reciprocal interaction between medical School and Health System created real conditions for a better development of both, with better technical quality in Health Care and learning process (Puccini et al.

2012).

Conclusions: The Pro-Health was in fact an inducing policy of the State that provided a more comprehensive and better training in Primary Health. Take-home messages: "Nobody educates anybody, no one educates himself, we all educate each other, mediated by the world" (Freire, 1981).

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Spending £10k a minute transforming a 1m strong health workforce

Ian Cumming (Health Education England (HEE, United Kingdom)

Background: Health Education England (HEE) is a new organisation created to improve the quality of care by focussing on education, training and developing the current and future workforce. A simple stated outcome, but a monumental task.

Summary of work: HEE spends £5bn per annum to educate, train and develop the NHS workforce, but how we spend that money is changing. We are focussing on recruiting, training and appraising for values. We are developing new roles, training in the community not hospitals and creating a dementia aware workforce. Quality Improvement Science and Genomics are also at

the centre of educating a new workforce for a new future.

Summary of results: We are creating 4000 new community health visitors. We will train 100,000 staff to be dementia aware this year alone. We will spend £15m education and training the current workforce in genomics and in creating a new specialty of Bio-informaticians. We will assess the values of every potential new recruit into either jobs or education for their values; and say no to those who fail, and we will use gamification of our careers service to attract the next generation from our schools into careers in the

NHS.

Conclusions: Only fundamental change to our whole workforce, from before a teenager makes a career choice through to a consultant mentoring on their last day on the job, can we make a workforce fit for the future.

Take home messages: Tinkering at the edges will fail staff, patients and ultimately sustainable healthcare provision for the next generation.

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Implementation of the Physician Assistant in Dutch health care organizations: Primary motives and outcomes

Anneke van Vught (HAN University of Applied Science, Physician Assistant Program, Sint Annastraat 312, Postbus 6960, Nijmegen 6503 HG, Netherlands) Geert van den Brink (HAN University of Applied Science, Physician Assistant Program, Nijmegen, Netherlands) Theo Wobbes (HAN University of Applied Science, Physician Assistant Program, Nijmegen, Netherlands)

Background: Physician assistants (PAs) are trained to perform medical procedures that were traditionally performed by physicians. In the Netherlands however, the PA is a relatively new professional. Summary of work: To gain insight in the primary motives of specialists to employ a PA and the outcomes of the implementation, we interviewed supervising medical specialists who applied a PA in their practice. The interviews were semi-structured and took one hour. Two scientists coded the findings with respect to motives and outcomes. In total 55 specialists were interviewed about their motives to employ a PA and 15 about the outcomes of employing a PA. Summary of results: With respect to the primary motives to employ a PA, the most frequent motive was to increase continuity and quality of care, followed by relieve of the specialist's workload, increase in efficiency of care and substitution of the medical resident. The outcomes were in accordance with the motives. Conclusions: The preliminary results about the PAs in the Netherlands seem to meet expectations of Dutch medical specialists and are in accordance with the American results.

Take-home messages: Medical specialists are satisfied with the employment of PAs in their practice.

ABSTRACT BOOK: SESSION 4 MONDAY 26 AUGUST: 1400-1530

4K/5

Manpower planning in Post Graduate Medical Education: Is there a need for an EU-policy?

Abe Meininger (University of Groningen, Postgraduate School of Medicine, University Medical Center Groningen, Hanzeplein 1, Groningen 9700RB, Netherlands)

Angelique Reinders (University of Groningen, UMC Groningen Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands) Raquel de Vito (University of Groningen, Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands) Johan Groothof (University of Groningen, Department of Health Sciences, University Medical Center Groningen, Groningen, Netherlands)

Jan Borleffs (University of Groningen, UMC Groningen Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands)

Background: Manpower planning is a crucial topic in the 21st century in order to guarantee an adequate quality of healthcare. We examined the perspectives of EU-policymakers concerning manpower planning of medical specialists.

Summary of work: The so-called "CIA-project", was conducted with the use of a semi-structured questionnaire and stakeholder interviews in order to analyze three main aspects at the macro-system level: 1. Current situation and trends; 2. Importance of developments and desired innovations; 3. Attainability of desired innovations. The interviews were held among policymakers in eight selected EU-countries. Summary of results: The results include a summary of the policies in terms of manpower planning in the field of PGME. Five of the eight countries indicate the need for more „generalists" in medical care. None of the eight countries agree that EU-policy assists in developing sufficient local training capacity. Capacity planning and employability appears to be of major importance in some countries, whereas it is of less importance in other countries.

Conclusions: A shared vision for EU-policy on manpower issues hardly exists. The conducted international analysis shows that a coherent policy between EU-countries is lacking e.g. mobility of doctors. Take-home messages: We suggest the development of more synergy in policy and further research in order to control manpower in healthcare more effectively and better align the PGME curriculum with future quality goals.

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International Collaboration between the Brazilian Department of Health, its School and the University of Maastricht: Innovation in post­graduate health services and education

Mourad Ibrahim Belaciano (Federal University of Brasilia, Collective Health, Brasilia, Brazil) Regina Helena Petroni Mennin (Federal University of Sao Paulo, Preventive Medicine, Bordes Lagoa, 1341, Sao

Paulo 04038-034, Brazil)

Adriana Aguiar (Fundagao Fio Cruz, Communication and Information, Rio de Janeiro, Brazil) Stewart Mennin (Mennin Consulting, Mennin Consulting, Sao Paulo, Brazil)

Background: Health care is a citizen's right and a duty of the State under the Unified Health System (SUS) in Brazil. A mismatch exists between "reductionist, disease-oriented, hospital-centred, specialisation-driven education "and a strong demand by the government and the people for a more humanistic, health-oriented, education and service focused on primary health care, and socially committed professionals." Summary of work: The Federal District of Brasilia created the Escola Superior de Ciencias da Saude, a SUS-based medical and nursing school within the Department of Health to reorient higher education to a profile consistent with national needs by employing faculty working in health services. Still, faculty are drawn from a traditional education system. Faculty development is a key issue in sustaining innovations. An international collaboration between the University of Maastricht School of Health Professions Education (SHE) and the Department of Health in Brasilia provided the nidus for faculty development and regional health challenges through post-graduate study. Summary of results: Results from the first masters graduates focused on details of problematization methodology, minority performance as function of access to medical school, reorientation of nursing curricula to a continuum of authentic learning in health services, and ethics and professionalism in health systems research and education. Conclusions: Unifying the Department of Health with health professions and post-graduate education can reorient health workers' profiles towards improving the health of people.

Take-home messages: The difference that makes a difference in the profile of health professionals to improve peoples' health is a post-graduate collaboration between the Brazilian Department of Health, the Escola Superior de Ciencias da Saude and the University of

Maastricht, SHE.

4L Short Communications: Selection:

Multiple Mini Interview

Location: Club C, PCC

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