Автор неизвестен - Mededworld and amee 2013 conference connect - страница 92

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Background: In 2010, the Charite - Universitatsmedizin Berlin started to implement a new integrated, outcome-based medical curriculum. This process is accompanied by large organizational, conceptual and institutional challenges. There is a need of an instrument which identifies sensitively and immediately problems. Here we used students' perceptions of the new learning environment.

Summary of work: The aim was an in-process qualitative evaluation of the implementation process of the medical curriculum by means of an online-supported, semi-structured study diary which is completed daily, weekly and modularly by a students' subset of the first study cohort. Data were analyzed using qualitative content analysis according to Mayring. We conducted triangulation with the results of the general evaluation and the debriefing of the modules. Summary of results: Students' feedback revealed relevant redundancies in lectures and modules, which could be removed immediately for the second module run. Additional feedback related to module structure, organizational and institutional contexts, social climate and feasibility of the work load. In order to solve the problems identified, specific steps were worked out involving short- and medium-term interventions carried out with the target groups involved. Conclusions: Study diaries can serve as an effective instrument to improve the implementation process of a new curriculum and to provide immediate curricular feedback loops. They deliver differentiated information about the students' perspective of their learning environment created by the new curriculum. Take-home messages: Student diaries are an effective instrument to facilitate the implementation process of a new medical curriculum.

8G/3

Accountable Curriculum Management

Chris Candler (The University of Oklahoma College of Medicine, Medicine, 940 Stanton L Young Blvd, BMSB

357, Oklahoma City 73104, United States)

Background: The University of Oklahoma College of Medicine curriculum committee recently unfurled a new transparent curriculum management system in which

faculty critically examined their colleagues' courses against shared curriculum performance expectations. Summary of work: College curriculum governance groups collectively designed a new transparent curriculum management system through the use of collaboratively developed course scorecards, course peer review committees, and educational performance benchmarks.

Summary of results: As a result of the new accountable curriculum management approach, key educational outcomes and student evaluations of courses and instructors were substantially improved. All outcomes and student ratings were measured against predetermined quality benchmarks and compiled into a curriculum scorecard for curriculum committee review. Conclusions: A faculty-driven approach to transparent curriculum management was used to promote accountability, reinforce what was working well, fix what was broken, and promote confidence faculty members' ability to continually improve the educational program. Educators embraced a new accountable curriculum management system by collaboratively setting performance expectation standards, examining key outcomes, and listening to colleagues' comments and critiques. This information was used to gauge progress toward educational program objectives and as a means to refine and enhance the educational experience.

Take-home messages: Accountable curriculum management requires a faculty commitment to transparency, a shared vision of quality improvement, and a willingness to accept open and constructive criticism from colleagues.

8G/4

What do our learners have to tell us about our program? Using learner feedback about core program competencies in ongoing curriculum review and improvement

Dale Lackeyram (University of Guelph, Ontario Veterinary College, 50, Stone Road East, Guelph, Ontario N1G 2W1, Canada)

Stephanie Nykamp (University of Guelph, Ontario Veterinary College, Guelph, Canada) Kerry Lissemore (University of Guelph, Ontario Veterinary College, Guelph, Canada)

Background: Many veterinary schools have implemented alumni and employer surveys as outcomes assessment tools to address the external and internal quality assurance of their DVM Programs. Current efforts to evaluate internal curriculum quality utilize a variety of approaches to evaluate teaching effectiveness and the resulting student performance that occurs in the program. These approaches predominantly include disciplinary-based assessments and skills utilization and performance measures.

Summary of work: This abstract presents an embedded curricular assessment paradigm by which learning experiences can be integrated at a curricula-level in order to enrich the internal quality assurance processes.

ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530

We also discuss the importance of students' reflection on their proficiency of core competencies as they progress through the program as an engagement method for ongoing curriculum review and improvement.

Summary of results: Program-level competencies can be deconstructed to develop a framework for curricular review and assessment that includes student feedback. Conclusions: The relationship between how students perceive themselves as learners and the intended learning objectives of a program can be used for engagement and curricular improvement. Take-home messages: Student feedback about program competencies provides timely and important information to help maintain quality in veterinary curricula.

8G/5

Evaluating a Medical Curriculum - How best to proceed?

Katherine R Cameron (University of Glasgow, School of Medicine (Student), Glasgow, United Kingdom) Andrew Grosset (University of Glasgow, School of Medicine (Student), Glasgow, United Kingdom) Dr Alastair Gracie (University of Glasgow, School of Medicine, Glasgow, United Kingdom) Dr Joanne Burke (University of Glasgow, School of Medicine, Glasgow, United Kingdom)

Background: Curriculum Evaluation is becoming increasingly important in developing and maintaining the best educational experiences for students worldwide. This review was conducted in an aim to explore how best to evaluate with respect to a curriculum revision at the University of Glasgow Medical School.

Summary of work: A systematic literature review was carried out using a three-pronged search of; books, databases, and selected journals. Articles were sourced using a standard search query. Initially, a total of 2,119 articles and 20 books were discovered. The articles were further narrowed to 114 using a matrix model derived from De Montfort University (Leicester). Summary of results: Evaluation is a fundamental part of any curriculum bringing benefits in student learning, satisfaction, course development and reflection. It takes two main forms: Models and Methods. Over time, educationalists have proposed structured models, each with their own merits and pitfalls. Many literature sources regard the "Plan" aspect of any model to be the most important to avoid over collecting of information by establishing first how it will be used. There are many evaluative methods available: questionnaires, interviews, focus groups, assessment, interrupted lectures and observations. No single method of evaluation is uniformly felt to be the best: each varies in terms of resources required, quality of data and implications for change.

Conclusions: Comprehensive course-tailored evaluation is essential for both students and staff. Selection of a model that fits the specific curriculum will provide

structure, supporting identification of the most appropriate methods. Adequate planning and closure of the feedback loop is essential to success.

8H Short Communications: Clinical Reasoning

Location: Club H, PCC

8H/1

How clinical reasoning is taught and learned: Cultural perspectives from the University of Melbourne and the University of Indonesia

Ardi Findyartini (Faculty of Medicine, University of Indonesia, Department of Medical Education, Salemba 6, Jakarta 10430, Indonesia)

Lesleyanne Hawthorne (Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Medical Education Unit, Melbourne, Australia) Geoff McColl (Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Medical Education Unit, Melbourne, Australia)

Neville Chiavaroli (Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Medical Education Unit, Melbourne, Australia)

Background: Clinical reasoning (CR) skill is a critical skill for medical graduates. There is growing literature on how CR should be taught and learned in medical education. Little however is known about the possible influence of cultural perspectives in the attitude of teaching and learning CR.

Summary of work: This study explored CR teaching and learning in two undergraduate medical courses (University of Melbourne, UoM, University of Indonesia, UI) using a comparative case study. A total of 11 student focus group discussions (FGD, 4 at UoM and 7 at UI), and 24 medical teacher individual interviews (13 at UoM, and 11 at UI) were completed in this study. A thematic analysis using Hofstede's four areas of culture of learning (Hofstede, 1986) was conducted. Summary of results: Clear cultural differences in relation to the power distance and uncertainty avoidance were evident in the two institutions. Different attitude in power distance was expressed in relation to content expertise, learning in PBL tutorials and importance of patient collaboration in CR process. Likewise, different perspectives in information thoroughness, knowledge adequacy and the role of pattern recognition in CR related to the uncertainty avoidance aspect were evident.

Conclusions: Attitude in teaching and learning CR can be influenced by different culture of learning. Take-home messages: Insights to culture of learning may facilitate understanding on how CR is best taught and learned in various contexts of medical education.

8H/2

Introducing case-based clinical reasoning (CBCR) course at the Tbilisi State Medical University

Zurab Vadachkoria (Tbilisi State Medical University, Department of Medical Education, Research and Strategic Development, Tbilisi, Georgia)

ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530

Gaiane Simonia (Tbilisi State Medical University,

Department of Medical Education, Research and

Strategic Development, 33 Vazha Pshavela ave, 23

Pirosmani Street, Tbilisi 0861, Georgia)

Rima Beriashvili (Tbilisi State Medical University,

Department of Medical Education, Research and

Strategic Development, Tbilisi, Georgia)

Marina Mamaladze (Tbilisi State Medical University,

Department of Medical Education, Research and

Strategic Development, Tbilisi, Georgia)

Background: Evaluation of existing teaching methods at the Tbilisi State Medical University (TSMU) showed that students experience difficulties in clinical decision making during their clinical studies. To develop students' independent thinking ability CBCR course was introduced in the 3rd year of study. The method is developed to train students in applying previously acquired knowledge on patient problems. Summary of work: Introduction of CBCR is one of the main goals of currently implementing TEMPUS project "Modernizing Undergraduate Medical Education in EU Eastern Neighboring Area". CBCR sessions were designed by guidelines elaborated by Prof. Olle ten Cate at University Medical Center Utrecht (UMCU). Seven professors of TSMU were previously trained in CBCR methodology at UMCU. Trained professors, in turn conducted training in CBCR for 20 clinical professors at TSMU Faculty Development Center. About 10 CBCR clinical cases were designed and properly structured. By the end of each CBCR session feedback was provided by CBCR consultants and students using questionnaires. Summary of results: 96% of consultants assessed CBCR methodology as useful in improvement students ability to resolve clinical problems. 84% of 3rd year students rated CBCR course as excellent teaching them proper approach to patient's problem and improving their communication and leadership skills. Conclusions: Integration of CBCR course in the existing TSMU subject-based curriculum might be considered as an important step towards integrated approach as students are applying already acquired knowledge in basic subjects to solve various clinical problems. Take-home messages: CBCR course is considered to be a useful tool in the improvement of teaching and learning enhancing students' clinical reasoning ability.

8H/3

Further development of the Dual Training Model using real patient encounter in undergraduate medical education in Japan

Yu Yamamoto (Jichi Medical University, Department of General Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi

329-0498, Japan)

Harumi Gomi (Jichi Medical University, Center for Clinical

Infectious Diseases, Tochigi, Japan)

Koichi Takada (Jichi Medical University, Department of

General Medicine, Tochigi, Japan)

Yuka Urushibara (Jichi Medical University, Department

of General Medicine, Tochigi, Japan)

Reiko Mochizuki (Jichi Medical University, Department of Emergency Medicine, Tochigi, Japan) Shizukiyo Ishikawa (Jichi Medical University, Department of Community and Family Medicine, Tochigi, Japan)

Background: The Dual Training Model has been developed and implemented to teach clinical reasoning in undergraduate medical education in our institution since 2010. It is a workplace case-based learning model to train both residents and students simultaneously. Since 2012, this model has been revised to utilize real patient encounter by students for discussion instead of patients seen and presented by residents. Summary of work: The Dual Training Model provides resident-led, faculty-supervised, live, and interactive situated learning sessions among Year 4 students. A group of three to four students rotate the Department of General Medicine for two weeks. Each group has one Dual Training Model session during the rotation. Residents are given three roles. One is a facilitator, one is a scribe on the white board, and the rest are observers. Faculty plays a role of supervision and facilitation as needed. Students present a patient who was seen by them.

Summary of results: In the revised model, students are required to present a patient seen by them. This gives further challenges in facilitation skills among residents. Residents are required to analyze limited or insufficient patient information by the students, and to adjust their facilitation to students' prior knowledge and their responses.

Conclusions: The Dual Training Model using real patient encounter has promoted situated learning further. Assessment of educational effects is necessary for this revised model.

Take-home messages: The revised Dual Training Model has preserved feasibility and significant educational value for both students and residents as the former model.

8H/4

Unraveling expert assessment of diagnostic clinical reasoning of medical students in clinical practice by a grounded theory approach

C.M. Haring (Radboud University Nijmegen Medical Centre, Internal Medicine (463), Postbus 9101, Nijmegen

6500 HB, Netherlands)

B. M. Cools (Radboud University Nijmegen Medical Centre, Internal Medicine, Nijmegen, Netherlands) P.J. van Gurp (Radboud University Nijmegen Medical Centre, Internal Medicine, Nijmegen, Netherlands)

J. W.M. van der Meer (Radboud University Nijmegen Medical Centre, Internal Medicine, Nijmegen, Netherlands)

C. P. Postma (Radboud University Nijmegen Medical Centre, Internal Medicine, Nijmegen, Netherlands)

Background: The process of clinical reasoning is complex, not yet completely understood and it takes years of deliberate practice to become good at it. Its assessment is in need of improvement.

ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530

Summary of work: A grounded theory approach was used to analyze what indicators expert physicians use to assess clinical reasoning abilities while observing medical students during the process of history taking. Twelve randomly selected recorded clinical encounters of students at the end of the internal medicine clerkship were observed by six expert clinical teachers. The teachers were stimulated to think aloud to get insight in their assessment process. Summary of results: Main indicators of clinical reasoning ability were distilled from the observable acts of the students. These were: taking control, recognizing and responding to relevant clues, specifying symptoms, asking specific questions that point to pathophysiologic thinking, placing questions in a logical order, checking with the patient, summarizing and body language. Next to that also activities of the patients, the course and result of the conversation were seen as indicators of clinical reasoning. Efficiency was also regarded as an important point. Context factors, own preferences, and undefined feelings appeared to be variables in their judgment of clinical reasoning also. Conclusions: A concept for expert assessment of the process of clinical reasoning was created by a grounded theory approach. This concept can be used for further development of assessment methods of clinical reasoning.

Take-home messages: By grounded theory approach new concepts of expert assessment can be revealed.

8H/5

A recognition study to test the psychological validity of illness scripts

Eugene Custers (University Medical Center, Center for Research and Development of Education, Universiteitsweg 98, P.O. Box85500, Utrecht 3508 GA, Netherlands)

Background: Diagnostic knowledge is often supposed to be organized in the format of illness scripts, structures tuned toward efficient use of incoming information enabling physicians to arrive at a diagnosis. Yet, the specific features of such scripts are rarely investigated. Summary of work: This study investigates whether predictions for recognition memory of case information based on illness script theory can be confirmed, and whether differences between more and less experienced participants can be found. Second and sixth year students and experienced family physicians participated in an experiment; the influence of typicality of information (prototypical versus atypical statements), textual presence (verbatim or implicit), and delay (15 minutes or 1 week) on recognition memory discrimination and recognition reaction times was measured.

Summary of results: As predicted, memory discrimination was better at a shorter delay and for atypical, as opposed to prototypical, information. In addition, at the longer delay, the influence of the script becomes more dominant, as opposed to memory for specific case information. Reaction times, on the other

hand, did not show a consistent pattern, and the predicted developmental differences were not found. Even the amount of disease-specific experience did not make a difference.

Conclusions: Experienced as well as inexperienced physicians appear to dispose of illness script structures, which explains poorer memory discrimination for prototypical than atypical information, and the dominance of script knowledge over memory for specific information after a delay.

Take-home messages: Differences between expert and nonexpert illness scripts will probably become apparent in script activation, rather than in the knowledge contained in the script.

8H/6

Modified Venndiag in Learning Clinical Reasoning: The role of Meta-cognitive and Cognitive Prompts

Oktarina Oktarina (Medical and Health Faculty of Muhammadiyah Jakarta University, Medical Education, Bendungan Jago 006/001 no 19 Serdang-Kemayoran, Jakarta Pusat 10650, Indonesia) Anique de Bruin (Maastricht University, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands)

Mariette van Loon (Maastricht University, Department of Educational Development and Research Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands)

Background: Learning clinical reasoning is affected by student guidance, affect/motivation, and mastery of biomedical sciences. Student guidance aims to assist students in generating knowledge, skills, and empowering student to be an independent learner. Guidance provided externally in the teaching session is expected to be internalized by students. The aim of this study is to compare the effect on clinical reasoning skills by utilizing combination of meta-cognitive and cognitive prompts (Modified Venndiag) as well as the cognitive prompt (Venndiag) among the medical students. Summary of work: This experimental study was set up at Medical school of Muhammadiyah University of Jakarta, whose students are the subjects. Participants selected randomly were grouped into two groups: control (Venndiag) and experimental (Modified Venndiag). The comparison between control group and experimental group was analyzed by a chi-square test and an independent t-test.

Summary of results: The chi-square test results show significant association between the type of prompting and status of post-test score 2(1)= 4.08, p= 0.043. The odds ratio of increasing score was 3.06 times higher if students used a combination of Modified Venndiag. On average, the difference between post test and pre-test in control group and experimental group was not significant t(53) = 1.688, p = 0.097. Conclusions: The result shows that the possibility of increasing clinical skills reasoning by applying a

combination of Modified Venndiag is greater than applying only Venndiag.

Take-home messages: It is implied that the transition of external guidance (only from a teacher) to shared guidance (from student and teacher), and then to internal guidance (only from student) should be fostered.

8I Short Communications: Problem

Based Learning 1

Location: Club A, PCC

8I/1

Evaluation of summary writing with a mind map to enhance the PBL learning process

Sneha Ravindranath (International Medical University, School of Dentistry, No 126, Jalan Jalil Perkasa 19, Bukit Jalil, Kuala Lumpur 57000, Malaysia) Warnakula Kusum De Abrew (International Medical University, Clinical Skills and Simulation Centre, School Of Medicine, Kuala Lumpur, Malaysia) Vishna Devi Nadarajah (International Medical University, Department of Human Biology, School of Medicine, Kuala Lumpur, Malaysia)

Background: Problem based learning enables constructive, contextual and collaborative learning but an inherent disadvantage of PBL is the knowledge acquired through PBL is perceived to be poor and unorganized. Some studies have suggested documentation of the PBL discussion to organize information and fully realize the benefits of PBL. Summary of work: This study evaluates the benefits of summary writing with a mind map in PBL. Medical students were briefed on the process of mind mapping for summarizing the PBL group discussion and completed a pre intervention feedback form on the PBL learning process. The mind maps were collected at the end of PBL session 2, feedback was provided on each student's mind map and returned before the next PBL trigger. Students then completed a post intervention feedback form. Statistical analysis was performed with the Student's t-test and ANOVA with post hoc analysis

(LSD).

Summary of results: The mean pre and post intervention scores continued to be positive even after the intervention of summary writing with a mind map but there was a difference in the ranking of the PBL learning processes with summarizing and structuring concepts at the top after mind mapping. The qualitative analysis of students' comments indicated that the students considered the mind mapping exercise useful although it was time consuming. The key benefits perceived by the students were, mind mapping helped in summarizing the PBL discussion and provided a revision tool for reflection and recall. Conclusions: The study has shown that students perceived summary writing with a mind map in PBL beneficial.

Take-home messages: PBL learning process can be enhanced by summarizing the PBL group discussion using a mind map which allows for active learning and provides a revision tool.

ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530

8I/2

What makes a bad PBL tutor?

Tim Neild (Flinders University Medical School, Dept of Human Physiology, GPO Box 2100, Adelaide 5001, Australia)

Background: In student centred Problem Based Learning the tutor must be a skilful facilitator. The characteristics of good tutors have been enumerated frequently, but bad tutors have not been studied as closely. Summary of work: This study draws on 10 years' experience supervising PBL tutors at Flinders University. "Bad" tutors were identified from reports by students either verbally to me or from the (anonymous) routine evaluation of tutors conducted by students at the end of each tutor's period with the group (4-9 weeks). Information often came from other sources too, but was not included. Following an unsatisfactory evaluation, I interviewed the tutor.

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