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Background: The GOSC regulates approximately 4700 UK Osteopaths and seeks to foster a community of learning in practice. It recently released new Osteopathic Practice Standards and Guidance and is developing dialogic e-learning programmes for practitioners based around them. Summary of work: Articulate software is used to develop online dialogic programmes combining written scenarios and videos, accompanied by critical thinking exercises based on the principles of Situational Judgement Tests. Dialogic learning is achieved by providing formative feedback from the learning community, permitting reflection and re-application to the issues in the scenarios. The scenarios have been scripted by GOsC officers with responsibility for Regulation and Professional Standards, and an education consultant with experience of professional Fitness to Practice procedures. Summary of results: To enhance dialogic learning, we have included Likert scales that require learners to make judgements about the severity and nature of lapses in professionalism within the scenarios. Data are collated and reviewed against responses from experts and role models in UK osteopathic professionalism, to identify areas of congruence and dissonance between learners and experts/role models. This will guide the GOsC and the Osteopathic Educational Institutions in the UK in providing relevant learning opportunities in the future. Conclusions: Online software analytics can be used to facilitate dialogic learning in a community of practice such as Osteopathy by providing feedback and reflective learning functions.
Take-home messages: Regulatory organisations can use dialogic e-learning to foster learning in practice around the standards expected of practitioners in their communities of practice and learning.
ISMETT Nursing Education Program For Development Of Advanced Perianesthesia Competencies
Filippo Marchese (ISMETT (Istituto Mediterraneo dei Trapianti e Terapie), Nursing Education, Via Liberta) 54 Isola Delle Femmine (PA) 90040, Italy) Giancarlo Cappello (ISMETT (Istituto Mediterraneo dei Trapianti e Terapie), Nursing Education, Palermo, Italy)
Background: Pre, intra and post procedural care of patients undergoing interventional procedures requiring anesthesia is critical in determining successful outcomes. ISMETT treats critically ill patients waiting for solid organ transplant. Interventional procedures are part of our work-up protocols, and are often needed in acute or chronic patients at risk of procedure complications. ISMETT's interventional services work closely with the PACU. PACU nurses receive specialized training from ISMETT's Nursing Education, and Anesthesia Departments, and from Simulation Centre in the areas of ACLS/BLS/PALS, EKG interpretation, airway
management, medications, and conscious and deep sedation. PACU nurses are supervised by an attending anesthesiologist, provide optimal care, and communicate with attending physicians. Summary of work: Preprocedural care: Patients arrive for interventional procedures in the PACU, where nurses assess clinical status, optimize preprocedural therapy, check exams, control the radial or femoral routes, and give psychological support. Intraprocedural care: PACU nurses are involved in conscious or deep sedation, and are responsible for checking hemodynamic and respiratory status. In agreement with the attending physician, PACU nurses are ready if the patient becomes unstable. PACU nurses manage IABP, optimize gas exchanges, and provide emergency medications, as well as emergency ventilatory assistance and CPR. Postprocedural care: Patients return to the PACU for cardiovascular monitoring, for full assessment, according to attending physician's orders. Summary of results: PACU nurses provide optimal care and develop advanced competencies thanks to an internal training program that includes medical simulation.
Conclusions: Integration of a traditional education program and simulation training at ISMETT has provided these specialized nurses with advanced competencies, and patients with high quality nursing care, contributing to optimal results.
Take-home messages: Perianesthesia nursing competencies are central in managing critically ill patients requiring anesthesia. At ISMETT these competencies are acquired through an internal training program that includes extensive simulation training.
Challenges of implementing Moodle as a learning platform in a medical school
Maria do Rosario Ferraz Roberti (Universidade Federal de Goias, Clinica Medica, Rua L, n° 53 ap. 501, Setor Oeste, Goiania 74120-050, Brazil) Luisa Patricia Fogarolli Carvalho (Unifenas, Clinica Medica, Alfenas, Brazil)
Pedro Augusto Gontijo (Universidade Federal de Goias, Goiania, Brazil)
Nathalia Meireles (Universidade Federal de Goias, Goiania, Brazil)
Henry Holanda Campos (Universidade Federal do Ceara, Clinica Medica, Fortaleza, Brazil) Michael Rowe (University of the Western Cape, Physiotherapy, Bellville, South Africa)
Background: Lack of integrative practices and of students focused teaching methodologies to promote integration between basic and clinical disciplines set the stage for E-learning to be used as a tool that can fulfill these needs.
Summary of work: First year medical students were given a 40 hour course on the use of Moodle as a platform and a survey was conducted in order to determine their perception of their own ICT skills and the possibility for using the Moodle platform for
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learning. There was a 60% response rate among 110 students.
Summary of results: Even though 99% of the responders had a computer at home and used it regularly they reported difficulties using Moodle. These difficulties included poor understanding of the user interface (44%), finding access buttons (45%), posting information (52%) and using forum discussion (69%). As a learning tool, 53% of students agree that the interface is fair or poor and do not believe that the platform provides flexibility in terms of time (69%) and learning place (62%). The majority of students (90%) do not feel motivated to use Moodle as a tool for learning. While students reported poor familiarity with Moodle, they did not report signs of digital iliteracy as 75% informed use of social networks.
Conclusions: Our students are properly equipped, with good access to the network, but lack the incentive to use this methodology.
Take-home messages: E-learning may be a useful integration tool, but to achieve this goal, there is a need to adequate training and support to implement Moodle as an E-learning platform.
Interdisciplinary clinical case discussion using e-learning environment
Lyudmila Turgunova (Karaganda State Medical University, Department of Internal Diseases No. 2, Karaganda, Kazakhstan)
Berik Koichubekov (Karaganda State Medical University, Department of Medical Biophysics and Informatics, Karaganda, Kazakhstan)
Yelena Laryushina (Karaganda State Medical University,
Department of Internal Diseases No. 2, Gogol st., 40,
Karaganda 100008, Kazakhstan)
Yevgenia Markelova (Karaganda State Medical
University, Department of Medical Biophysics and
Informatics, Karaganda, Kazakhstan)
Viktor Riklefs (Karaganda State Medical University,
Clinical Skills Center, Karaganda, Kazakhstan)
Background: E-learning in medical education is limited by the concept of primary role of bedside teaching. However, medical schools can certainly benefit from e-learning. Our University piloted its first e-learning project "Interdisciplinary clinical case discussion using e-learning environment" involving 13 junior interns and 4 faculty members of clinical departments. Summary of work: We created the clinical case blog, which included patient presentation, physical examination, learning objectives and the first task for learners. The learners could comment on the clinical case. Different faculty members joined in into the discussion at specified time, evaluated previous comments and introduced new data (biochemical, cytological, microbiological, etc.). Summary of results: The pilot project took 2 weeks to complete and all participants were surveyed on their experience. By respondents' opinion, the major advantage of e-learning is absence of rigid time-
constraints; the major disadvantage is necessity of technical support. All respondents were satisfied with the results and recommended e-learning for discussion of 'interesting' clinical cases in the future. Conclusions: The results could be best concluded by a student's comment: "E-learning really made me re-think my abilities, see my own mistakes and get corrected by more experienced colleagues. This actually happened to me in the beginning of the case. I could feel myself to be 'a real doctor' and certainly recommend this format of learning into routine practice. I just loved it all!" Take-home messages: Medical education should not be bound to only patient's bedside but make the best use of available technology as well.
The implementation of distance teaching in the Swedish Regionalized Medical Program - multiple small steps of change for an inert system
Anders D Olofsson (Umea University, Department of Education, Umea University, Umea 90187, Sweden) Fanny LM Pettersson (Umea University, Department of Education, Umea, Sweden)
Christina Ljungberg (Umea University, Department of Surgical and Perioperative Sciences, Umea, Sweden) Magnus Hultin (Umea University, Department of Surgical and Perioperative Sciences, Umea, Sweden) Silvana Naredi (Umea University, Department of Surgical and Perioperative Sciences, Umea, Sweden)
Background: This study examines possibilities and challenges when implementing distance teaching for teaching theoretical content in the Swedish regionalized medical program (RMP). The distance teaching by means of digital technologies and Technology-Enhanced Learning (TEL) is seen as an alternative to the face-to-face teaching in the medical program. Summary of work: A framework built upon the work of Sannino (2008) including the notion of dominant and non-dominant activities, conflicts and transitional actions were used for analysis.
Summary of results: In the results a number of conflicts were identified which inhibit medical teachers from adopting especially interactive and communicative elements of distance teaching. Those were for example teachers' digital literacy, lack of trust in digital teaching tools and willingness to keep to the face-to-face teaching practice.
Conclusions: Illustrated by transitional actions it is discussed how the non-dominant distance teaching activity actually functioned as a catalyst for minor but important changes in the medical teachers' dominant face-to-face teaching practice. Based on the results from this study one can raise the question of what really can be seen as a success or a failure when implementing TEL in medical education. Implementation processes in medical education is a process of interplay between dominant and non-dominant activities. Recognizing such interplay provides possibilities for future educational development.
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Take-home messages: Implementing distance teaching is not a straightforward process but rather characterized by small steps of change that needs to be continuously supported by the medical program management.
Simulated learning by clinical trainees of communications strategies: facilitating development of collaborative competency in an acute care environment
Heather Ward (University of Saskatchewan, Medicine, Royal University Hospital, Saskatoon S7H 0H9, Canada) M Suzanne Sheppard (Saskatoon Health Region, Saskatoon, Canada)
Dylan Chipperfield (University of Saskatchewan, Saskatoon, Canada)
Sharon Card (University of Saskatchewan, Medicine, Saskatoon, Canada)
Background: Patient complexity in the setting of an acute care environment may provide challenges to learning effective collaboration competencies (role knowledge and communication strategies) by clinical trainees. Providing opportunity to learn collaboration strategies in a small group virtual environment to be applied to their clinical training experience may facilitate collaborative competency development. Summary of work: We had previously developed a virtual Interprofessional learning program of a COPD patient preparing for discharge from an acute care environment. For this project, the COPD simulation is utilized to facilitate small group, currently uniprofessional, one hour interactive learning among clinical trainees. The concepts of shared mental models (SMM) and situational awareness (SA) are introduced as a framework for complex collaboration scenarios, but the focus is on learning SBAR (situation, background, assessment and recommendation) as a collaborative communication strategy.
Summary of results: 32 responses from 26 internal medicine trainees and 6 physiotherapy students evaluating the application of these 3 tools using a 3 point rating scale demonstrated the following results: SMM 66% very useful and 34% somewhat useful; SA 75% very useful and 25% somewhat useful; SBAR 75% very useful, 22% somewhat useful and 3% not useful in their clinical environment. Comments encouraged all health care providers become familiar with these tools. Conclusions: Virtual simulations of patients similar to those seen in acute care provide opportunity for interactive interprofessional learning of the collaboration competency.
Take-home messages: Collaboration competencies introduced in virtual learning environments have clinical applications.
How Can Collaborative Online Educational Environments Be Developed for Busy Health Professionals? Getting People Talking in Less Than Four Hours
AB Janssen (The University of Sydney, Workforce
Education and Development Group, Sydney Medical
School, Room 206, Level 2, Mackie Building K01,
University of Sydney 2009, Australia)
T Shaw (The University of Sydney, Workforce Education
and Development Group, Faculty of Medicine, Sydney,
Background: Over the last two decades demand has risen for online CME that is engaging and effective at imparting complex ideas and concepts, without placing further strains on already time-poor health professionals. The OTAC is an established online educational course in the field of addiction medicine. In 2011 its educational design was revised to reduce contact time for busy health professionals without compromising educational quality, by encouraging the growth of collaborative online learning environments. Summary of work: The course was revised in the context of a new educational design model, developed within WEDG, around the three domains of Knowledge, Process and Practice (KPP). The revised course encouraged, collaboration self-directed learning and participant ownership of their existing and deficit knowledge. Participants collaborated in a professional practice forum with peers and facilitators to achieve shared learning goals.
Summary of results: Over a twelve month period the forum succeeded at fostering collaboration and discussion amongst users, and assisted them in meeting the learning objectives of the program. However it was necessary to implement unexpected scaffolding measures to achieve this success. Conclusions: Collaborative online environments can be effective tools for autonomous learning over short durations, by encouraging breadth of engagement with resources and personal knowledge review as well as encouraging effective engagement in an online collaborative environment were those skills are both reviewed by experts and challenged by peers. Take-home messages: Effectively growing collaborative online continuing medical education communities can provide a major challenge to educators. However such communities are increasingly valuable tools for medical education and knowledge translation in the health sector.
Learning effect of trans-disciplinary case reflective web forum on clerkship moral cognitive decline
Nen-Chung Chang (Taipei Medical University, Department of Internal Medicine, School of Medicine,
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College of Medicine, No 250., Wuxing St.,Xinyi Dist, Taipei 11031, Taiwan)
Background: Moral sense and ethical reasoning skills are regarded as the educational indicator of medical ethics. Studies have shown these two moral cognitive abilities will decline after exposure on the highly homogeneous and professional clinical environments. Summary of work: We enrolled 82 6th year medical (47) and 4th year nursing (35) students. We assess the learning effect of trans-disciplinary case reflective practice on clerkship moral cognitive decline through structured four box ethical reasoning teaching, 3 weeks' closed web forum transdisciplinary clinical cases discussions, reflective writings, and medical humanities extended reading. We used the same anonymous questionnaire of 14 questions, before and after the course. At the end of the course, 54 6th year medical (34) and 4th year nursing (20) students completed the questionnaire.
Summary of results: Understanding the importance of reflection was the same before and after the course. Overall reflective knowledge and skills, communication ability, talk ability, law knowledge, understanding the role of individuals in a team, team mutuality, self protection ability, and reflection ability was much improved (P<0.05). Ability to express empathy, interactive capabilities, listening skills, understanding patients' feelings, understanding the essence of doctors' attention on patients, and patient protection ability improved, but there was no statistical significance. Conclusions: This teaching model demonstrated much improvement on some items of knowledge and skills of communication and reflection. However, some items did not show significant improvement. This means long term practice is important.
Take-home messages: We suggest introducing this model to senior students. Longitudinal study is suggested for evaluating the long term effects.
Fostering academic writing and publishing skills in medical students and junior doctors: 360-degree evaluation of an online innovation
Nicholas Boxall (University of Sheffield, Academic Unit of Medical Education, Beech Hill Road, Sheffield S10 2RX, United Kingdom)
Laura Horseman (University of Manchester, Faculty of Life Sciences, Manchester, United Kingdom) Ashlea Norton (North Manchester General Hospital, Medicine, Manchester, United Kingdom) Elspeth Hill (University of Maastricht, School of Health Professions Education, Maastricht, Netherlands)
Background: There is increased pressure on medical students and junior doctors to publish. There are limited opportunities as an undergraduate in gaining medical writing experience, most of which are reliant on a supportive supervisor. An online peer-reviewed medical notes revision website (Fastbleep Notes) was established to provide medical students and junior
doctors the opportunity to publish and edit clinical articles within a supportive environment. Summary of work: Written reflections from a purposive sample of those involved in the project, including users, authors, editors and managers. Feedback was sought in four domains; motivation to engage with the project, benefits and barriers to engagement, and a free text domain.
Summary of results: Overwhelmingly, participants felt engagement with the programme was beneficial, though this was felt most strongly by those who engaged most and felt most invested in the project. Benefits included "being creative", "giving something back", "preparing to publish" and "a sense of satisfaction". Barriers included "struggling with technology" and "difficulty getting started". Participants had built confidence and felt part of the "Fastbleep community" through this initiative. Conclusions: Fastbleep Notes is a worthwhile initiative to help foster collaboration, academic writing and publication skills in medicine. Engagement was crucial to maximise the benefits, and thus next steps will focus on improving and facilitating engagement for newcomers to the project.
Take-home messages: Medical students and junior doctors were able to lead each other through the process of academic publishing, and the peer-led environment fostered a sense of community engagement.
On-line evaluation in medical education
Vera Lucia Blaia-DAvila (Sao Paulo Catholic University,
Medicine, Rua Assuncao 341, Rua Riachuelo 460,
Sorocaba 18046715, Brazil)
Ronaldo D'Avila (Sao Paulo Catholic University,
Medicine, Sorocaba, Brazil)
Marcelo Cliquet (Sao Paulo Catholic University,
Medicine, Sorocaba, Brazil)
Isabel Cappelletti (Sao Paulo Catholic University,
Education, Sorocaba, Brazil)
Background: One of the characteristics of active learning methodology introduced in many medical schools in the last decade is the stimulus for maturation of the student in pursuit of knowledge and capacity development of the "learn and think for yourself." Summary of work: The main objective of this study was to assess how would be, in a chosen elective discipline during the medical course, the behavior of students submitted to online evaluation without the physical presence of teachers. Evaluations were online inserted through the software Moodle at the end of the course. The first evaluation, discussion of a clinical case, allowed free study and access to bibliographic references. The second evaluation, with right/wrong questions and restricted time to resolution did not allow free consultation. Online feedback was given, with commentary and suggestions in the interpretation of the clinical case and the right/wrong questions. Summary of results: From 20 students, only one (5%) did not show commitment to the proposed schedule
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and did not answer the questionnaire adequately. Additionally, 90% of the participant students considered the online evaluation as very satisfactory and really important for learning.
Conclusions: Experience has demonstrated commitment to the process by the students, and satisfaction with this type of assessment.
Take-home messages: For motivated students, online evaluation is possible and reliable. We think that this evaluation model should be used on regular activities and not only on elective courses.
From Learning to Implementation: An Electronic Commitment to Change at Large CME Conferences
Daniel Ngui (St. Paul's Hospital, Family Medicine, #1025990 Fraser Street, Vancouver V5W 2Z7, Canada) Tunde Olatunbosun (University of British Columbia, Division of Continuing Professional Development, Vancouver, Canada)
Joss DeWet (St. Paul's Hospital, Family Medicine, Vancouver, Canada)
Brenna Lynn (University of British Columbia, Division of Continuing Professional Development, Vancouver, Canada)
Garey Mazowita (St. Paul's Hospital, Family Medicine, Vancouver, Canada)
Rhonda Low (St. Paul's Hospital, Family Medicine, Vancouver, Canada)
Background: St. Paul's Hospital Family Medicine CME committee piloted an electronic commitment to change tool called "TIPs" (Tool to Implement tips and Pearls into Practice) to improve reflective learning at continuing medical education conferences. Summary of work: At the St. Paul's Family Medicine conference in November 2012, participants (n=1400) were invited to use TIPs. One month later they received an email of their top 3 tips/pearls identified from the conference. Subsequently, two months later, an email of what learners intended to implement to practice, a summary of the top 10 learning themes and a follow-up survey was sent.
Summary of results: 182 family physicians identified their top three learning tips they intended to implement into practice. At two months, 53 participants completed follow up surveys with 98% saying they: a) "liked to use an electronic reflective learning tool at a conference"; b) preferred email as the method to be reminded about their commitment to change. Regarding TIPs usage: a) 72% of respondents found the reminder email of their top 3 tips was impactful; b) 60% of respondents were female; c) 43% were within the first 10 years of practice; d) 65% found it easy to use; e) 70% were very satisfied with TIPs. Finally, 92% of respondents reported they would use it again if offered at a conference.