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Summary of work: With guidance of faculty specialists we developed a structured questionnaire with 44 open questions covering basic science facts about liver, heart, kidney, lung and blood - thought to be clinically relevant and essential basic science knowledge. Summary of results: 98 students (5th year) participated in this test. All of the questions were rated to be comprehensible and 35 were classified as clinical meaningful. The expected essential knowledge could be reproduced in less than 48%.
Conclusions: It is impossible for the preclinical students to assess the clinical relevance of all the preclinical information. They cannot decide what is essential 'core knowledge' and what is peripheral 'nice to know' - the teachers don't provide guidance. Instruction of basic science facts should guarantee that every student understands and knows a core of essential knowledge by heart.
Take-home messages: Less but clinically relevant knowledge is more than encyclopedic matters of no importance.
Patient exposure in the basic science classroom enhances clinical decision-making
Justin G Peacock (Mayo Clinic College of Medicine, Mayo Medical School, Rochester, United States) Brad A Martin (Mayo Clinic College of Medicine, Mayo Medical School, Rochester, United States) Lindsay L Warner (Mayo Clinic College of Medicine, Mayo Medical School, Rochester, United States) Joseph P Grande (Mayo Clinic College of Medicine, Laboratory Medicine and Pathology, 200 First St. SW, Rochester 55905, United States)
Background: A major challenge for medical students is making the leap from the basic sciences to clinical practice through the course of medical school. We propose that real patients' histories with assignments
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
focused on clinical decision-making during basic science courses will better prepare students for this challenge. Summary of work: Three patients with different pathologies described their history and presentation without revealing their diagnosis. Students were required to submit a differential diagnosis in writing, and then they were able to ask questions to arrive at the correct diagnosis. Students were surveyed on the efficacy of patient-based learning. Summary of results: Average student scores on the differential diagnosis assignments significantly improved 32% during the course. From the survey, 72% of students felt that patient encounters should be included in the pathology course next year. 74% felt that the differential diagnosis assignments helped them develop clinical decision-making skills. 73% felt that the experience helped them know what questions to ask patients. 86% felt that they obtained a better understanding of patients' social and emotional challenges. 68% felt that they have better insight into what their clinical experience will be like. Conclusions: Having students work through the process of differential diagnosis formulation when encountering a real patient and their clinical presentation improved clinical decision-making skills during a basic science pathology course.
Take-home messages: Real patient encounters in the basic science classroom coupled with assignments aimed at clinical decision-making will improve clinical skills and help to unite the basic sciences with clinical practice.
The positive side effects of early authentic experience
Bianca Schuh (Medical University of Vienna, Department of Medical Education, Spitalgasse 23, Vienna 1090, Austria)
Alexandra Schmid ("Haus der Barmherzigkeit", Geriatric Long-Term Care Facility, Department of Education and Research, Vienna, Austria)
Christoph Gisinger ("Haus der Barmherzigkeit", Geriatric Long-Term Care Facility, Executive Director, Vienna, Austria)
Anita Rieder (Medical University of Vienna, Department of Social Medicine, Centre for Public Health, Vienna, Austria)
Background: According to literature early patient contact has positive effects on the professional development of medical students. At the Medical University of Vienna a 30-hours course in a modern long-term care hospital is mandatory for all 740 freshmen of each year. The learning goals of the course are the development of professional attitudes toward care recipients and toward non-medical health professionals. This study assesses the intended and unintended learning outcomes of the course, with main focus on the additional positive and negative side effects.
Summary of work: Obligatory randomly drawn reflection reports of n = 52 students were analysed with regard to the question, what intended and unintended learning outcomes the students report. A qualitative content analysis was performed. Summary of results: Seven main categories emerged from inductive analysis: Experience in interaction with care recipients; Recognizing important factors for successful interaction with care recipients; Understanding the perspectives and needs of care recipients; Reflection of one's own capabilities; Appreciation of non-medical health professionals' work; Increased understanding of different diseases; Others. Conclusions: Additional unintended learning outcomes have been identified, mainly in the categories "Reflection of one's own capabilities", "Increased understanding of different diseases" and "Others". Besides the intended learning outcomes there are positive side effects of early authentic experience. No negative effects could be identified. The non-research-led purpose of the analysed reports and other limitations of the study will be discussed. Take-home messages: Keep your mind on side effects of early authentic experience for controlling the actual learning outcomes.
Clinical Decision Making Educator Tool in a Preclinical Course
Lindsay Warner (Mayo Clinic, Mayo Medical School, 200 1st St SW, Rochester 55905, United States) Brad Martin (Mayo Clinic, Mayo Medical School, Rochester, United States)
Justin Peacock (Mayo Clinic, Mayo Medical School, Rochester, United States) Joseph Grande (Mayo Clinic, Lab Medicine and Pathology, Rochester, United States)
Background: The aim of preclinical medical education is to provide a clinical decision making framework. Students gain differential diagnosis skills that often are graded without a standard rubric. Without guidelines, difficulty remains about whether or not educational interventions improve differential diagnosis skills. Summary of work: Graders developed a standardized differential diagnosis grid with a 0, 1 or 2 point grading system. The grid was posted on a live Google document where graders could see what others had given and give feedback about any discrepancies. This allowed graders to gain consensus on answers and compare personal opinions.
Summary of results: 75% of grading participants always referenced the live document before grading assignments. 75% of graders occasionally questioned other graders on their points given which allowed for discussion and ultimate resolution and consensus. 75% of graders agree or strongly agree that the live document was a useful resource for conversing with others regarding the assignment. 71.4% strongly agreed that the document worked better with their schedule than a traditional meeting. 62.5% thought a traditional
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
meeting would have been impractical for grading assignments. 62.5% agreed that their fund of medical knowledge increased as a result of referencing the live document.
Conclusions: Graders used the live document on a regular basis and found it to be a helpful learning resource and a time-saving intervention. Take-home message: Live document grading and point-based rubrics facilitate objective measurements of curriculum outcomes and improves learning for students and graders
Integration of clinical cases into preclinical teaching: simulated cases are perceived to be as effective as theoretical case-based seminars
Rebecca Rewbury (University of Oxford, Medicine, New College, Holywell Street, Oxford OX1 3BN, United Kingdom)
Simon Gomberg (The University of Oxford, Medicine, Oxford, United Kingdom)
Shirley Yick (The University of Oxford, Medicine, Oxford, United Kingdom)
Fiona Rhodes (The University of Oxford, Medicine, Oxford, United Kingdom)
Thomas Hine (The University of Oxford, Medicine, Oxford, United Kingdom)
Background: The traditional structure of Oxford and Cambridge medical degrees focuses on biomedical science in the first three years. The Oxbridge Clinical Skills Course for Preclinical Students (OPS) aims to integrate basic science with clinical skills, with particular emphasis on demonstrating the relevance of preclinical knowledge. Previous work has shown that case-based teaching effectively achieves this aim, whereas practical sessions such as suturing are more enjoyable but incorporate preclinical science to a lesser extent. Summary of work: This study aimed to investigate whether a more interactive and hands-on teaching method in the form of simulated emergency scenarios with manikins and dummy medical equipment could be as effective as theoretical methods. 60 students completed 5 sessions: suturing, phlebotomy, cranial nerve examination, differential diagnosis and a new station entitled 'emergency scenarios'. Data was collected using pre- and post-course questionnaires. Summary of results: Prior to the course, students anticipated that theoretical teaching (formulating a differential diagnosis) would better demonstrate the clinical relevance of their preclinical science compared to practical teaching (simulated emergency scenarios) (n=60, p<0.01). However, following completion of the course, theoretical and practical teaching methods were rated equivalent in showing the relevance of preclinical science to clinical medicine.
Conclusions: Despite minimal clinical teaching, students were able to use their basic physiological and anatomical science to deal with simulated clinical scenarios in 'real time'. This hands-on interactive
teaching method was effective in highlighting the application of preclinical science to clinical medicine. Take-home messages: Earlier introduction of practical teaching methods could be used to demonstrate the relevance of basic sciences and sustain students' enthusiasm.
A Novel Case-Based Research Strategy Brings Relevance to Studying Immunology and Clinical Immunology-a Case Study of Contact Dermatitis
Suzana Micova (Faculty of Medicine, University Goce Delcev, Immunology and Clinical Immunology, Stip, Macedonia)
Stojka Vasileva (Clinical Hospital Stip, Department of
Gastroenterology, Stip, Macedonia)
Evica Bojadzieva (Faculty of Medicine, University Goce
Delcev, Immunology and Clinical Immunology, Stip,
Liljana Stevceva (California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA 95757, United States)
Background: It is important to bring relevance to immunology concepts by relating the basic science with clinical outcomes.
Summary of work: This approach was introduced to 57 students that elected Clinical Immunology course. In a group of maximum 3, students were required to shadow a medical doctor and to follow a case of immunologically mediated disease until resolution. A list of immunologically mediated diseases, letter for the medical doctor and blank form for permission to be photographed were provided at the beginning of the course. Results were measured by grading the resulting research paper that contained case description and the immunological mechanisms of the disease that was followed. This activity was optional and could bring up to 15 bonus points (10 points minimum to obtain a pass grade).
Summary of results: This activity was well received by the students. Majority of the students opted to pursue this activity (82.45%). Support was offered from the medical doctor that mentored them in the clinic and faculty at the university. Most of the research papers required at least one correction with about 6% requiring multiple corrections.
Conclusions: Case-Based Research (CBR) achieved bringing case studies early in the curriculum and it combined practical experience, teamwork and learning the basics of writing a research paper. It also brought relevance to immunological concepts as it connected them with real life diseases.
Take-home messages: CBR could be implemented in several pre-clinical courses. Students enjoy it and it is a valuable, active learning experience.
5GG ePosters: Student as Teacher
Location: North Hall, PCC
Approaching the OSCE- A teaching initiative for junior medical students run by senior medical students
Vruti Dattani (University College London, Medical
School, London, United Kingdom)
Tanmay Kanitkar (University College London, Medical
School, London, United Kingdom)
Sindhu Bhaarrati Naidu (University College London,
Medical School, London, United Kingdom)
Elissa Rekhi (University College London, Medical School,
London, United Kingdom)
Owain Donnelly (University College London, Medical School, London, United Kingdom) Patrik Bachtiger (University College London, Medical School, London, United Kingdom)
Background: The recent move to integrated medical school curricula has resulted in teaching clinical skills earlier in the medical course and using Objective Structured Clinical Examinations (OSCEs) for their assessment. However, junior medical students have little exposure to this examination format and thus may feel unprepared. We devised and delivered a novel near-peer teaching initiative for first and second year medical students prior to a newly introduced formative OSCE. This comprised workshops for small groups of students taught by students in their penultimate year focusing on developing a confident, structured and professional approach to OSCE stations.
Summary of work: Students attending rated a number of parameters on a six point Likert scale from 'Very Poor' to 'Excellent'. Tutors were asked for their feedback in a similar manner.
Summary of results: 224 students attended and feedback was positive. 84% of students rated the initiative 'very good' or 'excellent' in reassuring them about the OSCE, while 89% gained confidence in approaching OSCE stations. Of the 83 tutors, 93% rated their experience as 'very good' or 'excellent' and 90% were more confident about teaching afterwards. Conclusions: As integrated curricula become more common, senior students are well placed to use their experiences to benefit junior students. Furthermore these initiatives give senior students an opportunity to develop teaching skills essential for their future career. Our teaching initiative successfully reassured and prepared junior students for their OSCE assessment and had additional benefits for senior students teaching. Take-home messages: As the medical curriculum changes, senior students are a valuable resource in introducing clinical skills to junior students.
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
A randomised study to explore the effect of tutor training on Objective Structured Clinical Examination (OSCE) performance in a large Peer Assisted Learning (PAL) project
Guy Rughani (University of Edinburgh, Medical School, Edinburgh, United Kingdom)
Kate Milner (University of Edinburgh, Medical School, Edinburgh, United Kingdom)
Laura Clifton (University of Edinburgh, Medical School, Edinburgh, United Kingdom)
Valerie Rae (University of Edinburgh, Medical School, Edinburgh, United Kingdom)
Adam Collins (University of Edinburgh, Medical School, Edinburgh, United Kingdom)
Amira Baharin (University of Edinburgh, Medical School, Edinburgh, United Kingdom)
Background: There is currently limited evidence on whether feedback from student tutors improves peer performance in a PAL setting. Aim: Evaluate the effect of training in generic feedback skills given to tutors on the performance of tutees in a validated mock exam station. Summary of work: Year 4 students at Edinburgh University will run a mock OSCE for year 3 students to help them prepare for their professional exam. Each year 3 student will sit 8 stations of 5 minutes and receive 1 minute of feedback from a year 4 tutee after each station. Prior to the event, half of the tutors will be randomly allocated to attend training on how to give good feedback. This will focus on generic feedback skills. The other half will receive an advice sheet on feedback. During the PAL, half of the tutees will consistently be advised by year 4 tutors who have had training, and the other half will consistently have year 4 tutors who have not been trained. The tutees will be blind to the training status of their tutors. After 8 stations, the tutees will sit a validated mock exam station on lower back pain. All tutors will act as examiners on this station and mark according to a consultant-approved scheme. At the end we'll ask the tutees about the feedback they received from the tutors and their perceptions of its quality, investigating if there are any differences between those who had trained versus untrained tutors. Summary of results: Awaiting study completion. Conclusions: Awaiting study completion. Take-home messages: Awaiting study completion.
Using near-peers for curriculum development in global health
Emma Plugge (University of Oxford, Department of Public Health, Old Road Campus, Headington, Oxford
OX3 7LF, United Kingdom)
Karina McHardy (Ko Awatea Auckland, New Zealand) Manisha Nair (University of Oxford, Department of Public Health, Oxford)
Kremlin Wickramasinghe (University of Oxford, Department of Public Health, Oxford)
Sucharita Yarlagadda (University of Oxford, Department of Public Health, Oxford)
Background: Near-peer teachers have a number of benefits for the teachers, the students and the learning environment. Near-peer teachers can provide particular benefits because their similar age and recent experiences mean they have a better understanding of the students' knowledge and thus can teach at an appropriate level.
Summary of work: This initiative used near-peers (doctoral students) to develop a programme of teaching for masters students. Those doctoral students developing the curriculum had graduated from the MSc Global Health Science within the previous three years and had identified a 'gap' in the teaching of practical skills - skills important for their future careers as researchers or policy-makers. They also identified the need for doctoral students to develop teaching skills. Summary of results: The doctoral students delivered a coherent programme of practical skills training for masters students; this included team working, writing, oral presentation, advocacy and debating skills. The masters students valued the training programme and, despite a pressurised course, felt it a worthwhile use of their time. Doctoral students developed not only skills in but also in organisation and leadership. Conclusions: Doctoral students who have recently graduated from a masters programme are in an excellent position to identify the need for changes in the curriculum. With adequate support and resources, they can also deliver the changes thus enriching the learning of the masters' students and developing their own teaching skills.
Take-home messages: Those with responsibility for curriculum development at masters level should regard alumni as an important resource.
A study to explore the effects of anonymity on peer feedback in an integrated clinical anatomy presentation
Kerry Gilbert (Plymouth University, Peninsula Schools of Medicine and Dentistry, 4th Floor - Block C, Portland Square, Drake Circus, Plymouth PL4 8AA, United Kingdom)
Leo Donnelly (Liverpool University, Human Anatomy Resource Centre, Liverpool, United Kingdom) Lee Coombes (Plymouth University, Peninsula Schools of Medicine and Dentistry, Plymouth, United Kingdom)
Background: It is widely recognised that to develop competency in professional skills it is necessary for a student to reflect on his/her behaviour. In order to facilitate reflection, it is important to have constructive feedback on how others (including peers) view that behaviour.
Summary of work: 225 medical students were randomly allocated to groups, half of which were given tuition on how to provide constructive feedback. All students subsequently gave feedback (either anonymously or
ABSTRACT BOOK: SESSION 5 MONDAY 26 AUGUST: 1600-1730
named) on formatively assessed peer presentations. Feedback forms included six Likert-style statements which required marking of a line (extending from 0 to 100) to indicate degree of agreement. Quantitative feedback data was categorized in one of four groups depending on whether it had been given anonymously or non-anonymously, and with or without extra instruction.
Summary of results: Mann-Whitney U-tests were applied to the non-parametric data sets. Students who had been tutored in giving constructive feedback showed significantly improved scoring, which appeared to counter the effect of anonymity. Conclusions: As expected, anonymity allowed students to be more critical of their peers in a formative assessment setting. This effect was, however, ameliorated by prior tuition on how to be constructively critical when giving feedback. It also came to our attention that students giving a presentation were able to positively engage with providers of feedback (when identified).
Take-home messages: Providing appropriate tuition to students on how to give constructive feedback improves the value of the feedback given, while also providing an opportunity for collaborative learning.
Peer tutoring translates to the confidence level in the clinic and is driven by high motivation of the peer tutors
Jetro J Tuulari (The University of Turku, Medical Faculty, Medical Education Research and Development Centre, Kiinanmyllynkatu 10, Turku 20520, Finland) Riina Almgren (The University of Turku, Medical Faculty Medical Education Research and Development Centre, Turku, Finland)
Linus Tornqvist (The University of Turku, Medical Faculty Medical Education Research and Development Centre, Turku, Finland)
Minna Paasioksa (The University of Turku, Clinical Skills Learning Centre, Turku, Finland) Pekka Kaapa (The University of Turku, Medical Faculty Medical Education Research and Development Centre, Turku, Finland)
Outi Kortekangas-Savolainen (The University of Turku, Medical Faculty Medical Education Research and Development Centre, Turku, Finland)
Background: We have implemented peer assisted learning (PAL) in a clinical skills' refreshing course for medical students before their clinical attachment. Each of the peer tutors is trained and assessed by a clinical teacher and they receive structured pedagogical guidance before and after tutoring. Summary of work: We focused on the experiences on tutoring of twelve peer tutors with a semi-structured interview. Data were analyzed qualitatively. Summary of results: All peer tutors reported improvement in their pedagogical and clinical skills, as was expected. Some reported significant translation to clinical competence when they worked as assistant
doctors in clinics the following summer. Motivation to teach was the driving factor for applying to peer tutoring as compared to pre-acquired skill level in a certain topic indicating a strong future motivation to teaching among peer tutors. Peer tutoring promoted collegiality, and was especially valued by the peer tutors. Conclusions: Peer tutors are highly motivated to teaching and learning while tutoring transfers to confidence in clinical work. Peer tutoring offers motivating learning to tutors and tutees alike and would be perfect for scouting skilled future teachers. Take-home messages: Peer tutors are highly motivated and tutoring is a strong learning experience that promotes collegiality.