Автор неизвестен - Mededworld and amee 2013 conference connect - страница 128

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learning as a surgical trainee. Review of relevant literature confirms the commonalities between the two fields, and suggests training techniques which can be applied effectively to the learning of surgical trainees who aspire to become masters of their field. Summary of work: A comprehensive PubMed literature search and review articles relevant to skill learning in sport and surgery and study of elite performers in each field was undertaken.

Summary of results: Analysis of the literature reveals there are clear neurophysiological, motor, and behavioural attributes shared by elite sportsmen and master surgeons. There is evidence that novel sport training techniques which harness these traits can be used to effectively teach surgical skills. Conclusions: Masters of sport and surgery demonstrate clearly identifiable shared traits in each domain required for performance of their particular skill. Sports science has developed new coaching techniques to accelerate learning of these skills, and these have been demonstrated to have crossover applicability to surgical


Take-home messages: Learning and mastery of surgical skills can be taught effectively using sports science principles.


Enhancing surgical skills training through metacognition

Daniel Cocker (Imperial College, Surgery and Cancer, St Mary's Campus, Praed Street, London W2 1NY, United Kingdom)

Stella Mavroveli (Imperial College, Surgery and Cancer, London, United Kingdom)

Daniel Leff (Imperial College, Surgery and Cancer, London, United Kingdom)

George Hanna (Imperial College, Surgery and Cancer, London, United Kingdom)

Background: Surgical training opportunities in the UK have been reduced by the European Working Time Directive, Modernising Medical Careers, and increasing concerns regarding patient safety. Simulation has gained popularity as a method to teach in a safe and structured environment. This study was conducted to examine whether good learners used metacognitive learning strategies, and whether encouraging the metacognitive learning strategies were applicable to surgical skills training.

Summary of work: Ten semi-structured interviews were conducted with Professors of Surgery, Surgical Educators and members of the Council of the Royal College of Surgeons of England. Interviews included questions on good learning traits, tried and trusted teaching techniques, and the suitability of the metacognitive learning strategies when encouraged in surgical trainees, and, in particular, slow learners. The interviews were analysed by two independent assessors using NVivo.

Summary of results: All participants agreed that good surgical learners applied metacognitive learning


strategies. In the context of experiential learning and a close relationship between trainer and trainee, expert demonstration, mental imagery, planning and goal-setting and reflection were highlighted as key elements of successful learning in the field of surgery. Setting of learning goals and rigorous reflection over longer term attachments were traits trainers attempted to foster in trainees. Participants also felt that encouraging these metacognitive learning strategies would enhance learning for trainees, and especially slower learners. Conclusions: From these interviews there seem to be a correlation between positive learning traits in high quality surgical trainees and metacognitive learning strategies. With reduced exposure in the OT, trainees will benefit from metacognitive teaching and learning strategies.

Take-home messages: 1. Metacognitive learning strategies seem to correlate closely with the learning strategies employed by top-level surgical trainees. 2. The use of these learning strategies may help surgical skill training in the OR and in the simulation lab. 3. Further work in this field is warranted.


"As one gradually gains experience, one loses one's youth": The relationship between academic performance and level at entry to an online Surgical Sciences programme

Paula JW Smith (University of Edinburgh, Clinical Surgery, School of Clinical Sciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom) Stephen J Wigmore (University of Edinburgh, Clinical Surgery, Edinburgh, United Kingdom) Peter Lamb (University of Edinburgh, Clinical Surgery, Edinburgh, United Kingdom)

Anna Paisley (University of Edinburgh, Clinical Surgery,

Edinburgh, United Kingdom)

Malcolm Wright (University of Edinburgh, Clinical

Surgery, Edinburgh, United Kingdom)

O James Garden (University of Edinburgh, Clinical

Surgery, Edinburgh, United Kingdom)

Background: In 2007, a three-year online part-time Master of Surgical Sciences (MSc)/Edinburgh Surgical Sciences Qualification (ESSQ) degree programme was launched, utilising an innovative platform which included virtual case scenarios based on surgical conditions within the Membership Examination of the Royal Colleges of Surgeons (MRCS) curriculum. The influence of surgical trainees' level of work experience at entry to the ESSQ programme on academic performance was examined. Summary of work: Academic assessment data and information on training post held were sourced from student records relating to academic years 2007/08 to 2011/12 of the ESSQ programme at the University of Edinburgh/Royal College of Surgeons of Edinburgh. Summary of results: 424 surgical trainees from 38 countries were admitted to the ESSQ programme over the five-year period (2007-11). 212 of the 279 (76%) students whose level of work experience was known,

entered as foundation doctors (interns) within two years of graduation from medical school. The remaining 67 were in a surgical training (ST) programme (ST1 = 54; ST2 = 11; and ST3 = 2). There was no significant influence of level of training on entering the ESSQ programme and end-of-year results (Year 1: P=0.26, n=279; Year 2: P=0.12, n=188; and Year 3: P=0.48, n=117; one-way ANOVA).

Conclusions: Each student within a particular level of training can have a very different profile of skills and experience compared to others at the same level, accounting for the lack of a relationship between performance and level at entry to the ESSQ programme. Take-home messages: Greater experience held by more advanced trainees may be offset by a longer period away from formal academic study, conferring an advantage to recent graduates who are more accustomed to intensive study


Observing the 'surgeon trainee teaching dynamic' in cataract phacoemulsification

Christine Fessey (St George's University Medical School, Centre for Medical Healthcare Education, Cranmer Road, London SW17 ORE, United Kingdom)

Background: Trainee surgeons were until recently at the mercy of willing but often idiosyncratic teaching in the operating department. This paper reports a small UK observation study exploring surgical teaching in ophthalmology and the experiences of ten trainees prior to introduction of the postgraduate curricula. Summary of work: The teaching dynamic between attending consultant surgeon and trainee provides the focus. Typically the attending surgeon provided brief spoken feedback on conclusion of the case and this never exceeded a few sentences relating required improvements in technique, habits, instrument usage and the trainees' hands and posture. The observer was able to create a heuristic matrix of key feedback and use this to debrief the trainee immediately after the case (Fessey 2002: Patterson et al 2003). Summary of results: Teaching interventions were categorised by typing surgeon teachers and trainees' responses in a post event debrief. Three types of surgeon teacher were identified and their qualities distinguished; the natural teacher who set up a calm climate talking quietly to the trainee throughout a selected phase of the case; the charismatic quick tempered teacher who was at once inspiring and unpredictable and who resorted to hubris, humiliation or blame; and finally the cautious and reluctant teacher who trusted only senior trainees. Conclusions: Trainees' responses to teacher types are discussed and the impact of the struggle to operate and progress.

Take-home messages: Ensuring surgeon teachers are trained, observed and given practice feedback.



The joint project 'Practical clinical competence'

Miriam Ruesseler (Goethe University Hospital, Department of Trauma Surgery, Theodor Stern Kai 7, Frankfurt 60590, Germany)

Faidra Kalozoumi-Paizi (Goethe University Hospital,

Department of Trauma Surgery, Frankfurt, Germany)

Alexander Damankis (Phillips University, Department of

Surgery, Marburg, Germany)

Holger Hoffmann (Phillips University, Marburg,


Iris Schleicher (Justus Liebig University, Department of

Surgery, Giessen, Germany)

Joachim Kreuder (Justus Liebig University, Giessen,


Background: Undergraduate training competes with patient care and experimental research, mostly to the disadvantage of the training of clinical skills and competencies. Surgery with its various skills important even for beginners is predestined to analyse and implement training concepts for practical clinical competence. The present work aims to improve undergraduate training of practical skills in surgery in a nationwide network.

Summary of work: The joint research project was conceptualized by the medical faculties of Frankfurt, Gie(5en and Marburg (Germany) in collaboration with the German Society of Surgery (DGCH), the German Society of Medical Education. The project is funded by the German Federal Ministry of Education and Research with almost two million Euro for a period of 5 years (Begin: April 2012). It consists of a curriculum development part with analysis, development and integration of teaching and assessment methods, a content part, analysing and developing online teaching contents, which are made available for both teachers and students as mobile learning tool. Third, qualification programmes for physicians are implemented in order to improve both undergraduate education and attractiveness of educational research. Summary of results: A curriculum map aroused for all three surgical curricula allowing a detailed analysis regarding existing learning objectives and teaching methods. An ontology for the nationwide learning objectives was developed, linked to online teaching contents (e.g. videos). A checklist evaluating these contents was developed. Conclusions: The present work presents a joint curriculum and faculty development project of three medical faculties with nationwide partners exemplary for the surgical training.

10J Short Communications: Patient

Safety 2

Location: Club E, PCC


Improving leadership, teamwork and communication skills using an integrated, simulation-based patient safety curriculum

Robin Hemphill (Veterans Health Administration, National Center for Patient Safety, 24 Frank Lloyd Wright Drive, Lobby M, Ann Arbor 48105, United States) Douglas Paull (Veterans Health Administration, National Center for Patient Safety, Ann Arbor, United States) Linda Williams (Veterans Health Administration, National Center for Patient Safety, Ann Arbor, United


Background: Communication breakdown and leadership failure are among the most common root causes of adverse events. The solution, in part, requires building a patient safety curriculum that fosters faculty development; teaches teamwork and communication skills to residents; and cultivates leadership. Summary of work: The curriculum, based on crew resource management principles, was delivered via workshops and video conferences. Simulation-based experiential training allowing learners to apply new knowledge was a prominent component of the intervention. Quantitative data included pre and post-intervention surveys and observational data from simulations measuring leadership, teamwork and communication confidence and skills. Summary of results: Survey data revealed that following training, residents were more confident (pre vs. post course, Likert scale 1 to 5, n = 156 surveys, p < 0.001) in establishing a common, shared understanding of a patient's condition (3.8 vs. 4.7); using specific communication strategies, e.g. readback (3.7 vs. 4.5); and utilizing a team-approach to deal with situations (3.8 vs. 4.5). Observational data demonstrated improvement (first vs. last simulation, scale 0 to 10, n = 124 observations, p < 0.001) in teamwork (6.1 vs. 7.1), communication (6.0 vs. 7.0), and leadership (6.1 vs. 7.6). Conclusions: A standardized, simulation-based patient safety curriculum for residents was associated with demonstrable improvements in confidence and skills in teamwork, communication, and leadership among participants.

Take-home messages: Healthcare organizations can close the gap in the patient safety leadership, teamwork and communication skills necessary to reduce preventable adverse events by implementing a simulation-based patient safety curriculum into residency training.



Quality Improvement projects are an effective method of educating junior doctors in patient safety

Benjamin Plumb (North Bristol NHS Trust, Postgraduate Medical Education Department, Learning & Research Building, Southmead Hospital, Bristol BS10 5NB, United Kingdom)

Katherine Finucane (North Bristol NHS Trust, Postgraduate Medical Education Department, Bristol, United Kingdom)

Background: The science of healthcare improvement is new and emerging into medical curricula. There is no consensus on how to deliver the knowledge, skills and most importantly attitudes which allow junior doctors to become active in patient safety. However, it has been recognised that they are a fantastic resource for quality improvement work and the recent Francis Report in the UK highlighted the importance of empowering this group of health professionals to speak up and act. Summary of work: We have developed a programme which delivers the Institute for Healthcare Improvement 'model for change' theory over the Foundation 1 year as the trainees apply it to a project on their ward. We provide faculty and experts to drive their projects forward, learning the skills in teams as they put plans into action. We have surveyed their attitudes to quality improvement and patient safety before and after. Summary of results: Our questionnaire demonstrates an increase in trainees' knowledge which accompanies a shift in attitudes towards believing that they understand the importance of patient safety and know how to drive forward a change. Following our programme, 95% of trainees feel empowered to act to improve patient safety.

Conclusions: Educating junior doctors about quality improvement and delivering our programme which combines theory, practical advice and skills to develop their projects has led to a positive shift in attitudes towards patient safety and the model for change. Take-home messages: Delivering an adaptable, practical and example-based approach to teaching quality improvement methodology improves junior doctors' knowledge, skills and attitudes towards patient safety.


Distraction impairs left-right discrimination ability in medical students - is it time for non-technical skills training as part of a wider patient safety curriculum?

John McKinley (Regional Neurosciences Unit, Neurology, 274 Grosvenor Road, Belfast BT12 6BA, Ireland) Martin Dempster (Queen's University Belfast, Psychology, Belfast, Ireland)

Gerard Gormley (Queen's University Belfast, Centre for Medical Education, Belfast, Ireland)

Background: Clinicians are aware of the impact of distraction on performance. Human factors and non­technical skills training have been instrumental in improving aviation safety and given that doctors work in a complex, unpredictable and equally high stakes environment, we should learn from innovations of aviation. Basic left-right errors leading to wrong site surgery can have devastating consequences for patients. In medical students, using a neuropsychological paradigm we elucidate the impact of different methods of distraction on left-right discrimination ability, an important non-technical skill or 'human factor'. Summary of work: Psychometric study measuring left-right discrimination ability in medical students using validated Bergen left-right discrimination test under auditory (continuous ambient ward noise), cognitive (interruption with clinical cognitive task) and combined auditory and cognitive distraction against controls. Summary of results: 234 students were recruited. Isolated cognitive distraction had the greatest negative impact on performance in the left-right psychometric test (p<0.001, partial s2=0.17). Isolated auditory distraction had a significant negative effect (p=0.008, partial s2 =0.05). Combined auditory and cognitive distraction did not have any significant effect beyond that of cognitive distraction alone. Conclusions: Distraction has a significant impact on performance in this key cognitive function. Historically medical curricula have focused on technical skills acquisition. High stakes industries such as aviation have elucidated the need to acquire non-technical skills to maintain safety and this study highlights the need for a human factors and wider patient safety curriculum and assessment strategy as part of undergraduate and postgraduate training if catastrophes such as wrong site surgery are to be avoided.

Take-home messages: Distraction impairs left-right discrimination.


Teaching medical students about human factors in patient safety using the WHO surgical safety checklist

Abhilasha Patel (Clinical Sciences Research Laboratories,

Clinical Sciences Building, University Hospitals of

Coventry and Warwickshire Trust, Clifford Bridge Road,

Coventry CV2 2DX, United Kingdom)

Nishit Patel (Bernays and Whitehouse Consulting

Partnership, Shirley Medical Practice, Solihull, United


Lucy Ambrose (Keele Medical School, Keele, United Kingdom)

Rajiv Nair (George Eliot Hospitals NHS Trust, Department of undergraduate education, Nuneaton, United Kingdom)

Vinod Patel (Warwick Medical School, Coventry, United Kingdom)

Background: The WHO Surgical Safety Checklist (SSC) has reduced errors in the operating room. Our objective was to design a tutorial, using the SSC, to illustrate a


human factors approach to patient safety and evaluate its impact on knowledge/skills/attitudes. Summary of work: The SuTURES (SUrgical Tutorial Using Realistic Events in patient Safety) tutorial contains four stations on aspects of patient safety and a group simulation exercise using the SSC. Objective assessment followed by immediate feedback drives further learning. Forty 3rd year medical students participated. Attitudes were evaluated using the APSQ3 and knowledge/skills acquisition through self-reported confidence (Likert) in key areas. Students paired t-test and ANOVA were used for statistical analysis (SPSS Version 18). Summary of results: Attitudes, knowledge and skills as assessed by mean pre and post tutorial scores (±SD) improved: [Attitudes:123(±10) vs 137(±10.3),p<0.001], [Knowledge:38(±9.3) vs 58(±6.6),p<0.001], [Skills:30(±7.1) vs 47(±4.7),p<0.001]. Most significant areas included error reporting (12.1 vs 16.7, p<0.001), team working (11.6 vs 12.1, p=0.009) and importance of patient safety (16.4 vs 18.2, p<0.001). Students scored significantly poorly on the error reporting station (mean score 20/40, p<0.001).

Conclusions: The SuTURES tutorial design appears effective at introducing key concepts in patient safety to undergraduate medical students. Furthermore, it provides assessments on core aspects of clinical practice that reflect the responsibilities of junior doctors. Take-home messages: Simulation using the SSC enables medical students to discuss near misses and adverse events in a non-judgemental, productive manner and equips them with the skills necessary to deliver patient centred care that is safe.


'Stuck in the Moment'; reflections on acute care simulation through Significant Event Analysis

Janet Skinner (University of Edinburgh, Centre for Medical Education, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom) Nikki Maran (NHS Lothian, Patient Safety, Edinburgh, United Kingdom)

Background: Significant event analysis (SEA) is a widely used patient safety tool to identify and learn from errors within a healthcare system. SEA can also be used as an individual educational tool to promote reflection on and learning from such events. The aim of this qualitative study is to explore the content of SEA forms submitted following a simulation event. Summary of work: Final year medical students participated in an acute care simulation session. Each scenario was followed by an in-depth debrief and subsequently students were asked to submit a structured SEA form by email relating to an 'event' that had taken place during the day. A grounded theory approach was taken to thematic analysis of the content of the SEA forms.

Summary of results: 102 SEA forms were submitted (48% of students). The two overarching themes to emerge from the forms were that of 'managing uncertainty' and 'taking effective action'. Subthemes

were arranged into a framework that helps to describe students' perceptions of their performance and difficulties in acute care situations. Conclusions: Students described difficulties in calling for help, making sense of the diagnosis, applying the rules and transferring knowledge into practice as well as non­technical skills such as situational awareness. Take-home messages: The content of the SEAs reveal recurring areas of acute care that students find difficult. More experience of acute care simulation is needed at an undergraduate level to help students address these difficulties.


Assessing the impact of a patient safety course on medical students' attitudes

Ilya Shekhter (University of Miami - Jackson Memorial Hospital, Center for Patient Safety, 4107 N 50th Ave, Hollywood 33021, United States) Kaitlyn Ferreri (University of Miami - Jackson Memorial Hospital, Center for Patient Safety, Miami, United States) Jill S Sanko (University of Miami, School of Nursing and Health Sciences, Coral Gables, United States) David J Birnbach (University of Miami - Jackson Memorial Hospital, Center for Patient Safety, Miami,

United States)

Background: At AMEE 2011, we described a course that introduces incoming third-year medical students to the subject of patient safety, focuses their attention on teamwork and communication, and creates awareness of patient safe practices which will positively impact their performance as clinicians (Shekhter et al 2012). To measure the impact of the course, we assessed the students' attitudes towards patient safety using a validated survey.

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