Автор неизвестен - Mededworld and amee 2013 conference connect - страница 5

Страницы:
1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60  61  62  63  64  65  66  67  68  69  70  71  72  73  74  75  76  77  78  79  80  81  82  83  84  85  86  87  88  89  90  91  92  93  94  95  96  97  98  99  100  101  102  103  104  105  106  107  108  109  110  111  112  113  114  115  116  117  118  119  120  121  122  123  124  125  126  127  128  129  130  131  132  133  134  135  136  137  138  139  140 

Continuous program of Community-based Education: Facilitating the continuity of health program

Tri Nur Kristina (Faculty of Medicine, Diponegoro University, Medical Educational Unit, Jl Dr. Sutomo 18 Semarang 50213, Indonesia)

Background: Most CBE programs are conducted in a single activity. We aimed to evaluate how continuous CBE program improve students' learning as well as the health of malnourished children under five. Summary of work: In collaboration with Community Health Centre (CHC), first group of students identified malnourished children under five, analysed factors influencing the disease and implemented health education to mothers. One month later, the second group of students visited the identified malnourished children, screened for tuberculosis, and evaluated mothers' compliance in feeding their children. Students' work was followed up by CHC. Qualitative data was used to collect data on students' activities, students' perceptions, and community perceptions. One year later, body weight and health status were measured as information of those children.

Summary of results: Continuous CBE program resulted in active community participation. Students perceived that their experiences were basically in accordance with community needs, and felt that the community also experienced the benefits of such continuous activities. One year later, however, only 67% of the identified malnourished children were cured. Those with tuberculosis, were only 69% cured.

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

Conclusions: Continuous CBE program is not only beneficial to improve students' learning, but also useful to facilitate the continuity of the health program in community settings.

Take-home messages: To increase the benefit for the community, the CBE program of each group can be adjusted in that particular phase, and the next groups of students can also be used to follow up.

2H/5

An analysis on the basis of Ege University School of Medicine's experience: How probable is community-based education under market-oriented reforms in university hospitals in Turkey?

Kevser Vatansever (Ege University Faculty of Medicine, Medical Education, Ege Universitesi Tip Fakultesi Tip Egitimi AD Dekanlik Binasi 2. Kat D Blok, Bornova, Izmir

35100, Turkey)

Halil Ibrahim Durak (Ege University Faculty of Medicine, Medical Education, Izmir, Turkey)

Background: Community-based-education necessitates close collaboration of health authorities and medical schools and needs to immerse students in key relationships of clinical, institutional, social, and personal axes, as proposed by Worley. Summary of work: Community-based-education activities of Ege University School of Medicine from 2000 to 2009 were analysed considering key relationships defined by Worley. Also functional relationship of health authorities and the school was assessed according to the taxonomy defined by Lewkonia. Between 2000 and 2009, students studied in community hospitals and primary care centers. Primary care centers were equipped by university as teaching sites, and various professional development activities were organized.

Summary of results: Community-based-education involved clinical, institutional and social axes. Clinical axis included early-patient-encounters in primary care and internship in community hospitals. Besides, faculty development and continuing professional development programs for primary care workers were organized. Institutional axis included practice-based-research-networks, and social axis involved health politics training within vertical community health corridor curriculum. On the basis of the taxonomy of functional relationships, mixed-method-design project on priority health problems was assessed as "contiguity" type relationship. Equipment of primary care centers by university corresponded to "interdependence". Conclusions: Considering this experience, recent legislations related to medical education were reviewed. Performance-based remuneration resulted in decreased interest of faculty staff to education. Privatization of primary care ended with abolishment of affiliation protocols. Recent legislation on affiliation increased the authority of General Insurance Institution and Ministry of Health over academic medicine, which could limit academic autonomy of medical schools.

Take-home messages: Health care reforms need to be carried out considering its influences on medical education.

2H/6

A novel approach to teaching in undergraduate paediatrics: making the most of experience

Jo Horsburgh (Imperial College, London, Educational

Development Unit, London, United Kingdom)

Sarah Worton (Imperial College, London, Educational

Development Unit, Level 5 Sherfield Building, Exhibition

Road, London SW7 2AZ, United Kingdom)

Martyn Kingsbury (Imperial College, London, Educational

Development Unit, London, United Kingdom)

Background: Pairs of year-2 medical students are attached to a pregnant woman and follow infant and family development with regular home visits throughout the remainder of their MBBS course. They are supported with regular small-group tutorials. This pilot study provides students with a longitudinal experience of factors impacting on a child's health and development. Summary of work: With support from programme organisers, data was collected from students' applications, a student evaluation survey and tutor feedback. Thematic analysis was performed by the authors who were external to the programme. Summary of results: Students' applications show good alignment of their expectations with those of organisers and tutors, although perhaps they overestimate their exposure to paediatrics as a specialty. Students' initial experiences were similar and overwhelmingly positive. Over 90% of students agree that the tutorials are useful, they are learning from the experience and the programme is what they expected. However, qualitative survey data suggests students are having diverse experiences, which need to be harnessed to maximise potential learning. An 'external' perspective aids integration and distribution of learning potential. Conclusions: 1.Tutors, organisers and participants should share common expectations to maximise learning. 2. Given the expected variability of experiences in a 'clinical' setting, an awareness of themes and patterns is important to effectively distribute learning across the cohort.

Take-home messages: Learning in a complex 'clinical' setting is likely to be opportunistic, unpredictable and disjointed. A mechanism for integrating and distributing ad hoc experiences maximises potential learning in this challenging but worthwhile context.

2I Short Communications: Assessment

Location: Club A, PCC 2I/1

Incorporating context factors in communication assessment

Geurt Essers (UMC St Radboud, Department of Primary & Community Care, Geert Groteplein 21, PO Box 9101, Nijmegen 6525 EP, Netherlands) Anneke Kramer (UMC St Radboud, Department of Primary & Community Care, Nijmegen, Netherlands) Chris van Weel (UMC St Radboud, Department of Primary & Community Care, Nijmegen, Netherlands) Cees van der Vleuten (Maastricht University, Department of Educational Development and Research, Maastricht, Netherlands)

Sandra van Dulmen (UMC St Radboud, Department of Primary & Community Care, Nijmegen, Netherlands)

Background: In competency-based specialty training, the assessment of communication performance usually focuses at rating generic communication skills. However, in daily practice, communication seems determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the GP (trainee) proficiency. So far, in communication assessment, context is only implicitly incorporated. Summary of work: We explored how assessment of GP and GP trainee communication performance changes if previously identified context factors are explicitly taken into account.

Summary of results: A scoring protocol was developed to incorporate context factors into performance assessment. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p=0.000); the effect size for the total mean score was large (0.84). In GP trainee scores, we found a significant difference in 5 out of 13 MAAS-Global items. The effect size was moderate (0.57). Conclusions: Contextual factors affect communication performance. Incorporating contextual factors in workplace-based assessment of communication has more influence on GP scores than on GP trainees. Context factors should be considered as 'signals' instead of 'noise' in communication assessment. Take-home messages: In assessing communication performance of GPs and GP trainees in daily practice, contextual factors are identifiable and should be taken into account by making explicit scoring rules. GP training needs to focus on a context-specific application of generic communication skills. Communication raters need to be taught how to incorporate context factors into their assessments.

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

2I/2

Generating communication and medical performance profiles for assessment of trainees during patient encounters

M Oerlemans (Maastricht University, General Practice, Vocational training, PO Box 616, Maastricht 6200 MD, Netherlands)

B Maiburg (Maastricht University, General Practice, Vocational Training, Maastricht, Netherlands) P Ram (Maastricht University, General Practice, Vocational Training, Maastricht, Netherlands) C van der Vleuten (Maastricht University, Medical Education, Maastricht, Netherlands)

Background: Assessing a sample of video observations can reveal repeating behavior in general practice (GP) trainees. Feedback on these patterns might be of great interest in enhancing learning. Providing a series of distinguishing profiles is an essential step to test this hypothesis.

Summary of work: From November 2012 till January 2013, semi-structured interviews regarding observed patterns in GP trainees, were performed with 18 GP trainers of the Department of Vocational Training at Maastricht University. The interviews are analyzed according to the constant comparative method in order to retrieve underlying themes that trainers used in describing observed patterns. Summary of results: Qualitative analysis of the interviews is performed at this moment. We expect to create a variety of profiles from the descriptions and retrieved themes. These profiles will be used to rank trainees on their communication and medical performance during patient encounters. Conclusions: As far as we know this is the first study that investigates behavioral patterns in depth. Results will be presented during the AMEE congress 2013. GP trainers distinguish a variety of behavioral patterns in their trainees. With these behavioral patterns we are able to construct profiles. Further research is needed to investigate whether feedback using profiles can enhance learning in trainees.

Take-home messages: Video observation provides the opportunity of giving feedback on behavioral patterns. This feedback might be of great interest in enhancing learning, as it is about authentic behavior, that is repeating.

2I/3

What factors impact on Mini-CEX assessor judgements in the postgraduate setting? A Systematic Literature Review

Victor Lee (Monash University, Clayton campus, HealthPEER, Wellington Road, Clayton Victoria 3800, Australia)

Background: WBAs are recognised as valid and reasonably reliable low-stakes assessments of performance in the workplace. Of these, the Mini-CEX is

the most validated and investigated assessment tool. However, the factors which impact on assessor judgements of workplace performance in the postgraduate setting has not been well researched. Summary of work: A systematic literature review forming part of a Masters in Health Professional Education by thesis work will be presented. The aim is to review the literature and investigate what factors impact on assessor judgements when performing Mini-CEX in postgraduate medical training. Summary of results: The literature review methodology will be described and the data extraction and quality assessment using BEME guide no. 11 will be presented. Using the PICO framework, the search strategy of 4 databases returned 1429 articles for review. 8 studies met the inclusion and exclusion criteria for the review question. 7 of the 8 studies were quantitative but it was the single qualitative study that best addressed the review question. The major factor contributing to score variation is assessor variability, usually measured as stringency. Other factors are case specificity and trainee variability. The effect of rater training remains uncertain. One proposed model suggests assessors use their own frames of reference and inferences to convert observations into numerical scores. There are also factors external to the observed performance. Conclusions: Currently little is known about the cognitive and contextual factors which impact on Mini-CEX assessor judgements in the postgraduate setting. Take-home messages: More research involving asking how assessors make their Mini-CEX judgements is required.

2I/4

Construct validity of a framework for assessing ultrasound skills - the Objective Structured Assessment of Ultrasound Skills

Martin G Tolsgaard (Copenhagen University Hospital Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark)

Eva Dreisler (Copenhagen University Hospital Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark)

Anne Loft (Copenhagen University Hospital Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark)

Charlotte Ringsted (Toronto University and the Wilson Centre, Dept. of Anesthesia, Toronto, Canada) Jette Led Sorensen (Copenhagen University Hospital Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark)

Ann Tabor (Copenhagen University Hospital Rigshospitalet, Juliane Marie Centre, Copenhagen, Denmark)

(Presenter: Aase Klemmensen, Copenhagen University Hospital Rigshospitalet, Juliane Marie Centre, Blegdamsvej 9, 2100 Copenhagen, Denmark)

Background: Ultrasonography has become increasingly used in many medical specialties. Although considered a safe procedure, it relies greatly on the skills of the

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

operator. Therefore, the ultrasound societies recommend 200-300 supervised scans before independent practice. However, this does not necessarily guarantee proficiency for all, while some may need fewer supervised scans to become proficient. Thus, there is a need for validated assessment instruments to enable proficiency-based training of ultrasound practitioners.

Summary of work: 5 novices, 5 intermediates, and 5 senior Obstetricians-Gynecologists managed one transvaginal ultrasound examination. All examinations were video-recorded to allow assessment by two independent blinded raters. Performances were rated using the Objective Structured Assessment of Ultrasound Skills (OSAUS), which was developed in a previous consensus study.

Summary of results: The novices, intermediates, and seniors scored a mean OSAUS-score on the transvaginal scans of 1.60 (SD 0.37), 3.08 (0.23), and 3.48 (0.64), respectively. An ANOVA showed significant differences between groups (P<0.001). A post-hoc analysis showed significant differences between the three groups with regards to items relating to applied knowledge of examination, image optimization, systematic examination, and documentation of examination. Only the item 'interpretation of exam' did not differ between intermediates and experts.

Conclusions: The OSAUS framework possess construct validity in terms of reflecting increasing levels of ultrasound skills and may be used for future in-training assessment purposes.

Take-home messages: Ultrasound training should include in-training assessment using validated instruments.

2I/5

Predictors of Physician Performance on Competence Assessment

Elizabeth S. Grace (CPEP, The Center for Personalized Education for Physicians, Executive Office, Denver, Colorado, United States)

Elizabeth F. Wenghofer (Laurentian University, School of Rural and Northern Health, Sudbury, Ontario, Canada) Elizabeth J. Korinek (CPEP, The Center for Personalized Education for Physicians, Executive Office, 7351 Lowry Blvd, #100, Denver, CO 80230, United States)

Background: Ensuring that physicians are practicing safely and effectively is a critical role of licensing agencies, hospitals and other credentialing entities. Competence assessment and remedial education programs play an important role in helping these organizations identify physicians who are not safe to be in independent practice and for whom remediation would be difficult.

Summary of work: We conducted a retrospective analysis of 683 physicians who completed a competence assessment. Factors predictive of an unsafe outcome were determined using multivariate logistic regression. Summary of results: Physicians were more likely to have an unsafe outcome if they were in solo practice

(p=0.023) or if they had previous board action (p=0.004). Physicians were more likely to have an unsafe outcome for each year of increasing age (p<0.001). Board certified individuals (OR=0.356, p=0.001) and physicians whose practice scope matched their training (OR=0.413, p=0.024) were less likely to have unsafe outcomes. Conclusions: Results suggest there are important predictors of physician performance on a competence assessment that include personal characteristics, practice context, and reasons for referral. The results have implications for policies and programs designed to assess risk of poor physician performance and to improve practice through organizational design or remedial education.

Take-home messages: Risk factors for unsafe practice included solo practice, practicing outside of the scope of one's training, lack of board-certification, and increasing age. Physician performance appears to be the product of a complex interplay of physician-specific and external/contextual factors, and therefore should be evaluated in a broader environmental context.

2I/6

Poor performance on the MRCP(UK) examination predicts license limitations in subsequent medical practice

Katarzyna Ludka-Stempien (University College London, Medical School, Academic Centre for Medical Education, Whittington Campus, 2-10 Highgate Hill, London N19 5LW, United Kingdom)

Katherine Woolf (University College London, Medical School, Academic Centre for Medical Education, London, United Kingdom)

I. Chris McManus (University College London, Medical School and Psychology and Applied Linguistics Department, London, United Kingdom)

Background: Doctors wanting to enter physician training in the UK must first pass the examination for the Membership of the Royal College of Physicians [MRCP(UK)]. MRCP(UK) consists of two written parts and a clinical part (PACES). Although there is an extensive literature on the psychometric quality of MRCP(UK), its predictive validity has hardly been researched. The current study examined whether doctors' MRCP(UK) performance predicted their subsequent UK license registration status.

Summary of work: The General Medical Council keeps a register of all doctors licensed to practise medicine in the UK, including doctors who have had a serious performance issue resulting in license limitation ("license issue"). Register datasets were obtained for a 50 month period (2008 to 2012). These were merged with 50,311 candidates' MRCP(UK) results, providing 33,359 matched records and identifying 330 doctors with a license issue. Logistic regression and comparison of means were used to analyse the data. Summary of results: The mean score on each MRCP(UK) part was lower for those with license issues than those without licence issues (p<0.001). Logistic regression results indicated that lower PACES scores [odds

ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015

ratio=0.96 ± 0.04 CI], male gender [odds ratio= 0.29 ± 0.19 CI], and older age [odds ratio=1.06 ±0.03 CI] were independent predictors of experiencing license issues. Conclusions: Our finding that doctors who performed more poorly on PACES were more likely to experience license issues supports the validity of MRCP(UK). Take-home messages: High-stakes clinical examination results can be useful in predicting clinical performance in practice.

2I/7

Walking the Talk: faculty & educational systems development for improving assessment practices in residency education

Susan Glover Takahashi (University of Toronto,

Postgraduate Medical Education, 500 University Avenue,

Suite 602, Toronto M5G1V5, Canada)

Glen Bandiera (University of Toronto, Postgraduate

Medical Education, Toronto, Canada)

Marla Nayer (University of Toronto, Postgraduate

Medical Education, Toronto, Canada)

Khushnoor Adatia (University of Toronto, Postgraduate

Medical Education, Toronto, Canada)

Caroline Abrahams (University of Toronto, Postgraduate

Medical Education, Toronto, Canada)

Background: In-training evaluation reports (ITERs) are the foundation of workplace assessment of residents. While there has been some adoption of "minimum standards" more than 70 University of Toronto residency program directors (PDs) design ITERs unique to their programs, creating confusion for users and difficulty in studying trends across programs. There is strong educational rationale for introducing best practices for ITER design.

Summary of work: Key steps included: literature review, guideline development, consultation with stakeholders; approval by relevant committees; formal PD coaching, structured ITER review/approval; guideline refinement; and tracking progress and outcomes. Summary of results: PDs needed the most support with: decreasing the excessive number of ratings, linking goals to objectives; developing descriptors for ratings, and mapping of rotations and assessments. Guidelines applied to 'new' ITERs, but many PDs also revised existing ITERs consistent with the guidelines. In the first 6 months, 105 ITERs from 27 programs were reviewed. Length varied from 30 -97 ratings per ITER. After review, most ITERs had less than 20 ratings but more than the guideline target of 12.

Conclusions: All new ITERs are linked to rotation goals and objectives so that different Medical Expert competencies and one or two other intrinsic CanMEDS roles are emphasized, a result of curriculum mapping. Take-home messages: ITERs are more explicitly aligned to goals and objectives and, although much shorter, are still longer than ideal. Consensus around guidelines was important but not sufficient to ensure change. Considerable 'just in time' coaching and support from PGME educational consultants was needed. Further efforts to shorten ITERs will be informed by statistical

analysis of updated ITERs after one year, and from faculty and resident feedback.

2J Short Communications:

Professionalism 1 Location: Club E, PCC

2J/1

Making short film vignettes to teach medical ethics

Carolyn Johnston (King's College London School of Medicine, Division of Medical Education, 4.18 Shepherd's House, Guy's Campus, London SE1 9RT, United Kingdom)

Background: Two minute film clips were commissioned which have been successfully used in OSCE stations to assess the ethical reasoning of year 2 medical students. Building on from this experience medical students are now working with Faculty to create short film vignettes to be used in small group teaching sessions for medical ethics.

Страницы:
1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31  32  33  34  35  36  37  38  39  40  41  42  43  44  45  46  47  48  49  50  51  52  53  54  55  56  57  58  59  60  61  62  63  64  65  66  67  68  69  70  71  72  73  74  75  76  77  78  79  80  81  82  83  84  85  86  87  88  89  90  91  92  93  94  95  96  97  98  99  100  101  102  103  104  105  106  107  108  109  110  111  112  113  114  115  116  117  118  119  120  121  122  123  124  125  126  127  128  129  130  131  132  133  134  135  136  137  138  139  140 


Похожие статьи

Автор неизвестен - 13 самых важных уроков библии

Автор неизвестен - Беседы на книгу бытие

Автор неизвестен - Беседы на шестоднев

Автор неизвестен - Богословие

Автор неизвестен - Божественность христа