Автор неизвестен - Mededworld and amee 2013 conference connect - страница 75

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personality. 39(4), 395-422.

4. Cutrona C, Russell D. (1987). The provision of social relationships and adaptation to stress. Advances in Personal Relationships 1, 37-67.

5. Folkman S, Moskowitz JT. Coping: Pitfalls and promise. Annu Rev Psychol. 2004; 55:745-774

7F Short Communications: Assessment: Feedback

Location: Chamber Hall, PCC

7F/1

Evaluating two feedback mechanisms for MCQ exams

David Hope (University of Edinburgh, Centre for Medical Education, The Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom) Kyle Gibson (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom) Helen Cameron (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom)

Background: Students generally regard feedback as essential. Feedback research often focuses on clinical/simulated clinical contexts, but a large proportion of medical assessment is delivered via MCQ exams and students repeatedly request personalised feedback from them. We must develop effective feedback mechanisms for such exams. Summary of work: In a first year cardiovascular module students sat one of two 30 minute formative exams. Group one spent 15 minutes after the exam reviewing their answers and viewing detailed feedback explaining why each option was correct or incorrect. Group two received domain level information on their performance in absolute terms and relative to the class, which they could take away. Three weeks later they sat a second 30 minute formative exam after which all students received domain level information and reviewed their answers. Assignment to the conditions was randomized. Summary of results: Both methods were extremely popular. By comparing performance change across exams we evaluated the efficacy of the techniques. By comparing the results to the previous cohort's performance on the same formative exam - then sat in a single sitting - we could evaluate both against a no-feedback baseline. We are monitoring group performance to see if differences emerge in summative exams.

Conclusions: It is possible to routinely and effectively deliver MCQ exam feedback in a way that is personalized and relevant to students. Take-home messages: Developing robust and cost-effective feedback mechanisms appropriate to MCQ exams is important to improve student satisfaction and increase student performance. The educational impact of such techniques will vary.

7F/2

Clerkship feedback content is focused on 'good points' and lacks specificity

J.M.M. van de Ridder (Albert Schweitzer hospital, Department of Education, P.O. Box 444, Dordrecht 3300

AK, Netherlands)

J.M. van Meeteren (Academic Medical Center, Department of Surgery, Amsterdam, Netherlands)

ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230

R.J. Oostenbroek (Albert Schweitzer hospital, Department of Education, Dordrecht, Netherlands)

Background: Medical schools often demand students to ask frequent for feedback during clerkship. Therefore, supervisors need to fill out a specific form in a feedback note book which belongs to the student. Staff and residents are not always motivated to provide feedback due to time constraints. On the other hand, students do not always ask for feedback. They feel troubled to 'disturb' supervisors. The central question in this study is: given these circumstances how complete are feedback forms filled out, and how specific is the provided feedback?

Summary of work: Feedback note books from 36 students were collected. These students were required to have a total of 292 completed feedback forms. With a mixed method approach the research questions are answered. Instruments were developed a) to determine the completeness of the forms and b) to analyze the specificity of the content of the written feedback. Summary of results: From the required forms 178 (61%) were empty. 74% of the filled out forms were complete. Woman filled out more complete forms. Information about 'good points' was often completely filled out, contrary to information about 'points for improvement' and 'suggestions'. The given feedback points lacked specificity. We found significant differences in specificity among disciplines, gender and seniority (residents -staff) (p <0.05). Female residents gave most specific feedback.

Conclusions: Students could more benefit if they asked more often feedback, and if supervisors put effort in formulating points for improvement and suggestions in a specific manner.

Take-home messages: Completed feedback forms and specific feedback content lead to rich feedback.

7F/3

Factors influencing trainers' feedback-giving behaviour

EAM Pelgrim (Radboud University Nijmegen Medical Centre, Department of Primary Care and Community Care, Postbus 9101; Huispostnummer 117, Nijmegen

6500 HB, Netherlands)

AWM Kramer (Radboud University Nijmegen Medical Centre, Department of Primary Care and Community Care, Nijmegen, Netherlands)

HGA Mokkink (Radboud University Nijmegen Medical

Centre, Department of Primary Care and Community

Care, Nijmegen, Netherlands)

CPM Van der Vleuten (Maastricht University, SHE School

of Health Professions Education, Maastricht,

Netherlands)

Background: The literature provides some insight into the role of feedback givers, but little information about factors influencing 'feedback-giving behaviours'. We looked for relationships between characteristics of feedback givers (self-efficacy, task perception, neuroticism, extraversion, agreeableness and

conscientiousness) and elements of observation and feedback (frequency, quality of content and consequential impact).

Summary of work: We developed and tested several hypotheses regarding the characteristics and elements in a cross-sectional digital survey among GP trainers and their trainees. We conducted bivariate analysis using Pearson correlations and performed multiple regression analysis.

Summary of results: Sixty-two trainer-trainee couples from three Dutch institutions for postgraduate GP training participated in the study. Trainers' task perception and neurotic personality correlated positively with frequency of feedback and quality of feedback content. Multiple regression analysis supported positive correlations between task perception and frequency of feedback and between neuroticism and quality of feedback content. No other correlations were found.

Conclusions: This study contributes to the literature on feedback giving by revealing factors that influence feedback-giving behaviour, namely neuroticism and task perception. Trainers whose task perception included facilitation of observation and feedback (task perception) and trainers who were concerned about the safety of their patients during consultations with trainees (neuroticism) engaged more frequently in observation and feedback and gave feedback of higher quality.

Take-home messages: Trainers with a more neurotic personality and trainers with a task perception towards the organization of observation and feedback observe more and give better

7F/4

Engaging with Constructive Feedback when Separated from Summative Assessment: The RHIME Experience

Andrea Gingerich (University of British Columbia, Northern Medical Program (UNBC), University of Northern British Columbia, 3333 University Way, Prince George, British Columbia V2N 4Z9, Canada) Stephane Voyer (University of British Columbia, Internal Medicine, Vancouver, Canada)

Joanna Pedersen (University of British Columbia, eHealth Strategy Office, Vancouver, Canada) Kendall Ho (University of British Columbia, eHealth Strategy Office, Vancouver, Canada)

Background: Medical faculty and trainees report difficulty engaging in the exchange of constructive feedback while simultaneously validating its importance and promoting its increased use. Summary of work: Qualitative content analysis of focus group transcripts was used to explore the experience of third year medical students receiving feedback as part of a pilot project named RHIME (Remote Hands-On Interactive Medical Education). Focus groups were conducted as part of the evaluation of this design-based research project developed to provide medical students completing a 12 month longitudinal integrated clinical

ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230

clerkship under the supervision of rural family medicine doctors in remote regions with access to clinical skills feedback from university-based general internists. Summary of results: Students described four properties of the project that may have supported the ongoing exchange of constructive feedback. These include 1) deliberate practise during dedicated practice time separate from clinical duties 2) the use of videos to exchange feedback 3) a dedicated coach with the sole role of providing formative feedback on clinical skills and 4) exclusively formative feedback. Conclusions: Students willingly engaged in the exchange of constructive feedback when its focus was on developmental improvement as part of a longitudinal relationship with non-supervisory faculty. Future research could explore the conflation of summative and formative assessment in our curricula designs as a contributing factor to the pervasive dissatisfaction with the exchange of constructive feedback by both trainees and faculty.

Take-home messages: Students welcomed constructive clinical skills feedback but opposed combining formative feedback with summative assessment.

7F/5

Skype as a tool to provide feedback to resident learners

Erik Langenau (National Board of Osteopathic Medical Examiners, Continuous Professional Development and Innovations, Philadelphia, United States) Elizabeth Kachur (Medical Education Development, Medical Education, 201 East 21st Street, Suite 2E, New York 10010, United States)

Dorothy Horber (National Board of Osteopathic Medical Examiners, Continuous Professional Development and Innovations, Philadelphia, United States) John Gimpel (National Board of Osteoapthic Medical Examiners, Executive Offices, Philadelphia, United

States)

Background: Providing feedback to learners after completing Standardized Patient (SP) exercises is a common practice in medical education. Written and verbal feedback have been the traditional methods for providing feedback.

Summary of work: The National Board of Osteopathic Medical Examiners (NBOME) has developed a formative assessment of communication skills using Remote Standardized Patients (RSPs) and a web-based communication interface (Skype). Each encounter includes a 15-minute doctor-patient communication task using Skype, a 5-minute self-assessment exercise, and a 10-minute debriefing and verbal feedback exercise. The program was pilot tested with 59 resident physicians from around the United States, each of whom completed four cases, totaling 236 encounters. After program participation each study participant (RSPs and residents) completed a 53-item web-delivered questionnaire and participated in focus group discussions.

Summary of results: Ninety-nine percent of residents agreed or strongly agreed that receiving feedback via Skype was valuable. During 10 resident focus groups it was consistently viewed as the most valuable aspect of the program. RSPs reported that the web-based format for providing feedback was effective in their focus group, and RSPs revealed some challenges they encountered as well as opportunities. Conclusions: User acceptance for this web-based communication exercise using RSPs was high, and both resident and RSP participants valued the feedback component. Such e-learning initiatives may benefit students, residents and practicing in the future. Take-home messages: As a web-based communication tool, Skype provides a potential tool for providing effective feedback to learners after completing communication exercises.

7G Short Communications: The Curriculum

Location: Conference Hall, PCC 7G/1

Assessment of a Biomedical Informatics course for medical students at UNAM Faculty of Medicine in Mexico

Melchor Sdnchez-Mendiola (UNAM Faculty of Medicine,

Medical Education, Facultad de Medicina de la UNAM.

Secretaria de Educacion Medica. Edif. B, 3er Piso, Ave.

Universidad 3000. Ciudad Universitaria. Col. Copilco.,

Distrito Federal 04510, Mexico)

Adrian I. Martinez-Franco (UNAM Faculty of Medicine,

Biomedical Informatics, Mexico City, Mexico)

Fernando Flores-Hernandez (UNAM Faculty of Medicine,

Medical Education, Mexico City, Mexico)

Fabian Fernandez-Saldivar (UNAM Faculty of Medicine,

Biomedical Informatics, Mexico City, Mexico)

Gumaro Cano-Gutierrez (UNAM Faculty of Medicine,

Biomedical Informatics, Mexico City, Mexico)

Adrian Martinez-Gonzalez (UNAM Faculty of Medicine,

Medical Education, Mexico City, Mexico)

Background: Biomedical Informatics (BMI) is an emerging discipline that is starting to be incorporated in medical training programs. There are few published experiences of implementation and assessment of BMI courses in medical schools. UNAM Faculty of Medicine in Mexico is the largest medical school in Latin America, and has included BMI in its undergraduate program. Summary of work: Two one-semester courses (BMI-1 and BMI-2) were designed for the first two years of the curriculum. BMI-1 includes core conceptual notions and practical aspects of informatics applied to medicine (medical databases, electronic health record, telemedicine, among others), and BMI-2 embodies medical decision making and clinical reasoning. This study reports an assessment of the 2012 BMI-2 course with a one-group pretest-posttest knowledge exam and an opinion questionnaire. The test was a 40-item multiple-choice question instrument, which included mostly items targeted to application and problem-solving levels.

Summary of results: This paper focuses on the assessment of the 2012 BMI-2 course, which was one semester long, with 16 two-hour sessions. We used a blended-learning model, with 60 teachers and 1,160 students in 41 groups. Pre-post test assessment of knowledge showed an improvement (Cohen's d effect size=1.6). The program had a positive evaluation by students and teachers.

Conclusions: Health care professionals need to acquire BMI competencies, this report shows that a BMI course increases knowledge and produces a satisfactory educational experience in medical students. Take-home messages: BMI teaching in medical schools is necessary, formal courses need to be developed, integrated in the curriculum and evaluated. Effective use

ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230

of BMI concepts is essential for modern healthcare professionals.

7G/2

In the Name of Health: Doctors' advocacy on behalf of the vulnerable

Cristian Rangel (University of Toronto, Sociology, 725 Spadina Avenue, Toronto, Ontario, Canada M5S 2J4; The Wilson Centre, 200 Elizabeth Street, 1ES-565, Toronto, Ontario, Canada M5G 2C4)

Background: While health advocacy is one of the seven core roles Canadian physicians are expected to fulfill, it is to conceptualize, quantify, and teach. A literature review was conducted to trace the emergence of health advocacy in medical practice and to identify ways in which the advocate role is utilized by academics, physicians, and the public.

Summary of work: Utilizing the FACTIVA database and searching for key terms (doctor*/physici* AND adcoca*/activis*) the author identified and collected all newspaper articles referring to or interviewing physician advocates in Canada (1984-2012). Using qualitative analysis software (INVIVO10) to organize the data, the author analyzed the content of the newspaper articles and identified the ways in which the advocate role appears in public discourse and academic debates Summary of results: The emergence of the Advocate Role in the Canadian medical education context can be traced to the early 1980s. The definition and scope of doctors' advocacy work has been heavily debated in medical journals. Health Advocacy work, when woven into medical practice, has the potential to blur the lines between the performance of scientific and professional expertise and the personal political positions of physicians. Yet, it is a source of social legitimacy. Conclusions: Through targeted political action and the active exercise of citizenship, physicians enhance the social legitimacy of their profession. Advocacy work establishes direct links between the profession and society by serving as a source of practical expertise for social ills.

Take-home messages: Physicians' participation in social causes enhances both public discourse and the profile of the profession in society.

7G/3

Prescribing in practice: the impact of simulated prescribing once students become doctors

A Hawkins (Great Western Hospital, Academy, Marlborough Road, Swindon SN3 6BB, United Kingdom) VM Taylor (Great Western Hospital, Academy, Swindon, United Kingdom)

M Masiello (Great Western Hospital, Academy, Swindon, United Kingdom)

G Woodfield (Great Western Hospital, Academy, Swindon, United Kingdom)

K Jones (Great Western Hospital, Academy, Swindon, United Kingdom)

AE Stanton (Great Western Hospital, Academy, Swindon, United Kingdom)

Background: Many newly qualified doctors lack confidence in prescribing and a recent GMC investigation found an 8.4% error rate. In 2011-12, a series of simulated prescribing tutorials were delivered to a cohort of final year medical students; there was a reduction in prescribing errors and improved prescribing confidence). The aim of this study was to assess the impact of the tutorials now these individuals are prescribing in practice.

Summary of work: Of the 35 students who undertook the tutorials, we contacted those for whom we had a forwarding email address (n=23) with an online questionnaire. There were 13 respondents (57%), all of whom were practicing as junior doctors. Questions comprised semantic differential scales and free text boxes. We also collected confidence scores from 11 FY1 doctors who had not received the tutorials. Descriptive statistics and qualitative analyses were performed. Summary of results: Mean scores for the impact of the tutorials on prescribing confidence and safety were 5.2/7 and 5.8/7 respectively. For anaphylaxis, confidence was higher amongst FY1 doctors who had received the tutorial compared to those who had not (p=0.008). For the other topics, there was a trend in this direction (p=0.068-0.926). Qualitative analysis showed that students were less confident with drug interactions and prescribing in renal failure. Conclusions: Use of simulated prescribing tutorials during the final year of medical school improved prescribing confidence amongst newly qualified doctors. Take-home messages: Low-fidelity simulated prescribing tutorials create a safe and effective environment in which to practice this key skill.

7G/4

Implication of Evidence-Based Medicine into Health Promotion Teaching Block for Medical Students

Tippawan Liabsuetrakul (Prince of Songkla University, Epidemiology Unit, Faculty of Medicine, Hat Yai 90110, Thailand

Panumad Pornsawat (Prince of Songkla University, Division of Medical Education, Faculty of Medicine, Hat Yai, Songkhla, Thailand)

Thitima Suntharasaj (Prince of Songkla University, Obstetrics and Gynecology, Faculty of Medicine, Hat Yai, Thailand)

Pasuree Sangsupawanich (Prince of Songkla University, Pediatrics, Faculty of Medicine, Hat Yai, Thailand) Chanon Kongkamol (Prince of Songkla University, Community Medicine, Faculty of Medicine, Hat Yai, Thailand)

Background: Evidence-based medicine (EBM) is well-known among health professionals for their practices. Although health promotion is promoted worldwide, there is a debate whether EBM is needed in health promotion. This study aimed to assess the utilization of

ABSTRACT BOOK: SESSION 7 TUESDAY 27 AUGUST: 1045-1230

EBM into health promotion block among medical students.

Summary of work: A comparative study was conducted among the 4th-year medical students in 5-week health promotion block at Prince of Songkla University, southern Thailand. All 135 students were divided into two groups: one-week EBM integrated in the first week of block (1st group) and in the last week (2nd group). Self-reported questionnaire including knowledge and skills in terms of questioning health problem, searching evidence and appraising identified evidence and the application of EBM into health promotion and in future practices was rated by medical students before and after EBM. Sixteen faculty members evaluated the student's group presentation of their project on health promotion at the end of block. All evaluation items were rated into from 1 (lowest) to 5 (highest). Data were analyzed using t test or wilcoxon test as appropriate. Summary of results: Baseline self-report by students before EBM between two groups were similar. Knowledge and skills on EBM and application of EBM into health promotion block and future practices were increased significantly (p<0.001). Both groups of students did not rate differently. Faculty members rated higher scores for the 1st group than the 2nd group for topic of interest, searching for evidence-based information, critical appraisal of evidence before using it and their applied knowledge but the significant difference could not be identified. Conclusions: Evidence-based medicine was useful not only in clinical practices but also in health promotion. Future development and evaluation of well-assessed tools for its application is required. Take-home messages: Evidence-based medicine was useful not only in clinical practices but also in health promotion.

7G/5

Impact of an Evidence Based Medicine curriculum focused on inquiry and searching in a medicine clerkship

Champica Bodinayake (University of Ruhuna, Department of Medicine, Galle 8000, Sri Lanka) Lauren Maggio (Stanford University School of Medicine, Lane Medical Library, Stanford, United States)

Background: Evidence Based Medicine (EBM) is a common component of medical curriculum. Yet, research has demonstrated limited curricular coverage of EBM's first two steps: formulating clinical questions and literature searching, which are essential to engage

in EBM.

Summary of work: At University of Ruhana, Sri Lanka we designed and implemented a 10-hour interactive EBM module held over several weeks to develop clerkship students' inquiry and search skills. Prior to training, students completed a portion of the inquiry component of the Fresno Test and completed an 11-question EBM knowledge, skills and attitudes questionnaire. During training, students were prompted to formulate questions related to their patients and to search for

applicable evidence. Found evidence was assessed using the Fresno Test guidelines for literature searching. Post training, students re-took the Fresno Test inquiry component and questionnaire.

Summary of results: Sixty-four students completed the preliminary survey, the module and post-test. Following EBM training, all students reported increased skill in formulating clinical questions and 97% felt competent searching for evidence. These self-evaluations were confirmed by empirical measures. Pre and post mean scores, (out of maximum 3) 1.02 (SD.24) and 2.45(SD.74)(P <0.001). Fifty-eight students (90%) completed literature search and 78% achieved competency. Ninety-eight percent of students reported feeling motivated to use EBM presently and in the future.

Conclusions: This EBM training module, focusing on clinical question formulation and literature searching, increased students' confidence in their clinical inquiry and search skills. Development of EBM education should include targeted training in these key domains.

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