Автор неизвестен - Mededworld and amee 2013 conference connect - страница 97

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Summary of work: 2nd year students from our medical school participate on Electrocardiography (ECG) program level 1. In 2012/2013 different methods/models were used to introduce basic ECG contents: webinar presentation, small groups discussion in the Clinical Skill's Lab, and practice with feedback in clinical context. The objectives of this study is to get medical students' feedback, to find out if there's a preferred method/model and to understand the advantages and disadvantages of chosen models. On­line questionnaire form was sent to all these students, with open questions.

Summary of results: The majority of 2nd year medical students can't choose just one method/model of teaching. However they preferred practice on clinical context, considering that they quickly integrate theoretical contents and technical execution. Practice in a clinical environment in early years is desired by all students.

Conclusions: Using different methods to teach increase the overall learners' interest. All models were useful, although performing it in a clinical context seems to be preferred.

Take-home messages: Offering students different methods/models to learn, increase their motivation, taking into account each other preferences

(individuality). Clinical context practice is important to show relevance of the skill.

8Z/6

Outcome of Self-EKG Examination and Interpretation by Fourth-year Medical Students, Medical Education Center, Chiangrai Prachanukroh Hospital,Thailand

Wattana Wongtheptian (Medical Education Center Chiangrai Prachanukroh Hospital, Medicine, 1039 Chiangrai Prachanukroh Hospital, T. Viang A. Muang, Chiang Rai, 57000, Thailand)

Sopita Khankeaw (Medical Education Center, Chiangrai Prachanukroh Hospital, Chiangrai, Thailand)

Background: Electrocardiography (EKG) is an important test for cardiac problem diagnosis. Studying basic EKG interpretation is 2 hours class time for fourth-year medical students. Practice in self-EKG testing and interpretation may help them to better understanding. This study aimed to assess whether practicing self-EKG testing and interpretation helps students to improve their understanding of EKG testing and interpretation. Summary of work: This is a descriptive analytic prospective observational study. After finishing the basic EKG class, the teacher assigned volunteer medical students to do self-EKG examination and systematic interpretation, and to study all anomalies detected. Those students then presented their EKG results and the teacher discussed and commented on them. The assessment for OSCE was compared with students who did not do self-EKG examination. Summary of results: 118 fourth-year medical students were enrolled between 2008-2012. 94 students, did self-EKG examination and interpretation. In this group, it was found that the EKG test results showed that 80 students (85.1%) had minor abnormal and/or normal variations. After studying their own EKG tests, 93.6% showed better understanding of EKGs. The group which had practiced self-EKG testing and interpretation had OSCE examination mean score of 52.6% in EKG reading and 50.4% in EKG interpretation. In contrast, the students who had not practiced self-EKG testing had OSCE mean score of 30.2% and 30.6% respectively

(p=0.06).

Conclusions: Self-EKG examination and interpretation improved the ability of medical students to interpret

EKGs.

Take-home messages: Learning EKG minor abnormality /variant from own EKG is easy and useful method.

8Z/7

Introduction of the Student Report Activity for Fourth Year Medical Students

Zeina Kanafani (American University of Beirut Medical Center, Internal Medicine, Cairo Street PO Box 11-0236/11D, Riad El Solh, Beirut 1107 2020, Lebanon) Nadim El Chakhtoura (American University of Beirut Medical Center, Internal Medicine, Beirut, Lebanon)

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

Muriel Ghosn (American University of Beirut Medical

Center, Internal Medicine, Beirut, Lebanon)

Ayman Hallab (American University of Beirut Medical

Center, Internal Medicine, Beirut, Lebanon)

Khalil Anouti (American University of Beirut Medical

Center, Internal Medicine, Beirut, Lebanon)

Background: The Department of Internal Medicine at the American University of Beirut Medical Center conducts daily Morning Report for the housestaff officers. Since 2011, we introduced a similar activity geared towards fourth year medical students during the Internal Medicine Clerkship. The objective of this activity is to enhance several skills, including self-learning, search for evidence-based medicine, and presentation

skills.

Summary of work: Each student selects a clinical case for presentation in the presence of a faculty preceptor. The student starts by introducing the chief complaint and students from the audience elicit questions about the history and physical examination. The presenting student then guides the discussion of the differential diagnosis, and presents a review of the most recent literature about the topic. Students are evaluated based on the completeness of the history and physical examination, the breadth and accuracy of the differential diagnosis, the appropriateness of the literature presented, and on presentation skills. At the end of the academic year, we conducted a survey among medical students to get feedback about the educational value of the student report activity. Summary of results: A total of 90 students completed the survey. 96.3% of students thought that the preceptor coordinated the activity well. 89.0% of students thought that the activity helped them improve their self-learning skills and 79.3% thought that it promoted the practice of evidence-based medicine. In addition, most students thought that the student report helped them identify gaps in their knowledge (92.7%), their presentation skills (82.9%), and their teaching skills (78.0%). Finally, 51.2% of students rated the overall educational value of student report as excellent, and 30.5% as very good.

Conclusions: The student report activity for clinical

students has been very well received by students and

has helped them improve their skills.

Take-home messages: Student-centered educational

activities are very valuable and promote independent

learning.

8Z/8

An evaluation of the ambulatory part of the final year at the Medical Faculty Mannheim

Elisabeth Narciss (Medical Faculty Mannheim, Heidelberg University, Medicine, Theodor-Kutzer-Ufer 1­3, Mannheim 68167, Germany)

Udo Obertacke (Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim, Germany)

Jens Kaden (Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim, Germany)

Harald M. Fritz (Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim, Germany)

Nicole Deis (Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim)

Katrin Schuttpelz-Brauns (Medical Faculty Mannheim, Heidelberg University, Division for Study and Teaching Development, Mannheim, Germany)

Background: Ambulatory patient care-setting is increasing in Germany due to structural and financial reasons, but also according to patients wishes. Several characteristics in ambulatory care-setting are distinct from in-patient-setting. Traditional medical education in Germany did not address this specific situation. In 2011 we therefore established a mandatory ambulatory patient care-setting part (12 weeks) during the clerkship year at the Medical Faculty Mannheim. We were interested to know how satisfied students are with this newly established part of the final year compared to other mandatory and elective subjects. Summary of work: 119 students answered an anonymous online-questionnaire developed by Glahn (2011) with validated 5-point Likert-scales concerning satisfaction, mentoring and learning success of all four parts of their clerkship year. Rating of five is the best rating. Student-Newman-Keuls-test was conducted as post-hoc -test.

Summary of results: Return rate was between 50-70%. Students were as satisfied with ambulatory patient care-setting (M=4.0) as with their elective subjects (M=3.7). Mentoring in the ambulatory patient care-setting (M=4.2) was rated even better compared to all other subjects (M=3.3 resp. M=3.7). Learning success was rated similar comparing elective and mandatory subjects

(M=4.0).

Conclusions: Even though ambulatory patient care-setting is mandatory students are very satisfied and feel well mentored. In future we have to take a closer look at the reasons for this and the implications for other subjects in the final year. Finally, a follow-up is needed to see if this new training focus ultimately leads to more out-patient doctors.

Take-home messages: The ambulatory part of clerkship is a satisfying way to teach ambulatory care.

8Z/9

Developing 'clinical presence' in medical students

David C D Hope (King's College Hospital, Denmark Hill

Teaching Group, London, United Kingdom)

Alice Eldred (King's College Hospital, Denmark Hill

Teaching Group, London, United Kingdom)

Govinder Oliver (King's College Hospital, Denmark Hill

Teaching Group, London, United Kingdom)

Nadia Muspratt-Tucker (Kings College Hospital, Denmark

Hill Teaching Group, London, United Kingdom)

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

Beverley Yu (King's College Hospital, Denmark Hill Teaching Group, London, United Kingdom) Polly Robinson (King's College London, Denmark Hill Teaching Group, London, United Kingdom)

Background: 'Clinical presence' is an overall impression made on a patient or colleague [BMJ 2013]. We have previously shown our clinical presentation workshops significantly improve medical students' self-assessed ability to present to a colleague. We hypothesised this would improve clinical presence therefore outcomes in objective structured clinical examinations (OSCEs). Summary of work: Medical students attended history (n=35) and examination (n=25) presenting workshops, assessing their confidence and effectiveness in presentation (0-10 Likert score) before and after. Students (n=104) completed history and examination stations in an OSCE and overall marks (0-5) were correlated to the number of workshops attended. Summary of results: Self-assessed presentation confidence and effectiveness improved significantly after attending the workshops (average increased confidence and effectiveness scores 1.6, 1.7 respectively, p<0.0001). Attending did not have a significant effect on OSCE average marks (3.6, 3.7, 3.6 when attending none, one or two workshops respectively).

Conclusions: Our workshops significantly increased self-assessed ability to present however did not correlate with OSCE results, perhaps due to study power and confounding factors. Further studies may determine whether presentation workshops alone improve clinical presence and examination outcomes. However, given our data, opportunities for additional ways of developing clinical presence have emerged. Take-home messages: Developing 'Clinical Presence' is an exciting aspect of medical education which improves student, patient and interprofessional relationships. This maximises learning opportunities and drives future efficiency in the healthcare system. We aim to develop students' clinical presence by introducing novel scenarios including mock student-led ward rounds and patient ownership ideas.

8Z/10

Role of Instructor Nurse for Training Medical Students in Minor Surgical Procedures

Anurak Amornpetchsathaporn (Sawanpracharak Hospital, Department of Surgery, Atthakawee Road, Paknampho District, Nakhonsawan 60000, Thailand)

Background: Patient safety is a hot topic in medical education. For minor surgical procedures medical students may or may not be trained and closely supervised by teaching surgeons. After a brief, observing live-demonstration and model practices, it is not known how students could acquire surgical skills. They might do it by themselves or be trained by instructor nurses. Summary of work: The 28 students of surgical rotation were asked about what procedure they did and who were their instructors.

Summary of results: The 13 fourth year students performed 68 procedures. They did it by themselves and under supervision of surgeons and nurses 6(8.8%), 15(22.1%) and 47(69.1%) respectively. The 7 fifth year students performed 52 procedures. They did it by themselves and under supervision of surgeons and nurses 2(3.9%), 14(26.9%) and 36(69.2%) respectively. The 8 sixth year students performed 78 procedures. They did it by themselves and under supervision of surgeons and nurses 1(1.3%), 74(94.9%) and 3(3.8%) respectively. The total 198 procedures were done under supervision of surgeons 103(52.0%), nurses 86(43.4%) and only 9(4.6%) were done by themselves. Conclusions: The results strongly indicated that instructor nurses were also one of the main stakeholders as surgeons. In hospital of limited teaching surgeons and surgical residents who did not have enough time to teach medical students, these certified, skillful and senior nurses were excellent supervisors because they had learned how to supervise and feedback students in doing procedures from surgeons. With basic psychomotor skill training, they could be even better supervisors for students in minor surgical procedures.

Take-home messages: A prospective study will be done to clarify how much a role of instructor nurses in surgical training for medical students, and also further identify which type of minor surgical procedures need to be trained and supervised by teaching surgeons or instructor nurses, and which one they could do it by themselves.

8Z/11

Adding an Educational Prescription to SNAPPS

James Nixon (University of Minnesota Medical School, Medicine, 420 Delaware St SE, MMC 741, Minneapolis 55105, United States)

Georges Bordage (University of Illinois at Chicago,

Medical Education, Chicago, United States)

Alan Schwartz (University of Illinois at Chicago, Medical

Education, Chicago, United States)

Terry Wolpaw (Case-Western Reserve University,

Medicine, Cleveland, United States)

Briar Duffy (University of Minnesota, Medicine,

Minneapolis, United States)

Jeremiah Menk (University of Minnesota, Medicine, Minneapolis, United States)

Background: SNAPPS is a six-step, learner-centered technique for student case presentations. We evaluated the addition of a PICO-formatted educational prescription (Patient-Intervention-Comparison-Outcome) to the final SNAPPS' Select step. We hypothesized that this would foster high quality questions and answers.

Summary of work: Students were instructed to use educational prescriptions as a complement to their SNAPPS case presentations at the bedside. The educational prescriptions were collected and coded regarding 4 outcomes: topic of uncertainty, PICO conformity score (8-point scale), presence of an answer,

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

and quality of the answer (directness, presence of evidence, and preferred management). Summary of results: A total of 191 education prescriptions were coded, of which 190 (99%) included a question; of which 176 (93%=176/190) included an answer. Therapy questions constituted 59% (112/190) of the questions generated by the students while providing care for their patients; 19% (37/190) were related to making a diagnosis. Three fifths of the questions (61%=116/190) were scored either 7 or 8 on the 8-point conformity scale. The quality of the answers varied, with 37% (71/190) meeting all three criteria for high quality. There was a positive correlation between the PICO conformity score and the quality of the answers (Spearman Rank-Order Correlation Coefficient =0.726;

p<.001).

Conclusions: This technique was easily integrated into the inpatient clerkship structure and guaranteed that virtually every case presentation had a well-formulated question and quality answer.

Take-home messages: SNAPPS+ could promote lifelong learning skills by teaching students to ask clear questions regarding their self-identified areas of uncertainty, which in turn can lead to quality answers.

8Z/12

Clinical skill evaluation of undergraduate medical students in management of pregnancy, delivery and newborn

Achmad Kemal Harzif (Faculty of Medicine Universitas Indonesia, Obstetrics and Gynecology, Diponegoro Street no. 71, Jakarta 10430, Indonesia) 8Z/14 (16118) Rima Irwinda (Faculty of Medicine Universitas Indonesia, Obstetrics and Gynecology, Jakarta, Indonesia) Noroyono Wibowo (Faculty of Medicine Universitas Indonesia, Obstetrics and Gynecology, Jakarta, Indonesia)

Rinawati Rohsiswatmo (Faculty of Medicine Universitas Indonesia, Child Health, Jakarta, Indonesia) Astrid Sulitstomo (Faculty of Medicine Universitas Indonesia, Community Health, Jakarta, Indonesia)

Background: To evaluate process and education outcome in management of pregnancy, delivery and newborn in Faculty of Medicine Universitas Indonesia. Summary of work: Cross sectional study to evaluate the process and education outcome in undergraduate FMUI students who receive women's health module from August to October 2011. Variables that were evaluated are clinical competence in antenatal care, normal delivery and newborn evaluation. We also evaluated number of cases, length of supervision, level of confidence and satisfaction among the students. Summary of results: There were 66 students who completed the evaluation. Median numbers of antenatal care and delivery per student were 31.5 and 4 cases respectively. Mean length of supervision in a week was 4.4 hours. From clinical competence evaluation percentage of students that were competent in antenatal care, normal delivery and newborn evaluation were 97%, 97% and 74.2% respectively. Further analysis

showed that there were no associations between number of cases, length of supervision and clinical competence. Most of the students stated that they are confident in assisting normal delivery and newborn evaluation.

Conclusions: A good education process had been conducted and clinical competence can be achieved by the majority of undergraduate students. Take-home messages: High involvement of students in managing patients will help in achieving clinical competence.

8Z/13

"The entire consultation" Maximising and integrating individual consultation skills in a simulated encounter

Diane Owen (Swansea University, College of Medicine, Grove Building, Singleton Park, Swansea SA2 8PP, United Kingdom)

Background: Students conventionally are taught consultation techniques in a segmented fashion. History taking, consultation skills and explanation are often taught separately to examination and diagnostic reasoning. Student experience of a real life consultation typically occurs as a bystander in the clinical setting, and they rarely have an opportunity to practice the entire consultation until they qualify. Summary of work: In Swansea, student groups undertake a whole patient consultation with a live simulated patient. They conduct an interview, before proceeding to examine patient, specifically looking for and seeing clinical signs which may be expected from the information gleaned in the interview. Discussion builds on clinical reasoning principles, before the students contemplate potential diagnoses and explain the diagnosis and management plan to the patient. Summary of results: Questionnaire design was used to explore student perception of this method, in order to identify whether or not the continuity adds anything to their learning of clinical techniques. Thematic analysis, which is ongoing, was used in order to identify themes in the data. Emerging themes include an understanding of the consultation process, consolidation of learning, heightened realism and understanding of importance of continuity.

Conclusions: Students value the ability in being able to undertake a full consultation and put into practice components of the consultation which they have learned separately in order to understand the consultation and diagnostic reasoning process. More details will be provided.

Take-home messages: Medical students in their first years value the worth of conducting an entire simulated consultation.

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

8Z/14

Basic Life Support is effectively taught in groups of three, five and eight students per tutor in a prospective, randomized and double-blind simulation study

Moritz Mahling (University of Tuebingen, Faculty of Medicine, Medical School, Elfriede-Aulhorn-Str. 10, Tuebingen 72076, Germany)

Alexander Muench (University of Tuebingen, Faculty of Medicine, Medical School, Tuebingen, Germany) Andreas Manger (University of Tuebingen, Department of Anesthesiology and Intensive Care Medicine, Tuebingen, Germany)

Joerg Reutershan (University of Tuebingen, Department of Anesthesiology and Intensive Care Medicine, Tuebingen, Germany)

Stephan Zipfel (University of Tuebingen, Department of Internal Medicine VI: Psychosomatic Medicine and Psychotherapy, Tuebingen, Germany) Nora Celebi (University of Tuebingen, Faculty of Medicine, Tuebingen, Germany)

Background: Teachers and participants commonly believe that teaching in small groups is superior compared to teaching in larger groups. We investigated the impact of different group size on the training of BLS

skills.

Summary of work: Medical students (n = 74) were randomized to BLS courses with three, five or eight students per tutor. Students received a standardized BLS training while we video-recorded teaching observations. Before and after the training, all participants performed an Objective Structured Clinical Exam (OSCE). We analyzed the BLS quality using a checklist (pass level 75%) and measured the chest-compression parameters with a high-fidelity CPR manikin. Summary of results: Checklist pass-levels were comparable between groups of three, five and eight students per tutor at follow-up visit (93%, 100% and 96%, respectively). Chest compressions showed comparable compression depths. Mean compression rates were mostly between 100-120/min with some shortcomings in the eight students group. Students in groups of eight classmates asked fewer questions (p < 0.001), had less training time (p = 0.02), conducted more irrelevant conversations (p < 0.001) and had a lower self-assessment than groups of three students per tutor

(p = 0.03).

Conclusions: Although resuscitation checklist scores were comparable high for all group sizes, smaller groups had certain advantages in teaching interventions and effective learning time. However, these advantages could just provide "in-details" knowledge and might not be necessary to learn and perform relatively simple tasks as BLS skills.

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