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Take-home messages: "Humanities is not a stranger at the gate, but just a long-lost friend" (H. M. Evans) and "Cure sometimes, treat often, comfort always (Hippocrates).
Integrated approach for teaching Humanities in undergraduate medical curriculum
Ksenia A Mitrofanova (Ural State Medical Academy, Department of Foreign Languages, Gagarina str. 47-27, Repina str. 3, Yekaterinburg 620078, Russia) Elena A Penkova (Ural State Medical Academy, Department of Foreign Languages, Yekaterinburg, Russia)
Background: The role of the Humanities in medical education is crucial as they assert humanistic values in medicine. The integrated approach to teach the Humanities may allow the development of appropriate ethical humanist skills, critical thinking and professionalism.
Summary of work: The attempts of integration of courses related to the Humanities (Medical English, Latin and Intercultural Communication in Medicine) were made in the Ural State Medical Academy. These subjects are traditionally taught during the first year of study. We rearranged the structure of courses to introduce and discuss the corresponding topics in a parallel way to enhance comprehension of the material. Fourteen first-year students were involved in the pilot study conducted during September-October 2012. Their participation was voluntary. We interviewed students to get their feedback on the integrated courses in the Humanities. Summary of results: All students found the integration of courses helpful. The majority (n=12) of students noticed that it made them reflect on such issues as humanism, tolerance and empathy in medicine even outside the classroom. All students also enthusiastically accepted discussions as a form of controlling task, as it gave them an opportunity to "feel more involved" in the educational process compared to "the feeling of isolation" when passing examinations and getting credits in conventional way. Conclusions: The integrated approach to teach the Humanities in medical schools may be effective in providing vast amounts of information in a comprehensive manner. Currently the need for integration is obvious both for students and lecturers. Take-home messages: The integrated approach in medical education helps to avoid fragmented manner of teaching.
5I Short Communications: Clinical Skills
Location: Club A, PCC
Introduction of Undergraduate Medical Student Clinical Skills Logbook
Adela Brigic (Department of Undergraduate Medical Education, Northwick West London Hospitals Trust, Watford Road, Harrow HA1 3UJ, United Kingdom) Aaron Southgate (Northwick West London Hospitals Trust, Department of Undergraduate Medical Education, Harrow, United Kingdom)
Kinesh Patel (Northwick West London Hospitals Trust, Department of Undergraduate Medical Education, Harrow, United Kingdom)
Neil Pattani (Northwick West London Hospitals Trust, Department of Undergraduate Medical Education, Harrow, United Kingdom)
Josephine Wright (Northwick West London Hospitals Trust, Department of Undergraduate Medical Education, Harrow, United Kingdom)
Joan Pitlin (Northwick West London Hospitals Trust, Department of Undergraduate Medical Education, Harrow, United Kingdom)
Background: Medical students need to be aware of their responsibility to maintain clinical skills throughout their careers and collate evidence in portfolios. We recently introduced 'DOPS' assessment with positive student feedback. In this study, we aimed to evaluate the introduction of a compulsory logbook and 'real-patient' learning experiences.
Summary of work: 52 third-year students were provided with a logbook for documentation of supervised venepuncture and cannulation 'real-patient' procedures, performed or attempted during an 8-week clinical attachment. All students attended weekly clinical skills teaching sessions. Students completed post-attachment feedback questionnaires; responses were assessed using a 6-point Likert scale and are presented as [median, (IQR)].
Summary of results: All students agreed that they should be competent and confident to perform venepuncture and cannulation on patients by the end of year 3 [6, (5, 6)]. Most students found skills-lab sessions useful prior to performing procedures on live patients [4, (2, 5)]. Students performed approximately 30% more procedures following logbook introduction and most agreed that the procedural logbook should be introduced into their curriculum [4, (2, 5)]. Conclusions: Students are keen to embrace concepts of continuing professional development. Venepuncture and cannulation are key curriculum skills and student experience requires on-going monitoring and evaluation.
Take-home messages: Introduction of a logbook appears to have a positive effect on the number of procedures performed during clinical attachment and encourages students to seek learning opportunities during busy clinical attachments.
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
When thoughts become actions: The detrimental effects of negative social-comparative feedback in medical trainees learning suturing techniques
Kinga L. Eliasz (McMaster University; University of Toronto; The Hospital for Sick Children, Kinesiology; The Wilson Centre; The Learning and Research Institutes, 1280 Main Street West; 200 Elizabeth Street, Department of Kinesiology 219C; 1st floor Eaton South Room 559, Hamilton; Toronto L8S 4K1; M5G 2C4, Canada)
Adam Dubrowski (University of Toronto; The Hospital for Sick Children, The Wilson Centre and Department of Paediatrics; The Learning and Research Institutes, Toronto, Canada)
Aaron D.C. Knox (University of Toronto; University of British Columbia; The Hospital for Sick Children, The Wilson Centre; Division of Plastic & Reconstructive Surgery; The Learning and Research Institutes , Toronto, Canada)
Faizal A. Haji (University of Toronto; University of Western Ontario; The Hospital for Sick Children, The Wilson Centre; Division of Neurosurgery; The Learning and Research Institutes , Toronto) David Rojas (The Hospital for Sick Children, The Learning and Research Institutes, Toronto, Canada) James Lyons (McMaster University, Kinesiology, Hamilton, Canada)
Background: Social-comparative feedback has been shown to influence learner self-efficacy beliefs and motor skill acquisition. This feedback is provided to make the learner believe that he/she is performing better or worse than the group average, regardless of his/her actual performance. Our objective was to examine the role of social-comparative feedback in medical trainees learning basic suturing techniques. Summary of work: Novices (n=30) observed and practiced the simple interrupted suturing technique. Following this, trainees were divided into groups and shown fabricated performance summaries indicating that they were performing better or worse than their peers, regardless of their actual performance. Trainees were then asked to perform the horizontal mattress technique and following practice, again received positive or negative feedback consistent with their initial group assignment. A retention test was performed ~48hours later to infer learning of the horizontal mattress technique. Subjective variables of interest included self-reported situational motivation, self-esteem, and self-efficacy. Objective measures included expert assessment of video data, total skill completion time, and number of hand movements.
Summary of results: There were no group differences at baseline for self-reported outcome measures and on the pre-feedback manipulation task (simple interrupted suture). Those receiving negative feedback reported lower self-efficacy during acquisition and retention testing (horizontal mattress) compared to those receiving positive feedback (p=0.004), and required
significantly more time (p=0.031) and hand movements (p=0.046) to complete the task. Conclusions: Our findings suggest that there is a significant relationship between negative social-comparative feedback and mindset that modifies performance, learning, and self-efficacy beliefs in medical trainees acquiring basic procedural skills. Take-home messages: Providing social-comparative feedback can impact a trainee's psychological well-being and performance while learning basic suturing techniques.
Technical skills podcasts are acceptable and useful to undergraduate students as an adjunct to simulation-based clinical skills teaching
Alna J P Robb (University of Glasgow, Undergraduate Medical School, Glasgow, United Kingdom) Angela Jaap (University of Glasgow, School of Education, Glasgow, United Kingdom)
Hannah C Muir (University of Glasgow, Undergraduate Medical School, Glasgow, United Kingdom) Brian J Stewart (University of Glasgow, Academic Unit of Surgery, Level 3, McGregor Building, Western Infirmary, Glasgow G11 6NT, United Kingdom)
Background: We believe that Podcasts have significant potential in the teaching of procedural skills within the undergraduate medical curriculum. We embarked on a programme of podcast development focussing on common procedural skills required of the new medical graduate with the intention of creating high quality, gold-standard, reusable learning resources embracing the key podcasting features of portability and usability. Summary of work: 12 technical skills podcasts were developed based on skills listed in Appendix 1 of Tomorrows Doctors 3. An evaluation was carried out with medical and nursing students participating in clinical skills sessions within the clinical skills centre. Summary of results: Evaluations were returned from 460 medical students and 160 nursing students. 90% felt that using podcasts would make them feel more confident performing procedural skills in the clinical setting. All students would use the podcasts before, during and after clinical skills teaching sessions and would incorporate podcasts into their exam revision. 61% of students feel that access to learning resources while mobile is important to them and 80% would download these podcasts onto portable devices instead of streaming them online.
Conclusions: The use of podcasts within the clinical skills curriculum is acceptable to undergraduate students and students embrace the key features of portability and usability.
Take-home messages: Podcasting is an effective educational method to maximise the use of the student's time within the clinical skills lab.
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
Videopodcasts in a "blended learning" approach to medical skills training
Cita N0rgard (University of Southern Denmark, Faculty of Health, J.B. Winsl0ws Vej 19, Odense C 5000, Denmark)
Ole Graumann (University of Southern Denmark, Faculty of Health, Odense C, Denmark)
Peter Bollen (University of Southern Denmark, Faculty of Health, Odense C, Denmark)
Henrik Hein Lauridsen (University of Southern Denmark, Faculty of Health, Odense C, Denmark)
Background: This study aims to challenge the traditional tutor based teaching of practical skills in the Clinical Skills Centre and other experimental settings. The concept of learning was changed to "blended" as the teachers constructed an online task as preparation for the practical lessons. The online lessons consisted of a combination of videopodcasts and e-tests. Summary of work: The project included designing production standards for "practical skills videopodcasts -setup and content", rethinking curriculum, implementation of the videos, and understanding the teacher's role. The evaluation included student questionnaires and the teacher evaluations. Summary of results: Students generally evaluated that the use of videos enhanced their performance and the learning outcomes. Teachers tell that the face-to-face lessons became more efficient due to the new standards for student preparation. The results also show that podcasts interact positively with the students' Personal Learning Environment (PLE) and give us a hint on how students manage their learning process using the videopodcasts both for preparation and for additional purposes as well. Students underlined the importance of the validity of the videopodcasts we produce ourselves in contrast to what they can browse on the internet. Conclusions: Students seem to perform better and have more time to practice the clinical skills in class when preparation includes videopodcasts. The students willingly use the instructional videos in their self-organized studies after the tutorial sessions. Take-home messages: The use of videopodcasts in blended learning around clinical skills training is considered to be of great importance among students and teachers.
Lay-Person Facilitated Intimate Examination Training: a Systematic Review
Aaron Braddy (Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Centre of Medical Education, Institute of Health Sciences Education, London, United Kingdom) James MN Duffy (Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Women's Health Research Unit, Blizard Institute, London, United Kingdom)
Samuel K Chequer (Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Centre of Medical Education, Institute of Health Sciences Education, London, United Kingdom) Sophie KH Mylan (Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Women's Health Research Unit, Blizard Institute, London, United Kingdom)
Khalid S Khan (Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Women's Health Research Unit, Blizard Institute, London, United Kingdom)
Annie M Cushing (Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Centre of Medical Education, Institute of Health Sciences Education, London, United Kingdom)
Background: Intimate examinations play a key role in the diagnosis of disease and are a required competence for healthcare professionals. Intimate examination training emphasises the importance of the required combination of technical, interpersonal and communication skills. Current methods to deliver training include video demonstration, simulation utilising manikins, physician-led within clinical settings and patient-led training. The objective of this study is to undertake a high quality systematic review of published randomised controlled trials (RCTs) and controlled studies comparing patient-led training with any other method of training.
Summary of work: A meta-analysis of all relevant RCTs (n=10) and controlled studies (n=13) evaluating layperson led training compared to any other training method with pooled and adjusted outcomes reported for technical competence, communication and interpersonal skills, participant anxiety and evaluation. Summary of results: Our high quality systematic review will report and interpret the results of published the meta-analysis and we look forward to presenting these
at AMEE 2013.
Conclusions: There is no consensus regarding the optimal method for delivering intimate examination skills training. When completed, the pooling of results from individual studies will provide a fascinating insight into the efficacy of lay-person led training for intimate examinations and opportunities for further quantitative and qualitative research. Take-home messages: This study highlights the potential for patient involvement in the teaching of healthcare students & postgraduates. Educational studies should aim to be RCTs paying careful attention to CONSORT guidelines to provide the high quality evidence to plan the delivery of medical education.
Moving towards autonomy: integrating simulated (surgical skills lab) and community-based practice during clerkship
Maria de Fatima Galli Sorita Tazima (Faculdade de Medicina de Ribeirao Preto da Universidade de Sao
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
Paulo, Cirurgia e Anatomia, Rua Geriva, 404 - Jardim Recreio, Avenida Bandeirantes, 3900 -10° andar - sala 1032, Ribeirao Preto 14048-900, Brazil) Valdes Bollela (Faculdade de Medicina de Ribeirao Preto da Universidade de Sao Paulo, Clinica Medica, Ribeirao Preto, Brazil)
Background: For many decades, surgery clerkship was only inside a tertiary hospital. In the past years, major changes were made in the surgery curriculum including a rotation in an outpatient clinic. During one week, two students and the preceptor see all patients who need a small surgical procedure. All students had basic training before entering clerkship. Summary of work: During 2012, 45 students (in couples), had one week to learn by doing basic procedures, under direct supervision. All the students were assessed with direct observed procedure skills (DOPS). The focus was on basic steps required to perform a surgical procedure in an outpatient clinic. DOPS were performed in the first and last day of the rotation. A self-assessment survey was also done. In the middle of rotation students had a 4hr practice on surgical skills' Lab. Another DOPS was done at the end of the rotation.
Summary of results: The direct observation showed that around 70% of the students start clerkship not performing well the basics of surgical procedures, and 90% said they didn't feel confident to do it without supervision. At the end of the rotation, 95% were above expectations after final DOPS and 70% answered "high" or "very high" confidence on doing the procedure without supervision.
Conclusions: The results of DOPS and self-assessment survey showed real gain on performance and consistent increase on students' confidence. Take-home messages: Integration of Skills' Lab and real practice during clerkship seems to be a good strategy to improve performance, autonomy and create patient safety environments.
5J Short Communications: Postgraduate
Education: General Practice/Family
Medicine Location: Club E, PCC
Knows how, shows how, does? The impact of facilitated small group learning on GP trainees' consultation skills
Duncan Platt (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Mailpoint 10, Southampton University Hospital Trust, Tremona Road, Southampton SO16 6YD, United Kingdom) Selina Sawhney (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Southampton) Alice Mavrogordato (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Southampton, United Kingdom)
Samantha Scallan (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Southampton, United Kingdom)
Kelly Thresher (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Southampton, United Kingdom)
Background: Preparation for high stakes assessments such as the CSA (membership exam for the RCGP, UK) can lead trainees to focus on the assessment process and rigid consultation models rather than their knowledge and skills, resulting in them losing sight of the interaction at the heart of the consultation. This innovative programme of education aimed to help trainees gain insight into their consulting skills whilst preparing for the CSA. Using role-play with facilitated feedback, sessions helped trainees identify and focus on aspects of the consultation that required further development.
Summary of work: Trainees worked in small groups facilitated by three newly qualified GPs, the 'Near Peer Educators,' with recent experience of passing the CSA assessment. Each group met for four sessions, during which they role-played CSA-style thumbnail scenarios devised by the facilitators. During the first two sessions they gave and received feedback using the ALOBA approach; in the last two sessions feedback was structured using the generic RCGP marking guidelines. At the end of the programme, the trainees attended a mock CSA circuit comprising cases written by the facilitators. Trainees were scored using the RCGP marking scheme and received oral and written feedback. Feedback was gathered from participants (pre-, mid and post the programme), the group facilitators and the assessors.
Summary of results: Major benefits reported by the participants were: insight into areas for development, improved feedback skills and refocused learning needs. Facilitators reported observing improved consultation
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
Conclusions: Approaches to learning that promote shared reflection and constructive feedback can have an impact on trainees' learning and consultation skills.
Developing Integrated Dual-Residency Training in Family Medicine
Leilanie Nicodemus University of the Philippines, Family and Community Medicine, Taft Avenue Manila, Manila 1000, Philippines)
Erlyn Sana (University of the Philippines, National Teachers' Training Center, Manila, Philippines)
Background: The dual track residency program in Family Medicine at the Philippine General Hospital, Manila was designed to provide graduates with career options to become specialist practitioners, researchers, educators and public administrators. The program is composed of a 3-year residency training and 1-year postgraduate degree in Family Medicine. After 4 years of implementation, the high attrition rate prompted the institution to suspend admission of new trainees. Thus there was a need for program review. Summary of work: Following the Research and Development design, a web-based survey was sent to the 13 trainees to enumerate all enabling and inhibiting factors that contributed to their performance. The intended and actual programs were analyzed. Based on the identified deficiencies in the comparison, the appropriate curricular components were added and methodologies were changed. Summary of results: Trainees reported coverage of concepts, principles and theories in the postgraduate classes interspersed with actual clinical experiences in the hospital redundant and inconsistent. Within the first 3 years of residency, trainees take formal postgraduate courses and render service in the hospital. The changes in response to these findings revitalized the residency training to become integrated and competency-based. The connecting threads were: (1) application of the core values of family medicine to clinical practice, teaching, research and management; (2) development of library for that contain sample clinical cases, articles and templates of teaching-learning activities and assessment instruments and (3) faculty development. Conclusions: The dual track residency training was revitalized using curriculum integration by connecting the thread of overlap between clinical residency and postgraduate degree in family medicine. Take-home messages: A novel training program that is encountering implementation problems that can lead to its failure can be revitalised by conducting a program review. Findings of the review can be used to make necessary revision in the curriculum design, learning strategies and evaluation system.
Ambulatory procedures skills training in graduate medical education: Are primary care oriented training programs doing enough?
Robin Klein (Emory University School of Medicine, 49 Jesse Hill Jr Dr, Atlanta 30030, United States) Stacy Higgins (Emory University School of Medicine, Atlanta, United States)
William T Branch (Emory University School of Medicine, Atlanta, United States)
Background: Procedure training is a valuable aspect of preparing trainees to practice safely and independently. As such, ambulatory procedure training is an important task of primary care oriented training programs. Summary of work: We surveyed 61 primary care (PC) internal medicine training programs in the US to assess how these programs provide ambulatory procedural training.
Summary of results: Programs routinely provide training in ambulatory procedures including pap smear(97.4%), arthrocentesis(94.9%), incision and drainage(68.4%), skin biopsy (63.2%), and cryotherapy(52.6%). Less than half provide training in suturing, splinting, toenail removal, colposcopy, IUD placement, endometrial biopsy, sigmoidoscopy, or treadmill stress testing. Teaching methods include models (63.2%), lectures (47.4%), instructional media (34.2%), ambulatory procedure clinic (36.8%), procedure skills lab(28.9%), and standardized patients (13.2%). Procedure clinic and skills lab are often used to teach arthrocentesis and pap smear. The majority rated the typical graduate as competent to perform pap smears (91.9%) and arthocentesis(73.7%). Approximately one third felt graduates required more training and half were unable to assess competency to perform other ambulatory procedures.
Conclusions: Ambulatory procedure training among PC programs emphasizes training in two key procedures, pap smears and joint injection and aspiration. Specialized methods such as procedure clinic and skills lab were employed most often with these key procedures and competency rates were high in these procedures. Training in other ambulatory procedures was limited in scope and practice yielding lower competency rates.
Take-home messages: Ambulatory procedure training heavily emphasizes key procedures. Revisiting this focus and methods used may add depth and breadth to ambulatory procedure training.
Mind the Gap: using EBL as a platform for transition in General Practice training
Rachel Owers (Southampton GP Education Unit, Wessex School of General Practice, Wessex Deanery, Mailpoint 10, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom)
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
Johnny Lyon-Maris (Southampton GP Education Unit, Wessex School of General Practice, Wessex Deanery, Southampton)
Samantha Scallan (Southampton GP Education Unit, Wessex School of General Practice, Wessex Deanery, Southampton, United Kingdom)
Background: General Practice (GP) trainees in their first two years of training attend monthly educational sessions focused on their needs as a future GP. We introduced a new programme using Enquiry-Based Learning (EBL), which blends aspects of the facilitated small group work used in the final year of GP training and Problem-Based Learning. Summary of work: EBL sessions took place for 68 trainees, divided into five groups across two centres. Learning was through case-based discussion and role play prompted by a written scenario. Groups were encouraged to identify their own learning needs and to develop skills in team working and self-directed learning. We distributed questionnaires to all participants after each session and at the mid-point and end of the year. Summary of results: The sessions were generally well received by the trainees. The questionnaire response rate was 78%. 92% of respondents agreed or strongly agreed that sessions improved their skills in reflection and ability to learn in a group. The majority of trainees reflected on EBL sessions afterwards or used them in clinical practice. Themes from trainee comments highlighted the sessions' relevance to General Practice, peer support and interactive nature. In addition to the clinical topic of each session, trainees recognised strands of the curriculum embedded vertically across all sessions, such as consultation skills. Conclusions: EBL can be used to help GP trainees on their educational journey by bridging the gap between hospital-based education and GP training. This is both in terms of the educational style and also content, with vertical GP-focussed curriculum strands embedded across sessions.