Автор неизвестен - Mededworld and amee 2013 conference connect - страница 131

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Robbie Foy (University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom) Tracey Farragher (University of Leeds, Leeds Institute of Health Sciences, Leeds, United Kingdom)

Background: There are known, important variations in the quality of primary health care. A range of approaches are used in efforts to reduce variations and improve quality (e.g. clinical audit, financial incentives). Less attention has been paid to whether participation in undergraduate and postgraduate medical education may have an indirect role in improving quality. Is there an association between education and quality of care? What mechanisms may explain the association? Summary of work: We will present findings from an expert consensus panel of primary care educators to examine the relationship between routinely available quality indicators and factors relating to practice participation in education. Panellists will independently rank indicators for quality of care and education involvement to define the key measures and help identify other predictors of quality of clinical care. Summary of results: We will present the initial results of statistical analyses applied to the data sources identified, and the reflections of the expert consensus panel and lay advisors as to the plausibility of relationships identified and possible causative mechanisms. From these initial results a model will be developed to explain any associations between educational involvement and quality of clinical care whilst accounting for other predictors of quality using latent variable modelling techniques. Conclusions: As healthcare provision changes healthcare commissioners and providers may demand convincing evidence of the likely benefits of participation in education.

Take-home messages: There are known variations in clinical quality in primary care settings. Participation in education may indirectly help improve care quality. Associations and possible mechanisms for these will be presented.


Standards for clinical teaching and how well they are met in one English region

Nisha Dogra (University of Leicester, School of Psychology, Greenwood Institute for Child Health, Westcotes Drive, Leicester LE3 3TP, United Kingdom) Robert Norman (University of Leicester, Department of Medical and Social Care Education, Leicester, United Kingdom)

Background: Standards for clinical teachers, consistent with the AMEE charter for medical teachers in the key areas of the educational process (preparation, delivery, teacher conduct and student management and; on development and appraisal) were drafted and piloted. They were found to be acceptable to medical teachers and students. As part of a wider regional study to establish the levels of teaching undertaken by clinical

staff, we also examined how many were meeting the standards outlined in the above document. Summary of work: A study specific on-line survey was designed and administered in Spring 2012. The standards were presented as statements and respondents asked, using a Likert Scale, if they were doing the activity defined as part of their teaching practice. Data was analysed using SPSS 20. Summary of results: The survey was completed by 518 consultants (25.8 % response rate). There was between 23 and 95% agreement by respondents that the various standards outlined were being met. Just over three quarters agreed that they prepared effectively; around 95% agreed with statements regarding receipt of feedback from peers but just under a third were peer observed in teaching practice. Most respondents indicated teaching was not adequately resourced and attracted variable support.

Conclusions: Respondents indicated that they were meeting most of the standards, although this was not corroborated. This indicates that the standards may be usable for appraisal purposes to support clinical staff contribution to teaching. Take-home messages: The standards could help improve resources and support for clinical teaching and teachers.


Does teaching make you a better physician?

Jocelyn Lockyer (University of Calgary, Community Health Sciences, 3380 Hospital Drive NW, TRW Building, Calgary T2N 4Z6, Canada)

Claudio Violato (University of Calgary, Community

Health Sciences, Calgary, Canada)

TZU Lee (University of Alberta, Medicine, Edmonton,


Sonia Faremo (University of Calgary, Continuing Medical Education and Professional Development, Calgary, Canada)

Carol Hodgson (University of Alberta, Medical Education, Edmonton, Canada)

Bruce Fisher (University of Alberta, Medicine, Edmonton, Canada)

Background: To examine whether physician involvement in teaching activities is associated with level of clinical performance.

Summary of work: This study drew on performance data from a multisource feedback (MSF) dataset from medical colleagues, co-workers, and patients for family physicians; medical specialists (e.g. internal medicine, pediatrics, and psychiatry and their subspecialties); and surgeons. MSF data were examined in relation to information about physician teaching activities including time spent teaching in patient care and in the classroom, and academic appointment information. We examined between group differences employing multivariate analysis of variance (one and two way MANOVAs) with MSF total instrument mean and MSF instrument subscale mean performance scores and the teaching and appointment data.


Summary of results: Data from 1,831 family physicians, 1,510 medical specialists and 542 surgeons were available for analysis. Higher clinical performance scores were associated with having an academic appointment, and with more time spent teaching in patient care and in the classroom. This was evident for the data from medical colleagues and co-workers, less so for patients. It held across all specialty groups, albeit, with some differences.

Conclusions: This study provides evidence of the association between involvement in teaching activities and higher levels of clinical performance. These results may support revalidation decisions that award study credit for teaching and enable Faculties of Medicine to highlight the importance of teaching to potential recruits and the maintenance of a clinical practice by teachers.

Take-home messages: Teaching activities may protect clinical skills and result in better performance. Conversely, more skilled physicians may be attracted to teaching roles.


Development of a web-based multisource-feedback tool for teachers

JME van Bruggen (University Medical Center Utrecht, Center for Research and Development of Education, Huispost HB4.05. PO Box 85500, Utrecht 3508GA, Netherlands)

GJ Bok (University of Utrecht, Faculty of Veterinary

Medicine, Utrecht, Netherlands)

Th J ten Cate (University Medical Center Utrecht, Center

for Research and Development of Education, Utrecht,


Background: Competent teachers are indispensable in obtaining high quality education. Feedback plays a crucial role in encouraging teachers to think about their performance and ways of improving it. Single evaluation sources, like student evaluations, provide valuable insights, but by using multiple sources a broader picture on teaching capacities could be formed. Summary of work: University Medical Center Utrecht (UMCU) developed a web-based multisource feedback (MSF) instrument to collect feedback from different sources. Eleven tasks teachers can have in medical education are predefined in the tool. For each of those tasks five key questions were defined and linked to the competencies of communication, organisation, collaboration, professional expertise, and teaching skills. The tool was presented to and discussed on with 40 experienced teachers.

Summary of results: Teachers reported a high face validity of the tool. It was derived from, and promises to be as user friendly and effective as the UMCU-developed MSF tool for residents, used since 2008 (Ten Cate & Sargeant, 2011). The collected and aggregated multisource feedback on teaching was estimated to be very valuable. Teachers indicated that the information leads to enhanced reflection and self-directed learning.

Conclusions: The web-based MSF-teaching tool is designed to provide an overview of teacher performance and to foster reflective behaviour and self-directed learning. The tool was found useful to collect feedback from a variety of sources on different teaching tasks.

Take-home messages: Collecting multisource feedback provides teachers with information on their teaching skills and stimulates reflective behaviour and self-directed learning.


Tutoring medical students during early clinical training. Recognition of relevance of the teacher's facilitator role

Isabel Leiva (Pontificia Universidad Catolica de Chile, Departamento de Enfermedades Respiratorias, Facultad de Medicina, Marcoleta 350 Primer Piso, Santiago

8330033, Chile))

Marcela Bitran (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Facultad de Medicina, Santiago, Chile)

Denisse Zuniga (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Facultad de Medicina, Santiago, Chile)

Alemka Tomicic (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Facultad de Medicina, Santiago, Chile)

Maribel Calderon (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Facultad de Medicina, Santiago, Chile)

Background: Tutoring medical students require a variety of competencies and attributes. While the information provider role is important in early years of medical education and the model role fundamental in later years of clinical training, it is not clear which role is the most important to be a good clinical tutor in students' early clinical training.

Summary of work: To describe perceptions of clinical tutors about teacher's roles in the early clinical training, eight clinical tutors were interviewed. These interviews were analyzed using Grounded Theory. Summary of results: Clinical tutors identified four roles, which facilitate learning teaching in early clinical training: information provider, role model, facilitator and evaluator. The facilitator role was the most often mentioned, and includes, according clinical tutors, activities such as selection of patients to be interviewed by students, planning activities for students, giving them autonomy, feedback and support in the maturation of knowledge and skills, as well as motivating them, amongst others.

Conclusions: Clinical tutors recognized the facilitator role as particularly important in early clinical training of medical students. Most of the components of this role were identified as consistent with the student-centred educational approach.

Take-home messages: In student-centred education, facilitator role should be considered as a desirable area

of expertise to be developed when tutoring in early clinical training.

Funded by grant FONDECYT 1120534

10O Workshop: Introducing a practical guide to sequential testing: Realising educational and economic benefits

Location: Meeting Room 3.5, PCC

Richard Fuller (School of Medicine, University of Leeds, Leeds Institute of Medical Education, Worsley Medical & Dental Building, Leeds LS2 9JT, United Kingdom) Godfrey Pell (School of Medicine, University of Leeds, Leeds Institute of Medical Education, Leeds, United Kingdom)

Matthew Homer (School of Medicine, University of Leeds, Leeds Institute of Medical Education, Leeds, United Kingdom)

Background: Institutions have conflicting pressures of quality, feasibility and cost in the assessment of students. Students desire fair assessment processes ideally completed by all in a single academic year. This usually takes the format of assessment of the whole student cohort, followed by a period of remediation and retesting for those who underperform. However, underperforming candidates are not a homogenous group and considerable difficulty persists in accurately identifying and profiling these 'at risk' students. Emergent work also reveals that traditional models of test-remediate-rest may not lead to sustained long term improvement in performance for these students, raising major implications in assessment policy for educational institutions (Pell et al 2009; Hauer et al 2009). Intended outcomes: Participants will explore theoretical and practical applications of sequential testing methodology, and gain confidence in practical approaches to managing cost-benefit analyses and quality issues in assessment policy. The workshop will conclude with a 'toolkit' to help participants in implementing 'take home lessons' in their own institutions

Structure of workshop: This interactive workshop will overview existing literature in this area, and the impact on assessment strategies and methodologies for underperforming students vzv. competent students. The development of sequential test methodologies, based on regression towards the mean phenomena (Bland & Altman, 1994) will explore a way of meeting this challenge

Who should attend: This workshop has particular significance for those responsible for the design and delivery performance based assessment Level: Intermediate

10P Workshop: FAIRness and teaching on the clinical placement

Location: Meeting Room 4.1, PCC

Philip Chan (University of Sheffield, Medical School, Beech Hill Road, Sheffield S10 2RX, United Kingdom)

Background: Student learning on clinical attachments is highly variable, and does not usually take into account the students' learning needs. Teaching traditionally takes the form of a bedside interrogation, or, as groups increase in size, a classroom presentation. Students' own work and performance and not often scrutinised, and opportunities for improvement therefore pass by unused. The clinical attachment faces many challenges; including increased student numbers, increased clinical specialisation and lack of "general" clinical experience, changing roles, work patterns and attitudes of hospital junior staff and consultant teachers, and increasing expectations of students. Over many years, we have evolved a clinical attachment based on the principles of FAIRness (Harden); which are feedback, active learning, individualisation and relevance. This model has some potential to address current shortcomings and future challenges to the clinical placement as a learning experience.

Intended outcomes: This workshop is intended to encourage reflections and exchange ideas on the current shortcomings and future challenges of the clinical placement as a learning experience; to share innovative approaches to problems with clinical teaching and to consider a model of improvement, based on the underlying concept of FAIRness. Structure of workshop: The workshop is presented largely by student facilitators, who use real clinical work examples to re-create the actual learning sessions that are used in our model.

Who should attend: It may be of interest to students, clinical educators, full time clinical staff with an interest in student education, curriculum planners, administrative staff with responsibility for clinical placements, and quality assurance professionals. 10Q Workshop: Teaching and learning clinical reasoning in everyday practice

Location: Meeting Room 4.2, PCC

Ralph Pinnock (James Cook University, Child and

Adolescent Health, Clinical School, The Townsville

Hospital, Townsville 4811, Australia)

Fiona Spence (University of Auckland, Learning

Technology Unit, Auckland, New Zealand)

Marcus Henning (University of Auckland, Centre for

Medical and Health Sciences Education, Auckland, New


Wayne Hazell (Prince Charles Hospital, Emergency Department, Brisbane, Australia) Louise Young (James Cook University, Rural and Remote Medicine, Townsville, Australia)

Background: Clinical reasoning is one of the clinician's most important skills and continues to present a challenge to educators and clinicians. The dual-process model of clinical reasoning proposes an iterative process of hypothesis generation, often with pattern recognition and analytical hypothetico-deductive reasoning. Clinical reasoning is learnt in the workplace. Experienced clinicians use rapid tacit cognitive reasoning processes and often find it difficult to slow down and explain how they are thinking when working in a busy clinical environment; because of this they often find clinical reasoning difficult to teach. Intended outcomes: Know the current theories of clinical reasoning, understand how to use virtual patients and be able to teach clinical reasoning in everyday practice.

Structure of workshop: A review of the history of the development of clinical reasoning will be followed by an explanation of the dual process theory using examples from the presenters' and participants' clinical practice. Participants will make virtual patients to convert their clinical experiences into clinical reasoning exercises. Examples of common errors in clinical reasoning will be discussed. By making use of the 'think aloud' technique of verbal protocol analysis participants will learn how to teach clinical reasoning during supervision of students and residents in every day practice. Who should attend: Doctors and nurses who wish to learn how to teach clinical reasoning in their daily practice. Participants will be invited to bring two cases from their practice to use during the workshop Level: Introductory


10R Workshop: Facilitating interprofessional education and collaboration through interactive teaching

Location: Meeting Room 2.2, PCC

Marie Eason Klatt (St. Joseph's Health Centre, Occupational Therapy, 30 The Queensway, Toronto M6R 1B5, Canada)

Farah Moid (St. Joseph's Health Centre, Laboratory Medicine, Toronto, Canada)

Suzanne Wong (St. Joseph's Health Centre, Obstetrics-Gynecology, Toronto, Canada)

Jerry M Maniate (St. Joseph's Health Centre/University of Toronto, Medical Education & Scholarship, Toronto, Canada)

Background: Interprofessional learning requires the formation of new mental constructs through social interaction and collaboration with members of different healthcare professions. Facilitation of this new learning necessitates recognition and appreciation of the unique socialization of healthcare professions and creation of learning opportunities where positive interaction can occur. The interprofessional education (IPE) facilitator is challenged to initiate learners in the process of incorporating interprofessional collaboration (IPC) competencies into their mental constructs, and ultimately their repertoire of behaviors to enhance patient care. Teaching methods which foster interaction are essential to successful development of IPC competencies such as knowledge of professional roles and responsibilities, communication skills, shared decision making and willingness to work together, appreciating differences, trust and mutual respect. Through interactive teaching and carefully crafted questioning using an appreciative focus, positive learning environments can be created where the impact of power relationships and organizational structure is lessened. Engaging in interprofessional learning facilitated by interactive teaching methods allows learners to openly voice their opinions and discuss options whilst building social connections that cross interprofessional boundaries. Intended outcomes: Following this workshop, participants will be able to:

Apply constructivist learning theory to the development of IPE using various interactive teaching techniques Appreciate the potential of these educational tools to enhance IPE/C

Identify strategies for implementing interactive teaching into continuing educational opportunities within healthcare organizations.

Structure of workshop: This experiential workshop will introduce participants to several interactive teaching techniques including an icebreaker, think- pair- share exercises, communication and team building games, breakout groups and a hands on trial of an Audience Response Technology (ART) system Who should attend: Clinicians, Clinician-Teachers, Trainees, Clinician-Educators, Faculty Developers 10S Workshop: Live streaming and recording solutions for medical classes in an interactive environment

Location: Meeting Room 3.1, PCC

Philip Anner (Medical University of Vienna, Department for Medical Education, Spitalgasse 23, Vienna 1090, Austria)

Philipp Pavelka (Medical University of Vienna, Department for Medical Education, Vienna, Austria) Andrea Praschinger (Medical University of Vienna, Department for Medical Education, Vienna, Austria) Franz Kainberger (Medical University of Vienna, Department of Radiology, Vienna, Austria)

Background: Extending the reach of medical classes to remote locations is becoming an increasing factor for many educational institutions, be it because of limited room capacities or the need for distance or blended learning programs. Recent advances in information technology provide viable solutions to deal with such challenges. Together we will dig deeper into video live streaming & recording technologies and how to leverage them effectively with tools for interaction. Intended outcomes: Attendees will receive a basic understanding of streaming solutions and effective communication channels for medical lectures. After attending this workshop participants will be able to set up a streaming solution on their own and will be able to act as consultants for their local ICT department. Structure of workshop: At the beginning, basics of video techniques and video live streaming technology will be explained. This theoretical part provides the necessary fundamentals for the following hands-on lesson. An overview of freely available server and client software for live streaming will be given and afterwards attendees will implement a solution with the presented software themselves. Subsequently tools for efficient interactive communication in medical classes will be presented. Participants will have the opportunity to test and to combine them with their newly created streaming solution.

Who should attend: Technologically experienced persons interested in innovative and interactive learning solutions.

Level: Introductory


10T Workshop: Implementing best practices for intraining assessment - an institutional change management approach

Location: Meeting Room 3.2, PCC

Glen Bandiera (University of Toronto, Postgraduate Medical Education, 500 University Avenue, Ste 602, Toronto M5G1V7, Canada) Susan Glover Takahashi (University of Toronto, Postgraduate Medical Education, Toronto, Canada)

Background: In-training assessment is the foundation of the workplace educational model of clinical medical education. A good system relies not only on principled design of assessment instruments but also on the local context in which they are deployed. Numerous psychometric, logistic and socio-cultural challenges impede successful implementation. The literature provides direction in all of these areas. This workshop outlines a comprehensive evidence-informed approach to developing best practices for in-training assessment with a focus on institutional change management and broad uptake.

Intended outcomes: Participants will be able to: Identify key issues that can undermine workplace-based in-training assessment and the literature base supporting these

Systematically design a process for developing and implementing an effective workplace in-training assessment system, and

Describe various models for monitoring and oversight of such a system.

Structure of workshop: The workshop will involve a brief review of the literature around in-training assessment, including original research from the local context of the presenters. Participants will then work in small groups to review a case study showing how to integrate evidence with local context to design an in-training assessment system. The workshop will finish with a general discussion of principles, questions and declared next steps for participants interested in changing assessment systems in their local environment. Who should attend: Program directors, education coordinators, decanal members, and other education leaders interested in improving intraining assessment strategies. Level: Intermediate

10U Workshop: Complex Learning and CPD: Linking Educational Design to Outcomes

Location: Meeting Room 3.3, PCC

Don Moore (Vanderbilt University, Division of Continuing Medical Education, 320 Light Hall, Nashville 37232,

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