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Summary of results: The most common complaint was that the tutor talked too much. The subject of the talk varied, but the least appreciated was repeated anecdotes from the tutor's many years of valuable experience. Accounts of the tutor's non-medical interests were also disliked. A less frequent problem was constant intervention in group process rather than waiting to see if the group could solve its own problems, or when the group did not have a problem. The common thread was the tutor wanting to be the centre of attention. Less common was the tutor doing nothing when intervention was needed. This seemed to occur when the tutor was either too timid, or tutoring only because it was an obligatory part of their job. Twice it was due to the tutor's poor hearing, which was easily rectified by a hearing aid.
Conclusions: Once identified correctly, most of these problems were successfully remediated by counselling. Take-home messages: "Bad" tutors can improve.
How medical students perceive their studies: a comparison of reformed and traditional medical degree programs at Charite - Universitatsmedizin Berlin
Susanne Dettmer (Charite - Universitatsmedizin Berlin, Institute of Medical Sociology, Berlin, Germany) Asja Maaz (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center for Medical Education, Berlin, Germany)
Josefin Bosch (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center for Medical Education, Invalidenstrafie 80-83, Berlin 10117, Germany) Stefan Schauber (Charite - Universitatsmedizin Berlin, Institute of Medical Sociology, Berlin, Germany) Harm Peters (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center for Medical Education, Berlin, Germany)
Background: This study investigates self-reported aspects of academic success in three medical degree
programs at the Charite (traditional complete cohort, problem-based small cohort, problem-based, outcome-oriented complete cohort) and combines them with students' characteristics. Focus was the influence of problem-based learning on subjective measures of academic success.
Summary of work: A secondary analysis of data first published by Dettmer & Kuhlmey (2010) is combined with newly collected data. First and second year students of each curriculum answered multiple questionnaires. They were analysed in terms of academic success, which is operationalised according to the educational aims of the Charite as well as the German Medical Licensure Act. Investigated outcome criteria (study satisfaction, career plans, thoughts about quitting, perceived stress and its consequences, work life balance) are in line with theoretical approaches to academic success.
Summary of results: 517 first year and 332 second year students replied (response rate 53%). Results favour the problem-based curriculum in terms of study satisfaction (p< .01), stress perception (p< .01) and working as a physician in curative domains. Regression of anxiety and burnout symptoms on students' self-efficacy beliefs confirms their negative relation (p< .01). Conclusions: Students of problem-based curricula present themselves as being less distressed, more satisfied and more motivated to choose specialities that highly involve communication and patient work. Educational and organisational differences of the three curricula are taken into account to discuss their benefits and strains.
Take-home messages: Students' perception is key to the global outcome picture of problem-based curricula and adds to a theoretically founded analysis of academic success.
Tutor interventions in dealing with conflicts on knowledge
Matti Aarnio (University of Helsinki, Hjelt Institute, P.O. Box41 (Mannerheimintie 172), Helsinki FI-00014, Finland)
Sari Lindblom-Ylanne (University of Helsinki, Centre for Research and Development of Higher Education, Helsinki, Finland)
Juha Nieminen (University of Helsinki, Centre for Research and Development of Higher Education, Helsinki)
Eeva Pyorala (University of Helsinki, Hjelt Institute, Helsinki, Finland)
Background: This study examines tutor interventions and their role in facilitating students to collaboratively resolve conflicts on knowledge in PBL-tutorial discussions.
Summary of work: Four videotaped reporting phase tutorial sessions including three tutors and 33 first-year medical and dental students were analysed using qualitative interaction analysis. The aim was to find out 1) how the tutor interventions helped the students to
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
resolve conflicts on knowledge, 2) how the tutor interventions during conflict episodes differed from the interventions during the rest of the sessions, and 3) how the tutors intervened during conflicts about different types of knowledge.
Summary of results: The tutorial discussions included 92 tutor intervention episodes and 43 conflict episodes. The tutors intervened during 24 of the conflict episodes and resolved 13 of these episodes. During conflicts on knowledge, the tutors often gave explanations instead of asking questions or encouraging students to deal with the issues. The tutors gave more explanations during conflict episodes. The tutors more often resolved conflicts on factual knowledge than conceptual knowledge.
Conclusions: The lack of thought-provoking questions and the amount of explanations during conflict episodes hinders students from collaboratively resolving conflicts on knowledge. The findings suggest that tutor training should focus on promoting tutors' understanding on when and how to intervene in the discussion during conflicts on knowledge.
Take-home messages: Tutors' skills to encourage students to collaboratively handle conflicting ideas and to stimulate discussion with questions that promote the elaboration of the issues need improvement.
Using Social Network Analysis to investigate Patterns of Interactions in online Problem Based Learning (PBL)
Mohammed Saqr (Qassim University - College of Medicine, Medicine, PO Box 6655, Melida 51452, Saudi Arabia)
Abdullah AlGhasham (Qassim University - College of Medicine, Pharmacology, Unaiza, Saudi Arabia) Habiba Kamal (Qassim University - College of Medicine, Clinical Skills, Buraydah, Saudi Arabia)
Background: Social Network Analysis (SNA) is an innovative method for the study of social interactions of online groups at an individual level as well as group level. Qassim College of Medicine uses collaborative online group discussions (virtual PBL) to complement conventional PBL; to help overcome student perceived shortcomings and improve their learning experience. To evaluate the participation of students and their relations to each other and to their tutors, we need to go through tons of online non-structured information. Automated discovery and analysis of groups, contributions and relationships by means of SNA could help in identifying patterns of interactions between students in virtual PBL, flow of information exchanged among participants/groups.
Summary of work: We used Meerkat-ED, an application that prepares and visualises overall snapshots of participants in the discussion forums, their interactions, and the leaders/peripheral students in these discussions.
Summary of results: By analysing the data and visual mapping of interactions we were able to identify: Active
and inactive Groups; Separate and interconnected PBL groups; Most influential members (most outgoing connections); Most prominent members (most incoming connections); Central members in the group; Outliers (least connected); Density of contributions; Evolution of networks and patterns of interactions between members and groups over time. Conclusions: SNA can analyze huge amounts of information in a short time and provides a bird's eye view of students' contributions and interactions in online PBL and inter-group relationships. Take-home messages: SNA could help instructors better assess online discussions.
Does PBL work? Does music?! - A metaphor for education
Brian Bailey (Napier University, Faculty of Health Sciences, Edinburgh, United Kingdom)
Background: With respect to the Conference's theme of coloring outside the lines of conventional education, the author revisited a music metaphor he presented at AMEE 2004 in which he discussed "the moribund state of problem-based learning theory and research", this based on his observation that the widely recognised positive emotional effects of PBL remained under-examined and under-theorised. While the present PBL literature reveals that little has changed, theoretical developments in other fields both within and beyond education indicated that re-animation of the metaphor could be productive.
Summary of work: Metaphor theory posits that they can facilitate 'epistemic access' to new ideas and theories that can illuminate a target topic. Here immersion in the literature of metaphor itself and its intersections with musicology and music, emotion theory and medical education provided the basis for a search for a richer understanding of PBL than that afforded by the health sciences education literature. Summary of results: A number of overlapping theories and insights emerged all of which, in sum, pointed to the primacy of emotional, cultural and social factors in education.
Conclusions: Metaphor theory suggests that successful metaphors "possess the prestige of the dominant discourses" of their time. A satisfying outcome from this study is the congruence between the results above and the features of the paradigm shift reportedly occurring in medical education, this reflected in a growing awareness of the importance of the emotions in education and the emergence of socio-cultural models of learning.
Take-home messages: Music metaphors, as does music itself, provide a powerful stimulus for learning.
8J Short Communications: Best Evidence Medical Education (BEME) 1
Location: Club E, PCC
Evidence regarding the utility of Multiple Mini-Interviews for selection to undergraduate health courses: a BEME systematic review in progress
Eliot L Rees (Keele University, School of Medicine, David Weatherall Building, Keele, North Staffordshire ST5 5BG, United Kingdom)
Ashley Hawarden (Keele University, School of Medicine, North Staffordshire, United Kingdom) Andrew Hassell (Keele University, School of Medicine, North Staffordshire, United Kingdom)
Background: In selection for undergraduate health programmes, applicant numbers invariably exceed the number of available places. Admissions procedures focus on identifying which candidates have the necessary intelligence and personal attributes to be successful in the chosen profession. Intelligence can be assessed, for the purposes of admissions, through previous academic qualifications and scores on admissions tests. Personal attributes are more difficult to assess. In 2004, McMaster University developed the Multiple Mini-Interview (MMI), a multiple sample approach to admissions interviews, with the intention of increasing reliability and ability to predict clerkship performance. MMIs assess candidates personal attributes through separate stations. Many schools have since adopted the MMI approach internationally. Summary of work: We are undertaking a systematic review and meta-analysis of evidence regarding MMIs. Our study protocol has been approved by the Best Evidence Medical Education collaboration (BEME). 13 databases have been searched through 34 terms and their Boolean combinations. Several key journals have been hand searched since 2004. Studies meeting the inclusion criteria will be coded using a modified BEME coding sheet. Extracted data will be synthesised through meta-analysis and narrative synthesis. Summary of results: Preliminary results will be available for presentation.
Conclusions: MMIs are becoming increasingly popular in selection for all health professions. Through this review we intend to explore, analyse and synthesise the evidence relating to MMIs for selection to undergraduate health courses. Ultimately we aim to synthesise the existing literature to guide and inform those responsible for admissions to health professions courses.
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
A BEME Review: the contribution of theory to the effective development and delivery of interprofessional curricula in health and social care professional education
Sarah Hean (Bournemouth University, Health and Social
Care, Royal London House, Christchurch Road,
Bournemouth BH1 3LT, United Kingdom)
Elizabeth Anderson (University of Leicester, Medical
School, Leicester, United Kingdom)
Chris Green (University of Essex, School of Health and
Human Sciences, London, United Kingdom)
Carol John (The Anglo-European Chiropractic College,
Bournemouth, United Kingdom)
Richard Pitt (University of Nottingham, Centre for
Interprofessional Education and Learning, Nottingham,
Debra Morris (University of Southampton, Hartley Library, Southampton, United Kingdom)
Background: Strong theoretical underpinnings are essential to the development of interprofessional education and medical education in general. In interprofessional education, researchers and educationalists alike have mined other disciplines for theories with potential utility. This has resulted in many theories on 'offer'. This plethora, and the varied quality of theory application, often confuses, rather than clarifies, ways in which theory contributes to effective IPE curricula.
Summary of work: A BEME review is currently in progress that aims to offer guidance to curriculum developers on how to design rigorous professional curricula with strong theoretical underpinnings. It asks: What is the contribution of theory to the effective development and delivery of interprofessional curricula in health and social care professional education? Summary of results: We present the outcomes of the pilot conducted for the review and highlight the challenges we have faced. We focus specifically on the benefits and challenges to having a librarian on the review team, the importance of a pilot in such a review and the challenges to measuring the quality of theory application in medical education development and delivery. We also share some of the preliminary findings from the pilot.
Conclusions: The review will enable medical educators to select and apply theories that are fit-for-purpose, that promote reflection on the why, rather than just the how, of designing, delivering and evaluating an effective curriculum.
Take-home messages: A librarian is an invaluable resource to a review team. A pilot of the review is essential to test the protocol at all stages of the review.
Teaching Professionalism in medical education: A best evidence in medical Education (BEME) systematic review
Hudson Birden (University Centre for Rural Health, North Coast, Medical Education, PO Box 3074, Lismore, NSW 2480, Australia)
Nel Glass (Australian Catholic University, School of Nursing, Midwifery & Paramedicine, Fitzroy, VIC, Australia)
Ian Wilson (University of Wollongong, Graduate School of Medicine, Wollongong, NSW, Australia) Michelle Harrison (University of Sydney, Medical library, Sydney NSW, Australia)
Tim Usherwood (University of Sydney, Medical School, Sydney, NSW, Australia)
Duncan Nass (University of Wollongong, Graduate School of Medicine, Wollongong, NSW, Australia)
Background: There is no consensus in the literature as to the best methods for teaching professionalism, nor even on how professionalism in medicine should be defined. While many papers have been published on teaching medical professionalism, little evidence of effectiveness is included in them. We sought to identify best evidence for teaching medical professionalism to medical students.
Summary of work: Through a systematic search of the literature we identified 217 papers, of which we deemed 43 to be of higher quality. We also identified eleven books on teaching professionalism. Summary of results: There was a wide diversity in study types. Most papers were of the viewpoint/opinion variety. Since we were interested in the conceptual basis of teaching professionalism, and since much of what has been published (and most of what has been highly cited) consists of this type of paper, we included them in our review. Evident themes in the literature are that role modelling and personal reflections, ideally guided by faculty, are the important elements in teaching professionalism, and are widely held to be the most effective techniques for developing professionalism.
Conclusions: We conclude that there is as yet no unifying theoretical or practical model to integrate the teaching of professionalism into the medical curriculum that has been validated over time or across institutions as being effective.
Take-home messages: While it is generally held that professionalism should be part of the whole of a medical curriculum, the specifics of sequence, depth, detail, and the nature of how to integrate professionalism with other curriculum elements remain matters of evolving theory.
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
How does the teaching of a structured tool for communication within and between teams contribute to student learning? A Best Evidence Medical Education (BEME) systematic review
Sharon Buckley (University of Birmingham, College of Medical and Dental Sciences, Vincent Drive, Edgbaston, Birmingham B15 2TT, United Kingdom) Lucy Ambrose (University of Keele, School of Medicine, Keele, United Kingdom)
Elizabeth Anderson (University of Leicester, Department of Medical and Social Care Education, Leicester, United Kingdom)
Jamie J Coleman (University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom)
Marianne Hensman (University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom)
Christine Hirsch (University of Birmingham, College of Medical and Dental Sciences, Birmingham, United Kingdom)
Background: Recent prominent cases of poor patient care and compromised patient safety have highlighted the importance of good communication within and between health care teams. In response, standardised forms of communication, such as Situation Background Assessment Recommendation (SBAR) are increasingly used in practice and taught to trainee health care professionals.
Summary of work: We have undertaken a BEME systematic review to consider how the teaching of such 'tools' contributes to student learning in the pre-registration setting. Our review explores the range of tools currently taught within pre-registration curricula, the teaching methods employed and how such teaching influences students' knowledge, skills and attitudes. We are particularly interested in how such teaching varies with profession and how far it takes place within the context of interprofessional education (IPE). Summary of results: For our review, we have used a definition of 'team' that encompasses the different types identified by the 'TeamSTEPPs' programme (1). Such teams may be temporary or long standing and involve two or more individuals, either from the same or different professions. We define a 'structured tool' as any systematic approach to communication that is taught to students in order to enhance their ability to communicate effectively within or between professional teams.
Conclusions: This presentation will discuss progress with our review, including protocol development, literature searching, our approach to assessment of quality and preliminary findings. We will also report on our experience of using review management software DistillerSR in the context of an educational systematic review.
(1) Agency for health care quality and research. Available at: http://teamstepps.ahrq.gov Accessed 11 03
Is OSCE meeting current educational assessment requirements when used in undergraduate medical studies? Evidence from a BEME Systematic Review points to the OSCE as a '6 STAR EXAM'
Madalena Patricio (Faculty of Medicine, University of Lisbon, Center for Evidence Based Medicine, Av. Prof. Egas Moniz Lisbon 1649-028, Portugal) Miguel Juliao (Faculty of Medicine, University of Lisbon, Center for Evidence Based Medicine, Lisbon, Portugal) Filipa Fareleira (Faculty of Medicine, University of Lisbon, Center for Evidence Based Medicine, Lisbon, Portugal) Antonio Vaz Carneiro (Faculty of Medicine, University of Lisbon, Center for Evidence Based Medicine, Lisbon, Portugal)
Background: Previously assessment requirements were focused in reliability and validity of the assessment tools but in recent years the importance of further criteria that relates to the closer relationship between assessment and teaching has been added (van der Vleuten 1996; General Medical Council 2011, Norcini et al. 2011). The objective of the study was to produce scientific evidence on OSCE suitability to assess learning outcomes i.e. to what extent is the OSCE meeting current assessment standards when used in undergraduate medical studies. Summary of work: BEME methodology was applied by two independent coders, who scrutinized literature from 1975 until the end of 2008. From 1083 identified studies, 1065 were analysed to describe the alignment between OSCE and current requirements. Summary of results: Evidence points to the OSCE as a reliable, valid, feasible, fair and acceptable exam (relevant and satisfactory) with a steering effect on learning and teaching.
Conclusions: It appears that OSCE has a more important role to play in the future, namely by being an 'authentic', 'overall exam' (multiple competencies in a single exam) where assessment is 'for learning' and not just 'of learning'.
Take-home messages: Although we must be aware of the possibility of a bias in the results - since the tendency is to publish more the stories of success than negative ones - the evidence brought up by this BEME systematic review on OSCE feasibility, reliability, validity, fairness, acceptability and educational impact justifies the OSCE being considered a '6 STAR EXAM'.
Communities and medical education: from complexity to understanding
Rachel Ellaway (Northern Ontario School of Medicine, UME, 935 Ramsey Lake Rd, Sudbury P3E 2C6, Canada)) Roger Strasser (Northern Ontario School of Medicine, Sudbury, Canada)
Lisa Graves (Northern Ontario School of Medicine, UME, Sudbury, Canada)
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
David Marsh (Northern Ontario School of Medicine, Community Engagement, Sudbury, Canada) Cathy Cervin (Northern Ontario School of Medicine, PGME, Sudbury, Canada)
Background: There have been many models of how medical education programs should and do interact with communities. These range from activities that address topics in community health but still take place in traditional academic settings to activities that directly engage members of a community in their design, conduct and evaluation. At the same time more and more programs are engaging aspects of community in their design and operation.
Summary of work: We have designed a two-arm BEME-registered systematic review to answer our question: 'how do different relationships between medical education programs and communities impact educational and health outcomes?'. One arm employs standard outcomes reviews based on Kirkpatrick criteria and strict filtering based on empirical methods and analyses to explore 'what works?'. The other arm is based on realist enquiry to explore 'what works, for whom and in what context?'. We have recruited 30+ reviewers from around the world who are working through a purpose-built online collaborative work environment that allocates, stores and provides aggregate reports on their reviews. The material selected for review is a combination of articles from academic journals, book chapters and other academic sources and greyer literature from institutional reports and similar sources. The study has been reviewed and approved by BEME and has passed REB review, and is currently under way.
Conclusions: We are developing models and meta-models that capture and describe a complex web of philosophies, practices and ideologies that in turn shape how medical programs engage with the idea and the reality of community.
8K Short Communications: Leadership 2
Location: Club B, PCC 8K/1
Collaborative leadership in action: developing the leadership faculty community
Emily Bate (The Royal Liverpool University Hospital and The University of Liverpool, School of Medicine, Cedar House, Ashton Street, Liverpool L69 3GE, United Kingdom)