Автор неизвестен - Mededworld and amee 2013 conference connect - страница 68

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Can We Do An Attractive Elective Radiology Course?

Chanpen Buranachokpaisan (Department of Radiology, Buddhachinnaraj Medical Education Center, Phitsanulok

65000, Thailand)

Kosa Sudhorm (Buddhachinnaraj Medical Education Center, Department of Pediatrics, Phitsanulok, Thailand) Sa-ang Dansawang (Buddhachinnaraj Medical Education Center, Director of Buddhachinnaraj Medical Education Center, Phitsanulok, Thailand)

Background: In the past, radiology elective taught medical students like an observer. Therefore, it was not attractive to medical students. But we thought that radiology has more advanced modalities and plays important roles in medical practice. Our aim was to study the attraction of elective radiology course and the confidence gained.


Summary of work: We developed the new radiology elective curriculum by mixing many teaching methods and assessments such as team-based learning, teaching film, case conference, ultrasound practice and small group discussion. Five levels Likert scale questionnaires (Cronbach's Alpha reliability 0.81) were used to ask for "Satisfaction and knowledge for choosing radiology elective" in the 5th and the 6th year medical students in the academic year 2012, after completion of radiology elective course.

Summary of results: Ninety five percent of all medical students chose radiology elective. They thought that radiology elective curriculum was good and appropriate (93.3%). The teaching film was the favorite teaching method (69%). The mean of confidence for film interpretation before and after course completion were significantly increased (2.36 and 3.87, P<0.001). Ninety three percent were satisfied and confirmed that they would not change their minds from radiology. Conclusions: Many mixed teaching methods make radiology curriculum more interesting. Take-home messages: An attractive radiology curriculum is the cornerstone for medical students to choosing elective.


Medical Students' Attitudes to Traditional and Integrated Basic Sciences Curriculums

Jalil Kuhpayehzadeh (Tehran University of Medical Sciences, Social Medicine, Tehran, Iran) Saeideh Daryazadeh (Tehran University of Medical Sciences, Department of Medical Education, Faculty of Medicine, Tehran 0098, Iran)

Kamran Soltani Arabshahi (Tehran University of Medical Sciences, Medical Education, Tehran, Iran)

Background: Studying the medical students' attitudes to their academic major is significant in the improvement of the national planning and evaluation of the curriculum. This study was an attempt to investigate the students' attitudes toward the traditional and integrated basic sciences curriculum.

Summary of work: This descriptive-cross sectional study was conducted in 2010 in all of Tehran and Shahid-Beheshti Universities of Medical Sciences and 200 internship medical students were selected using simple random sampling. The students selected from Tehran University of Medical Sciences were assigned to the traditional curriculum and students of Shahid-Beheshti University of Medical Sciences were assigned to the integrated curriculum. Data collection tool was standardized self-administered questionnaire to examine the medical students' attitude. Statistical analysis of data was done using SPSS 17 software as well as independent T-test to compare the 9 items of the questionnaire in two mentioned universities. Summary of results: For both of Tehran and Shahid-Beheshti Universities of Medical Sciences, no significant difference was observed between the students' attitude regarding the items 1, 3, 4, 5, 7 and 9 (p>0.05). However, concerning items 2, 6 and 8, there was a

significant difference. Moreover, for items 6 and 8, between the male students and for item 1, between the female students of two universities significant difference was observed.

Conclusions: In spite of the lack of positive attitude toward the real importance of the basic sciences, medical students are more interested in the integrated teaching of basic sciences.


Patient centredness as discursive practices in a UK medical school

MichaelKlingenberg (University College London, Medical School/ The Clinical and Professional Skills Centre, UCL Medical School/ Royal Free Campus, Rowland Hill Street, London NW3 2PF, United Kingdom) Caroline Pelletier (Institute of Education, Department of Lifelong and Comparative education, London, United Kingdom)

Background: Patient centredness (PCN) is a prevalent concept in medicine and medical education in the UK. Past research was concerned with establishing definitions and proxy measures. A gap is identifiable in the literature that seeks to understand how PCN is discursively constructed and how such constructs affect the reality of medical education.

Summary of work: A Foucauldian discourse analysis was performed. Four focus groups with students of varying seniority were conducted. Curriculum materials and UK policy and regulatory guidelines were examined. Analysis was concerned with establishing normalized concepts and available subject positions for patients, students and teachers.

Summary of results: Three preliminary discourses were described: 1. PCN is inherent to medicine and healthcare personnel. 2. PCN is a set of skills and behaviours which need to be learned and taught. 3. PCN is a reactive response to societal changes and pressures. PCN may increase the doctor/ patient divide, re-enforce hierarchies, and to some extent, harden professional boundaries.

Conclusions: PCN is constructed in various, at times in­commensurable, ways. These discursive practices potentially counteract the purpose of PCN where this is seen to be an increase in patient autonomy, a flattening of hierarchies and a move towards inter-professional healthcare.

Take-home messages: Educators need to be aware of the discursive potentials of the concept of patient centredness. For PCN to retain educational value, clear statements portraying its intended meaning in specific contexts, need to accompany the use of the concept.



"The times are changing". Influences on the evaluation of an unchanged course concept within a period of six years

Volkhard Fischer (Hannover Medical School, Dean of Studies Office, Academic controlling, Carl-Neuberg-Str. 1, Hannover D-30625, Germany) Ingo Just (Hannover Medical School, Toxicology, Hannover, Germany)

Hermann Haller (Hannover Medical School, Nephrology, Hannover, Germany)

Philip Bintaro (Hannover Medical School, Nephrology, Hannover, Germany)

Background: Our students have to attend a course with lectures conducted by several disciplines as an introduction into fifteen disease patterns. Each day a different pattern is taught by a team of three disciplines, mainly specialists in internal medicine, physiologists, pathologists and pharmacologists. The course is offered three times a year due to rotations within the cohort. Summary of work: The course has been offered with the same main characteristics for six years. There has been some changes in staff, but none in the overall concept: To present a clinical picture in theory and at the example of a real patient. The evaluation took place at the end of the course after the exam. Because the course had decreasing ratings by the students, the content was reconsidered in 2011 and lectures again harmonised. We also started a daily evaluation. Summary of results: A MANOVA of the evaluation data found an expected significant effect of the year in which the course was taught. The intervention had a dramatic impact on overall evaluation rates. An unexpected main effect of the rotation and a significant interaction effect demands for an analysis of the daily evaluations. Results reveal that the unexpected effects in the MANOVA doesn't correspond to differences in regression analyses.

Conclusions: The evaluation of an established course concept shows that content harmonisation diminished year by year, but can be compensated by renewing coordination between staff members. But the adaptation of the course content to rotation plans for students is still lacking.

Take-home messages: The evaluation of an established course concept shows that content harmonisation diminished year by year, but can be compensated by renewing coordination between staff members.


The movement from seven to six year medical curriculum in Taiwan

Chi-Wei Lin (E-Da Hospital, I-Shou University, Department of Family Medicine, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 82445, Taiwan) Tsuen-Chiuan Tsai (E-Da Hospital, I-Shou University, Department of Pediatrics, Kaohsiung, Taiwan) Chyi-Her Lin (Medical College, National Cheng-Kung University, Department of Pediatrics, Tainan, Taiwan)

Keh-Min Liu (College of Medicine, Kaohsiung Medical University, Department of Anatomy, Kaohsiung, Taiwan) Chi-Wan Lai (Ministry of Education, Committee of Medical Education, Taipei, Taiwan)

Background: In Taiwan, there are 12 medical schools with 7-year undergraduate medical curriculum for high school leavers. Having the commitment to improve medical education on its quality and efficiency, the Ministry of Education in Taiwan has formed a task force to initiate the medical curricular reform since 2008. The purpose of this study is to review the process and the preliminary results on the nationwide curricular reform. Summary of work: In the first stage, surveys of the opinions among medical educators on the quality of current medical education were conducted. In the second stage, through series of symposia, medical education experts from abroad were invited to share their experiences on different medical curricular models. Finally, series of meetings were conducted for consensus.

Summary of results: Curricular problems were identified as redundancies/ irrelevancy, lacking integration, Information overload, and too much passive learning. About half of the participants expressed the desire to change. Through many meetings of the task force, consensus was reached to propose a new curriculum with six years in length which will be implemented in 2013. The new shorter curriculum encourages integration and outcome-standardization, fosters habits of inquiry and improvement, plus professional formation.

Conclusions: There have been changes from individual level to the institutional level on faculty development, administration, and leadership. The nationwide activities of medical curricular reform has promoted sharing and collaboration among the medical schools in Taiwan.


First Degree Medical Students' Face Up To Emergency

Carlos Edmundo Fontes (Universidade Estadual De Maringa, Medicina, Pioneiro Antonio Ruiz Saldanha 351 Casa 11, Maringa 87 065290, Brazil)

Background: The undergraduate medical programme at a certain Brazilian public medical school follows a traditional curriculum. Due to the structure of the current curriculum, undergraduate medical students at this institution are not sufficiently skilled to provide any care in emergency situations. This is of great concern since as trauma and medical emergencies are the most common cause of disease in Brazil. Health professionals must be prepared to implement worldwide protocols in such situations.

Summary of work: This study attempted to enable first year undergraduate medical students to provide firstaid care in emergency situations, within the legal and ethical boundaries of not being a qualified practitioner. An emergency care intervention was designed and implemented. All 40 first year medical students


consented and participated in the intervention. Students were assessed on their prior knowledge of basic life support using MCQs. A six month intervention that included lectures, training sessions and simulated scenarios were implemented in the clinical skills laboratory. At the end of the year another questionnaire was applied. Students were successful. Their improvement in knowledge of the subjects studied was proved.

Summary of results: The class averaged a score of 40% in the pre-test, while their post-test average was 90%. As students entering medical school clearly have an interest in medicine, and some of them complete first aid courses, it explains the 40% average in the pre-test. The post-test results demonstrate a dramatic improvement in their knowledge, and their performances in the "real" scenario confirmed their newly acquired competence in basic life support. Feedback obtained from the students confirmed their perceived pride and reassurance in being able to perform basic life support.

Conclusions: The project offers first degree medical students opportunity to get prepared to give support in emergency situations.

Take-home messages: Basic life-support training empowers first year medical students.


"Fol espoir": a process of curricular reform

Sergio Zaidhaft (Faculdade de Medicina. Universidade Federal do Rio de Janeiro, Psychiatry, CCS - Centro De Ciencias Da Saude - Bloco K - Sala K49 - Ilha do Fundao -Cidade Universitaria, Rio de Janeiro 21.941-000 Brazil)

Background: The French group "Theatre du Soleil" names "fol espoir" (crazy hope) the boat that takes the characters of a play (The castaways of "fol espoir") toward the ideal of building a new society. The Medical Education Program of a Brazilian medical school has been arguing, since 2009, its curriculum in order to fit the National Guidelines.

Summary of work: As it is an institution with hundreds of teachers and students involved, the working group that was formed included representatives from all its segments; a routine of meetings was established, always with results published to ensure transparency process and all the disciplines of the current curriculum were revised. The diagnosis was that the school has a traditional teaching model, primarily hospital and teacher-centered, with basic and clinical cycles disintegrated in themselves and with each other. The course does not have a Political-Pedagogical Project, there is a disengagement of much of teachers with undergraduate students and there is resistance to the field of Medical Education.

Summary of results: In order that the curriculum reform is not limited to a dispute over hours, we elaborated proposals of vision and mission of the institution, and later the competencies that should be developed. They have all been approved, and we are building the curriculum based on these assumptions.

Conclusions: The Medical Education Program is our boat "Fol Espoir".

Take-home messages: Know your school very well before entering any reform process. Listen. Avoid implementing others' reform process to your school. Find your own. Beware of enemies. Find your stakeholders.


Promoting student-centered learning through the use of Guided Frameworks

Richard Feinberg (New Jersey Medical School, Office of Education, 185 South Orange Avenue, MSB - C642B, Newark 07101, United States) Elizabeth Koltz (New Jersey Medical School, Office of Education, Newark, United States)

Background: We developed guided "frameworks" (course development templates), to help faculty move from a lecture-based curriculum to a multi-modal curriculum. Our goal was to provide a structured mechanism for faculty to create student-centered learning.

Summary of work: The frameworks were developed with embedded design elements and instructions on how to convey and integrate the content more effectively. The lecture template provided an organized structure - Introduction/Objectives, Core Concepts including engaging student activities, and Summary, as well as links to contextual prompts and supporting material. Faculty reviewed the lecture template and we incorporated their input. We introduced the frameworks initiative at a new faculty orientation and conducted a workshop on how to use the lecture template. We are currently creating podcast templates. Summary of results: All faculty who have reviewed the template affirmed its potential benefits. Faculty have used the template to organize their content and focus on difficult concepts. We continue to introduce and educate faculty on using the Guided Frameworks and track its impact. We are conducting interviews with faculty, monitoring the number of lectures updated, and types of updates made. Peer evaluation and the impact on learning will be measured. Conclusions: Faculty are piloting the template for delivery of their lectures this spring. We are anticipating improvement in the delivery of content and more opportunities for greater student engagement. Faculty who adapt their content into the frameworks will be providing students with more choices over how they are learning.

Take-home messages: Providing guided frameworks for faculty will help develop and facilitate the delivery of a student-centered learning curriculum.


Medical students' attitudes towards the addictions

Kenneth Mullen (University of Glasgow, School of Medicine, Glasgow, United Kingdom)


Iain Smith (University of Glasgow, School of Medicine, Glasgow, United Kingdom)

Background: The need for medical students to engage with patients with addictive problems is projected to increase in coming years. There will also be a concomitant greater emphasis on community-based learning. The present study assessed the impact of a community based teaching initiative, the Student Selected Component (SSC) Lay and Professional Perspectives on the Addictions, on students' attitudes to these groups.

Summary of work: The SSC is assessed by a final student report which includes a self-reflective section. The free text data from this section of 28 qualitative reports over 7 years was analysed using content analysis.

Summary of results: Students were clear they believed the experience of the SSC had increased their understanding of both the psychological and social complexity related to the addictions and the role of medicine within this.

Conclusions: We discovered that the SSC Lay and Professional Perspectives on the Addictions not only gave students first-hand experience of those suffering from and treating addictive problems, but also had a positive effect on their attitude towards this group. Take-home message: It is possible to positively influence medical students' attitudes towards these stigmatised groups; it is therefore important that we continue to enhance opportunities for learning about the health and social impact of the addictions throughout the medical curriculum.

5EE Posters: Reflection and Clinical Reasoning

Location: Terrace 1, PCC


Script Concordance Technique as a Teaching Strategy for Clinical Reasoning Skill in Management of Common Pediatric Respiratory Problems

Woranart Ratanakorn (Chonburi Medical Education Center, Department of Pediatrics, Chonburi Hospital, Bansuan, Muang District, Chonburi 20000, Thailand)

Background: Clinical reasoning is the foundation of professional clinical practice and iterative process involving hypothesis generation and testing. The medical student encounters problems in these processes. Can the script concordance technique account for this? The objective of this study is to compare clinical reasoning skill in teaching with script concordance technique to case based lecture.

Summary of work: In 2012 academic year, thirty-one final year medical students were randomized to instruct about management of common pediatric respiratory problems through either script concordance technique or case based lecture. Both groups contained four cases of clinical scenarios where the information provided was insufficient to reach a decision and had to discuss in the interactive manner. In script-concordance group, the students were given a number of items comprising a lead-in that provided a hypothesis, followed by an additional piece of information to evaluate the likelihood that the proposed hypothesis was correct. Constructed response question (CRQ) of those four scenarios were assessed at the end of five-week rotation and compared by unpaired t-test. Summary of results: Sixteen and fifteen final year medical students were assigned to script concordance and case based lecture group respectively with three to four students in each rotation. Both groups had no significant difference in CRQ scores (67.92% and 60.47%) but script concordance group had higher scores in hypothesis testing questions significantly (69.95% and

57.83%; p=.01).

Conclusions: Script concordance technique was an effective strategy for the development of hypothesis testing skill which need analytic rather than pattern recognition.

Take-home messages: Effective clinical reasoning can develop from script concordance strategy.


Script concordance test in assessing professionalism reasoning for medical students

Pairoi Boonluksiri (Hatyai Hospital, Pediatrics, 182 Hatyai Hospital, Rattakarn Road, Hatyai 90110, Thailand)


Background: Script concordance test (SCT) is an assessment tool for an ill-defined problem. The capacity to reason in this context is the hallmark of professional competence. There are also many authentic situations with uncertainty regarding ethics and professionalism that SCT is likely used to teach and assess medical students. Objective: To develop an assessment method of reasoning in the context of ethics and professionalism for students using script concordance approach. Summary of work: There were 38 fifth-year medical students invited to be assessed. Ten authentic situations described in vignettes with 30 items for reasoning and decision making in professionalism were developed with specific format of SCT. Five-point Likert scale was made. The scoring method was performed using 7 multidisciplinary experts. Content validity using index of congruence (IOC >/=0.5) and reliability Cronbach's alpha were performed.

Summary of results: The vignettes related to respect, accountability, altruism, ethics and legal understanding, communication, knowledge, humanism and cultural competence. Most IOC was 1 (0.67-1). The reliability was 0.98. The students' average score was 53.58% (36.67­73.60).

Conclusions: The feasibility, validity and reliability of SCT for assessment of professionalism reasoning can be conducted. Vignette can be constructed like MCQ especially developed from authentic situations. Take-home messages: SCT is a method for reasoning assessment in uncertainty which is not only in aspect of treatment but also in professionalism performance. As a suggestion, it could be applied as teaching tools and progress test.


Reliability and validity of an assessment tool for clinical reasoning based on conceptual mapping in family medicine

Celine Daviau (University of Nantes, Family Medicine, Nantes, France)

Jean-Marie Castillo (University of Nantes, Family Medicine, 1 rue Gaston Veil, Nantes 44035, France) Lionel Goronflot (University of Nantes, Family Medicine, Nantes, France)

Pierre Pottier (University of Nantes, CHU Nantes, Internal Medicine, Nantes, France)

Background: A key element of medical competence is problem solving. Previous work has shown that doctors use inductive reasoning to progress from facts to hypotheses and deductive reasoning to move from hypotheses to the gathering of confirmatory information. An individual assessment tool has been designed to quantify the use of inductive and deductive procedures within clinical reasoning. This tool has been validated in pregraduate medical students. The aim of this study was to explore the feasibility and reliability of this tool in family medicine residents. Summary of work: The study included three groups of four participants. These comprised groups of residents in Years 1 and 3 and a group of experimented

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