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1Eva KW. Dialogue in Medical Education: Enabling the academic voyeur that lurks inside us all. Med Educ 2012;46:826-7.
5B Symposium: Integrated Cases: Promises, pitfalls, and progress in the development of a "new" simulation format to assess hard-to-measure competencies
Location: Meeting Hall I, PCC
David B Swanson (National Board of Medical Examiners, USA)
Kathleen Z Holtzman (National Board of Medical Examiners, USA)
Michael Wilkes (University of California at Davis, USA)
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
Integrated Cases (ICs) are designed to assess aspects of professionalism and communication, in addition to patient care skills. As ICs unfold, examinees face challenges embedded in real-world clinical tasks in which they naturally arise, with video used to portray clinical context and patient findings more authentically. Dave Swanson begins with a brief history of the IC approach in relation to research on patient management problems and key features work. Kathy Holtzman demonstrates ICs and associated stimulus/response formats. Michael Wilkes illustrates how video is used to broaden the competencies assessed. Last, Dave Swanson reviews results of two pilots of IC formats.
5C BEME Think Tank: The BEME Collaboration: Moving from recent challenges to opportunities for greater impact on educational practice
Location: Panorama, PCC
Dale Dauphinee (McGill University, Canada) (Chair) John Norcini (USA) Geoffrey Norman (Canada) Liz Anderson (UK) Marilyn Hammick (UK)
BEME has entered its second decade of existence and BEME reviews are increasing in number. In Vienna in 2011, the nature and impact of evidence in health sciences education was reviewed and discussed and it was concluded that evidence has many meanings depending on its use and the social and educational contexts. At the initial BEME Congress in Lyon in 2012, it was noted that specific lessons from the first decade of BEME were becoming evident. Furthermore, a consensus was reached that while both better technical and methodological improvements were needed, a careful relook at BEME's vision and mission would be in BEME's strategic interests. An international panel, representing BEME users, editors, researchers and policy makers, was appointed to report back at the 2013 BEME Congress. This session will highlight issues for discussion emphasizing the next continuous quality improvement steps for the collaboration and proposing new strategic activities for BEME.
5D AMEE Fringe 1
Location: Meeting Hall IV, PCC 5D/1
How not to 'flop' a 'flipped classroom'
Anne Minenko (University of Minnesota, Medicine, MMC108 (A 652 Mayo Building), 420 Delaware Street SE, Minneapolis 55455, United States)
Me: US medical schools are both inspired and
challenged by accreditation requirements of integration,
active learning, independent study, and clinical
You (exasperated): Don't remind me.
Me: 'Classroom Flipping' is a clever way of meeting all
You: Look, I'm already turned upside down!
Me: ...and to keep you upright, this session will show
you how the 'Flipped Classroom' approach is as simple
as the idea and as amusing as the name.
You: (sarcastically) Simple you say? Now that's funny!
Me: For instance, independent study of video-captured
lectures frees up class space.
You: How is teaching to an empty class clever?!!
Where's the higher order learning?!!
Me: It's designed into the paired pre-class online
activity / large-class interactivity. Frameworks (e.g.
Perry's Scheme, Bloom's Taxonomy, Motivational
Theory, etc.) can guide the design of a 'Flipped
Classroom' to promote student engagement and critical
You: I get it! AND I'll stop bothering staff to find nonexistent seminar rooms.
Me: Right! And we'll keep patients happy, by not having to recruit physician-instructors away from clinics to facilitate small group seminars. You: Speaking of practicing physicians, I'm no framework aficionado.
Me: The session will be empowering, enabling, memorable and fun. You'll learn 7 words that rhyme with 'flip' and 7 that rhyme with 'flop', to help you remember key framework elements and avoid pitfalls. You: 7 + 7 words, from Cognitive Load Theory, to help do a 'Classroom Flip' and avoid a 'Classroom Flop'!
Me: .without the gym attire :).
Naked before the class: exposing the essential anatomy of directors of brand new medical school courses
Kenneth Locke (University of Toronto, Undergraduate Medical Education and Medicine, 457-600 University Avenue, Toronto, ON M5G1X5, Canada)
Creating a new paradigm of learning in an established medical school curriculum is a challenging endeavour. While instructional design, curriculum mapping and needs assessment have been well described in the
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
education literature, very little attention has been focused on the personal experiences of the people leading the development and implementation of new courses, particularly when those courses look and feel different to students. Yet anyone introducing a fledgling course to skeptical students realizes that their own personal qualities are soon tested. The experience of putting one's face and name to something new, and surviving the ups and downs of the first course cycle, can leave faculty members exposed and vulnerable. This presentation is based upon the experiences of the author and colleagues, working in a traditional curriculum, in developing courses based on new learning paradigms. Students at this institution were introduced to teamwork and management theory, simulated resource allocation, reflection on personal experiences, and an expanded emphasis on the determinants of health, alongside the standard biomedical curriculum. The course directors involved in the initial cycles found themselves "sticking their necks out" to make the new courses work. Further investigation has found many other anatomical correlations, all essential to undertaking this task.
This presentation uses a multimedia format to expose the anatomy of a director of a new medical school course. The audience will be led through this anatomy lesson, and encouraged to examine themselves for the same qualities (but later, in private, with the blinds drawn). Safe for family viewing.
Medical Careers - a game for everyone
David Topps (University of Calgary, Family Medicine, 2808 11 Ave NW, Calgary T2N1H9, Canada) Maureen Topps (University of Calgary, Family Medicine, Calgary, Canada)
Medical Professionals face an abnormal number of stressors in their careers. Medical students occasionally hear some of the effects of these stressors but receive little guidance on career choices and how to handle these stressors. Physicians have a higher than usual prevalence of process addictions and substance addictions - we self-drive to be high achievers and workaholics, thereby producing a number of unhealthy by-practices.
Based on some work with the Norlien Foundation on Early Brain & Biological Development in Addictions, we created a version of the classic board game, Careers, using the OpenLabyrinth virtual patient platform. This game, Medical Careers, can be played online using any web browser and is open for public use. For this Fringe presentation, we will adapt the game for a highly interactive, rapid-fire team-based competition, featuring live role-play action. This will highlight some of the features of the online version, showing teachers how they might incorporate the game into their own teaching settings. The live action will demonstrate in a fun and entertaining manner some of the faults and misbehaviours that physicians get up to.
A Crossword About Curricular Crossroads
Cristian Stefan (Georgia Regents University, Medical College of Georgia, 1120 15th Street, CB-1101, Augusta 30912, United States)
Robert Hage (St. George's University, School of Medicine, Grenada)
The proposed horizontal and vertical integration has been an important goal in curricular planning and an intended engine to support educational change and transformation. Let's pause for a second. Are we truly doing this personally or just because the curriculum is mandating it? Are the delivery of and testing on factual information appropriately balanced by the application of knowledge to various situations and emphasis on critical thinking? Do we encourage communication with others, real partnership and open exchange of ideas in the process or do we tend to protect our own field of interest while agreeing to change everything else? And how much remains to be changed in this case? This session is interactive. It's challenging. It's realistic. And it's fun. Why? Because it is about distilling the root cause analysis of the difference between talking the talk and walking the walk into reflection and teaching moments. And the audience is part of it. Let's talk and walk together (horizontally and vertically) through a crossword in which the words integration, collaboration, efficient and effective may... or may not look in reality what they mean on paper. We will explore together new ways to define their significance, how to face barriers, and, most of all, how to ignite, maintain or reignite the inner quest to embrace and promote a meaningful educational transformation.
The case of Dr. Alecto: clinical educator, misogynist
Hudson Birden (University Centre for Rural Health, North Coast, Medical Education, PO Box 3074, Lismore, NSW 2480, Australia)
Presenting for the enlightenment and infuriation of the audience the case of Dr. Alecto, an experienced clinical educator, in which the doctor's views will be aired, the appropriate response discussed, and the proper place of Strontium established.
"I think [professionalism] ...has not only displaced important subjects from the curriculum, but is actually doing harm. ...I think it is just worthy of nothing other than contempt. It's part of a bigger picture, I think, that has eroded medical education, and that is that basic sciences are being sacrificed to make room for this rubbish. ... How do you create a framework, a lattice, of knowledge and understanding of a huge area by just taking a chunk here, a chunk there, and the kids have got no idea of what the structure is in between these chunks."
"The whole business of problem-based learning and the emphasis on the touchy-feely crap, I no longer can
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
separate them because I think [what] they have buried within them...is that the feminisation of medical education is anti-scientific."
"Boys are going to be interested in the sciences and the maths and the girls are not. ...having shifted the whole axis of medical education along feminised lines, the bit that suffers is the scientific element of it... the fact is that there are going to be graduating huge numbers of female graduates who will just play Mickey Mouse with the profession throughout their lives, and never really achieve anything and never really put any hard yards
5E Research Papers: General Practice/Family Medicine and Faculty
Location: Meeting Hall V, PCC
The Influence of Academic Discourses on Medical Students' Interest in Family Medicine as a Career Choice: An International Comparative Case Study
Charo Rodriguez (McGill University, Family Medicine, Montreal, Canada)
(Presenter: Teresa Pawlikowska, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, United Kingdom)
Introduction: Despite important differences in terms of medical curricula, health care delivery systems, and sociocultural features, current evidence highlights a widespread trend towards medical specialization in developed countries (1). Scholars have explored different factors to explain medical students' declining interest in family medicine (or general practice) as a career choice, such as a significant gap between specialty and family medicine incomes. However, the influence of institutional discourses on the construction of the professional identity of family physicians in academic centers during undergraduate medical training had not been investigated so far. The questions that guided the present investigation were thus the following: 1. what do medical students and their educators think about the discipline of family medicine? 2. In what ways do these academic discourses influence medical students' career choice? Methods: An interpretive case study research design was adopted (2), and four cases (i.e. medical schools) were involved in the study. They were located in four different countries, i.e. Canada, France, Spain, and the United Kingdom, as we decided to compare the results from different countries to further our understanding of emergent issues. Data sources included 18 focus groups with medical students, 67 individual semi-structured interviews with Faculty educators, and supporting documents. Thematic analysis was applied to interviews transcripts. Within- and cross-case analyses were performed.
Results: The most striking finding was the clear polarization existing between the medical school where family medicine was a fully-recognized academic discipline to which students were exposed from the very beginning of their studies, and the other medical schools where students had little or no exposure to this practice, and where family medicine was disregarded as a valid career option. In the former, the prestige of the profession was relatively high, and the features of this professional practice as well as the knowledge and skills necessary to perform as a general practitioner, although contentious in hospital settings, appear to be held in high esteem by both students and Faculty educators. It was the opposite in the other three medical schools, where family medicine was devalued, either overtly or
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
through a double academic discourse that stressed the importance of the practice for the health care system while demeaning family medicine because of its lack of a hard technical medical skill set.
Discussion and Conclusion: From our comparative case study analysis follows that where (a) medical students are exposed early and intensively to the practice of family medicine and to family physicians who are good role models, (b) family medicine is a fully recognized medical academic discipline, and (c) graduates practice in a health care system supportive of the discipline (e.g. good remuneration, easier professional/personal life balance), family medicine exhibits a better reputation. Students can therefore more easily identify with this professional practice during their medical training, which increases the proportion of students that choose general practice as a career pathway. Our work emphasizes the critical influence that academic discourse has on facilitating or preventing medical students' identification with family medicine practice. Explicit consideration of professional identity formation in medical students' training appears an imperative. References: 1. Organization for Economic Co-operation and Development. Health at a Glance 2009 - OECD Indicators.
(http://www.oecd.org/health/healthatglance). Accessed February 4, 2010.
Stake RE. The Art of Case Study Research. Thousand Oaks, CA: Sage; 1995.
Applying the Trigger Review Method after a brief educational intervention: Potential for teaching and improving safety in GP specialty training?
John McKay (NES, General Practice, Glasgow, United Kingdom)
Carl de Wet (NHS Education for Scotland, General Practice, 89 Hydepark Street, Glasgow G3 8BW, United Kingdom)
Moya Kelly (NES, General Practice, Glasgow, United Kingdom)
Paul Bowie (NES, General Practice, Glasgow, United Kingdom)
Introduction: The Trigger Review Method (TRM) is a structured approach to screening clinical records for undetected patient safety incidents (PSIs) and identifying learning and improvement opportunities. In Scotland, TRM participation can inform GP appraisal and is financially incentivized by some health authorities. TRM will be part of a forthcoming national primary care patient safety programme but the clinical workforce needs up-skilled. Additionally, the potential of TRM in GP training has yet to be tested. Current TRM training utilizes a workplace face-to-face session by a GP expert, which is not feasible. A less costly, more sustainable educational intervention is necessary to build capability at scale. We aimed to determine the feasibility and impact of TRM and a related training intervention in GP training.
Methods: We recruited 25 west of Scotland GP trainees to attend a 2-hour TRM workshop. Trainees then applied TRM to 25 clinical records and returned findings within 4-weeks. A follow-up feedback workshop was
Results: 21/25 trainees (84%) completed the task. 520 records yielded 80 undetected PSIs (15.4%). 36/80 were judged potentially preventable (45%) with 35/80 classified as causing moderate to severe harm (44%). Trainees described a range of potential learning and improvement plans. Training was positively received and appeared to be successful given these findings. TRM was valued as a safety improvement tool by most participants.
Discussion and Conclusion: This small study provides further evidence of TRM utility and how to teach it pragmatically. TRM is of potential value in GP patient safety curriculum delivery and preparing trainees for future safety improvement expectations. References: 1 De Wet C, Bowie P. Screening electronic patient records to detect preventable harm: a trigger tool for primary care. Quality in Primary Care
2 De Wet C, Bowie P: A preliminary study to develop and test a global trigger tool to identify undetected error and patient harm in primary care records. Postgrad Med J
Bowie P, Halley L, Gillies J, Houston N, de Wet C. Searching primary care records for predefined triggers may expose latent risks and adverse events. Clinical Risk
4 Royal College of General Practitioners. RCGP Curriculum 2010, Statement 2.02 The contextual statement on Patient Safety and Quality of Care.
London: RCGP; 2012:1-20.
5 McKay J, Bowie P, Murray L, Lough M. Levels of agreement on the grading, analysis and reporting of significant events by general practitioners: a cross-sectional study. Quality & Safety in Health Care 2008
The Caring Doctor in Canadian Postgraduate Family Medicine: A Critical Discourse Analysis
Cynthia Whitehead (University of Toronto Faculty of Medicine, Family and Community Medicine, 500 University Ave, 5th Floor, Toronto M5G 1V7, Canada) Ayelet Kuper (University of Toronto, Medicine, Toronto, Canada)
Batya Grundland (University of Toronto Faculty of Medicine, Family and Community Medicine, Toronto, Canada)
Risa Freeman (University of Toronto Faculty of Medicine, Family and Community Medicine, Toronto, Canada)
Introduction: It is a widely held understanding that optimal healthcare involves compassionate care as well as biomedical knowledge and technical skills. However, the provision of compassionate care requires more than innate good nature or good intentions. A medical curriculum crammed with biomedical content does not
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
prepare learners to bring generosity of spirit into complex practice settings (Witz 1990). Professional power relations play out within rigid hospital structures limiting the flexibility needed for creative, person-focused care. Simply being kind-hearted will not surmount the educational and institutional factors that comprise the hidden curriculum (Hafferty 1998). To improve educational programs and inculcate values and practices of caring we must understand the discourses of the caring doctor in the documents and standards that frame our teaching programs. Canadian family medicine has recently adopted CanMEDS as its competency framework and revised its accreditation standards to reflect this change. Analysis of Canadian family medicine therefore has relevance for other countries and curricula. Our research question was: what are the discourses of the caring doctor in family medicine residency training in Canada? Methods: Using Foucauldian methodology, we conducted a critical discourse analysis (Foucault 1999) of the caring doctor in postgraduate family medicine training in Canada. Our primary textual archive included current College of Family Physicians of Canada accreditation standards and curricular documents, Association of Faculties of Medicine reports and documents, and key international medical education reports. Secondary texts included relevant documents from a literature search of compassionate care in medical education texts in the past 10 years. Documents were analysed to identify statements and metaphors that form current discourses of the caring doctor and to describe their discursive effects on specific practices, power relations and institutions. Results: Discourses of the caring doctor were not prominent in the formal documents and reports that frame Canadian postgraduate family medicine training. They were also limited in the education literature. Role modelling was identified as a one of the best ways to teach and inculcate values of caring, however literature to support this assertion was surprisingly sparse. Aspects of compassionate care were embedded in statements about professionalism, patient-centred care, and the doctor-patient relationship, however discursive framing of these focused more on clinical efficacy and maintaining boundaries than compassion. Discussion and Conclusion: Absence of phenomena can provide important insights. We realized as we engaged in our data analysis that we had to probe more deeply into proxies for compassionate care than we had initially anticipated. If we consider the practice of compassionate care to be important, we need to pay attention to the formal descriptions of our training programs and accreditation standards. Medical educators must consider whether the language we use reflects the educational values we wish to promote. References: (1) Witz A. Professions and patriarchy: the gendered politics of occupational closure. Sociology.
(2) Hafferty FW. Beyond curriculum reform: Confronting medicine's hidden curriculum. Acad Med. 1998
(3) Foucault, M. (1999). Aesthetics, Method, and Epistemology (R Hurley and others, Trans.). New York: The New York Press.
From feedback to action: explaining how faculty act upon residents' feedback to improve their teaching performance
Renee van der Leeuw (AMC Amsterdam, Professional Performance Research group, Center for Evidence-Based Education, Meibergdreef 9, Amsterdam 1100DE, Netherlands)
Irene Slootweg (Maastricht University/AMC Amsterdam, Professional Performance Research group, Center for Evidence-Based Education, Amsterdam, Netherlands) Maas Jan Heineman (AMC Amsterdam, Professional Performance Research group, Center for Evidence-Based Education, Amsterdam, Netherlands) Kiki Lombarts (AMC Amsterdam, Professional Performance Research group, Center for Evidence-Based Education, Amsterdam, Netherlands)
Introduction: The goal of residency training is to provide training while ensuring patient safety. This requires excellent performance from teaching faculty. Multiple feedback systems are being used to support faculty to remain or become high-quality teachers. However, there is a lack of knowledge on how faculty react to and act upon feedback received from residents. This multi-specialty, multi-institutional interview study was conducted to (i) gain insight into how teaching faculty proceed after they have received residents' feedback on their teaching performance and (ii) what influences their progression.
Methods: Between August 2011 and December 2011 twenty-four faculty who had received formative feedback on their teaching performance through a valid and reliable evaluation system (SETQ system [1-4]) participated in this study. They reflected upon their (re)action(s) during individual semi-structured interviews. The interview protocol and analysis were guided by Prochaska's comprehensive trans-theoretical framework describing and explaining stages and processes of behavioural change . Results: Faculty involved in residency training used residents' feedback to different extents to adapt or improve their teaching performance. Important tipping points in the processes of change for faculty to put feedback into practice were: experiencing negative emotions for themselves or residents from not acting upon the feedback, realising that something should be done with or without support from others, and making a strong commitment to change. In addition, self-confidence to act upon feedback and recognizing benefits of change were found to stimulate faculty to change their teaching behaviour. Discussion and Conclusion: New knowledge is now available on the various ways faculty continue after they receive residents' feedback. This study provides insight in the stages and processes of change faculty proceed through. Since faculty use feedback to improve their