Автор неизвестен - Mededworld and amee 2013 conference connect - страница 106

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Conclusions: Overall Surgical F1 jobs were well supported, providing a wealth of clinical and academic experience.

Take-home messages: More evidence is needed to justify reduction and conversion of surgical F1 posts into primary care.


Simulation-Based Directed Self-Regulated Learning vs. Instructor Regulated Learning of Advanced Cardiac Life Support (ACLS) Skills - A Randomized Trial

Luke Devine (University of Toronto, Medicine, 600 University Ave, Suite 427, Toronto M5G 1X5, Canada) Jeroen Donkers (Maastricht University, Education Development and Research, Maastricht, Netherlands) Rodrigo Cavalcanti (University of Toronto, Department of Medicine, Toronto, Canada)

Vsevolod Perelman (University of Toronto, Department of Family and Community Medicine/Emergency Medicine, Toronto, Canada)


Ryan Brydges (University of Toronto, The Wilson Centre, Toronto, Canada)

S. Barry Issenberg (University of Miami, Gordon Center for Research in Medical Education, Miami, United States)

Background: Simulation-based mastery learning of ACLS skills is effective. Traditional ACLS courses incorporate instructor regulated learning (IRL). Directed self-regulated learning (DSRL), where an educator designs the self-regulated learning, may provide an effective and less resource intensive way to teach ACLS skills. Summary of work: Forty first-year internal medicine residents at the University of Toronto participated in a randomized trial comparing simulation-based DSRL to IRL of ACLS skills, using a mastery learning model. The DSRL group was provided simulation scenarios, assessment instruments, instructions to conduct a focused debriefing and access to relevant resources to direct their own learning. The IRL group had access to the same materials, but the teaching and feedback provided was at the discretion of the instructor. Summary of results: After controlling for pre-test scores of performance on a simulated ACLS scenario, there was no significant difference between post-test scores in the

DSRL and IRL groups, F(1,37) = 0.007, p = .935.

Residents in the DSRL group were significantly more likely to express a desire to train in the IRL group than the converse (p =.001). Both groups agreed that participation within their assigned group was an effective way to learn ACLS skills, however, residents in the IRL group more strongly agreed with this (p =.016). Conclusions: DSRL is as effective as IRL in teaching residents ACLS skills. Despite the benefits associated with DSRL, residents prefer to learn in an IRL environment.

Take-home messages: DSRL is effective for learning ACLS skills. Research is needed to understand why residents are resistant to DSRL and how to increase acceptance.


The development and prevalence of musculoskeletal disorders in orthopaedic surgery and internal medicine residents

Nicolas Bowers (University of Toronto, Faculty of

Medicine, Toronto, Canada)

M Lucas Murnaghan (Hospital for Sick Children,

University of Toronto, Orthopaedic Surgery, Toronto,


Lynfa Stroud (Sunnybrook Health Sciences Centre, University of Toronto, Internal Medicine, Toronto, Canada)

Peter Ferguson (Mount Sinai Hospital, University of Toronto, Orthopaedic Surgery, Toronto, Canada) Tulin Cil (Princess Margaret Hospital, University Health Network, University of Toronto, Surgical Oncology, Toronto, Canada)

Background: It has been shown that surgeons are at risk for the development of musculoskeletal disorders (MSKD) due to the ergonomic stresses of the operating

room, which can translate to loss of work time and productivity. However, little work has been done investigating the prevalence of MSKD in residents. This study looks to investigate the prevalence of MSKD in orthopaedic surgery and internal medicine residents. Summary of work: The Physical Discomfort Survey was distributed to all orthopaedic surgery and internal medicine residents at the University of Toronto. The prevalence of musculoskeletal symptoms in specific anatomical regions was compared between the two groups.

Summary of results: Fifty percent of residents responded to the survey. Internal medicine residents reported a prevalence of 69%, 68% and 51%, and orthopaedic surgery residents reported a prevalence of 58%, 51% and 47%, for upper extremity, back and lower extremity MSKD, respectively. Internal medicine residents had a higher prevalence of neck symptoms (53% vs. 28%, p=0.01) and upper back symptoms (31% vs. 9%, p=0.01) than orthopaedic surgery residents. Conclusions: This data suggests that both orthopaedic surgery and internal medicine residents have significant MSKD. Thus, the impact of residency training on MSKD in residents should be acknowledged for both groups. The implementation of early interventions could be beneficial in the prevention of future significant MSKD in physicians.

Take-home message: Internal medicine and orthopaedic surgery residents at the University of Toronto experience significant MSKD, and awareness of this area of resident health could prevent the development of MSKD in the future.


New Initiatives In Registrar Training

Johan Bezuidenhout (University of the Free State, Health

Sciences Education, P O Box 339, Park West,

Bloemfontein 9300, South Africa)

Marietjie Nel (University of the Free State, Health

Sciences Education, Bloemfontein, South Africa)

Gert van Zyl (University of the Free State, Office of the

Dean, Bloemfontein, South Africa)

Background: A need for professional development in the training of registrars was identified by the School of Medicine, University of the Free State, in 2007. The module on Health Care Practice (GPV703) was developed to address these shortcomings. Summary of work: A quantitative study, enhanced by qualitative methodologies, was conducted. A self-administered questionnaire that included a rating scale and open-ended questions was used. The quantitative responses were statistically analysed using Microsoft Excel, and the qualitative statements were edited, categorised and summarised.

Summary of results: The questionnaire was completed by 38 (95%) of 40 registrars. On the quantitative questions regarding the orientation session, content and applicability of the content of the module, the majority of registrars showed satisfactory to very good responses. Of the 40 questionnaires collected, 31 (77.5%


response rate) were completed by Heads of Department on the insight of registrars into the module. Seventeen above-average and 14 average scores were given showing a significant improvement in the competence of registrars. No under-average scores were given. Conclusions: The study focused on the quality assurance and improvement of the module. The module in Health Care Practice, as part of the MMed programme, was found to add value and addressed aspects required by registrars to develop and/or enhance their skills, knowledge and professional behaviour with regard to Ethics, Practice Management and Patient Communication in their professional capacity and training. Registrars were generally satisfied with the content and presentations. The open-ended questions indicated some concerns that need to be addressed to improve the quality of the module. Take-home messages: The strive towards excellence in Medical Education is essential.


The design, implementation and administration of an educational website for emergency medicine registrars in Australia

Sheila Bryan (Southern Health, Emergency, David Street, Dandenong 31795, Australia)

Background: Southern Health Emergency network covers three campuses. It has > 60 + trainees at different stages in a 5 year vocational training program. There was a need to develop a communication and education strategy to provide coordination of educational opportunities for the trainees. There was no funding and no in house web design expertise. Summary of work: Using online website development an educational website was built. There was extensive communication with key stakeholders regarding content and governance of the site. The trainees and the contributors to the site were surveyed and >95% of respondents were either satisfied or very satisfied with the website.

Summary of results: The results presented will include the process of engagement of stakeholders, the issues identified and the strategies for ongoing governance of the site.

Conclusions: A medical educator with no previous experience with website design can develop and implement a successful educational web site.


Teaching and learning Emergency Obstetrics in low-resource settings: an experience with different learning strategies and residents-as-teachers

Lucas Cota (Universidade Federal de Uberlandia, Medical Clinics, Av. Mato Grosso, 2409, apt 304, Uberlandia 38400-724, Brazil)

Ana Flavia Ferreira (Universidade Federal de Uberlandia, Medical Clinics, Uberlandia, Brazil)

Jessyca Resende (Universidade Federal de Uberlandia,

Medical Clinics, Uberlandia, Brazil)

Paloma Carisio (Universidade Federal de Uberlandia,

Medical Clinics, Uberlandia, Brazil)

Renata Catani (Universidade Federal de Uberlandia,

Obstetrics and Gynecology, Uberlandia, Brazil)

Helena Paro (Universidade Federal de Uberlandia,

Obstetrics and Gynecology, Uberlandia, Brazil)

Background: Although competencies in emergency medicine are claimed crucial for medical students, some schools still face challenges in designing disciplines and opportunities for medical students to practice emergency procedures with clinical simulation. In our institution, emergency medicine for undergraduates has been restricted to experiences on theoretical basis and observations of ER consultations. Summary of work: We describe our first experience in designing an eight-hour module on Emergency Obstetrics simulation for fourth-year medical students at a low-resource traditional medical school in Brazil. Summary of results: Students' learning objectives were previously established in accordance to national curricular guidelines for medical schools. We provided Ob-gyn residents with training on obstetric emergency simulation, feedback and assessment through objective checklists. Students practiced competences in small groups (eight to ten students), facilitated by a faculty and a resident-as-teacher, in a variety of strategies: brief communications, structured simulated scenarios with provision of theoretical written guidance and structured checklist, feedback by facilitators, debriefing and team-based learning activities. Students provided formal written module evaluation at the end of activities. Discussion: The variety of activities facilitated students' engagement in this time-restrained module. The contribution of resident-as-teachers was a useful strategy, as students felt confident after simulations. It was also useful for training residents for teaching (and learning) emergency obstetrics. Conclusions: An effective module on emergency obstetrics is possible when a careful planning is designed.

Take-home messages: The contribution of residents-as-teachers may be helpful in designing emergency modules in low-resource settings. Future challenges include designing similar longitudinal experiences throughout curriculum with effective integration of all medical areas.


Residents' Perspective of New Accreditation Council of Graduate Medical Education Ophthalmology Residency Program in Singapore

S Wiryasaputra (National Healthcare Group Tan Tock Seng Hospital, Department of Ophthalmology, 4 Greendale Avenue, Singapore 289500, Singapore) LKM Lee (National Healthcare Group Tan Tock Seng Hospital, Department of Ophthalmology, Singapore)


Background: Graduate medical education in Singapore has long been overseen by surgeons and physicians appointed to the Joint Committee on Specialist Training (JCST). The JCST served to select trainees, establish and maintain structured training programs modelled after British training programs and accredit training centres. In recent years, Singapore has looked to adopting the American graduate medical education system and hence implemented the programs of the Accreditation Council for Graduate Medical Education (ACGME). Summary of work: Having had the ACGME Ophthalmology program run alongside the department's original training program for more than a year, we would like to assess how residents feel about the program. A survey was carried out amongst all residents in the National Healthcare Group Ophthalmology Residency Program.

Summary of results: A total of 8 residents in the program were given a copy of the survey, with a response rate of 100%. 5/ 8 (62.5%) felt that overall the new training program is better than the original training program. However, 4/ 8 (50%) felt that the shortened training period may disadvantage them and 1 resident felt that the ACGME duty hours curtails learning opportunities. Nonetheless, on a scale from 1-5 regarding confidence of being able to work independently upon completion of the program, the mean score of all residents was 3.69 and the mode 4. Conclusions: The new ACGME program provides a streamlined yet rigorous training schedule. Whilst the training period has been shortened, residents are confident that they will be equipped with the skills to work independently upon completion of the program.


Lean based learning among residents and registrars in a Dermatology Department

Anne Braae Olesen (University Hospital of Aarhus, MEDU, Dermatology, Marselisborg Centret, P.P. 0rumsgade 11, Aarhus 8000 C, Denmark) Mette Deleuran (University Hospital of Aarhus, Dermatology, Aarhus, Denmark) Henrik Lorentzen (University hospital of Aarhus, Dermatology, Aarhus, Denmark)

Background: We have observed that the long and standardized training program in laser and surgery implies insufficient level of skills to manage approximately 10 percent of dermato-surgical consultations resulting in waste of resources, rework and over-refinement as experts have to perform missed procedures leading to increasing waiting time. By performing value stream mapping on surgical training courses, waste in the process of competence achievement will be identified and eliminated. Summary of work: The pivotal management tool for this is a table listing required skills (rows) for each doctor (columns). The individual cells are coloured according to level of expertise: red (want to learn), yellow (can perform) or green (can perform and teach). All green cells thus become mentoring cells for corresponding red

cells. Red cells drag the lacking skills to the doctor and minimise waste by over-refinement by exposing her to repetitive clinical situations during classical training, allowing fast track training.

Summary of results: A cross-sectional measure of the competence level among all doctors before the start of the project and after 12 months will be performed. All diagnoses and treatment codes on all patients one month before project start and after 10 months of implementation will be measured. A measure of mean time to 75% and 100% competence acquirements for the young doctors will be calculated. The doctors' quality of life will be investigated by interview in a selected group of trainees.

Conclusions: We suggest that lean based education may increase the trainees' skills and competences faster because they are driven by their own wish for more learning and the patient need for specific treatments through visible evaluation of all doctors. Take-home messages: Lean based learning may increase the learning curve of 'trainees and minimize waste consultations.

8GG ePosters: Patient Safety

Location: North Hall


Teaching disclosure of medical errors to pre­clinical students: a pilot study at Chulalongkorn medical school

Punnapop Emsiriratn (Chulalongkorn University, Faculty of Medicine, 3rd Year Medical Student, Bangkok, Thailand)

Kantawit Suantawee (Chulalongkorn University, Faculty of Medicine, 3rd Year Medical Student, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand Sittinun Thangjui (Chulalongkorn University, Faculty of Medicine, 3rd Year Medical Student, Bangkok, Thailand) Wissarut Sakulpaptong (Chulalongkorn University, Faculty of Medicine, 3rd Year Medical Student, Bangkok, Thailand)

Theerawut Wongjeeraphat (Chulalongkorn University, Faculty of Medicine, 3rd Year Medical Student, Bangkok, Thailand)

Chitsanu Pancharoen (Chulalongkorn University, Faculty of Medicine, Pediatrics, Bangkok, Thailand)

Background: Disclosure of medical errors is a topic in medical ethics section of the Thai medical council's standards for general practitioner. A group of Year 2 students chose to pursue their learning in this topic as a project in 'Medical Ethics & Critical Thinking' course. Summary of work: Thirty students participated in the workshop. The principle of professional communication was introduced first. They were then divided into two groups (doctors and patients). Each group was oriented separately before role-playing in the OSCE format (5 cases of medical errors x 3 loops x 10 minutes). In addition to being assessed by 5 patients, each doctor assessed their own performance for each case. At the end, there was a group discussion to brainstorm and reflect on what they had learned from the workshop. Summary of results: Overall, the scores correlated negatively with the difficulty of the cases. The three highest-rated items are (1) saying sorry (2) use of easy-to-understand language and (3) showing empathy. The three items with the lowest scores are (1) opening the conversation (2) giving complete and useful information and (3) patients being able to make decision by themselves. Most students had more understanding of how to disclose medical errors. More importantly, they learned from both doctor's and patient's perspectives from the same event.

Conclusions: Role-playing in the OSCE-style with feedback is the powerful tool to teach medical errors disclosure.



Training health care professionals in root cause analysis: post-training experiences, benefits and attitudes

Paul Bowie (NHS Education for Scotland, Postgraduate

General Practice, 2 Central Quay, 89 Hydepark Street,

Glasgow G3 8BW, United Kingdom)

Joe Skinner (NHS Education for Scotland, Postgraduate

General Practice, Glasgow, United Kingdom)

Carl de Wet (NHS Education for Scotland, Postgraduate

General Practice, Glasgow, United Kingdom)

Background: Root cause analysis (RCA) is routinely applied to investigate patient safety incidents and facilitate organizational learning. Despite a limited evidence base, Scottish healthcare authorities - similar to those internationally - have invested in related training programmes and this is a cornerstone of many organizational policies for investigating safety-critical issues. Given the investment in people, time and funding we aimed to learn from the reported experiences, benefits and attitudes of RCA-trained staff. Summary of work: We adapted a published questionnaire to undertake a cross sectional online survey of health care professionals formally trained in RCA by a single Scottish health board region. Summary of results: A total of 228/469 of invited staff completed the survey (48%). A majority of respondents had yet to participate in a post-training RCA investigation (n=127, 55.7%). Of RCA experience staff, 71 had assumed a lead investigator role (70.3%) on one or more occasions. A clear majority indicated that their improvement recommendations were generally or partly implemented (82%). The top three barriers to RCA success were: lack of time (54.6%), unwilling colleagues (34%) and inter-professional differences (31%). Differences in agreement levels between RCA-experienced and inexperienced respondents were noted on whether a follow-up session would be beneficial after conducting RCA (65.3% v 39.4%) and if peer feedback on RCA reports would be of educational value (83.2% v 37.0%). Comparisons with previous research highlighted differences such as less reported difficulties within RCA teams (P<0.001) and a greater proportion of respondents taking on RCA leadership roles in this study


Conclusions: The evidence points to an organisational learning need to provide RCA-trained staff with continuous development opportunities and performance feedback.

Take-home messages: Healthcare authorities may wish to look more critically at whom they train in RCA, and how this is supported educationally to maximize learning and safer patient care.


Doctors Teaching Patients and Trainees: finding common ground

Terese Stenfors-Hayes (Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Widerstrom building, Tomtebodavagen 18 A, Stockholm 17177, Sweden)

Ian Scott (University of British Columbia, Department of Family Medicine, Vancouver, Canada) Joanna Bates (University of British Columbia, Centre for Health Education Scholarship, Vancouver, Canada)

Background: Physicians engage in teaching both patients and trainees in the clinical setting. While these two fields of patient counseling and clinical teaching are considered separate in the literature, the two activities are frequently engaged in by the same physician and often at the same time.

Summary of work: We conducted semi-structured interviews with thirteen family physicians at a family practice teaching unit in Vancouver, Canada to explore how they conceptualize teaching patients and trainees. A thematic analysis was conducted in which separate sets of themes for teaching patients and teaching trainees were identified through an iterative coding process. We synthesized these two sets of themes and extracted the similarities and differences between them. Summary of results: We identified four key areas of overlap between the two fields (being learner-centered; supporting the acquisition, application and integration of knowledge; role modeling; and facilitating autonomy) and four areas of divergence (aim of teaching; power differential; establishing rapport; and providing feedback).

Conclusions: Creating a common conceptual framework for counseling patients and teaching trainees would open up new avenues for improving training and practice in both domains. It may also facilitate knowledge translation between the two domains of scholarly inquiry.

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