Автор неизвестен - Mededworld and amee 2013 conference connect - страница 24

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Experiences of a professional behavior board

P.C. Barnhoorn (Leiden University Medical Center, Public Health and Primary Care, Coornhertstraat 56, Leiden

2332 AS, Netherlands)

J.H. Bolk (Leiden University Medical Center, Public Health and Primary Care, Leiden)

M.W. Ottenhoff (Leiden University Medical Center, Public Health and Primary Care, Leiden, Netherlands) A.J. de Beaufort (Leiden University Medical Center, Leiden, Netherlands)

Background: Professional behavior has become a cross-cutting element in medical curricula. Our definition of professional behavior is "observable behavior from which the norms and values of the medical professional can be inferred". Professional behavior can be divided into three domains, i.e. 'dealing with tasks/work', 'dealing with others' and 'dealing with oneself'. At our medical school, a student who behaves unprofessionally, can be referred to the LUMC professional behavior board. This board consists of MDs as well as a psychologist and invites the student to discuss his/her case. In conjunction with the student a remediation program will be started. Summary of work: We categorized the reported cases (June 2009-January 2013) in terms of the three domains, in terms of the phase in the curriculum, gender and background of the student.

Summary of results: Over the past 3,5 years, 69 cases were reported (about 2 % of the students), most of them during the internships. The majority was male (n=46, i.e. 67% of the reported students, whereas of the total amount of students only 35% is male), about 30% (n=21) was of foreign background and in most cases a combination of domains was impaired. Conclusions: Unprofessional behavior is most often observed during internships. Men and foreign students are over-represented. The outcomes at LUMC seem to match with the outcomes of other medical schools, but more research is needed to confirm this. Take-home messages: A minority of the students is referred to our professional behaviour board, most often during internships. Men and foreign students are over-represented.


Students with professionalism lapses: Remediation approaches at US and Canadian medical schools

Deborah Ziring (Drexel University College of Medicine,

Medical Education, Philadelphia, United States)

Suely Grosseman (Universidade Federal de Santa

Catarina, Pediatrics, Rua Arno Hoeschel 121, apto 802,

Florianopolis 88015-620, Brazil)

Deborah Danoff (University of Ottawa, Medical

Education, Ottawa, Canada)

Steven Rosenzweig (Drexel University College of

Medicine, Emergency Medicine, Philadelphia, United


Dennis Novack (Drexel University College of Medicine, Medical Education, Philadelphia, United States) Amanda Esposito (Drexel University College of Medicine, Medical Course Student, Philadelphia, United States)

Background: Medical schools have been increasingly engaged in the teaching and assessment of medical professionalism, as reflected in the medical education literature. By contrast, there have been limited reports on formal remediation for medical students with lapses in professional behavior, an area that has not been well researched.


Summary of work: The authors conducted a cross-sectional, descriptive study examining strategies used by US and Canadian medical schools to remediate students' lapses in professionalism. Senior faculty or administrators responsible for professionalism at these schools were invited to participate in the study and 85 accepted (55%). Data were collected by phone interview using a structured questionnaire comprising open and closed-ended questions.

Summary of results: Schools generally use a number of strategies to remediate unprofessional lapses. The most commonly used are mandated mental health evaluation (and/or treatment); repetition of course or clerkships under faculty supervision focusing on professionalism deficit; directed independent study with or without assigned projects; stress management counseling and professionalism mentoring. Community service is not frequently prescribed. Some respondents highlighted the importance of dialogue with the student and others emphasized the evaluation of student stress level and mental health. Thirty-eight schools have a faculty development program to train faculty on how to respond to professionalism issues. Conclusions: This survey found schools employing a range of professionalism remediation strategies. Take-home messages: The remediation of professionalism lapse requires a variety of individualized strategies.


Teaching, training, and assessment of professional behaviour at VUmc School of Medical Sciences Amsterdam

Marianne Mak-Van der Vossen (VUmc School of Medical Sciences, Department of General Medicine and Elderly Care Medicine, Van der Boechorststraat 7, MF-D 512, Amsterdam 1081 BT, Netherlands) Saskia Peerdeman (VUmc School of Medical Sciences, Department of Neurosurgery, Amsterdam, Netherlands) Gerda Croiset (VUmc School of Medical Sciences, Amsterdam, Netherlands)

Rashmi Kusurkar (VUmc School of Medical Sciences, Amsterdam, Netherlands)

Background: Training in professionalism has been recommended as an integral part of the medical curriculum. We wanted to design a programme in which professional behaviour would be enmeshed in medical and technical/clinical courses.

Summary of work: We designed an educational theme "Professional Behaviour" (PB) as a longitudinal thread throughout the six-year curriculum, and implemented it from September 2010. All teachers are involved in explicit and implicit teaching of PB. PB is taught to all students and not only to those who display unprofessional behaviour. Both formative and summative assessments are carried out for PB. Students' self-reflection is promoted by feedback from peers and teachers. Longitudinal guidance of "unprofessional" students is achieved by "forward feeding" of students' learning goals.

Summary of results: The total number of students in our institution is about 2500. In the last five academic years the number of unsatisfactory judgments on PB rose

from 12 (2008/2009), 38 (2009/2010), 38 (2010/2011),

83 (2011/2012) to more than 100 (expected for


Conclusions: The awareness and knowledge of students and teachers about PB has improved and unprofessional behaviour is increasingly being reported. Creating an educational theme of PB helped in communicating the importance of good professional behaviour and of reporting unprofessional behaviour to the teachers, as was reflected in the increase in the number of unsatisfactory judgements reported. Take-home messages: Formative assessments are important moments for giving feedback to the students on their professional behaviour. Summative assessments can be used to filter students with unprofessional behaviour.


Components of the Conscientiousness Index and Peer Estimates of Professionalism in undergraduate medical students

Andrew Chaytor (Durham University, School of Medicine, Pharmacy & Health, Queens Campus, University Boulevard, Holliday Building C141, Stockton-on-Tees TS17 6BH, United Kingdom) Marina Sawdon (Durham University, School of Medicine, Pharmacy & Health, Stockton-on-Tees, United Kingdom) Gabriella Finn (Durham University, School of Medicine, Pharmacy & Health, Stockton-on-Tees, United Kingdom)

Background: Negative behaviour in medical students is associated with post-graduate disciplinary action. It would therefore be useful to have a model whereby unprofessional behaviour at undergraduate level can be easily identified.

Summary of work: We have previously developed a scalar measure of conscientiousness, the Conscientiousness Index (CI), which positively correlates to estimates of professional behaviour in undergraduate medical students. We have examined which of the 16-20 components that comprise the CI have the greatest level of correlation with peer estimates of professional behaviour.

Summary of results: Initial evaluation of data suggests that the component with the greatest level of correlation to peer estimates of professional behaviour is whether students have completed course evaluation feedback tasks. This is despite this activity being a relatively small component in terms of CI points awarded.

Conclusions: Completion of course evaluation tasks is a good predictor of peer estimates of professional behaviour.

Take-home messages: When constructing and implementing a scalar of conscientiousness as a proxy measure of professional behaviour in undergraduate medical students the inclusion of course evaluation


tasks is a key component despite comprising only a small proportion of available CI points.

3K Short Communications: Leadership 1

Location: Club B, PCC


A study to explore the effectiveness of different leadership learning opportunities

Lindsay Hadley (KSS Deanery, School of Leadership, 7 Bermondsey Street, London SE1 2DD, United Kingdom) David Black (KSS Deanery, Dean, London, United Kingdom)

Background: Because of its importance in improving and maintaining high standards of patient care, leadership is part of the curriculum for postgraduate doctors in all specialties. This study demonstrates that doctors in training are more likely to report learning in all the domains of the Medical Leadership Competency Framework(MLCF) if they have carried out a project over time or held a leadership role.

Summary of work: The Deanery has made one annual documented formative leadership assessment mandatory for trainees and their supervisors who were encouraged to use the LEADER tool which supports discussion about each of the domains of the MLCF. Trainees were surveyed about their experience of this assessment, their leadership learning opportunities, and asked to map their leadership learning to these domains.

Summary of results: 212 trainees completed the survey. Trainees that reported learning in all domains of MLCF were more likely to have reflected on a number of different experiences as part of implementing a change project or to have held a leadership role such as trainee representative. Where the learning opportunity was a single experience, trainees were more likely to have covered only one or two of the domains. Conclusions: Undertaking a project to implement a change over time or taking on a leadership role is more likely to enable trainees to develop their leadership skills in all domains of the MLCF during the course of the year. Take-home messages: Sustained projects and leadership roles are good opportunities to increase the breadth of leadership skills learning for doctors in training.


Leadership behaviors in clinical practice in relation to job-satisfaction of residents

MA van der Wal (University Medical Center Groningen, Center for Research and Innovation in Medical Education, Antonius Deusinglaan 1, Groningen 9713 AV, Netherlands)

F Scheele (St Lucas Andreas Hospital/VU University

Medical Center, Amsterdam, Netherlands)

JCC Borleffs (University Medical Center Groningen,

Groningen, Netherlands)

J Cohen-Schotanus (University Medical Center

Groningen, Center for Research and Innovation in

Medical Education, Groningen, Netherlands)


Background: Job satisfaction is related to job performance, patient safety and stress -a common problem among residents. Therefore, it is important for residents to be satisfied with their job. Research outside of medical education shows that leadership behaviors contribute to job-satisfaction. In transactional leadership theories, task and relation leadership behaviors are distinguished. In this study we investigated whether task-oriented and relation-oriented leadership in clinical practice relate to residents' job-satisfaction. Summary of work: Recently appointed residents (N=165) were invited to fill out a questionnaire. Task-oriented and relation-oriented leadership of clinical supervisors were each measured on 2 behavioral aspects (4-point scale,1=never,4=often). Job-satisfaction was measured on 14 aspects, categorized in three domains of work: the cognitive, affective and instrumental (10-point scale,1=not satisfied,10=completely satisfied) (Ostroff,1993). Summary of results: Respondents were 117 residents (71%). Task-oriented leadership correlated significantly with appreciation for management (r=.22) and appreciation for administrative tasks (r=.17). Relation-oriented leadership correlated significantly with satisfaction with professional accomplishments (r=.20), appreciation of (r=.22) and collaboration with colleagues (r=.12), appreciation for management (r=.26) and appreciation of patients (r=.26). Conclusions: Task-oriented leadership related to less aspects of job-satisfaction than relation-oriented leadership. According to theory, task-oriented leadership enhances residents' learning. However relation-oriented leadership seems to be at least as important for residents because of its larger influence on job-satisfaction.

Take-home messages: Clinical supervisors should be aware of the influence of their leadership behaviors on several aspects of job-satisfaction of residents.


What makes a practice leader good?

Adam Tibor Schlegl (University of Pecs Medical School, Department of Behavioural Sciences, Kontrassy utca 8, Kaposvar 7400, Hungary)

Adam Feldmann (University of Pecs Medical School, Department of Behavioural Sciences, Pecs) Zsuzsanna Fuzesi (University of Pecs Medical School, Department of Behavioural Sciences, Pecs)

Background: As our previous studies have shown, the quality of the practical education is the most important factor influencing student satisfaction. Therefore, development in this field can efficiently increase the prestige and marketability of the faculty. The goal of our study was to explore the connection between the personality of the practice leader and the judgement of the subject and to define the factors, which determine the judgement of the practice leaders. Summary of work: 16581 anonymous questionnaires have been processed. Explorative and confirmative factor analysis has been used to validate the inventory.

Forward stepwise automatic linear modelling was used to explore the underlying connections between the items.

Summary of results: Our developed questionnaire can define the judgement of practice leaders with 94,6% validity and in four components. Satisfying, 65-80% accurate linear models were made, which have determined, that the personality of practice leader is only the sixth most important factor in the judgement of his/her subject. In the judgement of the practices, the personality of practice leader is the second most important, right after the usefulness of the practice. External factors do not influence the judgement of practice leader, each of the ten important influencing factors are connected to his/her personality. Conclusions: Although the practice is the most important in the judgement of the subject, but its usefulness is more important, than the personality of practice leader. External factors do not influence the judgement of practice leaders, but different factors depend on the year and the nationality. Take-home messages: The secret of the good practice is the usefulness.


A unique evaluation approach to examine and enhance effectiveness of a Leadership and Management Training Programme (LaMP) for Medical Specialty Trainees in NHS Scotland

Linda Halley (NHS Education for Scotland, Educational Research & Medical Directorate, Westport 102, West Port, Edinburgh EH3 9DN, United Kingdom)

Background: To provide high-quality service to patients, Doctors need to possess leadership and management competences. NHS Education for Scotland and the TDSU* deliver a national Leadership and Management Training Programme (LaMP) which aims to support medical professionals to become effective leaders/managers through the acquisition of generic competencies, that map to the Medical Leadership Framework.

Summary of work: New educational research is examining the effectiveness and impact of LaMP training through an integrated evaluation approach combining the use of an enhanced version of the Kirkpatrick Model (Levels 1-3) with a Theory of Change approach i.e. Logic Modelling. Employing mixed methods, the evaluation aims to assess clinicians' satisfaction with courses and knowledge, attitudes and behaviours related to leadership and management using a comprehensive self-report pre/post-course questionnaire (L 1-3). A test of knowledge examines learning acquired of course taught content (L 2). Changes in clinicians' behaviour/practice are examined using detailed training impact surveys, semi-structured qualitative interviews and an analysis of workplace multi-source feedback data (L 2 & 3). Qualitative data is thematically analysed. Access, Excel and SPSS are used to analyse quantitative data.


Summary of results: The on-going evaluation has captured some positive results endorsing the quality and delivery of LaMP. The Programme Logic Model and results from the tests of knowledge will be presented as well as the impact of the programme upon clinicians. Self-reported and workplace assessment data will be triangulated.

Conclusions: Leadership and Management training may have the potential to exert a positive impact upon Doctors. Improving quality of training could strengthen its impact and this can be more reliably assessed utilising integrated evaluation approaches. Take-home messages: Implications and learning from the programme and evaluation are informing the wider national and international agenda of health service quality improvement and better patient care.


Developing leadership in rural healthcare education

Judi Walker (Monash University, School of Rural Health, Wellington Road, Clayton 3800, Australia) Jennene Greenhill (Flinders University, Rural Clinical School, Adelaide, Australia)

Background: Rural healthcare educational leadership and succession planning have been identified as areas of need across the world. The Federation of Rural Australian Medical Educators (FRAME), the peak body representing 17 Rural and Regional Clinical Schools (RCS) has developed an innovative course for potential leaders.

Summary of work: Australian RCS have been outstandingly successful in establishing training infrastructure evidenced by emerging numbers of medical graduates trained in and for rural practice. While the development of clinical leadership skills and roles is increasingly recognised as a prerequisite for improvements in the quality of care, there is little evidence of successful succession planning to advance healthcare educational leadership in rural settings. Summary of results: An Australian course to develop health educators' leadership skills has evolved over the past three years. In 2013 it will be delivered by RCS faculty for colleagues. Evaluation results will be presented and discussed. The four day program has been designed as an intensive, experiential and active approach to learning with activities built around 4 central themes: Leadership concepts and challenges in rural healthcare education; Understanding self as a leader; Leading teams and managing difficult and complex situations; Setting direction and RCS succession planning.

Conclusions: Succession planning is an essential part of educational strategy. Developing rural healthcare education leadership is complex and takes time. Service and training issues are inextricably linked and capacity-building around both must be continuous to ensure sustainability.

Take-home messages: Invest in leadership training as an essential pre-requisite for workforce sustainability.


Exploring a health professions students' perceptions toward leadership and facilitation: a case from Japan

Chihiro Kawakami (Gifu University, Medical Education Development Center, Yanagido1-1, Gifu 501-1194, Japan)

Takuya Saiki (Gifu University, Medical Education

Development Center, Gifu, Japan)

Kazuhiko Fujisaki (Gifu University, Medical Education

Development Center, Gifu, Japan)

Masayuki Niwa (Gifu University, Medical Education

Development Center, Gifu, Japan)

Yasuyuki Suzuki (Gifu University, Medical Education

Development Center, Gifu, Japan)

Background: Effective human relationship among health professions is vital in multidisciplinary teamworking. Although there is a wealth of literature on team working and leadership from western countries, more studies in undergraduate settings are needed in Japan since how a team works is usually based on cultural context. We aim at exploring health professions students' perceptions towards teamwork, leadership and facilitation. Summary of work: A two day-case based seminar with small group discussions was delivered for 26 health professions students from 5 different professions. Focus group was conducted to investigate perceptions toward multidisciplinary team working, leadership and facilitators. The transcriptions were analyzed with thematic analysis.

Summary of results: The seminar provided participants with deep understanding of the role as well as competence of their own or other health professionals, which was hard to understand within their own schools. Their image of other health professions was already transformed. Medical students took it for granted to take initiatives while other students did not because of their incompetence as professionals or prejudice against other professionals.

Conclusions: Although previous literature demonstrated that interprofessional teams need skilled leadership and members who respect and value each other, health professions students have already transformed their stereotyped perceptions of other health professions from early stages of the school. Nevertheless, positive cognitive change was also indicated. Japanese health professions students' perceptions of leadership/facilitator were demonstrated, which may be useful for quality improvement of the seminar. Take-home messages: Stereotyped perceptions and clinical experiences must be well balanced when designing multidisciplinary education.

3L Short Communications: Teaching and


Location: Club C, PCC


The art of observation: visual analysis training for medical students

Carol Capello (Weill Cornell Medical College, Academic Affairs, 1300 York Avenue, Room C-205, Box 243, New

York 10065, United States)

Rachel Dubroff (Weill Cornell Medical College, Medicine, New York, United States)

Background: Although visual skills are inarguably crucial for competent clinicians and although many institutions have initiated programs using visual arts to develop observational skills, enhance creativity, and introduce cultural models of illness and healing, little evidence reflects these goals are being met. Summary of work: Clinical observation extends beyond what one sees to how one processes and integrates that information. We developed a novel, elective, visual-arts-based series of courses to enhance students' visual observation skills and help them explore the role of perception, biases, emotion, and communication in the observational process. Small groups of first- and second-year students spend 5-15 two-hour sessions at the Metropolitan Museum of Art with an art educator. Through inquiry-based discussion and writing and sketching exercises, they explore the formal elements of myriad artworks and participate in activities to pique understanding of biases, emotion, and communication in the visual process.

Summary of results: Assessment plans include pre- and post-course visual observation using both art and medical images, as well as longitudinal tracking of performance in visually-associated courses (e.g., radiology, histology). We are currently exploring other methods to quantitatively assess impact on clinical thought processes and practice. Conclusions: Strengths include helping students learn skills not traditionally addressed in medical education. Limitations include whether acquired skills are applicable in clinical settings and whether the general student population will be open to this novel approach. Take-home messages: The visual arts offer a rich resource to enhance observational and other clinical competencies. Further study is necessary to demonstrate its efficacy.

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