Автор неизвестен - Mededworld and amee 2013 conference connect - страница 2

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Anna Tereza Soares de Moura (State University of Rio de Janeiro, Faculty of Medical Sciences, Av. Prof. Manoel de Abreu, 444 - Vila Isabel, Rio de Janeiro - RJ, 20550­170, Rua Oliveira Rocha 22/101, Jardim Botanico, Rio De Janeiro 22461-070, Brazil)

Henry Holanda Campos (Federal University of Ceara, Medicine School, Fortaleza, Brazil)


Albanita Viana de Oliveira (State University of Rio de Janeiro, Faculty of Medical Sciences, Rio de Janeiro, Brazil)

Marcos Junqueira do Lago (State University of Rio de Janeiro, Faculty of Medical Sciences, Rio de Janeiro, Brazil)

Renata Nunes Aranha (State University of Rio de Janeiro, Faculty of Medical Sciences, Rio de Janeiro, Brazil)

Background: Medical education in Brazil has evolved greatly in recent decades, driven by public policies and awareness for alignment with community's and health system necessities. Transformations in traditional profile schools are not an easy task especially because faculties' resistance and overvaluation of post graduate and research. Faculty of Medical Sciences in State University of Rio de Janeiro has a traditional educational model and its pedagogical project is not yet aligned with National Curriculum Guidelines. Summary of work: Three thematic workshops were conducted with about 100 participants from all departments, other academic units and central management. Six working groups were created to review political pedagogical project from the perspective of basic-clinical and health system integration, student attention, new teaching and assessment methods. Moodle Platform was used as a facilitating tool. Students' participation was also enhanced in all initiatives.

Summary of results: Staff already sensitized, innovative experiences and management support are positive factors that facilitate the entire process. Response to initiatives has been encouraging, with perception of a growing movement of institutional integration and strength for undergraduate practices. Conclusions: The path is challenging, requiring institutional partnerships and legitimacy peer. Teachers would like to identify a clear path from managers to be followed and want to be reward for their academic activities.

Take-home messages: Faculty development is an important tool to promote learning environment, integrative curriculum and better networking in order to overcome challenges of engaging teachers in their practices with undergraduates.

2D Short Communications: Basic Science 1 - Clinical Integration

Location: Meeting Hall IV, PCC


Linking basic science knowledge retention and perceived clinical relevance in a vertically-integrated curriculum

Bunmi S. Malau-Aduli (University of Tasmania, Medical Education Unit, School of Medicine, 17 Liverpool Street, Private Bag 73, Hobart TAS 7000, Australia) Adrian Y.S Lee (University of Tasmania, School of Medicine, Hobart, Australia)

Marianne Catchpole (University of Tasmania, School of Medicine, Hobart, Australia) Nick Cooling (University of Tasmania, School of Medicine, Hobart, Australia) Matthew Jose (University of Tasmania, School of Medicine, Hobart, Australia) Richard Turner (University of Tasmania, School of Medicine, Hobart, Australia)

Background: For medical students to apply clinical reasoning based on sound scientific principles, they must be able to retain basic science knowledge as they progress. However, when knowledge gained is not perceived as applicable to clinical contexts, it is less likely to be retained.

Summary of work: We investigated the relationship between perceived clinical relevance and retention of basic science knowledge in Years 2-5 students through a 50-item multiple-choice question (MCQ) examination. Information was collected pertaining to demographics, prior educational experience, and the perceived clinical relevance of each question.

Summary of results: A total of 232 students (response rate 50%) undertook the assessment task. Retention of basic science knowledge was significantly affected (p<0.001) by year of study, gender and student origin. There were increasingly positive correlations between items answered correctly and their perceived relevance

from Years 2 to 5 (Year 2, r=0.040; Year 3, r=0.26; Year 4, r=0.36; Year 5, r=0.60).

Conclusions: This study highlights the increasingly positive correlation between perceived clinical relevance and the retention of basic science knowledge with progression to more senior years. Strategies to promote the clinical relevance of teaching material to students may be critical to the retention of that knowledge and its ultimate transfer to the clinical context. Perceived relevance of a subject matter elicits deep learning and fosters retention of knowledge.

Take-home messages: Basic science knowledge is more likely to be retained if students have a greater perception of its clinical relevance.



On the relevance of biomedical knowledge for the acquisition of clinical knowledge

Stefan K. Schauber (Charite - Universitatsmedizin Berlin, Institute of Medical Sociology and Dieter Scheffner Center, Luisenstrafie 57, Berlin 10117, Germany) Martin Hecht (Humbold Universitat zu Berlin, Institute for Educational Quality Improvement, Berlin, Germany) Zineb M. Nouns (Charite - Universitatsmedizin Berlin, Dieter Scheffner Center for Medical Teaching and Educational Research, Berlin, Germany) Susanne Dettmer (Charite - Universitatsmedizin Berlin, Institute of Medical Sociology, Berlin, Germany)

Background: Basic science education in undergraduate medical education faces several challenges. One prominent discussion is focused on the relevance of biomedical knowledge for the development and integration of clinical knowledge. Although the value of basic science knowledge is generally emphasized, several theoretical positions differ on the relative role of this knowledge and the optimal approach for its instruction. We address the question whether and to which extent biomedical knowledge is related to the development of clinical knowledge. Summary of work: We analyse repeated measure data of performances on basic science and clinical knowledge assessments. A sample of N=598 medical students from a traditional curriculum participated in the study. Overall a developmental phase of 2 years of medical education was covered. Structural equation modelling was used to analyse the temporal relation between biomedical knowledge and the acquisition of clinical knowledge.

Summary of results: Our data indicates a decline in basic science knowledge which is complemented by a growth of clinical knowledge. Statistical comparison of several structural equation models revealed that a model specifying unidirectional relations from earlier states of biomedical knowledge to subsequent changes in clinical knowledge explained the data best. However, the parameter estimates indicate that this association is negative.

Conclusions: Our analysis suggests a negative relation between earlier levels of basic science knowledge and subsequent gains in clinical knowledge. We discuss limitations of our study such as the given educational context and the non-experimental nature. Take-home messages: Results presented here hint at possibly critical issues in basic science education that have been rarely addressed thus far.


Student perceptions toward case based approach of teaching physiology

Lubna Al-Asoom (University of Dammam, Physiology, Dammam, P.O. Box 2114, Dammam 31451, Saudi Arabia)

Background: Integrated learning is targeted recently by the medical schools in the developing countries. In the college of medicine, university of Dammam, the main theme of teaching is the traditional subject based curriculum. We aimed in the department of physiology to introduce a model of vertically integrated curriculum for second year medical students for respiratory physiology in Dec 2012. Case based approach was implemented. The student perceptions for this approach were tested.

Summary of work: Twelve lectures of respiratory physiology were given. Each lecture commenced with one clinical scenario related to the main physiological concepts of the lecture. Multiple choice questions were posted following the scenario to attract the attention of the students. Relevant facts were explained. Lastly, the case related questions were discussed interactively with the students. A questionnaire was given to the students to check their perception of the case-based method. Summary of results: Fifty eight students participated in this evaluation. 90% think the case based approach is a better method, 84% think it makes understanding better, helps them for better understanding in the future, and it should be continued in the future. About 75% found clinical scenario based MCQs and SEQs is a better way of judging their knowledge, and agreed that it motivates their critical thinking. Conclusions: Most of our second year students have good perception toward case based approach in teaching physiology in understanding, assessment and future application of the knowledge. Take-home messages: Case based approach in teaching physiology seems to be a good implementation toward vertical integration in university of Dammam.


Educational Strategies to Promote Clinical Reasoning: Arguments for Medical University to Plan Curriculum Modernization

Aleksandra Nadiradze (David Tvildiani Medical University, Pathology, 2/6 Ljubljana Str., Dighomi, Tbilisi 0159, Georgia)

Nino Tabagari (David Tvildiani Medical University, Internal Medicine, Tbilisi, Georgia) Sergo Tabagari (David Tvildiani Medical University, Medical Biochemistry, Tbilisi, Georgia)

Background: David Tvildiani Medical University (DTMU) plans to transform its pre-clinical clerkship curricula for setting learning content into learning context in the framework of TEMPUS project: "Establishment of the Supra-Regional Network of the National Centers in Medical Education, Focused on PBL and Virtual Patients". The aim was to assess the "status quo" regarding students' knowledge (basic and clinical sciences) retention and its linkage with clinical cases and to justify the need for such modernization. Summary of work: DTMU students of 3rd (69, 2%) and 6th (82,6%) year were given anonymous knowledge test of 13 pairs of questions (E. Lazic et al., 2006) and 12


clinical cases, developed by working group consisting of academic staff specifically for this purpose. Summary of results: Students from 3rd and 6th year answered basic questions successfully (>60% questions were correct 44, 5% and 42,2% accordingly). For clinical questions: 85, 2% of 3rd year and 84,3% of 6th year students have answered of clinical questions successfully (>60% correct). In clinical cases 11, 1% of basic students has answered >75% of clinical cases, compared to 47, 3% of clinical students. 88,*% of basic students can't answer more than 50% of cases vs. 52, 6% of clinical students.

Conclusions: Retention level of basic knowledge is high for clinical year students. The structure of DTMU MD program enables efficient mapping of basic sciences with clinical content, while putting of the content into particular patient cases is still problematic. Take-home messages: There is a need for strengthening students' clinical problem-solving and clinical management skills through PBL and VP learning.


Teaching differential diagnosis formation during pre-clinical training: first year medical student attitudes toward clinical integration and self-directed learning

Brad Martin (Mayo Clinic, Mayo Medical School, 200 First Street S.W., Rochester, MN 55905, United States) Joseph Grande (Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, United States)

Background: The skill of acquiring medical knowledge through self-directed learning is essential for the practicing physician. The Association of American Medical Colleges (AAMC) agrees that "the maturation of self-directed learning skills and reflection are essential to the development of clinical expertise1." Summary of work: Forty seven first-year Mayo medical students were taught the clinical skill of differential diagnosis formation during the Pathology course and displayed a consistent pattern of self-directed learning stemming from the need to arrive at solutions to problems for which the students had little previous formal instruction.

Summary of results: Students reported via anonymous survey that practicing differential formation before experiencing the formal systems-based curriculum led to their searching through electronic databases to find such solutions (85% respondents), appreciating the place of such clinical skills in future practice (100% respondents), and becoming more comfortable at performing such skills (85% respondents). Further, students reported a belief that they should be learning these skills during the first year (96% respondents) and that they learned information about disease processes not explicitly taught during the course (89% respondents).

Conclusions: We believe that the practice of integrating the clinical skill of differential diagnosis formation early in the medical school curriculum fosters self-directed

learning and positive student attitudes toward such learning.

Take-home messages: Pre-clinical medical students develop positive attitudes toward self-directed learning through early integration of clinical skills in the medical school curriculum.

Recommendations for Clinical Skills Curricula for Undergraduate Medical Education. Task Force on the Clinical Skills Education of Medical Students. Association of American Medical Colleges, Washington DC, 2008 www.aamc.org/meded/clinicalskills/


A study to explore the role of SimMan as an adjunct in teaching clinical skills to preclinical medical students

Take-home messages: SimMan acts as a useful adjunct to teach clinical skills to preclinical medical students by providing a more realistic and holistic experience of examining a patient.

Meenakshi Swamy (Durham University, School of Medicine, Pharmacy and Health, The Holliday Building, Durham University Queen's Campus, University Boulevard, Stockton-on-Tees TS17 6BH, United Kingdom) Thomas Bloomfield (Western General Hospital, Intensive Care Unit, Edinburgh, United Kingdom) Robert Thomas (University Hospital North Tees, General Surgery, Stockton-on-Tees, United Kingdom) Harnaik Singh (Freeman Hospital, Newcastle upon Tyne, United Kingdom)

Roger Searle (Newcastle University, School of Medical Sciences Education Development, Newcastle upon Tyne, United Kingdom)

Background: Simulation training has potential in developing clinical skills in preclinical medical students, but there is little evidence on its effectiveness. Summary of work: 24 first year graduate entry preclinical medical students participated in this crossover study. They were divided into two groups, one performed chest examination on each other and the other used SimMan. A pretest, midtest and post-test was conducted with the same questionnaire (ten questions on knowledge, and confidence levels rated using a Likert scale). They were assessed formatively using the OSCE marking scheme. 23 students completed a feedback questionnaire. Data was analyzed using one­way ANOVA and independent t-test. Summary of results: When the two groups were compared, there was no significant difference seen between the groups in their pretest and post-test scores on knowledge questions whereas midtest scores increased significantly (P< 0.001) with the group using SimMan initially scoring higher. A significant increase in the test scores was seen between pre-test and mid-test for this group (P=0.009). Their confidence ratings increased significantly in differentiating between normal and abnormal signs. When their ability to perform examination on each other for both groups was compared, there was a significant increase in the scores of the group starting with SimMan (P=0.007). Conclusions: This study demonstrated a significant improvement in the students' knowledge and competence to perform chest examination after simulation with an increase in their confidence. Students' feedback was extremely positive.

2E Research Papers: Education in the

Clinical Context 1

Location: Meeting Hall V, PCC


Validation of the Interprofessional Collaborative Competency Attainment Survey

Douglas Archibald (University of Ottawa, Faculty of Medicine, Department of Family Medicine, 43 Bruyere St., Room 369y, Ottawa K1N 5C8, Canada) David Trumpower (University of Ottawa, Faculty of Education, Ottawa, Canada)

Colla J. MacDonald (University of Ottawa, Faculty of Education, Ottawa, Canada)

Introduction: The Interprofessional Collaborative Competency Attainment Survey (ICCAS) is a unique assessment instrument in the field of Interprofessional Education (IPE) as it is one of the first validated surveys to measure the competences of interprofessional care and incorporates a retrospective pre-test/post-test design. The ICCAS includes 20 pre IPE program and 20 post IPE program items, each answered on a seven point Likert scale (from strongly disagree to strongly agree). Items on the survey relate to the elements of interprofessional collaboration (IPC): communication, collaboration, patient/family centred approach, roles and responsibilities, conflict resolution and management, and team functioning. Methods: Data were collected from research participants who included five hundred and eighty four students and clinicians in Canada and New Zealand registered in 15 interprofessional education undergraduate, graduate, and continuing professional development programs. Several psychometric analyses were conducted using this data set to provide evidence regarding the validity and reliability of the ICCAS. The internal consistency of the ICCAS scale was assessed with Cronbach's alphas. Item-total correlations were computed between individual item responses and the total scale score. Construct validity of the ICCAS was assessed with Exploratory Factor Analyses with Varimax rotation for the pre-test and post-test items. Results: Paired-samples t-tests were conducted between the pre/post IPE program scores. There was a significant difference in ratings for each pre-test/post-test item of the ICCAS. The 20 pre-test and 20 post-test were subjected to principal components analysis (PCA). The KMO and Bartlett's Test of Sphericity was .96 and .97 for the pre-test and post-test respectively, reaching statistical significance and supporting the factorability of the matrix. PCA revealed the presence of two factors for the pre-test items with eigenvalues exceeding 1, explained 62.9% and 3.8% of the variance respectively. A single factor with an eigenvalue exceeding 1, explained 71.7% of the variance for post-test items. The ICCAS has good internal consistency with Cronbach alpha coefficients of .96 and .94 for the pre-test items and .98 for post-test items.


Discussion and Conclusion: Given the need for a psychometrically sound measure of IPE/IPC competency, we examined the reliability and validity of the ICCAS in a variety of IPE settings. Overall, these data from 584 learners across 15 programs support the ICCAS as a psychometrically sound and valid measure for assessing self-reported attitudes and behaviours toward IPC. It appears from the factor analysis of the pre-test items that the first factor corresponds with individual's own role/skills in collaborating, whereas the second factor corresponds with the roles and functioning of the rest of the team. After the IPE intervention there appears to be only a single factor indicating there is no distinction between the individual and team. This study shows evidence in support of the reliability and validity of the ICCAS for measuring self-report retrospective pre and post IPE intervention competency attainment for IPC. However, this research explored interprofessional collaboration as a single competence consisting of all the IPC elements. Future research might consider how all the elements of IPC interrelate and explore how the ICCAS can be used with other IPE assessments.

References: Curran V.R., Casimiro L., Banfield V., Hall P., Lackie, K., Simmons B., Tremblay M., Wagner S., Hollet A., Oandasa, I. (2009). Research for Interprofessional Competency-Based Evaluation (RICE), Journal of Interprofessional Care, 23(3): 297-300. Giordano C., Umland E., & Lyons K.J. (2012). Attitudes of faculty and students in medicine and the health professions toward interprofessional education. Journal of Allied Health, 41(1), 21-25.

Hoogstraten J. (1982). The retrospective pretest in an educational training context. Journal of Experimental

Education, 50, 200-204.

MacDonald C. J., Archibald D. B., Stodel E. J., Chambers L.W., & Hall P. (2008). Knowledge translation of

interprofessional collaborative patient-centred practice. McGill Journal of Education, 43(3), 283-308. MacDonald C.J., Archibald D., Trumpower D., Cragg, E., Casimiro L., & Jelley W. (2010) Quality standards for interprofessional healthcare education: Designing a toolkit of bilingual assessment instruments. Journal of Research in Interprofessional Practice and Education,

1(3), 1-13.


Self-centeredness or patient-centeredness - final year nursing students' learning experiences at a clinical education ward

Katri Manninen (Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Karolinska University Hospital, Department of Infectious Diseases, Stockholm 141 86, Sweden) Elisabet Welin Henriksson (Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden)

Max Scheja (Stockholm University, Faculty of Social science, Department of Education, Stockholm, Sweden)

Charlotte Silen (Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Stockholm, Sweden)

Introduction: Clinical education wards have been established giving students more autonomy and responsibility with the aim of facilitating transition from student to professional. In a previous study we found that the most important components in first year students' learning in a clinical ward are mutual relationships with patients and a sense of belongingness in the caring team. This created feelings of both internal and external authenticity. Transformative learning theory is used as a framework concerning learning in this study. The aim was to explore final year nursing students' experiences of learning when they are encouraged to take care of patients independently under supervision.

Methods: Individual and group interviews with 18 students were conducted after their clinical practice. Data were analyzed using qualitative content analysis with a particular focus on students' experiences of their encounters with patients, supervisors, students and other professionals.

Results: The final year students' learning turned out to be very different. Their experiences of being asked to take responsibility and being closely involved in patient care were signified by uncertainty and resistance to engage with patients. The feeling of uncertainty was characterized by self-centeredness and ambivalence. Patients were described from the perspective of performing different tasks. Uncertainty seemed to constitute a threshold for creating relationships with patients and being a part of the caring team. Caring for patients with extensive need for nursing care helped the students to overcome the threshold and experiencing engagement and learning similar to first year students. Discussion and Conclusion: The comparison between the two groups is interesting in order to better understand how a clinical ward can benefit students on different levels. Threshold concept theory and the concept of authenticity provide a framework for discussion of the results. The final year students become aware of the complex reality, which they will soon enter as active professionals without having someone to rely on for advice on how to tackle challenges. They have started the transition from student to professional nurse and the feeling of uncertainty becomes a hindrance for learning. Faced with responsibility to take care of patients the students seem to experience a threat. The reaction is to distance themselves from the patients, the supervisors and other students and put nursing tasks up front. At the same time they look for guidance and support. A clinical education ward, with explicit pedagogical framework, offering both challenges and support provides opportunities for final year students to overcome their uncertainty and become patient-centered in their learning. The experiences of both external and internal authenticity seem to be important for student learning in clinical practice. External authenticity is reached by being in a ward taking care of patients. Internal authenticity is experienced when the

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