Автор неизвестен - Mededworld and amee 2013 conference connect - страница 32

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Medical students' perceptions on the promotion of values and attitudes within a competence-based educational model

Oralia Barboza-Quintana (Facultad de Medicina, UANL, Surgical Pathology Department, Monterrey, Mexico) Mario Hernandez-Ordonez (Facultad de Medicina, UANL, Legal Medicine Department, Monterrey, Mexico) Angel Martinez-Ponce de Leon (Facultad de Medicina, UANL, Neurosurgery Department, Monterrey, Mexico) Norberto Lopez-Serna (Facultad de Medicina, UANL, Embryology Department, Calz. Francisco I. Madero y Dr. Eduardo Aguirre Pequeno S/N, Col. Mitras Centro, Monterrey 64460, Mexico)

Raquel Garza-Guajardo (Facultad de Medicina, UANL, Surgical Pathology Department, Monterrey, Mexico) Gerardo Enrique Munoz-Maldonado (Facultad de Medicina, UANL, General Surgery Department, Monterrey, Mexico)

Background: The need for competent medical professionals nowadays implies not only the development of clinical knowledge and skills but also the consolidation of values and attitudes required in an international social context characterized by rapid changes and complexity. Having a university academic program that explicitly calls for the emphasis on and the assessment of socio-affective skills, leads to a reflection on substantial teaching methodological considerations as well as on the student's commitment to contribute to his own professional growth.

Summary of work: The study was conducted with 680 students in the fourth year of their medical studies, mean age of 20.5 years. A 42-item survey was designed to assess attitudes and values contained in the formal university medical curricula in terms of their impact on students' views about the implementation of this competence-based model. Summary of results: The results highlight the importance of attitudes such as respect for others, commitment to carry out academic work effectively and being helpful when required, showing 75.7% of students' preference. There was a low perception regarding the engagement in activities related to the improvement of natural resources and the involvement in class discussions as only 35.4% of the participants chose these options.

Conclusions: The findings from this study reflect the emphasis given to the attitudinal component of competences in medical curricula. Students recognize a need for contributing in the preservation of nature more actively and becoming involved in class discussions. Take-home messages: Monitoring the effect of diverse teaching methodologies on the development of students' attitudes during medical school guide to curriculum innovations.


The empathy of medical students does not decline everywhere: cross-sectional and longitudinal evidence from the University of Minho

Patricio Costa (Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Gualtar Campus, Braga 4710-057, Portugal)

Background: Declines in empathy throughout medical education have been reported internationally, particularly in the transition to clinical training. The undergraduate medical curriculum in the School of Health Sciences of the University of Minho emphasizes empathy in several moments and learning contexts. Summary of work: A cross-sectional and longitudinal analysis on the empathy of medical students in Minho. Empathy was assessed using the Portuguese adaptation of the Jefferson Scale of Physician Empathy-students version (JSPE-spv) validated by our research group. Summary of results: Cross-sectional study: For 3 cohorts of undergraduate medical students in the first (n = 356) and last (n = 120) year, global JSPE-spv score differences were examined by year of medical school, gender and specialty preferences. Scores of students in the final year were higher as compared to first year students. Longitudinal study: Global JSPE-spv scores in 3 time points were analyzed with latent growth modeling, conditioned by gender and personality traits. Empathy scores at all times were higher for females than for males, but only significantly different at the end of the preclinical phase. The model showed a satisfactory fit level and undergraduate medical student's empathy did not decline over time. Empathy scores were significantly and positively related with Openness to Experience and Agreeableness at admission, but the rate of change across time was not significant.

Conclusions: The cross-sectional and longitudinal results reveal a stability of empathy between the different time points.

Take-home messages: Our results suggest that the empathy of medical students does not deteriorate in every medical school.


Determination Of Medical Empathy In Pre-Graduate Students From Medicine School At National Autonomous University Of Mexico (UNAM) With Jefferson's Modified Scale

Patricia Vidal-Licona (UNAM, School of Medicine,

Clinical Teaching, Circuito de los Diamantes #135,

Colonia Joyas del Pedregal. Delegacion Coyoacan,

Mexico City 04660, Mexico)

Roberto Sanchez-Ahedo (UNAM, School of Medicine,

Family Medicine, Mexico City, Mexico)

Cristina Muzquiz-Fragoso (UNAM, General Compute

Direction, Collaboration and Vinculation Direction,

Mexico City, Mexico)


Karem Mendoza-Salas (UNAM, School of Medicine,

Clinical Teaching, Mexico City, Mexico)

Arturo Espinosa-Velasco (UNAM, School of Medicine,

Clinical Teaching, Mexico City, Mexico)

Enrique Espinosa-Manriquez (UNAM, School of

Medicine, Clinical Teaching, Mexico City, Mexico)

Background: Empathy is a fundamental component in the physician-patient relationship, difficult to measure because it is a broad concept that includes various aspects, such as cognition, emotion and affection. Its concept refers to understanding experiences and feelings of others and their assessment has been made through different instruments. The Jefferson Scale has been used for medical education in undergraduate students.

Summary of work: Objective: To apply the modified Jefferson Scale to determine its reliability and to recognize the empathy elements in pre-graduate students from Medicine School at UNAM. This is a descriptive, transversal, survey kind study that includes reliability and validity tests, applied to 1213 students. Summary of results: Cronbach's alpha was 0.80 which means an adequate reliability. The exploratory analysis of factors reported 3 different ones which explains 41.68% of variance: perspective taking, caring with compassion and taking someone else's place. The validity exceeded the minimum criteria for considering the model as good (KMO test, Bartlett's sphericity, explained variance and three latent factors). Our results do not differ from those of Alcorta-Garza. Conclusions: Modified Jefferson Scale in Mexican pre-graduate Medicine students is reliable. The instrument provides a range of broad application possibilities to approach the study of physician-patient relationship that is currently very important. Take-home messages: Empathy is an important attribute to evaluate in medical students because of its relevance in clinical practice. The Jefferson modified scale can be used in developing countries and in Spanish-speaking countries.


How to teach medical ethics for better and happier doctors

Nonglak Kanitsap (Thammasat University, Medicine, Faculty of Medicine, Thambon KlongNoeng, Amphur KlongLaung, Pathum Thani 12120, Thailand) Pisit Wattanaruangkowit (Thammasat University, Medicine, Pathum Thani, Thailand) Background: The rapid improvement of medical technology changes the perception of patients including expectations of the doctor's responsibility and accountability. Some physicians tend to focus on technological aspects of treatment with lagging awareness of patient outcomes and values. Summary of work: The objective of this project is to improve medical ethics teaching and motivate an awareness of action as role-model medical instructors. This is a qualitative research about how to teach medical ethics, by a focus group study.

Summary of results: After searching the literature and asking the opinion of senior consultants who have long experiences and a well-known person about humanized medicine in Thailand, we conducted a meeting of our institute instructors on the topic of how to make better and happier doctors. 35 medical teachers participated in this meeting. During that meeting, we discussed about humanized medicine and how to teach medical ethics. The participants' medical teacher suggested 3-steps: teach medical students to know good practice, show them good practice, and let them practice humanized medicine.

Conclusions: To improve doctor-patient relationship and motivate an awareness of taking care of patients in a holistic way is important. Better doctors need good instructors to not only teach them, but also show them and let them practice the right thing to the patients as a human being.

Take-home messages: Teaching medical doctors in a rapid pace of technological change should not focus on technological aspects of treatment, but should also be aware of patient outcomes and values.


Developing and validating a questionnaire to assess spirituality in the clinical practice of Brazilian physicians

Gabriel Beraldi (University of Sao Paulo School of

Medicine, Internal Medicine, R. Cardeal Arcoverde, 500,

Pinheiros, Sao Paulo 05408-000, Brazil)

Silmar Gannam (University of Sao Paulo School of

Medicine, Internal Medicine, Sao Paulo, Brazil)

Julio Gagliardi Filho (University of Sao Paulo School of

Medicine, Internal Medicine, Sao Paulo, Brazil)

Maria do Patrocnio Nunes (University of Sao Paulo

School of Medicine, Internal Medicine, Sao Paulo, Brazil)

Background: 90% of US and 59% of UK medical schools offer some course about spirituality. Few Brazilian medical schools have courses in this area. We developed and validated an instrument to assess how physicians deal with spirituality. No other study was conducted in Brazil with this intention.

Summary of work: The instrument was developed based in a literature review. Validation process consisted in statistical tests to analyze the validity (content validity, face validity and construct validity) and reliability (test-retest reliability and internal consistency) of the questionnaire.

Summary of results: 184 physicians of various specialties filled out the Physicians Spirituality Questionnaire (PSQ) during the validation process. PSQ demonstrated to have appropriate questions and good comprehensibility, stability and internal consistency. Factor analysis revealed 4 domains. Final version consisted of 34 questions divided in the domains: Behavior, Beliefs, Religious/Spiritual Identification and Difficulties. PSQ covers many aspects of spirituality in physicians' professional and personal lives. "Behavior" domain analyzes physicians' practices concerning spirituality; "Beliefs" assesses physicians' knowledge


about spirituality; "Religious/Spiritual Identification" inquires beliefs and the importance of religion in physicians' lives. "Difficulties" assess why physicians would not address patients' spirituality. Conclusions: PSQ demonstrated good validity and reliability. Validating PSQ enhanced its quality and allowed its use along the time to detect changes in the behavior, beliefs and difficulties considering the insertion of spirituality in the clinical practice. Take-home messages: Once the teaching of spirituality in increasing among medical schools, new instruments need to be developed to assess the impact of this knowledge in the medical practice, particularly in Brazil.


Medical student attitudes towards spirituality

M R Finlay (University of Aberdeen, School of Medicine

and Dentistry, Aberdeen, United Kingdom)

A Revolta (University of Aberdeen, School of Medicine

and Dentistry, Aberdeen, United Kingdom)

J Cleland (University of Aberdeen, School of Medicine

and Dentistry, Aberdeen, United Kingdom)

Background: Medical training recognises that people are not just biological systems but complex individuals with physical, emotional and spiritual needs. Only a few UK medical schools provide teaching on spirituality. This varies in content and delivery and there is a lack of data regarding student attitudes towards spirituality. Aberdeen introduced a Personal and Professional Development (PPD) strand in its new MBChB curriculum which incorporates spirituality teaching. This project reports the evaluation of this teaching in terms of student attitudes towards spirituality and spirituality teaching. Summary of work: This was a cross-sectional questionnaire survey, comparing Year 1 MBChB students who had not received teaching on spirituality with Year 3 students who had. Questions developed in reference to the literature. Demographic data was collected from participants. Students were emailed in advance of data collection with an explanation of the study and its voluntary nature. Paper questionnaires were distributed following a Year group lecture. Ethical approval was granted for the study. Data was entered into SPSS for analysis. Descriptive analysis and non-parametric tests were carried out. Summary of results: Questionnaires returned by 168 Y1 students and 119 Y3 students. More students in Y3 agreed that spiritual care is important to patients. However, more students in Y3 reported feeling unequipped to discuss spiritual issues if this was desired by a patient. Furthermore, 74% of Y3 students were unaware of NHS Scotland spiritual care guidelines (98% unaware in Year 1).

Conclusions: The results show a mixed impact of spirituality teaching in our curriculum. Students understand that spiritual care is important to patients but not how it fits into holistic and practical delivery of a patient's health care. Further work is required to explore

students' ideas on how spiritual care teaching can be delivered.


A study about the inclusion of Sociology and Anthropology subjects in undergraduate Health Sciences courses at a Brazilian university

Aline Winter Sudbrack (Universidade Federal de Ciencias da Saude de Porto, Health Education, Rua Francisco Ferrer, 239/301 cep: 90140420, Rua Sarmento Leite, 245 cep 90050-170, Porto Alegre, Brazil)

Background: In Brazil, it has been noticed, for the past years, the implementation of innovative pedagogical proposals for the undergraduate Health Sciences courses. Social Science offers a significant contribution to the epistemological debate - by opposing life sciences to social studies lore, and by including related themes to the health studies field.

Summary of work: This study analyses the inclusion of Health Sociology and Anthropology subjects in Medical, Biomedical, Pharmacy and Physiotherapy Schools, in the context of recent attempts to regain a wider interaction among these dissimilar fields, in order to size the historicity and multidimensionality of the phenomena of health, illness, suffering, life and death. It follows the impact of the introduction of social sciences subjects in an environment of approximately 640 students of four different courses at UFCSPA University - Brazil, since 2008, encompassing proactive methodologies which favors the student as the center of the education process and delineates education in a problem-raising perspective.

Summary of results: A reorientation of pedagogical projects approaches social to health sciences, providing an important transdisciplinarity between fields of knowledge, emphasizing the 'humanization' of academic training of future professionals, so that demands deriving from Public Health System may be met. Conclusions: The proposed formation will result in professionals better prepared to face fundamental issues concerning healthcare at community level, capacitating these individuals to promote necessary changes in Brazilian society.

Take-home messages: The reciprocity among fields of knowledge are deepened, henceforth, pedagogical contents are able to cope with new themes arising from contemporary healthcare issues.


Teaching medical genetics and physician-patient relationship using medical humanities

Carla Benaglio (Universidad del Desarrollo, Medical Humanities, Av Kennedy 5436, D-81, Santiago 76305866,


Cristina Di Silvestre (Universidad del Desarrollo, Postgraduate Office, Santiago, Chile) Paula Repetto (Universidad del Desarrollo, Communication, Santiago, Chile)


Gabriela Repetto (Universidad del Desarrollo, Genetics, Santiago, Chile)

Andres Maturana (Clinica Alemana - Universidad del Desarrollo, Neonatology, Santiago, Chile)

Background: Opportunities for using the arts and humanities in medical education have increased. Medical schools are integrating humanities into their basic curriculum. We report our experience in using literature for teaching medical genetics and reflecting on the physician-patient relationship. Summary of work: The Pulitzer price novel, "Middlesex" by Jeffrey Eugenides was used for teaching sexual differentiation disorders and to reflect on the relationship of the patient and family with the physician with second year medical students in an elective activity within the medical genetics course. Students were asked to read the novel and report on the clinical presentation, patient and family perspective, the acceptance of the diagnosis and role of the physicians involved. Guided group discussions were done with context expert clinicians. A quantitative and qualitative evaluation using a self-administered questionnaire and focus group of this intervention was done. Summary of results: Twenty-eight percent of the students (22) participated in this elective activity and all reported it as a very intense and motivating learning experience. Both evaluations confirmed that the objectives for this activity were achieved. The novel makes the students reflect on the patient and family perspective and how they want to be as physicians. Conclusions: This activity has repeatedly (4 years) shown the impact of a novel approach for integrating knowledge of genetic disorders with the emotional impact on the patient, family and treating physicians. Take-home messages: Humanities are a very creative and motivating educational strategy causing an immense emotional impact on the student.


Comparison Diagnoses of Medical Students versus Residents in Difficulty

Betsy White Williams (Rush University Medical Center, Behavioral Sciences, 1421 Research Park Dr. 3B, Lawrence, KS 66049, United States) Michael V Williams (Wales Behavioral Assessment, Chicago, IL, United States)

Background: Across the educational continuum, individuals encounter difficulties for many reasons. Researchers have studied outward, observable behaviors and underlying causes. For this study, we compared behavioral difficulties and diagnostic formulation for medical students versus residents. All were referred for multidisciplinary evaluation secondary to difficulties in their programs. We hypothesized that lapses in professionalism would be the primary concern for both groups. We expected that diagnoses and personality patterns would be similar, as personality patterns are static across development.

Summary of work: Subjects were medical trainees referred to an assessment and treatment center for professionals. Two groups (students (N=15), residents (N=35)) were compared on reasons for referral, competency area of difficulty, and diagnostic formulation.

Summary of results: Students and residents were most likely to be referred for issues involving professionalism. Residents were nearly twice as likely to have failures in interpersonal and communications skills and/or system-based practice. Medical students were significantly more likely to have Axis I diagnoses while residents' primary diagnosis was a personality disorder. Conclusions: Appropriate remediation requires an understanding of the area of difficulty and underlying causes of that failure. At least in our sample, medical students in difficulty were more likely to be suffering from clinical diagnoses. Difficult and challenging personality issues appear to become more apparent when trainees are engaged in clinical rotations. Take-home messages: Reason for referral didn't discriminate between groups. Similar to clinical medicine determination of appropriate treatment/remedial course first requires thorough assessment.


First Code of Conduct for Thai Medical Students: Self-Perception vs. Observed Practice in 2013

Amnuayporn Apiraksakorn (Khon Kaen Medical Education Center, Pediatrics, Khon Kaen Hospital, Srijan Road, A. Muang, Khon Kaen 40000, Thailand)

Background: A Code of Conduct (13 sections) for Medical Students was announced in November 2012 by consensus of the Thai Medical Students' Association Committee and the Thai Medical Council. The implementation—as judged by medical students themselves vs. their practice as observed by relatives of patients, nurses, staff and residents—was the focus of our research.

Summary of work: A self-administered questionnaire was distributed at Khon Kaen Hospital to each of: (a) 44 graduating medical students, (b) 35 relatives, (c) 39 nurses, (d) 31 staff and (e) 8 residents. Student self-evaluations of practice were rated using a 5-point Likert scale while the observations of their practice were recorded for a comparison.

Summary of results: The response rates were (a) 88.6%, (b) 80%, (c) 87.2%, (d) 96.8% and (e) 100%, respectively. Most students "strongly agreed" or "agreed" with the practicability of the code. Generally, this was comparable to the "strongly satisfied" or "satisfied" patient relatives, staff and residents; however, <50% of nurses were "satisfied" on 3 of the 13 subsections. Students ranked "not gaining from patients except education" as the easiest and "efficiently using technology whenever economical" as most difficult. Some staff and nurses reported medical students substandard communication skills and disrespect to experienced medical professionals.


Conclusions: The discrepancy between students positive self-evaluation and their actual performance needs to be addressed; particularly their overconfidence. Take-home messages: Practice of the Medical Students Code of Conduct will benefit both patients and working relationships among healthcare professionals.


Changes in medical students' perception of a good doctor as they progress through medical school

M Newman (Institute of Education, University of London, Faculty of Policy Studies, London, United Kingdom) M Kawai (Keio University, School of Medicine, Tokyo, Japan)

A Mitsuishi (Keio University, School of Medicine, Tokyo, Japan)

R Nakajima (Keio University, School of Medicine, Medical Education Center, Tokyo, Japan) T Amano (International University of Health and Welfare, Center for Postgraduate Medical Education, Tokyo, Japan)

Y Toyama (Keio University, School of Medicine, Orthopaedic Surgery, Tokyo, Japan) (Presenter: Noriko Takahashi Okuyama, Keio University, School of Medicine, Musculoskeletal Reconstruction and Regeneration, 35 Shinanomachi, Shinjuku, Tokyo 1608582, Japan)

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