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Newly appointed leaders in academic medicine often are unprepared for administrative challenges. This symposium will: 1) examine practices that contribute to able academic leadership, 2) outline personal characteristics and skills of successful leaders, and 3) offer strategies to nurture new leaders. Citing relevant literature and providing examples in the form of "pearls" or brief experiences, seasoned administrators will describe ways that leaders in academic medicine can best communicate and promote the missions of an institution, relate to students and faculty, implement change, manage the budget, and interact with the community and society, all in a manner that advances the institution.
7C Short Communications: Continuing Professional Development
Location: Panorama, PCC 7C/1
"Journal Based Blogs"- Is this the future of medical publications?
(Miriam Friedman Ben-David 2012 Award Winner Presentation)
Kenar D Jhaveri (Department of Medicine, Hofstra North Shore LIJ School of Medicine, Great Neck, NY) Vinay Nair (Icahn School of Medicine at Mount Sinai,
New York, NY)
Background: Young physicians and students are more comfortable viewing online publications and often prefer online educational material to print. To serve this growing change, most journals have created web sites enabling their readers to view publications online. As the need for an ongoing evaluation process grows, some journals have begun creating web logs or "blogs" and allowing public commentary on web sites, which allows readers to express opinions on publications and share them with colleagues.
Summary of work: We reviewed all biomedical journals with an impact factor >=4 (Journal Citation Report, 2010) for the use of web sites, blogs, commentary sections, and social media. A summary list of all journals was sorted by impact factor. Each journal web site was accessed and reviewed for a blog; for Twitter, Facebook, or e-mail sharing; and for a comments section. Summary of results: Out of 588 biomedical journals with impact factor >=4 reviewed, 9% of the journals had a blog. The option of direct commenting after an article was present only in 8% of journals while 90% utilized social media or email for sharing. Only mere 2% of journals offered all three features: commentary section immediately after the article, a blog and social media features. General internal medicine journals were more likely to have a blog and commentary section compared to specialty journals.
Conclusions: Only a small percentage of biomedical journals had a blog. Journal based blogs have started but still have a long way ahead for impact on education and readership.
Take-home messages: Allowing sharing and readers to comment directly after an article or in a journal based blog, will allow better discussion of published manuscripts, facilitate ongoing peer review, and encourage interaction between authors and readers. Journal blogs might provide that avenue for readers and authors.
ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230
Can the reasons why clinicians use PubMed or UpToDate inform education in Evidence Based Practice? A qualitative analysis
Lauren Maggio (Stanford University Medical Center, Lane Medical Library, 300 Pasteur Drive, Room L-109, Stanford 94305, United States)
Olle ten Cate (University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, Netherlands)
Feikje van Stiphout (University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, Netherlands)
Edith ter Braak (University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, Netherlands)
David Irby (University of California, San Francisco, Medicine, San Francisco, United States) Bridget O'Brien (University of California, San Francisco, Medicine, San Francisco, United States)
Background: To engage in evidence-based practice (EBP), physicians must locate evidence. Whereas EBP curricula traditionally train physicians to search for evidence via PubMed, physicians use a variety of resources in EBP, including the popular resource UpToDate. Little is known about why physicians select particular resources such as PubMed or UpToDate to guide clinical care.
Summary of work: We conducted semi-structured interviews of physicians in the United States (n=13) and The Netherlands (n=9), eliciting participant's reasons for using PubMed and UpToDate and perceived usefulness of these resources. Interviews were recorded, transcribed and analyzed using thematic analysis. Initially two researchers reviewed all transcripts and, using open coding, identified codes related to resource selection. Codes were vetted by four additional researchers for appropriateness, then applied to all transcripts.
Summary of results: Participants in both countries similarly described PubMed and UpTodate and reasons for selecting resources. We identified seven reasons for using PubMed and UpToDate, including: to refresh knowledge, confirm knowledge, undertake research, answer logistical questions, teach, generate ideas and support personal learning. Our analysis revealed that participants' perception of each resource's usefulness also influenced resource selection. Conclusions: Physicians seeking evidence select PubMed and/or UpToDate based on their reason for seeking information and on perceived fit with the strengths and limitations of each resource. Physicians' reasons and perceptions are currently not incorporated into EBP education. Our findings challenge traditional EBP curricula, which focus on PubMed, and suggest a broadening of information resource training to prepare learners with evidence retrieval skills synchronized with the realities of clinical practice.
Perceived Value of CME systems in meeting the Learning Needs of Orthopaedic Surgeons in Community Hospitals
Peter de Boer (AO Foundation, AO Education, Stettbachstrasse 6, Dubendorf 8600, Switzerland) Michael Cunningham (AO Foundation, AO Education, Dubendorf, Switzerland)
Background: As a response to concerns of patients and employers educational systems have been set up in many countries to ensure that medical practitioners are up to date. These systems require doctors to accumulate points by participation in CME accredited events. Data relating to the effectiveness of such schemes is limited. Summary of work: 54 consultant orthopedic surgeons and 10 hospital managers were interviewed in 10 different countries to identify the educational needs and preferences of surgeons in community hospitals. Details of the formal CME requirements for these surgeons were obtained in nine of these countries. Summary of results: Nearly all surgeons interviewed are either unaware of CME regulations or feel they are unimportant. Non-CME accredited education provided by commercial companies is highly valued by surgeons when they wish to introduce new technologies. Conclusions: Doctors usually look for education to enable them to solve clinical problems .The study suggests that meeting CME requirements is not important to orthopedic surgeons and that policies to ensure high medical standards may need to focus more on the effectiveness of education than the presence of a surgeon at a CME accredited event. Orthopaedic surgeons in community hospitals do not base their educational choices on the grounds of CME accreditation.
Take-home messages: Existing systems of ensuring that doctors practice safely are not perceived to be of high value by surgeons working in community hospitals.
A guide to inter-professional continuing professional development
Claude Guimond (Federation des medecins omnipraticiens du Quebec (FMOQ), Continuing Education, 2, Place Alexis Nihon, 3500 boul. De Maisonneuve Ouest, Bureau 3500, Westmount H3Z 3C1, Canada)
Martin Labelle (FMOQ, Continuing Education, Montreal, Canada)
Daniel Paquette (FMOQ, Continuing Education, Montreal, Canada)
Background: The Quebec primary care model for chronic disease management is transforming. General practitioners, nurses, pharmacists and other health care professionals are embedded in Family Medicine Groups (GMF) and other community health care organizations to work in in an environment of inter-professional
ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230
collaboration (IPC).The current perception that interprofessional continuing professional development (IPCPD) is designed for the lowest knowledge common denominator must change. IPCPD should be designed to facilitate team collaboration as well as to improve the health care continuum, patient care and security. As well, the IPCPD model should improve satisfaction among the healthcare team.
Summary of work: The FMOQ has partnered with Eli Lilly Canada's medical education department to form a working group with the following objectives: develop a guide with key principles to IPCPD activity creation; define the legal implication of IPC; elaborate and apply key principles in the creation of IPCPD; respect the adult learning cycle; propose tools for the development and the evaluation of IPCPD with the aim of enhanced patient care. Methodology: An extensive literature search has been performed. The keys principles developed were validated by an IPC group. The guide was reviewed by an experimented IPCPD provider. Summary of results: 11 key principles were identified: 1.Identify the target audience; 2.Identify the team and the population needs; 3.Develop learning objectives; 4.Adapt the learning format to the working environment; 5.Target content to patient needs; 6.Integrate communication skills; 7.Negotiate and share roles and responsibilities; 8.Promote a process of shared decision making; 9.Prevent and resolve conflict; 10.Appoint a leader; 11.Assess and respond. Conclusions: In the context of changing Quebec's primary care model, the guide will promote the development of IPCPD and improve team inter professional collaboration, thus enhancing patients care. Take-home messages: IPCPD improves the IPC and then health care continuum, patient care and safety. The conception of an IPCPD activity should respect the 11 identified key principles.
Plastic dolls and all the other stuff: a case study of learning and emergency preparedness in 6 primary care GP practices in South London
Huon Snelgrove (St George's Healthcare NHS Trust, Education and Development, Blackshaw Road, London SW17 0QT, United Kingdom) Britta Mitthoff (St George's Healthcare NGS Trust, Anaesthesia, London, United Kingdom) Mark Fleet (St George's Healthcare NHS Trust, Anaesthesia, London, United Kingdom) Nicholas Gosling (St George's Healthcare NHS Trust, Education and Development, London, United Kingdom) Vaughan Holm (St George's Healthcare NHS Trust, Education and Development, London, United Kingdom) Clarissa Carvalho (Guy's and St Thomas' NHS Foundation Trust, Anaesthesia, London, United Kingdom)
Background: Evidence shows that most general practices have at least one emergency presentation per year. We developed a simulation-based learning (SBL) programme for GP practice staff which we delivered to 6
primary care practices in South London. The aim of this study was to use SBL technologies to probe practice response to emergencies and to explore and evaluate changes in practices emerging after a cyclic learning collaboration between hospital staff and practice staff. We drew on contemporary theories of work-place learning to sharpen our analysis of impact. Summary of work: We worked at 2-month intervals with 42 clinical and non-clinical staff in 6 primary care GP practices in South London (UK). We analysed: Video documentation of simulation exercises; developmental SMART plans from each practice after every cycle; field notes from hospital clinical facilitators; pre and post primary care safety questionnaire (SAQ).; 4 focus group interviews with clinical and non-clinical staff. Summary of results: Practices initially overstated their 'readiness' to respond to emergencies in mandatory UK Quality Outcomes framework. This framework appears insensitive to the ideas of emergency preparedness emerging from the collaboration. Perceptions of safety and teamwork in the practices increased significantly. Conclusions: We related our observations and data to mandatory legal frameworks for primary care and individual practice self-assessments and identified a number of inconsistencies and contradictions. Take-home messages: Non-optimal levels of emergency preparedness were common in large practices. Contemporary theories of work-place learning are useful to conceptualize how SBL can probe preparedness and expand notions of learning.
Continuing professional development: Learning that leads to changes in individual and collective clinical practice
Stephen May (Royal Veterinary College, LIVE Centre, Hawkshead Lane, North Mymms, Hatfield, Herts, AL9 7TA, United Kingdom)
Tierney Kinnison (Royal Veterinary College, University of London, LIVE Centre, Hatfield, United Kingdom)
Background: Traditional continuing professional development (CPD) has often failed to produce changes in professional practice, or patient benefits. The RCVS Certificate in Advanced Veterinary Practice (CertAVP) has tried to address this through a combination of individually selected elements, assessed through reflective essays, each receiving personal feedback. The aim of this project was to explore the effectiveness of learner centred CPD on professional practice, through the CertAVP final summary essays. Summary of work: Twelve essays were selected for content analysis, and independently coded. At an initial meeting, content, behavioural and outcomes-related codes were identified, revealing parallels with Kirkpatrick's hierarchy for educational programme evaluation. Therefore, a matrix was developed for further directed coding of areas of practice against learning, changes in behaviour, and practice/patient benefits.
Summary of results: The effect of this CPD can be understood through a framework of "stakeholder" dynamics, with impact and at the individual level having an effect on practice team behaviours, leading to patient benefits. Dominant themes at the individual level were communication and the learning process. Emergent themes at the level of the practice team focused on how people and systems-related factors affected standards, motivation and performance to the benefit of the practice team, business performance and client satisfaction.
Conclusions: Exploration of the RCVS CertAVP, learner-centred approach to CPD has demonstrated that learner choice of material, together with iterative developmental feedback (assessment for learning) can lead to meaningful learning, changes in practice and benefits for animals and their owners. Take-home messages: Appropriately structured CPD can lead to meaningful learning in terms of changed behaviours of clinicians.
7D Short Communications: Social
Accountability Location: Meeting Hall IV, PCC
Medical students and social accountability
Chivaugn Gordon (University of Cape Town, Obstetrics & Gynaecology, 10 Livingstone Road, Claremont, Cape Town 7708, South Africa)
Background: Social accountability is a prerequisite for all Faculties of Health Sciences. There is considerable literature acknowledging this and encouraging institutions to increase their efforts to implement change to create socially responsive graduates. Lack of exposure to 'coal face' primary health-care situations may be restricting students' growth in developing greater social awareness and responsiveness. One way to accomplish this could be through participation in student-run volunteer clinics. These clinics reflect the shift in students' training from hospital-based to more student-centred, community-based learning. Summary of work: The University of Cape Town is exploring students' attitudes to student-run, volunteer, after-hours clinics, which take place in under-serviced and disadvantaged areas. Method: Purposively selected focus groups are being undertaken to gauge the motivations behind students' volunteering to attend the Students' Health and Welfare Community Organisations (SHAWCO) clinics. These clinics take place in informal settlements around Cape Town. The focus groups will assess students' attitudes to this constructivist, and potentially transformative learning experience. Summary of results: Data from the interviews about students' attitudes and perceptions of their personal growth and clinical acumen gained from clinic attendance will be presented in quantitative and qualitative format. The pilot study has already indicated a considerable growth in altruistic pride through attendance at the clinics.
Conclusions: Undergraduates who volunteer to serve in clinics set up by fellow students find the experience formative, and that the experience fulfils a significant role in promoting social accountability in their education.
Take-home messages: Student-run clinics have the potential to promote social accountability in the medical curriculum.
Are we selecting medical students who will provide socially accountable health care?
Robin Ray (James Cook University, Medicine and Dentistry, Building 39, Townsville 4811, Australia) Louise Young (James Cook University, Medicine, Townsville, Australia)
Background: The doctor to population ratio in rural areas is in inverse proportion to health status in many
ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230
countries. The School of Medicine at James Cook University has a philosophy of social accountability, purposively recruiting students from rural areas and screening applicants through interview. Medical students are selected from a wider pool than those with high academic scores from urban settings. Summary of work: As part of a review of selection processes, we explored knowledge and understanding of rural medical practise among beginning medical students. Data were collected from 77 first year students undertaking an academic writing exercise. Data were coded and thematically analyzed then compared with interview data from 10 rural GP registrars in-training.
Summary of results: Beginning students and GP registrars in-training expressed many similar conceptions of rural practise including community engagement, access to resources and services, and job satisfaction. Variations occurred in perspectives on isolation, financial issues and personality characteristics needed to succeed as a rural practitioner. Beginning students displayed little insight into solutions or compensatory factors.
Conclusions: While selection criteria may enable choice of candidates with the innate character traits predisposing graduates to work in rural areas, the degree program needs to provide opportunities to nurture these inclinations. Social accountability in curriculum design and delivery including clinical mentoring are critical factors. Selection including rurality and personality characteristics coupled with placement support is more likely to meet workforce needs for rural and remote populations. Take-home messages: Ability as well as intent to practise socially accountable medicine is an important factor in selection and cultivation of medical students.
The impact of a new medical school on primary care in its locality
Robert K McKinley (Keele University, School of Medicine, David Wetherall Building, Keele ST5 5BG, United Kingdom)
Maggie Bartlett (Keele University, School of Medicine, Keele, United Kingdom)
David Blanchard (Keele University, School of Medicine, Keele, United Kingdom)
Simon Gay (Keele University, School of Medicine, Keele, United Kingdom)
Sheena Gibson (Keele University, School of Medicine, Keele, United Kingdom)
Robert Jones (Keele University, School of Medicine, Keele, United Kingdom)
Background: Keele University School of Medicine has an innovative new curriculum with a strong focus on the community, primary care and general practice: all our students spend a minimum of 113 days in general practice placements in years 3, 4 and 5 of which 75 days are in the final year. We now describe the impact of the School on general practice in our area.
Summary of work: We collated data on the list size of current teaching practices, county populations and the investment in practice quality and premises development.
Summary of results: We currently have 100 active teaching practices: 86 in Staffordshire and Shropshire, the rest in 6 neighbouring counties or cities. 31% of 279 practices in Staffordshire and Shropshire teach. Our active teaching practices provide primary medical care for 802,857 people: 714,272 are registered with practices in Staffordshire and Shropshire which represents 45% of the counties' population. We have invested in the premises of 25 practices which provide services for 208,047 or 13% of people living in Staffordshire and Shropshire. In the academic years 2010 to 2012 we conducted 194 practice development visits and provided 27 half days of general practices tutor development activity.
Conclusions: Our School has made a major impact in Staffordshire and Shropshire and beyond by investing in the premises and skills of practices which serve a large proportion of the population. Take-home messages: A medical school can have an influence on medical practice beyond that in its associated teaching hospitals.
Social Accountability: hearing community voices
Lionel Green-Thompson (University of the Witwatersrand, Centre for Health Sciences Education, Faculty of Health Sciences, 7 York Road, Parktown 2193, South Africa)
Background: Social accountability of educational institutions has been defined as responding to defined communities' needs in the area of research, service and education (Boelen and Heck 1995). The Lancet Commission has recommended the transformation of educational programmes in the health professions to produce graduates which are change agents responsive and accountable to the communities which educate them and in which they are called to serve. There is little data from communities in South Africa about their expectations of medical practitioners. Medical students at Wits University have contact with communities in three provinces.
Summary of work: Focus groups were held in several communities in which Wits medical students have clinical clerkships. These groups were selected together with the coordinators of the community sites and included young people, traditional healers and older members of the community. The numbers in each group varied from six to twelve participants. Group discussions were conducted in the vernacular of that region with the aid of an interpreter.
Summary of results: Three main themes have emerged from the focus group discussions: doctor - patient relationships (Participants have negative experiences with doctors in the public sector. They report more positive experiences in private sector), respect and love (For many participants, social accountability of doctors is
ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230
the expectation that doctors treat them with "respect and love") and identification of health priorities (both social determinants and medical conditions described) Conclusions: Communities are able to define their health priorities. They expect doctors to treat them with respect as part of their accountability. Take-home messages: There is a need for increasing the active involvement of communities in developing the definitions of social accountability.
Measuring Social Accountability
David Marsh (Northern Ontario School of Medicine, Community Engagement, 935 Ramsey Lake Road, Sudbury, ON P3E2C6, Canada)
Background: Social Accountability (SA) has been gaining attention as an obligation for health professional schools over the past 20 years. Defined by the WHO in 1995, the concepts have been developed and elaborated both by the Global Consensus on Social Accountability and the Training for Health Equity Network (THENet). Summary of work: As interest in SA has grown, there has been a need identified to articulate how to measure progress towards this aspirational goal. THENet is a collaboration of health professional schools with an explicit SA mandate. These schools have developed an evaluation framework to guide self-assessment of schools of SA. More recently AMEE has launched the ASPIRE initiative including a SA category. Summary of results: NOSM was a founding member of THENet and participated in the pilot of the SA Evaluation Framework. NOSM also was a pilot site for ASPIRE in SA. This presentation will compare and contrast the two pilot processes with a view to lessons learned. Take-home messages: Tools for evaluation of SA must be tailored to the context of the school, the goal of evaluation and take into account the processes and values of SA.