Автор неизвестен - Mededworld and amee 2013 conference connect - страница 122

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Regional teaching days positively influence the learning climate of a postgraduate school of paediatrics

Alexandra Brightwell (London Deanery, Speciality School of Paediatrics, 32 Russell Square, London WC1B 5DN, United Kingdom)

Susie Minson (London Deanery, London Speciality School of Paediatrics, London, United Kingdom) Melanie Menden (Royal London Hospital, Paediatrics, London, United Kingdom)

Seema Sukhani (Imperial College, Paediatrics, London, United Kingdom)

Mando Watson (London Deanery, London Speciality School of Paediatrics, London, United Kingdom)


Background: Our large regional postgraduate school of Paediatrics (>1000 trainees) delivers a two year programme of study days which aim to address areas of the curriculum which had been identified as difficult to access in the workplace. The training days are focussed on trainees who are currently 4-5 years into an 8 year training programme and are delivered centrally, with trainees attending from 35 different base hospitals. Summary of work: We evaluated the impact of these innovative days on the learning environment of the regional school of paediatrics via a series of focus groups. Participants were either attendees at the training days, or regional training representatives. Focus group transcripts were independently analysed using a modified thematic analysis and themes were identified and further refined using the framework analytic approach.

Summary of results: The emerging themes fell into the following categories: Regional teaching days: Promote networking and sense of collegiality; Strengthen the community of practice; Provide inspiration for career development; Increase standards of training by increasing awareness of other learning environments; Increase quality of patient care by highlighting innovation and good practice; Empower trainees to deliver change.

Conclusions: Regional training days influence the learning climate of a postgraduate school in a variety of ways beyond curriculum delivery. Particular attention to optimising the learning climate must be paid when planning curriculum delivery programmes and regional teaching must be protected in order that the described benefits are maintained.

Take-home messages: Regional teaching positively influences the learning climate beyond curriculum delivery in a variety of important ways.


Impact of the anaesthesia specialist examination on trainee approaches to learning

Jennifer Weller (University of Auckland, Centre for Medical and Health Sciences Education, FMHS Grafton Campus, PO box 92019, Auckland 1142, New Zealand)

Background: Assessments should support trainee development towards specialist practice, encourage learning approaches promoting deep understanding, and engender habits for effective career-long learning. We explored the extent to which the Australian and New Zealand College of Anaesthetists (ANZCA) Final Exam (FEX) met these goals.

Summary of work: We surveyed all ANZCA advanced trainees using an established learning approaches inventory with additional questions on time spent, perceived value and how they studied for the four FEX components: MCQ, SAQ, Medical Viva, Anaesthetic viva. Summary of results: We received 239 responses (35%). There were significant differences between perceived value and time spent on the four components, with more time spent on less valued components. Time and relevance were not aligned with the weighting or pass

rate for the individual components. Eighty per cent of trainees adopted predominantly deep learning approaches, but 20% adopted predominantly surface approaches. Written comments suggested the written ANZCA curriculum was seldom used to guide study, and different approaches were used for the four FEX components, with more superficial approaches for the MCQ, including rote learning, and deeper approaches with the SAQ.

Conclusions: The FEX was generally seen as relevant, encouraging deep learning approaches but this varied between components. This contrasts with reports suggesting learning approaches become more surface through undergraduate programs. Participants rarely used the written curriculum for learning. Take-home messages: A high stakes exam in specialist training drives knowledge acquisition but the curriculum can become, by default, previous test items. Some assessment methods encourage deeper approaches and likely to promote skills for life-long learning.


Regional competency based study days for paediatric trainees in London: How trainee involvement can improve learning outcomes

Melanie Menden (University College London Hospital

Trust, Paediatrics, London, United Kingdom)

Seema Sukhani (St. Mary's, Imperial Healthcare,

Paediatrics, London, United Kingdom)

Alex Brightwell (London School of Paediatrics,

Paediatrics, London, United Kingdom)

Susie Minson (London School of Paediatrics, Paediatrics,

London, United Kingdom)

Mando Watson (London School of Paediatrics, Training Programme Director, London, United Kingdom)

Background: The London School of Paediatrics developed regional study days specifically to address areas of the curriculum which are difficult to achieve in the local workplace. One of the challenges was to deliver specialty knowledge that adequately addresses the learning needs of attending trainees. Summary of work: In response, we involved senior paediatric trainees to individually design all study days. Specialty trainees were invited to chair each day, recruit enthusiastic experts as speakers, identify important learning needs to be covered in workshops, and provide an overview about training in their specialty. Educational fellows coordinated each day, ensuring the learning needs of general paediatric trainees were adequately met.

Summary of results: Our regional study days are extremely popular with high attendance and satisfaction rates. The majority of attendees felt that the competencies covered were successfully tailored towards their learning needs. 75% perceived information on speciality training as useful. Trainees especially valued the opportunity to interact with senior trainees and experts in each specialty. As a result, many have been inspired to develop a special interest, and had confidence to initiate change of local practice. For


speciality trainees, the experience has provided a valuable opportunity to develop education and leadership skills.

Conclusions: Paediatric trainees play a pivotal role in improving the quality of regional study days by ensuring competencies are tailored to learning needs and offering junior trainees insight into each paediatric speciality. Take-home messages: Engaging trainees in the development of training programmes enhances the quality of education provision and has direct impact on high quality education and patient care.


Resident Inspired Radiology Curriculum for Subspecialties (RICS): Piloting a Kolb learning based, integrated clinical-radiology program for gastroenterology

Siwar Albashir (McMaster University, 1280 Main St W, Gastroenterology Department 2F, Hamilton L8S4L8, Canada)

Girish Bajaj (McMaster University, Gastroenterology, Hamilton, Canada)

Zain Kassam (McMaster University, Gastroenterology, Hamilton, Canada)

Frances Tse (McMaster University, Gastroenterology, Hamilton, Canada)

Ted Xenodemetropoulos (McMaster University,

Gastroenterology, Hamilton, Canada)

Nina Singh (McMaster University, Radiology, Hamilton,


Background: Radiology plays a critical role in the clinical care of many specialties including gastroenterology. Currently, radiology training for subspecialty learners is based on approaches radiologists employ to train core radiology trainees. However, subspecialty trainees are fundamentally different from radiology residents in knowledge, learning styles and needs, given their clinical background. Accordingly, teaching content and strategies must be adapted. As no standardized gastroenterology radiology curriculums exist in Canada, we have developed a novel radiology curriculum that can be utilized as a template for other subspecialties. Unique features include development by residents, direct application of the Kolb learning theory and integrated clinical-radiology modules. Summary of work: A literature review of subspecialty radiology education was undertaken with subsequent theme analysis extracted. Gastroenterology fellows created the module with radiology and gastroenterology faculty support. Module objectives were vetted, Delphi style, by trainees and opinion experts. The pilot module was delivered to McMaster University gastroenterology trainees and evaluated using pre- and post-module surveys, content-based assessment and OSCE radiology sub-scores. The Kolb learning theory was applied to each module moving through diverging, assimilation, converging and accommodating learning styles in a practical manner. Modules address 4 core domains: 1) Creation of a motivating personal experience, 2) Development of new concepts, 3) Practical application

with immediate feedback, 4) Reflection, synthesis and extension. Sessions are co-facilitated by a clinical gastroenterologist and radiology faculty to integrate both learning spheres.

Summary of results: Preliminary data will be presented

on trainee knowledge and attitudes.

Conclusions: This new radiology curriculum, authored by

current resident-teachers, employs robust educational

methodology and serves as a model for radiology

curriculums in other specialties.

Take-home messages: This is a new radiology

curriculum tailored to subspecialty trainees applies the

Kolb learning theory in each module. This curriculum can

serve as a model for other subspecialties.


Failure of high stakes postgraduate medical exams - what is the impact on trainees and how can they achieve success after multiple failures?

Susan Minson (London Deanery, London School of Paediatrics, London, United Kingdom) Annika Adodra (London Deanery, London School of Paediatrics, Stewart House, 32 Russell Square, London WC1B 5DN, United Kingdom)

Alexandra Brightwell (London Deanery, London School of Paediatrics, London, United Kingdom)

Background: Progression through UK postgraduate medical training is dependent on passing high stakes postgraduate examinations. Multiple examination failures have significant impact on trainees and implications for workforce planning. Summary of work: We contacted paediatrics trainees who had failed the MRCPCH clinical examination at least 3 times and had eventually passed. Participants completed structured interviews with full consent. 5 trainees were interviewed with questions focussed on performance, perceived problems, impact of failure and key changes enabling them to pass. Summary of results: Trainees had taken the examination between 3 and 6 times and all had achieved significant improvements in their scores. All participants described significant impacts of multiple failure including reduced confidence, lack of credibility, stress and significant financial burden. Perceived reasons for failure included poor structure and presentation skills and trainees believed that improving these had been important. Significantly, all the participants identified that reviewing their feedback with a trusted senior and a mindset to being less defensive were key features that helped them to pass. Conclusions: Our results show that trainees can pass exams after struggling. Multiple failures have significant impacts on trainees professionally and personally. Important features in eventual success included a change in mindset and reviewing feedback with a trusted senior. These could be used to develop support strategies for trainees struggling with exams. Take-home messages: Multiple failure of high stakes postgraduate medical examinations has a significant impact on trainees. A change in mindset and reviewing


feedback with a trusted senior are key features in eventual success and we should support trainees in achieving this.


Using live internet polling during teaching sessions to answer multiple choice exam style questions for General Practice trainees

Alexandra Macdonald (Winchester University/ Wessex Deanery, GP education, Wessex Deanery, NHS South of England, Southern House, Otterbourne, Winchester SO21

2RU, United Kingdom)

Background: The written component of the MRCGP examination, the Applied Knowledge Test (AKT), is a three-hour machine-marked test of 200 questions. The first-attempt failure rate is 22%. Many candidates feel inadequately prepared, yet simple tests fail to engage both the individual and the group. Summary of work: At each teaching session, live internet-based polls were run on two topics, with three to five questions on each. The expert resource taking each session then integrated the learning needs from the questions into the teaching. When each question is displayed, each trainee texts their answer by mobile phone. The server displays these live on-screen in chart form, showing how many choose each option, allowing the individual to target their learning and compare their answer with those of their peers. The instructor then immediately steers teaching into areas of weakness. Summary of results: Polls were run for 31 students over 16 topics. Feedback was taken midway through the project to permit format adjustments and again at its conclusion. 27/31 trainees liked the technique, 2/31 did not and 2/31 were neutral. Comments were that it made teaching relevant to exams, it focused their minds, it showed areas needing work, it allowed them to compare themselves with others, it improved interaction, and they liked the instant feedback. Conclusions: This dynamic e-learning approach allows students to compare themselves to their peers anonymously, with instant feedback in an enjoyable environment, with increased engagement, allowing the teaching session to be steered live towards areas of need.


General Practice Out of Programme Study Sessions

Jonathan Rial (Wessex School of General Practice, Wessex Deanery, UK, Southampton GP Education Unit, Mailpoint 10, University Hospital Southampton, Tremona Road, Southampton SO16 6YD, United Kingdom)

Aurelia Butcher (Wessex School of General Practice, Wessex Deanery, UK, Primary Healthcare Education, Winchester, United Kingdom)

Background: Seven trainees from Wessex had not demonstrated enough to obtain their General Practice

certificate of completion and were therefore placed out of programme for six months.

Summary of work: A bi-weekly study session was set up for these trainees to attend which was run by recently qualified GPs who were also educationalists. The programme included Clinical Skills Assessment (CSA) practice with feedback, presentations by GPs who had previously struggled with the CSA as well as careers advice.

Summary of results: After six months each of the trainees has continued to attend. It is perceived by the supervisors that they have all improved in their consultation skills. Some have gained a huge amount of insight into the purpose of the CSA. Conclusions: This programme allowed the trainees to keep in touch with general practice. It also gave them the opportunity to meet with other colleagues in the same situation which psychologically has helped them. They are now back in programme and believe that the sessions have facilitated some continuity despite their unfortunate position.

Take-home messages: A regular supervised study session is helpful for trainees who are out of programme. It can help maintain continuity of practice as well as improve insight. Although extra funding is required for these sessions, the hope that is in the long run the outcome for the trainees will be favourable.


Using art to interpret clinical experience

Kelly Thresher (Wessex School of General Practice, Wessex Deanery, GP Education Unit, Mailpoint 10, Southampton University Hospital Trust, Tremona Road, Southampton SO16 6YD, United Kingdom) Samantha Scallan (Wessex School of General Practice, Wessex Deanery, UK, GP Education Unit, Southampton)

Background: The role of art in helping trainees to reflect on their learning and development is acknowledged, but poorly understood. An already over-crowded curriculum may emphasis the purely clinical nature of learning, and the opportunity to reflect on experience through other means may be limited. This innovative teaching session aimed to encourage foundation trainees to step outside the consulting room, and to reinterpret their clinical experiences through reflective writing about art.

Summary of work: A group of foundation trainees (n.5), their tutor (KT) and a researcher (SS) visited the Wellcome Gallery, London. Whilst there, trainees were encouraged to seek out works of art which resonated with a clinical encounter or experience, and to write a reflective piece about one. The group met again in a follow up focus group, during which they discussed their writing and its impact on them as trainees and doctors. Summary of results: The reflective writing of the group collectively demonstrated engagement with themes commensurate with deeper levels of learning, the feelings, assumptions, beliefs and values of clinical practice. Extracts will be presented to illustrate the findings


Conclusions: The strength of this session was that it was not a specific and focused supervised learning event, rather it offered the freedom for participants to link and construct their reflections on clinical practice as suited them at the time. The responsibility for learning was shared amongst all participants, and it opened up new areas for discussion and learning.


Failure to secure a training post in an applicant's first choice deanery as a risk factor for difficulties during training

Richard Crane (Wessex Postgraduate Deanery, School of General Practice, Southern House, Otterbourne,

Winchester SO21 2RU, United Kingdom)

Peter Haig (Wessex Postgraduate Deanery, School of General Practice, Otterbourne, United Kingdom) Samantha Scallan (Wessex Postgraduate Deanery, School of General Practice, Otterbourne, United Kingdom)

Background: Trainees in difficulty present an increasing challenge. Recent emphasis has shifted from remedial activity to early identification of those at risk, combined with proactive intervention. Low recruitment scores have been associated with increased risk of difficulties. We examined this group more closely to identify other risk factors.

Summary of work: We identified 39 trainees who scored poorly in the UK national GP recruitment process. It was immediately obvious that a large proportion of these trainees (28) had not chosen to train in Wessex, having come to the deanery through the clearing process or recruitment round two. We then compared their outcomes with the 11 low-scorers who had applied directly to Wessex.

Summary of results: Every trainee recruited via clearing fell into the cohort of 39. The mean recruitment scores of the clearing group were not significantly different to those of the low-scorers who applied directly to Wessex. Clearing recruits were four times less likely to finish their training after three years, twice as likely to receive a training extension and more likely to resign or be released from training.

Conclusions: Accepting a training post in a deanery other than those applied to is a risk factor for difficulties during training, independently of a low recruitment score. These trainees are more likely to resign or fail to complete training than a trainee who did apply to Wessex.

Take-home messages: Clearing recruits are a high risk group who should be considered for intervention early. Clearing recruits may be social isolated or commuting long distances and may benefit from additional pastoral support.


Structured e-Assisted Handover Improves Patient Safety: a Better Training, Better Care Project

Richard J B Ellis (Leighton Hospital, Emergency Care Division, Middlewich Road, Crewe CW1 4QJ, United Kingdom)

Daniel Monnery (University of Keele, Keele, United Kingdom)

Shirley Hammersley (Leighton Hospital, Emergency Care Division, Crewe, United Kingdom) Alistair Thomson (Leighton Hospital, Department of Pediatrics, Crewe, United Kingdom)

Background: Effective clinical handover is essential at all levels of patient care. Change to shift-work patterns has placed a greater emphasis on the continuity of clinical information. It is a key priority established by the World Health Organisation and Royal College of Physicians (RCP), but handover skills are rarely taught to undergraduates or postgraduates. Summary of work: At MCHT we introduced a structured handover, supported by validated training on task prioritisation, time management and effective handover with all trainees within the general medicine department. We simultaneously implemented an electronic handover system (Ascribe, UK) which captures all out of hours tasks and assists in allocating, tracking, and documenting completion of all tasks. We summarised task completion rates documented on the e-system. We assessed trainee attitudes to handover safety using the Safety Climate Questionnaire. Summary of results: All handovers are easily auditable with a named, accountable individual allocated to each task. Handover task completion rates improved from 30.4% before intervention to 90.1% (relative benefit 2.96, p<0.0001). Trainee attitudes towards handover safety have improved significantly (p=0.0054). Improved trainee confidence was reflected in increased capacity to manage their out-of-hours' workload. Conclusions: Formal, grade-specific handover training supplemented by e-assisted handover in a structured process has a positive impact on the rates of handover task completion. This reduces the risk patient deterioration being missed or important results not acted on.

Take-home messages: A structured handover supported by a formalised training program and assisted by electronic handover is managing, tracking and completing clinical tasks in an appropriate timescale.

9GG ePosters: Student Wellbeing

Location: North Hall, PCC


Sleep deprivation in Medical Students: Impact on Environment Academic Perception

Bruno Perotta (Evangelical Medical School of Parana, Department of Medicine, Al Julia da Costa, 1181 ap 41, R Mal Deodoro, 51 Sl 1707A, Curitiba 80430110, Brazil) Daniel Silvestre (School of Medicine of the University of Sao Paulo, Department of Pathology, Sao Paulo, Brazil) Munique Almeida (School of Medicine of the University of Sao Paulo, Center for Development of Medical Education, Sao Paulo)

Patricia Tempski (School of Medicine of the University of Sao Paulo, Center for Development of Medical Education, Sao Paulo, Brazil)

Milton A Martins (School of Medicine of the University of Sao Paulo, Department of Medicine and Center for Development of Medical Education, Sao Paulo, Brazil) Paulo SP Silveira (School of Medicine of the University of Sao Paulo, Department of Pathology, Sao Paulo, Brazil)

Background: Adequate sleep is necessary for well-being and is considered an indirect measure of quality of life. Summary of work: We compared Epworth sleepiness scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) with the Dundee Ready Education Environment Measure (DREEM). From 1,650 randomized students of 23 medical schools, was obtained 1,350 (81.8%) completed questionnaires. Data analysis was stratified in female and male students from first and second (group I), third and fourth (group II), and fifth and sixth (group III) undergraduate years of the Brazilian medical school. Summary of results: ESS showed that 46.5% of the students present excessive daytime sleepiness (pathologic score > 10). There was a greater proportion of females showing pathologic scores than males (chi-square test, p<0.001). PSQI showed that 63.7% had poor quality of sleep (score > 5) and no difference between females and males. There was also no difference among the course years. Comparison among DREEM domains and ESS or PSQI scores showed negative associations, meaning that the students' perception improves with decreased sleepiness.

Discussion: This study revealed that a large proportion of medical students have poor sleep quality which may influence or be influenced by several components in the educational environment. It is somewhat surprisingly that sleepiness does not increase with medical school years.

Conclusions: Excessive daytime sleepiness, mostly in females, and poor quality of sleep occur in high number of students. Students' perception of the educational environment decreases with increasing sleepiness. Take-home messages: It is a cause of concern that the lack of sleep of our students may lead to poor environment perception.



Psychological Support Group for Medical Students

Ana Cristina Kuhn Plestch Roncati (Anhembi Morumbi University, Medical School, Rua Aimbere, 909, ap 41, Sao Paulo 05018011, Brazil)

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