Автор неизвестен - Mededworld and amee 2013 conference connect - страница 85

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Take-home messages: Clinical experience may not correlate with student OSCE scores.


OSCE examiners and their scoring behaviors: An observation

Parasakthi Navaratnam (Monash University Sunway Campus, School of Medicine and Health Sciences, Jalan Lagoon Selatan, Bandar Sunway, Selangor Darul Ehsan 46150, Malaysia

Amudha Kadirvelu (Monash University Sunway Campus, School of Medicine and Health Sciences, Bandar Sunway, Selangor Darul Ehsan, Malaysia) Loretta Garvey (Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia) Margaret Hay (Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia) Shahjahan Yasin (Monash University Sunway Campus, School of Medicine and Health Sciences, Bandar Sunway, Selangor Darul Ehsan, Malaysia)

Background: In performance-based assessments such as the objective structured clinical exams (OSCEs) examiners remain a significant source of variance. In this study, we report the scoring pattern of OSCE examiners in the second year of the undergraduate MBBS program. Summary of work: The examination consisted of 8 stations, involving up to 24 examiners. All examiners attended a pre-examination station specific briefing and standardization process including a discussion of the scoring sheet. The examiners' mean scores, station mean scores, standard deviation and pass scores for each station were determined. Summary of results: The station mean scores varied from 13.89 to 17.25 out of a maximum possible score of 20. The SD range was 1.96 to 3.01 and pass scores were from 11.85 to 13.17. The percentage of examiners whose mean scores were within 1 SD of the station mean score ranged from 75% to 100%. Conclusions: The results are preliminary and suggest that variation in examiner scoring behavior exists and

reasons for this could include the hawk and dove phenomenon, station difficulties and the station objectives. Further analyses of the data are required to deal with some of the confounding factors. This will inform on the design of appropriate interventions to improve standardization among OSCE examiners. Take-home messages: As the OSCEs depend heavily on individual raters, consideration might be given to finding useful, defensible, and legitimate statistical means to detect and reduce or minimize such variance.

7CC Posters: Standardized Patients / Virtual Patients

Location: South Hall, PCC


Development of Standardized Patients for learning how to communicate with patients

Shima Sepehr (Medical Education, Universiti Sains Malaysia- Kota Bharu- Health Campus- PPSP, Kota Bharu 16150, Malaysia)

Rogayah Jaafar (Universiti Sains Malaysia, Medical Education, Kota Bharu, Malaysia) Hafiza Arzuman (Universiti Sains Malaysia, Medical Education, Kota Bharu, Malaysia)

Background: Standardized Patients (SPs) are used as one of the educational tools for learning clinical skills for medical students. If students learn better in clinical training session with SPs, they will be able to work with real patients more confidently and more skilfully. Summary of work: The study comprises two components: a developmental project and a descriptive research component. The first objective of the study was to train and use a number of SPs for the communication skills training in history taking sessions (in the Respiratory Block for second year medical students (MD program), School of Medical Sciences. Chronic cough script developed and after validation and translation used for training the potential SPs, which they then used/applied when teaching communication skills".

Summary of results: The results showed that all 155(100%) students were satisfied with the overall teaching and learning sessions with the SPs, as well as the different aspects of history taking and SPs' performance.

Conclusions: The results of the study indicated a potential use of SPs as a valuable tool in teaching and learning effective communication skills in undergraduate medical education.

Take-home messages: Our attempt was also to explore the roles of SPs and teachers in providing feedback on students' performance in the history taking session, the findings however are not included in the study.


Empathy, clue hunters and exam blindness. Inclusion of a photograph in an undergraduate


JM Illingworth (Royal Brompton & Harefield NHS

Foundation Trust, Anaesthesia, 26 Kingscourt Road,

London SW161JB, United Kingdom

J Hollands (King's College London, Department of Clinical

Assessment, London, United Kingdom)

SR Strachan (King's College Hospital NHS Foundation

Trust, Critical Care, London, United Kingdom)

Background: King's College London medical undergraduate final Objective Structured Clinical


Examination (OSCE) includes two prescription writing stations. The 2012 OSCE included a simulated patient photograph. Simulated patient materials can promote student empathy (Deladisma, 2007), however it is unclear if this alters performance during assessment (Hojat, 2002). We evaluated the effect on exam performance of including a photograph and explored students' views on its inclusion.

Summary of work: Scores for 2012 prescription writing stations were compared against 2011 scores. Cohort differences (2011 cf 2012) were controlled for by analysing a separate non-prescription "control" station which was the same for both groups. Results were analysed using t-tests & ANOVA. Immediately following their OSCE students self-completed an anonymised questionnaire. Responses were analysed using thematic analysis.

Summary of results: The study included 224 students, 181 (81%) completed the questionnaire. No difference in control station scores. No difference in prescription writing station scores 2011 vs. 2012. Student views divided into 4 groups: positive, neutral, negative & those not 'seeing' the photograph. 55 students (31%) thought the photograph increased realism and improved their prescribing. 74 (43%) felt unaffected by the photograph, commonly remarking on insufficient time to consider it. 20 (12%) found the photograph distracting and were unsure whether missing diagnostic 'clues'. 25 (14%) did not see the photograph. There were no gender differences.

Conclusions: Inclusion of a photograph did not affect student scores. Student views on the photograph were mixed. Students may not process all information available.

Take-home messages: Simulated patient materials can promote empathy but did not objectively affect performance.


OSCE assessment of student inter-personal and communication skills by simulated patients compared with clinical tutors - Is there a correlation?

FM Meagher (Royal College of Surgeons in Ireland,

Medicine, Education and Research Centre, Beaumont

Hospital, Dublin 9, Ireland)

KM Sheehan (Royal College of Surgeons in Ireland,

Pathology, Dublin, Ireland)

RM Conroy (Royal College of Surgeons in Ireland,

Epidemiology, Dublin, Ireland)

NG McElvaney (Royal College of Surgeons in Ireland,

Medicine, Dublin, Ireland)

Background: Incorporation of standardised patient (SP) ratings of student performance is a useful approach to the assessment of student inter-personal skills and professionalism. This study aims to determine the correlation between SP and clinical tutor ratings of final year medical student performance in a communication skills OSCE.

Summary of work: Students' inter-personal skills and professionalism were assessed in a 2-station OSCE, which was a component of the Final Professional OSCE Examination. Students (n=215) were independently graded on their performance by a clinical tutor and an SP. Using a 5-point scale, judgments ranged from 'clear fail' to 'excellent.'

Summary of results: Students' overall (global) grades for the 2 stations were analysed and the relationship between clinical tutor and SP scores was determined. The correlation coefficient (rs) for station 1 and station 2 was 0.71 and 0.69 respectively, indicating a strong positive relationship between the 2 types of examiners at each station.. Further analysis showed that by combining the 2 station scores, both examiners were in full agreement for 49% of students. There was a one-point difference for 43%, 2-point difference for 7.7% and in the case of only one student, there was a 3-point divergence in scoring (0.2%).

Conclusions: The results of this 2-station OSCE indicate a high level of agreement between SPs and clinical tutor examiners. Using a 5-point scale, 92% of the grades were either equal or within a 1-point difference. Take-home messages: These results suggest that there may be a role for incorporating SP ratings in an OSCE assessment of inter-personal and communication skills. This approach will re-enforce the perceived importance of these skills to all stakeholders.


Effect of emotionally-complex roles on standardized patients

Ximena Triviho (Pontificia Universidad Catolica de Chile,

Centro de educacion Medica, Escuela de Medicina,

Noruega 6595 Dpto 1804 Las Condes, Santiago, Chile)

Lilian Ferrer (Pontificia Universidad Catolica de Chile,

Escuela de Enfermeria, Santiago, Chile)

Margarita Bernales (Pontificia Universidad Catolica de

Chile, Escuela de Enfermeria, Santiago, Chile)

Rosina Cianelli (Pontificia Universidad Catolica de Chile,

Escuela de Enfermeria, Santiago, Chile)

Philippa Moore (Pontificia Universidad Catolica de Chile,

Centro de Educacion Medica, Escuela de Medicina,

Santiago, Chile)

Nilda Peragallo (University of Miami, School of Nursing and Health Studies, Miami, United States)

Background: Standardized patients (SPs) have participated successfully in nursing and medical education. SPs portraying stressful situations may have psychological or physiological effects after their performance; however long-term effects have not been well documented in the literature. Objective: to explore the impact of interpreting roles related to HIV among SPs.

Summary of work: Qualitative descriptive approach. Questionnaires with open ended questions were conducted immediately after the interpretation of HIV related roles and a year later by 10 SPs, who performed his/her role 12 to 24 times in an OSCE. In addition, a


focus group was run a year later using a pre-established interview guide.

Summary of results: Two major themes emerged based on content analysis: a) Effects of the interpretation: physical (weariness, headache, nausea), emotional (sadness, anguish, fear, vulnerability), and behavioral (talk with their partners and friends, use prophylactic methods, take an HIV test), and b) Complexity of the roles: previous experience as SPs in OSCEs, nature of the role, preparation, training and debriefing. Conclusions: The findings stress that interpreting an HIV related role produces emotional, behavioural and physical effects in SPs, at any stage during the training or performance, and has a long-term impact on their perception of his/her personal health and risk. Take-home messages: a) To interpret complex roles can produce emotional, physical and behavioral effects in SPs; b) To portray stressful roles may have short and long-term impact on SPs; c) Selection, preparation, training and debriefing are issues to consider for reducing negative effects on SPs.


The use of standardized patients in training Advance Trauma Life Support (ATLS)

Myrna Montemayor (UANL, Surgery, Calzada del Valle 301 interior 106, San Pedro Garza Garcia NL 62220, Mexico)

Santos Guzman (UANL, Anatomy, Monterrey NL, Mexico) Gerardo Munoz (UANL, Surgery, Monterrey NL, Mexico) Martin Alvarez (UANL, Surgery, Monterrey NL, Mexico)

Background: In the ATLS course health professionals are trained in the skills and abilities required for the management of acute situations in multiple trauma patients. Standardized patients interventions are widely used in medical educations as a common instructor and assessment tool enables the representation of different developmental stages of an illness, complications and side effects.

Summary of work: The course was aimed at health professionals involved in emergency medicine. Six simulation rooms were available with standardized patient and diverse medical and surgical equipment: pneumothorax, cardiac tamponade, 2nd degree burn, fractured pelvis, patient transfer and penetrating wound. Standardized patient is the centre of scenarios designed to support learning in procedural skills, provides safe and effective practice of diagnosis and treatment algorithms as well as of communication and teamwork skills, before these situations are met in daily practice.

Summary of results: Most students found that standardized patients were instructive and helpful to make the simulated trauma scenarios real. They are a valid, reliable, acceptable and feasible method to teach the skills necessary for the training. Students evaluate the interaction with standardized patients for teaching favorably.

Conclusions: The standardized patients facilitates the recognition of acute trauma, the learning of their

management, prompting the decision, making diagnostic and therapeutic decisions of the team in a realistic environment, detection of training deficiencies and promote the integration of complex clinical knowledge and skills in the most common scenarios of the critically patients.

Take-home messages: Standardized patient is a well-established tool for training personal health in emergency medicine.


E-Learning: Comparing the Effectiveness of Virtual Patients and Lectures as Pedagogies for Medical Students

Ganan T Radhakrishnan (Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, United Kingdom) Mehul Patel (Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, United Kingdom)

Raj Thuraisingham (Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, United Kingdom)

Caesar Wek (Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, United Kingdom)

Taseem Choudhury (Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, United Kingdom)

John Fuller (Queen Mary University London, Barts and The London School of Medicine and Dentistry, London, United Kingdom)

Background: Virtual patients are simulated clinical scenarios that are increasingly integrated into medical curriculums to enhance traditional teaching practices. This study aims to establish if virtual patients can lead to better knowledge acquisition and problem-solving skills when compared to lectures or whether the two techniques are complementary. Summary of work: Approximately 100 third year medical students will be randomly assigned to two groups. Group A will attend a lecture and group B will complete a virtual patient both on the topic of acute kidney injury. Both groups will subsequently complete a MCQ examination. Students will also complete a questionnaire relating to the perceived usefulness and feasibility of the e-learning module compared to the lecture.

Summary of results: Our pilot study revealed that students who completed the virtual patient achieved higher scores (81%) on a topic specific MCQ examination compared to the lecture group (61%). 88% of students felt the VP was set at an appropriate level. The majority of participants (94%) believed VPs should not replace physical patient encounters and would be willing to undertake the modules independently (63%). A larger scale study is currently in progress and will be completed in April 2013.


Conclusions: Virtual patients are an effective adjunct to lectures and they help develop a student problem solving and decision making skills. Take-home messages: This study shows that students value VPs as a self-directed learning resource and will utilise its benefits to complement learning.


Virtual Patients: 'This way' for evidence based, accessible, open-access resources

James Bateman (Warwick Medical School, Education and Development Research Team, Coventry, United Kingdom)

Maggie Allen (University Hospitals Coventry and

Warwickshire NHS Trust, Department of Medical

Education, Coventry, United Kingdom)

Jane Kidd (Warwick Medical School, Education and

Development Research Team, Coventry, United


Nicholas Parsons (Warwick Medical School, Statistics and Epidemiology, Coventry, United Kingdom) David Davies (Education and Development Research Team, Warwick Medical School, The University of Warwick, Coventry CV4 7AL, United Kingdom)

Background: Virtual patients (VPs) are online representations of realistic clinical cases. Widely used, there is limited evidence as to how they should best be designed. Significant resources are required to develop VPs. The recent Medbiquitous international technical inter-operability VP standard supports sharing, re-purposing, and collaboration. Summary of work: We studied 16 VPs in four core musculoskeletal topics in a multi-centre randomised factorial study of year three and four medical undergraduates. We evaluated the impact of two design properties: branching and clinical reasoning instruction. The VPs were developed to the Medbiquitous standard, using a Creative Commons licensing strategy for content development. Outcomes included scores from decisions and a published self-reported VP evaluation (EViP). This research was funded by an education research grant 19330 from Arthritis Research UK. Summary of results: We invited 718 students from three UK Schools, 591 (82.5%) consented to participate. They completed 1778 VPs and 1229 evaluations (69.1%). They spent 28.6 minutes (SD 13.7) per VP, scoring 8.5/15 per VP (SD 2.1). The cases were positively evaluated (44.5/55, SD 5.44). We found: (1) a number of significant differences supporting individual design properties; (2) correlations between VP scores and summative assessment data (r=0.3-0.5).

Conclusions: This large VP research study is the first to our knowledge to publish the VPs and student performance metrics as open-access resources to support the research dissemination. We call for open publication of research cases to promote scrutiny, transparency, uptake, and VP development. Take-home messages: We have evidence to support individual VP design properties. The VPs used are

accessible via our study website www.go.warwick.ac.uk/virtualpatients.


Virtual Patients in the form of a Medical Application for smartphones and tablet devices

Janet Iqbal (The University of Glasgow, Undergraduate Medical Department, University Avenue, Glasgow G12 8QQ, United Kingdom)

Iain Johnson (Glasgow University, Undergraduate Medical Department, Glasgow, United Kingdom) Adrian Raudaschl (Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, United Kingdom)

Background: Since the 1970s on-screen simulations of clinical scenarios have been created and subsequently used in education. However, it is only in recent years that virtual patients have begun to form an integral part of mainstream healthcare education due to the advancement in technology resulting in lower cost and ease of construction

Summary of work: Two 4th year medical students developed and evaluated a medical application for use on iphones and tablet devices as a part of a 5-week student selected component. The topic of microbiology/infectious disease was chosen since this is an area that students find challenging. Following a literature review, 9 cases were written which, following input from topic experts were transferred into a virtual patient medical application. Medical students from years 3, 4 and 5 were then invited to use the application. Pre and post-questionnaire data was collected. Summary of results: A total of 60 students tested and evaluated the application. Analysis of the results showed that both students and staff found that the application: (1) was an effective and enjoyable way to learn; (2) had increased confidence and knowledge; (3) would use it again and would recommend it to a friend. Conclusions: The development and implementation of a medical application using virtual patients was a useful learning resource.

Take-home messages: This study makes a valuable contribution to the limited literature which is available to provide evidence in support of the use of this technology.


Establishment of a Supra-Regional Network of National Centres in Medical Education, focussed on PBL and Virtual Patients (ePBLnet)

Trupti Jivram (St George's University of London, Division of Population Health Sciences and Education, e-Learning Unit, Cranmer Terrace, London SW17 0RE, United Kingdom)

ePBLnet Consortium (Aristotle University of Thessaloniki, St George's, University of Nicosia, Karaganda; Astana; David Tvildiani; Zaporozhia Medical Universities; Sumy and Kutaisi State Universities)


Background: In 2012, a consortium of 9 institutions, 3 from EC countries and 6 from participant countries in Eastern Europe, received EC Tempus Funding for the creation of national medical education centres (MECs) in Georgia, Ukraine and Kazakhstan. Their initial task was to modernise the teacher classroom-oriented biomedical science component of the medicine course in the 6 Eastern European universities, to a more student-motivating, competency-based learning styles more relevant to clinical practice. The second task was to link with other medical education modernisation networks and use this ePBLnet 'string of pearls' network to generate the critical mass of academics/institutions needed for sustainable development in medical education across several regions. Summary of work: It is the task of MECs to produce generalisable curriculum development plans for each of the partner institutions, taking advantage of the similarity of their post -Soviet curricula. The curricula are being restructured with a focus on competence-based learning and assessment systems built around Problem-Based Learning and Virtual Patients. Summary of results: The network MECs have been set up and agreed a generalised curriculum. Partners are now focussed on developing the individual PBL curricula. During this period the consortium will begin to widen the network to include other education networks. Conclusions: A consortium approach is successful in this instance because of the great similarities in the Eastern European medical education structures in general, and in particular post-Soviet countries. Take-home messages: For those with similar interests the ePBLnet should offer a sustainable network for continuing engagement.

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