Автор неизвестен - Mededworld and amee 2013 conference connect - страница 89

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Conclusions: The approach used to develop the FD program was effective in designing an innovative framework and strategy to meet the unique needs of our new academic community. Take-home messages: To create faculty engagement and preparedness within a new academic community, we need to integrate understanding of the local practice context into the design of FD initiatives.

7GG ePosters: Clinical 1

Location: North Hall, PCC 7GG/1

An Assessment of Ward Rounds and Clinics for Medical Students in their Child Health Block

Pretin Davda (University of Leicester, Department of Medical and Social Care Education, Leicester, United Kingdom)

Elain Carter (University of Leicester, Department of Medical and Social Care Education, Leicester, United Kingdom)

Background: Ward rounds and clinics are an integral part of medical student learning, utilising experiential learning theory and forming the foundations of structured clinical placements. In these days of increasing student numbers and increased use of e-learning, they preserve and provide valuable patient contact, however experiences are often variable. Summary of work: This study assessed whether these environments helped students learn key skills such as Paediatric clinical skills and what attributes of the teacher contributed to a good learning experience. One block of medical students completed a questionnaire 3 weeks into their placement (n=32, 100% response rate), which provided both quantitative and qualitative data. Summary of results: 1) The majority of students found ward rounds and clinics useful and enjoyable. 2) In both settings, over 75% of students learnt how to take a Paediatric history and perform an examination, how to communicate with patients and families and how to manage specific Paediatric problems. 3) Qualities of doctors that contributed to the learning experience included: Active involvement and questioning; Enthusiasm and willingness to teach; Friendly; 4) Ward rounds could be improved by increasing students' involvement.

Conclusions: Paediatric ward rounds and clinics allowed the majority of students meet the important learning objectives. However, increasing student involvement would further improve the learning experiences. Take-home messages: 1. Ward rounds and clinics create useful student learning experiences in the Child Health Block. They should therefore continue to be an essential component of clinical placements. 2. Interactive teachers who explain, ask questions and involve students in discussions contribute to a greater learning experience.

7GG/2

What are the barriers to learning clinical reasoning?

Janina Iwaszko (University of Birmin gh am Clinical Teaching Academy, Worcester Acute NHS Trust, Alexandra Hospital, Woodrow Drive, Redditch B98 7UB, United Kingdom)

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

Kamal Nathavitharana (University of Birmingham Clinical Teaching Academy, Worcester Acute NHS Trust, Alexandra Hospital, Redditch, United Kingdom)

Background: Currently little is known about how new clinical students approach diagnostic problem solving. The initial part of this process involves the acquisition and prioritisation of clinical information. The pathway to the acquisition of clinical competence requires the assimilation of a substantial amount of biomedical information. They then have to access this, integrate it with patient information and generate a coherent diagnosis.

Summary of work: Twenty 3rd year medical undergraduates interviewed simulated patients. The students then reviewed their consultations with the researcher. Student commentaries were taped digitally and their hypotheses and diagnostic processes were thematically coded. Students then completed a previously validated Clinical Reasoning and Diagnostic Thinking Inventory Form, these were then analysed. Summary of results: Participants used a variety of hypothesis generation methods; some were linear, others were initially narrow or broad, and some were unstructured. They used mainly analytical reasoning with some non-analytical reasoning. Qualitatively, students described difficulty in integrating prior knowledge into the clinical context. They also had difficulties formulating questions, and prioritising the information obtained.

Conclusions: Students employ different models of clinical reasoning. They experienced both problems integrating prior knowledge and interpreting the significance of the clinical symptoms they elicited. These issues adversely initially affected their ability to develop diagnostic skills.

Take-home messages: Novice clinical students use a variety of ways to solve diagnostic problems during a consultation. A major barrier is the initial acquisition and prioritising of the clinical information.

7GG/3

Interviewing Adolescents Across the Curriculum Continuum: Sex, Drugs & Rock 'n' Roll

Kim Blake (IWK Health Centre, Pediatrics, 5850/5980

University Ave, Halifax B3K 6R8, Canada)

Nadim Joukhadar (Halifax, Canada)

Genna Bourget (Halifax, Canada)

Sarah Manon (IWK Health Centre, Pediatrics, Halifax,

Canada)

Karen Mann (Dalhousie University, Medical Education, Halifax, Canada)

Background: Interviewing adolescents requires a particular skill set. The Structured Communication Adolescent Guide (SCAG) has been developed as a teaching, learning and assessment tool for medical students, residents and physicians, to obtain feedback from adolescents, both standardized and real patients. The goal is to improve feedback to learners on their adolescent interviewing.

Summary of work: The SCAG was developed after a randomized control study demonstrated that structured feedback significantly improved medical students' interviewing skills of adolescent standardized patients, both immediately and with sustained effect. A recent study has shown that undergraduate training with the SCAG has produced sustained effect into residency education

Summary of results: This E-poster will show how the SCAG can be used in undergraduate, post graduate and CME settings. The SCAG is reliable with untrained adolescents (R=0.85)2 and therefore can be used independently of faculty time. It is a useful tool in the clinic, ER and ward settings to produce a formative evaluation of the learner. Developed at a grade 8 reading level (age 12-13 years) the SCAG has also been translated into French, German, Spanish. Mandarin in process.

Conclusions: The SCAG is a reliable teaching, learning and assessment tool for teaching adolescent interviewing skills and can be scored by both trained and untrained adolescents. A cost effective, formative assessment can be obtained on learners with no extra faculty time.

Take-home messages: A reliable teaching and assessment tool for adolescent interviewing that can be used across a variety of settings, learners and languages.

7GG/4

Concept of veterinary training in a clinical skills

lab

Marc Dilly (University of Veterinary Medicine Hannover, Foundation, Clinical Skills Lab, Bischofsholer Damm 15, Geb. 116, Hannover 30173, Germany) Andrea Tipold (University of Veterinary Medicine Hannover, Foundation, Clinic for Small Animal Medicine and Surgery, Hannover, Germany) Elisabeth Schaper (University of Veterinary Medicine Hannover, Foundation, Competence Centre for e-Learning, Didactics and Educational Research in Veterinary Medicine, Hannover, Germany) Jan P Ehlers (University of Veterinary Medicine Hannover, Foundation, Competence Centre for e-Learning, Didactics and Educational Research in Veterinary Medicine, Hannover)

Background: In Germany, veterinary curricula focus on imparting knowledge, whereas practical competence-based education is mainly performed during the last practical year. Hence, veterinary studies conflict between academic literacy and practical preparation for profession. In 2012 the first German veterinary clinical skills lab (CSL) was set up by funding of the Federal Ministry of Education and Research. Summary of work: Aim of this concept is to establish a dynamic and interdisciplinary guideline for training skills at the CSL. Therefore, we developed a 3-step-concept of training veterinary skills to provide an opportunity for students to train skills in context with the curriculum to foster practical competence.

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

Summary of results: Essential competences were classified and embedded in the concept by the following steps: general skills, specific skills, and professional skills. Overall, each of the three steps contains a selection of "Day one" skills according to the requirements of the clinical departments and the European Association of Establishments for Veterinary Education. All skills were adjusted for the respective study year. Conclusions: Different teaching methods have to be implemented in a 3-step-concept to match and enhance the current knowledge/competencies of the students of different study years.

Take-home messages: To implement veterinary skills lab a training concept is at least as important as simulators.

7GG/5

PALS mini-work shop for the last year medical students of Lampang Medical Education Center

Natthachai Muangyod (Lampang Hospital, Pediatric, 280 Paholyothin Rd., Ampur Muang, Lampang 52000, Thailand)

Background: Previously, the final year medical students of Lampang medical education center were taught pediatric advanced life support (PALS) according to AHA guidelines 2010 by a lecture. Some of them were not attentive and sleepy, resulting in ineffectiveness of learning and practice. A new method of PALS teaching was applied.

Summary of work: Two hours and two assistants were used in mini-workshop teaching of PALS. The assistant was a nurse who guaranteed PALS provider achievement. Twenty minutes were used in each section respectively, PALS guideline lecture, three stations of practice (chest compression plus intubation, foreign body aspiration assist and defibrillation), CPR team management and the final 20 minutes for comments, questions and summary. In CPR team management, the students were divided into two groups to join in different simulation of cardiopulmonary resuscitation in which team work was emphasized. Summary of results: Three groups of medical students, 6 students in each group were taught by the new method. 100% of students were interested and satisfied with the learning. 80% of all divided student group could practice correctly in simulation of cardiopulmonary resuscitation. 100% of students suggested mini-workshop helped them to gain knowledge more than the old method.

Conclusions: PALS mini-workshop teaching improved medical student knowledge of PALS. Take-home messages: Learning by doing is better than teaching by lecture.

7GG/6

A comprehensive evaluation of the quality and barriers of bedside teaching from professors' point of view

Leili Mosalanejad (Jahrom University of Medical Sciences, Education, Jahrom, Iran) Mohsen Hojjat (Jahrom University of Medical Sciences, Education, Jahrom, Iran)

Sakine Shahsavari Esfahani (Jahrom University of Medical Sciences, Education, Jahrom, Iran) (Presenter: Farzane Alipour, Jahrom University of Medical Sciences, Medical Student, Main Campus, Motahary Street, Jahrom 74148, Iran)

Background: Bedside teaching is a patient-centered teaching method. The aim of this paper is to examine the quality and barriers of bedside teaching from professors' point of view.

Summary of work: We performed a cross sectional study on 60 professors (clinical, nursing and paramedicine) in Jahrom University of Medical Sciences. Data gathering was done using a 3-part questionnaire. Demographic data, qualifying bedside teaching with ten 5-part questions (r=0/83) and surveying the barriers of bedside teaching with 12 questions (r=0/93) were included in the first, second and third parts, respectively. Summary of results: Results showed that professors evaluated the quality of bedside teaching to be higher in three aspects: developing communicative skills 4/50 (0/54), standard physical examination 4/44 (0/53) and improving professional skills 4/44 (0/66). The most important barrier of using this method was reported to be shortage of time, teachers' lack of skills in applying techniques, and students' lack of knowledge about this approach.

Conclusions: According to results, professors evaluated the quality of this method as medium to high. It seems that there is still a large gap to reach the standard use of this method. So, offering appropriate education to professors in order to provide the situation for optimum use of this method, improving health and actual implementation of medical dominance seems to be necessary.

7GG/7

Overall Performance of the Clinical-Year Medical Students in Department of Medicine, Khon Kaen University (KKU): correlation between theory and clinical skill

Siraphop Suwannaroj (Khon Kaen University, Department of Medicine, Faculty of Medicine, Mitraphab Road, Khon Kaen 40002, Thailand) Anupol Panitchote (Khon Kaen University, Deaprtment of Medicine, Khon Kaen, Thailand)

Background: To evaluated clinical-year (the 4th, 5th, and the 6th year) medical students' summative evaluation performance and study the correlation between theory and clinical skill.

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

Summary of work: We retrospectively studied our students' theory and clinical skill performance (MPL=60%) in 2012 to focus on parts that students failed and made a correlation between theory and clinical skill evaluation using Pearson's correlation coefficient and Spearman's rank correlation coefficient. Summary of results: The number of students who failed theory and clinical skill were 14 (5%) and 45 of 280 (16.1%), 20 (7.2%) and 7 of 277 (2.5%), and 21 (7.4%) and 17 of 285 (6.0%) for the 4th, 5th, and 6th year students respectively. The mean ± SD of theory and clinical skill were 70.6 ± 6.7% and 65.5 ± 7.7%, 67.9 ± 6.0% and 72.1 ± 6.1%, and 70.6 ± 8.0% and 69.5 ± 6.0% for the 4th, 5th, and 6th year students respectively. We found statistically significant correlation between theory and clinical skill performance among the 4th and 5th year students (Pearson's correlation coefficient were 0.41 [p < 0.001] and 0.53 [p< 0.001] respectively), but the correlation was poor among the 6th year students (Spearman's rho = 0.29, p < 0.001). Conclusions: The students' performance that need to be improved are clinical skill for 4th year students, theory for 5th year students, and both theory and clinical skill for the 6th year students. The correlation between theory and clinical skill is modest for the 4th and 5th year students but is poor for the 6th year students. Take-home messages: We should consider students' learning experience and evaluation process in order to improve our students' summative evaluation performance.

7GG/8

How does shame affect acquisition of manual

skills?

WE Blaum (Charite Berlin, Lernzentrum, intern: Virchowweg 5 CCM, Chariteplatz 1, Berlin 10117, Germany)

TSchroder (Charite Berlin, Lernzentrum, Berlin, Germany)

H Holzer (Charite Berlin,

Simulationspatientenprogramm, Berlin, Germany)

M Marz (Charite Berlin, DSFZ, Berlin, Germany)

O Ahlers (Charite Berlin, Curriculumsorganisation, Berlin,

Germany)

A Thomas (Charite Berlin, Obstetrics & Gynecology, Berlin, Germany)

Background: Acquiring intimate examination skills as well as continuously conducting those examinations is often described as embarrassing for medical students. However, effects of embarrassment on learning are not well understood.

Summary of work: 49 students were first taught how to examine a female breast, trained in examination at an isolated silicone model (first training) and documented their findings. Afterwards, students were randomised to either train at a life-size mannequin (MQ-group) or the natural breasts of a standardized patient (SP-group). 48 hours after this second training, students performed a breast examination on a SP with strap-on silicone breasts and documented their findings. Two blinded

experts rated communication and manual performance with previously validated check lists independently. TOSCA 3 was used to measure students' proneness to embarrassment along with other known confounders before the study, ESS was used to measure "current embarrassment" at four points of time. A p-value smaller 0.05 was used to determine significance. Summary of results: Groups do not differ in measured confounders. During second training, MQ-students experienced significantly lower current embarrassment than SP-students. MQ-students showed a significant increase in state embarrassment from training to examination, while SP-students showed a significant embarrassment-decrease. SP-Students performed significantly better than students from MQ. Conclusions: Teaching format directly affects current embarrassment and manual skills acquisition. Whether there is an effect of embarrassment on learning results from stress remains open. Take-home messages: Embarrassment affects acquisition of manual skills. Different teaching formats may be employed to alter embarrassment during skills acquisition.

7GG/9

"Hunt of signs": a new tool to develop clinical observation among medical students

Maria Alenita Oliveira (Anhembi Morumbi University,

Medical School, Sao Paulo, Brazil)

Fernando Augusto Alves da Costa (Anhembi Morumbi

University, Medical School, Sao Paulo, Brazil)

Marcos Paulo Freire (Anhembi Morumbi University,

Medical School, Sao Paulo, Brazil)

Sergio Timerman (Anhembi Morumbi University, Medical

School, Sao Paulo, Brazil)

Karen Cristine Abrao (Anhembi Morumbi University, Medical School, Rua Aimbere, 909, ap 41, Sao Paulo 05018011, Brazil)

Background: In the world of technology and fast decisions, doctors tend to give less importance to the physical examination and to rely much more on laboratory findings and subsidiary exams. In this scenario, we developed a new tool to incite clinical observation among medical students. Summary of work: At the beginning of their clinical rotation, students are encouraged to observe and document every significant clinical sign they find during their rotation. After patient's consent, every sign noted by the students is registered with photos, films or sound clips, using any available tools, such as cell phones or hand cameras. During the rotation, the students prepare a portfolio describing every sign they found during their rotation. This is an open activity and students are free to send as much information as they want. The portfolios are shared and discussed among the students at the end of the process.

Summary of results: Documents sent by the students range from 6 to 46 clinical signs found during their 2-month rotations. Students are committed to this open

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

activity and showed great interest in producing information.

Conclusions: Using this ludic tool, students demonstrate more interest in clinical examination, "hunting" for different and rare clinical signs to share among their colleagues. For the 21th century doctor, physical examination is still one of the most important tools in medical practice, despite of modern technology. Take-home messages: The development of tools to incite our medical students in the art of observation must be stimulated and improved.

7GG/10

Full written clinical clerkings (medical histories): what can we learn from them? A pilot study

H. John Fardy (University of Wollongong, Graduate School of Medicine, PO Box 463, Kiama 2533, Australia)

Background: Most patients admitted to an acute care hospital are still "admitted" by the Junior Medical Staff by doing a clinical clerking (full history, full examination, provisional and differential diagnoses and management plan and problem list). We request our students, in their 1st full clinical year, to do and submit one of these each week in their clinical rotations in medical and surgery. Each is reviewed by a clinical member of Faculty. Summary of work: A scoring sheet has been developed. Free text feedback has been collected. A review of exam results versus submitted clerkings is underway. Summary of results: Free text feedback shows that students see benefit in submitting work. Conclusions: Encouraging students to perform and practice this important element of the Junior Doctor's role is educational for the student and a strong indicator of the student's increasing clinical maturation over time. Take-home messages: This is a useful activity at less than 5 minutes Faculty staff time per student.

7GG/11

Heterogeneity of medical student experiences during clinical attachments

Michael Bowen (Leicester Royal Infirmary, Department of Surgery, Level 6 Balmoral Building, Leicester LE1

5WW, United Kingdom)

Nisha Kumar (Leicester Royal Infirmary, Department of Anaesthetics, Leicester, United Kingdom) David Bowrey (Leicester Royal Infirmary, Department of Surgery, Leicester, United Kingdom)

Background: The day-to-day education of medical students is delivered by large numbers of personnel. The impact on student learning experiences remains unclear. Summary of work: Students participating in the study self-completed a 5-day diary during a Perioperative Care attachment. They recorded each learning encounter noting the duration, setting, details about the supervisor and perceived educational value. Summary of results: 35 students returned diaries between February and May 2012. Students spent a mean of 15 hours per week (range 0-37) in operating

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