Автор неизвестен - Mededworld and amee 2013 conference connect - страница 90

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theatres, 14 hours (range 0-29) on wards and 3 hours (range 0 - 10) in outpatient clinics. The perceived educational value was rated as good or very good with the following frequencies: theatre 86%, wards 84% and clinics 92%. Multi-disciplinary team meetings received the lowest ranking (61% good or very good), although minimal time was spent in this setting (mean 1 hour, range 0-5). The majority of education was consultant led (mean 23 hours, range 10-38). The remainder was delivered by specialist registrars (mean 4 hours, range 0­21), other junior doctors (mean 3 hours, range 0-12) and allied healthcare professionals (mean 1 hour, range 0-6). Students were unsupervised for a mean of 3 hours (range 0 - 13). All grades of supervisors received ratings of good or very good over 80% of the time. Conclusions: There was significant heterogeneity in experiences during a Perioperative Care attachment. However, students did not report major differences in perceived educational value between different learning encounters.

Take-home messages: Heterogeneity of medical student experiences during a clinical attachment does not appear to impact on education.


Using summer school design to approach the integrated curriculum: teaching and assessing practical skills

Anca Dana Buzoianu (University of Medicine and Pharmacy "luliu Hatieganu" Cluj-Napoca, Dean Office, str. Victor Babes 8, Cluj-Napoca 400012, Romania) Ofelia Mosteanu (University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Curriculum Office, Cluj-Napoca, Romania)

Teodora Atena Pop (University of Medicine and

Pharmacy "luliu Hatieganu" Cluj-Napoca, Curriculum

Office, Cluj-Napoca, Romania)

Soimita Suciu (University of Medicine and Pharmacy

"Iuliu Hatieganu" Cluj-Napoca, Vice-Dean, Cluj-Napoca,


Valentin Muntean (University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Curriculum Office, Cluj-Napoca, Romania)

Background: Implementation of an integrated curriculum for training in advanced clinical skills represents an unmet need in most Romanian medical universities.

Summary of work: Our aim was to design an integrated curriculum module using a summer school design as field-testing with both students and lecturers involved regarding any improvement in teaching and assessing clinical skills. The summer school was national and 52 students and 15 teachers from 5 Romanian medical universities attended. 12 preclinical (anatomy, physiology, pathophysiology, histopathology, pharmacology) and clinical experts (clinical cardiology, heart and vascular surgery) co-operated in order to integrate the practical skills training into the pre-existing cardiovascular medical curriculum. The chosen lectures

were: thoracic pain, heart murmurs, palpitations, headache and dyspnea.

Summary of results: The experts came from an H-type curriculum background. The summer school preparation experts' team work evolved from isolation to sharing and correlation. The integrated curriculum program included lectures, case reports, workshops: EKG, heart ultrasound, anatomy, histopathology and one simulation session of heart murmurs. Both students and lecturers considered the experience worth repeating. The simulation session was the most popular and 62.3% of the students would have preferred more practical sessions. The workshops and case reports were more popular than lectures. 88.7% of the involved experts would change their way of teaching after the summer school experience.

Conclusions: The experts' role was crucial in structuring the summer school integrated curriculum design. Introducing an interdisciplinary training and a corresponding practical skills development in a medical curriculum is feasible.

SESSION 8: Simultaneous Sessions

Tuesday 27 August: 1400-1530

8A Symposium: AMEE PGME Committee: Best Practices & Challenges in Postgraduate Medical Education: A Global View

Location: Congress, Hall, PCC

Linda S Snell (McGill University, Canada)

Richard Doherty (Royal Australian College of Physicians,


Jason Frank (Royal College of Physicians & Surgeons of Canada)

Jonas Nordquist (Karolinska Institute, Sweden)

Change is coming to PGME. Around the world postgraduate medical education is entering a period of rapid reform and globalization. What are the key issues facing postgraduate systems right now? What are considered current best practices? What are the emerging directions for PGME? This dynamic panel session will provide insights from a diversity of PGME systems around the world, debate challenges and their solutions, and discuss directions with members of the audience. Participants will leave with insights that they can readily bring home to their own institutions.

8B Symposium: Selection methods in

medical school: Where are we now and

where are we heading? Location: Meeting Hall I, PCC

Susanna M Lucieer (Erasmus MC Desiderius School, Rotterdam, the Netherlands)

Anouk Wouters (VUmc, Amsterdam, the Netherlands)

Geoff Norman (McMaster, Canada)

Fiona Patterson (City University, London, UK)

Axel PN Themmen (Erasmus MC, Rotterdam, the


Gerda Croiset (VUmc, instuut voor onderwijs en opleiden, Amsterdam, the Netherlands)

Medical schools have the task to train medical students to become well-performing doctors who will provide the excellent care that society expects. Since medical education is expensive and the available places in medical school are limited, medical schools aim to select those students who will be able to successfully complete the programme, and will become excellent care providers. But how can we select those excellent students and future health care providers? An overview of the contemporary state of the art and promising research to improve selection methods will be provided.


8C Symposium: XI Ibero-American Session: Health and Medical Education Systems in the Americas and the Iberian Peninsula: A leadership discussion

Location: Panorama, PCC

Pablo Pulido Emmanuel Cassimatis Julio Frenk Alberto Oriol i Bosch

This discussion group session provides an overview and some examples of the current situation of the emerging health systems and medical education efforts and needed systems to meet the challenges in the Americas and the Iberian Peninsula. Particular attention is focused on efforts to enhance not only the quality of medical education itself through traditional means like accreditation and certification, but through the development of innovative working models and tools for quality improvement, including professionalism, meeting patient and social needs such as safety and satisfaction, along with medical students, faculty Institutions and the community. Aim also could include discussion models of the competencies and attributes of physicians, mostly working in primary care delivery services. Conclusions should orient and align action agendas in the countries and the region to produce significant systems approach to harmonize improvements of health care delivery through systems of medical education.

The aim of this session is to address relevant and needed changes and decision making towards:

1. An efficient - productive organization and functional structure of quality Health Services

2. A focused review of systems to develop the needed Health Manpower, to improve education at needed levels, strategically related to Primary Health Care Services

3. Further coverage and access to health services, providing financially feasible solutions

4. Intelligent application of Information technologies to develop a harmonized Continuing Professional Education and Development program meeting population and physicians needs, a long lasting education based on a core curriculum.

5. Enhancement of non-clinical skills and disciplines to advance the above i.e. managerial skills, ethics, informatics and most importantly patient-physician interactions.

6. Satisfaction of both Communities and Physicians and Health care manpower.

8D PhD Reports 2

Location: Meeting Hall IV, PCC


Mind the gap; the transition to hospital consultant

Michiel Westerman (VU Medical Centre, Department of Medical Education, Sassenheimstraat 78-3, Amsterdam 1059BM, Netherlands)

Introduction: The aim was to investigate and clarify the processes situated within the transition to hospital consultant in order to achieve a deeper understanding of this intricate stage within the medical career. Three specific research questions were: (1) what factors in the transition to hospital consultant do doctors perceive as salient? (2) What is the influence of preparation received through specialty training on the progression and outcome of the transition to hospital consultant? (3) What influential contextual and psychological factors can be identified within the transition to hospital consultant?

Methods: A literature review together with two exploratory qualitative studies, one cross sectional and one longitudinal, were performed. Furthermore, two population based survey based research projects were conducted in The Netherlands and Denmark. Results: New consultants perceive themselves adequately prepared for the medical and clinical aspects of their work, like mastery of clinical knowledge and skills. However, they report being unprepared for the generic competencies such as supervision skills, leadership, management, and handling financial issues. Received progressive independence during training was found to be essential for a smooth transition. Ten percent of the new consultants met the criteria for burnout and 18% scored high on the emotional exhaustion subscale. Finally, the results illustrate how the transition is characterised by an intricate interplay between preparation received through training, psychological characteristics such as coping strategies and feedback seeking behaviour, and contextual factors. Discussion and Conclusion: The triangulation of the results and the varying theoretical perspectives on transitions results in a different perspective on the transition to hospital consultant and transitions in general. This perspective postulates transitions not as threats, but as opportunities for rapid personal and professional development. This approach contrasts with medical education's most prevalent view on transitions as threats that should be prevented through curriculum alterations. The latter perspective builds on the view that transitions result from inadequate preparation, and thereby ignores the psychological and contextual characteristics of transitions. References: 1. Teunissen PW. & Westerman M, "Opportunity or threat; ambiguity in the consequences of transitions in medical education", Med Educ, 2011 vol. 45, p.51- 9

2. Nicholson, N. 1990, "The transition cycle: causes, outcomes, processes and forms," in On the move: the


psychology of change and transition, S. Fisher & C. L. Cooper, eds., John Wiley & Sons inc., New York, pp. 83­108

3. Higgins R, Gallen D, & Whiteman S, "Meeting the non­clinical education and training needs of new consultants", Postgrad.Med J 2005, vol. 81, no. 958, pp. 519-523.

4. Cook DA, Bordage G, & Schmidt HG, "Description, justification and clarification: a framework for classifying the purposes of research in medical education", Med Educ 2008, vol. 42, pp. 128-33.

5. Westerman M et al, "Understanding the transition from resident to attending physician: a transdisciplinary, qualitative study.", Acad Med 2010, vol. 85, pp. 1914-9


The association between medical education accreditation and examination performance of internationally educated physicians seeking certification in the United States

Marta van Zanten (FAIMER, Research and Data Resources, 3624 Market Street, Philadelphia 19104,

United States)

Introduction: The purpose of the first phase of this study was to examine medical education accreditation practices around the world, with special focus on the Caribbean region, to determine the association of accreditation of medical schools with student/graduate performance on examinations. The aim of the second phase of this research was to evaluate the quality of accrediting agencies and the association of the inclusion of specific protocols with outcomes. Methods: Graduates of international medical schools (IMGs) seeking to enter postgraduate training positions in the United States must pass the United States Medical Licensing Examination (USMLE) Step 1 (basic science), Step 2 Clinical Knowledge (CK), and Step 2 Clinical Skills (CS). In phase one, examination first-attempt pass rates were compared for all IMGs who took one or more examinations from 2006 through 2010 by presence of a national system of accreditation in the countries of the physicians' medical schools. In phase two, the quality of a select group of accrediting agencies was evaluated according to criteria determined by a panel of experts to be the most salient features of an accreditation system. The association between accreditation systems' inclusion of the selected criteria and student performance was investigated.

Results: During the study period approximately 70,000 individuals took one or more examinations, and over one quarter of the physicians were from schools located in the Caribbean. For the Caribbean population, after controlling for personal variables, the odds of passing Step 1 on the first attempt for those individuals from accredited schools were 4.9 times greater as compared to the odds of passing the examination for individuals from non-accredited schools. There was no association between accreditation and performance for the non-Caribbean group. Results were similar for Step 2 CK. For Step 2 CS, after controlling for personal variables, the

odds of passing the examination on the first attempt for those individuals from accredited schools were 2.4 times greater for the Caribbean group, and 1.1 times greater for the non-Caribbean group, compared to individuals from non-accredited schools. In phase two, the expert panel unanimously agreed on 14 essential standards that should be required by accrediting agencies to ensure the quality of physicians. Certain essential standards were associated with better performance for all three examinations.

Discussion and Conclusion: The association between medical education accreditation and student/graduate performance is positive in certain regions and for some outcomes. Because substantial resources are needed to successfully implement oversight processes, these results provide some positive evidence that accreditation of educational programs, and certain elements within systems, are associated with the production of more highly skilled physicians. References: 1. Davis, D. J. & Ringsted, C. (2006). Accreditation of undergraduate and graduate medical education: How do the standards contribute to quality? Advances in Health Sciences Education: Theory and

Practice, 11, 305-313.

2. Karle, H. (2006). Global standards and accreditation in medical education: a view from the WFME. Academic

Medicine, 81, S43-S48.

3. Stensaker, B., Langfeldt, L., Harvey, L., Huisman, J., & Westerheijden, D. (2010). An in-depth study on the impact of external quality assurance. Assessment & Evaluation in Higher Education, 789296667, 1-14.


Becoming a doctor: the early emotional and professional development of medical students

Esther Helmich (Academic Medical Centre, University of Amsterdam, Center for Evidence-Based Education, Room J1A-138, PO Box 22660, 1100 DD Amsterdam, Netherlands)

Introduction: How and why may early clinical experience enhance the emotional and professional development of medical students? Methods: We used a mixed-methods design with a predominance of qualitative methodologies, including content analysis, phenomenology and grounded theory. As learning within clinical practice necessarily takes place in interaction with patients, doctors and nurses on wards, we approached learning during early clinical experience from a predominantly socio-cultural perspective, conceptualising meaning and identity as negotiated and constructed through interaction with other individuals while participating in communities of practice.

Results: During their first clinical placements, medical students had many powerful experiences, leading to a broad variety of positive and negative emotions. Developing a professional identity was a highly emotional process in itself, involving issues such as identification, self-categorisation and getting access to a new and unknown community. Tensions along four


dimensions (idealism versus reality, critical distance versus adaptation, involvement versus detachment, and feeling versus displaying) gave rise to strong emotions. Many conditions influenced students' emotional learning, such as their personal attributes and social relationships with others from inside (patients, nurses, doctors, peers, clinical preceptors, medical school teachers) and outside (family, friends) the medical community. This process resulted in more or less favourable learning outcomes, depending on the positions students took on the different dimensions. Discussion and Conclusion: Becoming a doctor is a highly emotional process. Students need to learn how to deal with and feel strengthened by these emotions. As neither students nor supervisors can accurately predict what students will face during their first introduction into medical practice, it seems necessary to help them find ways of reflecting on this experiential and unplanned learning. Supervisors should help students to be sensitive to their emotions, offer concrete support, stimulate critical reflection, offer space to explore different meanings, and suggest alternative interpretations. The subject of the thesis - the interrelatedness of emotions and professional identity development in the context of early clinical experiences - is strongly embedded within current medical education research. There is a shared common reliance on qualitative methodologies.

References: 1. Helmich, E., Bolhuis, S., Dornan, T., Laan, R., Koopmans, R. (2012) Entering medical practice for the very first time: emotional talk, meaning and identity development. Med.Educ., 46, 1074-1086.

2. Helmich, E., Bolhuis, S., Prins, J., Laan, R., Koopmans, R. (2011) Emotional learning of undergraduate medical students in an early nursing attachment in a hospital or nursing home. Med.Teach., 33, e593-e601.

3. Helmich, E., Derksen, E., Prevoo, M., Laan, R., Bolhuis, S., Koopmans, R. (2010) Medical students' professional identity development in an early nursing attachment.

Med.Educ., 44, 674-682.

4. Immordino-Yang, M. H., Damasio, A. (2007) We feel, therefore we learn: The relevance of affective and social neuroscience to education. Mind, brain, and education,

1, 3-10.

5. Yardley, S., Littlewood, S., Margolis, S. A., Scherpbier, A., Spencer, J., Ypinazar, V., Dornan, T. (2010) What has changed in the evidence for early experience? Update of a BEME systematic review. Med.Teach., 32, 740-746.


Defining and Teaching Veterinary Professionalism

Liz Mossop (University of Nottingham, School of Veterinary Medicine and Science, College Road, Sutton Bonington LE12 5RD, United Kingdom)

Introduction: Three questions were addressed: (1) What is veterinary professionalism? (2) How is the hidden curriculum influencing students' development at one veterinary school? (3) How should a curriculum of veterinary professionalism be structured?

Methods: The lack of empirical knowledge about veterinary professionalism means a constructivist grounded theory can be developed (Charmaz 2006). An iterative approach, using interviews and focus groups, collected information from stakeholders including veterinary surgeons and nurses, professional bodies and clients. Sampling was theoretical. Data analysis was managed in NVIVO® and sampling concluded when theoretical saturation had been reached. A concurrent analysis of the hidden curriculum of one veterinary school was also undertaken using a cultural web model to perform a thematic analysis of staff and student focus group narratives. The outcomes from both studies were combined to develop a curriculum of veterinary professionalism.

Results: The normative definition of veterinary professionalism produced places balance as the central component. Veterinarians are constantly managing the requirements and expectations of their clients, the animals under their care, society and their employer. The ability to balance these demands and therefore demonstrate professionalism is helped by attributes which are: efficiency, technical competence, honesty, altruism, communication skills, personal values, autonomy, decision making, manners, empathy, confidence and acknowledgement of limitations. The hidden curriculum analysis established a central paradigm of a hard-working and friendly community. Both positive and negative role models were readily identified, as was the contribution of routines and rituals. The curriculum of veterinary professionalism is an integrated, spiral structure involving early clinical experience and critical event analysis to guide student reflections and shape their development as professionals. Four core professional skills of communication, ethical reasoning, reflective practice and learning skills are used to reinforce the values and behaviours included in the definition of professionalism. Discussion and Conclusion: The definition includes attributes described in several definitions of medical professionalism. However the central behaviour of balancing responsibilities between clients, animals, the practice and society appears to be uniquely positioned. This component of professionalism is interesting for UK medical professionals to consider as NHS structures change, putting pressure on different priorities. Implementation of the proposed curriculum will require effective clinical leadership and strong institutional support. A post-positivistic, qualitative study of this nature has limitations, but the need to gain an in depth understanding of the topic alleviates these concerns. References: 1. Charmaz, K. (2006). Constructing Grounded Theory. London, Sage.

2. Freidson, E. (2001). Professionalism - the Third Logic. Cambridge, Blackwell Publishers Ltd.

3. Mossop, L. H. (2012). "Is it time to define veterinary professionalism?" J Vet Med Educ 39(1): 93-100.

4. van Mook, W. N., S. J. van Luijk, et al. (2009). "The concepts of professionalism and professional behaviour: conflicts in both definition and learning outcomes." Eur J

Intern Med 20(4): e85-89.

8E Research Papers: Research in Medical Education

Location: Meeting Hall V, PCC


Immediate reflection on clinical performance is more valued than delayed reflection on competency development

Mieke Embo (University College Arteveldehogeschool Ghent, Midwifery Department, Voetweg 66, Ghent 9000, Belgium)

Erik Driessen (Maastricht University, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht, Netherlands)

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