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Jamie Green (Abington Medical Centre, Abington
Medical Centre, Northampton, United Kingdom)
Jordana Abraham (Croydon University Hospital, Medical
Education, London, United Kingdom)
Kirsty Forrest (Yorkshire and Humber Deanery, Medical
Education, Leeds, United Kingdom)
Judy McKimm (Swansea University, College of Medicine,
Swansea, United Kingdom)
Background: The international focus on developing students and doctors as teachers, researchers, clinical leaders and managers has led to inclusion of specific competencies at undergraduate level and the expansion of postgraduate training programmes, e.g. academic awards and workshops. However, there is a shortage of suitably trained leadership faculty, many of whom work in isolation.
Summary of work: The aim was to create a Leadership Faculty Community of Practice (LFC), which would support the development of junior clinical and educational leadership faculty, and provide a collaborative working and research network for more experienced faculty.
Summary of results: A Leadership Faculty Community has been developed, and continues to thrive, comprising leadership trainers and trainees within ASME, AMEE and JASME and leadership training programme providers. The first cohort of junior faculty are being trained and will shortly be running Leadership training courses themselves, supported and mentored by senior faculty. Conclusions: The demand for leadership and management training for clinicians has led to the need for active faculty development to sustain the quality and delivery of these programmes. The LFC provides a collaborative forum for experienced faculty, and helps the development and mentorship of new and junior faculty. The formation of the LFC exemplifies Collaborative leadership. Our network is developing a critical mass of qualified faculty and supporting shared resources able to sustain, develop and deliver high quality leadership programmes worldwide. Take-home messages: 1. An international shortage of leadership trainers requires proactive faculty development. 2. Engaging juniors early in their career helps succession planning.
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
Using Simulation for leadership training
Francina Cunnington (Great Ormond Street Hospital, Postgraduate Medical Education, Great Ormond Street,
London WC1N 3JH, United Kingdom)
Rachel Shute (Great Ormond Street Hospital, Postgraduate Medical Education, London, United Kingdom)
Jenni Hibbert (Great Ormond Street Hospital, Postgraduate Medical Education, London, United Kingdom)
Geoff Speed (Great Ormond Street Hospital, Postgraduate Medical Education, London, United Kingdom)
Background: This innovative program Clinical Leadership in Action (CLiA) successfully advances simulation into the leadership training arena. Contrary to traditional lecture-based leadership courses, CLiA encourages deep learning through lived experience supporting trainees as they move into senior roles. Summary of work: Working in a group simulation, trainees are challenged to investigate and respond to a complex patient complaint, by letter, and proposals for service improvement are also presented to a hospital board. Fidelity is enhanced by a bespoke hospital website, official hospital documentation and opportunities to attend face-to-face meetings with real experts, and a parent.
Summary of results: Within a safe environment, trainees assimilate new knowledge and work through the decision making process of responding to this complaint proposing a resulting service re-design. Participants report increased understanding of the senior role and greater confidence meeting these challenges. Trainees indicate that simulation is a useful tool in facilitating a change in attitudes and behaviours stating their intention to apply these changes in their workplace.
Conclusions: Teamwork is integral to the depth of enquiry. It is reinforced by the accessibility to electronic resources and targeted learning enabling direct application of new knowledge. Immediate feedback from faculty enables significant shifts resulting in a more patient-centred approach. Changes in attitude and behaviour are evident by the end of the programme. CLiA avoids the limitations of traditional lecture-based leadership courses by providing the opportunity to practice new skills, learn from each other and build on current knowledge.
Take-home messages: Simulation is an effective learning tool for leadership and management training in healthcare.
Walking the talk: The utility of a multi-source feedback tool in postgraduate medical education
Susan Lieff (University of Toronto, Centre for Faculty Development, Li Ka Shing Healthcare Education Centre,
209 Victoria St, 4th Floor, Room 480, Toronto M5T1T8, Canada)
Ari Zaretsky (University of Toronto, Psychiatry, Toronto, Canada)
Glen Bandiera (University of Toronto, Post Graduate Medical Education, Toronto, Canada) Salvatore Spadafora (University of Toronto, Post Graduate Medical Education, Toronto, Canada) Melissa Hynes (University of Toronto, Post Graduate Medical Education, Toronto, Canada) Susan Glover Takahashi (University of Toronto, Post Graduate Medical Education, Toronto, Canada)
Background: Postgraduate Program Directors (PGPDs) get little formal feedback on their leadership. This research evaluates the feasibility and utility of a competency-based multisource feedback (MSF) instrument and process in providing PGPDs with comprehensive and constructive feedback on their leadership. The MSF instrument was designed based on a review of competency inventories and an iterative process involving national and local input. Summary of work: 106 PGPDs were invited to participate and provide contact information for 10-20 colleagues (e.g. administrators, faculty, residency committee members, chairs, deans) to be invited to provide feedback on their performance. PGPDs also completed a self-assessment. The identified participants (IPs) received an email invitation and following their consent, they completed the online MSF instrument. Summary of results: 17 (16%) of University of Toronto PGPDs identified a total of 389 potential IPs (mean 22 per RPD). 166 IPs completed the MSF, with a mean of 9 (response rate 43%) per RPD. Most often, RPD self-ratings were lower than the mean of IP ratings on the five key performance domains (Communication and Relationship Management, Leadership, Professionalism and Self-Management, Environmental Engagement and Management Skills and Knowledge). Conclusions: The combination of RPD views of their own performance and the feedback received served as useful tools for feedback on their leadership performance. Although the interest in participation in this pilot was high, the feasibility and utility of the tool was challenged by assessors' response rates. Our findings indicate that formal feedback is welcome, feasible, and can support medical education leaders in providing direction for improving their practices. Take-home messages: Multisource feedback for postgraduate program directors is welcome, feasible, and can support them in providing direction for improving their practices.
Towards a reliable assessment of management competencies in postgraduate medical education: A Delphi study
Lokke M. Gennissen (University Maastricht, Faculty of Health, Medicine and Life Sciences, Coolhaven 180E2, Rotterdam 3024 AM, Netherlands)
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
Lorette A. Stammen (University Maastricht, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands)
Rob M.J. Moonen (Atrium Medical Center, Heerlen, Paediatrics, Heerlen, Netherlands) Jamui O. Busari (Atrium Medical Center, Heerlen, Paediatrics, Heerlen, Netherlands)
Background: Recent research has shown that current post-graduate training programs do not prepare trainees adequately in the field of health management. It is also thought that the key to the development of successful management-training programs is when valid and reliable assessment tools are used to test specific domains of management competencies in residents. A recent review of the literature however, revealed that there was little evidence supporting the validity and reliability of the assessment tools currently in use. We therefore decided to explore the current methods of assessments of management competency in the Dutch residency-training program and investigate the benefits and shortcomings of the assessment tools. Summary of work: In November 2012 a Delphi survey among an expert panel group in medical management and leadership in the Netherlands was conducted. The panel comprised of clinical educators, care management stakeholders and residents with special interest in care management.
Summary of results: Respondents agreed that current assessment tools were inadequate for measuring the management competencies of residents. Although they agreed with the feasibility of the tools in use, they disagreed with the validity and agreed that there was a need for reliable assessment tools. The panel expressed that current assessment tools were not reproducible, did not provide a clear reflection of performance, were not capable of assessing all domains of the management competency and were not useful for differentiating residents' level of competency. Conclusions: Of the current assessment tools in use, a combination of 360-degree feedback, portfolio, self-designed projects and clinical observations were recommended for assessing management competencies in residents.
Development and reliability testing of Ward Round Assessment of Performance (WRAP) - A 360 degree assessment tool for ward round leadership skills
Indumathy Lakshminarayana (Coventry and Warwickshire Partnership Trust, Paediatrics, Stoney Stanton Road, Coventry CV1 4FS, United Kingdom) David Wall (West Midlands Deanery, Birmingham, United Kingdom)
Taruna Bindal (Alexandra Hospital, Redditch, United Kingdom)
Helen Goodyear (West Midlands Deanery, Birmingham, United Kingdom)
Background: Although leading a ward round is an essential prerequisite for hospital consultants, this skill is rarely assessed during training. There is often a lack of supervision and feedback on ward rounds, resulting in inadequate preparation of senior trainees for this important responsibility.
Summary of work: An assessment tool called WRAP was developed to provide 360 degree multisource feedback of ward round leadership skills and piloted in West Midlands Deanery. The WRAP tool has 5 domains with description for each of the domains and a 5 point rating scale. WRAP forms were distributed by trainees to assessors who were asked to observe the trainee leading ward rounds. The completed forms were summarised by the trainee's educational supervisor and feedback provided.
Summary of results: 90 trainees completed 289 individual assessments. Reliability of WRAP is very good with a Cronbach's alpha of 0.843. Consultants gave consistently low scores than other assessor groups and this was statistically significant with a p value of 0.002 for the domain preparation and organisation. A generalizability D study showed good reliability with a G co- efficient of 0.8 for three raters. Conclusions: WRAP tool with feedback from three assessors gave good reliability and hence it is a practical one that can be used in both large and small units. This was designed for senior trainees in Paediatrics but is also likely to be of benefit to those in other specialities. Take-home messages: WRAP tool enhances trainees' learning by assessment of their leadership on supervised ward rounds and promotes a culture of constructive feedback.
Team harmony in healthcare: Lessons from musicians
Clare Whitehead (University of Ottawa, Faculty of Medicine, Ottawa, Canada)
Cynthia Whitehead (University of Toronto, Department of Family and Community Medicine, Toronto, Canada) Gabrielle McLaughlin (University of Toronto, Faculty of Pharmacy, Toronto, Canada)
Zubin Austin (University of Toronto, Faculty of Pharmacy, Toronto, Canada)
Background: As healthcare becomes increasingly team-based, we need new ways of educating trainees. One approach is to seek innovative ideas from other professions who have effective models of collaboration. Doctors have already turned to musicians for lessons in skills development, improvisation, and performance. However there has been little empirical study of musicians' interactions in ensembles with a view to enhancing healthcare education in communication and collaboration.
Summary of work: Using semi-structured interviews of non-conducted professional small musical ensembles, we explored factors musicians consider important for effective ensemble function. The interviews were transcribed and then coded thematically.
Summary of results: Several prominent themes were identified related to group interaction and leadership; we will focus discussion on one major theme relating to effective collaborative chamber ensemble function, that of the fundamental role of accompaniment. The supporting voices are in not seen as secondary to melody, but rather as a driving force for the group sound. The importance musicians place on all of the musical parts may offer healthcare more nuanced models of group interaction than traditional medical models of hierarchical leadership. Musicians' strong appreciation of balance and the need for all members to be active participants, active listeners and forceful voices may enhance healthcare team interactions. Conclusions: Examining various effective means musicians have found to communicate and collaborate in small groups suggests potential ways to improve healthcare team function. These insights may help lead to better healthcare team education and practices. Take-home messages: Chamber ensembles have valuable lessons to teach healthcare about communication, collaboration, and group leadership.
8L Short Communications: Interprofessional: Undergraduate
Location: Club C 8L/1 (15334)
Promoting collaboration between medical students and nursing students through clinical research - A model for Interdisciplinary Collaboration
Hedda Dyer (Ross University School of Medicine, Introduction to Clinical Medicine (ICM), Directorate Surgical Clerkships, Portsmouth Campus, P.O. Box 266, Roseau, Dominica)
Background: Teamwork is a key component of healthcare and training in the health sciences. Evidence-based medicine necessitates that students in the health sciences become familiar with the health research continuum. It is therefore vital that medical students, nursing students, physicians and nurses be given the opportunity to participate in interdisciplinary collaboration through clinical research. Summary of work: Medical students from the Ross University School of Medicine (RUSM) oncology club and nursing students from the Dominican school of nursing were members of a group of trained interviewers who administered a questionnaire in the face-to-face format as part of a clinical research project to improve the early detection and diagnosis of breast cancer in Dominica. This project was aimed at identifying the knowledge, attitude, practice and behaviour of health care workers and general practitioners directly involved in breast care. The subject matter of breast cancer served as an appropriate catalyst for interdisciplinary collaboration in view of the high incidence of breast cancer and the multidisciplinary approach to the diagnosis and treatment of breast cancer in the clinical setting. Summary of results: The medical students and nursing students expressed satisfaction in being able to work alongside one another in the gathering of information from their peers. All participants were able to actively participate and partner in the processes of discovery and development that is health research. The interviewers themselves reported an increase in their knowledge, and positive reinforcement of practice and behaviour of the subject matter through their administering of the questionnaires. Conclusions: An interdisciplinary approach to participation in clinical research helps to facilitate teaching and learning of knowledge, and develops the skills which are required for the interdisciplinary teamwork necessary for the practice of medicine. Take-home messages: Interdisciplinary collaboration between medical and nursing students should be encouraged and facilitated.
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
Promoting interdisciplinary learning in a multidisciplinary faculty
Patricia McInerney (University of the Witwatersrand, Centre for Health Science Education, Faculty of Health Sciences, 7 York Rd, Parktown, Johannesburg 2193, South Africa)
Lionel Green-Thompson (University of the Witwatersrand, Centre for Health Science Education, Johannesburg, South Africa)
Shirra Moch (University of the Witwatersrand, Dept of Pharmacy and Pharmacology, Johannesburg, South Africa)
Deanne Johnstone (University of the Witwatersrand, Dept of Pharmacy and Pharmacology, Johannesburg, South Africa)
Oluwafolajimi Fadahun (University of the Witwatersrand, Centre for Health Science Education, Johannesburg, South Africa)
Preyesh Goven Shiba (University of the Witwatersrand, Dept of Pharmacy and Pharmacology, Johannesburg, South Africa)
Background: The University of the Witwatersrand offers undergraduate degrees in six health science professions. Teaching and learning are usually discipline-based with each discipline planning and implementing the curriculum individually. Teachers may teach in other disciplines, but students generally do not learn together. Summary of work: The medical students begin clinical practica in their third year of study. At the beginning of the third year students are allocated to wards to work with nurses. During this placement students are required to participate in all the nursing activities. The value of this experience has been documented in students' portfolios of learning. The second interdisciplinary experience which the medical students have been exposed to is having pharmacy students accompany them in the wards during practica. There are usually 3-4 medical students and 1-2 pharmacy students who as a group are allocated to a particular ward. They are required to take patient histories and examine patients.
Summary of results: Students have described the value of both types of learning experiences, in particular noting the value of learning about the roles of other disciplines, the development of respect for what the other does and the value for the patient when there is interdisciplinary care. The value of both these learning opportunities can be aligned with Kolb's experiential learning cycle.
Conclusions: Interdisciplinary learning opportunities are valuable for both the student and the teacher as relations between the disciplines are fostered. Take-home messages: Interdisciplinary learning opportunities must be identified and encouraged to promote multidisciplinary care.
The impact of curricular design and expert modelling on interprofessional education in the health workplace
Elizabeth Molloy (Monash University, Health Professions Education and Educational Research, Building 13C, Wellington Road, Clayton, Melbourne 3800, Australia) Louise Greenstock (University of Melbourne, Australian Health Workforce Institute, Melbourne, Australia) Patrick Fiddes (Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia) Catriona Fraser (University of Melbourne, Australian Health Workforce Institute, Melbourne, Australia) Peter Brooks (University of Melbourne, Australian Health Workforce Institute, Melbourne, Australia)
Background: Studies of interprofessional education (IPE) report that structured initiatives can help to develop learners' dispositions for team-based practice. The majority of studies focus on interprofessional education initiatives in the university setting, with less research investigating the experience and outcomes for learners of interprofessional education activities in the workplace setting.
Summary of work: This research was funded in 2011 and investigated medical students' experiences of an IPE placement (Greenstock et al 2013). Medical students (n=15) who rotated through the targeted placement at a rehabilitation and palliative care facility were interviewed via focus groups to elicit their experiences of the placement.
Summary of results: Thematic Analysis of the data revealed three key findings: 1) For the learners, interprofessionalism was seen to sit on the margins of medical practice. 2) The placement, although intended to promote the development of interprofessionalism, lacked the design qualities needed to achieve these aims. 3) Discipline-based role models are key to orientating learners to what is important in practice. Conclusions: The medical students, while able to identify the advantages of interprofessional practice "once they became" a qualified practitioner, saw IPE as relatively low on their priority list as busy students, subject to regular assessments of their technical skills. They reported that they were being assessed on their 'doctoring' and dismissed any activities seen to be peripheral to this agenda.
Take-home messages: Students reported that their engagement with IPE activities was motivated by a focus on acquiring patient related clinical skills and on learning from role models within their own profession. The results call for more research into the extent to which educators model interprofessionalism in the academic and clinical workplace.
Greenstock L, Molloy E, Fiddes P, Fraser C, Brooks P (2013): We are studying medicine. The Clinical Teacher
(accepted 18 Feb 2013)
ABSTRACT BOOK: SESSION 8 TUESDAY 27 AUGUST: 1400-1530
International Classification of Functioning, Disability and Health (ICF): A framework for transformative interprofessional education
Stefanus Snyman (Stellenbosch University, Centre for Health Professions Education, PO Box 19063, Tygerberg 7505, South Africa)
Marina Clarke (Stellenbosch University, Centre for Health Professions Education, Cape Town, South Africa) Klaus Von Pressentin (Stellenbosch University, Division of Family Medicine, Cape Town, South Africa)
Background: To promote health equity, focus is needed on providing patient-centred and community-based care. This challenges educationalists to advocate for instructional and institutional reform, including the advancement of interprofessional education (IPE). To enhance patient-centred interprofessional care, the WHO recommends using the framework of the International Classification of Functioning, Disability and Health (ICF). Stellenbosch University's IPE strategy has promoted the ICF since 2010. Medical students use this framework in approaching and managing their patients. When presenting patients using the ICF, they are assessed by an interprofessional healthcare team. Summary of work: This study aimed to evaluate how using the ICF was experienced by medical students, facilitators of learning and patients; and how applying the ICF framework contributed to instructional reform, institutional reform and interprofessional practice. Associative group analysis was used to conduct this study, assessing spontaneous free word associations given by different groups in response to specific questions. The groups in this study consisted of medical students (37), facilitators of learning (18) and patients (15). During a systematic analysis of the responses, themes were formed and interpreted. Summary of results: Students found the ICF assisted them to adopt a patient-centred approach. Patients experienced healthcare received positively: being listened to and cared for. Facilitators reported being indirectly challenged to apply the ICF framework themselves resulting in patient-centred and interprofessional care. This enhanced teamwork and job satisfaction.
Conclusions: Assessment of student presentations using the ICF was the driver to encourage interprofessional practice among students and health professionals resulting in improved patient outcomes. Take-home messages: The ICF framework as interprofessional approach facilitates patient-centred care.
What do medical and nursing students narrate about Interprofessional Collaboration during their study?
Cora L.F. Visser (Institute for Education and Training, VU University Medical Center, VUmc School of Medical
Sciences, Postbox 7057, Amsterdam 1007 MB, Netherlands)
Rashmi A. Kusurkar (Institute for Education and Training, VU University Medical Center, VUmc School of Medical Sciences, Amsterdam, Netherlands) Gerda Croiset (Institute for Education and Training, VU University Medical Center, VUmc School of Medical Sciences, Amsterdam, Netherlands)
Background: Interprofessional Learning (IPL) and Interprofessional Collaboration (IPC), important in medical practice, are not included in the Dutch medical education. The Institute for Education and Training, Amsterdam, would like to integrate IPL in the curriculum, which is aligned with the conceptions of students to make the learning more authentic. Narratives, as a research method, can be used to uncover the unconscious conceptions of students. Summary of work: We asked 10 medical (all years) and 5 nursing students to narrate one positive and one negative experience of IPC and how they would like to learn about IPC. The objective was to find out what the students unconsciously thought about learning with, from and about their own roles and those of the other professions.
Summary of results: Two researchers analyzed the narratives independently. While recalling both positive and negative experiences, the students described mostly two themes: 1. Teamwork is important for IPC and is visible when the patient situation is critical. 2. There is a strong effect of power relations on communication. Sometimes, in spite of being more aware of the patient situation, nurses refrain from giving their opinion because of earlier experiences of being excluded from the decision making process. About formally learning about IPC, the students would like to learn through self-reflection rather than through assignments. Conclusions: Students find teamwork and power relations important in IPC. Medical students are less aware of the roles of nurses than nursing students are of doctors.
Take-home messages: Students' conceptions can be useful as a starting point in developing themes for Interprofessional Learning.