Автор неизвестен - Mededworld and amee 2013 conference connect - страница 76

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The attitude of Saudi Medical Students towards learning alternative Medicine

Abdulkader Al Juhani (Royal Commission Medical Center, Training Dept., King Fahad Street, Yanbu, Saudi Arabia)

Background: Alternative medicine is defined as a broad set of health care practices that are not part of that country's own tradition and are not integrated into the dominant health care system (WHO). In Saudi Arabia there are large multiple geographical areas which lead to many alternative medicine practices, but how does the new generation of medical students look to these practices and how interested are they to know about them?

Summary of work: A web-based questionnaire was developed and posted on a Saudi Medical Student Society group on the internet. It has 10 questions but only 2 will be analyzed for this presentation. Summary of results: 60% of the participants agreed or strongly agreed to have alternative medicine as an elective course. 47% of the participants agreed to have it as a mandatory course while 26% disagreed to have it as a mandatory course.

Conclusions: There is tendency of the participants to have alternative medicine as an elective course in addition to the current curriculum. Take-home messages: Alternative medicine needs a serious consideration in the medical school curriculum planning to make use of the knowledge and experience in this field.



Effect of the Bologna bachelor degree on considerations of medical students to interrupt or terminate their medical training

Sjoukje van den Broek (University Medical Center Utrecht, UMC Utrecht Medical School, Universiteitsweg 98, Postbus 85500, Huispost HB. 4.05, Utrecht 3508 GA, Netherlands)

Olle ten Cate (University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, Netherlands)

Marjo Wijnen-Meijer (University Medical Center Utrecht, Center for Research and Development of Education, Utrecht, Netherlands)

Marijke van Dijk (University Medical Center Utrecht, UMC Utrecht Medical School, Utrecht, Netherlands)

Background: The Bologna declaration for higher education in Europe describes the introduction of a two-cycle system, that forces higher education programs to split into two phases: a bachelor program and a master program. This system, introduced in medical schools by 7 of the 47 Bologna countries, potentially enables medical students to stop after obtaining a bachelor degree or to temporary interrupt their medical training. A survey at the time of introduction of this model in Dutch medical education showed little interest among students in these possibilities. Now that this system is well established, a new survey was conducted. Summary of work: Questionnaires were sent to 314 second year and 348 third year medical bachelor students and 256 first year master students at Utrecht Medical School in 2012. Both the bachelor and the master program have a duration of three years in all Dutch medical schools.

Summary of results: Response rates were 33.4% for the second year and 42.0% for the third year bachelor students and 48.8% for the first year master students. Of all these students, 1% to 3% seriously considered a permanent stop. Of the bachelor students about one quarter seriously considered a temporary stop after finishing the bachelor program. Of the master students one seventh indicated that they actually took a break at that opportunity.

Conclusions: These results are comparable to the results of the survey at the time of the introduction of the bachelor-master system.

Take-home messages: Awarding the bachelor degree does not particularly encourage students to discontinue or interrupt their medical study.

7H Short Communications: Competency Based Education/Outcome Based Education 1 - Postgraduate

Location: Club H, PCC


Using narrative descriptions as data to document learners' progress on milestones: a practical response to the Next Accreditation System

J. Lindsey Lane (University of Colorado School of Medicine, Pediatrics, Aurora, Colorado, United States) Adam Rosenberg (University of Colorado School of Medicine, Pediatrics, Aurora, Colorado, United States) Janice Hanson (University of Colorado School of Medicine, Pediatrics, 13123 East 16th Ave., B-158, Aurora, Colorado 80045, United States

Background: The ACGME's Next Accreditation System (NAS) requires graduate medical education programs in the United States to document learners' progress toward competence in areas defined by milestones. Pediatric programs must document 21 milestones biannually.

Summary of work: Steps to develop a milestone documentation process: 1) Review data from existing rating scales/comments. 2) Consider data options: Provide rating scales for 21 required or 51 all-encompassing milestones to faculty; Provide rating scales for subsets of milestones to various faculty members; Request comments about listed milestones; Request descriptions of work observed in clinical settings. 3) Develop a Descriptive Comments (DC) form to collect narrative data (written descriptions of work observed with feedback). 4) Match DCs to milestones. 5) Identify milestones with insufficient data. 6) Compare summaries to residents' self-assessment. 7) Reflect; discuss; plan future learning. Summary of results: Rating scales and general comments provide insufficient data to assign residents to positions on milestones. Rating residents' performance on 21 or 51 milestones is unwieldy for clinical teachers. Dividing milestones for rating among faculty limits the scope of data and provides no context that indicates why a milestone position was selected, while creating a challenge of calibrating faculty. Descriptive data facilitate discussion, reflection and learning goals. When matching DCs to 21 required milestones many comments do not match. Matching DCs to all 51 milestones captures all comments. After matching DCs to milestones, core faculty can review comments under each milestone to assign positions. Conclusions: Narrative data can be matched to milestones to fulfill NAS requirements and provide meaningful feedback to residents. Take-home messages: Descriptive comments document progress and facilitate learning.



Making a teaching demonstration film: a method to improve the skill in teaching ACGME Competencies

Bei-wen Wu (Taipei Medical University - Shuang Ho Hospital, Internal Medicine, Taipei, Taiwan) Chiung-yu Chiu (Taipei Medical University - Shuang Ho Hospital, Internal Medicine, Taipei, Taiwan) Chaur-Jong Hu (Taipei Medical University - Shuang Ho Hospital, Neurology, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan) Mei-Yi Wu (Taipei Medical University - Shuang Ho Hospital, Internal Medicine, Taipei, Taiwan) Tsu-Yi Chao (Taipei Medical University - Shuang Ho Hospital, Internal Medicine, Taipei, Taiwan) Yuh-Feng Lin (Taipei Medical University - Shuang Ho Hospital, Internal Medicine, Taipei, Taiwan)

Background: Education committees in charge of assessing teachers to fill education position vacancies require a way to assess their candidates. The assessment results are intended to serve as evidence of the teacher's skill and allow these potential candidates to see whether the potential teacher's style is a good match for their educational institution. Summary of work: We trained the potential candidates in a general internal medicine ward to become the teachers in ACGME competencies. After the training program, they all requested to make a film to demonstrate the way how to teach the residents to have competencies in patient care. In a feedback conference, trainers communicate their ideas about education skills. The outcome was candidates' satisfaction degree. Summary of results: Of the 37 candidates, 95% of them agreed that they become more confident in teaching after making the teaching demonstration film. The satisfaction degree was 97% after conducted the assessment skill.

Conclusions: The method is intended to be a comprehensive approach. The elements of performance are more appropriately evaluated using qualitative models. These emphasize observation, behavior or performance as the evaluation context, and the value of subjective human interpretation in the evaluation process.

Take-home messages: Making a teaching demonstration film is a good way to understand the candidates' ability in teaching ACGME competencies - Professionalism, Patient Care, Practice-based learning and improving, Medical Knowledge, Communication Skills and System Based Practice.


Comprehensive Family Practice Review: Using the CanMEDS Competencies Framework for Curriculum Development

Alan A. Monavvari (University of Toronto, Family and Community Medicine, 500 University Ave., 3rd Floor, Toronto M5G 1V7, Canada)

Kate Hodgson (University of Toronto, Continuing Education and Professional Development, Toronto, Canada)

Background: The Comprehensive Family Practice Review (CFPR) Program was developed to equip family physicians and general practitioners with the knowledge, skills, expertise, and judgment to provide high quality 21st century care to patients in family practice. This program is of particular value to physicians intending to re-enter or change their scope of practice to family medicine as well as physicians looking for a comprehensive update in family practice. Summary of work: Innovative application of the CanMEDS-FM framework was used to develop the integrated CFPR curriculum. The CFPR is composed of two components including 5 residential weekends of small group learning based on therapeutic themes over nine months interspersed with preparatory work and professional reflection, practice application exercises, and collegial coaching

Summary of results: The CFPR Program has been extensively evaluated and participants learning outcomes have been assessed at longitudinally at multiple levels over the past three years. Conclusions: Outcome assessment confirmed the exceptional curriculum design and successfully applied continuous professional development nature of the CFPR program resulting in a change in practice. Take-home messages: After active engagement in the CFPR Program, participants will be better able to: Improve the quality of their approach to managing clinical conditions. Use technology to answer clinical questions effectively. Demonstrate better patient-centred care. Collaborate and communicate more effectively with others in the healthcare system. Develop a self-directed approach to life-long learning and professional development.


Postgraduate competency-based curriculum in internal medicine: Pilot study of clinicians' definitions and perceptions of CanMEDS roles and physicians' competencies

Matteo Monti (University of Lausanne-School of Medicine, Medical Education and Internal Medicine, Rue du Bugnon 44 BH-10.642, Lausanne 1011, Switzerland) Raphael Bonvin (University of Lausanne-School of Medicine, Medical Education, Lausanne, Switzerland) Nu Viet Vu (University of Geneva-School of Medicine, Unit of Development and Research in Medical Education (UDREM), Geneva, Switzerland)

Background: The new Swiss postgraduate medical training largely gets inspiration from the "CanMEDS framework". Since controversy exists regarding transferability of general competencies in different social and political settings, we undertook to determine, in the Swiss internal medicine (IM) hospital setting, 1) how front-line clinicians define competencies expected of residents at the end of their postgraduate training , 2)


how they weight the importance of roles defined in the


Summary of work: Mixed qualitative-quantitative study, among a purposive sample of faculty, chief residents, and residents at two large urban IM departments in Switzerland. 33 physicians participated in six semi-structured focus groups and completed a questionnaire. Transcriptions of tape-recorded discussion were coded by two independent researchers. We used for the analysis a partial "Grounded theory" approach. Summary of results: Participants: 9 attending/faculty, 13 senior residents or chief residents and 11 junior residents. Participants' definition of competence included statements amenable to all seven CanMEDS roles. No new role emerged. Nevertheless when exposed to the Canadian definitions, physicians weighted the "Medical Expert", "Communicator", "Collaborator", "Professional" and "Scholar" roles as most relevant to an in-patient internal medicine rotation. Conversely items which define the "Manager" and "Health Advocate" roles were judged as least relevant. Qualitative and quantitative analyses support both those findings, independently from the physician status.

Conclusions: The use in the context of Swiss internal medicine of the Canadian framework CanMEDs is possible and meaningful. Nevertheless, adjustments are needed in the description of some roles and competencies in order to make them fully acceptable and understandable for both the trainees and the clinical supervisors.

Take-home messages: The CanMEDS framework is transferable in contexts other than the Canadian.


Aligning Accreditation along the Medical Education Continuum for Excellence in Residency Training

Genevieve Moineau (Association of Faculties of Medicine of Canada, Committee on Accreditation of Canadian Medical Schools, 265 Carling Avenue, Suite 800, Ottawa K1S 2E1, Canada)

Jason Frank (Royal College of Physicians and Surgeons of Canada, Ottawa, Canada) Anne-Marie MacLellan (College des medecins du Quebec, Montreal, Canada)

Paul Rainsberry (College of Family Physicians of Canada, Toronto, Canada)

Marianne Xhignesse (Committee for Accreditation of Continuing Medical Education, Sherbrooke) Nick Busing (Association of Faculties of Medicine of Canada, Ottawa, Canada)

Background: The Future of Medical Education in Canada - Postgraduate recommendation ten is "Accreditation standards should be aligned across the learning continuum beginning with undergraduate medical education (UGME) and continuing through residency and professional practice, designed within a social accountability framework, and focused on meeting the healthcare needs of Canadians".

Summary of work: The key transformative action is to facilitate and enable a more integrated postgraduate medical education (PGME) system by aligning accreditation standards and processes across the continuum of learning in the UGME, PGME, and continuing professional development (CPD) environments. Accreditation bodies are working collaboratively to develop a rigorous effective and efficient accreditation system with outcome-based standards and streamlined processes aimed at maintaining excellence in medical education. Summary of results: The leadership from the Committee on Accreditation of Canadian Medical Schools, the College of Family Physicians of Canada, the College des medecins du Quebec, the Royal College of Physicians and Surgeons of Canada, the Committee on Accreditation of Continuing Medical Education and Accreditation Canada have established a Working Group to develop a thematic map of UG, PG and CPD standards and perform a comparison of policies and processes to determine opportunities for alignment. The thematic map of standards and comparison of policies and processes will be presented as well as an update of the activities of the working group.

Conclusions: The Working Group will also review current best practice in accreditation, focus on developing outcomes based standards and requirements for documentation and ensure processes have a continuing quality improvement focus.

Take-home messages: This may prove to be an excellent model of collaborative leadership between organizations with a common goal.


How Faculty Entrust Residents with Appropriate Autonomy

Sally Santen (University of Michigan Medical School, Medical Education, 3960 Taubman Medical Library, 1135 Catherine St, Ann Arbor, MI 48109-5726, United States)

Katie Saxon (University of Michigan, Emergency

Medicine, Ann Arbor, United States)

Nadia Juneja (University of Michigan, Emergency

Medicine, Ann Arbor, United States)

Ben Bassin (University of Michigan, Emergency

Medicine, Ann Arbor, United States)

Background: In preparing to assume professional responsibility, residents strive to independently manage their patients, while the attending varies between supervision and allowing autonomy (ten Cate, 2006). The objective is to study how attendings effectively entrust residents.

Summary of work: This study was part of a qualitative study in emergency medicine. Four focus groups of faculty/residents were conducted. Transcriptions from audio recordings were then anonymously coded using ground theory.

Summary of results: Analysis of the transcripts yielded themes illuminating how faculty entrust. 1) Shared ownership- "I view [attendings] as consultants and I'm managing the patient and I have a frank conversation


and I say this is what I want to do." 2) Comfort with not having control- Residents appreciate when faculty avoid solely directing care and micromanaging. "Certainly there are attendings that will walk in the bay and sit down and watch you do your thing and not really say anything if you're doing okay." 3) Stealth observation-Some faculty "Try to hide in plain sight [...] pretending to do something else or - just listen and sort of spy." 4) Coaching- "I have your back, and I will make sure that I will get you there in the end, and I will let you make your mistakes." 5) Resident Control- effective faculty allowed the resident to take control rather than having the resident adjust to the attending's style. Conclusions: There are themes for faculty entrustment to guide actions.

Take-home messages: Faculty can effectively and safely entrust residents by modeling the themes described especially coaching and shared ownership with appropriate guidance.


How trust, trustworthiness and entrustment relate to the concept of EPAs

Asja Maaz (Dieter Scheffner Fachzentrum, Charite

Universitatsmedizin Berlin, Germany)

Tanja Hitzblech (Dieter Scheffner Fachzentrum, Charite

Universitatsmedizin Berlin, Germany)

Ylva Holzhausen (Dieter Scheffner Fachnzetrum, Charite

Universitatsmedizin Berlin, Invalidenstrasse 80-83, Berlin

10117, Germany)

Harm Peters (Dieter Scheffner Fachzentrum, Charite Universitatsmedizin Berlin, Germany)

Background: Physicians have to decide frequently whether a resident is capable of performing independently a specific professional activity. The term "entrustment" is a key component in this process, which is why ten Cate (2005) identifies clinical tasks as "entrustable professional activities" (EPAs). Only a small number of studies have investigated so far factors that can influence the decision to entrust. Summary of work: Aim of this work is to clarify the definition of the terms trust, trustworthiness and entrustment, and to determine how these terms are interrelated. Understanding of their interconnection is essential to detect and characterize factors that potentially impact on the medical entrustment process. Summary of results: A model was developed in which the perceived trustworthiness of a medical trainee, together with factors inherent in the supervisor, influence the supervisory decision to trust the medical trainee. This trust, together with environmental factors and the nature of the EPA, affects the decision to entrust the professional activity to the medical trainee. Conclusions: The model proposed illustrates broadly the interaction of factors that influence the entrustment process. On this basis, it will be the aim to identify and characterize empirically variables and their interactions that affect trust and trustworthiness of medical trainees. Take-home messages: A model is proposed to support understanding and further definition of the process that

results in the entrustment of professional activities in medical education.

7I Short Communications: Postgraduate

Education 2

Location: Club A, PCC


Developing generic skills during residency: A novel specialty-specific approach

Ahmet Murt (Cerrahpasa Medical Faculty, Internal Medicine, Cerrahpasa Tip Fakultesi, Istanbul 34098, Turkey)

Enes Arikan (Cerrahpasa Medical Faculty, General Surgery, Istanbul, Turkey)

Sabanur Cavdar (Cerrahpasa Medical Faculty, Public Health, Istanbul, Turkey)

Ahmet Ertas (Cerrahpasa Medical Faculty, Anatomy, Istanbul, Turkey)

Sertac Asa (Cerrahpasa Medical Faculty, Nuclear Medicine, Istanbul, Turkey) Metehan Imamoglu (Cerrahpasa Medical Faculty, Gynecology&Obstetrics, Istanbul, Turkey)

Background: Generic skills development is accepted as one of the essential components of higher education. In medical education, it is always aimed to develop these skills in the undergraduate phase. However, with the perspective of continuum in medical education they also have been a part of postgraduate training. Summary of work: Looking at the national residency education framework in Turkey (endorsed by Specialty Education Council) and taking the examples of CanMEDS and ACGME into account, generic skills outcomes in residency education were listed. The list, consisted of 25 items was sent to 450 residents who work in the same university hospital. How important they accept each item as a part of their profession on a Likert scale [from 1 (unnecessary) to 5 (very important)] and their further comments about each item were asked. Summary of results: None of the residents chose unnecessary option for any item. The answers generally ranged from moderate (3) to very important (5). There were occasional not important (2) answers by some residents to some items which was not significant. Interestingly, qualitative analysis of comments for each item showed differing standpoints for residents of different specialties

Conclusions: There is a strong consensus among residents about the generic skills that a medical professional should possess. However, context of each generic skill for different specialties vary considerably among its members.

Take-home messages: It is important to develop generic skills during residency. A common program does not fit for all specialty trainings. Specialty specific approach should be applied.


7I/ 2

Variation in the Contemporary Hidden Curriculum in Graduate Medical Education

Will Rafelson (Robert Wood Johnson Medical School, Medical School, Camden, United States) Andrew Moore (Robert Wood Johnson Medical School, Medicine, Camden, NJ, United States) Consuelo Cagande (Cooper University Hospital, Cooper Medical School of Rowan University, Psychiatry, Camden, NJ, United States)

Vijay Rajput (University Hospital, Cooper Medical School of Rowan University, Medicine, 401 Haddon Avenue, Room 390, Camden 08103, United States)

Background: There is a renewed interest in cultivating compassionate patient-centered care among residents.The erosion of professionalism can be attributed to the "Hidden Curriculum." Summary of work: We identified eight areas in the literature where the Hidden Curriculum exerts influence on trainees and faculty in Graduate Medical Education (GME), which include: Lack of Accountability, Legal Phobia, Physician and Nursing Overload, Negative Attitudes from Teachers, Electronic Health Record (EHR) and Patient Depersonalization, "Work-Life" Balance, "Difficult Patients," and Evidence-Based Medicine on a Patient-Centered Approach. We designed a non-validated 32-question survey tool to assess residents' attitudes towards the Hidden Curriculum. Statements were pooled into groups of consensus and disagreement.

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