Автор неизвестен - Mededworld and amee 2013 conference connect - страница 114

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9W Workshop: THE HELM C0URSE:

Development of a transformational leadership and collaborative management programme for medical trainees and other senior healthcare professionals

Location: Room B, Holiday Inn

Deepak Gupta (Great Western Hospital, Postgraduate Education, Marlborough Road, Swindon SN3 6BB, United Kingdom)

Alan Cook (Severn Deanery, Faculty Development and Education, Bristol, United Kingdom) Amy Cook (Great Western Hospital, Postgraduate Education, Swindon, United Kingdom)

Background: The need: an integrated, practical and accredited leadership and management programme for medical trainees and other senior healthcare professionals including Consultants and nurses. Had to be based on knowledge, service improvement, realisation of the need for change and multidisciplinary interaction. Staged programme providing various levels of competence: CPD,certificate,diploma or Masters; Delivered by a mix of Academic and Practical Faculty; Affordable and sustainable. The format should be acceptable to various organisations and deliverable to a large number of participants. 3 modules of 2 days each: leadership and change, healthcare management and health economics, strategy and innovation. Participants include mostly senior postgraduate medical trainees, and some senior healthcare professionals Intended outcomes: Understanding of the leadership and management needs of trainees and healthcare professionals; Awareness of the lacunae in clinical and managerial engagement; Knowledge about development of an appropriate curriculum; Going about accreditation; Project management; Assessment of outcomes.

Structure of workshop: interactive; discussion of the problem and the need; possible solutions; finding an appropriate solution: discussion about the curriculum, course length, faculty, participants, accreditation; interactive discussion of affordability and sustainability; how to assess outcome; management of service improvement projects; assessment of financial implications of the SIPs; development of business case for the course.

Who should attend: medical trainees, clinicians, managers, other healthcare professionals and educationists with an interest in healthcare leadership and management, and also in facilitating clinician-managerial engagement to increase healthcare organisations' (NHS or others) efficiency and output. Level: Intermediate

9X Workshop: Emotions in the art and science of learning medicine

Location: Room D, Holiday Inn

Peter Musaeus (Aarhus University, Center for Faculty

Development, Brendstrupgaardsvej 102, B, INCUBA

Science Park, Aarhus N 8200, Denmark)

Anne Mette M0rcke (Aarhus University, Center for

Faculty Development, Aarhus, Denmark)

Tim Dornan (Maastricht University, Department of

Educational Development and Research, Maastricht,


Esther Helmich (University of Amsterdam, Centre for Evidence-Based Education, Academic Medical Center, Amsterdam, Netherlands)

Background: Humans experience emotions in childhood, adulthood and old age and in all sorts of situations at work, at home, when hospitalized etc. Humans cry, laugh, smile and sometimes say emotional things to each other. Everyday experience tells us that doctors, medical students and patients experience and express emotions but it does not say how to conceptualize emotion and what the significance of emotion is to medical education. The rapid increase in research on emotions within the past decades has led some commentators to identify an affective turn in the social sciences referring to the shift from a linguistic paradigm of studying social phenomena as discursive to a paradigm aiming to grasp the role emotions play as windows into the social world. This workshop invites educators and researchers to consider how students and health practitioners learn to communicate the proper emotions at the right time in emotionally taxing situations of human suffering; in other words, to what extent are emotions malleable by clinical experience and morality? It does so from two perspectives: (1) What are the implications to our educational programs of treating emotion as e.g. individual skill, clinical emotional competence or emotional intelligence? (2) What are the implications of situating emotions at the nexus of cultural identity and communal morality? Intended outcomes: Participants will: Be introduced to contemporary theories of emotions. Draw a theoretical map of the complex multi-level phenomena of emotions in the landscape of learning medicine as art and science Discuss the implications of an affective turn to the practice of medical education.

Structure of workshop: Short introductory lectures to topic followed by discussion-based teaching with participants' reflections and one or two cases from research/cases from healthcare being used in case-based teaching format.

Who should attend: Researchers, MD/practitioners, and faculty developers. Level: Advanced

9Z Posters: Teaching and Assessing

Communication Skills

Location: South Hall, PCC


Using a checklist to assess history-taking skills of final year medical students

Wanaporn Anuntaseree (Prince of Songkla University, Pediatrics, Faculty of Medicine, Kanjanawanich Street, Hat yai, Songhkla 90110, Thailand) Kitja Panabut (Prince of Songkla University, Pediatrics, Faculty of Medicine, Hat yai, Songkhla, Thailand) Nannapat Pruphetkaew (Prince of Songkla University, Epidemiology Unit, Faculty of Medicine, Hat yai, Songkhla, Thailand)

Background: History-taking skills are essential in a medical curriculum. Obtaining the history guides the physical examination. It is a key to reach a diagnosis. Summary of work: This study was performed to assess history-taking skills of last year medical students when they attended the Department of Pediatrics, Prince of Songkla University in southern Thailand. Students were assigned to take the medical history from well-trained simulated mothers using a checklist designed for the conditions under direct observation within strict time limits. The checklist included three sections: (1) interview initiation, (2) interview conduction, and (3) asking the details of symptoms and making the diagnosis.

Summary of results: Eighty-three students participated in this study. Sixty-six percent of the students had a good performance under the category of interview initiation. Under the category of interview conduction, 89.2% asked open and clear questions, 50.6% asked questions in the appropriate sequence, 65.1% summed up the results of the interview properly, and 94% expressed nonverbal communication with mothers and listened to their words. In Section 3, 47% of the students had a score equal to or greater than 60%. The checklists with high scores were not associated with the students' grade point average (GPA).

Conclusions: Using a simulated mother with a structured checklist is useful in evaluating student performance in history-taking skills. The skills of medical students vary among different sections and are not sufficient in quality in some categories.

Take-home messages: It is necessary to emphasize and repeat training in history-taking skills for the last year medical students and reassess periodically to improve the quality.


Role-plays with peers are fun - but are they of any use in learning patient interviewing?

Asta Toivonen (Faculty of Medicine, University of Helsinki, Hjelt Institute, P.O. Box41, Helsinki FI-00014, Finland)


Eeva Pyorala (Faculty of Medicine, University of Helsinki, Hjelt Institute, Helsinki, Finland)

Background: In Helsinki the use of simulations alongside role-plays in communication skills studies started in 1997. Role-plays were given up in 2002 but reintroduced in 2010. Since then these learning methods have been used in a patient interview course for 2nd year students. The aim of this study was to assess how students assessed their patient interview learning. Summary of work: Data were collected with a web-based self-assessment in the beginning and in the end of the course. Sixty-nine students (73.4 %) answered the questionnaire. It consisted of quantitative part of statements with 5-point Likert scales and open-ended questions. Statements were analyzed statistically. Open-ended answers were analyzed with content analysis. University's Ethical Board approved the study. Summary of results: The statistical analysis showed students' patient interviewing skills improved along the course. The mean value for gathering information by using open-ended and closed questions improved from 3.30 (SD 0.65) to 3.77 (SD 0.69) (p<0.0001). The patient interviewing skills enhanced the students' self-efficacy in diagnostic skills. The mean value for the ability to offer information to the patient increased from 3.07 (SD 0.83)

to 3.48 (SD 0.8) (p=0.002).

Content analysis showed role-plays were considered useful warm-ups for simulations and good rehearsal of the patient interview structure. Simulations were considered to be the most valuable learning experience in the course.

Conclusions: The students' self-assessed patient interviewing skills improved along the course. Students preferred simulations, but considered role-plays as good warm-ups reducing anxiety towards simulations. Take-home messages: Role-plays and simulations together develop patient interview skills. Good communication skills enhance self-efficacy in diagnostic



Patient feedback - impact of student gender on communication skills

Regina Ahrens (Institute of Family Medicine, Faculty of Medicine, Murtenstrasse 11, Berne 3010, Switzerland) Sven Streit (Institute of Family Medicine, Faculty of Medicine, Berne, Switzerland) Mireille Schaufelberger (Institute of Family Medicine, Faculty of Medicine, Berne, Switzerland)

Background: Literature shows gender differences in communication skills of medical students in self, peer-and tutor-evaluation favoring female students. But patient satisfaction related to the physicians' gender is still controversial. Our focus was on how the student's gender influences the patients' perception of communication skills.

Summary of work: In 2012, all 3rd year medical students from the University of Bern on practical training in a general practice were evaluated on their communication

skills by two patients per student. Evaluators were chosen in advance based on examination order. The non-anonymous evaluation took place directly after a consultation, containing 5 questions rated on a 4 point Likert Scale.

Summary of results: Overall, patients ranked students' performance high: 57% of the patients ranked the students highest possible in all 5 categories. Yet female students seem to perform significantly better than male students (p=0.04), especially in being interested (p=0.05), and in being empathetic (p=0.02). The trend was similar also when controlling for patient age and gender.

Conclusions: Female medical students seem to be more competent in some aspects of communication also when evaluated by patients. It remains to be shown how communication skills finally correlate with patient satisfaction. The results support our hypothesis that patients' perception of communication skills depends on the medical student's gender. Take-home messages: Patients evaluated female students' communication skills better than those of male students in their 3rd year during consultation in a general practice.


Identifying and grading the current tools used in evaluating communication skills in surgical and medical trainees at the point of transition to independent practice

Amy E. Gillis (Trinity College Dublin, AMNCH, Surgery, Trinity Education Centre, Adelaide and Meath Hospital, incorporating the National Childrens Hospital, Tallaght, Dublin 24, Ireland

Marie Morris (Trinity College Dublin, Medical Education, Dublin, Ireland)

Paul F. Ridgway (Trinity College Dublin, AMNCH, Surgery, Dublin, Ireland)

Background: Effective communication skills are essential to successful physician-patient relationships. Though necessary, little formal training has been integrated into current medical training schemes. Our objective is to systematically review the literature and to identify and evaluate the current tools used to assess communication skills in medical and surgical trainees at the point of transition to independent practice. Summary of work: Two reviewers independently reviewed the literature to identify communication skill assessment tools, specifically for postgraduate trainees within the PRISMA framework, inclusion/exclusion criteria and search period. Databases: Pubmed, CINAHL, ERIC, EMBASE, PsycInfo, Psyc Articles, Cochrane. Summary of results: Of the 300 abstracted articles, 54 identified communication skill assessment. These abstracts were screened for relevant content, eliminating a further 37 articles, leaving 19 for review. Of these, 5 were review articles, 1 did not fit criteria due to level of postgraduate training, 1 did not include medical personnel. Twelve articles were available for complete evaluation; 8 articles used OSCE/standardized


patient (SP) based exams in an observational (6) or interventional capacity (2), and 4 written evaluations, including 2 using author-developed questionnaires, 1 survey, and 1 self assessment validated tool. The levels of evidence were good, scoring 3-4 on the BEME guide. Conclusions: Communication skills should be evaluated as one of the components of the medical professional, as established by certifying bodies. The reviewed literature is heterogeneous for objectives and measurement techniques for communication. Observed interactions, with patients or SPs, is the current favoured method of evaluation. Four studies showed no association with PGY level and communication skills ability.

Take-home messages: Conclusions cannot be made on whether communication interventions are beneficial in improving skill level. More research is needed to determine whether communication interventions are effective.


Teaching Public Speaking Skills is Essential For Future Medical Leadership

Thomas Hansen (Royal Bolton NHS Foundation Trust, Medicine, Minerva Road, Bolton, Greater Manchester

BL4 0JR, United Kingdom)

Paul Baker (Royal Bolton NHS Foundation Trust, Medicine, Greater Manchester, United Kingdom)

Background: Leadership is an integral part of the medical profession. To be a good leader one needs to be able to express oneself effectively, to allow others to understand a vision and act on it. Oratory is the "the art or practice of formal speaking in public". Public speaking is something which we do every day as doctors, yet it is something which very few have been educated in. Good leadership through public speaking training is vital not only for our everyday practice but for the future of our profession as a whole. A literature search for "medical education" and "public speaking" OR "oratory skills" revealed very few relevant papers. No papers dealt with the need for teaching students for future leadership. Summary of work: We have designed an educational intervention for medical students which will focus on the core skills required for oratory. Examples to enable them to avoid common mistakes and tips to improve the memorability of their presentation will be given. We hope to provide a second session where students can do presentations and receive feedback. Summary of results: We will present data detailing how this intervention has been received. Conclusions: For post graduate medics there are organisations such as Toastmasters International that enable even beginners to gain practice at public speaking. It would greatly benefit the profession if such courses counted towards continuing professional development.

Take-home messages: Public speaking is often thought to be something that comes to individuals innately, but this is not the case. Public speaking can and should be taught and practiced.


A clinical communication curriculum - lessons learned from a five year programme evaluation

Jonathan Ward (The University of Birmingham, Interactive Studies Unit, Primary Care Clinical Sciences, School of Health and Population Sciences, 90 Vincent Drive, Birmingham B15 2TT, United Kingdom)

Background: Medical Students receive (mixed-method) clinical communication teaching during years 1, 2, 3 and 5. An online-survey was distributed to all medical students in 2012. Study purpose was to (1) investigate students' attitudes towards clinical communication, and (2) to evaluate the response of students towards current communication interventions in order to inform curriculum development. Summary of work: In addition to participants rating/critiquing clinical communication teaching/teachers during their undergraduate years, the questionnaire-study captured data about participant beliefs. As examples: whether communication is "inherent", how its value is defined, and how well (or not) early exposure prepares them for the rigours of their first medical job. Prospectively, we asked them how they would change the curriculum, and how they would assess communication.

Summary of results: At 31/12/12 response n=329. Data-collection is ongoing, so a second 5-year cohort of students will be analysed (and added) in summer 2013. Conclusions: Students indicated feeling prepared for the clinical environment by the teaching received and are keen to understand how communication relates to clinical practice. Discussion will include strategies for integration.

Take-home messages: The key message (thus far) is the need for enhanced integration with clinical contexts and environments.


Communication Skills Training Programs in Iranian Medical Schools: a national survey

Azim Mirzazadeh (Tehran University of Medical Sciences, Medical Education, PO Box: 14185-481, Tehran 1443734835, Iran)

Narges Saleh (Tehran University of Medical Sciences, Educational Development Office, School of Medicine, Tehran, Iran)

Taraneh Dormohammadi (Tehran University of Medical Sciences, Internal Medicine, Tehran, Iran)

Background: Poor communication skills have been reported in many Iranian medical schools. The present survey aimed to gather the required information about the current situation of communication skills courses for medical students in Iranian medical schools. Summary of work: Those medical schools that have a communication skills course have received the questionnaire by email. The data extracted from the questionnaires was then analyzed.


Summary of results: From 47 public medical schools only 12 schools have courses on communication skills. About 70% of the questionnaires were received. The courses were mainly held during pathophysiology (87%), 13% during the clerkship. Mean duration of these courses was 9 hours, (range: 2 to 21). The main teaching method was lecture (87%); the other teaching methods were small group discussion in 75%, role-playing in 12% and interview with a simulated patient in 12%. No assessment was performed in 45% of the courses. In others, however, various methods were used (OSCE: 17%, MCQ: 80%, Essay: 40%).

Conclusions: Despite the fact that communication skills abilities of many medical students are reported to be poor, related training programs are only part of the curriculum of 25% of the studied medical schools. The teaching methods in most of these courses seem not suitable for learning communication skills. Interventions targeting effective learning of communication skills need to be developed to help medical students understand the importance of communication and the complexity of communication issues in health care. Take-home messages: We need more effort to enable our medical students to communicate well with their patients.


An effective teaching method to young physicians in Taiwan: Breaking Bad News by Role Playing

Sio-Meng Lei (E-Da Hospital, Medical Education, Psychiatry, 58 Baoyang Street, San min District, Kaohsiung 807, Taiwan)

Tsuen-Chiuan Tsai (E-Da Hospital, Medical Education, Pediatrics, Kaohsiung, Taiwan) Pon-Eu Lai (E-Da Hospital, Oncology, Palliative Care, Kaohsiung, Taiwan)

Background: There are challenges to break bad news especially within the Asian cultural setting because of the strong family tie. We studied how the role playing method in small group teaching could improve the communication skills of young physicians in Taiwan. Summary of work: We used role playing in small group for teaching skills of breaking bad news in our clinical training program. The participants included 6 year 1~2 residents & 12 post-graduated young physicians, divided as 6 per group/session. A hypothesized case of renal cell carcinoma was used, and the participants are asked to take a role of physician, patient or one of the families. The facilitator is a psychiatrist. The physician was assigned to disclose the unexpected bad news to the patient, while the family requested him/her to hide the truth that violated patient's right of autonomy. Summary of results: This clinical training was rated with high satisfaction over 85%. 90% participants claimed that it was helpful and useful for improving their communication skills. More than 70% of participants reflected their impressive experience of standing next to the patient and the family as well. Conclusions: Even though breaking bad news is especially challenging within a Taiwanese rural family,

young physicians are flexible to learn to act in the situation, gain empathy, to promote their communication skill in small group training by using role playing

Take-home messages: Role playing is an effective method to teach communication in a small group in Taiwan, especially for young physician to learn breaking bad news.


The Evaluation of Communication Skills Training in Breaking Bad News for the First Year Medicine Residents

Bundarika Suwanawiboon (Faculty of Medicine Siriraj Hospital, Mahidol University, Medicine, 2 Prannok Road, Bangkoknoi,, Bangkok 10700, Thailand) Nadwipa Yuangtrakul (Faculty of Medicine Siriraj Hospital, Mahidol University, Medicine, Bangkok, Thailand)

Chanin Limwongse (Faculty of Medicine Siriraj Hospital, Mahidol University, Medicine, Bangkok, Thailand) Kanokwan Boonyapisit (Faculty of Medicine Siriraj Hospital, Mahidol University, Medicine, Bangkok, Thailand)

Supot Pongprasopchai (Faculty of Medicine Siriraj Hospital, Mahidol University, Medicine, Bangkok, Thailand)

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