Автор неизвестен - Mededworld and amee 2013 conference connect - страница 110

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Conclusions: Curricula can actively integrate reflective practice models in ways that effectively tie into development of clinical skills and help set the stage for producing trainees as leaders in patient-centered care.


Medical training and the "risk epidemic" in preventative medicine

Annika S K Forssen (Family Medicine, Department of Public Health and Clinical Medicine, Umea University, Research and Development, Norrbotten County Council, Lulea 971 89, Sweden)

Background: In Sweden and other Western societies, preventive medicine based on risk-factor investigation of individuals and population screening, is given increasing priority by doctors and politicians. But has a medically induced "risk epidemic" now replaced earlier infectious and cardiovascular epidemics? More and more people are labelled "at-risk", even in countries


with the highest life expectancy in the world. The Hippocratic Oath for physicians includes the promise "to abstain from doing harm", but any medical intervention can be harmful. Investigation of healthy people, as part of preventive medicine, is no exception. Summary of work: I discuss these issues in a lecture on Family Medicine to Term 8 medical students at Umea University, aiming to promote critical thinking around a problem I regard as crucial for the future. I also emphasize people/patient-empowering approaches in research and practice, introducing concepts such as "salutogenesis" and "personal health resources". Summary of results: Like most medical students approaching graduation, my students appreciate "hard facts" and "how-to-do-knowledge". This lecture has caused some hostility among students as well as the teaching-staff, for rocking the students' earlier learning in a critical period of their training, but I have also been awarded a pedagogical prize from the students - for elucidating the complexity in health care-work. Conclusions: The negative effects of preventive measures, risk-focusing and medicalisation of everyday problems are difficult to discuss professionally, but such a discussion is also longed for by medical students. Take-home messages: Critical thinking about the "risk epidemic" in medicine, and a discussion about empowering and sustainable medicine, should be introduced into medical training.


Using concept maps and mind maps to enhance reflection on academic and medical professionalism in preclinical students

Janusz Janczukowicz (Medical University of Lodz, Centre for Medical Education, ul.Pomorska 251, bldg A4 / 431, Lodz 92-213, Poland)

Background: The evidence supporting the fact that professionalism has to be explicitly taught, learnt and assessed starting from the very beginning of medical education is currently very strong. The main role of preclinical phase of teaching and learning professionalism is to develop cognitive foundations of professionalism and to initiate the process of self-reflection for further experiential and situated learning during clinical years.

Summary of work: Concept maps and mind maps are diagrams used to visually present ideas, tasks or complex projects. While concept maps are more structured, mind maps are considered to be more flexible and personal, hence more useful for reflecting on personal and professional attitudes. Both concept and mind maps can serve as instruments to promote reflection on students' own, individual models of professionalism, to compare it with the team members' views and to finally agree on the most fundamental and universal professional values, simultaneously respecting the diversity of culturally conditioned opinions and attitudes. Concept maps can be also used as a tool to enhance the reflection on relationships between the academic and medical professionalism and to increase

the awareness of complexities of borderline between students' and doctors' private and professional life. Summary of results: We have successfully implemented concept- and mind-mapping for the preclinical Introduction to Academic and Medical Professionalism courses for Polish and international students of the Medical University of Lodz.

Conclusions: Upon our experience and the evaluation of students' opinions we find concept and mind maps to be effective tools enhancing students' reflection on professional values.


Reflection in the Lineproject for pharmacy students at the Vrije Universiteit Brussel (VUB)

Pascale Petit (Vrije Universiteit Brussel (VUB) Belgium, The Study Guidance Center - Life Sciences, Laarbeeklaan 103, Brussels 1090, Belgium)

Bart Rombaut (Vrije Universiteit Brussel (VUB) Belgium, Pharmaceutical Institute, Brussels, Belgium)

Background: During the first year of the bachelor pharmacy students start with the course 'Line Project I'. The next three years of the bachelor program they acquire and expand their competences. Reflection, as self regulation or the possibility to improve the own action, is important in this learning process. Summary of work: Teaching goals of these Lineprojects are: (i) offer students a first impression of the profession of a pharmacist; (ii) promote teamwork, (iii) enhance the communication level of students; (iv) increase interdisciplinarity and lifelong learning. During these Lineprojects students receive an impression of the evolution of their competences. By using reflection students learn: (i) how to discuss personal aspects, (ii) how to justify these personal actions, and (iii) how to relate these actions to their future profession. Because not every student will reflect automatically, we help them to reflect during these Lineprojects. Summary of results: Students have to fill in reflection questionnaires (self-assessment) and reflect about their individual competence acquisition during follow-up interviews. During this follow-up interview students have to reflect about their individual competence acquisition with the game leader. This educational innovation helps students to reflect more and to correct their mistakes.

Conclusions: By doing research we concluded that students show a greater sense of responsibility and involvement in their own learning process. A reason is that this teaching method is more based on a self-learning approach.

Take-home messages: It is estimated that they will further control their evolution as reflective thinkers, including the awareness of the importance of life-long learning.

9I Short Communications: Problem

Based Learning 2

Location: Club A 9I/1

Further emerging benefits of PBL: insights from theoretical and functional analyses

Ted Sommerville (Nelson R Mandela School of Clinical Medicine, Anaesthesia, Private Bag 7, Congella, Durban 4013, South Africa)

Veena Singaram (Nelson R Mandela School of Clinical Medicine, Research, Durban, South Africa)

Background: Over five decades, Problem-based learning (PBL) has compared favourably with traditional curricula, in research largely emanating from the First World. We explored its implementation, and its own inherent benefits, in a developing country. Summary of work: Bernstein's sociological concepts of classification and framing and of knowledge structures were used in a mixed-method interpretive study to analyse a South African medical school's PBL curriculum. At the same time, a mixed-method study was made of aspects of collaborative small-group learning as described by Slavin.

Summary of results: The curriculum studied was in fact found to be closer to a traditional teacher-centered, lecture-based programme. Nevertheless, collaborative learning served to stimulate transformation of attitudes and relationships within the small groups. Conclusions: We argue that the knowledge structure of medicine is closer to that of the social than the pure sciences, and that, while the typical pedagogical form of PBL may not be predominant in this setting, it still functions in an integrative and transformative way amongst a diverse student body. These observations relate to the power relations within the faculty and between faculty and students, they have implications for the way medical knowledge may optimally be transmitted, and they serve as yet another argument for a learning methodology that integrates both disparate areas of knowledge and dissimilar student backgrounds. Take-home messages: This twofold integration may be one of the most effective ways of combining teacher and learner characteristics, learning contexts and processes, and course content, to achieve learning outcomes appropriate to medical practice in the 21st century.


Emotional intelligence, personality and psychological defense as predictors of PBL preferences

Are Holen (NTNU, Neuroscience, PO Box 8905 MTFS, Trondheim 7491, Norway)

Background: PBL is based on interactive skills that subsequently are supposed to translate into the patient-doctor relationship.


Summary of work: Second year medical students at the NTNU completed several questionnaires. The aim was to explore attitudes towards PBL in relation to emotional intelligence, personality traits and psychodynamic defense mechanisms.

Summary of results: The preliminary data analysis indicates that favourable attitudes towards PBL are positively associated with emotional intelligence, extrovert personality traits and mature levels of emotional regulation.

Conclusions: Students who like PBL also tend to have an empathic profile suitable for patient interaction. Take-home messages: PBL facilitators should aim for the development of group dynamics as this may improve interpersonal skills that also are relevant for future work with patients and other health personnel.


A Comparison of Facilitator and Second Year Medical Student Attitudes and Perceptions of a Virtual Patient Environment and Student Case Approaches, Development of Learning Issues and Development

WT Gunning (University of Toledo, Pathology, 3000 Arlington Avenue, MS 1090, Toledo, Ohio 43614, United


UGH Fors (Stockholm University, Computer and Systems Science, Kista, Sweden)

Background: We converted our problem based learning (PBL) course for preclinical medical students from paper-based content to a virtual patient (VP) environment (Web-SP). This has been extremely beneficial as the use of VPs controlled student case readers from disclosing unrequested information. With paper-based content, some readers would divulge whole sections of clinical history without inquiry for specific information by the discussion group and, dependent upon the facilitator, some of our PBL group dynamics evolved into document-dominated sessions. Summary of work: 175 medical students, divided into 17 discussion groups, and their faculty facilitators, consisting of basic science and active and retired clinical faculty, completed a questionnaire to assess attitudes and perceptions of the VP platform for PBL at the conclusion of their first case and at the end of the course. The group data were organized into three facilitator categories (active MD, retired MD, or PhD) for comparison. Individual and aggregate group VP interactions were compared using the total number of inquiries by each group for each of 3 case sessions and their respective learning issues and differential diagnoses.

Summary of results: Switching to VPs for case content reinvigorated our PBL course and enriched the opportunity to learn for our students. Significant variance between groups categorized by facilitator background was not observed however individual faculty did affect students' attitudes and approaches to VP cases.

Conclusions: An individual faculty member's attitude and perception of the learning environment will affect small group dynamics.

Take-home messages: Faculty facilitators for PBL-based discussion groups must be cognizant that their attitudes matter in small discussion group settings.


A renewed teaching approach to achieve the learning goals of a PBL course

Katrien Bosselaers (Catholic University of Leuven, Faculty of Medicine, Herestraat 49, Leuven 3000, Belgium)

Annick Dermine (Catholic University of Leuven, Faculty of Medicine, Leuven, Belgium)

Bernard Himpens (Catholic University of Leuven, Faculty of Medicine, Leuven, Belgium)

Agnes Goethuys (Catholic University of Leuven, Faculty of Medicine, Leuven, Belgium)

Isabel Gheysen (Catholic University of Leuven, Faculty of Medicine, Leuven, Belgium)

Background: In 2000 a PBL course was introduced in the final year of the medical school at KU Leuven. Some of the objectives were: stimulating clinical reasoning based on evidence based medicine, team work, multidisciplinary teaching and integration of knowledge achieved during the curriculum. Students were asked to solve clinical problems beforehand in small groups, using reliable scientific resources. During class, an interactive discussion facilitated by the lecturer took place. After 11 years we noticed that these objectives were no longer met: students didn't prepare the lectures in the intended way and they used resources of questionable quality.

Summary of work: A new teaching approach was piloted with 15 (volunteer) lecturers. For 30 lectures students received reliable scientific material on the topic as preparation material, but no clinical vignette. During class, clinical cases were solved in an interactive way. All lectures were observed by a member of the medical education unit, students were surveyed and teachers were interviewed.

Summary of results: 3320 student surveys, 58 observations and 29 interviews with teachers were analyzed. Observers noted an increase in interactivity and discussion between students. Teachers were very enthusiastic considering the new approach enhances flexibility in their teaching and they had guarantees that students used reliable scientific material. Students, however, perceived course interactivity as rather 'teacher dependent' and the reading material as too extensive.

Conclusions: The new approach facilitated the re-attainment of some of the learning goals. Take-home messages: Re-activating some of the learning goals in a course can be useful after some years of 'routine' work. It can also 're-motivate' teachers.



An exploration of the use of figurative language in PBL student explanations

Catherine Haines (The University of Nottingham, Medical Education, B94b, The Medical School, Nottingham NG7 2RD, United Kingdom)

Background: Figurative language has been studied in relation to concepts of illness and has long been thought useful for teachers in making effective explanations. The circulation is like a central heating system; cancer is like a civil war within the body, for example. Summary of work: A corpus of 100 hours of PBL discussion among Graduate Entry Medical Students has been studied using corpus analysis to identify usage of figurative language in explanations from over 100 hours' worth of learning discussion. Summary of results: Figurative language features surprisingly rarely among student discussion and explanations, challenging assumptions about how medical students acquire fluency in the concepts and terminology of medicine.

Conclusions: Explaining new knowledge in terms of an analogy, may not be as helpful as teachers think when students are in the initial stages of learning. There may be parallels with second language acquisition theory which may suggest enhancements to teaching and learning in the initial stages of medical training. Take-home messages: Teachers and learners may benefit from paying explicit attention to the way they can most effectively gain fluency in medical language, before they are able to attain conceptual fluency.


Integration of facilitated online discussion forum with PBL: a model to improve students' learning

Ahmad Alamro (Qassim University, Faculty of Medicine, Medical Education, Qassim, Saudi Arabia) John Sandars (Leeds Institute of Medical Education, Medical Education Unit, Leeds, United Kingdom)

Background: Problem-based learning (PBL) is widely used. Previous research showed often there is little sharing of knowledge between the sessions. One suggested solution could be the use of integrating facilitated online discussion between PBL sessions to give an opportunity for students to share knowledge and increase their learning.

Summary of work: A facilitated online discussion forum was integrated between PBL sessions on a four-week traditional PBL course at Qassim Medical School, Saudi Arabia. Fifteen tutors (5 females and 10 males) and 145 students were included in the study. A mixed methods approach was conducted using questionnaires and interviews to evaluate perceived usefulness (knowledge sharing/ learning) and an objective measure of knowledge sharing and elaboration using a validated tool that evaluated the online discussions. Summary of results: Students and tutors considered that the intervention improved student's understanding

of PBL in a collaborative environment. Both students and tutors enjoyed the integration of the online discussion forum and look forward to have same experience in the future. The objective measure of knowledge construction in the online discussions showed that knowledge was shared and elaborated, consistent with an active learning process. Conclusions: An integrated and facilitated online discussion forum between PBL sessions has the exciting potential to improve knowledge construction and learning.

Take-home messages: A facilitated online discussion forum between PBL sessions has the exciting potential to enhance learning on a traditional PBL course.

9J Short Communications: Best Evidence Medical Education (BEME) 2

Location: Club E, PCC


Building Capacity for Education Scholarship Among Clinical Educators in the Health Professions: A Best Evidence Medical Education Systematic Review of the Scope and Impact of Interventions

Rabia Ahmed (University of Alberta, Medicine, Edmonton, Canada)

Ameer Farooq (University of Alberta, Undergraduate

Medicine, Edmonton, Canada)

Anna Oswald (University of Alberta, Medicine, 564

HMRC, Edmonton T6G 2S2, Canada)

Dale Storie (University of Alberta, Edmonton, Canada)

Lisa Hartling (University of Alberta, Pediatrics,

Edmonton, Canada)

Liam Rourke (University of Alberta, Medicine, Edmonton, Canada)

Background: There is a growing desire for health professions educators to generate high quality scholarship; however, few of them encounter the training to do so. In response, the field is devoting increasing resources to provide its members with these skills for education scholarship. The form and impact of these efforts have not been surveyed, though such a synthesis could be useful for practice. Our objectives were to (i) identify interventions aimed at building capacity for education scholarship of discovery among health professions and (ii) examine the evidence behind these interventions.

Summary of work: A systematic review protocol was prospectively registered with the Best Evidence in Medical Education (BEME) organization. We conducted a comprehensive search of health professions' databases and related grey literature. Systematic methods were applied to studies for inclusion, data extraction, and methodological quality assessment. Studies were included if they reported outcomes for interventions designed to capacity of health professions educators to conduct educational research. Summary of results: Our query returned 14, 149 results, 241 of which were retained after title and abstract screening, 30 of which met inclusion criteria after full text review. Seven groups of interventions were identified, the most frequent being teaching scholars programs(7) and master or fellowships in medical education(10). The most common measured outcome of interventions were changes in products of productivity (grants, papers, abstracts, and presentations) post-intervention. Most of the included studies were of low/moderate quality.

Conclusions: This review demonstrates that various interventions can have a positive impact on the ability of health professions educators to conduct educational research although better study quality is required in order to determine efficacy.


Take-home messages: Interventions with strongest study designs were teaching scholars programs, and fellowships/masters.


The Effectiveness of the Use of Virtual Patients for Medical Students. A BEME Systematic Review in Progress

Hisham Khalil (Plymouth University Peninsula Schools of Medicine and Dentistry, Division of Medical Education, John Bull Building, Tamar Science Park, Derriford, Plymouth PL6 8BU, United Kingdom) Nick Cooper (Plymouth University Peninsula Schools of Medicine and Dentistry, Division of Medical Education, Plymouth, United Kingdom)

Aris Poulios (Plymouth University Peninsula Schools of Medicine and Dentistry, Division of Medical Education, Plymouth, United Kingdom)

Adrian Copplestone (Plymouth University Peninsula Schools of Medicine and Dentistry, Division of Medical Education, Plymouth, United Kingdom) Desmond Nunez (University of British Columbia, Otolaryngology, Vancouver, Canada) Thomas Gale (Plymouth University Peninsula Schools of Medicine and Dentistry, Division of Medical Education, Plymouth, United Kingdom)

Background: Virtual Patients (VP) are computer-based patient simulations used to educate and test medical knowledge and skills. There are numerous arguments for including VP in the medical curricula including the reduced patient contact time medical students experience due to changes in healthcare delivery. Reported disadvantages in the literature include being expensive and resource intensive, difficult to edit and author, limited by technology and poor at evaluating complex cognitive skills.

Summary of work: We conducted a comprehensive search to retrieve all literature relating to the use of virtual patients in undergraduate medical education from 1980 onwards. All retrieved titles were imported into an Access database we designed based on a modified BEME coding sheet. References focusing on assessments were excluded as this will be the topic of a separate BEME review.

Summary of results: In total, 1,890 references were retrieved in the searches. This number dropped to 1,311 references after the removal of duplicates. We included 108 references. These covered a number of themes including VP design and development, applications, teaching pedagogy, student attitudes and evaluation. New VP designs include the incorporation of simulators and haptic devices. An update search and statistical analysis of the results is underway and will be presented.

Conclusions: Initial results demonstrate VP are effective in the education of medical students in various domains including medical knowledge, clinical reasoning, clinical and communication skills, attitudes as well as curricular integration.

Take-home messages: VP should be considered as part of the teaching and learning strategies for medical students.


BEME Systematic Review: Impact of an Intercalated BSc on Medical Student Performance & Careers

M Jones (UCL, The Research Department of Primary Care and Population Health, Rowland Hill Street, London NW3 2PR, United Kingdom)

S Eastwood (UCL, The Research Department of Primary Care and Population Health, London, United Kingdom) P Hutt (UCL, The Research Department of Primary Care and Population Health, London, United Kingdom) S Singh (UCL, The Research Department of Primary Care and Population Health, London, United Kingdom)

Background: IBScs are optional parts of undergraduate (UG) courses in many countries, consisting of extended study, with research. They are expensive and delay workforce entry.

Summary of work: A mixed-method systematic review (meta-analysis [MA] & critical interpretive synthesis [CIS]) of biomedical & educational literature, focusing on the impact of iBScs on UG performance, skills, and career choice, and to explore stakeholders' opinions. Summary of results: MA- From 5 studies 2 report an improvement in UG performance; 1 reports OR of 3.58 [1.47-8.83]), 1 reports a significant finals scores improvement (1.27 pts [0.52-2.02]). Others were inconclusive. 1 study suggested iBScs lead to the development of deeper learning styles. 2 studies report an increased chance following academic careers [OR 3.6 (2.3-5.8) to 5.94 (3.6-11.5)]. 7 of 8 studies (broader selection criteria) report iBSc students were less likely to

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