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Summary of work: Medical students become involved in this on-going project as part of a student selected module or library project. They identify a topic that could be usefully explored through the medium of film and match against ethics and law learning outcomes. Pre-production includes scriptwriting, creating the storyboard and organising actors. Clinicians check the veracity and accuracy of the scenario and dialogue. Students have taken the lead with filming and post production.
Summary of results: Seven films have been made for ethics and law small group sessions. Topics include confidentiality (doctor aware epileptic patient is continuing to drive), consent/refusal (15 year old girl refuses chemotherapy), professionalism (dealing with child abuse, racism in the workplace). Facilitators state they are an effective means of drawing out students' knowledge on complex issues and student feedback indicates they enjoy these teaching sessions. Conclusions: Students enjoy involvement in creating innovative teaching materials and they have shown immense skill and dedication with this project. The use of film vignettes promotes student engagement and encourages discussion of complex ethical issues. Take-home messages: The creation and use of short film vignettes has proved to be popular and effective in engaging students' learning of ethics and professionalism.
Using structured critical event report to teach medical students professionalism
Ling-Yu Yang (National Yang-Ming University, School of
Medicine, Department of Pediatrics, 201, Sec. 2, Shih-Pai
Rd., Taipei 11217, Taiwan)
Jen-Feng Liang (Taipei Veterans General Hospital,
Department of Medical Education and Research, Taipei,
Chun-Chi Lin (Taipei Veterans General Hospital, Department of Medical Education and Research, Taipei, Taiwan)
ABSTRACT BOOK: SESSION 2 MONDAY 26 AUGUST: 0830-1015
Jing-Feng Lirng (National Yang-Ming University, School of Medicine, Department of Radiology, Taipei, Taiwan) William J. Huang (National Yang-Ming University, School of Medicine, Department of Urology, Taipei, Taiwan) Chen-Huan Chen (National Yang-Ming University, School of Medicine, Department of Internal Medicine, Taipei, Taiwan)
Background: Teaching professionalism is very important in the clinical years of the medical curriculum. But unprofessional behaviors of the faculty will distress the medical students.
Summary of work: Critical event report is a method to guide students how to reflect and build up their own professional behavior and attitude. We used small group tutorial to guide the year 5 medical students (the first clinical year of our curriculum). The report was well-structured. It includes description of the event, writing down their feeling of conflict, and identifies the items relating to professionalism. Meanwhile, the students have to think about the feeling of the patients, their families and medical personnel. Summary of results: We have gone through 40 critical event reports in the program. Students learned how to speak out their conflict feeling and shared the ideas of their peers and facilitators. They learned the boundary of law, ethics and professionalism. Conclusions: Critical event report has been applied in training empathy. But the experience of applying it in teaching professionalism is limited. This pilot study provides experiences in the practice. Take-home messages: Critical event report is a good module of teaching professionalism for medical students. Small group discussion in workplace is a good way to teach professionalism. We also prove that the medical students learn what we do, not what we say.
Perceptions on Professionalism in a Highly Dense Multi-cultural Institution in Arabian Gulf, Qatar: Needs Assessment of faculty and Trainees
Amal Khidir (Weill Cornell Medical College in Qatar, Medical Education, Doha P.O. Box 24144, Qatar) Khalid Alyafei (Hamad Medical Corporation, Department of Pediatrics, Doha, Qatar) Abdul Naser Elzouki (Hamad Medical Corporation, Department of Internal Medicine, Doha, Qatar) Ara Tekian (College of Medicine, University of Illinois, Department of Medical Education, Chicago, United
Background: Hamad Medical Corporation (HMC), a highly dense multi-cultural Academic Health Center in Qatar, got its institutional accreditation by the Accreditation Council for Graduate Medical Education-International (ACGME-I). Since professionalism is one of the six core competencies required by all the programs, it was necessary to study the perceptions of the faculty and trainees to better integrate professionalism in curriculum development and assessment methods.
Summary of work: Faculty and trainees from four disciplines - Obstetrics and Gynecology (OB & GYN), Medicine, Surgery and Pediatrics - were invited to a brief orientation session which included presentation of a published definition of professionalism, and by the usage of clickers their perception was surveyed, in addition to completion of a reflection sheet to capture their comments. Each group met separately. Summary of results: A total of 184 participants were surveyed (94 faculty and 90 trainees). One third of the faculty identified professionalism problems with their colleagues and another third with administration. One third of trainees had professionalism issues with faculty and a fifth with nurses. One third of the faculty mentioned responsibility as a common professionalism lapse, while it was an issue within the Medicine trainees. The OB & GYN and Pediatric trainees identified trustworthiness and compassion as a concerning issue respectively.
Conclusions: The data highlighted significant differences among disciplines and between faculty and trainees.
Take-home messages: When significant differences of perceptions exist about professionalism, special attention should be paid during curriculum development and design of assessment tools in a multi-cultural institution.
Medical students' understandings of professionalism in response to ethical dilemmas
Rosie Belcher (UCL, Medical School, London, United Kingdom)
Background: Medical students frequently experience personal ethical dilemmas during their training. Their responses to these dilemmas are important, as they are likely to influence their responses after qualification. There has been increased in interest in teaching and learning professionalism recently, but conceptualizations of professionalism vary. Students differ in their development of personalized understandings of professionalism. I was interested to understand how medical students' understandings of professionalism influenced their perceptions of and responses to ethical dilemmas.
Summary of work: The research was conducted within the framework of Interpretative Phenomenological Analysis. Fourteen semi-structured interviews were conducted with clinical medical students from one medical school. The interviews were analyzed for themes.
Summary of results: Students drew on a several different understandings of professionalism in describing their ethical dilemmas and responses. Students were often aware of the differences in understanding of professionalism between themselves and other people involved in the dilemma. Ethical dilemmas were a powerful stimulus to discussion and reflection on what professionalism means for doctors. Some students' understandings of professionalism
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disempowered them as they felt that lacked the knowledge or experience to judge a situation, or they perceived challenging a senior as unprofessional. Conclusions: Students drew on a range of conceptualizations of professionalism, but these were sometimes conflicted, and inhibited some students from taking action.
Take-home messages: Ethical dilemmas stimulate discussion and reflection on professionalism in medical students. They could be used within the curriculum to help students develop a range of more empowering understandings of professionalism.
The use of 'intervision' sessions for the discussion of personal and professional development experiences of clerks
Hanke Dekker (University of Groningen, University Medical Center Groningen, Institute for Medical Education, A. Deusinglaan 1, Groningen 9713 AV, Netherlands)
Johanna Schdnrock-Adema (University of Groningen, University Medical Center Groningen, Center for Research and Innovation of Medical Education, Groningen, Netherlands)
Jos Snoek (University of Groningen, University Medical Center Groningen, Institute for Medical Education, Groningen, Netherlands)
Thys Van der Molen (University of Groningen, University Medical Center Groningen, Primary Care Medicine, Groningen, Netherlands)
Janke Cohen-Schotanus (University of Groningen, University Medical Center Groningen, Center for Research and Innovation of Medical Education, Groningen, Netherlands)
Background: Reflection on experiences is crucial to the enhancement of students' personal and professional development. 'Intervision' sessions are one means of facilitating this. During these sessions, students introduce work-related experiences and discuss these following a predefined peer review structure. We report which experiences are discussed and how these relate to personal and professional development. Summary of work: During clerkships in the second Master's year at the University Medical Center Groningen, clerks participate in 20 longitudinal small group sessions. These sessions are chaired by clerks (by rotation) using the 'intervision structure'. A senior doctor (coach) facilitates the sessions. We asked 24 coaches to list the topics clerks reported during the last 5 sessions. The first author grouped the topics into categories; the other authors checked this coding in an iterative process.
Summary of results: The 106 reported topics were grouped into 3 dimensions of professionalism, with 10 underlying categories. Categories related to professionalism as an individual characteristic included doubts about own functioning and emotional incidents. Categories related to interpersonal interactions concerned problems between clerks, clerks and
supervisors and/or patients. Categories related to societal phenomena included ethical dilemmas, poor organization of care and/or clerkships. Conclusions: Reported experiences during 'intervision' sessions match very well with the internationally recognized three perspectives on professionalism. Take-home messages: A longitudinal course of 'intervision' sessions during clerkships facilitates the professional development of clerks.
Altruism and medical professionalism in Japan through the perspective of Bushido
Hiroshi Nishigori (Kyoto University, Center for Medical Education, Yoshida-konoe cho, Sakyo-ku, Kyoto 6068500, Japan)
Rebecca Harrison (Oregon Health & Science University, Hospital Medicine, Portland, United States) Jamiu Busari (Atrium Medical Center, Pediatrics, Heerlen, Netherlands)
Tim Dornan (Maastricht University, School of Healthcare Professions Education, Maastricht, Netherlands)
Background: Medical professionalism is an important topic in medical education and one of its core principles is "altruism". This concept is mainly described in the literature from a western culture perspective, but when discussing internationally, we must consider how it is perceived in cultures other than those of the west. In Japan, we have imported and "translated" this term for use in medical education and practice however, it seems that this concept does not reach the heart of clinicians. That is probably because we have our own word having similar but slightly different concept. The question to be asked is how the concept of altruism of doctors is perceived in Japan.
Summary of work: There is a moral guideline handed down over centuries in Japan, which is "Bushido", having seven virtues. It is likened to chivalry and the noblesse oblige of the warrior class of Europe, but has a basis in Buddhism, Confucianism, and Shintoism. We describe Bushido's seven virtues and compared them with the elements of medical professionalism. We also did an e-survey for current Japanese doctors asking, "How much does the Bushido's virtue influence your clinical practice and why?" in both quantitative and qualitative ways.
Summary of results: The virtue of Benevolence (Jin) and Loyalty (Chugi) can be related to the western concept of altruism based on the qualitative results. The percentages of doctors answering "Strongly agree" or "Agree" for each the virtue were: 88% for Rectitude (Gi), 62.4% for Courage (Yu), 92.5% for Benevolence (Jin), 83.4% for Politeness (Rei), 70.7% for Honesty (Sei), 64.6% for Honor (Meiyo), and 46.6% for Loyalty (Chugi). Take-home messages: Bushido can enrich the discussion of altruism and other elements of professionalism in an international sense.
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Overview of medical professionalism among undergraduate medical students in Khartoum
Jihad Abdelgadir Imam (University of Khartoum, University of Khartoum, Community Medicine, Alqasr St., Khartoum 11111, Sudan)
Background: The key values of medical professionalism continue to underpin the daily life of medical practitioners, Identifying the full range of sources of conflict for the undergraduates and their awareness of professionalism will create opportunities to address problems, improve the efficacy and relevance of educational interventions, and promote a more effective working environment.
Summary of work: Analytic cross sectional study in which a self-administered, semi-structured questionnaire was distributed among undergraduate medical students, final analyses covered 504 students that were chosen randomly. Internal consistency of the questionnaire was determined was determined by employing Cronbach's alpha which was found to be
Summary of results: The study showed that most of the students have fair knowledge, attitude and practice of professionalism, there's significant association between knowledge/attitude and knowledge/practice, also both knowledge and attitude were found to improve with increase in year of study. Regarding teaching and assessment 56% preferred to be taught medical professionalism through lectures, seminars, tutorials and clinical rounds, while in assessment 32% thought it should be formative assessment, while 26% thought it should be summative, over 60% of participants thought that the assessment should have an impact. Conclusions: This study highlights that there's improvement in professionalism awareness corresponding to increasing exposure to medical education. It is important to gather such baseline information to guide the evaluation of the current professionalism curriculum along with its teaching and assessing methodologies. The findings suggest that teaching and assessment of professionalism should be more targeted and the students' sense of importance of professionalism is rather good. Take-home messages: Extensive studies among all medical faculties are suggested to determine the factors affecting professionalism and best methods of teaching and assessment, debates and small working groups are suggested to explore and further develop professionalism teaching and assessment methodologies. Further research is required regarding the environment in which assessment should take place.
2K Short Communications: Accreditation and Change
Location: Club B, PCC 2K/1
A Meta-evaluation of 2nd Phase Medical College Accreditation in S. Korea
Sung-Hoon Kim (Dongguk University, Education, Seoul, Korea, Republic of (South Korea)) Soo-Jin Chae (Ajou Medical College, Medical Education, Suwon, Korea, Republic of (South Korea)) Mi-Ryeong Lim (Dongguk University, Education, Seoul, Korea, Republic of (South Korea)) (Presenter: Ducksun Ahn, Korea Univ. Medical College, Medical Education, 126-1 5ga, Anam-Dong, Sungbuk-Ku, Seoul 136-705, Korea, Republic of (South Korea))
Background: In 2000, an accreditation system for basic medical education was established in S. Korea. The second phase of the BME accreditation was conducted from 2006 to 2011. In order to determine the educational impact of the 2nd phase accreditation process, a meta-evaluation was conducted. Summary of work: From fall 2011 to spring 2012, a meta-evaluation for the second phase of the BME accreditation was conducted to evaluate whether the accreditation contributed to improving the quality of medical education. The standards for meta-evaluation were categorized into five domains: purpose-relevance, implementation-feasibility, information-accuracy, report-faithfulness, and education-orientedness. Data used for meta-evaluation include the questionnaire from self-evaluation committee member; working-level staff members; faculty and external surveyors; in-depth interviews with personnel significantly knowledgeable about medical education evaluation; and surveys of focus groups consisting of five experts in medical education.
Summary of results: Evaluation findings turn out to be quite positive in all five domains. However, two points needed to be complemented. One is to conduct evaluation with more emphasis on the value of education-orientedness, and the other is to seek for ways to make more active use of the Korea Medical School Information System (KOMSIS). Conclusions: Based on the results, it can be said that the medical college accreditation was implemented overall in a reasonable manner.
Take-home messages: Meta-evaluation for the accreditation of BME is a very useful procedure, not only to assess the process of the accreditation itself, but also to evaluate the outcome of the accreditation. The validation of the meta-evaluation standards requires external triangulation.
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Establishing the Japan Accreditation Council for Medical Education to extend quality assurance of medical schools in Japan
Nobuo Nara (Tokyo Medical and Dental University, Center for Education Research in Medicine and Dentistry, Yushima 1-5-45, Bunkyo-Ku, Tokyo 113-8510, Japan)
Background: The Japan Accreditation Council for Medical Education (JACME) is organized as an accreditation body of medical schools in Japan. Summary of work: In 2011, the structure and function of the accreditation body, JACME, was organized. In 2012, educational standards to be referred in the program evaluation and accreditation was formulated; and the Ministry of Education provided funding for good practice to undergo trials of program evaluation and accreditation in several medical schools. Summary of results: Accreditation will be based on external evaluation after thorough self-evaluation practiced by each medical school. The accreditation process will include a review of self-evaluation, site visits, feedback, and conferment of certification. The interval of accreditation is yet to be determined. JACME should function to manage the accreditation process, organize an external evaluation team, and foster evaluators. JACME shall be a third party organization, independent from the medical school association and government, which will be recognized regionally and internationally. The educational standards will be in accordance with the Basic Medical Education Global Standards for Quality Improvement (2012) published by the World Federation for Medical Education with Japanese specifications. An international program evaluation based on the Global Standards was performed in 2012 in one medical school as a pilot evaluation. Regional external evaluations simulating accreditation are scheduled in 2013. Conclusions: JACME will establish the medical education accreditation system in Japan which will conform to the global standards. In order to accomplish the first round of accreditation in all 80 medical schools in Japan by 2023, establishment of the system is urgently needed.
Take-home messages: The process, strengths, and hurdles to be overcome by JACME to implement an effective quality assurance system are described.
Medical education in Taiwan - problems found during accreditation site visits
Min Liu (Kaohsiung Medical University, College of Medicine, Kaohsiung, Taiwan)
Keh-Min Liu (Kaohsiung Medical University, College of Medicine, Kaohsiung, Taiwan)
Chung-Sheng Lai (Kaohsiung Medical University, College of Medicine and Kaohsiung Medical University Hospital, Kaohsiung, Taiwan)
Chun-Hsiung Huang (Kaohsiung Medical University, College of Medicine and Kaohsiung Medical University
Hospital, No. 100, Shin-Chuan 1st Road, Kaohsiung 807, Taiwan)
Jeng-Hsien Yen (Kaohsiung Medical University, College of Medicine and Kaohsiung Medical University Hospital, Kaohsiung, Taiwan)
Background: Taiwan Medical Accreditation Council (TMAC) is responsible for the accreditation of undergraduate medical programs in Taiwan. Areas of assessment include administration, curriculum, student, faculty, educational environment and resources. Medical schools introduce changes in their curricula following the recommendations of the site visit reports. Summary of work: Site visit reports are open to the public on TMAC website. This study reviewed the most recent reports (2009-2011) of all twelve medical schools in Taiwan to identify the most common problems. Summary of results: Major problems that occurred in at least four schools include (1) schools adopting the organ-systems model in pre-clinical years, without truly integrating the basic and clinical sciences. The new curricula were merely redistributing the traditional disciplinary-based sessions throughout the years of study. (2) Although Problem-Based Learning, Team-Based Learning and other innovative methods were introduced in some courses, didactic lectures remained the predominant teaching method and students remained passive learners. (3) Some inadequacies in quality and quantity of clinical teaching, especially in bedside teaching, primary care, hands-on experience and patient record documentation. (4) Schools expect teachers to excel in patient care, research and teaching, without providing them with sufficient support. Conclusions: Better communication and collaboration between the administration and the teaching faculty, and leadership and faculty development programs can solve some problems. To implement any changes successfully, however, medical schools must support and reward teaching more.
Take-home messages: Medical schools can use the recommendations of accreditation reports to initiate reform process, but the key to success is to create an educational environment that promotes excellence in teaching and learning.
Resident Involvement in Accreditation Program Reviews
Lise Dupere (The Royal College of Physicians and Surgeons of Canada, Educational Standards Unit, Office of Education, Ottawa, Canada)
Margaret Kennedy (The Royal College of Physicians and Surgeons of Canada, International Outreach, 774 Echo Drive, Ottawa Ontario K1S 5N8, Canada)
Background: In Canada, during a formal accreditation visit at a given university, all programs are scheduled for an in-depth review during the same week. The accreditation team is comprised of peer specialists and one resident representative per 20 programs being reviewed. The residents select which program reviews
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they will participate in based on a resident survey and review of documentation. Residents visiting a few, but not all, programs creates a logistical challenge and may lead to the assumption that a program selected for a resident visit has pre-determined concerns or weaknesses.
Summary of work: As a pilot, a trainee representative was assigned to every program during one university on-site review. Resident eligibility criteria was established in conjunction with the resident organization and workshops offered to trainees interested in participating in this pilot.
Summary of results: Approximately 100 residents were trained in a period of five months, 24 of which participated in a university-wide accreditation program review, all 55 programs were reviewed by a trainee co-reviewer.