Автор неизвестен - Mededworld and amee 2013 conference connect - страница 49

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Background: The study objective was whether a holistic education programme incorporating multiple educational strategies such as early exposure, ageing simulation and small group teaching results in improving

geriatrics knowledge and attitudes among medical students

Summary of work: We administered the University of California Los Angeles (UCLA) Geriatric Knowledge Test (GKT) and Singapore-modified UCLA Geriatric Attitudes Test (GAT) to 2nd year students of old curriculum (control) and before and after new module to students of new curriculum (intervention) with appropriate ethical approval.

Summary of results: For control group the response rate for GAT was 76.8% (195/254). For intervention cohort, response rate for GAT was 78.1% (204/261) before the module; whilst the response rates were 64.8% (169/261) and 75.8% (198/261) UCLA-GKT and UCLA-GAT respectively after the module. There was no difference UCLA-GKT scores between baseline control and intervention cohorts [mean: 31.6% (SD = 15.7%) versus 33.5% (SD = 14.2%), p = 0.207]. UCLA-GKT scores significantly improved in the intervention cohort after new module [mean: (before) 34.0% (SD=14.3%) versus (after) 46.0% (SD = 16.2%), P <0.001]. The attitudes towards geriatric patients of intervention cohort before new module was less positive than baseline reference cohort [mean GAT: (intervention) 3.46 (SD = 0.36) versus

(baseline reference) 3.56 [(SD = 0.32), P = 0.015].

Attitudes of the intervention cohort became more positive after new module [mean GAT: (before) 3.46 (SD = 0.36) versus (after) 3.53 (SD = 0.36), P = 0.001]. Conclusions: An integrated geriatric module incorporating sound educational principles improved both geriatrics knowledge and attitudes of early medical year medical students.

4CC Posters: Continuing Professional Development

Location: South Hall, PCC


Reliability analysis of medical record review for assessing patient care performances

Junichi Kameoka (Tohoku University Graduate School of

Medicine, Office of Medical Education, 2-1 Seiryo-cho,

Aoba-ku, Sendai 980-8575, Japan)

Mitsunori Miyashita (Tohoku University Graduate School

of Medicine, Department of Health Sciences, Sendai,


Tomoya Okubo (National Center for University Entrance Examinations, Department of Test Analysis and Evaluation, Tokyo, Japan)

Emi Koguma (Tohoku University Graduate School of Medicine, Office of Medical Education, Sendai, Japan) Seiichi Ishii (Tohoku University Graduate School of Medicine, Office of Medical Education, Sendai, Japan) Hiroshi Kanatsuka (Tohoku University Graduate School of Medicine, Office of Medical Education, Sendai, Japan)

Background: Implicit review of medical records has met with difficulties because of poor interrater reliability. To establish a reliable peer review system of medical records in Japan, we have attempted a pilot study in

2011, with moderate reliability. After revising an evaluation sheet and developing clear criteria, we have conducted a study to examine reliability and validity of this system.

Summary of work: We randomly selected 112 patients, who visited (and were hospitalized in) four general hospitals in the Tohoku region in Japan from 2008 to

2012. Their main diagnoses included 30 gastrointestinal diseases, 30 cardiovascular diseases, 12 respiratory diseases, and 40 other diseases. Four reviewers, who are well-trained general internists outside the Tohoku region, visited the hospitals independently, and evaluated the outpatient medical records (paper-based for one hospital and electronic for three hospitals) according to the evaluation sheet. The evaluation sheet consists of 14 items (3-point scale) for record keeping and 15 items (5-point scale) for quality of care. Summary of results: The total time required for evaluation ranged from 1170 to 1405 minutes (mean 1260 minutes: 11.3 minutes per patient). The mean total score was 84.1±7.7 (54-108). The single measure and average measure intraclass correlations for reviewers were 0.733 (95% confidence interval, 0.720-0.745) and 0.917 (95% confidence interval, 0.912-0.921) respectively. Factor analysis for the items revealed six factors: history taking, physical examination, clinical reasoning, management and outcome, rhetoric, and patient relationship.

Conclusions: This system proved feasible with high correlations for assessing patient care performances. Take-home messages: With a structured evaluation sheet, proper criteria, and trained reviewers, implicit


review of medical records could have adequate reliability.


Continuing Medical Education in a Resource-limited Setting: Staff Experiences

Tomas-Paul Cusack (Mae Tao Clinic, General Medicine,

Kirklington, Newark, Notts, United Kingdom)

Naomi Drummond (Mae Tao Clinic, Obstetrics and

Gynaecology, Mae Sot, Thailand)

She Mae (Mae Tao Clinic, Medicine, Mae Sot, Thailand)

Lois Thien (Mae Tao Clinic, Medicine, Mae Sot, Thailand)

Background: Medical care in resource-limited settings is commonly provided by clinical officers without medical school training. Continuing Medical Education (CME) is essential for these healthcare workers given their relative lack of academic background. At Mae Tao Clinic, Thailand, CME comprises weekly lectures to clinical officers from all departments, with written exams. By analysing staff experiences and individual learning behaviour, we hoped to identify key components of effective educational delivery that could potentially be applied to similar low-resource settings. Summary of work: We interviewed 32 clinical officers from 4 departments (medicine, paediatrics, surgery and women's health) to appraise the current programme, identify areas for improvement and characterise individual learning habits.

Summary of results: 27/32 (84%) attended most/all sessions. Because many staff anticipated future employment in smaller, general clinics, most preferred learning about a wide range of subjects, with only 6/32 (19%) preferring topics solely relevant to their department. Preferred teaching format was tutorials with handouts (84%). All found exams valuable as revision motivators and learning tools. 23/32 (72%) referred to lecture handouts when consulting. Only 6/32 (19%) used the internet as a learning resource, with lack of computer training and access as the main barriers. All expressed a desire for computer training. Conclusions: We have identified the following key components of an effective CME programme: 1. Frequent tutorials with handouts; 2. Broad range of cross-specialty topics; 3. Regular examinations; 4. Access to computer training and e-learning resources. Take-home messages: These features may be applicable across similar healthcare settings.


Tutoring in a Distance Education of Open University of National Health System, in Brazil

Marcia Hiromi Sakai (Open University of the National Health System/Fiocruz, Assessment and Evaluation, Av. Jose Gabriel de Oliveira, 999 ap 604, Jardim Aurora, Londrina, Parana 86047360, Brazil) Maria Jose Sparga Salles (State University of Londrina, Biology, Londrina, Parana, Brazil)

Vinicius Oliveira (Open University of the National Health System/Fiocruz, Knowledge Management, Brasilia, DF, Brazil)

Alysson Lemos (Open University of the National Health System/Fiocruz, Monitoring and Evaluation, Brasilia, DF, Brazil)

Francisco Campos (Open University of the National Health System/Fiocruz, Brasilia, DF, Brazil) Roberto Vianna (Open University of the National Health System/Fiocruz, Planning, Brasilia, DF, Brazil)

Background: UNA-SUS is a collaborative network of 16 Universities (Open University of Brazilian National Health System) that offer distance education in a postgraduate level for primary health care professionals in Brazil. One of the outcomes was the greater coverage and better quality of learning opportunities. UNA-SUS offered 33,167 places in all courses and graduated 15,766 healthcare professionals in postgraduate courses, in 2012. This paper aimed to evaluate tutorship developed in UNA-SUS.

Summary of work: The profile of the tutors and main activities developed by the tutors during the course of the 9 Universities and 11 Specialization courses of Family Health, Mental Health and Management of Pharmaceutical Assistance was analysed. Summary of results: Tutors were physician, nurse, dentist, pharmacist, and physiotherapist, with Specialization, master degree and doctorate degree. Their backgrounds were teaching in Higher Education and practice in healthcare services, mainly in Primary Health Care. Role of tutors were to promote learner autonomy, by providing environment, materials, and formative assessment to students to facilitate learning. They usually dedicated 12 hours per week. The relationship of tutor and students was established in a virtual learning setting, and each tutor followed 25-30 students.

Conclusions: The tutor had an important role to motivate students to study and finish their courses by offering guidance, assessment, and support. Take-home messages: Tutor development is key issue to ensure the quality of tutoring.


Readiness for Online Learning among Medical Professionals - The Sri Lankan Experience

Pramil C Liyanage (Post Graduate Institute of Medicine, Biomedical Informatics, A4/2/2, Maning Town, Colombo 08, Sri Lanka)

Indika Karunathilake (Faculty of Medicine, University of Colombo, Medical Education Development and Research Center, Colombo, Sri Lanka)

S C Wickramasinghe (Ministry of Health, Management Development and Planning Unit, Colombo, Sri Lanka) R B Marasinghe (Faculty of Medicine, University of Sri Jayawardenapura, Department of Medical Education & Health Sciences, Colombo, Sri Lanka)

Background: Providing continuous medical education to medical professionals requires an efficient and a speedy


channel of delivery. Many issues are identified related to traditional classroom teaching, making it inappropriate. Web based learning is gaining popularity and it is essential to evaluate its acceptance among medical professionals.

Summary of work: A self-administered questionnaire to identify level of access to IT facilities, current level of usage of IT for learning and self-perception of competence in using online material for learning was used. Stratified sampling method was used to facilitate representation of all major levels of health care. One unit from each speciality was randomly selected in each institution. All medical officers of the selected unit were included in the study.

Summary of results: From the sample, 96.3% had regular access to internet of which 91.9% had internet access at home and majority (74.5%) used laptops for this. Internet use was limited to less than one hour per day in 62.2% and use of internet for learning was 78.3%. For online learning, 32.9% were willing to spend less than 30 min per day. The competence in using internet was basic or above in 97.3% and 87.4% had confidence in using online journals and databases. Conclusions: Although most medical professionals have facilities to access internet, the time spent for browsing is restricted. They possess adequate skill to use internet for learning and training programmes need to fit to their time schedule for successful implementation. Take-home messages: Online Training can play a major role in Continuous Professional Development of medical professionals.


Integration of Translational Science into a Continuing Professional Development Curriculum

Hao-Min Cheng (Taipei Veterans General Hospital, Medical Research and Education, Rm. R409-2, Zhi-De Lou 4F., No.322, Sec. 2, Shipai Rd., Beitou Dist., Taipei City 112, Taiwan)

Chen-Huan Chen (Taipei Veterans General Hospital, Medical Research and Education, Taipei, Taiwan)

Background: The recent rapid development of medicine has led to an enormous growth in knowledge. However, this burgeoning of knowledge has not necessarily been equated with an increase in the availability of knowledge to policymakers and clinical practitioners. Therefore, knowledge translation has been proposed by advanced economies to tackle the prevailing failure in translating research into practice in health care. It is a process involving the ongoing, iterative and interactive process of translating knowledge from research into clinical practice and policy through addressing the relating translational gaps and complex interactions between researchers and the end users of research -including trainees in clinical practice. Summary of work: We propose a unique approach to integrate the translational science into a CPD curriculum in a tertiary medical center.

Summary of results: Skills and concepts of evidence-based health care are taught in a series of small-group

didactic lectures and workshops. With the skills of literature search and critical appraisal, participants are encouraged to conduct a systematic review to synthesize current best available evidence relevant to his/her clinical problems. A working group with members specialized in biostatistics and database searching has been setup to offer guidance in the process of knowledge translation. The translational gaps could be identified and closed by designing the relevant strategies through the ongoing and iterative efforts. The effects of the curriculum will be further enhanced and assessed through the link with the resultant quality improvement projects. Occasionally, unmet knowledge need and research opportunities could also be unveiled to better the quality of clinical practice. Conclusions: Skills in translating research into clinical practice could be taught in a clinical educational curriculum.

Take-home messages: Knowledge translation is a well-appreciated value for health professionals but has not been utilized in a systematic way. We herein demonstrate a preliminary program to integrate the translational science into a CPD curriculum.


"I feel trained to perform joint injections": An interprofessional, multiple-method "mini-residency" for musculoskeletal care

Michael J Battistone (Salt Lake City VA, Primary Care, 500 Foothill Blvd, Salt Lake City, UT 84148, United


Jorie M Butler (Salt Lake City VA, United States) Andrea M Barker (Salt Lake City VA, United States) Robert Z Tashjian (Salt Lake City VA, United States) Melissa P Grotzke (Salt Lake City VA, United States) Grant W Cannon (Salt Lake City VA, United States)

Background: The George E. Wahlen VA Salt Lake City Health Care System (VASLCHCS) has recently established an interprofessional "mini-residency" in musculoskeletal care. This program seeks to develop knowledge and skills of primary providers, enabling them to manage many patients with musculoskeletal complaints in their clinics, rather than refer.

Summary of work: The mini-residency is informed by Kolb's theory of learning cycles. Two one-week sessions are held, several weeks apart, at VASLCHCS. Curriculum is introduced in didactics (abstract conceptualization), reinforced in small-group, hands-on, interactive sessions with peer teaching and technologically enhanced simulations (active experimentation), and applied in the clinic in supervised patient encounters (concrete experiences with reflective observation). Course evaluation is informed by Kirkpatrick's model of assessing educational effectiveness. Summary of results: To date, 14 mini-residents have completed a post-course survey (5-point scale; 1 = "not at all satisfied"; 5 = "extremely satisfied"). Overall satisfaction was high (mean = 4.92), and participants felt that their job performance would improve (mean = 4.69). In free-response items, clinic sessions were highly


valued. Eight weeks after the program, eleven participants completed a structured interview. All recommended the training to others. Two had started their own musculoskeletal clinic; 82% had applied content from the mini-residency to their work. Data regarding impact on referral patterns is pending. Conclusions: An interprofessional "mini-residency" in musculoskeletal care is an effective model of continuous professional education (CPE). Take-home messages: The interprofessional "mini-residency" model, effective for CPE, may inform future medical student and resident educational experiences.


External motivation and opinion about the influence on the competency of medical doctors of an organized programme of continuous medical education in the field of resuscitation

Silvija Hunyadi-Anticevic (Croatian Medical Association, Croatian Resuscitation Council, Subiceva 9, Zagreb 10 000, Croatia)

Gordana Pavlekovic (Croatian Association for Medical Education, Zagreb, Croatia)

Davor Milicic (Medical School, University of Zagreb, Zagreb, Croatia)

Background: Final course results (MCQ and Cardiac Arrest Simulation Test) were registered for candidates that attended Croatian Resuscitation Council courses between 2002 and 2010. Questionnaire has been distributed to all attendees, covering subjects such as professional background, motivation, and satisfaction with courses.

Summary of work: From the total number of 1650 candidates, 793 replied to the Questionnaire. Factors that influence the competency (knowledge and skills) were analysed according to basic education (doctor-nurse).

Summary of results: The results of regression analysis show that many factors influence the competency of candidates at the end of the course (statistically significant model, p<0,001). In the group of medical doctors, external motivators to attend the course (independent decision to attend the course, the need for knowledge and skills due to the needs of everyday work) and the opinion about the course (knowledge refreshment, fulfilled expectations from the course, high overall evaluation of the course) have substantial impact on final course results. Neither of these variables showed connection with the final course result in the group of nurses.

Conclusions: In Croatia, competency of medical doctors, but not nurses, is influenced by external motivation for attendance and opinion about the course.


CPD in Dialog - a model for CPD improvement

Evita Zoucas (The Swedish Medical Association, Department of Profession and Politics, Lund, Sweden)

Magnus Andersson (The Swedish Medical Association, Department of Profession and Politics, Sodertalje, Sweden)

Turid Stenhaugen (The Swedish Medical Association, Department of Profession and Politics, Stockholm, Sweden)

(Presenter: Eva Engstrom, The Swedish Medical Association, Department of Profession and Politics, Fortroligheten 6, Gothenburg 412 70, Sweden)

Background: Once the specialist certification has been achieved for Swedish doctors, the conditions for continuing professional development are unspecified. It is an ethical obligation for a doctor to remain updated but the resources for CPD must be facilitated by the employer. Cutbacks in funding and staffing in recent years have brought into focus medical productivity. Summary of work: Yearly surveys by the Swedish Medical Association from 2005 to 2010 have shown a significant decrease in CPD activities for Swedish doctors. We have therefore developed a model for dialog between specialists and relevant employers intending to improve CPD. In the suggested instrument among the criteria for quality assurance are the provision for individual CPD plans, the presence of educational activities, research projects and time allocated for reflection and dialog within each department.

Summary of results: The model includes: 1. Completion of a questionnaire (a) by specialists and (b) by supervisors and clinical managers in each department under review regarding their perception of CPD; 2. Site visits upon which the results are presented, strong points are emphasized and areas for potential improvement are pinpointed. Conclusions regarding the reason for the outcomes are reached in dialog; 3. A structured action plan for improvement including suggestions for measurable goals and educational activities to be followed-up.

Conclusions: In Sweden CPD for doctors is voluntary. The employer has a fundamental responsibility for creating a supportive learning environment. This instrument is created to facilitate a dialog between the management of the department and the specialist physicians to improve and increase CPD activities.


Application of a 360° Survey as a Measure of Educational Activity Efficacy

Michael V Williams (Wales Behavioral Assessment, Research, 1400 William Street, Chicago, IL 60305, United States)

Betsy White Williams (Rush University Medical Center, Behavioral Sciences, Chicago, IL, United States)

Background: Current medical practice is becoming increasing more team dependent. It is often difficult, particularly when skill deficits involve interacting with team members to determine the efficacy of a remedial intervention. For this study, we employed a tool developed to measure elements of the ABMS/ACGME


core competencies focusing on interpersonal and communication skills. The tool, a 360° assessment, was validated against known groups at a single point in time. Here we employed the 360 over repeated waves to determine its sensitivity to change over time. Summary of work: Data were gathered on physicians referred to a specialized program for high accountability professionals. The 360° evaluated elements of three core competencies: Interpersonal and Communications skills, System-based Practice, and Professionalism were gathered at four points across a year. During that same period, the physicians participated in a Continuing Medical Education (CME) activity focused on these same core competencies.

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