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Conclusions: Despite improvements in recruitment since 2005, work-life balance and litigation continue to be perceived as negative features of the career; bad undergraduate experience is linked with those who decide against a career in O&G.
Take-home messages: Successful specialty recruitment depends on good student experiences and accurate career perceptions.
5BB Posters: Postgraduate Education 1
Location: South Hall, PCC
The Use of Smartphone/Tablet Technologies by Training Doctors in Clinical Settings
Susan Kennedy (KSS Deanery/ East Kent Hospitals University NHS Foundation Trust, Education Department/Medical Education Directorate, Queen Elizabeth the Queen Mother Hospital, Education Centre, St Peter's Road, Margate CT9 4AN, United Kingdom)
Background: Training doctors are using mobile technologies in clinical settings but there is still little research in this area. A master's research project was undertaken focusing on how training doctors experience these technologies both as learner and doctor. Summary of work: An initial survey was undertaken and then interviews were carried out. Transcripts, field notes and memos were all used as part of the grounded theory methodology used. Summary of results: Doctors are using their smartphones/tablets for learning and teaching, through the use of apps and the internet. On-the-move checking of emails, texting and phoning was universal. They are alert to negative attitudes regarding use but more often it is that they are concerned there might be negativity rather than that they have experienced it. Training doctors take their cue from consultants - if seniors are keen and advocate use, they will use them visibly; if seniors do not use and/or advocate them, trainees use their devices away from those seniors. Conclusions: Doctors are negotiating their use of these technologies in a context of complex professional and doctor/patient relationships and are alert to ways in which their usage might compromise those relationships. However, they see huge potential in the devices in terms of gaining in medical confidence and competence, in providing patients with information and support, in improving systems and processes and in communicating more effectively and speedily. Take-home messages: Their approach was enthusiastic but cautious. It is clear that in their use of these smart devices training doctors are exercising appropriate professional judgement regarding specific and individual contexts and circumstances.
PodMedPlus: an innovative educational intervention for junior doctors in the era of the European Working Time Directive
Matthew A Kirkman (Imperial College London, Faculty of Medicine, South Kensington Campus, London SW7 2AZ, United Kingdom)
Zeni Haveliwalla (Salford Royal NHS Foundation Trust, Postgraduate Education, Salford, United Kingdom) Nafeesa Ramzan (Salford Royal NHS Foundation Trust, Postgraduate Education, Salford, United Kingdom)
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Aysha Alla (University of Manchester, Manchester Medical School, Manchester, United Kingdom) Background: Changes to postgraduate medical training, including introduction of the European Working Time Directive (EWTD), have impacted the ability to deliver postgraduate medical education. We describe an innovative project, PodMedPlus, designed to optimise access to medical education by junior doctors. Summary of work: An educational programme comprising of audio/video podcasts has been piloted. The podcasts comprise of case-based discussions between a junior and senior clinician. The topics covered are relevant to postgraduate medicine and accessible as web downloads at any time. Qualitative and quantitative pilot data based on two trial podcasts, and participant feedback, have been obtained. Summary of results: Our pilot involved twenty-eight junior doctors from one teaching hospital. We issued knowledge-based questionnaires immediately before and after watching a podcast covering a specific topic. For one trial (topic: bronchiolitis), the mean percentage of correct answers to the questionnaire before the podcast being played was 69%, rising to 92% following the podcast; for the other trial (topic: stroke), a less marked rise from 86% to 92% was observed. Interestingly, more individuals (74%) felt the bronchiolitis podcast was educationally informative than the stroke podcast (25%). Feedback on the podcasts was generally positive, with most feeling the podcasts met the learning outcomes described at the beginning of the podcast (69%).
Conclusions: We have demonstrated the ability to improve clinical knowledge through podcasts. Our participants have suggested areas for improvement, and wider implementation of PodMedPlus is subsequently planned.
Take-home messages: Podcasts can help deliver an accessible education, with quantifiable knowledge gains, to junior doctors in the EWTD era.
What do junior doctors think about e-learning and podcasts in postgraduate medical education? Results of a survey
Aysha Alla (University of Manchester, Manchester Medical School, Stopford Building, Oxford Road, Manchester M13 9PT, United Kingdom) N Ramzan (Salford Royal Foundation Trust, Post Graduate Department, Manchester, United Kingdom) Z Haveliwalla (Salford Royal Foundation Trust, Post Graduate Education, Manchester, United Kingdom) Matthew A Kirkman (Imperial College London, Faculty of Medicine, London, United Kingdom)
Background: Restrictions on working hours of junior doctors in Europe presents a significant challenge in delivering postgraduate medical education. We sought to ascertain the opinions of junior doctors on e-learning, and podcasts in particular, as an instructional medium to overcome barriers to accessing learning.
Summary of work: We designed and distributed a detailed questionnaire about e-learning and podcasts to junior doctors in one teaching hospital. Summary of results: Twenty-seven junior doctors completed our survey (96% response rate). 37% studied medicine as a postgraduate, and the majority (78%) attended a problem-based learning curriculum medical school. Most agreed that e-learning is a useful method of learning in medicine (78%), felt confident in using e-learning (74%), and felt e-learning is essential for doctors (59%). However, only 30% preferred e-learning over traditional methods of learning, and 48% found it more engaging than traditional methods. Despite this, 93% felt podcasts have the potential to be useful and 70% would consider using podcasts as part of their training, with 52% having used them before for education. Discussion: Our survey highlights an overall positive opinion about the role of e-learning and podcasts in postgraduate medical education. However, our survey suggests that their role may be best as an adjunct as opposed to replacement for more traditional instructional methods.
Conclusions: E-learning and podcasts are generally well regarded as educational tools in postgraduate medicine Take-home messages: Wider implementation of e-learning, and podcasts in particular, as formal adjuncts in postgraduate medical education should be considered.
Using qualitative research and patient safety to review revise and reinvent the regional Foundation Doctor Induction training programme; an exploration of lessons learnt
Sonia Joseph (NHS Lothian, Directorate of Medical Education, Edinburgh, United Kingdom)
Background: Regionally the FY1 shadowing experience was inconsistently delivered across hospital sites with no evidence of adaptation to the needs of doctors, patients with no ability to share good practice. The programme aim was to identify and meet the needs of the FY1 doctors whilst balancing the needs of patients and the corporation.
Summary of work: Utilising qualitative research methods we conducted a series of surveys and focus groups on the current foundation year group. Institutional requirements were mapped against the GMC domains for good medical practice and the Scottish Patient Safety Programmes primary targets. The programme involved interactive lectures, workshops, simulation training and an interactive module. All sections met the pre-determined learning outcomes, reinforcing practical systems knowledge. Triangulated qualitative feedback was gained and patient outcomes measured in key areas ie. medicines reconciliation and insulin prescribing.
Summary of results: Thematic analysis with key points of learning outcomes for the corporation demonstrated improved perception and preparedness for working life
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and early data to suggest reduced clinical incidents and patient harm.
Conclusions: The implementation and review process of our programme has exposed a series of institutional assumptions about trainee prior knowledge but has permitted multi-professional silos to work together and co-ordinate with teaching programmes regionally. Take-home messages: By arming doctors with greater systems knowledge linked into patient care objectives we can engage and empower our trainees and allow early identification and support of doctors in difficulty.
European Postgraduate Medical Education Study
Bernard Klemenz (Northern Road Surgery, University of Southampton Training Practice, 56 Northern Road, Portsmouth P06 3DS, United Kingdom)
Background: Medical Education is the center of providing healthcare for the society's evolving increased healthcare needs in an aging population. In the last 20 years two major reforms of medical education have been undertaken in the UK, including that on specialist medical training by Sir Kenneth Calman in 1993 and the MMC Modernising Medical Careers in 2005, which led to reform of the SHO grade. The Senior House officer grade consisted of jobs of short term intervals sometimes combined with unstructured training. The Foundation Programme was established in 2005 .This is a two-year generic training programme to form a bridge between medical school and specialist training. It is considered to be necessary for the development of generic skills required for all doctors and to help them to make a more informed career decision based on exposure to a broad range of specialities. The F2 training grade is being exposed to placements consisting of a minimum of four to a maximum of six months in various specialities and an increased emphasis on General Practice, as 50% of doctors in training will need to become GPs in order to fulfil the UK health economy needs. In comparison in Germany the medical graduates enter directly the speciality training. Summary of work: EPMES is a survey of 40 UK specialists and their perception of the benefit of the current F2 training programme for their speciality. This is compared to 40 German specialists regarding their perception of introducing a F2 programme in order to improve their informed career decision.
Summary of results: awaiting summary of results. Conclusions: On-going study - soon finishing - await feedback from questionnaires.
Take-home messages: EPMES awaits evaluation for take home message.
Confidence in ACLS performance among newly graduated doctors
Thassanawut Dhearapanya (Srinakharinwirot University, Emergency Medicine, 988/64 Noble Solo
Sukhumvit 55 Thong lor, Wattana, Bangkok 10110, Thailand)
Apichai Pangsorn (Srinakharinwirot University, Forensic Medicine, Bangkok, Thailand)
Weeraya Sathawarawong (Srinakharinwirot University, Internal Medicine, Bangkok, Thailand)
Background: In Thailand, newly graduated doctors work as certified practitioners once they graduate from medical schools. Most, if not all, are appointed to run emergency rooms throughout the country. Inevitably, there are patients suffering from bradycardia, tachycardia and cardiac arrest, which require Advanced Cardiovascular Life Support (ACLS). Confidence in their ACLS performance among these fresh graduates is thus important.
Summary of work: At the end of the final academic year, 117 newly graduated doctors were asked questions concerning their ACLS confidence. A questionnaire was used, with a Likert scale of 1-5, where 1 means "very unconfident" and 5 means "very confident." Aspects of confidence include the respondent's knowledge, her confidence as a team leader and team member, confidence in teaching, the number of cases a respondent participates in, and reasons supporting her confidence. Summary of results: In one year, the number of cases a respondent participates in is limited, with 11 cases on average (the range varies between 2 and 30). Confidence in BLS is higher than those in ACLS. While the respondents seem confident with their role as a team member (4 out of 5), confidence decreases for knowledge, team leader role, and teaching (3.72, 3.55, and 3.44 respectively). 70 percent of respondents agree that the number of cases participated in contributes positively to their level of confidence. On the other hand, almost 40 percent believe ACLS education and examples are key contributors. Conclusions: The average level of confidence in ACLS among newly graduated doctors is medium to high. Take-home messages: Measures to increase the level of confidence in ACLS should be emphasized before graduation.
The work of recently graduated physicians in Emergency Room
Maria Helena Senger (Pontificia Universidade Catolica
de Sao Paulo, Medicina, Avenida Sao Paulo, 2918,
Sorocaba 18013004, Brazil)
Maria Celeste Goncalves Campos (Pontificia
Universidade Catolica de Sao Paulo, Medicina, Sorocaba,
Background: Emergency Room (ER) overcrowding, due to a variety of factors associated to the fact that the physician in charge may be, many times, an inexperienced recently graduated person, has transformed the area into one of the most problematic in the Brazilian health system.
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Summary of work: Research was conducted with a group of students of the class of 2011 of a private institution, after approval of local Ethics Committee. A structured questionnaire was used; graduates were asked whether they were attending medical residence (MR) and whether they are working in ER, independently of MR.
Summary of results: Out of 101 former students, 50 answered the questionnaire. Out of these, 31 (62.0%) were attending MR and 19 (38.0%) were not. Twenty in the first group (64.5%) and 12 (63.1%) in the second group have been working with in ER. Conclusions: Medical School is expensive and lengthy. The recently graduated person finds open doors in emergency services and ends up entering this kind of work early. This activity, when combined with MR, can hinder learning. ER job has proven to be a relevant option for the recent medical graduates in Brazil, regardless of the MR.
Take-home messages: The research reinforces the importance of the teaching/learning of emergencies during graduate years. The activity of resident physicians in extracurricular shifts needs to be better assessed. Presumably this overload of work provides decreased quality of life and can compromise the learning and performance in this important moment of their medical training.
Are we preparing our medical students and Foundation Trainees for managing acute urological emergencies?
Saiful Miah (University of Sheffield, Academic Urology Unit, Sheffield, United Kingdom) Angus Luk (University of Sheffield, Medical School, Medical School, Beech Hill Road, Sheffield S10 2RX, United Kingdom)
Roderick McDermid (Royal Hallamshire Hospital, Urology, Sheffield, United Kingdom) Suresh Venugopal (Royal Hallamshire Hospital, Urology, Sheffield, United Kingdom)
Mangera Altaf (Royal Hallamshire Hospital, Urology, Sheffield, United Kingdom)
Rosario Derek (University of Sheffield, Academic Urology Unit, Sheffield, United Kingdom)
Background: Urological emergencies account for 20% of all acute surgical admissions. As the first port-of-call, Foundation Year 1 (FY1) doctors are expected to assess and initiate treatment for these patients. This study was conducted to assess final year medical student's and FY1's knowledge on 6 common urological scenarios that they will encounter.
Summary of work: A questionnaire-based best response assessment tool was used. 83 final-year medical students from a single university who had completed a two-week urology placement and 67 FY1 doctors from a single deanery participated.
Summary of results: 92% and 97% of medical students and FY1s respectively were unsure of management of chronic urinary retention. Over a quarter in either group
were unsure with regards to evaluation of haematuria. With regards to PSA testing, over 56% in both groups held the false belief that a period of at least 7 days is required to perform this test following a digital rectal examination. 25% of medical students were unsure or believed that the insertion of a urinary catheter in a patient with prostate cancer required specialist urological expertise. In the non-acute scenarios, over 25% in both groups believed that vasectomy reduced potency.
Conclusions: There are significant gaps in core urological knowledge in medical students and FY1's which needs to be addressed at an undergraduate level. Take-home messages: Exposure to urology in medical school needs to be scenario dictated as medical students will encounter a high frequency of urological cases throughout their post-graduate careers.
Ophthalmology Teaching for Foundation Trainees
Michael Yoon Tze Lai (Birmingham and Midland Eye Centre, Ophthalmology, Dudley Road, West Midlands, Birmingham B18 7QH, United Kingdom) James Wong (Blackpool Teaching Hospitals NHS Foundation Trust, Medicine, Lancashire, United Kingdom)
Amit Sud (Guys' and St Thomas' NHS Foundation Trust, Medicine, London, United Kingdom) Stephenie Tiew (Royal Liverpool University Hospitals NHS Trust, Ophthalmology, Liverpool, United Kingdom)
Background: Foundation Year 2 (FY2) doctors in a central teaching hospital undergo compulsory placements in Accident and Emergency and General Practice where they are expected to deliver emergency eye care. They need to demonstrate "targeted examination skills and appropriate use of equipment, including an ophthalmoscope" (The UK Foundation Programme Office- UKFPO). However, undergraduate ophthalmology training is limited and variable. Summary of work: We aim to assess the baseline knowledge and practical skills of our Foundation Year 2 doctors. We also aim to measure the educational effect of an ophthalmology teaching session on improving baseline competencies. We introduced a structured ophthalmology teaching session consisting of didactic presentation and practical teaching on ophthalmoscopy and slit lamp examination with real patients. Pre- and post-course questionnaires assessed self-rated confidence of the FY2 doctors in recognition and management of ophthalmic emergencies. Baseline experience and confidence in using basic ophthalmological equipment were also evaluated. Summary of results: The average length of undergraduate ophthalmology exposure amongst our doctors is 4 days. FY2 doctors felt more confident in diagnosing and managing ophthalmic emergencies after the course (p < 0.001). All trainees had experience with direct ophthalmoscopy but 80% felt more confident in using an ophthalmoscope after the course. 40% of trainees have no experience with slit lamp
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biomicroscopy. Post-course, all trainees gained confidence in slit lamp examination. Conclusions: We recommend ophthalmic training at post-graduate level to equip foundation trainees for core placements and achieve competencies outlined by
Take-home messages: Junior doctors benefit from a dedicated practical ophthalmology teaching session to be more confident emergency eye care providers.
Postgraduate Medical Education Program Improvement: Moving from Unstructured (Experiential) to Structured
Margaret Kennedy (Royal College of Physicians & Surgeons of Canada, International Outreach, 774 Echo Drive, Ottawa K1S 5N4, Canada) Patti O'Brien (Royal College of Physicians & Surgeons of Canada, International Outreach, Ottawa, Canada)
Background: The Royal College of Physicians & Surgeons of Canada has developed a structured process to ensure that graduates of Canadian postgraduate medical education (PGME) programs have acquired the skills and competencies necessary to be good clinical practitioners able to meet societal needs. Oversight of the educational programs is through a structured accreditation process. This process has received international attention.
Summary of work: The Royal College has completed 37 PGME program consultations in 4 countries over the past 3 years. Ensuring processes that adequately prepare graduates for clinical practice responsive to societal needs was an overarching goal of the programs. Using the Royal College accreditation process as a framework, programs were able to identify opportunities for improvement. Summary of results: Following consultation, programs identified specific quality improvement and program development opportunities such as, formalizing the training program committee, introducing official faculty evaluation and resident assessment procedures, increasing resident involvement on program committees, and creating blueprints for teaching and assessing physician competencies. Conclusions: Program consultation using an established framework enables programs to develop better structures that increase involvement of faculty and residents. Programs that underwent a consultation also shared "lessons learned" with colleague programs resulting in knowledge diffusion and application locally. Take-home messages: External consultation can assist programs in the development of structured processes that provide evidence of quality.
Learning as positioning: A qualitative study of junior residents' workplace learning in oncology
Lars Williams (University of Aarhus, Center for Medical
Education (MEDU), INCUBA Science Park,
Brendstrupgaardsvej 102B, Aarhus 8200, Denmark)
Peter Musaeus (University of Aarhus, Center for Medical
Education (MEDU), Aarhus, Denmark)
Carsten Rytter (University of Aarhus, Department of
Oncology, D, Aarhus, Denmark)
Mette Krogh Christensen (University of Aarhus, Center
for Medical Education (MEDU), Aarhus, Denmark)
Background: This pilot-project aimed at investigating the learning potential of different workplace situations at a Danish oncological ward with a focus on team cooperation and communicative skills-learning of junior residents.
Summary of work: The study applied a short-term ethnographic research method in postgraduate medical education using positioning theory, i.e. studying the discursive production of self and team. Data was based on qualitative interviews (10 junior residents) and six full days of field observation. The aim was to gain insight into how the junior residents narrate their experiences in different workplace situations in which they learned to be a part of the professional team. Data was examined through thematic analysis e.g. using thematizing and content clustering. Summary of results: The study pointed towards a nuanced understanding of learning potential of different situations. The two recurring themes were 1) proximal role models in senior doctors, and 2) awareness of learning potential in which the junior residents were positioned or positioned themselves with respect to the rights and duties in their clinical workplace. Positioned selves arose in dilemmas of patient encounters, team ideals, and senior junior resident's expectations. Conclusions: Proximity of senior doctors and the positioning of the junior resident are vital categories for understanding how junior residents learn to navigate within patient-centered communicative dilemmas in different workplace situations. Take-home messages: Positioning theory forms a fruitful framework for analyzing dilemmas of medical workplace learning. Physical context, other professionals, patients, as well as imaginary positions can shape the learning landscape of junior residents.