Автор неизвестен - Mededworld and amee 2013 conference connect - страница 82

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Lisa Roth (Marburg University, Department of General Practice/Family Medicine, Marburg, Germany) Stefan Boesner (Marburg University, Department of General Practice/Family Medicine, Marburg, Germany) Norbert Donner-Banzhoff (Marburg University, Department of General Practice/Family Medicine, Marburg, Germany)

Background: A general practice and family medicine rotation is mandatory as part of undergraduate medical education in Germany. However, little is known about student-teacher interaction which takes place in this setting. We aimed to gain quantitative and qualitative information concerning various points of interest. The level of student involvement in patient consultation is one of them.

Summary of work: From April to December 2012 two researchers collected structured field notes of 410 individual patient consultations in twelve teaching practices associated with Marburg University, Germany. Informed, written consent was provided by all participants. For the categorization of student involvement, we developed a multi-step hierarchical scale from passive to different modes of active involvement. Multiple categorizations were possible. Summary of results: Passive student attention was the most common mode of teaching, occurring in 78.3% of all consultations. Allocation of single tasks or demonstration of findings by the GP occurred in 50.7%, and some form of student consultation in 32.2% of observed cases. Student consultation under direct GP supervision occurred in just 5.9% of consultations. Conclusions: Whereas most consultations during the family medicine rotation include passive student behavior, direct supervision of student consultation is scarce. This leads to the question whether GPs would benefit from further training in this area. Take-home messages: Passive attention is currently the most frequent, and supervised consultation the rarest mode of student involvement during the family medicine rotation.

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Integrating curriculum: the experience of a construct in medical school in Brazil

Helena Chini (Unifenas, Physiology, Rua Padre Joao Batista, 600, Rod. MG179 Km0 Campus Universitario Sala 610, Alfenas 37130-000, Brazil)

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

Miriam Graciano (Unifenas, Public Health, Alfenas, Brazil)

Eliana Amaral (Unicamp, Obstetrics and Gynecology, Campinas, Brazil)

Maria de Lourdes Negrao (Unifenas, Public Health, Alfenas, Brazil)

Renata Santinelli (Unifenas, Medical Humanities, Alfenas, Brazil)

Patricia Oliveira (Unifenas, Public Health, Alfenas, Brazil)

Background: Community-based learning is a pedagogical strategy for curricular integration. It helps to develop skills and attitudes, to promote teamwork and to understand determinants of health. Summary of work: In 2011, we started to integrate contents from 1st term, through discussion in small groups about their experience in primary health care. At the end of the each term the activity is evaluated by the students using a structured questionnaire, observing

Kirkpatrick level 1 (2010).

Summary of results: Students consider the strategy appropriate, highlighting: the relevance of education (82.1%), improvement of clinical reasoning (81.7%); integration of promotion, prevention, reasoning clinical, diagnosis and treatment (78%), teamwork (73.5%); integration of content (72.4%). By associating questions and terms, it was better evaluated by the 1st term. It was significant for: integration of promotion, prevention, clinical reasoning, diagnosis and treatment (OR=8.3/p=0.000); integration between clinical areas (OR=5.4/p=0.000); relevance of the subjects (OR=4.1/p=0.003), improvement of clinical reasoning (OR=2.6/p=0.030); integration of content half

(OR=6.1/p=0.000).

Conclusions: Community-based education facilitates the transformation of the student, as they take part of real experiences. In these cases, reality provides to the learning process more meaning and power, contributing to clinical reasoning. Although all students consider the experience beneficial, younger students are more receptive than the others to innovative proposals. Take-home messages: The active learning and approximation to reality, using community-based learning as pedagogical strategy, allow integration of scientific and clinical contents.

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Does "Learning the Life of Rural Doctor" change learning outcomes?

Pisit Wattanaruangkowit (Thammasat University, Faculty of Medicine, 292/31 Vistaparkvibhavadi 2 LakSi, Bangkok 10210, Thailand

Bongkot Iamchuen (Thammasat University, Faculty of Medicine, Pathum Thani, Thailand)

Background: Most medical graduates in Thailand have to work in community hospitals in the first 3-year of professional practice. Preparing them for working in the community hospital is important. "Learning the Life of Rural Doctor" course in preclinical year would help students and promote attitude of working in rural area.

Summary of work: To investigate student self assessment about changing in learning outcomes of self-selected "Learning the Life of Rural Doctor". This elective course was in the 3rd of 6-year curriculum and took place at the community hospitals. Thirty one medical students choose 8 hospitals across the country to live and learn. Survey by questionnaires about 8 learning outcomes was done before starting and after completing the course. Rating scale 1 to 5 was used to quantify students' perception of their ability. Additional course feedback was allowed. Wilcoxon Signed Ranks Test was used for the statistical analysis. Summary of results: All students responded and perceived that all of 8 learning outcomes are significantly increased after course completion. The main reasons of students choosing this course were to learn about the life of rural doctor and the real environment of healthcare system in their future working place and to develop and promote their good understanding of the medical profession. All students achieved their objectives and were satisfied with this course.

Conclusions: The 2- week course of learning the life of rural doctor is useful for preclinical year medical students to understand healthcare system and life of rural doctor. The students' perceptions towards 8 learning outcomes are increased. Medical students develop good professional attitude and prepare themselves for working in community hospital after graduation.

Take-home messages: Learning in the real world at the community hospitals help medical students develop their good professional attitude and prepare themselves for working as a rural doctor.

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Analysis Results and Development Strategies for Community Study Report of Medical Students, Thammasat University, Thailand

Srimuang Palangrit (Faculty of Medicine Thammasat University, Community Medicine, 95 Moo 8 Paholyotin Road, Klongnerg Klongluang, Pathunthani 12120, Thailand)

Background: The second and third year medical students of Thammasat University have community-based learning, which is to stay in rural communities for 10-14 days in a year. Group report is included for evaluation; therefore, analysis and searching for development strategies of report are needed. Summary of work: This is a documentary research, in order to analyze and search for development strategies of medical students' community study reports. Data are continuously collected from groups' reports of medical students on the academic year 2010-2011: the second year focuses on community approach, and the third year focuses on health promotion in the same community, 32 reports.

Summary of results: The strong points: student learning outcomes are covered. Descriptive presentation on community data is good, and the reports follow a

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

determination format. The weak points: related literature review for application and reference, and presentation should be improved: table, line graph, bar chart, pie diagram. Analysis and synthesis are not good. For development strategies: searching document or providing weak guidance is needed, including exemplifying and increasing skills training. Conclusions: The strong points: learning outcomes are clear. Descriptive writing on community data is written by observation. Reports follow a determination format. The weak points: because of medical students' inexperience on application, the reports are not good. For development strategies: focusing on education management is needed, in order to improve writing comprehension skills, which will be useful for medical students in the future.

Take-home messages: Providing guidance on report writing skills and students' report writing skills training should be improved.

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Graduate reflections on a year-long rural training experience: clinical exposure that really counts?

Susan Van Schalkwyk (Faculty of Medicine and Health Sciences, Stellenbosch University, Centre for Health Professions Education, PO Box 19063, Tygerberg 7506, South Africa

Juanita Bezuidenhout (Faculty of Medicine and Health Sciences, Stellenbosch University, Centre for Health Professions Education, Tygerberg, South Africa) Hoffie Conradie (Faculty of Medicine and Health Sciences, Stellenbosch University, Family Medicine, Tygerberg, South Africa)

Norma Kok (Faculty of Medicine and Health Sciences, Stellenbosch University, SURMEPI, Tygerberg, South Africa)

Ben Van Heerden (Faculty of Medicine and Health Sciences, Stellenbosch University, Centre for Health Professions Education, Tygerberg, South Africa) Marietjie De Villiers (Faculty of Medicine and Health Sciences, Dean's Division, Tygerberg, South Africa)

Background: In 2011, the first cohort of eight medical students spent their final year at the Ukwanda Rural Clinical School (RCS). Simultaneously, a longitudinal evaluative project commenced with a formative study investigating the influence on teaching and learning at the site during this first year of implementation. The second year of the project tracked the cohort, now graduates, to discern how their RCS year influenced their thinking and practice.

Summary of work: Focus group discussions were held with the cohort before entering the RCS followed by in-depth interviews in 2011 and in 2012, during their first year of internship. For each intern, a supervising clinician was interviewed. Drawing on these four data sets, Kirkpatrick's model for evaluating educational outcomes was used to develop a hierarchy from the participants' views.

Summary of results: The chronological analysis demonstrated how initial uncertainties about attending

the RCS had shifted. The graduates described their confidence in their clinical skills and how the RCS experience had prepared them for internship despite the challenging circumstances that characterise the South African public health system. This was often confirmed by the intern supervisors. The results demonstrate progression through the levels of Kirkpatrick's model. Attitudes, skills and knowledge were modified during the RCS year (Level 2a&b), followed by a change in behaviour (Level 3) and ultimately, in professional practice (Level 4a). Conclusions: This study confirms claims regarding the potential of an extended rural clinical experience to effect transformative learning. Benefits to patient care need to be explored.

Take-home messages: Extended rural clinical exposure offers authentic, relevant learning opportunities.

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Medical students' attitudes toward experiences in community hospitals of rural area

Sawitree Visanuyothin (The Medical Education Center of Maharat Nakhon Ratchasima Hospital, Social Medicine Department , 49 Changpeuak, Amphur Muang, Nakhon Ratchasima 30000, Thailand)

Surasit Chitpitaklert (The Medical Education Center of Maharat Nakhon Ratchasima Hospital, Social Medicine Department, Nakhon Ratchasima, Thailand) Sorarat Lermanuworat (The Medical Education Center of Maharat Nakhon Ratchasima Hospital, Orthopedic Department, Nakhon Ratchasima, Thailand) Maesar Srisukanya (The Medical Education Center of Maharat Nakhon Ratchasima Hospital, Psychiatric Department, Nakhon Ratchasima, Thailand)

Background: Community-orientation involving rural doctors is one of the medical education strategies to raise interest in rural medicine and a desire of being a rural doctor. The attitude of medical students who are involved must to be identified and explored in order to improve the rural training experiences provision. Summary of work: An innovative training model was constructed for 49 fourth year medical students. Pre­exposure, they set the objective, process, and evaluation. Post-exposure, each subgroup shared and learned among their 3 groups with teachers. Six months later, focus group and in-depth interview was applied to collect data from the representatives. It was tape recorded and then transcribed after getting permission from the groups. Content analysis was used to analyze and the multiple analysis triangulation was done to ensure reliability.

Summary of results: Students experienced living in community hospital and working with community. Rural doctors as role model, community hospital systems, teamwork, management, relationships were identified. They were aware of roles of rural doctors, shortage of rural doctors, and relationships. These resulted in a positive attitude of roles of rural doctor, teamwork, relationships among health care workers, patients, and medical students, and learning improvement. They

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

could predict their roles of working as a rural doctor in a community hospital in the future and satisfied their roles.

Conclusions: Many experiences in community hospital increased medical students' awareness of roles of rural doctors. They had a positive attitude of learning improvement and being rural doctors. Take-home messages: Experiences of living in community hospital influence medical learning improvement and desire of being rural doctor.

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Program Evaluation of a Community vs. a Tertiary Care Internal Medicine Clerkship

Jennifer Holyoke (University of Ottawa, Medicine, 2117 Stonehenge Cr., Ottawa, Ontario K1B 4N7, Canada) Melissa Forgie (University of Ottawa, Haematology, Ottawa, Ontario, Canada)

John J Leddy (University of Ottawa, Medicine, Ottawa, Ontario, Canada)

Claire Touchie (University of Ottawa, Medicine, Ottawa, Ontario, Canada)

Background: Studies have considered whether students undertaking their clerkship training within community hospitals (CH) have a similar learning experience to those placed at tertiary care centres (TCC). The goal of this study is to compare and contrast internal medicine (IM) clerkship streams at the University of Ottawa, one at a TCC and one at a CH.

Summary of work: Data from formative assessments were analyzed. Continuous variables used an independent ANOVA and categorical data used a chi-square to determine differences. Written feedback will be analyzed using a qualitative grounded theory iterative approach.

Summary of results: In the 2009 and 2010 cohorts, TCC students significantly outperformed those at the CH in pre-clerkship examinations. The same was true for the IM clerkship examinations. In the 2011 cohort, the differences were much less substantial for pre-clerkship and insignificant for the IM clerkship examination. The end-of-clerkship OSCE scores did not differ between the two streams in any cohort. Students' rotation feedback results are pending.

Conclusions: While there were significant differences between the TCC and CH students on their IM clerkship examination in cohorts 2009 and 2010, the same was true in pre-clerkship. In the 2011 cohort, the TCC and CH streams were more similar in pre-clerkship and there was no significant difference between their IM clerkship examination grades. These differences may be related to the student cohort and not to the site of training. Take-home messages: Measured outcomes of the two IM clerkship streams are equitable. Further study is needed to explore students' perceptions of the IM clerkship from each site of training.

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A Curriculum for the Community

Mpho Mogodi (University of Botswana School of Medicine, Family and Public Health Medicine, Corner Notwane and Mobutu Roads, P / Bag 00713, Gaborone, Botswana)

Julia Blitz (Stellenbosch University, Family Medicine, Cape Town, South Africa)

Background: When the University of Botswana (UB) opened the country's first School of Medicine (SOM) in 2009, the decision was made that medical students should be introduced to the community right from their medical training's onset. This study will guide UB SOM to come up with a curriculum for first and second year medical students' community placement module. Summary of work: Purposively selected key informant interviews were conducted among education experts, health services experts and leaders at the UB Faculty of Health Sciences. Semi-structured interview guides were used to elicit the respondents' understanding and suggestions regarding a rural placement curriculum design. Recorded data was transcribed and coded. Summary of results: The following themes were identified as required elements of a community placement curriculum: Curriculum design that includes clearly aligned outcomes, integrated multiple forms of assessment, and contextualized learning. Course elements entailing community needs assessment and intervention. Guiding values that support social accountability, holistic health definition, problem based learning and systems thinking. Logistical considerations included transport, accommodation and nationwide student placement sites. In order for health professionals to make a difference in their communities, they need to work in communities they will serve and find long lasting solutions to the community's needs. Conclusions: There is continuing support for UB SOM medical students to have community placements from the onset of their medical training. Take-home messages: Conducting key informant interviews on the issue of community placement can provide valuable input for the development and implementation of a socially accountable community placement curriculum.

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Teaching patient-centered Medicine through community-based practice

Patricia Roberta Berithe Pedrosa de Oliveira

(UNIFENAS, Public Health, Rua Joao Maria Casalinho, 525, Praca Francisco Escobar, 149 -1, Pocos de Caldas 37701027, Brazil)

Helena Chini (UNIFENAS, Physiology, Alfenas, Brazil) Jaqueline Barboza (UNIFENAS, Medical Psychology, Alfenas, Brazil)

Maristela Bareiro (UNIFENAS, Medical Psychology, Alfenas, Brazil)

Miriam Graciano (Unifenas, Public Health, Alfenas, Brazil)

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

Eliana Amaral (UNICAMP, Gynecology and Obstetrics, Campinas, Brazil)

Background: Communication skills are not developed as part of the medical teaching. However, the comprehension of the biological phenomena and the care in the hospital context have been one of the factors associated with the graduation of low empathy professionals.

Summary of work: A Clinical and Psychosocial Anamnesis module was inserted in UNIFENAS Medical Course forth year, focused on medical interviews, developed through the patients complaints and experiences, to get a practical clinical anamnesis and to develop principles and techniques of psychological listening, performed at Primary Care Services and through domiciliary visits. A qualitative evaluation of these experiences is presented. Summary of results: Students answered a semi-structured questionnaire and identified six positive aspects of this experience: "Reality contact", "Theoretical content applied to practical context", "Holistic care comprehension", "Rapport experience in the teacher-student-patient relationship", "Communication skills development" and "Meaningful learning". The negative points were: "Non-adhesion to the person-centered clinical assistance by some service doctors", "Lack of a structured guide for student orientation", "Difficulty to deal with patient refuse" and "Credit hour extended for some and small for others". Conclusions: Approach with the community and the patients in their environment were fundamental to better understanding of some doctor-patient relation theoretical aspects. Disease is not the only intervention target: there is an autonomous subject, supported by holistic and familiar approaches. It is required and possible to rescue the care and education arts at the same time, as an experiential learning process, in the coexistence among equals. Take-home messages: Medicine is definitely an art that can cure sometimes and often relieve, but should always comfort.

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A patient centered approach for teaching about the organisation and functioning of the health care system at VU University medical center, Amsterdam, The Netherlands

Marc Soethout (VU University Medical Center, Public and Occupational Health, Van der Boechorststraat 7, Amsterdam 10181 BT, Netherlands) Wendy Hopmans (VU University Medical Center, Public and Occupational Health, Amsterdam, Netherlands) Olga Damman (VU University Medical Center, Public and Occupational Health, Amsterdam, Netherlands)

Background: Medical students need knowledge of the organisation and functioning of the health care system, because they are a part of it when they are a medical doctor. But also they need awareness of (chronic ill) patients in relation to the health care system.

Summary of work: During a two weeks course for second year medical students, students are split in 6 main representatives of the health care system (e.g. health insurances company, patient organisation, general practitioner, hospital, home care institution and municipal health services). By small group sessions and visits to these organisations students have to prepare a health care project for chronic ill patients with the outcome of better care.

Summary of results: The course was well received and attended by the medical students who valued it for the relevance to medicine and interactive nature. Conclusions: Students and representatives of the health care system enjoyed this new innovative approach to teaching. Representatives of the health care system were also impressed by the discussion and question-asking by students at this early stage of their medical training.

Take-home messages: Chronic patient oriented courses with attention to the organisation and functioning of the health care system within the early years of medical school should be encouraged. Active collaboration of representatives of the health care system and planning are the keys to the programme's success.

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The Benefits of Introducing Foundation Trainees to Community-Based Health Promotion Clinics

Nishanthan Mahesan (Whipps Cross University Hospital, Endocrinology & Diabetes, London, United Kingdom) Mahdi El Harbe (Whipps Cross University Hospital, Endocrinology & Diabetes, Medical Education Centre, Whipps Cross Road, Leytonstone E11 1NR, United Kingdom)

Sarah Dunne (Whipps Cross University Hospital, Stroke Medicine, London, United Kingdom) Laura Liew (Whipps Cross University Hospital, Endocrinology & Diabetes, London, United Kingdom) David Levy (Whipps Cross University Hospital, Endocrinology & Diabetes, London, United Kingdom)

Background: The General Medical Council (GMC) is putting increasing emphasis on trainee doctors gaining exposure to community-based medicine and teamwork, alongside other healthcare professionals. Opportunities in the UK are limited, with foundation doctors being based primarily in hospital particularly in their first year following graduation. This leads to a lack of experience in recognising and managing long-term conditions. Summary of work: We developed walk-in health promotion clinics, where foundation doctors work alongside specialist nurses, dieticians, podiatrists and senior doctors to screen and provide advice to the local community. Questionnaires were issued before and after such events, and introductory and debrief sessions used to examine learning outcomes. Summary of results: Forty foundation doctors participated in the initiative. Participants reported greater confidence in managing long-term conditions and improved communication skills with patients and health professionals. Foundation doctors also felt more

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

valued as members of the team and benefited from interdisciplinary teaching.

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