Автор неизвестен - Mededworld and amee 2013 conference connect - страница 48

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Melchor Sanchez (UNAM Faculty of Medicine, Secretariat of Medical Education, Mexico City, Mexico)

Background: Curricular change in medical schools implies a change process fraught with challenges and opportunities. UNAM Faculty of Medicine in Mexico is the largest medical school in Mexico, and started a new curriculum in 2010, which includes generic outcome competencies. This paper focuses on a student assessment after the first two years of the program. Summary of work: The program defined two intermediate profiles (1 at the end of the second year and 2 at the end of the clinical years). The curriculum plan scheduled a diagnostic exam in each profile. The objectives were to evaluate the educational outcomes after the first phase, and to provide diagnostic information about student educational achievement to the relevant stakeholders. The test had two components: a written multiple-choice question test, designed to sample the knowledge domain of all the courses from the first two years; and an OSCE-type exam designed to explore the competencies. Summary of results: The exams were applied in June 2012, to 493 students that successfully completed second year. The written test had 211 items, Cronbach's alpha 0.85, mean difficulty of 0.60. The OSCE exam had nine six-minute stations, that sampled the intermediate profile competencies. The average score of the OSCE test was 58%. The global results were provided to the medical school authorities and the academic departments, and the individual results with detailed scores to the medical students. Conclusions: The study provided information on knowledge and competencies useful to the institution, teachers and students.

Take-home messages: Curricular change must be continuously evaluated, in order to diagnose the strengths and deficiencies of the educational strategies and outcomes.

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Application of SPICES model for stroke teaching and learning (SPICES the Stroke)

Phanpaphon Konpan (Sanpasitthiprasong Hospital,

Department of Medicine, Sappasit Road,

Ubonratchathani 34000, Thailand)

Parinya Chamnan (Sanpasitthiprasong Hospital,

Department of Social Medicine, Ubonratchathani,

Thailand)

Background: SPICES model has been proposed as a framework for improvement in teaching and learning. Little evidence exists to document the utility of the model in the assessment of stroke teaching and learning in Thailand.

Summary of work: Study participants included 61 clinical year students and 19 teachers. SPICES model was used to assess the medical students and teachers' perception of stroke teaching and learning, using five-point scale questions proposed by Harden. SPICES score was defined as the sum of the score on five aspects of expected and present stroke teaching and learning -higher scores represent more innovative teaching and learning. SPICES scores for expected and current stroke teaching and learning were compared. Factors associated with high SPICES scores were identified using logistic regression.

Summary of results: Mean (SD) work experience of the teacher was 11.8 (5.0) years, ranging from 2-23 years. Less than 10% of teachers and students perceived that current stroke teaching and learning was student-centred, elective and systematic- and community-based. Students tended to expect future teaching and learning to be more discipline, hospital-based and standard, while teachers expected more integration and community-based. Teachers reported that current teaching and learning was fairly traditional, and expected it to be a great deal more innovative (median score 11 and 24 for current and expected teaching and learning, respectively). Students also expected teaching and learning to be more innovative, but with a lesser extent (median score 12 and 19 respectively). Factors associated with future high score were age and working time of teachers (p<0.05).

Conclusions: Teachers expected teaching and learning to be more innovative than it currently was, and this expectation was more significant than students'. Age and working time of teachers were associated with expectation of innovative teaching and learning.

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

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Medical Students' Opinion about Structured Ward Round with Post-Ward Round Meeting at a Pediatric Ward of a Hospital School in Northeast Brazil

Fabiola Guedes (Instituto de Medicina Integral Professor

Fernando Figueira (IMIP), Department of Medical

Education Research, Recife, Brazil)

Antonio Arrais Filho (Instituto de Medicina Integral

Professor Fernando Figueira (IMIP), Department of

Medical Education Research, Recife, Brazil)

Gilliatt Falbo (Instituto de Medicina Integral Professor

Fernando Figueira (IMIP), Department of Medical

Education Research, Recife)

Hegla Prado (Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Department of Medical Education Research, Rua Paissandu, 381/503B, Boa Vista, Rua dos Coelhos, 300, Boa Vista, Recife 50070-200 / 50070-550, Brazil)

Tereza Lima (Instituto de Medicina Integral Professor Fernando Figueira (IMIP), Department of Medical Education Research, Recife, Brazil)

Background: Ward round is considered a valuable tool for acquisition of medical skills, but few studies investigate its efficacy and effectiveness for learning purposes. Structured formats for this activity have been considered in order to maximize learning opportunities, among which post-ward round meeting, an opportunity to discuss issues which are inappropriate at bedside. The aim of this study was to determine the students' opinion about structured ward round with post-ward round meeting.

Summary of work: A quantitative study was performed with medical students in their rotation at a pediatric ward. They attended ward rounds not followed by post-ward round meeting for two weeks. In the next fifteen days, post-ward round meeting was included. After that, a questionnaire (five point Likert scale) was applied to determine students' opinion on educational and operational aspects related to post-ward round meeting. Summary of results: Seventy four subjects were enrolled. Students' opinion about different aspects of post-ward meeting averaged satisfactory. The questions which obtained best scores were: "post-ward round meeting is an opportunity to discuss practical situations experienced at bedside" (mean=4.3, SD=0.8); "post-ward round meeting provides discussion of issues which are inappropriate at bedside" (mean=4.4, SD=0.6); and post-ward round meeting promotes student's motivation (average = 4.0, SD = 0.9). Questionnaire's reliability test (Cronbach's alpha) was 0,901. Conclusions: Considering the results, the medical students' opinion is that ward round structured with post-ward meeting had a positive influence on their learning process.

Take-home messages: Implementation of the post-ward meeting may benefit professional training of medical students, in particular regarding skills and attitudes' acquisition, such as communication skills and ethics attitudes.

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Multisource feedback analysis of pediatric outpatient teaching

Mao-Meng Tiao (Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Pediatrics, 123 Ta-Pei road, NiaSung, Kaohsiung 83301, Taiwan) Chih-Cheng Hsiao (Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Pediatrics, Kaohsiung, Taiwan)

Background: This study aims to evaluate the outpatient communication skills of medical students via multisource feedback, which may be useful to map future directions in improving physician-patient communication.

Summary of work: Family members of patients, nurses, a clinical teacher, and a research assistant evaluated video-recorded medical students' interactions with outpatients by using multisource feedback questionnaires; students also assessed their own skills. The questionnaire was answered based on the video-recorded interactions between outpatients and the medical students.

Summary of results: A total of 60 family members of patients completed the questionnaire, but only 58 (96.7%) of them agreed with the video recording. Two reasons for reluctance were "personal privacy" issues and "simply disagree." The average satisfaction score of the students was 85.1 points. The family members were most satisfied with the "teacher's attitude," followed by "teaching quality". In contrast, the family members were most dissatisfied with "being open to questions." Among the 6 assessment domains of communication skills, the students scored highest on "explaining" and lowest on "giving recommendations." In the detailed assessment by family members, the students scored lowest on "asking about life/school burden". In the multisource analysis, the nurses' mean score was much higher and the students' mean self-assessment score was lower than the average scores on all domains. Conclusions: The willingness and satisfaction of family members were high in this study. Students were not efficient in giving recommendations to patients. Multisource feedback is useful in providing more accurate evaluation of students' communication competence and in identifying the areas of communication that require enhancement. Take-home messages: Multisource feedback with video­taping is useful in providing more accurate evaluation of students' communication competence and in identifying the areas of communication that require enhancement than only teacher's evaluation.

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

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Ordering patterns for laboratory and radiology tests by students from different undergraduate medical curricula

Sigrid Harendza (University Hospital Hamburg-Eppendorf, Internal Medicine, Martinistr. 52, Hamburg D-20246, Germany)

Lonneke Alofs (UMC Utrecht, Center for Research and Development of Education, Utrecht, Netherlands) Jorike Huiskes (UMC Utrecht, Center for Research and Development of Education, Utrecht, Netherlands) Marjo Wijnen-Meijer (UMC Utrecht, Center for Research and Development of Education, Utrecht, Netherlands)

Background: The overuse of laboratory tests and radiology imaging and their possible hazards to patients is observed with growing concern in the medical community. With this study the authors wished to determine whether ordering patterns for laboratory and radiology tests by medical students are related to undergraduate training.

Summary of work: We developed an assessment for near graduates in the setting of a resident's daily routine including a consultation hour with five simulated patients, three hours for patient work up, and thirty minutes for reporting of patient management to a supervisor. In 2011, 30 students from a vertically integrated (VI) curriculum (Utrecht, The Netherlands) and 30 students from a traditional, non-VI curriculum (Hamburg, Germany) participated. We compared the number of laboratory and radiology requests and correlated the results with the scores participants received for the competence "scientifically and empirically grounded method of working." Summary of results: Students from a VI curriculum used significantly (p<.01) less total laboratory requests (N=283 versus N=466) which correlated with their scores for a "scientifically and empirically grounded method of working" (Pearson's r=.572). A significantly (p<.01) higher number of radiology imaging was ordered with a large effect size (V=.618) by near graduates from a non-VI curriculum (N=156 versus N=97) even when this was not supporting the diagnostic process. Conclusions: The focused ordering patterns from VI students might be a result of their early exposure to the clinical environment and a different approach to clinical decision making during their undergraduate education. Take-home messages: The type of medical undergraduate curriculum might affect students' ordering patterns in patient work-up.

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Assessing the quality of clinical teaching -Differences in medical students' versus interns' perceptions

Niclas Lewisson (Institution of Surgical Sciences, General Surgery, Uppsala University Hospital, Uppsala 75185, Sweden)

Johan Heinius (Institution of Surgical Sciences, Urology, Uppsala, Sweden)

Jakob Johansson (Institution of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala, Sweden)

Background: The quality of clinical teaching during rotations is important for both medical students and interns. The aim of this study was to evaluate the perception of the quality of clinical teaching for third and fourth-year medical students and interns at identical rotations.

Summary of work: Ten questions (Likert scale 1-6) reflecting different aspects of clinical teaching were distributed to medical students and interns at Uppsala University Hospital, Sweden. Data was collected during autumn 2011 through 2012 from all departments that had rotations for both medical students and interns (anesthesia, psychiatry, cardiology, orthopedics, infection and emergency medicine). Summary of results: The students' and interns' response rates were 70 % (n=749) and 100 % (n=176) respectively. The students' overall mean rating±SD was 4.69±0.99 compared to the interns' 4.60±0.79 (p=0.02). The students gave higher ratings regarding the learning climate at the rotation (5.28±1.01 versus 4.75±1.11, p<0.001) and the amount of feedback received from clinical tutors (4.53±1.46 versus 3.98±1.29, p<0.001). The interns rated a higher level of active participation

(5.06±1.16 versus 4.34±1.52, p<0.001).

Conclusions: Overall the medical students rated their clinical rotations slightly higher compared to the interns. In this setting, students appear to receive more feedback and to have a better learning climate, while interns are provided with better opportunities for active participation.

Take-home messages: Medical students and interns perceive different qualities of clinical teaching. Knowledge about the specific strengths and weaknesses for each phase of medical education enables opportunities to further strengthen the quality of clinical teaching.

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Comparison on OSCE Outcomes between Undergraduate and Post-Baccalaureate Medical Program

Yin-Chun Tien (Kaohsiung Medical University, Medical School, Tzyou 1st Road, San-Ming District, Kaohsiung 807, Taiwan)

Ke-Min Liu (Kaohsiung Medical University, Medical School, Kaohsiung, Taiwan)

Chung-Sheng Lai (Kaohsiung Medical University, Medical College, Kaohsiung, Taiwan)

Background: The choice between undergraduate medical program (UGP) and post-baccalaureate medical program (PBP) has long been discussed and debated. Our university has both 7-years UGP and 5-years PBP. The liberal curriculum is condensed into the first two years in the UGP and medical curriculum starts since their third year. Students of PBP enter the same medical curriculum since their first year.

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

Summary of work: A study was pursued by OSCE (Objective Structured Clinical Examination) to compare the clinical skill competency between the UGP and the PBP students in the month before they finished the program. The OSCE included 3 stations of history taking, 2 stations of communication skill, 3 stations of physical examination, and 4 stations of procedure skill. Summary of results: Among these examinees, 48 were PBP students and 144 were UGP students. The average score of 12 stations was 68.1 on PBP and 66.4 on UGP. The PBP students significantly were better than UGP students (p=0.032). While compare the average score of each station respectively: PBP was better than UGP on one station of history taking (p=0.06), UGP was better than PBP on one station of physical examination (p=0.017), no significant difference on other 10 stations. The overall success rate was 97.9% on PBP and 93.1% on UGP.

Conclusions: One of our previous studies showed the average score of medical curriculum of PBP students was better than UGP students because of more maturity and hard study. In this study, the average OSCE score also demonstrated the same tendency. Take-home messages: The OSCE showed the clinical competency of post-baccalaureate medical program students is better than undergraduate medical program students even though they accepted the same medical curriculum.

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Trainees' perception of medical teaching at Saraburi Medical Education Center from 2005 to

2012

Voralak Vichapat (Saraburi Medical Education Center, Internal Medicine, Saraburi, Thailand) Chitpongse Sujjapongse (Saraburi Medical Education Center, Pediatrics, 18 Thetsaban 4 Pak Phriao, Mueang Saraburi, Saraburi 18000, Thailand)

Background: Saraburi Medical Education Centre (SMEC) was established to increase the production of medical doctors distributed in the rural areas of Thailand. Trainees' perception on sufficient education and factors associated with it were evaluated. Summary of work: A cross-sectional semi-qualitative research was conducted to 240 alumni graduated from SMEC between 2005 and 2012. Information on trainees' grade point average (GPA) and the number of trainers was retrieved. The questionnaires were constructed to obtain general information as well as training satisfaction, clinical supervision, preparedness for practice and capacity of the center. Student t-test was used to assess the differences of GPA between 2005­2008 and 2009-2012. Relationship between key factors was investigated using Pearson's correlation. Summary of results: The data were completed for 51(21%) participants. Participants' GPA graduated after 2008 was better than those graduated before 2008 (p diff =0.005). When the two periods were compared, the satisfactory score of teaching quality increased significantly from moderate to high in most

departments. The decrease ratio of trainers to trainees was correlated to an improvement of satisfaction (r = 0.6). High rated and positive comments on clinical skills were reported. The trainees requested better educational resources but they were satisfied with capacity at the center.

Conclusions: Participants were satisfied with medical training at SMEC. A small ratio of trainers to trainees might contribute to the satisfaction. The center provided sufficient clinical knowledge, experiences and skills. However, an improvement in teaching quality and clinical supervision at SMEC are still recommended. Take-home messages: Close relationship between trainers and trainees could drive high levels of training satisfaction.

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Evaluation of academic teaching during clinical clerkships by undergraduate medical students

Benoit Raeckelboom (Centre hospitalier de Dunkerque, Emergency, 130 avenue Louis Herbeaux, Cedex1, Dunkerque 59380, France)

Ramy Azzouz (CH Dunkerque, Pneumology, Dunkerque, France)

Background: Academic medical education and clinical skills training should complement each other during clinical clerkships to optimize medical students' knowledge and enrich their future practice. Therefore, we conducted a study to assess the medical students' satisfaction regarding the academic teaching during clinical clerkships in our region.

Summary of work: The study included medical students underwent clinical clerkships between September 2009 and November 2012. Eligible students were invited to fill-in an online questionnaire. There were asked to rate their clerkships with a 20 points scale. Summary of results: The study included 3967 medical students who agreed to answer the questionnaire. The study showed that, medical doctors (66%) and residents (25%) are the main providers and organizers of academic teaching. The notation of education improved with the frequency of academic classes (Score > 14.5 / 20 if there is more than one class per week) even if these classes are rare (<1 class/month for 63% of students responded). Organizing sessions for medical students to present case reports increases their clerkship satisfaction (score rise from 13.1/20 until

14.7/20).

Conclusions: Students are willing to take profit from their clerkships in hospitals. Medical students give better notation to clerkships implementing educational academic programs in parallel to clinical trainings. We therefore suggest introducing such programs with case report presentation, presentations made by students and courses designed in relevance to department theme.

Take-home messages: Medical students satisfaction increases with organizing frequent educational activities during the clerkships and we believe that it is our duty to find more time to satisfy our future colleagues.

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

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Mirror, mirror on the wall: quality for all

ID Doornbos (Huisartsopleiding Nederland, Departments for Specialty Training of General Practice, Mercatorlaan 1200, Utrecht 3528 BL, Netherlands)

Background: Medical education encourages reflection in trainee doctors in order to improve professional practice. Yet do these training programmes also hold a mirror up themselves to improve their own level of quality?

Summary of work: GEAR - a national quality assurance system for the eight departments for specialty training of general practice in the Netherlands - consists of a five year cycle with two rounds of assessment and improvement. The first round was started in September 2012 with a self-evaluation. The training programmes evaluated their own performance on a number of domains, such as testing & assessment and academic level. Each programme produced a reflective report concerning its own performance based on the self-evaluation. A two-day audit followed on from this for each programme.

Summary of results: Each programme received a report of the results from the audit. An overall report was also produced in addition to this with the results from all eight programmes revealing the state of affairs and focus points for the courses. The overall report also enabled benchmarking between the programmes allowing examples of good practice to be exchanged. The programmes drew-up improvement plans based on the reports with eighteen months to implement these before a new GEAR round commenced. Conclusions: The GEAR system holds up a mirror to general practitioner training programmes in the Netherlands to facilitate collaboration for quality improvements in programmes.

Take-home messages: Practice what you preach: Don't just focus on trainee doctors, hold up a mirror to training programmes as well.

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Geriatric education: Didactic teaching improves knowledge but clinical exposure improves attitudes

Gerald Koh (National University Health System, Saw Swee Hock School of Public Health, Singapore) Reshma Merchant (National University Health System, Department of Medicine, Singapore) Wee Shiong Lim (Tan Tock Seng Hospital, Department of Medicine, Singapore,)

Zubair Amin (National University Health System, Paediatrics, NUHS Tower Block; Level 12,1 E Kent Ridge Road, Singapore 119228, Singapore)

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