Автор неизвестен - Mededworld and amee 2013 conference connect - страница 13

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Conclusions: Clinical supervision, its goals and ways of delivery need to be more clearly defined. Clinical


supervisors need training in pedagogy and how to give feedback. As trainer training is practically non-existent in the Finnish psychiatry, our train the trainer program will be a pioneering step in developing specialist training in psychiatry in Finland.

Take-home messages: There is a real need to train the supervisors to ensure better learning outcomes of the trainees.


A Reading into the Profile of Trainees in Difficulty in Psychiatry

Yousreya Amin-Selim (Kent Surrey & Sussex Deanery in UK/Kent & Medway NHS & Social Care Partnership Trust, Psychiatry Training, Tunbridge Wells, Kent, United Kingdom)

Background: Supporting a trainee in difficulty can be extremely challenging. Hence the importance to study the types of difficulty trainees may experience. This article aims at identifying the types of difficulty in post graduate core trainees in psychiatry. The aim is to reflect on the findings in relation to the demographic of the cohort and training in psychiatry. Summary of work: The register for the trainees in difficulty over three years (from 2008 to 2011) is reviewed. A specially designed format is used to collect data in relation to the characteristics of the cohort, the types of difficulty and the outcomes. Summary of results: The majority of the trainees belong to ethnic minorities. Female trainees in difficulty outnumber male trainees. Twenty-two percent of the core trainees present with difficulty. The most common type of difficulty -more than two third- is related to educational challenges. In this group, more than half the trainees had difficulty to pass the exit exam, which is a clinical exam requiring the demonstration of observed skills and applied knowledge. Nearly one third failed to achieve the intended outcomes in psychotherapy training. Other types of problems involved sickness, lack of professionalism, probity issues and communication difficulties. Only half the trainees in difficulty progressed to high specialty training.

Conclusions: In psychiatry, communication skills and cultural aspects seem to play a major role in formative and summative training objectives. Attention to the needs of trainees belonging to different cultures and intended training outcomes for communication skills may help trainees in the foreseen difficulties. Early identification of difficulties beyond exam obstacles is needed.

Take-home message: Attention to communication skills, cultural difficulties; go beyond educational challenges (exams) to underlying difficulties; early identification of difficulties

2BB Posters: Preparation for Practice Location: South Hall, PCC


Differences in learning needs and priorities between medical students and junior doctors: implications for transition from medical school to the work environment

Selina Jayant Chavda (University College London Hospitals NHS Foundation Trust, Department of Clinical Haematology, Euston Road, London NW1 2BU, United Kingdom)

Rahul Kumar Mukherjee (King's College Hospital NHS Foundation Trust, Department of Cardiology, London, United Kingdom)

Background: Preparing medical students for their junior doctor roles is becoming integrated into curricula throughout the UK. Non-technical skills such as decision-making, initiative and time management have been proposed as important components of preparing for practice. We studied the learning needs and priorities of medical students and compared them to junior doctors to identify discrepancies and better inform curriculum development.

Summary of work: 36 medical students and junior doctors filled out a questionnaire describing the importance they placed on twelve different learning needs and if they felt adequately trained in them. These were rated on a 5-point Likert scale. Summary of results: Junior doctors felt that making a good referral, writing prescriptions accurately and working effectively within a MDT were their most important priorities (mean differences - 1.53, 1.1 and 1.07 respectively on 5-point Likert scale, p<0.001). In contrast, medical students felt that making a correct diagnosis based on history and examination was their most important priority (p<0.05). However, only 71% of junior doctors and 6% of medical students felt adequately trained in making a good referral. 83% of medical students and 29% of junior doctors also reported poor training in effective time management despite both groups agreeing on its importance. Conclusions: Medical students tended to prioritise acquisition of factual information and clinical skills over non-technical skills. Despite recognising the need for non-technical skills in their everyday practice, many junior doctors felt inadequately trained in performing them.

Take-home messages: Increasing awareness of non­technical skills amongst medical students may help transition to a junior doctor role and should be integrated into curricula.


Instigating and running a teaching course as a junior doctor

Tiffany Berrington (Salford Royal NHS Foundation Trust, ICU, Salford, United Kingdom)


Background: When starting work as an on call junior doctor many are faced with unfamiliar tasks and have anxieties surrounding patient assessments and management.

Summary of work: An interactive teaching course aimed at preparing final year medical students for working on call was instigated by a first year junior doctor at a large UK teaching hospital in the 2011/2012 academic year. The course received excellent feedback and was expanded in the 2012/2013 academic year. The nature of the teaching meant that it was best delivered by first year junior doctors. Therefore, in the 2012/2013 academic year, the original course designer, now a second year doctor, taught the course format to a group of first year doctors and supervised it's delivery to the final year medical students.

Summary of results: Following the teaching, medical students felt better prepared for starting work and thought that such teaching should be incorporated into the official medical school curriculum. The first year doctors gained valuable teaching experience, and a sense of satisfaction from knowing they had improved the knowledge and confidence of their juniors. The course designer benefitted also, in terms of both teaching and management skills. Conclusions: Teaching does not need to be delivered by those in official teaching roles to be of use, if a gap in the curriculum is seen, those with the appropriate knowledge and skills should fill it. Take-home messages: Setting up a teaching course as a junior doctor has many challenges but if well designed and executed it benefits all those involved and ultimately improves patient care.


A "Virtual Night Shift": Improving out of hours care through simulation

Christopher Howarth (Royal Bolton Hospital, Laboratory Medicine, Minerva Road, Farnworth, Bolton BL4 0JR, United Kingdom)

Paul Baker (The Royal Bolton Hospital, Complex Care, Bolton, United Kingdom)

Background: The provision of medical cover at night is an area of growing concern for patient safety. Current undergraduate courses provide inadequate guidance on the practicalities of working "on call". Summary of work: We developed and evaluated a 1 to 2 hour simulated session for senior medical students. The simulation takes a holistic approach to organizing tasks and solving problems during the course of a medical night-shift. This involves the integration of handover, prioritization, acute care, communication skills, and ethico-legal issues.

Summary of results: Preliminary feedback has been overwhelmingly positive. We will follow up the participants when they have commenced work to evaluate the lasting impact of this intervention. Conclusions: The key innovation of our programme is the integration of diverse tasks into one simulation rather than just considering each element in isolation.

This illustrates to learners how performance in one area impacts many others; encouraging a holistic approach to problem solving. If the long-term follow up reflects the initial results, this will support our theory that simulation can improve clinical decision making and ultimately patient safety. Other educators could use this work as a basis for the development or their own simulated sessions.

Take-home messages: The transition from student to practitioner currently presents new doctors with unfamiliar challenges at times when supervision is lacking and they are physically and mentally impaired by tiredness. Simulation may improve the safety of this transition by allowing learners to encounter similar challenges for the first time in a supervised and supportive environment.


Deconstructing the general medical ward rounds through simulation -"SimRounds"-A novel initiative for medical students designed to enhance clinical transitions and interprofessional collaboration

Ranjana Acharya (National Healthcare Group, General Internal Medicine, Singapore)

Kendra Millington Amico (Harvard Affiliated Emergency Medicine Residency Brigham & Women's Hospital/Massachusetts General Hospital, Emergency medicine, Boston, MA 02115, United States) Kumying Tham (National Healthcare Group, Emergency Medciine, Singapore)

Background: General Medicine ward rounds are fundamental to patient care and physician training and comprise a complex set of exercises within interdisciplinary teams. Engaging medical students is important yet challenging, as their learning transitions from classroom to bedside. They may become passive observers, especially if patient care is prioritized over student teaching. With SimRounds, we sought to increase students' comfort with ward rounds, enabling active learning and appreciation for inter-professional collaboration

Summary of work: In the simulation centre, ward rounds including handover ("huddle") between nurses and doctors (10 minutes), pre-rounds with standardized patients (one hour), and rounds with consultants (one hour) were simulated. Participants included 13 year medical students, 15 nursing staff, 2 consultants and 10 standardised patients.

Summary of results: Semi-standardized focus groups with participating consultants, medical students, nurses and nursing students were conducted. Discussion points centered on how simulation was helpful, achieved objectives, evaluation methods and areas for improvement. All participants concluded that SimRounds was overwhelmingly successful. Medical students indicated the experience provided stress-free wards introduction, cases met learning needs, and they appreciated "patient" feedback. Nurses found SimRounds a safe environment which built confidence in


speaking up, enhanced communication, and improved their understanding of doctors' expectations Conclusions: Simulated ward rounds has the potential to address many goals and objectives for different learners in healthcare. Although initially targeting medical students, all participants achieved new learning, especially pertaining to inter-professional collaboration.


A Medical School Capstone Course for Student and Curriculum Evaluation

Claudia Ranniger (George Washington University, Office of Interdisciplinary Medical Education, 900 23rd Street,

NW, Room 6200, Washington, DC 20037, United States)

Colleen Roche (George Washington University, Emergency Medicine, Washington, DC, United States)

Background: Graduating medical students often feel unprepared for the challenges and increasing autonomy of internship.

Summary of work: We provide a 4-week capstone course for senior medical students to practice basic clinical, diagnostic, and procedural skills needed to succeed in residency. The course is taught after students have selected their specialty, and includes core lectures, specialty-specific curriculum, electives and simulation sessions. The core lecture series provides practical information about common medical issues such as electrolyte disorders, allergic reactions, and shock. Students are placed in specialty-specific tracks based on their career choice - Internal Medicine, Emergency Medicine, Surgery, Obstetrics/Gynecology, Anesthesiology, Pediatrics, Radiology or Psychiatry. Track-specific skills session prepare students for clinical practice, for example PreOperative Evaluation (Anesthesiology), Ultrasonographic diagnosis of shock (Emergency Medicine), Mock (cadaveric) OR (Surgery), or Contrast Reactions (Radiology). Students may choose electives such as evidence-based medicine workshops, public health policy discussions, and lab-based review of clinical anatomy. Simulation workshops include common procedures skills, care of critically-ill patients, and informed consent. Educational methods include lectures, interactive internet-based tutorials, small group discussion, workshops, and simulation sessions. Summary of results: Student performance in this course has impacted the school's overall educational curriculum. A vascular access skills assessment triggered development of a vertically-integrated, benchmarked IV training curriculum. Inconsistent student performance in integrated critical care assessment has prompted changes in the school's cardiovascular curriculum. Conclusions: The capstone course lets students integrate knowledge and skills within their future specialty, and enables the medical school to assess clinical competence and obtain feedback on curricular effectiveness.


Residents who received training in medical school perform better in an OSCE handoff

Jennifer Stojan (University of Michigan, Internal Medicine and Pediatrics, Ann Arbor, United States) Jocelyn Schiller (University of Michigan, Pediatrics, Ann Arbor, United States)

James T. Fitzgerald (University of Michigan, Medical

Education, Ann Arbor, United States)

Patricia Mullan (University of Michigan, Medical

Education, Ann Arbor, United States)

Hilary Haftel (University of Michigan, Internal Medicine,

Pediatrics and Medical Education, Ann Arbor, United


Monica Lypson (University of Michigan, Internal Medicine, Graduate Med Education, 2600 Green Rd Ste 150B, Ann Arbor 48105, United States)

Background: Physician duty hour regulations have increased patient handoffs, yet there is little evidence that medical schools provide formal instruction on transferring patient care to another provider. This study assessed incoming postgraduate first-year (PGY-1) trainees' previous instruction and self-assessed abilities about handoffs and evaluated their performance on a structured simulated patient handoff. Summary of work: 173 incoming PGY-1 trainees at one large university-affiliated hospital completed a survey eliciting their prior training and self-assessed confidence in conducting handoffs. Their handoff performance on an Objective Structured Clinical Examination (OSCE) was also assessed. Independent t-tests compared OSCE performance of trainees who received handoff feedback during medical school; analysis of variance examined differences in performance based on prior handoff instruction and across levels of self-assessed abilities. Summary of results: 35% of trainees reported receiving instruction and 51% reported receiving feedback about their handoff performance in medical school. Trainees who reported receiving instruction or feedback had significantly higher confidence in their abilities (P<0.0001). Trainees with higher self-assessed skills and perceived preparedness performed better on the OSCE. Trainees who received instruction during medical school had higher performance scores, including content (P=0.0028), clinical judgment (P=0.0046), total (P=0.0012), and global performance scores (P<0.001). Those who received feedback in medical school had higher content (P=0.0414), total (P=0.0406) and global performance scores (P=0.0349).

Conclusions: This study provides evidence that trainees receiving handoff instruction or feedback during medical school are more confident and perform better on standardized performance assessments. Take-home messages: Given the patient safety implications, medical schools should incorporate a handoff curriculum prior to graduation.



Stand Clear - Allowing students to find their own way in resuscitation training

Val McDowall (University of Edinburgh, Centre for Medical Education, Clinical Skills Centre, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom)

Lorraine Close (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom)

Background: Recognising and subsequently managing an acutely unwell patient is a skill junior doctors are expected to be competent in by time of graduation in the UK. Despite this, acute care is an area in which new graduates feel under prepared. In order to acquire and develop this knowledge, undergraduate medical students need to learn these skills. They need to understand the importance of a structured approach, but perhaps more importantly they need the opportunity to put their learning into practice. Summary of work: Third year medical students within the University of Edinburgh receive teaching on Initial Assessment and Recognition of the acutely unwell patient. Previously this was taught as a staff led demonstration, with students then guided through practice. Student participation was limited as the sessions became didactic in nature. Students now work through a Computer Assisted Learning package (CAL) prior to their session and proceed to work through four patient scenarios with minimal staff intervention. Following on from this, they are expected to form an initial management plan, discuss differential diagnoses and triage their patient according to their findings. Discussions are held at the end of the session and any additional learning points are addressed. Summary of results: Results will be discussed during the conference.

Conclusions: Flipping the class room and moving towards a more student centred approach, allows students to develop a greater understanding of the importance of sick patient assessment. Take-home messages: Preparing junior doctors to manage critically unwell patients requires novel approaches to teaching.


Intern Preparation Seminar Changes Behaviour of Final Year Medical Students

Anna Ryan (Anna Ryan, University of Melbourne, Austin Hospital Clinical School, Studley Road, Heidelberg 3084, Australia)

Barbara Goss (University of Melbourne, Austin Hospital Clinical School, Heidelberg, Victoria, Australia) Richard O'Brien (University of Melbourne, Austin Hospital Clinical School, Heidelberg, Victoria, Australia) Kathryn Hill (University of Melbourne, Austin Hospital Clincial School, Heidelberg, Victoria, Australia)

Background: At commencement of their last 6 months of study, Australian medical students have applied for,

and been allocated their internship job positions. Most internship preparation occurs at the start of their Intern year, whilst sessions during their undergraduate study are infrequent and not aligned to the curricular goals. Summary of work: A new seminar introduced to the Austin/Northern Clinical School was designed to give final year students a realistic expectation of Internship, and to direct their learning in their final semester. Students were contacted for anonymous feedback directly after the seminar, and at the start and completion of Internship. Responses were gathered on the influence & usefulness of the seminar, and whether it had an impact on their confidence as an Intern. Summary of results: 81% of the first cohort & 98% of the second cohort reported that the seminar would change their behaviour for the rest of the semester. At the start of their Internship, 81% of the first cohort & 88% of the second cohort rated the overall usefulness of the seminar as excellent or above average. Conclusions: After the seminar, students became more involved in their allocated units and were motivated to complete non-assessed tasks of relevance to their pending internship. During their work as Interns, they recalled this seminar being useful and reported that this seminar improved their confidence on commencing Internship.

Take-home messages: The Intern Preparation Seminar provides significant motivation for learning, results in behaviour change, and appears to result in better preparation for internship. Tying final year medical student learning events to their forthcoming Internship provides significant motivation for learning.


Enhancing readiness for postgraduate education: a baseline survey for a family medicine residency program

Maria Palacios (University of Calgary, Family Medicine, 260 Scenic Glen Place NW, Calgary, Alberta T3L 1K2, Canada)

Doug Archibald (University of Ottawa, Family Medicine, Ottawa, Canada)

Laura McEwen (Queens University, Family Medicine, Kingston, Canada)

Steve Slade (Association of Faculties of Medicine of Canada (AFMC), Ottawa, Canada) Shelley Ross (University of Alberta, Family Medicine, Edmonton, Canada)

Ivy Oandasan (College of Family Physicians of Canada; University of Toronto, Family Medicine, Toronto, Canada)

Background: Understanding what learning experiences students have had prior to residency is important for competency based curriculum planners. To be successful, having a baseline understanding of the specialty will enable learners to attain expected outcomes.

Summary of work: In 2012, a pilot study for entry level family medicine residents was conducted gaining understanding of their attitudes about the discipline,


their exposure to the discipline while in medical school and their intentions to practice domains of family medicine in future. The first of a 3 part longitudinal survey was administered to six family medicine departments across the country.

Summary of results: 69.8% response rate (317 learners). Respondents included graduates from every medical school in Canada. The residency programs included one Francophone, a distributed model including rural sites, a large city program and a couple mid-sized. 58% agreed/strongly agreed that they had extensive exposure to family medicine in medical school. 50% had no exposure/ limited exposure to palliative care, 10% had no exposure/minimal exposure to chronic disease management, and 24% had no exposure/limited exposure to office based procedures. Conclusions: Ensuring better transitions from undergraduate education to post-graduate education has been identified as a key FMEC-PG Project recommendation. It is important for undergraduate and postgraduate education leaders to look towards what is being taught in medical school in order to discern ways to enhance readiness for postgraduate education. This requires all specialties to look at the exposure being provided to medical students in key content domains forging a dialog with medical schools about how to ensure key content is taught and indeed competencies have been attained.


Programmed for Success: Program Director's Perspectives on Optimal Medical Student Experiences

Kathleen Watson (University of Minnesota Medical School, Office of Medical Education, Minneapolis, Minnesota, United States)

Majka Woods (University of Minnesota Medical School, Office of Medical Education, 420 Delaware St SE MMC 293, Minneapolis, MN 55410, United States)

Background: Undergraduate medical education is focused on providing the best possible educational experience to create successful and productive interns. However, little has been written about program directors perceptions of the early experiences, academic and non-academic, the perceived influence on the interns' performance in later years, and how this information could be used in curricular reform. Summary of work: Program Directors from the University of Minnesota Medical School participated in focus groups modeled on a series of open-ended questions focused on eliciting a conversation around the program directors perspectives of optimal experiences for medical students.

Summary of results: We found that all of the program directors who participated defined the exceptional intern as one who demonstrated academic proficiency and as well as sophisticated habits of professionalism, teamwork, communications, and critical thinking consistently throughout their time as a first year resident. These qualities were highly valued, when

apparent from their medical school and previous educational experiences.

Conclusions: The themes from the focus groups have significant implications for curricular development, assessment, advising, and faculty development in both the medical student and intern environments. The implications are complex and long reaching. Take-home messages: It is important to understand the hidden connections between early medical education experiences and success in intern years. The tacit areas are in greatest need of understanding and emphasis. With new accreditation standards and practices it is imperative that students become interns that are a value added and not a burden to the system.


Does mentoring increase confidence of medical students?

Ruth Jones (Gartnavel General Hospital, Medicine, 1053 Great Western Road, Glasgow G12 0YN, United Kingdom)

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