Автор неизвестен - Mededworld and amee 2013 conference connect - страница 11

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Conclusions: By continuous monitoring of students from learning content we affect teaching skills of a particular clerkship. Alerting educational staff to statistical results also had a happy ending of their effort to enhance their teaching skills.

Take-home messages: By managing these realtime, valid, reliable and equitable statistics we improved teaching skills to a satisfactory point of clinical clerkship teachings.


A mastery learning - based nurse training program for clinical skills in asthma exacerbation management in primary care

Wern Ee Tang (National Healthcare Group Singapore, Family Medicine Development Division, 6 Commonwealth Lane Level 7 units 01-02, GMTI Building, Singapore 149547, Singapore)


Lijuan Dong (National Healthcare Group Polyclinics,

Nursing Services, Singapore, Singapore)

Hui Min Seah (National Healthcare Group Polyclinics,

Nursing Services, Singapore, Singapore)

Rosna Sabani (National Healthcare Group Polyclinics,

Nursing Services, Singapore, Singapore)

Kwai Peng Chan (National Healthcare Group Polyclinics,

Nursing Services, Singapore, Singapore)

Background: In Singapore, many primary care (PC) nurses responsible for triaging patients with acute asthma exacerbations are not trained in chest auscultation and bronchodilator therapy initiation. Bronchodilator therapy may be delayed after triage as these nurses refer patients to physicians for evaluation and ordering of bronchodilator therapy. We designed a training programme to develop PC nurses' competencies in triaging patients with acute asthma exacerbations and in initiating bronchodilator therapy. Summary of work: This mastery-learning based training programme consists theoretical (induction) and practical (clinical skills acquisition) phases. The learner must demonstrate mastery on unit assessments to progress to the next phase. Learners progress at different rates but all who successfully complete the summative assessment would have attained the same minimum level of competency. The instructional methods included workshops and workplace-based clinician mentoring. Summary of results: All 8 nurses enrolled in the pilot programme successfully completed the Induction phase. Of these, 6 passed the summative assessment. Duration before programme completion ranged from 10-30 weeks (median:15weeks) Reasons for non-completion were job designation change and family commitments. The trained nurses reported being very confident of their ability in triaging and initiating bronchodilator therapy (median confidence rating 8.5-9.0, where 10.0=totally confident). Physicians were also highly confident of the nurses' ability (median ratings 7.0-8.0). Conclusions: Mastery-learning is an effective method of training nurses to achieve competency in clinical skills. Rigorous assessments to ensure mastery by learners requires substantial resource investment. Variations in training duration and dropout rate should be considered during programme planning.

Take-home messages: Mastery-learning is an effective competence-based training method for clinical skills acquisition.


Flying High: Integrating hybrid simulation modalities in training programs for flight medics and other critical care transport specialists

Jorge D Yarzebski (University of Massachusetts Medical School, Coordinator, Emergency Medicine Program; Office of Continuing Education, Worcester, Massachusetts 01655, United States) Wendy L Gammon (University of Massachusetts Medical School, Director, Standardized Patient Program; Office of Educational Affairs, Interprofessional Center for Experiential Learning and Simulation, Albert Sherman

Building AS3 - 2014A, Worcester, Massachusetts 01655,

United States)

Background: Simulated Patient (SP) modalities are not commonplace in allied health curricula. Graduate medical education including medical, nurse practitioner and physician assistant levels utilize SP's to train and assess the psychoaffective domains including interviewing patients, performing physical exams and mitigating crisis, which allied health personnel lack in traditional curricula. The SP program at UMass Medical School is developing curricula to train prehospital emergency providers with SP OSCE based testing. Summary of work: In 2013, UMass Memorial Lifeflight transitioned its flight crew configuration from physician/nurse to paramedic/nurse. This critical care medevac helicopter service hired 6 veteran 'street' paramedics with little to no critical care experience. To prepare the paramedics for work in critical care transport, UMASS Continuing Education and SP Program created a critical care transport specialist OSCE. A baseline OSCE focuses on communication and simple crisis mitigation. A summative OSCE after a 4-month didactic/practical orientation tests the paramedic's readiness to work in critical care flight transport. The OSCE included difficult patient handoffs, professionalism, and discord among team members. Summary of results: Positive evaluations highlighted opportunities to learn and practice skills in this non-threatening positive environment; formal assessment through collected data from OSCE checklists, and structured debriefing through guided discussion. Conclusions: Integration of hybrid simulation into flight paramedic training curricula will help learners acquire more confidence and competency in managing patient care and interprofessional behaviors in confined high anxiety situations.

Take-home messages: The goal is to provide a safe environment for paramedic, patient and flight crew through this experiential training program.


Needs and challenges in relation to the core content in emergency medicine curriculum for clerkships in South Korea

Su Jin Kim (Korea University, Emergency Department, Seongbuk-gu, Inchon-ro 73, Seoul 136-705, Korea, Republic of (South Korea))

Background: Many variations in the education of clinical clerkships in South Korea have been accepted without gathering opinions for competency-based core content due to Korean educational environment. There has been no attempt to set-up the competency-based core content on clinical practice for emergency clerkships and to recognize the gap of expectation on core content between clerkships and faculties. Summary of work: This study was a prospective study utilizing a survey instrument and semi-structured focus group interviews of 4th-year students after finishing emergency medicine clinical practice and emergency


faculties in seven university affiliated hospitals. The survey and interview composed of the questions in relation to knowledge, skills, attitude and barrier. Summary of results: Clerkship directors (n=6) participated in focus group interview. 4th-year students (n=361) and emergency faculties (n=42) in seven major university affiliated hospital participated in survey. Faculties and students required the limited level of the core content and competence. The level of competency was limited to only practise on part-task trainer or to make a differential diagnosis. The students tend to concentrate on just many skills/procedures for practice period (2 weeks).

Conclusions: The level of competency-based core content is very limited on clinical practice. Although the learning objectives have been defined by Korean association of medical colleges, it is difficult to apply preexisting objectives to clinical practice considering Korean educational environment. Our study was the first attempt to provide the competency-based core content in practical clinical teaching environment in view of the students and faculties.

Take-home messages: We found the applicable competency-based core content and propose to integrate these into the clinical practice curriculum.


Client perception of veterinary student involvement in patient diagnosis and treatment

Paul Gordon-Ross (Western University of Health Sciences, College of Veterinary Medicine, 309 E. Second Street, Pomona 92555, United States) Suzie Kovacs (Western University of Health Sciences, College of Veterinary Medicine, Pomona, United States) Martina Haupt (Western University of Health Sciences, College of Veterinary Medicine, Pomona, United States) Joseph Bertone (Western University of Health Sciences, College of Veterinary Medicine, Pomona, United States)

Background: Reports from human medical education indicate student involvement in healthcare delivery has little to no effect on patient satisfaction. This provides little information about veterinary clients' perceptions of student involvement in their animal's medical care. It is the investigators' hypothesis that clients perceive student involvement as having a positive impact on the overall healthcare provided to their animal(s). Summary of work: The focus of the investigation is clients of private veterinary practice, private industry, public, governmental, and institutional facilities where veterinary care is provided. Client perceptions of student involvement were ascertained by questionnaire. Data entry and analysis was subsequently completed using SPSS 17.0 software (SPSS). Summary of results: At this time 38 completed questionnaires have been analyzed. Descriptive results have been determined. To the question "Would you have liked to have a student involved in in your pets care?" 77.8 % of respondents indicated, "Yes" and to the statement "Students reflect positively on the practice"

85.3% respondents indicated they "agreed" or "strongly agreed" with the statement.

Conclusions: The frequency results are encouraging and appear to indicate clients at these facilities like to have student involved in their animal's care and feel that students at a practice reflect positively on the practice. This appears to be similar to reports from the literature on human medical education. Take-home messages: The authors' preliminary conclusions are that veterinary clients find student involvement in their pets care to be acceptable and perhaps enjoyable. They also feel that being involved with the training of veterinary students elevates the prestige of the practice indicating quality care.


Reflections on Advanced Cardiac Life Support (ACLS) Provider Course for the 6th Year Medical Students after One Year of Course Learning

Chatchai Prechawai (Prince of Songkla University, Department of Anesthesia, Faculty of Medicine, Hat Yai 90110, Thailand)

Ngamjit Pattaravit (Faculty of Medicine, Prince of Songkla University, Anesthesia, Hat Yai , Thailand) Sasikaan Nimmaanrat (Faculty of Medicine, Prince of Songkla University, Anesthesia, Hat Yai, Thailand) Thavat Chanchayanon (Faculty of Medicine, Prince of Songkla University, Anesthesia, Hat Yai, Thailand)

Background: The medical graduates lack competency in knowledge and skills of cardiopulmonary resuscitation (CPR). In Thailand, the 6th year medical students or externs are a part of CPR team, and may be the first person who takes care of sudden collapse patients. They should be trained and be able to perform CPR adequately, so 1.5-day ACLS provider course is designed for them.

Summary of work: A questionnaire utilizing a 5-point Likert scale assessed overall perception and attitudes toward the confidence and ability in management of CPR during externship after one year of course learning. Summary of results: 158 questionnaires were distributed and 109 (68.9%) were returned. More than 95% of the graduates agreed that they had sufficient knowledge and skills, could apply and integrate knowledge and skills for CPR, and during medical emergency care. Most graduates rated that they lacked of skills and confidence in transcutaneous pacing and cardioversion performing, post cardiac arrest, acute stroke and acute coronary syndrome care, and tachy-bradycardia management. The course enhances their examination performance. The OSCE scores in ACLS topic were higher than those obtained traditional CPR course (88% vs 59.8%).

Conclusions: The new medical graduates had positive perception of their experiences in ACLS provider course. Take-home messages: The ACLS provider course is useful to teach undergraduate medical students and help them deal with difficult scenarios.

2AA Posters: Stress and the Junior Doctor/Clinical Supervision

Location: Terrace 2, PCC


What do our interns identify as stress and how do they cope?

Gozie Offiah (Royal College of Surgeons in Ireland, Surgery, Education and Research centre, Smurfit building, Beaumont Hospital, Dublin D9, Ireland) Daragh Moneley (Royal College of Surgeons in Ireland, Surgery, Dublin, Ireland)

Background: Modern day medicine has become a breeding ground for stressful doctors especially with the recent economic strains. The medical environment is very complex and as a result has different effects on different individuals. Several studies mainly in the NHS have identified stress and burnout in as high as a third of the doctors measured by the General Health Questionnaire and the Maslach Burnout Inventory. Summary of work: Data was gathered at a stress management course delivered in three hospitals in the network namely James Connolly memorial hospital, Blanchardstown, Our Lady of Lourdes hospital, Drogheda and Waterford Regional Hospital. Summary of results: Data collected from the three hospitals showed several issues to be a cause of stress to interns with unpaid overtime, excessive bleeps while on call and the increase volume of workload to be the main causes across the network. Other interesting and important issues raised were dealing with confrontations with colleagues, not getting bleep free teaching and increased team demands. Conclusions: It can be concluded from our results that the common causes of stress are the same for all junior doctors in our cohort but that each doctor reacts to these stressors in different ways and this is related to their personality. In the future, we would like to evaluate the prevalence of stress and burnout in the interns both within our network and nationally and to determine the relationship between burnout and patient safety.

Take-home messages: Stress is a worldwide phenomenon with similar stressors for junior doctors. It is on the increased and coping strategies needs to be provided for junior doctors.


Can we help them cope? Stress in senior paediatric residents

Kathleen Nolan (Queen's University, Paediatrics, Kingston, Canada)

Moyez Ladhani (McMaster University, Paediatrics, McMaster University Medical Centre, Room 3N27, Hamilton, Ontario L8N 3Z5, Canada)

Background: Residency is stressful and can be associated with burnout, job dissatisfaction and low


quality of life. Examinations are known to induce high amounts of stress in medical trainees. Thus a resident's final year of training has the potential to be especially stressful. We aimed to assess the wellbeing of paediatric residents in their final year of training following the implementation of a series of sessions aimed to reduce stress.

Summary of work: Residents participated in three 1.5­hour sessions over a four-month period, led by a social worker with expertise in wellness. Resident wellbeing was assessed using the Perceived Stress Scale (PSS), measuring subjective stress, and the Maslach Burnout Inventory (MBI), measuring emotional exhaustion, depersonalization and appraisal of personal achievement.

Summary of results: Scores on the PSS indicated high stress levels. Average PSS scores were 23 pre-exam and 24 post-exam. MBI scores indicated high-moderate emotional exhaustion prior to and following the licensing examination. Levels of depersonalization were low and residents continued to gain satisfaction from their jobs, indicated by moderate (pre-exam) or low (post-exam) scores in the area of personal accomplishment. Subjectively, residents did not find the organized wellness sessions helpful. They did identify the utility of discussing stress in a group setting and learning relaxation techniques. Conclusions: This study confirms that residency is stressful and that licensing examinations likely add to the burden. Although paediatric residents scored high on the PSS and in emotional exhaustion, levels of depersonalization were low and they continued to gain a feeling of accomplishment from their work. The contribution of the organized wellness sessions to this finding is unclear.

Take-home messages: Senior paediatric residents experience significant stress in their final year of training. Wellness sessions may or may not ease this burden.


Comparison of quality of life of interns training in the terrorist area with that of interns training in other provinces in the lower southern region of Thailand

Thitima Suntharasaj (Faculty of Medicine, Prince of Songkla University, Obstetrics and Gynecology, Karnchanawanich Road, Hat Yai, Songkla 90110, Thailand)

Supaporn Tengtrisorn (Faculty of Medicine, Prince of Songkla University, Ophthalmology, Hat Yai, Songkhla, Thailand)

Supapun Jitsophon (Faculty of Medicine, Prince of Songkla University, Postgraduate Unit, Hatyai, Songkhla, Thailand)

Background: Since January 2004, terrorism in the lower southern region of Thailand has caused fear, stress and unpleasant feelings, especially for people living in 3 provinces: Pattani, Yala and Narathiwat. Our objective was to assess the quality of life (QOL) of interns who

worked in this area and to compare it with that of interns who worked in other provinces in the lower southern region.

Summary of work: During November to December 2009, 31 interns from the region experiencing terrorism and 87 participants from other regions completed the World Health Organization's 26-item quality-of-life assessment (WHOQOL-BREF).

Summary of results: Interns in the dangerous region had a higher income, more vacation time and a lower inpatient workload than interns in other regions (p < 0.01). Interns in the dangerous region found their workload to be more acceptable than did interns working in the other areas (48.4% v. 16.9%, p = 0.001). More interns in the region experiencing terrorism rated their overall QOL at the good or best level (35.5% v.

26.5%, p = 0.04). However, the WHOQOL-BREF

assessment showed no significant difference between

the 2 groups in overall, physical, emotional, social and

environmental aspects of QOL.

Conclusions: Interns who worked in the dangerous

region had some compensations that made them feel

better than interns in other regions.

Take-home messages: Interns in the terrorist area had

the same quality of life assessed by WHOQOL-BREF as

those in other area.


What derails trainee doctors' careers? The importance and complexity of transitions

Tailte Breffni (Deanery, Trainee Support, Vantage Business Park, Old Gloucester Road, Hambrook, Bristol BS161GW, United Kingdom)

Kate L Weatherall (Severn Deanery, Trainee Support, Bristol, United Kingdom)

Michael O'Connor (Severn Deanery, Trainee Support, Bristol, United Kingdom)

Background: It is estimated that, at any one time, 2-6% of doctors require additional pastoral support. A wide range of factors precipitate problems for trainee doctors, including environmental influences, behaviour, health and clinical competence. The aims of this study were to evaluate why and when trainees require support.

Summary of work: Data from 142 consecutive trainee doctors referred to the Severn Deanery for support were collected. Data were categorised according to five reasons for referral (home environment, work environment, behaviour, health and clinical competence) and grade of training. Summary of results: Trainees in the Foundation years and those in the first year of Specialist Training required additional support more frequently. Whilst the majority of referrals in the first Foundation year were due to health problems, it was found that reasons for referral overlapped. Higher rates of referral coincided with the key transition periods in the trainee doctors' careers. Transition into Foundation or Specialist Training is often combined with a change in environment, an increase in


responsibilities and higher expectations of clinical competence.

Conclusions: Times of transition in trainee doctors' careers are associated with an increase in their requirement for support. The reason for this appears to be complex, with environmental influences, behaviour, health and clinical competence all potentially playing a role.

Take-home messages: A realisation of difficulties being experienced at times of transition in medical careers is important. Further investigation is required to determine whether transitions can be managed proactively to prevent and minimise stress and improve performance.


Problem residents and Inadequate Postgraduate Training: Individual, cultural and organizational matters

Dorthe H0gh Hansen (Aarhus University, Centre of

medical education, Aarhus, Denmark)

Lotte O'Neill (Aarhus University, Centre of medical

education, Aarhus, Denmark)

Peder Charles (Aarhus University, Centre of medical

education, Aarhus, Denmark)

Lene Stouby Motensen (Aarhus University Hospital,

Hospital Service Centre, Human resources, Aarhus,


Karen Norberg (The Regional PGME administration office, Human Resource, Skottenborg 26,, Viborg 8800, Denmark)

Mette Krogh Christensen (Aarhus University, Centre of medical education, Aarhus)

Background: "Problem residents" or "trainees in difficulty" are residents who demonstrate a significant enough problem that requires intervention of someone of authority. International studies estimate that 5-7 % of all residents are problem residents. In Denmark, problem residents are termed "inadequate postgraduate training" because the phenomenon is considered both an individual and a cultural and organizational matter. Until now, the characteristic of residents experiencing "inadequate postgraduate training" in Denmark is unknown, and there is an urgent need for a systematic study of this phenomenon in a Danish context. The present study is the first sub-project of a larger inquiry into the phenomenon of "inadequate postgraduate training" in Denmark. Summary of work: A survey study was designed and completed to explore how educational consultants perceive "inadequate postgraduate training" at their wards. The purpose was to gain knowledge about the prevalence, identification, causes, educational framework, and actions taken in relation to these residents. A questionnaire survey was mailed to 200 educational consultants in all specialties in one out of three educational regions in Denmark. Summary of results: The collection of data and data processing is in progress and will be ready for presentation and discussion at the conference.

Conclusions: Conclusions will be presented at the conference.

Take-home messages: Understanding the phenomenon of problem resident and "inadequate postgraduate training" is complex and includes intertwining individual, cultural, and organizational matters. In this sub-project we have explored how educational consultants perceive problem residents and "inadequate postgraduate training" at their wards. To get a sufficient understanding of the phenomenon other measures are needed, e.g. interviews with residents.


Can we stop trainees failing the CSA?

Mike Deighan (NHS Midlands and East, Postgraduate School of General Practice, St Chad's Court, 213 Hagley Road, Birmingham B16 9RG, United Kingdom)

Background: The Clinical Skills Assessment (CSA) is a high stakes component of the MRCGP examination. It is the licensing assessment for entry into Family Medicine in the UK. There are marked differences in success in this examination between candidates from UK universities and those who qualified outside the UK. Why is it that female UK graduates have 93% success, whereas male non-UK graduates have 22%? Explaining this difference is essential if we are to develop effective educational interventions to increase the number of GP trainees who complete their training. We need to know which trainees are at greatest risk of poor scores. Do trainees' scores at selection tell us anything useful about their learning needs and subsequent performance at the CSA examination?

Summary of work: Two stages (written papers and OSCE) of selection into GP training produce numeric scores. We compared these scores with subsequent performance at the CSA examination. Summary of results: Early analysis shows both selection sub-scores predict CSA outcome. Final data and interpretation will be reported at the conference. Conclusions: We can predict trainees at highest risk of CSA failure by their performance at selection. More educational interventions can be targeted at those with lowest selection scores

Take-home messages: Primary prevention of CSA failure is the best strategy for both trainees and Deaneries. GP Training is short and the sooner we intervene, the more time learners have to make the necessary changes. A trainee's selection scores can inform the choice of interventions most likely to lead to CSA success.


Exploring the impact of residency on residents' personal relationships

Marcus Law (University of Toronto, Department of Family & Community Medicine, 500 University Ave, 5th Floor, Toronto M5G 1V7, Canada) Diana Wu (University of Toronto, Department of Family & Community Medicine, Toronto, Canada)

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