Автор неизвестен - Mededworld and amee 2013 conference connect - страница 58

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Learning together: GPs and Paediatricians in primary care

John Spicer (London Deanery, GP School, London, United Kingdom)

Bob Klaber (St Mary's Hospital, Dept of Paediatrics, London, United Kingdom)

(Presenter: Chloe Macaulay, London Deanery, School of Paediatrics, 32 Russell Sq, Stewart House London WC1B 5DN, United Kingdom)

Background: Integrated care is a developing framework within which the care of children is delivered in the UK. We sought to extend the integrated care model to include those in postgraduate training for general practice and paediatrics

Summary of work: 5 London secondary care paediatric units were identified where supervisors wished to extend paediatric training into primary care, building on systems where experienced paediatricians had taken

their skills into community clinics. 'Learning together' sessions were established where patients encountered trainees in GP together with trainees in paediatrics. Clinical supervision was arranged remotely from the secondary care unit, and on site by a GP supervisor. Summary of results: Patient mix was wide, comprising acute and long term illness. Patient satisfaction was evident with this new system, and joint learning similarly so. Paediatric trainees learnt about the context of community work, the key descriptors of primary care and systemic aspects of child health. GP trainees augmented their paediatric knowledge in a direct manner. Overall the value of experiential learning in a new clinical context was very powerful Conclusions: Placing learners in new clinical environments and systems pays dividends in teaching and learning, though attention must be paid to the governance and patient safety aspects. As service delivery moves increasingly from secondary to primary care, new models of education must follow. This pilot suggests an effective way of making this happen Take-home messages: Innovation in the clinical learning context is to be applauded, and demonstrates tangible results. It best happens where there is clear preparation, delivery and follow up. Working across the hospital/community divide is a necessary and productive adjunct to good learning.

5K Short Communications: Preparation

for Practice 1

Location: Club B, PCC


PIQUE'ing an interest in faculty development

Julia Blitz (Stellenbosch University, Family Medicine and Primary Care, F312 FISAN Building, Francie van Zijl Dr, Tygerberg 7505, South Africa)

Norma Kok (Stellenbosch University, Centre for Health Professions Education, Bellville, South Africa) Ben van Heerden (Stellenbosch University, Centre for Health Professions Education, Bellville) Susan van Schalkwyk (Stellenbosch University, Centre for Health Professions Education, Bellville, South Africa)

Background: Most medical schools in South Africa have as their overall aim for undergraduate medical education, the preparation of graduates for internship. If we are to reach this aim, one of the ways to evaluate this would be to explore whether our graduates indeed feel able to do the things that we think they should, or could, be doing in their internship. Summary of work: The Preparedness for Internship Questionnaire (PIQUE) was designed based on Hill's preparation for hospital practice questionnaire, with additional questions covering graduate attributes and the profile of the Stellenbosch doctor. The questionnaire asked the participant to respond to a series of statements preceded by "My undergraduate medical training prepared me to ..." with "fully", "well", "fairly well", "little" or "not at all" prepared. Open-ended questions allowed elaboration on other issues. In July 2012 an invitation to participate in the online survey was sent to all the 2011 Stellenbosch MB, ChB graduates. Summary of results: There was a 36% return rate. In general graduates felt that they had been well prepared for most mainstream clinical activities. However, there were also a number of areas in which respondents felt they could have been better prepared - largely in the areas of pharmacology, medico-legal work, minor surgery and the non-clinical tasks which an intern encounters.

Conclusions: Using this questionnaire has highlighted non-clinical areas needing attention within our curriculum.

Take-home messages: Identifying the areas in which graduates feel less well prepared for internship may serve as a method of piquing faculty's interest to develop skills to address these unmet needs.


Junior doctors' views about how prepared they are for starting work by their undergraduate medical training

Susan Miles (University of East Anglia, Norwich Medical School, Faculty of Medicine and Health Sciences, Norwich NR4 7TJ, United Kingdom)


Joanne Kellett (Norfolk and Norwich University Hospital, Norwich, United Kingdom)

Sam Leinster (University of East Anglia, Norwich Medical School, Norwich, United Kingdom)

Background: Norwich Medical School at the University of East Anglia (UEA) has a novel, patient-centred curriculum. This study was designed to evaluate how well prepared the graduates are for their Foundation Years.

Summary of work: 192 of 312 junior doctors in the local region, including 78 graduates from UEA, completed a questionnaire during their first 4 months of work. Respondents rated how prepared they felt by their medical school training for each of 53 items. Summary of results: Generally junior doctors agreed that medical school had prepared them well for work tasks. But differences emerged in how prepared they felt, related to the skill being rated. For example, junior doctors felt less well prepared to cope with responsibility, uncertainty, time-management, paperwork, dealing with acutely unwell patients and those with complex needs in comparison to history taking, examination, communication skills and team-working. UEA graduates felt at least as prepared as graduates from other medical schools; for 10 items they felt significantly better prepared. Full details will be presented.

Conclusions: Despite ongoing developments to undergraduate medical curricula graduates still feel unprepared to work in some areas. For some skills improved local inductions are required to better prepare junior doctors for the specific context in which they are working. Having identified areas of perceived unpreparedness we can make recommendations for both medical schools and employing hospitals to improve the transition from medical student to junior doctor.

Take-home messages: Junior doctors still feel unprepared for some aspects of work after medical school.


Intern preparedness to practise, an examination of a transnational approach to medical education

Sameer Kassim (University of Manitoba, Medical Microbiology and Infectious Disease, 707-2300 Portage Avenue, Winnipeg R3J0M4, Canada) Yvonne McGowan (Royal College of Surgeons in Ireland, Division of Population Sciences, Dublin, Ireland) Hannah McGee (Royal College of Surgeons in Ireland, Division of Population Sciences, Dublin, Ireland) David Whitford (Royal College of Surgeons in Ireland -Bahrain, Family and Community Medicine, Manama, Bahrain)

Background: The Royal College of Surgeons in Ireland (RCSI) has been providing undergraduate medical education in Ireland since 1886 and internationally for more than half a century. RCSI operates the largest medical school in Ireland with an enrollment of more

than 350 medical students across three continents entering into highly variable post graduate training systems worldwide.

Summary of work: We examined intern preparedness with the Preparedness for Hospital Practice Questionnaire of graduating students (2010/11). Summary of results: 43% of students responded to the survey. 39% domestic students/interning locally; 14% overseas/interning locally; and 42% overseas/interning internationally. Overall preparedness was rated at 'somewhat adequately' prepared (3/5) or better. Overseas students rated themselves better prepared than domestic and overseas/locally interning counterparts in several domains: interpersonal skills, confidence, prevention, holistic care, and self directed learning. Core indices such as collaboration, management and science were not different amongst medical graduates.

Conclusions: Preparing for internship is a multi-faceted relationship between learners, medical schools and health systems. This study has revealed variation between RCSI campuses and between local and international students in terms preparedness. Core indices were similar to all students. However, students from overseas returning to international internships reported greater preparedness across several indices, which may be attributed to student characteristics and exposure during medical school. Efforts should be taken in order to ensure all new medical graduates receive preparation for internship appropriate to their destination.

Take-home messages: Core indices of collaboration, management and science delivered served all graduates of RCSI regardless of internship/destination. Yet levels of preparedness vary, attributed to the student and learning environment.


Dealing with the Hidden Curriculum: An Assessment of Coping Strategies in First Year Clerkship

Wendy Stewart (Dalhousie University, Paediatrics and Division of Medical Education, 54B Marr Road, Rothesay,

NB E2E 3K7, Canada)

Jaclyn Leblanc (Dalhousie Medicine New Brunswick, Undergraduate Medical Education, Saint John, NB, Canada)

Sarah Higgs (Dalhousie Medicine New Brunswick, Undergraduate Medical Education, Saint John, NB, Canada)

Amy Russell (Dalhousie Medicine New Brunswick, Undergraduate Medical Education, Saint John, NB, Canada)

Susan King (Dalhousie University, Paediatric Neurology, Saint John, NB, Canada)

Background: Many undergraduate medical programs have incorporated clinical exposure into the first two years of their program. It is not until clerkship, however, that students have the opportunity to deal firsthand,


and often alone, with patients. This is also their first real exposure to the "hidden curriculum". Summary of work: The purpose of this study is to identify types of stressful and unexpected situations clinical clerks are exposed to early in clerkship and examine the evolution in coping strategies over the first year of clerkship. The study uses a mixed methods design. The Coping Inventory for Stressful Situations (CISS) was administered to first year clerks at Dalhousie University. Qualitative data from focus groups were recorded, transcribed and analyzed using content analysis.

Summary of results: Fifty nine (49%) students responded. The quantitative CISS data showed that students seek support from others. Sleep and food are often used to deal with stress. The majority work to learn from their experiences. Recurrent focus group themes included: feeling isolated, the degree of responsibility, lack of knowledge, disillusionment and unprofessionalism by staff. Conclusions: Students face many unanticipated challenges when they first enter clerkship. The use of a standardized tool to identify coping strategies and how they evolve provides useful information that can assist in planning curriculum that supports and prepares students for training transitions. Take-home messages: The transition to clerkship is difficult. The results from this study will be used to design faculty development programs which raise awareness of the clerk experience and ways in which faculty can support the students.


Early indicators of medical students' successful transition to clinical training: clinical tutors' views

Marcela Bitran (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Escuela de Medicina, Alameda 340, Santiago 8320000, Chile) Alemka Tomicic (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Escuela de Medicina, Santiago, Chile)

Denisse Zuniga (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Escuela de Medicina, Santiago, Chile)

Isabel Leiva (Pontificia Universidad Catolica de Chile, Departamento de Enfermedades Respiratorias, Escuela de Medicina, Santiago, Chile) Maribel Calderon (Pontificia Universidad Catolica de Chile, Escuela de Psicologia, Santiago, Chile) Arnoldo Riquelme (Pontificia Universidad Catolica de Chile, Centro de Educacion Medica, Escuela de Medicina, Santiago)

Background: Medical students differ in their ability to adapt to the initial year of clinical training and to accomplish the learning objectives: communicating with patients and integrating theoretical knowledge to the clinical practice. Here, we report the perceptions of clinical tutors regarding the students' features and behaviors associated with a successful transition to the clinic.

Summary of work: Eight individual and semi-structured interviews of experienced clinical tutors were conducted, transcribed and analyzed using open coding procedure, according to the Grounded Theory. Summary of results: One of the emerging categories, referred to as "transitional markers", describes the early indicators of students' successful transition to the clinical learning. These comprised cognitive and attitudinal elements; for example, the abilities to 'use a nonlinear reasoning', to 'act autonomously'; and to develop a 'sense of responsibility and rapport with the patient'. Emerging concepts could be organized along five dynamic axes: 'from the theoretical to the practical knowledge', 'from simulated to real patient/scenarios', 'from the automatic to deliberate action", "from dependence to independence and autonomy 'and 'from lower to a higher quality of tasks'. Conclusions: Clinical tutors identify a set of cognitive and attitudinal resources as markers of students' ability to succeed in the transition from the classrooms to the clinical training. Some of them are of common to other professions while others are specific to the medical practice.

Take-home messages: It can be of interest for clinical tutors and medical educators to identify and foster the development of transitional markers, in order to help students ease the transition to the clinic, and accomplish more readily the learning objectives of this curricular phase.

Funded by FONDECYT grant 1120534.


An educational intervention to improve the crucial non-technical skills of handover, referral and calling for help

James Tiernan (NHS Lothian, Medical Education Directorate, Postgraduate Medical Education Centre, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom)

Aisla Howie (NHS Lothian, Acute Medicine, Edinburgh, United Kingdom)

Edward Mellanby (University of Edinburgh, Centre for Medical Education, Edinburgh, United Kingdom)

Background: Calling for help, referring patients to other specialties and handing over care to colleagues are core skills required by healthcare professionals and crucial for newly qualified doctors. Traditionally medical students were given little or no training in such skills. Training may improve handover but limited evidence exists with regard to clinical impact. The role of educational interventions in the areas of escalation of care and referring to other specialties remains unclear. Summary of work: University of Edinburgh students partake in a student assistantship in final year. Many remain in the region for foundation posts, receiving an induction week prior to starting. A two-step, small group workshop was developed aiming to train students in these areas. The first session focuses on training in calling for help and referrals, while the second focuses on handover to the hospital-at-night team. Both involve

a combination of interactive tuition, audio-visual examples and case-based opportunities to practise the skills in a structured fashion.

Summary of results: Initial feedback suggests that the sessions were perceived as extremely relevant, providing them with more confidence to begin employing the skills. Further qualitative data will be presented.

Conclusions: Specific training for in handover, referral and escalation of care can help undergraduate medical students in their transition to junior doctors, equipping them with some of the non-technical skills that are likely to prove essential in their professional life. Take-home messages: Training undergraduate medical students how to refer, handover and call for help can help prepare them for work as junior doctors and, ultimately, may save lives.

5L Short Communications: International

Medical Education 1

Location: Club C, PCC


Effective Communication with Patients, Families & Colleagues: Development & Evaluation of an Online Program for International Medical Graduates (IMGs) in Newfoundland and Labrador (NL), Canada

Elizabeth Bannister (Memorial University, Professional Development & Conferencing Service, Faculty of Medicine, Rm. 2961, Health Sciences Centre, St. John's A1B 3V6, Canada)

Lisa Fleet (Memorial University, Professional

Development & Conferencing Services, Faculty of

Medicine, St. John's, Canada)

Robert Glynn (Memorial University, Professional

Development & Conferencing Services, Faculty of

Medicine, St. John's, Canada)

Anuj Charan (Memorial University, Professional

Development & Conferencing Services, Faculty of

Medicine, St. John's, Canada)

Background: Effective communication is an essential skill for all physicians. While such skills are often taught in Canadian universities, many International Medical Graduates (IMGs) often receive little or no specific training in this area. They may also face additional communication challenges as they assimilate into the Canadian cultural and medical environment. Summary of work: Literature review and environmental scan; instructional design of online modules combining didactic instruction, video, asynchronous discussion, and assessment; and development of a logic model approach for evaluation.

Summary of results: IMGs' educational needs related to patient/colleague communication in Canada and NL were identified. The program is presented around three modules, each addressing a different theme of communication; Patient-Centred Interview, Cultural Differences, Understanding Relationships. Modules are to be launched on the MDcme web portal (www.mdcme.ca) by July 2013. Participant assessment will include: pre/post program confidence; pre/post module knowledge; post-module satisfaction; and six months' post-program outcomes to determine impact of the program on participants' confidence, use of knowledge/skills, and patient outcomes. Conclusions: The role of communicator has been identified as one of the CanMEDS framework physician core competencies, yet an IMG's training may not translate appropriately into North American culture. Effective communication is critical for optimal patient outcomes. This program will provide IMGs practicing in NL with the necessary knowledge and skills to communicate effectively with patients, families, and colleagues.

Take-home messages: A communications program for IMGs at varying stages of training and practice-readiness


is necessary and helpful in effectively transitioning them to work and live in Canada.


OSCE Rater-Based Assessments as an Alternative to Standardized Language Proficiency Tests for


Bruce Holmes (Dalhousie University, Division of Medical Education, 1256 Barrington Street, PO Box 15000, Halifax B3H 4R2, Canada) Saad Chahine (Mount Saint Vincent University, Education, Halifax, Canada)

Linda Mosher (Dalhousie University, Division of Medical Education, Halifax, Canada) Frank MacLean (Dalhousie University, Division of Medical Education, Halifax, Canada)

Background: A practice readiness OSCE for IMGs assessed history taking, physical exam, problem definition & diagnosis, investigation & management, communication skills (CS) and quality of spoken English (QSE). Our belief was that simulated patient (SP) and physician examiner (PE) raters would be sufficiently equivalent on CS & QSE, and these ratings could be a preferred substitute for English language proficiency


Summary of work: Two consecutive annual 12 station OSCEs included 1708 PE and SP ratings for CS and 1720 ratings for QSE. Global ratings with behavioral anchor ratings from inferior (1) to excellent (6) were used as an alternative to checklists.

Summary of results: Paired-samples t tests were conducted to compare PE and SP ratings. For QSE, the results showed no difference between PE (M=3.43, SD = .81) and SP (M=3.45, SD = 1.04), t(859)=0.56, p=.58. The 95% confidence interval for the mean differences between the two ratings was 0.05 to 0.09. For CS, the results also showed no difference; PE (M=3.30, SD = .31) and SP (M=3.36, SD = 1.07), t(853)=0.08, p=.58. The 95%

confidence interval for the mean differences between the two ratings was 0.01 to 0.13. For both CS and QSE, we also compared ratings across individual examinees, the differences between PE and SP was minimal, no examinees had a statistically significant difference between the PE and SP rating.

Conclusions: Our findings suggest to us that assessing IMG CS and QSE in a clinical context is a reasonable alternative for English language proficiency. Take-home messages: An additional 3 years of retrospective data will be reviewed.


An adaptation of Problem Based Learning (PBL) to improve Clinical Reasoning Skills of International Medical Graduates (IMGs)

Ann Smalldridge (Salford Royal Foundation Trust, REACHE North West, Mayo Building, Stott Lane, Salford M86HD, United Kingdom)

Michael Sykes (Salford Royal Foundation Trust, REACHE North West, Salford, United Kingdom)

Background: As tutors of overseas-trained doctors preparing to work in the UK, we became aware of differences in approach to dealing with clinical problems, specifically clinical reasoning. Summary of work: Problem-based learning (PBL) was adapted to deliver weekly sessions over a 6 month period. Several issues emerged and the delivery of the sessions was modified to address these. Summary of results: Participants in general were not used to working in small groups, nor did they appear to be familiar with the hypothetico deductive model of clinical reasoning, or comfortable with admitting they did not know something but were going to find it out. Issues linked to medical practice and culture in the UK were poorly understood including teams in the NHS, the social context of many illnesses, epidemiology, health beliefs and colloquial language. Conclusions: IMGs will be expected to use clinical reasoning techniques throughout their careers in the UK. There are cultural and educational reasons why they are unfamiliar with PBL and why they may face difficulties using the techniques in clinical practice. 'Unknown unknowns' due to lack of exposure to life and clinical practice in the UK need to be uncovered by tutors and addressed directly. Take-home messages: It may be useful to include training in PBL as part of an induction programme for IMGs coming to study and work in the UK, with the clinical reasoning, group working skills, understanding health beliefs and the social context of care in the UK aspects made explicit.


"Back to basics": building a framework for understanding international medical trainees' challenges

Sanjeev Sockalingam (University of Toronto, Department of Psychiatry, 200 Elizabeth St-8EN228, Toronto M5G 2C4, Canada)

Background: Studies have highlighted the unique needs of International Medical Graduates (IMG) during their transition into medical training programs and practice. This study aims to build on previous frameworks and to further elucidate IMG training needs by studying the transition of IMG trainees into fellowship training programs.

Summary of work: We conducted a two-phase study involving Psychiatry and Surgery IMG fellows and supervisors. During Phase 1, we administered an online survey to fellows and supervisors during the first 3 months of fellowship training to assess resources and potential challenges in clinical communication, health systems and education domains. Survey data was analyzed using descriptive and Mann-U-Whitney statistics. In Phase 2, IMG fellows were interviewed during the latter half of their fellowship. Interviews were analyzed using a grounded theory approach. Summary of results: The survey response rate was 72% (n=70). Compared to fellows, supervisors perceived IMG fellows to have greater challenges in sever domains


including team communication (p<0.001), patient communication (p<0.001), adapting to the healthcare system (p<0.001), Canadian language/slang (p<0.001) and social adjustment (p=0.001) and specialty specific clinical skills (p=0.002). Fellow qualitative interviews (n=10) reached theme saturation and generated the following themes: disorientation, disconnection, challenges with interprofessional teams, need for support, and the benefit of a multicultural training environment.

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