Автор неизвестен - Mededworld and amee 2013 conference connect - страница 140

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Background: In Brazil, there is an urgent need to seek strategies to reduce a very high rate of cesarean section. Most of the medical schools still rely on a technocratic model which emphasizes an interventionist and medicalized approach without interdisciplinary work. Aim: To examine the preferences and reasons for mode of delivery for their own children among senior undergraduate medical students. Summary of work: Cross-sectional, quali/quantitative study was carried out using a questionnaire applied to senior medical students. Questions assessed the chosen mode of delivery in the event of a hypothetical pregnancy and justifications for their choice. Answers were grouped in categories. Summary of results: Fifty-three out of 90 students answered that their preference was for a vaginal birth. The reasons for their choice included: "lower maternal/perinatal risks", "natural/physiological/less aggressive", and "faster/painless recovery". The remaining 37 chose cesarean section and the justifications included: "less pain/suffering", "fear of anatomical changes", "predefined schedule/timelines", and "lower maternal/perinatal risks". Conclusions: Medical education should offer students experience on caring for less painful vaginal births. Take-home messages: To reach this goal, it is essential that they are exposed to evidence-based birth practices in the medical school, including: presence of a birth companion chosen by the women, continuous birth support, pharmacological and non-pharmacological pain relief methods, and interdisciplinary care.


Early Introduction of Respiratory Diagnostic and Therapeutic Skills to Medicine and Dentistry Students at the University of Alberta (FOMD)

Ronald W Damant University of Alberta, Medicine, 2e4.37 WMCHSC, 8440 -112 Street, Edmonton T6G 2B7, Canada)

Dwight Harley (University of Alberta, Department of Studies in Medical Education, Edmonton, Canada) Karrie Beck (University of Alberta Hospital, Respiratory Therapy, Edmonton, Canada)

Craig Rach (University of Alberta Hospital, Respiratory Therapy, Edmonton, Canada) Sandy Sandilands (University of Alberta Hospital, Respiratory Therapy, Edmonton, Canada)

Background: Respiratory illness is common. Our group developed a Respiratory Skills Laboratory (RSL) focusing on key diagnostic and therapeutic skills required to manage respiratory patients. Questions: how is the RSL perceived by learners?

Summary of work: The RSL's goal was to introduce learners to use of a bag-mask device, arterial blood gas sampling, oxygen therapy and Continuous Positive Airway Pressure/Non-Invasive Ventilation. Resources are available upon request. The lab consisted of 4 fifteen-minute stations. Students rotated in groups of 12. Stations were facilitated by content experts. Facilitators provided a brief overview. Hands-on experience was encouraged. Participants then completed a survey.

Summary of results: 201 students (167 MD, 34 DDS) took part. 177 students (88%) completed the survey. Scores (n/5.0): objectives clarity, 4.2; allotted time, 2.6; relevance, 4.5; enhanced comprehension, 4.4; overall value, 4.7; bag-and-mask, 4.6; oxygen, 4.5; CPAP/NIV, 4.5; ABG, 4.7. 97% of students agreed or strongly agree that the RSL was valuable. Station scores ranged from 4.5 to 4.7. 95% of students agreed or strongly agreed that the experience improved their comprehension of respiratory medicine. Medicine and dentistry students differed regarding relevance of the session (3.8 vs. 4.7; p


Conclusions: Student feedback to a RSL is favourable. Student scores support the allotment of more time to the activity as well as the addition of two stations: inhaler devices and spirometry. Take-home messages: The time allotted to the RSL is being increased. The two additional stations suggested by students are being added. Impact on student performance will be assessed. Follow-up respiratory skills sessions may be integrated into later years of the MD/DDS programs.


Logbook analysis: an evaluation strategy for a new Internal Medicine clerkship

Daniela Chiesa (Universidade De Fortaleza, Education Advisory, Travessa Russana 70 Casa 13 - Bairro Guaribas, Eusebio 61760-000, Brazil)


Valdes Roberto Bollela (Universidade De Sao Paulo, Medicine, Ribeirao Preto, Brazil) Rodrigo Escalante (Universidade De Fortaleza, Nami, Fortaleza, Brazil)

Ruy Guilherme Souza (Universidade Federal De Roraima, Medicine, Boa Vista, Brazil) Jacqueline Van Wyk (University of Kwazulu-Natal, Education Consultant, Durban, South Africa)

Background: Logbooks are well known as a student assessment tool, especially for auditing learning in clinical settings.

Summary of work: Internal Medicine clerkship in a new medical school has been offered over a five month period: one month in emergency department and three months in different general hospital wards and Intensive Care Unit. A logbook was introduced as a tool in the clerkship assessment system. The quality of learning experience was evaluated during 18 months of clerkship implementation, analysing 120 logbooks at the end of three semesters. A quantitative analysis was conducted of the most prevalent clinical cases and procedures performed by students, and compared to proposed learning objectives for their clerkship. Summary of results: The most prevalent cases followed by students were deep vein thrombosis; stroke; digestive tract diseases; pneumonia; diabetes; heart failure; sepsis and shock. Most common procedures were peripheral arterial puncture; peripheral and central venous access; tracheal intubation and paracentesis. Some wards did not allow students an opportunity to achieve expected learning objectives. There were gaps in learning experience in renal, endocrine and rheumatologic diseases. Students complained about lack of supervision in some settings. These findings resulted in adjustments in rotations (included outpatient clinic) and increasing of preceptors in each ward to address the identified gaps. Conclusions: Evaluation of logbooks and formative feedback to students became a monthly event to allow adjustments, before the rotation ends. Take-home messages: The findings suggest that logbook has also a strong potential as program evaluation tool, especially in clinical settings beyond the university boundaries.


Interactive Operating Theatre for Students of Dentistry

Jan Vokurka (Clinic of Dentistry, Faculty of Medicine, Masaryk University, Department of Periodontology, Pekarska 53, Brno 65691, Czech Republic) Antonin Fassmann (Clinic of Dentistry, Faculty of Medicine, Masaryk University, Department of Periodontology, Brno, Czech Republic) Lydie Izakovicova Holla (Clinic of Dentistry, Faculty of Medicine, Masaryk University, Department of Periodontology, Brno, Czech Republic) Jiri Vanek (Clinic of Dentistry, Faculty of Medicine, Masaryk University, Department of Periodontology, Brno, Czech Republic)

Background: Teaching undergraduate students of dentistry consists of lectures, seminars and practical exercises. It also includes the participation of students in the operating room, where they assist during the procedures. The surgeons are trying to show students the greatest possible number of different procedures, but for operational reasons, only two students can be present at a time. This greatly reduces the number of those who can directly observe the surgeon during the procedure. Good visualization along with theoretical knowledge are essential to the acquisition of surgical practices.

Summary of work: The aim of the project was to create a multimedia classroom connected to the operating theater, enabling students of dentistry to watch live surgeries. Students have the opportunity to enter their questions into a discussion with members of the operating team. The surgeon can get immediate feedback from students.

Summary of results: The procedures were recorded and are used in lectures and seminars of periodontics, dentoalveolar surgery and other fields of dentistry. Conclusions: The project improves and expands educational opportunities for students of dental medicine at our faculty.

Take-home messages: Interactive operating theatre helps to educate a greater number of students of medicine and improves the impact of the education.


Is there still a place for old school skills teaching?

Lisa Maclnnes (University of Edinburgh, Centre for Medical Education, Chancellors Building, 49 Little France Crescent, Edinburgh EH16 4SB, United Kingdom) Lorraine Close (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom) Val McDowall (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom) Barbara Findlay (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom) Janet Skinner (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom)

Background: Medical undergraduates at The University of Edinburgh are taught core practical skills within clinical skills labs. Technical skills such as Venepuncture are taught using part task trainers. Following this experience students are encouraged to consolidate their practice and skills in clinical areas with patients. Formal University evaluation and informal face to face discussion has revealed that students can struggle to gain opportunity to practise their skills. Summary of work: The clinical skills teaching team wanted to support students and assist with breaking down the barriers to patient practice. It was proposed that a pilot should run inviting students who attended their formal clinical skills teaching session, to sign up to voluntary supervised sessions within the clinical skills lab, where they could act as surrogate patients for the skill of venepuncture to be practised. Students were asked to complete a questionnaire which explored the


barriers in gaining experience in venepuncture and cannulation skills. The aim of the project was to increase student confidence by providing experience and feedback to help break down the barriers by learning from each other.

Summary of results: Students identified a number of barriers to practising their skills on real patients. This project provided opportunity for practice with supervision and feedback and consequently increased student confidence, directly improving their chance to access patients.

Conclusions: Conclusions of the project will be presented at conference.

Take-home messages: Practising clinical skills on each other gives medical undergraduates more confidence to gain experience in clinical areas.


Learning /non-learning process and key aspects of teaching in clinical placements: an analysis of medical students' self-descriptions on their learning experience

Machiko Shibahara (Kyoto University, Center for Medical Education, Konoe, Yoshida, Sakyo-ku, Kyoto 607 8501, Japan

Yasuhiko Konishi (Kyoto University, Center for Medical Education, Kyoto, Japan)

Background: Although previous studies emphasized active support and engagement of teachers are important in undergraduate clinical teaching, it is still obscure that what teachers should do as 'support' to medical students. Reflections by students will suggest teachers some useful implications towards this issue. Summary of work: At the Faculty of Medicine, Kyoto Univ. Japan, we deliver programs for 5th and 6th year students to reflect on their learning experience and consider how they learn further in clinical training. Students are encouraged to describe what and how they learned/did not learn with possible reasons for it, by answering open-ended questions. In this study, their descriptions were analyzed to clarify the elements of their learning/non-learning process, with intention to examine key aspects of teaching in clinical settings. Summary of results: From analyzing the data qualitatively, it was clear that their learning happened when they felt their knowledge was changed from theoretical to practical. On the other hand, they did not feel they had learnt something when they were unsuccessful to see people and workplace as a useful resource for their learning. This implies that learning for medical students means self-development as learners, rather than merely acquiring clinical skills. Conclusions: It is concluded that there are several key aspects of teaching in undergraduate clinical placements. 1) Development of students into self-directed learners, 2) Students' learning how to learn from people and workplace, 3) setting up learning climate, 4) awareness of restrictive nature of workplace. Take-home messages: For medical students who transit their knowledge from theory to practice, effective

'support' is to assist them to become self-directed learners.


Educating undergraduate medical students about the topic of unexplained physical symptoms: a systematic review

Zoe Wang (UCL, Department of Population Health and

Primary Care, London, United Kingdom)

Sophie Park (UCL, Department of Population Health and

Primary Care, London, United Kingdom)

Marta Buszewicz (UCL, Department of Population Health

and Primary Care, London, United Kingdom)

Kate Walters, UCL (Department of Population Health

and Primary Care, London, United Kingdom)

Background: While some patients present with clearly defined disease patterns, others experience physical symptoms which are unexplained by known organic pathology. These patients present several challenges to clinicians, students and medical educators, including negotiating appropriate management of: uncertainty; illness-disease boundaries; and use of investigations and referrals.

Summary of work: We systematically identified, summarised and synthesised the existing literature that evaluates teaching about unexplained physical symptoms to undergraduate medical students. Electronic databases and four journals were searched. Retrieved items were double screened using predefined inclusion criteria. Included full texts were quality assessed using the CASP tool. Noblit and Hare's meta-ethnographic synthesis methods were used to address pre-determined research questions and seek emergent themes from the texts.

Summary of results: Five papers were included from 1694 abstracts found. Most teaching was delivered in the 4th year, but was heterogeneous regarding content, structure, duration, and learning methods used. All studies evaluated student/teacher attitudes - 2 evaluated attitude change. Barriers to teaching this topic included: tutors lacking confidence in their expertise to teach it; lack of interdisciplinary teaching; resistance towards the topic from some faculty members and students.

Conclusions: Discordant views found within medical faculties may reflect the differing paradigm perspectives within clinical and medical education communities at large. These influence students throughout their training in formal and informal learning environments. Both teachers and students are learners in this evolving field. Take-home messages: Educators need to address certain challenges in order to incorporate important teaching about patients with unexplained physical symptoms into medical curricula.



Innovating Education for Pharmacogenomics in Clinical Practice at Mayo Clinic

Jerry Swanson (Mayo Clinic, Center for Individualized Medicine, 200 First Street, SW, Rochester, Minnesota

55905, United States)

Carolyn Rohrer Vitek (Mayo Clinic, Center for Individualized Medicine, Rochester, Minnesota, United


Petra Casey (Mayo Clinic, Center for Individualized Medicine, Rochester, Minnesota, United States)

Background: Increasing evidence indicates that human genetic variation modulates drug responses. Compelling arguments support using information on genetic variation to guide the choice of medications and dosages. The development of electronic medical records (EMRs) facilitates the dissemination of this information.

Summary of work: At Mayo Clinic, a pharmacogenomics task force selects drug-gene pairs for inclusion in the EMR. An interdisciplinary group contributes to this multi-faceted process and includes educators, information technology experts and content experts. An alert is triggered when a prescription for a drug is prescribed in the EMR. The alert describes the interaction and what gene test should be considered and why or indicates that there is already a test result for review. A link is provided for additional information about the drug-gene interaction. The information of the drug-gene interaction is curated and updated as needed. Summary of results: The initial gene-drug pairs have been implemented into the EMR. Significant effort has been expended to create work-flows which ensure the accurate and efficient provision of this information to prescribers.

Conclusions: The process to develop the information and system for the effective provision of drug-gene interactions has been enlightening and has required a coordinated, interdisciplinary approach. Pharmacogenomics information will play an increasing role in improved effectiveness and safety of drug therapy.

Take-home messages: The introduction of pharmacogenomics information into clinical practice will allow for the fulfilment of the promise of, "right drug, right dose, right time" and have an important impact on patient safety.


WEDNESDAY 28 AUGUST: 1045-1230

SESSION 11: Plenary 3

Wednesday 28 August: 1045-1230

11A Plenary: The things we know, the things we think we know but don't, and the things we don't know but should

Location: Congress Hall, PCC

Geoff Norman (McMaster University, Canada)

Summary: It is now more or less accepted that all educational interventions are created approximately equal. Systematic reviews provide little basis for continuing the common practice of espousing the virtues of one learning method over another. Such persistent beliefs in the face of negative evidence are pervasive in education. Conversely, contemporary educational psychology has identified a number of powerful educational interventions that can lead to large learning gains with minimal investment. Some examples are mixed practice, distributed practice, test-enhanced learning. Yet these strategies remain largely unknown to the medical education community. In this talk, I will systematically explore things we think work that don't, and things that do work that we don't know about. I will then advance some reasons why this may be the case, and some suggested strategies to avoid these problems in future.

Biography: Geoff Norman is Professor of Clinical Epidemiology and Biostatistics, McMaster University. He received a Ph.D. in nuclear physics from McMaster University in 1971, and subsequently a M.A. in educational psychology from Michigan State University in 1977. He is the author of 10 books in education, measurement and statistics, and 300 journal articles. His primary research interest is in cognitive psychology applied to problems of learning and reasoning. He presently holds a Canada Research Chair. He was elected a Fellow of the Royal Society of Canada in 2007. In 2008, he won the prestigious Karolinska Prize for lifetime achievement in medical education research.

11B Plenary: Taking evidence seriously: what would happen to our training programmes?

Location: Congress Hall, PCC

Cees van der Vleuten (Maastricht University, the Netherlands)

Summary: Research in (medical) education has matured considerably and the body of knowledge has increased substantially. What are the big messages that come through from the research about the effectiveness of our teaching and learning programmes? What works in education? How does that relate to what we do in educational practice? What if we were to take the evidence seriously? How much colouring outside the lines would we need to do? Should we radically change?

Biography: Cees van der Vleuten trained as a personality psychologist and psychometrician and has a PhD in Educational Sciences from Maastricht University. He is Chair of the Department of Educational Development and Research and Scientific Director of the School of Health Professions Education at Maastricht University. His area of expertise lies in evaluation and assessment. He has published widely on these topics and holds several academic awards for this work including several career awards. He has frequently served as a consultant internationally. He has been a supervisor of more than 40 PhD students.

amee -2014



30 August to 3 September 2014






The AMEE Team

If you would like more information about AMEE and its activities, please contact the AMEE Office: AMEE Office, Tay Park House, 484 Perth Road, Dundee DD2 1LR, UK. Tel: +44 (0)1382 381953    Fax: +44 (0)1382 381987    Email: amee@dundee.ac.uk


Scottish Charity: SCO31618

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