Автор неизвестен - Mededworld and amee 2013 conference connect - страница 87

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Medical education in Iran

Shima Tabatabai (Shahid Beheshti University of Medical Sciences, Medical Education Department, Velenjak,, Tehran, Iran)

Background: Medical education in Iran stands to benefit from 3 decades of well organized developments: new medical schools, Ministry of Health and Medical Education, strong primary care in rural areas, a commitment to evidence based medicine, mandated continuing medical education. Summary of work: In this project, we review some of the important characteristics of medical education and its progression in Iran.

Summary of results: Medical education in Iran is growing quantitatively and qualitatively. The number of medical schools has increased from 13 in 1979 (before the 1979 revolution) to 48 today, representing approximately one school for every 1.5 million people. Iran has been ranked ninth out of 235 countries in terms

of the number of medical schools Study in state universities is free. There is a highly competitive national examination for entering these programs. Conclusions: Despite the eight-year war with Iraq, U.S. sanctions, three United Nations economic sanctions, and consequent reduced government budgets for public spending, Iranian medical educators have not been disappointed from undertaking training programs in a wide variety of fields.


Coordination of Medical Residency for Municipal Public Health Service: Analysis of Results

Anna Beatriz Naumes (Faculdades Pequeno Principe, Medical Education, Alameda Augusto Stellfeld 2279,

Curitiba 80730150, Brazil)

Giseli Cipriano Rodacoski (Faculdades Pequeno Principe, Medical Education, Curitiba, Brazil) Izabel Cristina Meister Coelho (Faculdades Pequeno Principe, Medical Education, Curitiba, Brazil)

Background: National Curriculum Guidelines point to the integration of students with the Health System and the health needs of the population (ALMEIDA, 2005). Summary of work: The objective of this report is to present the experience of a Municipal Health Department to coordinate the residency program. The city government took over the driving making use of pedagogical training of tutors in active methodologies, creation of jobs, commitment of financial resources and publication of laws guaranteeing rights and institutionalization of remuneration for the teaching service to physicians.

Summary of results: Since 2011 30 places are offered annually for which there was an increasing number of candidates passing 76-420. The precepts are physicians who work in services and have different types of links with the Prefecture. It is difficult to pay for medical teaching function outsourced because the statute of cooperatives has as its object the provision of medical care exclusively.

Conclusions: After two years the Ministry of Education has evaluated positively the teaching program and granted final accreditation. The health management of two municipalities in the state has requested consultancy to replicate the experience on their scenarios.

Take-home messages: As a benefit to the services, the involvement of physicians with the functions of preceptorship contributed to: development of protocols, interface negotiation skills among the various specialties favoring the establishment of networks of health care, increased problem solving services.


Self-perceived confidence levels of Community Health Workers to carry out their Roles within the Primary Health Care Outreach Teams

Abigail Dreyer (University of Witwatersrand, Centre for Rural Health, PO Box 295, Zeerust 2865, South Africa)


Jose Frantz (University of Western Cape, Physiotherapy, Cape Town, South Africa)

Ian Couper (University of Witwatersrand, Centre for Rural Health, Gauteng, South Africa)

Background: Community Health Workers (CHWs) will be employed by Government, and will be part of the ward based PHC outreach team. Their role is seen in strengthening health promotion and prevention. The training of Community Health Workers to fulfil their roles has been tasked to NGO's. The curricula contain the theoretical base but the practical application of the skills/abilities needed to fulfil their roles, has not been included.

Summary of work: This study investigated the confidence levels of CHWs related to their roles and responsibilities using an online survey with a Likert scale, to rate the levels of confidence. This was used to identify the areas for capacity building needed and develop the training intervention. After completion of training the same survey was completed again and pre/post comparisons were made. Data was captured using survey monkey, with analysis of frequencies and cross-tabulations on quantitative variables. Summary of results: Participants had been working in their communities, for more than 2 years prior to them being recruited for the outreach teams. There was a significant increase in confidence levels pre and post intervention regarding skill and ability. 68% of participants' confidence levels in terms of working in ward based teams increased post intervention. The participants not feeling confident to collect information shifted from 88% to 12% post intervention. Take-home messages: The mastery of skills needed to fulfil the tasks has a direct impact on the confidence of CHWs. Their input in identifying the skills gap added to the value placed on the training.


Curriculum Development, Assessment and Clinical Rotations of Clinical Associates With Distance Learning At A Clinical Learning Centre

Frank Peters (University of Pretoria, Family Medicine, Van Gogh Cres 599 Moreletapark, PO Box 40350 Moreletaridge, Pretoria 0044, South Africa)

Background: Clinical Associates (CAs) are trained at 3 Universities in South Africa. They graduate with a Bachelors degree in Clinical Medical Practice (BCMP). The training of these CAs is based on distance and service delivery training on site in a hospital. After 3 years they are placed as Physician Assistants in a District Hospital and always work under the supervision of a registered medical officer. Summary of work: What are the curriculum development, assessment and rotations of these CAs working at a Clinical Learning Centre (CLC) with distance learning from the middle of the first year until the end of the third year?

Summary of results: The learning site was evaluated with a reflective in depth study of the curriculum,

assessment and clinical rotations at a CLC with questionnaires to facilitators at different CLCs for evaluation of results and impact. The curriculum is divided in 3yr clinical study and covers all the medical systems. Assessments are done with observed consultations (Mini CEX) and patient studies, as an assignment, according to their clinical rotations. Conclusions: The clinical rotations entitle that the CAs work certain hours in the Hospital where the CLC is based.

Take-home messages: The overwhelming feeling of facilitators is that the curriculum assessment and clinical rotations are adequate to be a competent CA.


The utility of a tutorial booking website

Jon Cleland (Oxford University Hospitals, Academic Foundation School, 10 Cowley Road, Oxford OX41HZ, United Kingdom)

Eugene Ong (Oxford University Hospitals, Foundation School, Oxford, United Kingdom) Robert A Watson (Green Templeton College, University of Oxford, United Kingdom)

Maria T Tsakok (Green Templeton College, University of Oxford, United Kingdom)

Arvind Singhal (Brasenose College, University of Oxford, United Kingdom)

Background: Every teaching session requires a degree of logistical organisation that potentially creates a barrier to teaching.

Summary of work: We created a tutorial booking website to reduce the logistical burden of organising tutorials and increased incentive to teach. The website allows tutors to advertise their teaching to large pools of medical student users, and students to sign-up to teaching via the website. Feedback is also integrated into the site via online forms generated after every teaching session. All teaching sessions are automatically documented on each user's profile page. Summary of results: We monitored the teaching activity on the website over a 10 month period. Over 850 users in Oxford organised over 500 teaching sessions, including clinical skills, peer-to-peer and bedside teaching and university examiner and teacher training days. 118 doctors and 223 students completed questionnaires after using the site. They rated it easier to organise teaching sessions through the site compared to traditional methods like email, and gain objective feedback from their teaching (all p<0.05). Conclusions: The site allowed users to connect and communicate more easily without the use of mass emails. It facilitated the organisation of teaching, generation of feedback and documentation of sessions, and allowed the quantity and quality of teaching to be monitored and increased.

Take-home messages: This website has helped to improve the quality and quantity of teaching in the Oxford deanery, and could have similar applications in other medical schools. Indeed, the site is now being piloted in Edinburgh and London.



The silence of the PPandas-challenges and failures to establish 'habitats' for simulation-based team training in a large teaching hospital

Emma Evans (St George's Healthcare NHS Trust, Anaesthesia, London, United Kingdom) Huon Snelgrove (St George's Healthcare NGS Trust, Education and Development, London, United Kingdom) Justin Richards (St George's Healthcare NHS Trust, Neonatology, London, United Kingdom) Mark Fleet (St George's Healthcare NHS Trust, Anaesthesia, 1st Floor, Grosvenor Wing, London SW17 0QT, United Kingdom)

Polly Hughes (St George's Healthcare NHS Trust, Obstetrics and Gynaecology, London, United Kingdom) Caroline Davidson (St George's Healthcare NHS Trust, Paediatrics, London, United Kingdom)

Background: Seamless quality of care in hospitals involves crossing clinical area boundaries. Developing and distributing expertise across different hospital teams can be facilitated by creating collaborative training networks. Analysis of constraints during attempts to implement sustainable collaboration can contribute to understanding work-place learning and organisational resilience. Summary of work: To learn from and adapt our response after poor implementation of simulation-based collaborative learning we critically examined our assumptions and strategies: 1. How effectively were goals generated and agreed upon? 2. What conceptions of work-place learning, safety and organisational resilience learning were implicit or explicit in plans to use simulation-based learning technologies? 3. What social and material constraints impinged on success? We conducted a Delphi consensus analysis with clinical and educational leads in neonatology, A&E, Maternity and Paediatric wards. Faced with a persistent failure to implement plans after 6-months we conducted focus groups and individual interviews with key clinical decision makers.

Summary of results: Despite much consensus on goals, implementation was troublesome. Themes emerging from qualitative data included: contested ideas of simulation-based training; how leadership motivation can be undermined by central quality audits which 'crowd out' bottom up training initiatives; the inertia of historical routines and hierarchies in clinical areas. Conclusions: Reproduction of past practices rather than a reconfiguration of practice across clinical boundaries is a default solution in the face of seemingly intractable obstacles.

Take-home messages: Adequate resources and understanding of factors in organisational change and work-place learning are vital ingredients for future transformation of practices.


Do students need a part-time, flexible medical degree programme?

Nikul Kotecha (Barts and The London, School of Medicine and Dentistry, Queen Mary, University of London, Centre for Medical Education, London, United Kingdom)

Holly Lyne (Barts and The London, School of Medicine and Dentistry, Queen Mary, University of London, Centre for Medical Education, London, United Kingdom) Sareena Gajebasia (Barts and The London, School of Medicine and Dentistry, Queen Mary, University of London, Centre for Medical Education, London, United Kingdom)

Viv Cook (Barts and The London, School of Medicine and Dentistry, Queen Mary, University of London, Centre for Medical Education, London, United Kingdom) Joy Hinson (Barts and The London, School of Medicine and Dentistry, Queen Mary, University of London, Centre for Medical Education, London, United Kingdom) Olwyn Westwood (Barts and The London, School of Medicine and Dentistry, Queen Mary, University of London, Centre for Medical Education, London, United Kingdom)

Background: A UK medical degree is generally taken full­time over 5 years, but with the increased emphasis on widening participation, a changing student demographic, increased university fees and concerns regarding student health and well-being, is there a need for flexible part-time provision? The aim of this research was to explore current student perspectives on part-time study.

Summary of work: Data was collected by: (a) On-line questionnaires distributed to (i) current medical students at Barts and The London; (ii) biomedical-science students at Queen Mary, University of London; (iii) potential applicants from local non-selective schools. (b) Focus groups with students to further explore issues arising from the questionnaires. Summary of results: Preliminary responses to the questionnaires from medical and biomedical-science students (n=167) suggested they saw the benefits of part-time provision, identifying that those with caring responsibilities, chronic-health conditions and financial dependents would benefit most from a flexible course. There was a balance of opinion as to whether a part-time degree would increase students' likelihood of applying for medicine. Emerging themes from the qualitative data showed evidence of a range of factors that might influence students' attitudes towards part-time study: finances, time constraints, personal responsibilities, extra-curricular activities, attitudes of significant others.

Conclusions: The evidence suggests that students perceive that a flexible, part-time medical degree may be beneficial for certain student groups. Take-home messages: The traditional model of a full­time medical degree needs to be revisited to determine whether it is best meeting the needs of an increasingly diverse student population.



New Dimension of Postgraduate Education at TSU Faculty of Medicine in Georgia

Nino Chikhladze (Tbilisi State University, Faculty of Medicine, 1, Chavchavadze Ave.,Tbilisi 0179, Georgia) Alexander Tsiskaridze (Tbilisi State University, Faculty of Medicine, Tbilisi, Georgia)

Nato Pitskhelauri (Tbilisi State University, Faculty of Medicine, Tbilisi, Georgia)

Background: Higher Education system of Georgia has been in the process of extensive reforms since 2005, when two major innovations were carried out: the new law about Higher Education was adopted and Georgia joined the Bologna process.

Summary of work: With regard to the new legislation and Bologna process three cycles of education (Bachelor, Master and PhD) and ECTS system were implemented. According to the Law the duration of PhD program is 180 ECTS. At the level of Tbilisi State University the minimal standards of PhD Education was elaborated and approved by TSU Academic Council. The document clarifies the minimal requirement for admission, enrolment and access criteria to the programs, requirement for the PhD thesis, supervisor, evaluation etc. According to this document the curriculum of each PhD program in TSU should include teaching component (40-60 ECTS) and research component (140-120 ECTS). Training in transferable skills is part of the teaching component. Summary of results: At the level of Faculty of Medicine the Statement of PhD Education was elaborated and the additional requirement for the PhD thesis, supervisor, and evaluation was implemented (eg, an article in a peer-review journal should be published, assessment board includes one member from other Educational Institutions, etc).

Conclusions: The aim of the Faculty of Medicine is harmonization of PhD Education in Georgia with PhD Education in Biomedicine and Health Sciences in the European Higher Educational Area. Take-home messages: The case of implementation of the new vision of PhD programs at Faculty of Medicine at Tbilisi State University is an example of establishing the new paradigm of PhD Education in Medicine in Georgia.


Public Private Partnership in Healthcare System -60 years' Experience of a Private Medical College in Mangalore, India

Venkatraya Prabhu (Kasturba Medical College (Manipal University), Mangalore, Internal Medicine, Mangalore, India)

Unnikrishnan Bhaskaran (Kasturba Medical College, Community Medicine, Mangalore, India) Gopalkrishna Bhat (Kasturba Medical College, Microbiology, Mangalore, India)

Latha Prabhu (Kasturba Medical College (Manipal University), Anatomy, Centre for Basic Sciences, Bejai, Mangalore 575001, India)

Background: Public Private Partnership (PPP) is an accepted norm in the healthcare and higher education system in many advanced and advancing countries, benefiting all stake holders in the system. Summary of work: Kasturba Medical College (KMC) Mangalore, India, is celebrating its Diamond Jubilee in 2013. The Medical College ventured into PPP with Karnataka Government 60 years ago. The benefits of PPP to private partner, public partner, medical students and patients were studied.

Summary of results: Karnataka State Government has a budget of Rupees 16 crores per year for two Government Hospitals in Mangalore. Kasturba Medical College, Mangalore spends Rupees 11 crores per year on these two hospitals. Further, it spends Rs. 1.25 crores per year on clinical investigation procedures. 52 MBBS seats and 27 postgraduate seats at KMC are filled by the Government quota. Qualified physicians and surgeons of KMC work round the clock in these hospitals. Conclusions: The PPP at place in Mangalore benefits all stake holders and is a win-win situation. KMC gets 630 teaching beds in these hospitals and the students are exposed to a vast plethora of clinical case for their study. The government gets the best services of the faculty and manages to provide seats in higher education institute. Patients from the poor sections of the society utilize good healthcare services available at nominal cost.

Take-home messages: PPP is a unique and successful venture that improves and strengthens the healthcare system.


Increasing Tuition Fees: Effect on Uptake of an Optional One-Year Intercalated Science Degree by Medical Students at King's College London

Helen Graham (King's College London School of Medicine, Medical Education, Sherman Education Centre, 4th Floor, Southwark Wing, Guy's Hospital, London SE1 9RT, United Kingdom) Aranga Lingham (King's College London School of Medicine, Medical Education, London, United Kingdom) Hannah Sewell (King's College London School of Medicine, Academic Centre, London, United Kingdom)

Background: In 2006, tuition fees for UK medical students doubled from £1,125 (€1, 249) to £3,175 (€3,524). In a 2009 survey, King's College London students indicated higher fees would deter them from taking an optional one-year intercalated science degree. We aimed to follow-up these cohorts (2005/6 and 2007/8) to determine if increased tuition fees influenced the uptake of intercalated degrees. Summary of work: In February 2013, we compared the effect of increased fees on low fees (n=344) and high fees (n=340) medical student cohorts with separate analyses by student entry groups: five year mainstream


(n=585) and six year "Access" course (n=99). Graduate and non-EU overseas entrants were excluded. Summary of results: There were no significant differences in the uptake of a one-year intercalated science degree between low fees and high fees mainstream students (67% v 69%) nor for "Access" students (58% v 43%). Significantly fewer students on the six- year "Access" course took an intercalated degree compared to mainstream students (51% v. 68%


Conclusions: Increased tuition fees had no significant effect on the uptake of a one-year intercalated science degree. This did not support students' predictions and might be explained by the 2007 introduction of a new UK postgraduate training application process which credited intercalated science degrees. Compared to mainstream students, there was a lower uptake of intercalated science degrees on the "Access" course. Take-home messages: Increased fees had no significant effect on the uptake of a one-year intercalated science degree. With recent trebling of tuition fees in the UK, the consequences should be monitored for detrimental effects on training.


Financing Post Graduate Medical Education in the European Union

Abe Meininger (University of Groningen, UMC Groningen Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands) Anke Wind (University of Groningen, Postgraduate School of Medicine, University Medical Center Groningen, Hanzeplein 1, Groningen 9700RB, Netherlands)

Jan Borleffs (University of Groningen, Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands) Jan Jacobs (University of Groningen, Department of Economics, Groningen, Netherlands)

Background: Although healthcare education and training eventually improves health outcomes, medical education is often a low priority for resources. This brings forth a dilemma; new specialists and GPs are needed to ensure continuity in health care, but postgraduate medical education (PGME) is expensive. The costs are often paid for by the government. To repay these costs a physician pays taxes and serves a fundamental role to society. This is lost when physicians migrate. The aim of this study was to provide an overview of the different PGME financing strategies in the target countries and the influence of physician migration on these strategies. Summary of work: Data from a partially structured questionnaire were collected through face-to-face interviews with one expert in each of the eight selected EU countries. Additionally a literature review of current PGME financing policies and migration patterns was done. The questionnaire included questions and statements on three aspects, i.e. Current situation and

trends, Importance of developments and desired innovations and Attainability of desired innovations. Summary of results: In most of the target countries the government regulates and finances at least part of the PGME. All countries agree that PGME has to be financed by the government. Due to EU regulations, physicians are free to migrate within the EU. In some countries this causes problems.

Conclusions: Physician migration influences financing strategies of PGME.

Take-home messages: We suggest research in the field of financing PGME in order to improve healthcare quality and move further in coordinating tax and employment policies.


Application of the RIME Framework for Education Administrators' Competencies

Yvonne Ng (National Healthcare Group, NHG Education Office, 71 Irrawaddy Road Renci Hospital Level 15, Singapore 329562, Singapore)

Background: Before 2010, administration of medical educational programs in Singapore has traditionally been the "part-time job" of departmental secretaries. However, with the introduction of postgraduate residency programs and their ownership by each sponsoring institution, and with it the mammoth tasks of program management and delivery, it was no longer reasonable or possible for the departmental secretaries to do it as a "part-time job". To systematically engage in tasks such as resident tracking, assessment and program evaluation as well as accreditation of programs, fulltime Program Coordinators (PCs) were hired by sponsoring institutions. The presentation will focus on how one sponsoring institution developed a process to evaluate the performance and progression of Program Coordinators in a systematic way using best evidence practices.

Summary of work: The RIME framework was used to define the developmental stages of PCs as a Reporter, Interpreter, etc., mapped against the competencies expected of PCs in NHG Residency. The matrix developed defined the expectations for each competency at each stage. It will be shown during the presentation.

Summary of results: Program Directors (reporting officers of the PCs), the PCs and the Institutional Coordinator have a common frame of reference for evaluating the performance of the PCs, reducing inter-rater differences and allowing meaningful feedback to be given to PCs for their development. Conclusions: The framework has thus far resulted in more objective evaluation of the program coordinators in NHG Residency but more importantly, started meaningful discussions about the development of the program coordinators as professionals for education administration.

Take-home messages: It is possible to meaningfully apply the RIME framework beyond the traditional way


that it has been used for the evaluation of medical student

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