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Philip Evans (University of Glasgow, Medical Education, Glasgow, United Kingdom)
Margaret-Mary Gordon (Gartnavel General Hospital, Rheumatology, Glasgow, United Kingdom)
Background: The start of clinical teaching is a significant milestone for medical students. Pre-clinical structure is replaced by the less organised routine of ward rounds and bedside teaching. This transition period between pre-clinical and clinical training has been highlighted as one of the most stressful experiences faced by the undergraduate. Third year medical students at Glasgow University recently reported lacking in confidence during their first ward-based clinical attachment. A mentoring programme was suggested as a potential way to overcome this.
Summary of work: Third year medical students undertaking a fifteen week clinical attachment at a Glasgow teaching hospital were assigned a foundation doctor as their mentor. Mentors were given guidance as to the expected level of contact between themselves and their mentee. A questionnaire was issued to the students at the beginning and end of the fifteen week period, evaluating how confident they felt in relation to various aspects of their clinical attachment. The questionnaire used a ten point Likert scale for evaluation.
Summary of results: Results of the study upon its completion will be presented with conclusions. Conclusions: Informal feedback during the study suggests that mentoring is a positive tool for third year medical students. However some barriers have been highlighted. Identifying a mentor is increasingly challenging as medical school class sizes increase and clinical rotations shorten. Results from the ongoing study will help to clarify whether mentoring is an effective tool in increasing levels of confidence amongst medical students.
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Take-home messages: Use of mentoring to increase confidence amongst medical undergraduates should help them to achieve their full potential.
Fluid prescription and its teaching as a medical undergraduate: What medical students think
Marguerite McCloskey (Belfast City Hospital, Regional Nephrology Unit, Lisburn Road, Belfast BT9 7AB, United Kingdom)
Alexander Peter Maxwell (Belfast City Hospital, Regional Nephrology Unit, Belfast, United Kingdom) Gerard Gormley (Queens University Belfast, Centre for Medical Education, Belfast, United Kingdom)
Background: It is well recognised that junior doctors find fluid prescription a difficult topic. The aim of this study was to gain a greater understanding of the experiences and challenges that medical students face regarding the learning of intravenous fluid prescribing. Summary of work: This was a qualitative study using focus groups analysis. Final year medical students in academic year 2011-12 at Queens University Belfast were approached during their work shadowing placement and were invited to participate in 5 focus groups consisting of 6-8 students per group. Thematic analysis was carried out to establish emerging themes. Summary of results: Six prominent themes emerged: 'Teaching experience: disruptive variation' where the teaching of intravenous fluids varied considerably; 'Insufficient curricular connections' where there was insufficient vertical and horizontal integration of the teaching between and within years; 'The driving test: theory-practice transformation' where there appeared to be a difference between what is taught in theory and what happens in practice; 'Theory-assessment gap' where a difference was noted between what is taught in theory and how it is assessed; 'Role modelling: which standard to aspire to?' where students regarded the doctors on the ward as being role models and had difficulty judging which standard to aspire to; and finally 'Perceived risk conflict' where students expressed a conflict between risks of fluid prescription highlighted in the media and teaching they had received. Conclusions: This study has added to the growing body of evidence that fluid prescription is a difficult topic, and is the first study to look specifically at the method of fluid teaching and advantages and disadvantages of each approach. It has generated a number of recommendations to improve fluid prescription and its teaching in the future.
Take-home messages: Fluid prescription remains a difficult topic and continued efforts should be made to improve its teaching.
Preparing for Employment
Denise Bee (The University of Sheffield, Medical Education, The Medical School, Beech Hill Rd, Sheffield S10 2RX, United Kingdom)
Nigel Bax (The University of Sheffield, Medical Education, Sheffield, United Kingdom)
Background: Despite the fact that the final phases of medical school curriculae are usually about gaining actual clinical experience, commonly in hospitals, the move from student to F1 doctor remains a difficult transition. In Tomorrow's Doctors 2009-GMC, a special placement - the student assistantship (SA) - was advised to be used to help the student do this. Summary of work: A six week SA was designed to take place after finals assessment but before graduation and during which undergraduates would act as an assistant to the F1 doctor whose job they would be taking over at the start of their employment. Preparedness questionnaires were distributed to the undergraduates before and after the SA. The self assessment included preparedness for clinical tasks, administrative tasks, building relationships, managing own welfare etc. Summary of results: The students indicated that they felt better prepared for employment after the SA than before and this was borne out in the detail across all points in the questionnaire. In particular, there was a much greater improvement in preparedness for the administrative tasks involved in becoming an F1 doctor. Conclusions: The student assistantship, provided the placement is matched to the student's first job, provides an excellent grounding for employment allowing the student to experience both the nature of working within the National Health Service and coming to terms with the detail of the post.
Take-home messages: A placement matched to the first F1 job is an excellent way to smooth the transition from undergraduate medical student to F1 doctor whilst still able to maintain appropriate supervision.
Australian medical graduates and blood-borne viruses: how do knowledge and experience of occupational exposures relate?
Olga Vujovic (Monash University, Department of
Infectious Diseases, Central Clinical School, The Alfred,
Commercial Road, Melbourne VIC 3004, Australia)
Nicole Koehler (Deakin University, Deakin Learning
Futures, Melbourne, Australia)
Claire Dendle (Monash University, Southern Clinical
School, Melbourne, Australia)
Christine McMenamin (Monash University, MBBS,
Faculty of Medicine, Nursing and Health Sciences,
Background: Medical students have high rates of occupational exposures to blood/bodily fluids (e.g.needlestick injury) with potential transmission of blood-borne viruses (BBVs). Little is known about the
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relationship between knowledge, including general disease-related BBV knowledge and specific knowledge of post-exposure prophylaxis (PEP), and behaviours in the context of occupational exposures Summary of work: Interns commencing at three Melbourne teaching hospitals were invited to complete an anonymous survey regarding knowledge of BBVs, including post-exposure prophylaxis, and rates of self-reported occupational exposures. Summary of results: Seventy-nine interns participated. General knowledge regarding HIV and hepatitis B and C was accurate. However, awareness of PEP availability was variable, being highest for HIV (94% of interns) and falling to 58% for hepatitis B. Alarmingly, 37% of interns incorrectly thought that PEP is available for hepatitis C. Occupational exposures were common (40%), often not reported (39%), and frequently occurred (31%) in non-university associated settings. Conclusions: Assessment of commencing interns' knowledge revealed a mismatch between general knowledge and knowledge of PEP. In addition, interns were likely to have sustained an occupational exposure which was often not reported.
Take-home messages: Hospitals should not assume that commencing interns have adequate knowledge of occupational exposure management. Deficits in knowledge may translate into poor practices following occupational exposures. Future education and research needs to focus on translation of knowledge into practice and modelling professional behaviours. Finally, these data provide support for the concept of a national curriculum in infection control for recent graduates in healthcare disciplines.
2CC Posters: Outcome-Based Education
Location: South Hall, PCC
Which practical medical skills will a doctor need
KA Dannenberg (Charite Berlin, Lernzentrum, intern: Virchowweg 5 CCM, Chariteplatz 1, Berlin 10117, Germany)
WE Blaum (Charite Berlin, Lernzentrum, Berlin, Germany)
Background: The catalogue „Practical Skills" as part of the German Catalogue of Learning Objectives consists of 288 objectives. In a separate Delphi study we identified 10 trends like demographic change or advancing modern technology to likely influence health care in the future. Given those trends, what future relevance will current learning objectives have? Summary of work: We invited 8000 MDs from all over Germany spanning all medical disciplines to rate the relevance of all 288 skills from the catalogue given the previously identified trends. Participants rated the relevance of 30 learning objectives in the year 2025 on a scale from 0 to 4 in a two-step Delphi process. In a second round we asked participants of the first round to re-rate those learning objectives with broad variations. Summary of results: 738 doctors responded to the first round and rated 242 learning objectives as relevant or very relevant while 44 objectives were rated as rather not relevant or not relevant, two were rated indifferently. 103 objectives were rated with broad variation among raters, 73 of these as relevant, 28 as not relevant and two without clear distinction. Those were subjected to a second round in which 314 of the initial 738 doctors participated. They rated 62 objectives as rather relevant and 41 as rather not relevant. Conclusions: The expert participants considered 230 of 288 learning objectives from the national skills catalogue as relevant for the future.
Take-home messages: Learning objectives should be constantly adapted to the future requirements to keep the curricula up to date.
Supporting Schools to Implement the Tuning Learning Outcomes through the MEDINE2 Thematic Network
Helen Cameron (University of Edinburgh, Centre for Medical Education, College of Medicine and Veterinary Medicine, Chancellor's Building, 49 Little France Crescent, Edinburgh EH16 4SB)
Background: Primary European medical qualifications must be recognised by other European countries by law. However variation in achieved competences risks patient safety, undermines confidence amongst graduates, makes it difficult to plan postgraduate medical education for doctors in training, and exposes
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the system of free movement to criticism by employers and the public. A Tuning (Medicine) Task Force within the EU funded MEDINE Thematic Network for Medical Education created a consensus statement on the learning outcomes for basic undergraduate medical education in Europe in 2007 to encourage the achievement of a common set of competences. The second Thematic Network for Medical Education (MEDINE2) permitted a further Tuning project to create tools and resources to support European schools in adopting the Tuning Learning Outcomes. Summary of work: The international project group developed tools and processes to inform schools further about the Tuning Outcomes. They designed a template and demonstrated examples from several schools of how the learning outcomes are delivered. They developed a self-assessment questionnaire through an iterative trial and pilot to permit schools reflect on how closely their programme and processes match the 2007 consensus statement. And they wrote a short guide on creating and implementing an outcomes-based undergraduate medical programme. Summary of results: Examples of these will be demonstrated.
Take-home messages: The Tuning project has taken another step towards harmonising the graduating learning outcomes for medicine across Europe. However further work is required to encourage all schools to engage with the learning outcomes and supporting materials to achieve the consensus agreed in
CanBetter: CanMEDS in the Netherlands, not just the core but also the petals of the flower
Jan Borleffs (University Medical Center Groningen,
Postgraduate School of Medicine, A. Deusinglaan 1,
Location De Brug, Building 3217, Internal postnr FB/10,
Groningen 9713 AV, Netherlands)
Joep Dorr, Leiden, Netherlands)
Corry den Rooyen, Utrecht, Netherlands)
Fedde Scheele, Amsterdam, Netherlands)
Ronald van den Bosch, Utrecht, Netherlands)
Background: Due to national guidelines postgraduate medical specialist programmes will implement the CanMEDS model. At present, the role of the medical expert is prominent in the modernized residency programmes. However, programme directors struggle with implementing the other, intrinsic competencies in daily practice.
Summary of work: A national committee has taken the initiative to design a programme that helps residents to become an expert in the intrinsic roles. Our doctrine is that the success of such programme greatly depends on the concept that it should be mainly workplace-based with courses being supportive.
Summary of results: During an invitational meeting with programme directors and residents, subjects and clinical activities that depend on intrinsic competencies were collected. All suggestions could be categorized in four
themes: patient safety, health care for elderly people, efficiency of care and medical leadership. For each theme training modules will be developed. First, the inventory of existing modules or learning situations (best practices) will be extended. Second, after analyzing the missing parts new workplace based training modules will be designed and tested in a pilot setting. Conclusions: The goal is to compose workplace-based modules for a set of four themes covering all intrinsic competencies. It is aimed to differentiate between modules needed for all residents and modules that will be part of an excellency track in one of the themes. Residents applying the excellency track may become our future leaders in good health care. Take-home messages: Applying CanMEDS in medical specialist programmes requires help for programme directors and residents for the implementation of the intrinsic competencies in daily practice.
Development of a Novel CanMEDS Health Advocate Portfolio for Pediatric Residents
J Holland (Dalhousie University, Department of Pediatrics, IWK Health Centre, 5850/5980 University Aventue, PO Box 9700, Halifax, NS B3K 6R8, Canada) A Al-Marzouqi (Dalhousie University, Department of Pediatrics, Halifax, NS, Canada)
K Blake (Dalhousie University, Department of Pediatrics, Halifax, NS, Canada)
A Ornstein (Dalhousie University, Department of Pediatrics, Halifax, NS, Canada)
Background: Learning and evaluating the role of Health Advocate has been described as challenging by learners and teachers. A portfolio is a potential tool to address this challenge.
Summary of work: Using focus groups and interviews we explored pediatric residents' and program directors' understanding and experiences of learning and teaching the Health Advocate role, as well as their thoughts on portfolio design, utility and feasibility. Transcripts from focus groups and interviews were independently analyzed by each investigator. Major themes and sub-themes were identified and then discussed to generate final themes by consensus. The findings were used to guide development of an electronic portfolio. Summary of results: Residents and program directors could identify the key components of the Health Advocate CanMEDS role. Residents identified lack of adequate teaching and feedback around this role, and program directors expressed feelings of discomfort in evaluating it. Both groups had some experience with portfolios and there were varied opinions on the best design and format. Portfolios were seen by residents as most helpful when they received regular feedback and guidance about content. Based on these findings, we developed an online portfolio with which residents can reflect on experiences in which they recognize opportunities for advocacy, discuss their colleagues' experiences, and receive regular faculty mentorship and
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feedback. Trialing and preliminary evaluation of the portfolio are underway.
Conclusions: There is a gap in pediatric residents' teaching, feedback and evaluation experience on the role of Health Advocate.
Take-home messages: A portfolio on health advocacy may improve residents' skills as advocates.
Training In Guideline Implementation: Using The CANMEDS Framework
Lee Manchul (University of Toronto, Medicine, Toronto, Canada)
Douglas L Wooster (University of Toronto, Surgery, 1243 Islington Ave, Ste 1202, Toronto M8X1Y9, Canada) Elizabeth M Wooster (OISE/University of Toronto, Leadership, Higher and Adult Education, Toronto, Canada)
Background: Studies of guideline implementation have shown that skills beyond awareness of the guidelines is important to their clinical application. Educational strategies that address broader aspects of guideline implementation facilitate uptake. The CanMEDs initiative has identified the roles of a physician; application of this framework in training can broaden the understanding of guideline use Summary of work: Community family physicians (FP) and vascular (VS) and imaging specialists (IS) were surveyed to identify the use of a specific guideline regarding screening for aortic aneurysm. A focused in-office practice audit was performed on a group of FP. Qualitative study theory was applied to analyze data and identify common themes. A literature search on strategies for guideline implementation was performed. Summary of results: Study of practicing physicians revealed that even when knowledge of a guideline (expert) was present only 20-42% of FP, VS followed the guideline in practice. Understanding of the validity of the guideline and its application to practice (scholar) played a role in defining the practice and care gaps in 40%. Available resources and clinical demands (manager) impacted on this in 25% (VS, IS). Specific ethical issues, such as self-referral, societal responsibilities and individual patient's access and freedoms (professional) were noted in 40% (VS, IS). The attitudes of other care providers and how best to address this in practice (communicator, collaborator) also contributed to the care gap (FP, VS, IS). Conclusions: Guideline implementation is a complex issue that requires more than a 'knowledge translation' educational model. Training in and preparation for guideline implementation benefits from a broad approach to develop an understanding of how specific CanMEDs roles can facilitate guideline uptake in practice.
Take-home messages: Guideline implementation requires additional skills than simply knowledge of the guidelines.
The value of an external assessment in the training for medical specialist
SI Velthuis (Leiden University Medical Center, Directorate of Education, Hippocratespad 21, PO Box
9600, Leiden 2300 RC , Netherlands)
J Bustraan (Leiden University Medical Center, Directorate of Education, Leiden, Netherlands) PJ Dorr (Leiden University Medical Center, Directorate of Education, Leiden, Netherlands)
Background: The role of medical expert is central in the CanMeds framework, but residents must also develop in generic competencies, such as communication and collaboration. Many recently graduated residents feel insufficiently equipped in areas of generic competencies. Therefore not only development but also assessment of these generic competencies needs more attention during residency. Efforts were made to evaluate these competencies in a way that is complementary to current practice. Summary of work: An assessment for learning half way during the residency period was developed together with an external assessment agency. This external assessment focused on general competencies, like communication, management and professionalism. Twenty residents from different departments have been assessed. The experiences of residents and lead consultants on this external assessment have been evaluated.
Summary of results: Preliminary evaluation shows that this external assessment, together with the observations of competencies by lead consultants, has given insight into the different competencies, direction to the personal development planning of residents and a perspective on the resident's career in which qualities, ambition and reality are in proper balance. Conclusions: By performing an external assessment, residents and lead consultants have access to a new instrument to make motivated choices for the second half of the training for medical specialist. Take-home messages: An external assessment of generic competencies may have added value in development of these competencies during residency.
Introduction of medical students to the CanMEDS competency of communication through an experiential case-based learning project
Adriana Lazarescu (University of Alberta, Department of Medicine, 130 University Campus, Edmonton T5K 0K4, Canada)
Steven Caldwell (University of Alberta, Department of Medicine, Edmonton, Canada)
Background: The CanMEDS competencies are an internationally-recognized framework of essential roles needed for optimal health care outcomes. Communication is one of the seven competencies.
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Undergraduate medical education focuses primarily on the medical expert role.
Summary of work: An educational activity has been developed and implemented to expand medical students' awareness of the CanMEDS roles in their last year of undergraduate medical education in a large medical school in Canada. Students undertaking a three-week clinical rotation in an internal medicine subspecialty are asked to reflect on the rotation through the lens of one of the CanMEDS roles. To facilitate reflection, they are asked to recount a case-based experience in a two-page composition and to share the account orally with a group of their peers and an instructor.
Summary of results: For the CanMEDS role of communication, students identified both positive and negative examples of communication ranging over expressive and receptive, written and oral, direct and indirect domains. Actively looking at their day to day interactions through the prism of the CanMEDS framework allowed medical students to increase their awareness of various forms of communication in the medical field and stimulated them to assess their own communications skills through a process of self-assessment and narrative reflection. Conclusions: Medical students' awareness and understanding of the CanMEDS role of communication can be increased by explicitly asking them to view clinical encounters through the CanMEDS framework and discuss these interactions with their peers. Take-home messages: The CanMEDS role of communication can be successfully introduced into the undergraduate medical curriculum using an experiential case-based learning project.
See it, do it, teach it: Competency-based training for trainers
ID Doornbos (SOON, Training Programme for Elderly
Care Physicians, Utrecht, Netherlands)
PR Lorier (SOON, Training Programme for Elderly Care