Автор неизвестен - Mededworld and amee 2013 conference connect - страница 77

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Summary of results: 105 of 171 (61.4%) residents from six specialties (Internal Medicine, Surgery, Pediatrics, Emergency Medicine, Obstetrics/Gynecology, and Psychiatry) participated in the survey. We reported specialty specific differences. Surgery residents more likely to break the duty hours regulation for patient care.(3.2 vs. 4.1, p<0.05). Internal Medicine residents believe that they practice less defensive medicine compared to their peers (3.6 vs. 4.5, p<0.05). Pediatrics residents were more likely than the other cohorts to trust the attending's opinion more than evidence-based medicine in patient care decisions (4.9 vs. 3.9, p<0.05). Obstetrics/Gynecology residents practice patient advocacy more than peers (4.25 vs. 3.0, p<0.05). Emergency Medicine residents enjoy their work-life balance (6.2 vs. 3.5, p<0.05). Conclusions: The effects of Hidden Curriculum were identified among residents, many of which were specialty-specific. Residents appear to have chosen their specialty based on work-life balance. Take-home messages: Residents view themselves as accountable to patients despite the transition to new duty hours regulations.


Resident Perceptions on Rewards and Challenges of Caring for Ambulatory Patients with Chronic Illness

David C Thomas (Icahn School of Medicine at Mount Sinai, Medicine, One Gustave Levy Place, Box 1118, New York 10029, United States)

Background: Many residents care for patients in a traditional environment, with suboptimal continuity of care and episodic, acute interventions. The complexity of patient care in a short ambulatory care visit may not provide enough time for the provider to discuss longitudinal components of their diseases. Summary of work: A prospective qualitative study at 3 Academic Health Centers was conducted from October 2011 through February 2012. Focus groups were conducted with Internal Medicine residents during their ambulatory block rotation using qualitative analysis to identify themes.

Summary of results: Discussions produced 224 comments, categorized in 5 domains and 36 themes. Twelve (12) themes related to perceptions of challenges in providing care. Eight (8) focus on strategies to improve the patient experience. Strengths of the residency program were identified in 7 themes. Six (6) related to ways for improving learning about caring for patients with chronic illness in the ambulatory setting and 3 themes related to perceptions of rewards in providing care.

Conclusions: Residents perceive both challenges and rewards in caring for patients with chronic illness in the ambulatory setting. They identify barriers in caring for their patients, from both the provider and patient's perspectives. It's critical to account for resident's perspectives during curriculum development for the care of patients with chronic illness in the ambulatory care setting.

Take-home messages: Residents develop strategies to provide effective care for their patients and make suggestions for improving the residency clinic.


Teaching and Assessment Toolkit to Integrate the Collaborator Role in Residency Training

Dawn Martin (University of Toronto, Postgraduate Medical Education, 500 University Avenue, Suite 602, Toronto ON M5G1V5, Canada)

Susan Glover Takahashi (University of Toronto, Canada) Denyse Richardson (University of Toronto, Postgraduate Medical Education, Toronto, Canada)

Background: Graduating physicians are expected to be able to competently collaborate with patients, families and interprofessional teams. Collaboration involves elements such as learning when and how to share power and information, knowing how to prevent misunderstanding and manage difference, and knowing how to work efficiently and effectively in teams


Summary of work: Given the absence of 'ready for use' learning, teaching and assessment tools, the authors adapted and developed a toolkit for use by faculty and residents to develop collaborator competencies in residency education.

Summary of results: This short communication will explore how the development of a learning, teaching and assessment resource which aims to support the development of the intrinsic role of Collaborator was beneficial in areas such as: selecting and prioritizing appropriate collaborator competencies to teach residents in your program; applying new approaches and tools for teaching collaborator competencies to residents in their discipline (i.e. including bedside and clinical teaching approaches); and applying new approaches and tools for the assessment of collaborator competencies to residents in their discipline (i.e. including bedside and clinical teaching approaches). Conclusions: Learners are frequently, and repeatedly, transitioning to new locations or units where they are expected to seamlessly interact in teams in order to provide optimal care to patients and families. The underlying concepts, skills and attitudes needed to collaborate efficiently and effectively are challenging to teach and difficult to assess.

Take-home messages: The collaborator toolkit provides a practical and educational starting point for faculty development of teachers and educational planners.


Learning behaviours and preferences of Canadian family medicine residents outside of the clinical setting

Alice Sy (Western University, Undergraduate Medical Program, London, Canada)

Eric Wong (Western University, Family Medicine, 346 Platt's Lane, London N6G1J1, Canada)

Background: Learning is maximized when there is concordance between education formats and residents' learning preferences. However, little is known about residents' actual learning activities outside of the clinical setting. Thus, the objective of this study is to characterize family medicine residents' learning behaviours and preferences outside of the clinical setting.

Summary of work: Retrospective descriptive analysis of mandatory academic learning logs submitted by family medicine residents (as part of their academic program requirement) enrolled at Western University between

2008 and 2011.

Summary of results: Seventy-two residents completed their academic requirements during the study period and logged a total of 25068 hours of academic learning. Residents chose to spend the majority of their academic time self-studying (43.8%), in staff's teaching sessions (20.2%) and in conferences/courses/workshops (12.2%). Textbooks (26.4%), medical journals (20.1%) and point-of-care resources (12.3%) were the three most common resources used for self-studying. The hospital (32.3%), residents' homes (32.1%) and family medicine clinics

(14.3%) were the most frequently cited locations where academic learning occurred. While all physicians used a variety of educational activities, most residents (69.4%) chose self-studying as their primary method of learning. The topic for academic learning appeared to have some influence on the learning modalities used by residents. Conclusions: Residents used a variety of learning modalities and chose self-studying over other more traditional modalities such as lectures for most of their academic learning.

Take-home messages: A successful academic program must take into account residents' varied learning preferences and habits while providing guidance and training in the usage of more effective learning methods and resources to maximize educational outcomes.


Trainees'perception of negative verbal feedback in Obstetrics and Gynaecology

Anita Sanghi (Barts Health NHS Trust, Obstetrics & Gynaecology, Royal London Hospital, New Stephney Way, London E1 1BB, United Kingdom)

Background: Bullying and harassment is a serious problem in the specialty of Obstetrics and Gynaecology. There is anecdotal evidence that bullying starts as verbal negative feedback in the specialty of Obstetrics and Gynaecology. Objective was to evaluate the trainees' perception of negative verbal feedback in Obstetrics and Gynaecology.

Summary of work: A survey with cross sectional research design involving 594 Obstetrics and Gynaecology trainees in London. A thematic analysis of the data are presented.

Summary of results: 115 questionnaires were returned. Analysis of open questions demonstrated two candidate themes - trainees' perception of negative verbal feedback and demotivation. In the candidate theme of trainees' perception of negative verbal feedback, the sub themes were lack of care, respect and support, unfair behaviour, manner of giving feedback and bullying and harassment. Conclusions: It is interesting that many trainees perceived negative verbal feedback as bullying and harassment. Negative feedback in the form of lack of respect, care and support, unfair behaviour, bullying and harassment goes against the principles and ethos of establishment of "practice" and "identity". The trainers in Obstetrics and Gynaecology have to address the issue of delivery of negative verbal feedback so that this is not perceived as lack of care, respect, support, unfair or bullying and harassment by the trainees. Take-home messages: The trainers face a challenge on how best to deliver critical feedback. This may have an implication for the Royal Colleges, and trusts, how best to train the trainers to meet this challenge.



Getting STARTed: the impact of a foundation level critical care course on subsequent patient management

Mary Herns (Royal College of Surgeons of England,

Education, London, United Kingdom)

Deborah Fowler (Royal College of Surgeons of England,

Education, London, United Kingdom)

John Jameson (Royal College of Surgeons of England,

Education, 35 - 43, Lincoln's Inn Fields, London WC2A

3PE, United Kingdom)

Daniele Bryden (Royal College of Surgeons of England, Education, London, United Kingdom)

Background: Systematic Training in Acute Illness Recognition and Treatment in Surgery (START) was developed by the RCS and is aimed at newly qualified doctors looking after surgical patients as 'first responders'. It comprises e-learning modules, a one day interactive face to face session and pre- and post-course assessment of knowledge and learning, providing a structured 3 stage approach to managing patients, along with peer group learning and senior support to improve communication, planning and basic decision making. The aim of this study was to assess whether the participants thought the course had impacted upon their subsequent clinical practice. Summary of results: To date, 447 trainees have completed the programme; levels of knowledge have increased following the course (Mean pre- and post-course scores 66% and 70% respectively, p <0.05) and immediate feedback has been positive, with 83% being satisfied or very satisfied with the course overall. A sample (n=88) of participants from the last year was surveyed: 35 responded (40%). All respondents who have since cared for an unstable surgical patient reported having used the START process and that it had made them feel more confident in their role. 89% felt that START had been an essential part of their training so far and 97% felt that it should be offered to all newly qualified doctors caring for surgical patients. Conclusions: Our evidence shows that a blended learning programme like the START course is an effective way of preparing newly qualified doctors to care for surgical patients by improving knowledge and clinical confidence.

Take-home messages: All Foundation Year 1 doctors doing a surgical post should do START.

7J Short Communications: Preparation

for Practice 2

Location: Club E, PCC


Exploring medical students' perceptions on preparedness for becoming a first year graduate doctor after undertaking a prolonged assistantship

Sarah Jayne Kingdon (Barts and the London School of Medicine, Oncology, London, United Kingdom) Elewys Lightman (The University of Sheffield, Medicine, Sheffield, United Kingdom)

Andrew Hill (Goldsmith's University, History, London, United Kingdom)

Michael Nelson (The University of Sheffield, Medical Education, Sheffield)

Background: Adequate preparation is essential for a smooth transition from medical student to junior doctor. The GMC expects students to have undertaken a period of 'shadowing' Foundation trainees. Sheffield Medical School responded to this by initiating a six week student assistantship following finals. This qualitative study aims to explore the perceptions of students on their preparedness for clinical practice following the assistantship.

Summary of work: Students undertaking the assistantship completed a brief questionnaire regarding their anxieties towards their FY1 year. Subjects were purposefully sampled and 20 participants underwent semi-structured interviews. Interviews were transcribed verbatim and thematic analysis conducted. Summary of results: The majority described a positive experience, felt they were given appropriate responsibilities and were well integrated into their teams. The most commonly reported anxieties included risk of causing harm, prescribing errors, overwhelming workload and general doubts concerning overall competence. In terms of the assistantship, discussion centred around: learning goals, consultant supervision, prescribing, and managing acutely unwell patients. Conclusions: Medical student assistantships enable gradual and monitored stepwise allocation of responsibility, superior to the previous 'in at the deep end' approach. To maximise the benefit of the placement students should create reflexive goals for their learning, a precursor to postgraduate reflective practise. Teaching sessions must be tailored around topics that cause most anxiety, particularly prescribing and the acutely unwell patient. Take-home messages: Assistantships improved students' sense of preparedness for FY1 training. In the near future a nationally cohesive programme allowing students to undertake a prolonged assistantship in their prospective job should be implemented.



Orientation course for MBBS students at entry level: Our Experience

Ramya Bhaskaran (Sri Ramachandra Medical College and Research Institute, General surgery/ Medical Education Unit, 1, Ramachandra Nagar, Porur, Chennai 600116, Tamil Nadu ,India, 1/21, Krishnapuri, 2nd Street, Srinivasa Avenue, R.A.Puram, Chennai 600028, India) R.B. Sudhagar Singh (Sri Ramachandra Medical College and Research Institute, General Medicine/Medical Education Unit, Chennai, India) P. Surendran (Sri Ramachandra Medical College and Research Institute, General Surgery/Medical Education Unit, Chennai, India)

T.V. Ramakrishnan (Sri Ramachandra Medical College and Research Institute, Emergency Medicine, Chennai, India)

P.V. Vijayaraghavan (Sri Ramachandra Medical College and Research Institute, Orthopaedics/Medical Education, Chennai, India)

Background: Students in India enter medical college soon after passing high school exams. There is a world of difference between school and a medical college, in terms of environment, curriculum, methods of teaching, learning and assessment. It would be beneficial to the students if they had adequate orientation towards the same.

Summary of work: With this in mind, the Medical Education Unit conducted a 8 day orientation course for 250 MBBS students at entry level in July 2012. The morning sessions comprised of large group discussions on medical ethics and professionalism, national health priorities and policies, etc. The afternoon was devoted to group activities like basic life support, communication skills, stress and time management, language training etc. Written feedback was obtained. Summary of results: This 8 day course was well appreciated by the students. 196 students completed the feedback forms. They felt that the orientation program was very effective in giving them a clear idea of the course, and the skills and efforts needed for it, through various activities. 98% felt they were better equipped to face the challenges of becoming a medical professional.

Conclusions: We are one of the very few colleges in India who have conducted such a course and the only college to have conducted it for 250 students. Based on our success, we plan to make this an annual feature. A well designed orientation course helps the students to understand and realize the various facets of the medical profession.

Take-home messages: A well structured orientation course for MBBS students at entry level should be conducted in every medical college as it would help students coming from different learning environments to cope with the vast body of knowledge and skills required in the rapidly changing health care system.


Identifying issues relating to the performance of newly qualified doctors during the early transition from medical student to F1

Penny Cavenagh (University Campus Suffolk, Faculty of Health, Science and Wellbeing, Waterfront Building, Neptune Quay, Ipswich IP4 1QJ, United Kingdom Susan Miles (University of East Anglia, Norwich Medical School, Norwich, United Kingdom) Joanne Kellett (Norfolk and Norwich University Hospital, Norwich, United Kingdom)

Alexia Papageorgiou (St George's University of London Medical School at University of Nicosia, Nicosia, Cyprus) Charlotte Salter (University of East Anglia, Norwich Medical School, Norwich, United Kingdom) Sam Leinster (University of East Anglia, Norwich Medical School, Norwich, United Kingdom)

Background: There is evidence to show that new medical graduates feel unprepared for the roles and responsibilities they face as junior doctors, which may have implications for patient safety. Summary of work: This research investigated areas which junior doctors find difficult during the early weeks of practising as a doctor from the perspective of the doctors themselves and senior doctors who supervise them. The evidence was gathered through interviews with 22 supervisors and interviews and focus groups with 53 junior doctors (across multiple hospitals in the region).

Summary of results: Specific areas where junior doctors felt and were reported to be unprepared included: prescribing and knowledge of pharmacology, administrative tasks such as writing discharge summaries, developing differential diagnoses, challenging communications, responsibility, decision-making, hand-over, task prioritisation and time management. Junior doctors also felt the need for more in-depth departmental inductions. Conclusions: The findings support existing research evidence that junior doctors are unprepared for work in some, but not all areas. There was consistency between the views of junior doctors and supervisors. This study confirms earlier findings that there is a need for better management of the transition from student to junior doctor. The findings have informed recommendations made to medical schools and employing hospitals in order to improve the transition between medical school and work as a newly qualified doctor and thus to enhance patient safety.

Take-home messages: The transition from medical student to F1 doctor needs to be handled more effectively.


The Apprentice: shadowing experiences of newly qualified doctors using qualitative research

Taruna Bindal (Alexandra Hospital, Paediatrics, Woodrow Drive, Redditch B98 7UB, United Kingdom)


Helen Goodyear (NHS West Midlands Workforce Deanery, Postgraduate School of Paediatrics, Birmingham, United Kingdom)

Background: The first few weeks of being a doctor are often stressful with a potential increased risk to patients. Job shadowing and taking part in day-to-day activities by final year students and medical graduates varies by medical school and deanery. In July 2012, a UK National Mandatory Paid Shadowing Week (NMPSW) was introduced for graduates beginning posts in August. This study looks at whether the NMPSW improved the transition from student to newly qualified doctor. Summary of work: 6 Focus groups, using semi-structured interviews looked at Foundation year one doctors' (FY1Ds) shadowing experiences both pre and post NMPSW at one large Hospital Trust. Summary of results: 46 participants took part. Thematic data analysis showed 4 themes: what makes the experience worthwhile, patient safety issues, the impact of shadowing on medical teams and suggested improvements. Overall, the NMPSW was considered beneficial. Ward based work, working out of hours and FY1Ds' job survival tips were more useful then senior staff lectures. Issues included lack of engagement by some consultants, organization, no guidelines on what to include in shadowing and the outgoing FY1D having increased responsibility.

Conclusions: The NMPSW was valued by FY1Ds and its timing enabled formal patient handover thereby improving patient safety. Shadowing guidelines are needed and the outgoing FY1D needs training for their teaching role. The optimal duration of student shadowing and the NMPSW needs evaluation. Take-home messages: A formal shadowing week, immediately prior to starting work is valued by newly qualified doctors and aids provision of safe, high-quality patient care.


Mentoring for junior doctors. A success for both mentor and mentee

Nynne Lykke Christensen (Junior doctors in Denmark, Education & Career, Kristianiagade 12, Copenhagen 0 2100, Denmark)

Bo Rahbek (Junior doctors in Denmark, Education & Career, Copenhagen, Denmark)

Background: In Denmark there is a significant difference between the life as a student and the life as a working doctor. Among newly educated doctors, this results in an expressed concern over the culture prevailing in the working life as a doctor. Therefore, in 2008 Junior Doctors decided to start a mentoring program for newly educated doctors. The mentors are recruited among more experienced doctors and specialists. Summary of work: From the beginning, the primary focus has been the mentees' work related to challenges and career coaching concerning their future specialisation. Mentees have been paired up with mentors from another hospital so that the mentee may

feel comfortable with their mentor without worrying about breach of confidentiality. Summary of results: It is clear that mentees have the prior expectation that they will benefit the most from career coaching. Nevertheless, our experience shows that sparring about daily challenges is the main contributor to the further education of the mentees. Futhermore, a clear pattern shows that mentors benefit from mentoring as much as the mentees, partly because they become better sparring partners, and partly because they become aware of their own choices in their career. Every year approximately 210 mentors and mentees are paired up.

Conclusions: Based on the results, we know that a mentoring program eases the transition to a working life as a doctor and helps improve doctors' future career choices.

Take-home messages: Matching should be done based on geography to ensure that mentor and mentee may meet relatively easily.


Gaps and Traps - Attuning Procedural Skills for Internship

Susan McKenzie (The University of Sydney, Clinical School RPAH, Camperdown, Sydney 2050, Australia) Annette Burgess (The University of Sydney, Clinical School, RPAH, Sydney, Australia) Craig Mellis (The University of Sydney, Clinical School, RPAH, Sydney, Australia)

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