Автор неизвестен - Mededworld and amee 2013 conference connect - страница 86

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7CC/10

Raising an e-baby facilitates medical students learning in child growth, development, and preventive care in Pediatrics

Jieh-Neng Wang (National Cheng Kung University Hospital, Pediatrics, No.1, University Road Tainan 701, Taiwan)

Chao-Neng Cheng (National Cheng Kung University Hospital, Pediatrics, Tainan, Taiwan) Zong-Xian Yin (Southern Taiwan University of Science and Technology, Computer Science and Information Engineering, Tainan, Taiwan)

Chyi-Her Lin (Medical College of National Cheng Kung University, Pediatrics, Tainan, Taiwan)

Background: Learning children's growth and development and providing preventive health care consultation are the core competencies of pediatricians. However, it is not easy for medical students to remember children's developmental milestone and schedule of vaccination during pediatric rotation. We hypothesized that if we could provide medical students a simulated system to raise a virtual child, we might facilitate their learning of growth, development, and preventive care in Pediatrics.

Summary of work: We used the National Child Health Care Handbook as the reference and translated the context, clinical problems into photos, voices, motion pictures, and/or video by using a simulated e-Case-based Learning (e-CBL) strategy. Medical students were invited to adopt a virtual child in the e-learning system the first day and providing child health care during their 6-week rotation in Pediatrics. They took a written exam at the end of rotation.

Summary of results: A group of 61 students received the traditional lecture mode and were used as the control group; another group of 50 students adopted a virtual child and were used as the experimental group. In the final examination, students in the experimental group had a higher ratio of correct answers (72.0 % vs. 63.3%) in questions related to vaccination (74.4% vs. 53.0%, p <0.05), growth and development (55.5% vs. 35.5%, p <0.05).

Conclusions: Raising a virtual child can facilitate medical students' learning of child growth development and preventive care in Pediatrics. Take-home messages: Raising a virtual child can facilitate medical students learning in child growth, development and preventive care in a 6-week rotation of Pediatrics.

7CC/11

Virtual Patients in Primary Care: Development of a Reusable Model that Fosters Reflective Practice and Clinical Reasoning

Helena Salminen (Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 12, Huddinge 14183, Sweden)

Nabil Zary (Management and Ethics, Department of Learning, Informatics, Karolinska Institutet, Stockholm, Sweden)

Charlotte Leanderson (Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden) Karin Bjdrklund (Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden)

Eva Toht-Pal (Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden)

Background: Virtual patients (VPs) may support learning processes and be a valuable complement in teaching communication skills, patient-centredness, clinical reasoning and reflective thinking. Studies in designing VPs in primary care education are rare. The objective was to create a VP-model that facilitates medical students' reflective practice and clinical reasoning. The main research question was how to design a VP-model with embedded process skills for primary care education Summary of work: OpenTUSK virtual patient system was used as an authoring tool. The VP-model was validated and further developed in a Delphi process by a group of primary care teachers. Focus group interviews with 14

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

students were performed after testing the model, and analysed using content analysis. Summary of results: A patient-centred model of consultation in alignment with the Calgary-Cambridge Guides was used. Iterated learning loops, based on Kolb's learning cycle, including a didactic inventory, a concrete experience and pre-formulated feedback, constituted the VP-model. The students were asked to expose their clinical reasoning and reflections in-action in every learning loop. The students experienced that the structure of the model was interactive and easy to follow. The content of the VP case was regarded as authentic and the immediate feedback was appreciated. The VP was regarded as an intermediate learning activity between theory and practice. The students also reported that the VP case supported their self-directed learning and reflective ability.

Conclusions: The VP-model for primary care education constitutes a valuable supplement in consultation training and clinical reasoning, and may support self-directed learning and reflective thinking. Take-home messages: VPs may support students' learning in primary care.

7CC/12

'Real' structure, power and agency in simulated diagnosis, prognosis and emergency care

Navindhra Naidoo (Cape Peninsula University of Technology, Emergency Medical Sciences, D12 Education Building, Box 1906, Bellville, Cape Town 7535, South Africa)

Lloyd Christopher (Cape Peninsula University of Technology, Emergency Medical Sciences, Cape Town, South Africa)

Ben de Waal (Cape Peninsula University of Technology, Emergency Medical Sciences, Cape Town, South Africa) Robin Heneke (Cape Peninsula University of Technology, Emergency Medical Sciences, Cape Town, South Africa)

Background: Prehospital emergency care contexts are fraught with inherent patient and practitioner risk. Whilst patient factors may be unavoidable, practitioner medico-legal risk is mitigated by a differential diagnosis, contextualised by their prognosis and the monitoring and evaluation of the relevant clinical interventions. The aim is to critique patient simulations and to recommend conceptual and structural enhancements to simulated practice in the interest of emergency care practitioner agency.

Summary of work: Almost 100 emergency care students and graduates were observed whilst voluntarily performing individual simulations. An educational intervention was provided after which the participants repeated the simulation. Diagnostic, prognostic and clinical interventions are compared before and after simulations using descriptive statistics and thematic analysis.

Summary of results: 'Patient-centredness' has value in diagnostic assessment but interventions in the simulated context requires a 'practitioner-centred' orientation. The structure of the simulation provides for

the diagnostic, prognostic and intervention. The power dynamic emerges in the known and unknown context, knowledge and scope. Agency is measured by the state of coherence of patient assessment, prioritisation and interventions provided.

Conclusions: Impediments to efficacious simulated (and by application, clinical) practice include fragmentation and deficiency of knowledge and experience, misaligned ontological assumptions and paedagogic misconceptions. Simulations should focus on the learner/practitioner as the lead actor whose actions are predicated upon knowledge, motives and beliefs, all of which can be problematized and influenced by the simulation.

Take-home messages: The reflexivity dynamic (in the form of reciprocal determinism) and diagnostic reasoning inherent in emergency care simulations enables agency building or limits there-to, particularly if the simulation is validly 'structured' and reliably 'powered'.

7CC/13

The role of virtual reality simulation in surgical training

Kirstie Laughlan (Hull York Medical School, General Surgery, University of York, YO10 5DD, United Kingdom)

Background: Surgical training within the United Kingdom has traditionally been one of apprenticeship. External pressures within the United Kingdom have necessitated changes in surgical training with virtual reality simulation being employed as a supplementary method of training.

Summary of work: Review and critical appraisal of published literature from searches on MEDLINE, EMBASE and the Cochrane Library from January 1999 to December 2012 evaluating the potential benefits of virtual reality simulation training compared to traditional teaching methods and identifying ways in which virtual reality simulation can be incorporated into the surgical curriculum.

Summary of results: Alternative techniques are being explored such as video-box training and virtual reality simulation. Within published literature four main outcomes have evaluated the effectiveness of virtual reality simulation compared to traditional training (1) reduced time taken to complete the task, (2) reduced error score, (3) increased accuracy of performance and (4) increased economy of movement. Conclusions: This review has demonstrated the beneficial effects of supplementing standard laparoscopic apprenticeship training by simulation techniques and provides clear principles for the introduction of simulation into the surgical curriculum. This review has major implications for clinical practice by demonstrating the beneficial effects of supplementing standard laparoscopic apprenticeship training by simulation techniques. Ultimately the adoption of surgical simulation within a structured curriculum will lead to recognition of the potential of surgical skills simulators in the modern era.

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

Take-home messages: Virtual reality training has been demonstrated to be beneficial in supplementing standard laparoscopic surgical training of apprenticeship.

7CC/14

Web-based virtual simulation of prescription order: Development and evaluation

Majid Zandkarimi (School of Pharmacy, Zabol University of Medical Sciences, Pharmaceutical Sciences Department, Shaheed Rajaiee, Mojtamae Amozeshi Oloome Pezeshki, Zabol 9861615881, Iran) Mohammad Ali Darbandi (School of Pharmacy, Zabol University of Medical Sciences, Pharmaceutical Sciences Department, Zabol)

Kaveh Tabrizian (School of Pharmacy, Zabol University of Medical Sciences, Pharmaceutical Sciences Department,

Zabol)

Alireza Nazashti (School of Pharmacy, Zabol University of Medical Sciences, Pharmaceutical Sciences Department,

Zabol)

Background: Development of skills related to reading and interpretation of prescription order is an important topic in introductory pharmacy practice. However, a wide range of handwritten-prescription orders along with limitation in practice time and faculty resources affect the outcomes of practice. In this study, a web-based software for virtual simulation of handwritten-prescription orders was developed, and effectiveness of its implementation was assessed. Summary of work: After developing the database and necessary tutorials and indexes, a collection of handwritten-medication orders was uploaded to the website. Based on readability, prescription orders were classified into 3 levels, subsequently, essential drug information of each item in the prescription was added to software. After implementation of program, user satisfaction and effectiveness were assessed by a questionnaire survey.

Summary of results: Students agreed that using the website increased their motivation to learn. Respondents state that the website generally improved their applied knowledge in the fields of drug interactions monitoring, practical aspects of dosage forms, drug safety assessment during pregnancy and lactation and identifying common brand names. Furthermore, the students' perception in efficiency of the website was positive, and they believe that their skills in reading and interpretation of prescription order were improved. A large number of students state that the capability of promptly checking the correctness of each answer is the major advantage of the program. Despite all positive comments, students still insist that the website cannot be a substitute for a practice in pharmacy set-up and they were not very confident that their consultation skills are improved.

Conclusions: Prescription reading software was viewed favorably by pharmacy students. Therefore, this simulation software could be implemented into the pharmacy education program.

7CC/15

A mixed methods observational simulation-based study of interprofessional team communication

Charlotte Paltved (SkejSim Medical Simulation and Skills Training, INCUBA Science Park, Brendstrupgaardsvej 102, Aarhus N 8200, Denmark) Kurt Nielsen (SkejSim Medical Simulation and Skills Training, Aarhus, Denmark)

Peter Musaeus (Aarhus University, Center for Medical Education, Aarhus)

Background: Interprofessional team communication plays a pivotal role in patient safety. However, in-depth insight into the complexity of team communication is limited. Mixed methods video-observational studies might fill a gap in terms of understanding the meaning of communication interactions and link team performance to outcome. The aims were to develop a theory-based instrument that measures team communication and to investigate the quality of summaries evolving step wise and progressively through scenarios.

Summary of work: The study used mixed methods. Team communications were video-observed in 29 simulation scenarios. Data analysis employed grounded theory. Communication events and failures were recorded and classified into four categories. Data also supported the building of the SkejSim Team Step Model that captures and conceptualizes the quality of summaries.

Summary of results: 1091 communication events and 58 communication failures were recorded and classified. Failure types included occasion, content, purpose and audience. Two thirds of these failures resulted in visible effects. Teams were found to differ which could be explained using the five-level model. In particular, verbal updates were found crucial for mutual team interactions when critical situations unfolded. Conclusions: The study found that complex interprofessional team communication does not readily reduce to mere observation and recording of events. An interpretive approach is required to meaningfully account for communication exchanges in context. The integration of these two models might provide a significant framework for the construct of efficient team performance.

Take-home messages: This research has advanced evaluation of team communication by allowing us to recognize and represent communication by complexity rather than by reductionism and oversimplification.

7CC/16

Simulation for junior doctors: enhancing non­technical skills training

Antonia Benton (Medway Maritime Hospital NHS Trust, Department of Anaesthetics, Medway Maritime

Hospital, Windmill Road, Gillingham ME7 5NY, United

Kingdom)

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

Marwa Salman (Medway Maritime Hospital NHS Trust, Department of Anaesthetics, Gillingham, United Kingdom)

Manisha Shah (Medway Maritime Hospital NHS Trust, Department of Anaesthetics, Gillingham, United Kingdom)

Background: One of the most difficult competencies a junior doctor must develop is that of integrating clinical management, effective communication and medical ethics in daily practice. The role of simulation in achieving this is recognised in the CMO Annual Report 2008 and National Simulation Strategy Review. Summary of work: At Medway Maritime Hospital we have developed a new learner-centric simulation programme for Foundation Year 2 doctors. Candidates in our simulation suite face clinical emergency scenarios complicated by non-technical challenges, e.g. "massive PE resulting from erroneous omission of VTE prophylaxis, with irate relative". Scenarios and debriefings are mapped to the Foundation Curriculum 2012, Crisis Resource Management, and the GMC's 'Good Medical Practice and The Trainee Doctor'. Summary of results: Using pre- and post-course questionnaires we evaluated how useful candidates found this training in achieving their competency-based curriculum requirements. Personally identified weaknesses included managing ethical conflicts and communication in difficult situations. Following the simulation, 100% of candidates gave positive feedback on the training overall. Commenting on the most useful aspects, 65% spoke positively of the scenarios delivered, 40% specifically praised the non­technical skills aspect and 65% found the debriefing to be particularly valuable. Conclusions: Junior doctors value the learning opportunities delivered by simulation based training, particularly in developing their non-technical skills in a safe and supportive environment with debriefing involving their peers.

Take-home messages: By combining technical and non­technical training through simulation, these skills are more transferable to daily practice, allowing junior doctors to deliver safe and effective care whilst achieving curriculum goals.

7CC/17

Core Simulation

B Rees (East Midlands NHS Workforce Deanery, General Surgery, Queens Medical Centre, Nottingham NG7 2UH, United Kingdom)

O Ng (East Midlands NHS Workforce Deanery, Registrar General Surgery, Nottingham, United Kingdom) A Buttery (Trent Simulation and Clinical Skills Centre, Nottingham, United Kingdom)

B Baxendale (Trent Simulation and Clinical Skills Centre, Nottingham, United Kingdom)

C Maxwell-Armstrong (Queens Medical Centre, Surgery, Nottingham, United Kingdom)

Background: Surgeons are working in busier more time constrained environments with the European Working Time Directive increasing the variety and unfamiliarity of team members, creating more frequent handovers and providing less training opportunities. It is known outcomes improve in high pressure situations with more experience and that simulation is a bridge to this where training hours are reduced.

Summary of work: A new course has been created to utilise an immersive simulated surgical environment to develop clinical decision making, communication and leadership in dynamic high hazard scenarios. It has been developed specifically for candidates in Core Surgical training (CT1/CT2) to develop registrar level executive skills in the East Midlands Deanery, UK. Summary of results: Feedback has been extremely positive. Candidates were also assessed in real time by their colleagues using the Non Technical Skills for Surgeons framework.

Conclusions: We have created a new course for core surgical trainees from scratch which aids transition from core trainee to Registrar. The course uses high-fidelity simulated scenarios and benefits from real time assessment of trainees and pre-post course evaluation. We believe this is the beginning of a new era of surgical training for surgical trainees.

Take-home messages: Surgical Simulation is an essential part of future education for surgeons. This is a new course for surgical trainees in the east midlands. This is just the beginning.

7CC/18

Undergraduate simulation training: Enhancing clinical experience and learning opportunities during medical emergencies

Kavitha Vimalesvaran (King's College Hospital, General Internal Medicine, London, United Kingdom) Aamir Saifuddin (King's College Hospital, General Internal Medicine, London, United Kingdom)

Background: Simulation has rapidly become an essential part of medical education. Within specialty training such as anaesthetics and surgery, there is much evidence that this can lead to effective learning. However, there is limited use of basic simulation training at undergraduate level, especially amongst more junior students. Furthermore, explanation of the multidisciplinary nature of the resuscitation team is lacking at medical school, which compromises students' appreciation for the real-life approach to acutely unwell patients. Summary of work: We have devised a small-group simulation programme where sessions involve medical students from different year groups participating in basic emergency scenarios, facilitated by junior doctors. This aims to increase exposure, familiarity and understanding of the management of critical events and the processes involved in successfully assessing, diagnosing and treating an unwell patient. Emergencies on the ward are invaluable learning opportunities for all students and familiarisation with these scenarios will optimise their clinical experience. Furthermore, as

simulation becomes more commonplace, the early introduction of this teaching method will be beneficial as their careers progress. Summary of results: The overall qualitative and quantitative data will be gathered and analysed in July. Conclusions: Participants complete a pre-simulation questionnaire assessing basic knowledge of emergency scenarios and, following the simulation teaching, complete a further similar questionnaire, with the opportunity for general feedback. A month later, the impact on their ward experiences is also explored. Take-home messages: Innovative approaches to undergraduate medical simulation training can be invaluable learning experiences and enhance understanding of emergency scenarios.

7DD   Posters: Management

Location: South Hall, PCC

7DD/1

Public versus private health centres - Are there differences in the quality of undergraduate clinical teaching?

Per Skardin (Faculty of Medicine, Uppsala University, Rackarbergsgatan 13, Uppsala 75235, Sweden) Jakob Johansson (Institution of Surgical Sciences, Department of Anesthesia and Intensive Care, Uppsala, Sweden)

Background: At Uppsala University (Sweden) the medical students do their primary health care clinical rotations at either a private or a public health centre (HC). It has been debated whether the type of ownership affects the quality of clinical teaching at HCs. Summary of work: A web-based questionnaire, inspired by a seven-category concept from Stanford University, was introduced 2011. The questionnaire had 10 questions regarding different aspects of clinical teaching (Likert scale 1-6). The students were randomly distributed to a public or a private HC. The students practised five afternoons per semester at the same HC during their first four semesters. Summary of results: Data was collected during four semesters (2011-2012). The students' response rate was 65% (n=1013). In total, 45 HCs were evaluated. The mean ratings±SD for public HCs were 4.61±0.97 and for private HCs 4.47±1.07 (p=0.08). Public HCs received higher mean ratings (p<0.01) for three out of the ten questions: the learning climate at the rotation (5.18 vs. 4.85), the tutor's knowledge of expected learning outcomes (4.71 vs. 4.22) and whether the rotation was well planned (4.49 vs. 4.19). Conclusions: There was no overall difference in the quality of clinical teaching between public and private HCs. However, one prominent difference was that the tutors at public HCs had greater knowledge of expected learning outcomes.

Take-home messages: Private and public HCs appear to be approximately equal alternatives regarding the quality of clinical teaching. Nevertheless, increased efforts to inform private HCs of expected learning outcomes are particularly warranted.

7DD/2

New Data to Inform Global Workforce Planning and Education of Physician Assistants

Anita Glicken (University of Colorado School of Medicine; National Commission on Certification of Physician Assistants Health Foundation, School of Medicine, 13001 East 17th Place, F543 Aurora 80045­0508, United States)

Anthony Miller (Shenandoah University, Physician Assistant Studies; Physician Assistant Education Association, United States)

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

Background: Physician Assistants (PAs) are effective healthcare partners, readily adaptable to an evolving delivery system. Nine countries, from South Africa to the Netherlands, recently launched the profession, through unique adaptation of US education/practice models. This study reports new information on PA education pipelines, programs and roles providing a model of how data can inform global planning and curriculum development.

Summary of work: Three national databases were reviewed for relevant variables. The Physician Assistant Education Association (PAEA), the Centralized Application Service for Physician Assistants (CASPA) and the National Commission on Certification of Physician Assistants analyzed information on PA pipeline, education and practice.

Summary of results: There are 170 educational programs (typically 26 months, offering Master's Degree) producing ~6,035 annual PA graduates; 71 institutions are seeking new program accreditation. Over the past 5 years, program capacity has increased on average by 17%. During the 2011/2012 admissions cycle, 18,501 unique applications were initiated, (10% increase; average age 27; 71% female). New data on PA practice describes 36 variables including geographic distribution, employment patterns, and description of clinical positions, activities and indirect services. Relevant study data will be reported at the conference. Conclusions: Collectively, this study provides important new information and model data collection strategies that inform international workforce policy and planning of educational programs to build workforce capacity through nonphysician providers.

Take-home messages: New models of inter-professional practice promote the utilization of physician assistants in doctor led teams. Armed with PA pipeline and graduate data, educational institutions can design programs that produce providers ready and willing to deliver high quality, effective care.

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