Автор неизвестен - Mededworld and amee 2013 conference connect - страница 51

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Developing study guides for Integrated Curriculum: AJKMC Experience of GIT Module

Sarmud Latif Awan (AJKMC, Anatomy, AJK Medical College, Muzaffarabad-AJK 53720, Pakistan) Muhammad Saeed (AJKMC, Medical Education, MZD, Pakistan)

Muhammad Iqbal Khan (AJKMC, Surgery, MZD, Pakistan) Ziyad Afzal Kayani (AJKMC, Surgery, MZD, Pakistan) Syed Sajid Shah (AJKMC, Pathology, MZD, Pakistan) Mohsin Shakil (AJKMC, Urology, MZD, Pakistan)

Background: The health care system has changed dramatically in the past four decades which compelled the changes in the training of health care workers. Medical students should be trained in a setting, reflective of actual practice. The present study was designed to disseminate our experience of Study Guide development and to evaluate its effectiveness. Summary of work: AJKMC is the first public sector medical college in Pakistan that implemented integrated curriculum right from its start. The college has a heterogeneous group of senior faculty. Considering the global changes and local health care needs, the leadership of the college decided to design, develop and implement integrated medical curriculum. A six step approach of Kern et al was adopted to define the needs. Multidisciplinary team of relevant specialties were

constituted to brainstorm, discuss and negotiate, and generate consensus on thematic core contents of the GIT module. The learning outcomes were linked to the themes in the domain of knowledge, skills and attitude. The authors were the core members of the module team. Study guide was provided to faculty and students prior to the start of the module.

Summary of results: The outcomes of the module were analyzed by a mixed method approach, involving quantitative and qualitative methods. Students and the faculty showed complete satisfaction on the roadmap provided by the study guide during learning process of GIT module and students suggested to continue the GIT module with iterative loop of annual retreat of curriculum with changing needs of students and society. Conclusions: Integrated medical curriculum is the need of the day and quite possible in a resource constrained environment like Azad Jammu & Kashmir. Take-home messages: Study Guides provide road map to learning; however, they should be developed indigenously.


Should students generate their own schemas or use an expert's? Evidence from a randomized trial

Sarah Blissett (University of Toronto, Department of Medicine, University Health Network, Toronto Western

Hospital -8E420, 399 Bathurst St, Toronto M5T2S8,


Rodrigo Cavalcanti (University of Toronto, Department of Medicine, Toronto, Canada)

Matthew Sibbald (University of Toronto, Department of Medicine, Toronto, Canada)

Background: Although instruction using expert-generated schemas is associated with higher performance, implementation is resource intensive. Learner-generated schemas are a less resource intensive alternative, but may be limited by increased cognitive load. We studied the effect of learner-generated schemas on diagnostic accuracy, cognitive load and discriminating knowledge.

Summary of work: Fifty-seven pre-clerkship students participated in a crossover design where students used an expert-generated schema to solve one set of ECG rhythms and learner-generated schema to solve a different set of ECG rhythms during a practice phase. Learning accuracy and cognitive load were measured during the practice phase. Testing of discriminating knowledge and diagnostic accuracy followed in the testing phase. Delayed testing occurred 1-2 weeks later. Summary of results: Diagnostic success was lower in the practice phase (mean difference=23%, p<0.001) with a learner-generated schema, however there was no difference in the immediate and delayed testing phases (p=0.301; p=0.129). The use of an expert-generated schema was associated with higher performance on discriminating knowledge on immediate and delayed testing (mean difference=12%, p=0.008; mean difference=7%, p=0.009). Cognitive load was higher


when students developed their own schemas (mean

difference=18%, p<0.001).

Conclusions: Students who generated their own schemas performed no differently on tests of diagnostic accuracy despite reporting higher cognitive load. Take-home messages: Generating a schema increases learners' cognitive load and is associated with lower practice but similar immediate and delayed testing performance compared with providing an expert-generated schema.


Teach-learning strategies used in health undergraduate courses: the standpoint of teachers and students

Maria Paula Panuncio-Pinto (Medical School of Ribeirao Preto University of Sao Paulo, Neuro and Behavioral Sciences, Av Bandeirantes 3900 Mt. Alegre 14 049 900, Av Dr. Antonio Uchoa Filho, 579. Jd Sao Luis 14 020 460, Ribeirao Preto 14 020 460, Brazil) Patricia Santos Zanotti (Medical School of Ribeirao Preto University of Sao Paulo, Neuro and Behavioral Sciences, Ribeirao Preto, Brazil)

Luzia Iara Pfeifer (Medical School of Ribeirao Preto University of Sao Paulo, Neuro and Behavioral Sciences, Ribeirao Preto, Brazil)

Marilia Mello An drade (Medical School of Ribeirao Preto University of Sao Paulo, Neuro and Behavioral Sciences, Ribeirao Preto, Brazil)

Background: The development of specific skills through learning techniques and concepts is directly related to the effectiveness of teach-learning strategies. Teaching practices at the university level must necessarily contemplate the complex and multifaceted nature of reality in which the health professionals will develop their performance.

Summary of work: This study aimed to identify teach-learning strategies used in undergraduate health courses at FMRP-USP and the perspective of students regarding their learning experience. It was developed through two stages: (A) nineteen teachers were approached about teach-learning strategies (semi-structured questionnaire, exploratory approach, quantitative); (B) eleven students participated in two focus groups about their learning experience (content analyses, exploratory approach, qualitative). Summary of results: Regarding teaching strategies, the traditional ones were cited as the most frequently used: lecture (100%), discussion groups (63%), discussion of clinical case (47%), PBL (26%), distance learning (15%). Over the evaluation strategies, the same trend repeats itself. Concerning students, qualitative content analyses allowed us to understand that they appreciate the student-teacher relationship, the teacher's ability to establish connections between the classroom and the professional reality, as well their mastery of content. Conclusions: Among teachers it was possible to identify the discrete emergence of active methods. However, work overload reported by teachers hampers their investment in active methodologies. Among students,

the most interesting finding concerns the understanding that the higher interaction between teacher and student, the better the class. Take-home messages: Education is a relationship between people. Investment in learning techniques and concepts cannot be greater than the investment in human interaction between teachers and students.


Following Christopher Langdell's steps

Nancy E Fernandez-Garza (Universidad Autonoma de Nuevo Leon, Physiology, Camino Real 298-35, Col. El Faisan, Santiago, Nuevo Leon 67300, Mexico) Diana P Montemayor-Flores (Universidad Autonoma de Nuevo Leon, Physiology, Monterrey, Nuevo Leon, Mexico)

Santos Guzman-Lopez (Universidad Autonoma de Nuevo Leon, Anatomy, Monterrey, Nuevo Leon, Mexico)

Background: In 1870 Langdell introduced in Harvard, as an alternative to lectures, the Case Method, based on the study of real problems where students reach their own conclusions. At the beginning it was not accepted, but with time it proved to be the best. In 2010, as Physiology Course Director I followed Langdell steps. Summary of work: In 2010 we started to use the case method instead of lectures two to three times a week. At the beginning it was rejected by students, who found more comfortable to sit and listen to lectures than to discuss a case that required its previous study. After a while students understood the benefits of this method and asked for it daily.

Summary of results: Students found that through this method they were able to apply their knowledge to solve medical problems, which was more useful than just the memorizing of facts. Nowadays the course consists of the discussion of 60 cases. Conclusions: Every change is difficult and even more when it moves students from a comfort zone to one where they must work hard. Medicine students want to solve medical problems and the challenge of solving a case is a great motivation to study. Case method is the best alternative to teach medicine introducing students in solving cases even in basic sciences. Take-home messages: If a medicine student is going to solve medical problems in his/her future professional life, they must learn to do it from the very first day in the medicine school.


Arterial blood gas interpretation: a new tool helping students to get it right

Deborah Mann (University of Bristol at Gloucestershire Academy, Undergraduate Medical Education, Redwood Education Centre, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, United Kingdom) Adam Youssef (University of Bristol at Gloucestershire Academy, Undergraduate Medical Education, Gloucester, United Kingdom)


Joyce Muhlschlegel (University of Bristol at Gloucestershire Academy, Undergraduate Medical Education, Gloucester, United Kingdom) Peter Fletcher (University of Bristol at Gloucestershire Academy, Undergraduate Medical Education, Gloucester, United Kingdom)

Background: Arterial blood gases (ABGs) are important in the assessment of acutely unwell patients. It is vital that clinicians are not only able to obtain these samples, but also able to interpret the results. In the UK, this is part of the postgraduate curriculum. However, both medical students and qualified doctors struggle interpreting complex 'real life' gases. Summary of work: A novel wheel was designed to reinforce common methods of arterial blood gas interpretation and to check answers. The tool was evaluated by year 5 medical students, refined from their feedback and used to support teaching with year 3 medical students.

Summary of results: Feedback from year 5 students was extremely positive: 93% rated the tool as >7/10 for its utility in reinforcing methods used in interpretation. 100% stated they would use it to check their answers. Year 3 students also found it beneficial. Conclusions: Doctors must be competent in interpreting results of simple investigations to ensure patient safety. Arterial blood gases are performed frequently in acutely unwell and deteriorating patients and rapidly provide useful information to clinicians. It is essential that these are interpreted efficiently and accurately. Current literature suggests that this is not the case; any tool that assists in training should be welcomed. Take-home messages: The ABG wheel is a useful tool. It is liked by medical students and can be used routinely when teaching methods of result interpretation and also for students to independently self-test.


Lecture course at the Department of General and Clinical Pathology using the module approach to the curriculum organization

Tatyana Fedorina (Samara State Medical University, Department of General and Clinical Pathology, Clinicheskaya str. 28-47, Chapayevskaya str. 89, Samara 443099, Russia)

Tatyana Shuvalova (Samara State Medical University, Department of General and Clinical Pathology, Samara, Russia)

Background: Principles of education based on the module approach have been applied at the Department of the General and Clinical Pathology of Samara State Medical University since 2009. Recognizing the importance of students' motivation to the study of basic sciences, we have provided some reforms in the lecture course.

Summary of work: We studied if these reforms in the lecture course on the topics of pathologic anatomy are useful for improvement of medical education.

Summary of results: What was changed in the course of lectures? Main features are: we change the contents of lectures and use the new forms of delivery of lectures -"lectures - discussions", "binary lectures"; the lectures delivered by two lecturers on one and the same theme help students to see the problem more deeply and to impress it on them; two or three lectures in the academic year are given by invited professors; we have begun to use workbooks for the lectures, where on one part of the list some information is already printed and on the another part of the list the students can make notes of their comments and analysis of clinical problems.

Conclusions: Students accept very positively this kind of studying. The usage of workbooks has improved the effectiveness of the comprehension of the lecture material, and incorporated into the lecture an active process of learning. Moreover the motivation of the teaching staff was increased through this method. Take-home messages: Our experience of an active lecture course using the module approach to curriculum organization seems to be very useful in medical education progress.


Learning benefits of Interactive Spaced Education in undergraduate medical students

Ricardo Jose Fonseca Oliveira (Federal University Rio Grande do Norte, Clinical Medicine, Largo maxaranguape,6 Tirol, Natal 59020760, Brazil) Rosiane Viana Zuza Diniz (Federal University Rio Grande do Norte, Clinical Medicine, Natal, Brazil)

Background: Interactive Spaced Education (ISE) is a teaching tool consisting of two components: the assessment component, composed of multiple-choice questions and/or short answers, and the educational component, which provides immediate feedback to the student's answer, and a brief explanation of the topic. The aim of this study was to assess the improvement in pulmonology learning of undergraduate students at a university in Northeast Brazil. Summary of work: A randomized trial involving 91 fourth-year medical students was conducted in 2012. After a cognitive pretest with 20 multiple-choice questions, participants were emailed an ISE covering eight topics (smoking, asthma, chronic obstructive pulmonary disease-COPD, pneumonia, pulmonary embolism, pleural diseases, lung cancer, respiratory failure) twice a week for 12 weeks. Participants, all of whom were enrolled in the pulmonology discipline, also received the contents by the conventional method. After twelve weeks, the students were submitted to a cognitive posttest identical to the pretest. According to the answer percentage, subjects were divided into two groups: G1 - answered 50% or more ISEs and G2 -answered less than 50%. Statistical analysis compared the mean scores obtained in the two groups using the Mann-Whitney test.

Summary of results: The G1 and G2 had 60 and 31

students, respectively. Cognitive knowledge assessed by


the pretest was similar between groups. Cognitive performance showed a statistically significant improvement in G1 (7.35 ±1.11) compared to G2 (6.60±1.31), p = 0.015.

Conclusions: We concluded that ISE improved the pulmonology learning of fourth-year medical students. Take-home messages: It might be a useful option for increasing cognitive ability in undergraduate medical students.


Peer assisted learning is effective for the education of undergraduate medical students and tutor competency influences the effectiveness of such sessions

Jonathan C Brooke (University of Sheffield, Academic Unit of Medical Education, 85 Wilkinson Street, Sheffield

S10 2GJ, United Kingdom)

Georgina KP Choi (University of Sheffield, Academic Unit of Medical Education, Sheffield, United Kingdom) Michelle Marshall (University of Sheffield, Academic Unit of Medical Education, Sheffield, United Kingdom)

Background: Peer Assisted Learning (PAL) has been used for many years to teach scientific information to undergraduate students. PAL is gaining prominence in many medical schools and this study aimed to determine a) whether PAL can be effective in a clinical environment and b) whether tutor competence impacted on the effectiveness of PAL. Summary of work: 410 first-year medical students were taught clinical skills in small groups by volunteer tutors from clinical years. Tutees completed a questionnaire focussing on tutor competency, session content and tutee learning outcomes. A 4-point Likert scale was used to classify responses. Free text was obtained and analysed for recurring themes.

Summary of results: An improvement in confidence in performing clinical skills was reported by 93% of tutees. 98% felt that PAL teaching was useful and pitched at the right level. 96% of tutees received constructive feedback and identified areas for improvement. Free text comments confirmed that tutees perceived sessions to be of high quality. Competency of peer-tutors was associated with improved history taking skills (r=0.31,p<0.001) and communication skills (r=0.34,p<0.001). Free text comments confirmed that competent tutors were more likely to deliver useful teaching sessions.

Conclusions: This is the first study to report that PAL is a beneficial and effective method of teaching first-year medical students in clinical scenarios and that the competency of peer-tutors is likely to influence the effectiveness of PAL.

Take-home messages: PAL is a useful method of improving the confidence of medical students in performing clinical skills and that competent peer-tutors are more likely to deliver effective teaching session.


Peer-Led Workshops: A Novel Approach to Teaching Core Clinical Data Interpretation to Students

Tanmay Kanitkar (University College London, Medical

School, London, United Kingdom)

Patrik Bachtiger (University College London, Medical

School, London, United Kingdom)

Owain Donnelly (University College London, Medical

School, London, United Kingdom)

Sindhu Bharrati Naidu (University College London,

Medical School, London, United Kingdom)

Elissa Rekhi (University College London, Medical School,

London, United Kingdom)

V Dattani (University College London, Medical School, London, United Kingdom)

Background: Clinical data interpretation skills often fall outside the remit of formal teaching, and are usually acquired in opportunistic, informal ward-based teaching sessions. Despite the obvious benefits of this practical and context-rich approach, inconsistencies in quality and timing put some students at a disadvantage. We conceptualised an evening of peer-led workshops, available to medical students early in their first clinical year. The aim was to introduce skills required to interpret core clinical data: electrocardiograms (ECG), chest radiographs (CXR) and three blood tests - full blood count (FBC), urea and electrolytes (U+E) and liver function tests (LFT).

Summary of work: Each topic (ECG, CXR, FBC and U+E/LFT) was allocated to a pair of medical students in their second clinical year. These pairs rotated around groups of 25 students to present a 30 minute interactive, case-based workshop using power-point presentation. Feedback was compiled using a questionnaire featuring eight questions pertaining to the quality and clinical relevance of the sessions. Responses were measured using a six-point Likert scale ranging from 'very poor' (1) to 'excellent' (6). Summary of results: Every workshop received very positive feedback, particularly in the domains of quality and clinical relevance. Students reported each workshop had significantly improved their understanding of the topics, whilst tutors perceived the experience as beneficial in improving knowledge and building confidence.

Conclusions: Our peer-led workshop successfully introduced key skills of core clinical data interpretation to first year clinical students.

Take-home messages: This unique approach offered an effective grounding in data interpretation skills, alleviating the dependence on informal, sometimes unpredictable ward-based teaching. Such an approach could easily be replicated in other medical education initiatives.



Can the Team-Based Learning approach replace student reports and motivate students in practical works in medical genetics?

Jaroslav Mares (2nd Faculty of Medicine, Institute of Biology and Medical Genetics, V Uvalu 84, Prague 143 00, Czech Republic)

Vera Tumova (2nd Faculty of Medicine, Charles University, Institute of Biology and Medical Genetics, Prague, Czech Republic)

Marcela Klabanova (Medicentrum, Diana Lucina, Prague, Czech Republic)

Background: For final evaluation total student scores were calculated from results of the IRATs and individual student report and presentation assessment. The quality of individual reports and presentations has not always been satisfactory. Consequently we transformed them into a more active type of learning. Summary of work: In 2012 we replaced individual reports by the TBL-strategy. TBL groups consisted of 6 students randomly assigned to perform GRATs with multiple choice questions, review questions and open-ended problems. Topics were disclosed 7 days ahead for out-of-class preparation. Teachers evaluated GRATs and awarded points for answers. Class groups competed for points and small gifts after final scoring. 139 students completed an individual survey to assess their attitude

to the TBL.

Summary of results: As learning strategy for medical genetics, the TBL resulted in high student satisfaction: 78.5 % of students assessed the TBL approach as excellent, 20.7% as very good, 0.8% as good and nobody evaluated it as unsatisfactory. Students acknowledged that the TBL encouraged them to study regularly, practise team-work and allow them to actively learn from tutors. All this served them to improve their own exam performance.

Conclusions: We found that the TBL strategy in teaching and evaluation of medical genetics allowed us to establish an active learning environment that improved students' performance and encouraged deeper discussion of course material. Preliminary data suggest that students performed better on subsequent examinations.

Take-home messages: In practical work, TBL is a valuable teaching tool. The students recommend using this method for other topics.


Comparison between Team-based Learning and Lecture-based Learning in Nephrology courses for Medical Students in Udonthani Medical Education Center

Piyarat Rojsanga (Udonthani Medical Education Centre, Udonthani Hospital, Medicine Department, 33 Potniyom Road, Mueng, Udonthani 41000, Thailand)

Background: In the past decades, the learning methods for medical students in Thailand were based on lecture-based learning (LBL). But in the last few years, the learning methods have been changed into active learning. Team-based learning (TBL) is a student-centered learning strategy. TBL is used in many medical education centers in Thailand but this strategy has never been used in department of Medicine in Udonthani medical education center.

Summary of work: TBL and LBL method were used in teaching about "Electrolyte disturbance" topic. TBL session consisted of 3 phases. Phase 1: students studied the assigned sheet before attending the class. Phase 2: students were tested with an individual readiness assurance test (IRAT) and then they were assigned into groups and retook the same test and made the consensus of the answers. Finally, students were examined with posttest. In LBL group, students were examined with pretest and posttest. After cessation of each class, students in both groups completed the same questionnaires to evaluate satisfaction. Summary of results: 51 medical students were enrolled. 28 students were in the TBL group and 23 students were in the LBL group. The learning outcomes were significantly improved in both groups according to IRAT and posttest scores in TBL group (p<0.001) and pretest and posttest scores in LBL group (p<0.001). The posttest scores were not significantly different between both groups (p=0.56). The levels of satisfaction were higher in TBL group and included valuable experience (p<0.001), comprehension of the course material (p=0.004), improvement in problem solving skill (p=0.001) and knowledge gain (p=0.006).

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