Автор неизвестен - Mededworld and amee 2013 conference connect - страница 135

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Peer Teaching of Evidence-Based Medicine for Undergraduate Medical Students

Eliot L Rees (Keele University, School of Medicine, North Staffordshire, United Kingdom) Yash Sinha (Keele University, School of Medicine, North Staffordshire, United Kingdom)

Abhishek R Chitnis (Keele University, School of Medicine, North Staffordshire, United Kingdom) James Archer (Keele University, School of Medicine, David Weatherall Building, Keele, North Staffordshire

ST5 5BG, United Kingdom)

Victoria Fotheringham (Keele University, School of Medicine, North Staffordshire, United Kingdom) Stephen Renwick (Keele University, School of Medicine, North Staffordshire, United Kingdom)

Background: It has been shown that many newly-qualified clinicians base their day-to-day practice on internalised guidelines, formed through their original reading and clinical experiences as students. The early use of evidence-based resources ensures student knowledge is based on the best evidence available at the time and promotes future use of evidence-based medicine (EBM).

Summary of work: Senior students at a UK medical school delivered workshops covering the basic principles of EBM and how evidence-based resources can be used to aid pre-clinical study in a problem based learning (PBL) curriculum. The scheme was evaluated using a pre-workshop survey and an 8-12 week post-workshop survey.

Summary of results: A total of 191 medical students attended the workshops. 90% and 59% of attendees completed the pre- and post-workshop surveys respectively. When asked if they had previously received formal training to search for evidence-based resources, 37% of attendees replied 'yes'. Pre-workshop, 29% of respondents felt 'confident' or 'very confident' searching for evidence-based resources, compared to 85% post-workshop. Pre-workshop, <1% of respondents used evidence-based guidelines as their preferred resource for studying, this rose to 31% post-workshop. Conclusions: The results show that whilst many students were aware of evidence-based resources, they tended not to use them as their preferred resource. Despite appreciating their value, few students were confident in accessing and using such resources for pre-clinical study. The workshops were successful in promoting the use of evidence-based resources.

Take-home messages: Students value teaching on how to use evidence-based resources. Peer-assisted learning can be an effective method for teaching evidence-based medicine.


Reducing students' doubts about EBM

Marek Perera (Queen Mary University London, Barts and The London School of Medicine and Dentistry, Centre of Medical Education, Garrod Building, Turner Street, Whitechapel, London E1 2AD, United Kingdom) Della Freeth (Queen Mary University London, Institute of Health Sciences Education, London, United Kingdom)

Background: Evidence-based medicine (EBM) is a systematic approach to clinical problem solving, which integrates the best available evidence with clinical expertise and patient values. Locating high quality evidence requires time and expertise. Few studies have explored medical students' perceptions of EBM, especially barriers and enablers for integration with their studies. The UK's National Institute of Health and Care Excellence (NICE) developed 'NHS Evidence': a free resource underpinning EBM by providing quality-reviewed evidence. NICE also developed a Student Champions Scheme to increase awareness and use of NHS Evidence. MP and two peers led the first cohort of NHS Evidence Student Champions at our Medical School. They provided optional NHS Evidence teaching sessions for 2nd year students.

Summary of work: A focus group study with second year medical students explored perceptions of EBM and NHS Evidence Student Champions' teaching sessions. Transcripts from focus groups held shortly after teaching sessions and approximately one month later were analysed using Framework Analysis. The study is ongoing until May 2013.

Summary of results: Medical students lacked conceptual awareness of EBM, but recognised its importance. Students cited lack of skills, time, awareness of suitable resources and access to these as barriers to practising EBM. Students perceived the NHS-Evidence sessions as useful.

Conclusions: Students had limited experience with EBM and doubted their EBM expertise. They welcomed the NHS Evidence sessions, which reduced doubts and provided practical skills. Student-led education for EBM is acceptable and well-received. Further research into NHS-Evidence and peer-led EBM teaching is needed. Take-home messages: Medical students doubt their EBM expertise. NHS-Evidence sessions can raise awareness and skills for EBM.

10BB Posters: Professionalism

Location: South Hall, PCC


Palliative care, a tool to nurture medical professionalism in medical school

Sakon Singha (Prince of Songkla University, Palliative Care Unit, Faculty of Medicine, Hat-Yai 90110, Thailand)

Background: Desirable doctors are not only competent in medical science knowledge and skill but also have medical professionalism. This study explores one of the settings of bed-side training, Palliative Care, regarding the impact on issues essential to medical professionalism.

Summary of work: Prince of Songkla University Hospital is a medical school hospital and a tertiary-level medical institute. As a result, there are cases with conditions requiring palliative care according to WHO definition. The final-year medical students were assigned to study in detail palliative care patients, the activities of which included preliminary interview with the patients, presentation to small group, bedside round guided by palliative care physician and small-group reflection. Immediately after the session finished, every medical student was required to write a short reflection essay about the experience. To analyze these essays, keywords that reflect values and contents of the principle of medical professionalism were identified and then matched.

Summary of results: The spectra of issues related to medical professionalism namely patients' autonomy, primacy welfare of the patients, holistic care, compassionate communication and medical competence of symptom control was clearly demonstrated in the essay.

Conclusions: The special circumstances of palliative care patients could lead to discussion and reflection of these issues.

Take-home messages: The privilege of being with patients and family to the end is the best experience for everyone to learn and grow.


Teaching professionalism to first year medical students

Maria Romero (Universidad San Sebastian, Medicina, Lota 2465, Santiago 7510157, Chile) Diego Munoz (Universidad San Sebastian, Medicina, Santiago, Chile)

Luis Roman (Universidad San Sebastian, Medicina, Santiago, Chile)

Mario Hitschfeld (Universidad San Sebastian, Medicina, Santiago, Chile)

Alejandro Morales (Universidad San Sebastian, Medicina, Santiago, Chile)

Claudia Araya (Universidad San Sebastian, Medicina, Santiago, Chile)


Background: Medical School in Chile starts just after high school, and lasts seven years with first three dedicated to basic sciences with almost no clinical experience. Universidad San Sebastian implemented an experience to approach medical professionalism (MP) as early as first term.

Summary of work: Session one was dedicated to study the 3 fundamental principles of MP and the 10 commitments of professional responsibilities. In session two students were given a case about an obstetrician who performed a C-section with no incidents. On the following day the patient's mother informed the hospital manager that she had perceived alcohol on the breath of the doctor.

Summary of results: 90% of students forgave the physician based on previous good behavior and good outcome. After a thorough discussion most students recognized having been led by emotions rather than objective principles and commitments. The following year the case was discussed again, but after 5 sessions of theoretical discussion. This time 50% of students wrote that the doctor deserved a verbal or written admonition and 20% a suspension or withdrawal of license.

Conclusions: Students were prone to forgive misconducts on MP when faced with evaluating situations before a thorough study of principles and commitments. Previous study and reexamination of principles contributed to a better evaluation. Students who had reflected longer on MP issues were more apt to observe principles and responsibilities. Take-home messages: Medical professionalism can be successfully introduced early in medical schools, stimulating the reasoning leading to a behavior according to principles and commitments of MP.


Professionalism evaluation in probation period as an eligible criterion for medical licensing examination in China

Ping Qing (West China School of Medicine, Sichuan University, Department of Academic Affairs, 37 Guo Xuexiang Chengdu 610041, People's Republic of China) Xun Yao (West China School of Medicine, Sichuan University, Department of Academic Affairs, Chengdu, People's Republic of China)

Xuehong Wan (West China School of Medicine, Sichuan University, Chengdu, People's Republic of China) Yongchang Lang (Office for Medical Licensing Examination, Sichuan Province, People's Republic of China)

Yuan Zhao (National Medical Examination Center, Beijing, People's Republic of China)

Background: Qualification Certificate for 1-Year Probation Period is required to apply for the medical licensing examination in China. The certificate was criticised as formalism because of its simple statement of "Qualified or Not". As professionalism has been identified as an important area for evaluation, we modified the certificate to an observation-based

evaluation form to measure the professional behaviors of the applicants.

Summary of work: Medical education requirements, eligible criteria of licensing examinations and PubMed were searched to identify potential items reflective of professionalism. Experts' consultation was used to screen and reconstruct the items. The form was tested on our graduates and residents in our teaching hospital and perception survey were conducted. Summary of results: From 42 items identified by literature analysis, 18 positive and 7 negative (strictly prohibited) items were converted into the evaluation form. Test results indicate content and construct validity. Exploratory factor analysis yielded 4 factors: doctor-patient-relationship skills, interprofessional-relationship skills, doctor-social-relationship skills and self-management skills. The perception survey indicated the evaluation is a little bit complex but necessary and useful to evaluate the applicants and can enhance self-discipline of the evaluators as well. Conclusions: This study suggests that professionalism evaluation in probation period might be a good supplement for measuring professionalism in medical licensing examination. The results of the evaluation can be used as one of the eligibilities for the exam and can be saved as portfolios for the future register, professionalism measurement and recertification.


How do future doctors define professionalism in the Arab World?

Dalia Al-Abdulrazzaq (Kuwait University - Faculty of Medicine, Pediatrics, POBox 24923, Safat, 13110, Kuwait)

Amani Al-Fadhli (Kuwait University - Faculty of Medicine, Pediatrics, Kuwait)

Andleeb Arshad (King Saud bin Abdulaziz University, Medical Education, Riyadh, Saudi Arabia)

Background: Professionalism is a core competency in medicine. Numerous studies investigate how this competency is taught and learnt. Few studies, however, report on the students' definition of professionalism especially in the Arab world. Summary of work: Eighty-five final-year medical students in Kuwait were asked to list qualities defining professionalism. The responses were analyzed using Miles and Huberman method. The responses were categorized into three themes according to the CanMEDs roles defining professionalism, namely, demonstrating commitment through ethical practice; participation in profession-led regulation; and demonstrating commitment to physician health and sustainable practice.

Summary of results: A total of 265 responses were generated and 93.2% of them were categorized under the CanMEDs theme describing professionalism as commitment through ethical practice. The three most commonly listed attributes were punctuality, respect, and well-attired. Only two attributes namely obligation to rules and team work were listed under the themes


describing professionalism as participation in profession-led regulation and commitment to physician health and sustainable practice.

Conclusions: Majority of the students defined professionalism in the context of ethics, reflecting their immaturity in medical practice and possible deficiencies in the curriculum. The most common listed attributes are different from other reported studies and might reflect differences in curricula, penalty system, and culture.

Take-home messages: Medical curricula in the Arab World should be designed to address a holistic and cultural definition of professionalism.


Traits of professionalism in students challenged with dilemmatic situations in video recorded simulations: a qualitative study

Fabrizio Consorti (University Sapienza of Rome, Faculty of Medicine and Dentistry - Dept. of Surgical Sciences, viale del Policlinico, Rome 00161, Italy) Laura Potasso (University Sapienza of Rome, Faculty of Medicine and Dentistry - Dept. of Surgical Sciences, Rome, Italy)

Emanuele Toscano (Universita Telematica G. Marconi, Faculty of Sciences of Education, Rome, Italy)

Background: As one of the activities in our framework for the development of professionalism along the six years of curriculum (Consorti et al Adv. Med. Educ. Pract. 2012; 2012(3): 55 - 60), five short videos about typical dilemmatic situations in medical practice (Ho et

al Med Educ. 2012 Mar;46(3):245-56) are used, to

challenge students of clinical years and explore their believes about professional behavior and image. Summary of work: Twelve students were interviewed after looking at the videos and the transcripts analysed for thematic analysis. Themes related to professionalism were extracted and cross-referenced with the seven types of professionalism proposed by Hafferty (Acad

Med. 2010; 85(2):288-301).

Summary of results: A strong overlap with "nostalgic" and "unreflective" professionalism types was observed, with key aspects like altruism, interpersonal competence, personal morality, professional dominance and technical competence. The aspect of professional autonomy never emerged, while the issue of teamwork - not explicitly present in Hafferty's proposal - was often mentioned. Despite the Faculty's efforts addressed to the development of a social view on profession, the themes of social justice and social contract never explicitly emerged, but rather patient's advocacy and empowerment, like instances of a personal relationship of care with the patient. Conclusions: Overall, an idealistic image of profession emerged, even if more updated traits like teamwork and patient empowerment were present. Take-home messages: Qualitative probing of the outcome of an educational process may give useful information, also to address a more objective assessment.


Identifying the attributes of professionalism in clinical students: a study at Chulalongkorn medical school, Thailand

Pakkapon Rattanachaisit (Chulalongkorn University, Faculty of Medicine, 6th Year Medical Student, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand) Danai Wangsaturaka (Chulalongkorn University, Faculty of Medicine, Pharmacology and Medical Education Unit, Bangkok, Thailand)

Narin Hiransuthikul (Chulalongkorn University, Faculty of Medicine, Preventive and Social Medicine, Bangkok, Thailand)

Background: There has been growing interest in how to assess professionalism and how professionalism is perceived differently from one culture to another. We, therefore, conduct this research to identify the attributes of professionalism in Thai clinical students. Summary of work: The study consists of two stages. Using grounded approach and triangulation, we interviewed Year 4-5 students, clinical teachers and nurses in the first stage to identify good and bad behaviours of clinical students based on their daily activities. The interviews continued until the data was saturated. The emerging issues were then arranged into the questionnaire. Year 5 students were asked to rate the importance of each issue from 1 (not important at all) to 5 (absolutely important).

Summary of results: In the first stage, 122 issues arose from interviewing 8 students, 14 teachers and 5 nurses. The importance of these items, at the end of the second stage, ranged from 2.82 to 4.61. The three most important items were: (1) being late or absent from on-call duty; (2) posting a patient's photo on social media; and (3) giving incorrect information to patients. The items with lowest scores were: (1) sleeping in classroom; (2) taking photos of medical records; and (3) eating while walking. The ten most important issues were raised in the first round by teachers (5), teachers and students (2), nurses (2) and students (1). Conclusions: It is interesting to see how much clinical students valued each issue in professionalism. We hope that our research will contribute to the literature in professionalism.


Canadian Professionalism programs: structure and remediation

Anna Byszewski (University of Ottawa, Faculty of Medicine, The Ottawa Hospital, Civic Campus, 1053 Carling avenue, Ottawa K1Y4E9, Canada) Heather Lochnan (University of Ottawa, Faculty of Medicine, Ottawa, Canada)

Jeewan Gill (University of Ottawa, Faculty of Medicine, Ottawa, Canada)

Background: As professionals, physicians are committed to the health and wellbeing of individuals and society through ethical practice, profession-led regulation, and


high personal standards of behaviour. The objective was to compare how professionalism is addressed among different Canadian medical schools, to explore resources used, and to investigate innovative methods used for remediation.

Summary of work: A literature review was used to explore background theory. An electronic questionnaire was circulated to directors of professionalism programs across Canada. An in-depth telephone interview was offered to further explore themes. Summary of results: In both pre-clerkship and clerkship, the foundation of teaching remains in the form of lectures and small group session. However portfolios are used by 34.5% and 30% respectively. 63% of programs have a professionalism website and some use podcasts. A "White Coat" ceremony is conducted at 73% of sites. 45% of sites have formal staff training in professionalism. For evaluation, supervisor evaluation is always used, but OSCE, portfolio and concern notes are novel methods utilized. Faculty report fear of reprisal and time requirement as major barrier to reporting and addressing lapses. Remediation can consist of remediation essays, reflection exercises, or professionalism modules.

Conclusions: Professionalism is taught and evaluated in varying degrees. Novel methods can be utilized especially in clerkship where there is a steady decrease of formal curriculum content. Innovative remediation programs are developing at several centres. Faculty development and support, including a formalized professionalism office are suggested as venues to develop programs.

Take-home messages: The results of this survey can guide curricula for professionalism content and development of a remediation algorithm.


Assessing professionalism as the determining factor in residents of Shiraz University of Medical Sciences (S.U.M.S)

Farzaneh Alipour (Jahrom University of Medical Sciences, Student Research Committee, Shiraz, Iran) (Presenter: Saied Amiri Lorestan, University Of Medical Sciences, Student Research Committee, Khoram Abad 7178716175, Iran)

Background: Education for professionalism is an international challenge. Professionalism is a core element which should be considered beyond knowledge and skills. Our aim is to assess the importance of professionalism in residents during their performance in different wards in SUMS.

Summary of work: A self-instructive questionnaire assessing the importance of professionalism by residents of SUMS was completed. They were evaluated based on checking different components of professionalism such as the sensitivity to sociocultural differences, empathetic behaviors, and congruency, professional skills in relationship with patients and colleagues and intimate examination. Data were analyzed by SPSS.

Summary of results: A total of 200 students participated in this study; 40% and colleagues of students marked sociocultural differences as the important factor; 65% indicated empathy as the most necessary one; 68% believed congruency as the best one; 58% believed in the importance of relationship with patients and colleagues; 69% indicated professionalism in intimate examination, and most of the cases indicated handwork and forgetfulness as the factors of ignorance of professionalism.

Conclusions: Improving professional attitude and behaviors requires critical reflection and good education, and it is better for the residents to participate in ethical classes in order not to ignore professionalism and the managers should assess them during their performance.

Take-home messages: Improving professional attitude and behaviors requires critical reflection and good education. Professionalism is a core element which should be considered beyond knowledge and skills.


Teaching professionalism to GP trainees

Richard Elliott (Wessex Postgraduate Deanery, GP Education, Education Centre, MP 10, C level, SAB, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom)

Background: Professionalism is an important aspect of medical practice, impacting on clinical care, patient safety and communication skills. In order to meet the requirements of the Royal College of General Practitioners curriculum for professionalism, we sought an innovative and engaging way of exploring professionalism with our trainees. Summary of work: A teaching pack following the principles of Enquiry Based Learning (EBL) was developed. This consisted of two clinical case scenarios which contained significant professional behaviour issues for the trainees to identify and discuss. The pack also included two workshops on exploring professional attitudes. The trainees were separated into mixed small groups of eight, consisting of ST1 and ST2 trainees. The groups were encouraged to explore the clinical cases and note the professional behaviours contained within each. Particular areas of interest were explored through facilitated discussion, with the facilitator drawing on an information pack of prepared research evidence. In addition each group had access to an iPad allowing for research of additional issues they identified. Summary of results: Written feedback was received from each trainee at the end of the day. Feedback was positive; in particular trainees valued the format and delivery of this educational event. On reviewing curriculum statements, trainees felt that there had been comprehensive coverage of a range of areas linked to professionalism.

Conclusions: Small group work undertaken within the EBL framework was found to be successful in helping our trainees explore professionalism in an engaging and enjoyable fashion.


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