AMEE 2003 Programme and Abstracts

AMEE 2003 Relevance in Medical Education 31st August – 3rd September 2003 Faculty of Medicine, University of Bern, Bern, Switzerland

President: Professor M Barón-Maldonado General Secretary: Professor R M Harden Administrator: Mrs Pat Lilley

AMEE Office University of Dundee Tay Park House 484 Perth Road Dundee DD2 1LR Scotland, UK Tel: +44 (0)1382 631953 Fax: +44 (0)1382 645748 E-mail: [email protected] Programme and Abstracts 12345678901234567890123456

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12345678901234567890123456 1234567890123456789012345Relevance6 in Medical Education 12345678901234567890123456

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12345678901234567890123456 12345678901234567890123456 st rd 12345678901234567890123456 12345678901234567890123456 31 August – 3 September 2003 12345678901234567890123456

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12345678901234567890123456 12345678901234567890123456 in collaboration with 12345678901234567890123456

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1234567890123456789012345Tay Park6 House, 484 Perth Road, Dundee DD2 1LR, Scotland, UK

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1234567890123456789012345 – ii – Contents

Welcome from the Dean of the Faculty of Medicine ...... v

Welcome from the University of Bern Medical Students ...... v

Organising Committees ...... vi

Conference Sponsor ...... vi

Section 1: General Information Bern: travel and accommodation ...... 1.1 General information ...... 1.2 Information about the Conference venue ...... 1.4 Registration ...... 1.5 Information on the Academic Programme ...... 1.6 Information on short communication sessions ...... 1.7 Information on poster sessions ...... 1.8 Information on conference workshops ...... 1.9 Exhibition ...... 1.9 Programme Overview ...... 1.12 Personal diary ...... 1.18 Maps and plans ...... 1.19

Section 2: The Conference Programme Sunday 31 August ...... 2.1 Monday 1 September ...... 2.4 Tuesday 2 September ...... 2.23 Wednesday 3 September ...... 2.66

Section 3: Accommodation, Social Programme and Tours .. 3.1

Section 4: Abstracts ...... 4.1

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1234567890123456789012345 – iv – Welcome

We look forward to welcoming you to Bern. We have tried to make this programme and abstract book as comprehensive as possible, and to provide all the information you may need. Please take some time to read through it. If you have any questions the AMEE Office will be pleased to help.

Welcome by Dr Emilio Bossi, Dean of the Faculty

The Faculty of Medicine at the University of Bern as co-host of the AMEE03 Annual Conference extends its warmest welcome to the participants. The Faculty is pleased and honoured that you have chosen Bern as the venue for your Conference. As you can see from the little brochure in your Conference kit, medical education has a long tradition in Bern. At the same time we are actively participating in shaping the future of medical education. We hope that you feel comfortable in our city and its beautiful surroundings, that you have ample opportunity to extend your professional network, that you can profit from the rich academic offerings, and above all that you leave our city with a warm glow.

Welcome by the Medical Students of Bern

grüezi, bienvenuto, bienvenue, welcome, bienvenido, dobro poschalovatj, khosch-amedid... We warmly welcome you on behalf of the medical students of Bern to the amee03 Conference. As you will be scientifically satisfied by the official conference, we would like to welcome you to the entertaining part. That’s why we just say: let us take care of you during the stay! We know where you can sleep for free, show you Bern’s nightlife, take you to the wonderful Aare- river, invite you to the hottest amee03-party ever seen and know where you can get good and cheap food. Those who stay till Thursday will experience an unforgettable bicycle-tour through the surroundings of Bern. So don’t forget to bring your swim-suit, party mood, aspirin (if needed), camera and lots of energy…! Do you need anything else? Feel free to contact us ([email protected] or [email protected]) and have a look on the students’ site of the amee03 homepage to get further information (http://amee03.unibe.ch/students.htm) Our phone number during the conference will be: +41 76 502 90 32 We are looking forward to see you in Bern. Let’s spend a good time together. See you Janine and Teresa

– v – AMEE 2003 Committees

Organising Committee Ralph Bloch Peter Schläppi Peter Frey Rainer Hofer Reinhard Westkämper Christa Beutler (Local Administrator) [email protected]

Student Representatives Teresa Hidalgo Staub [email protected] Janine Scherrer [email protected] Carmen Wolf [email protected]

Executive Committee

President: Margarita Barón-Maldonado (Spain) Secretary/Treasurer: Ronald Harden (UK) Committee: Ralph Bloch (Swizerland) Herman van Rossum (Netherlands) Florian Eitel (Germany) Madalena Patrício (Portugal) Graham Buckley (UK) Coopted member: Ioan Bocsan (Romania) Ex officio: Hans Karle (WFME) Jorgen Nystrup, Past President (Denmark) Administrator: Pat Lilley Admin Assistant: Tracey Martin

Conference Sponsor

AMEE is most grateful to the University of Bern for its support, and in particular for providing free use of the Conference accommodation and equipment.

– vi – Section 1

Bern: Travel and Accommodation

Travel Bern is a compact city and most hotels are within walking distance of the University, the Kultur Casino (where the opening ceremony and plenary sessions take place), the railway station, shops and most other facilities that participants are likely to need during their stay. Bern is served by an excellent road and rail network, the railway station being in the centre of the city. It also has a small airport about 8 km from the city. Zurich or Geneva airports are within easy reach of Bern, with a regular train service. There is a railway station at both airports, with many direct trains to Bern. The journey time from Zurich airport (Flughafen) takes about 90 minutes, with trains approximately every 30 minutes at peak times. From Geneva Airport the journey time is approximately 2 hours and direct trains run hourly. For rail timetables and fares information please see the SBB Swiss Federal Railway site: http://www.sbb.ch/pv/index_e.htm

Accommodation Bern Tourismus has reserved accommodation in a wide range of hotels and a youth hostel. Participants still requiring accommodation should complete Form C (available in the provisional programme or for download from the AMEE web site www.amee.org) and return it to Bern Tourismus as soon as possible. No deposit is required although a credit card number is requested to guarantee the booking. Depending on the hotel, you will be asked either to pay in advance or on check out. Confirmation of booking will be sent as soon as possible. Cancellation and changes to accommodation bookings made by Bern Tourismus: All changes should be notified to Bern Tourismus and not to the hotel. At least 48 hours’ notice of cancellation is required or one night’s accommodation may be charged. To guarantee rooms for late arrival (after 1800 hrs) please telephone the hotel direct one or two days before your arrival date. A representative of Bern Tourismus will be available by the AMEE registration desk at certain times throughout the Conference for bookings and advice on tours and accommodation. Participants who need assistance in advance of the conference should contact: Bern Tourismus PO Box CH-3001 Tel: +41 31 328 12 28 Bern Fax: +41 31 328 12 99 Switzerland email: [email protected]

A map of Bern and the surrounding area showing Conference hotels is available on the University of Bern AMEE Conference website: http://amee03.unibe.ch/accommodation.htm

– 1.1 – Section 1

General Information

Please check the AMEE website from time to time (www.amee.org) for Conference updates. The University of Bern AMEE Conference website contains some useful local information: http://amee03.unibe.ch

Passports and Visas A passport valid for the duration of your stay is required for all visitors to Switzerland. Please contact the Swiss Embassy in your country to determine whether a visa is necessary. The Swiss Embassy in London has some useful travel information: www.swissembassy.org.uk/ A letter of invitation to support visa application can be provided by the AMEE Office on request.

Credit Cards and Currency Exchange The currency in Switzerland is the Swiss Franc (CHF), although some hotels, restaurants and shops may accept payment in Euros. As a rough guide, the exchange rate at end June is 1 Euro = 1.5 CHF; £1 sterling = 2.2 CHF; US$1 = 1.3 CHF. Visa, American Express and Mastercard are widely accepted. Bank opening hours are: Monday-Friday 0800-1800 (eg, Berner Kantonalbank, Bundesplatz). Currency exchange is available (eg at Railway Station) on Monday-Friday from 0700-2000, Saturday 0700-1900 and Sunday 0900-1900.

Climate Bern enjoys a Central European continental climate. Likely daytime temperatures at the time of the Conference are 20-25oC.

Electrical Supply 220 volts.

Smoking Policy No general regulations apply about smoking in public places in Switzerland. However, the Conference venues including the lunch tents are strictly non-smoking areas.

Language All conference sessions will be in English.

Gratuities Usually already included in the price charged in restaurants, bars, taxis etc. An additional amount is always welcome for exceptional service.

CME accreditation and certificates of attendance The UK Royal Colleges have awarded the Conference 20 CME points. A register of attendance will be available to sign, and certificates of participation will be ready for collection on Wednesday morning at coffee time.

– 1.2 – Section 1

Disabled participants Participants with disabilities are asked please to contact the AMEE Office in advance of the conference so that appropriate arrangements may be made.

Where to Eat

Information on local bars and restaurants is available at the AMEE registration desk. A wide range of fast-food outlets can be found in the Railway Station (Bahnhof) concourse, open every day. From the University main building turn right and take the elevator from Uniterasse to the bottom level.

– 1.3 – Section 1

Information about the Conference venue

Where the Conference will take place All sessions, will take place at the University of Bern (see map of Bern on page 1.19) except for the opening ceremony and the plenary sessions which will be held at Kultur Casino.

University of Bern Address: University of Bern Hochschulstrasse 4 CH-3012 Bern Phone: +41 (0)31 632 49 56 (Christa Beutler) Email: [email protected]

Directions: On foot: From the Railway Station (Bahnhof) – train subway area track 13 – take the elevator at the end of the hall to the top level (“Uniterasse”) and turn right. You will arrive in front of the main building (total time 3 minutes). By bus: From the front of the Railway Station take bus no 12, direction “Langgasse”. Walk back through the little park and arrive at the rear of the main building (total time 5 minutes).

Kultur Casino The opening ceremony (Sunday evening) and the plenary sessions (Monday morning before coffee break and Wednesday all morning) will take place at Kultur Casino (map page 1.19): Address: Kultur Casino Herrengasse 25 CH-3011 Bern

Directions: On foot: From the Railway Station, take Spitalgasse, then Marktgasse. Turn right at Zytglogge (the old clock tower) into Theaterplatz. You will arrive at the front of the Kultur Casino (total time 8 minutes). By tram: From the Railway Station, take tram no 3 (direction “Saali”) or no 5 (direction “Ostring”), to “Zytglogge” (total time 4 minutes).

Please note that because Bern is a small and compact city, no coach transport has been arranged between hotels and the two conference venues. A BernMobil Pass providing free transport on buses and trams for three days will be provided for participants and registered accompanying persons.

– 1.4 – Section 1

Registration Registered participants should collect their conference packs from the following locations:

Date Time Location Saturday 30 August 1200-1700 University of Bern Sunday 31 August 0830-1600 University of Bern 1800-2100 Kultur Casino Monday 1 September 0730-0900 Kultur Casino 1030-1730 University of Bern Tuesday 2 September 0800-1800 University of Bern Wednesday 3 September 0800-1330 Kultur Casino

Please note: It is highly unlikely that we will be able to accept onsite registrations as the conference is fully subscribed.

Conference noticeboard and messages Please check the noticeboards for personal messages and conference updates.

Email and phone contact Messages for the AMEE Secretariat and for conference participants may be sent care of Christa Beutler: Tel: +41 (0)31 632 49 56 email: [email protected]

Participants may log in to their email in the Room -302 Juristische Bibliothek (Library – 3 floors down) – see location on plan on page 1.20. Please note that a password will be necessary, and this will be provided in your registration pack. Access will not be available on Sunday between 0830-1230 when the room is being used for a workshop.

Conference evaluation A general evaluation form as well as individual workshop evaluation forms are in the conference packs. Please complete and return them either to the Registration Desk or by fax/mail to the AMEE Office after the Conference.

– 1.5 – Section 1

Information on the Academic Programme

Please see the programme overview on pages 1.12-1.17. All sessions take place at the University except for the plenaries.

Pre-conference workshops Morning, afternoon and full-day workshops will take place on Sunday 31 August. All are fully booked, and admission is strictly by ticket only. Tickets will be included in the conference packs of those pre- booking these workshops. Coffee is provided morning and afternoon, but lunch is not provided. A range of fast-food outlets can be found at the Railway Station – see directions on page 1.3. Please see overview on page 1.13 for workshops and rooms.

Plenary sessions Three plenary sessions are scheduled and will take place at Kultur Casino (map page 1.19) on Monday 1 September from 0830-1000, and on Wednesday from 0830-1300.

Large group sessions and short communications Five simultaneous large group sessions are scheduled for Tuesday 2 September from 0830-1000. At the same time three short communications sessions will take place. Please see page 1.14 for details of sessions and locations.

Short communications Four short communications sessions are scheduled on Monday and Tuesday, each with multiple themed groups, and some short communications will also take place at the same time as the large group session. Please see page 1.14 for details of sessions and locations. Each session will have a chairperson and an opening discussant. We have tried very carefully to group relevant presentations together and encourage you to stay for a whole session and take part in the discussion at the end. Each presenter has been allocated a 10 minute presentation followed by 5 minutes for discussion. A 15 minute period has been allocated at the end of most sessions for a general discussion, led by the opening discussant.

Poster sessions AMEE regards posters as a very important part of the Conference. From the presenter’s point of view posters give maximum exposure, being available throughout the Conference. For the observer, posters may be viewed and re-viewed at leisure. Additionally there is the option of discussing the main features with the presenter during the presentation session or at other times. Poster sessions will take place by the poster boards on Tuesday 2 September from 1510-1640 hrs and all participants are invited to attend. Posters will be set up in themed groups each consisting of between 12-18 posters. See the plan on page 1.15 with details of sessions and location of poster boards. Each poster group will have a chairperson who will lead the group around the posters and invite discussion. Each presenter should highlight the key points of his/her poster.

– 1.6 – Section 1

Information on Short Communication Sessions

Information for the presenter

Presentation viewing area: Room 104 may be used for checking OHPs and for consultation with IT staff on PowerPoint presentations. Slide projection: Please note that slide projection is not available in any of the rooms. OHPs: An overhead projector is available in every presentation room. Computer projection: A data projector/beamer and a computer are available in every presentation room. In the interests of time and efficiency we request that you use the computer provided rather than your own laptop. All computers are equipped with Win and Office XP with PowerPoint 2002. Please follow the following instructions: • Save your presentation in PowerPoint 2002 (or in an older/lower version); • Bring it on a CD-ROM clearly marked with your name and session/presentation number, or on a USB memory stick, for loading onto the computer in the appropriate room. Floppy drives and Zip drives are not available; • Arrive in the room where your presentation is scheduled 30 minutes before the start of the session to have your presentation loaded onto the computer. • Introduce yourself to the chairperson at least ten minutes before the scheduled start of the session. • keep strictly to the time allotted for your presentation. The chairperson will remind you when your time limit has expired and will then ask the audience for questions; • Please speak slowly and clearly; • Ensure your OHPs/screens are clear, that there is not too much text to read in the limited time available and that the type is large enough to be legible for those sitting at the back of the room; • Whilst not obligatory, a single page handout, giving the key messages from your presentation, is always appreciated. As a rough indication you could expect between around 50-100 participants in the audience.

Information for the chairperson • Before the session starts, check that the presenters and opening discussant are present; • Introduce each speaker according to the programme, and tell him/her when the allotted 10 minute presentation period is over (a timer will be provided); • Allow 5 minutes for discussion between presentations; • If a speaker is not present, arrange for the 15 minute period to be used for further discussion; the next presentation should not start until the scheduled time; • Ask the opening discussant to lead off the discussion at the end of the session; • Draw the session to a close and thank participants.

Information for the opening discussant • Following all the presentations, introduce the topic in the context of the papers presented and highlight some of the key points arising from the papers that might be addressed in the discussion that follows. This introduction should take no more than 4 minutes. • Invite comments from participants and lead off a group discussion.

– 1.7 – Section 1

Information on Poster Sessions

Information for presenter Mounting your poster: Posters should be maximum height of 120 cm and maximum width of 95 cm (ie portrait). Fixings will be provided. Each board will be marked with the number and title of the poster, which may be found on pages 2.34-2.57 of this programme. Posters may be mounted from 1200 hrs on Saturday 30 August and should be removed by 1300 hrs on Wednesday 3 September.

Tips for preparing posters: • The poster should be eye-catching, attractive and not cluttered with unnecessary information. It should communicate well the key messages. Colour and different type styles should be used judiciously in order not to detract from the content. • Content: The poster should have a logical sequence and be understandable by non-experts in the field, with any abbreviations initially explained. • Title: The title should be clear enough to read from 5m, with letters approximately 5cm high. • Text: The text should be laid out attractively, using a range of font sizes. The smallest type should be legible from at least 1m. Consider using bullet points as appropriate. Graphical representation is preferable to large amounts of text. • Figures and photographs: Should be of good quality and large enough to be visible from 1m. Figures and tables should have legends that give adequate explanation.

Contact details: Full contact details for further information should be included, with an email address wherever possible.

Handouts: Participants appreciate a handout of the key points of your poster. These could be put into a folder or envelope attached to the poster board.

Further information: You may wish to attach to your board a note of times throughout the Conference when you will be available for discussion.

Information for chairperson • Arrive by the poster boards relating to your session at least 10 minutes before the scheduled start and check presenters have arrived; • Lead the group around the posters and ask each presenter to introduce him/herself and the key messages of his/her poster; • Invite comments/questions from the group. • Note: based on an average of 15 posters in each session, 6 minutes per poster has been allowed.

– 1.8 – Section 1

Information on Conference Workshops

Two workshop sessions (4 and 6) – each with simultaneous workshops and groups – are scheduled for Monday and Tuesday. Please see pages 1.16 and 1.17 for workshop details and locations. In order to reserve a place at the workshops of your choice, please complete and return the enclosed workshop selection form to the AMEE Office as soon as possible (form also available on our website). Participation in most workshops is by ticket only, and these will be included in your conference pack if you pre-book. Any remaining tickets may be obtained from the AMEE registration desk on site. Workshop organisers have designed their programmes with a specific number of participants in mind, and rooms have been allocated accordingly. We kindly request you do not try to attend without a ticket.

Exhibition

Commercial and academic exhibits may be mounted from 1200-1700 hrs on Saturday 30 August or between 0800-1600 hrs on Sunday 31 August, at the University of Bern. The exhibits will be open from Sunday 31 August at 0830 until Tuesday 2 September at 1800 hrs. Participants will be on site at these times, except between 0830-1030 hrs on Monday.

Commercial Exhibitors

AD Instruments GmbH ADInstruments develops, manufactures and distributes their PowerLab data acquisition and analysis systems for use in life science research and teaching. PowerLab is an integrated system of hardware and software, comprising the PowerLab recording unit with Chart and Scope software. Additionally, we supply an extensive selection of signal conditioners, transducers and accessories for use in a wide range of scientific applications. Our data acquisition systems are powerful and flexible research tools used by scientists in universities and research institutes around the world. Contact: Miss Paula Croft & Mr Ferdi Oberheinrich, ADInstruments GmbH, Unit 56, Monument Business Park, Chalgrove, Oxfordshire OX44 7RW, UK Tel: +44 1865 891623 Fax: +44 1865 890 800; Email: [email protected] Website: http://www.adinstruments.com

Blackwell Publishing Ltd Contact: Mrs Anne Weston, Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2Q, UK Email: [email protected]

Gold Standard Multimedia Gold Standard Multimedia is a leading developer of innovative drug information and medical education software and online services. Our Integrated Medical Curriculum (IMC) offers an electronic collection of courseware to support medical school subjects, featuring multimedia animations, audio and video streaming, interactive quizzes, photos, illustrations and problem-based case studies with text. Our Clinical Pharmacology drug reference program contains extensive data on US prescription drugs, over-the-counter, herbal and nutritional products, and its unique medication management tools, vast drug content coverage, cutting-edge technology, and interactive functionality have universal appeal for teaching and preparing students for the real-world practice setting. Contact: Mrs Tanya Thomas, Gold Standard Multimedia, 320 W Kennedy Blvd, Suite 400, Tampa FL 33606-1412, USA Tel: 800 375 4747 Fax: 813 259 1585 Email: [email protected] Website: www.gsm.com

– 1.9 – Section 1

Immersion Medical Immersion Medical (Gaithersburg/MD, USA) develops, manufactures, and markets medical simulators and is the leading company in the segment of computer-based task trainers having sold more than 650 simulator systems worldwide. These simulators allow medical personnel to practice even complex procedures in a virtual reality environment that poses no risks to patients and mistakes do not have dire consequences. Simulators for the training of vascular access (CathSim®), endoscopic (AccuTouch®) and laparascopic surgical procedures (LapSim® software from Surgical Science AB, Gothenburg/Sweden, and Immersion’s Virtual Laparascopic Interface) will be demonstrated. Contact: Dr Friedrich Gauper, Immersion Medical, Central & Northern Europe, Stettiner-Str. 26, D- 69514 Laudenbach, GERMANY Email: [email protected] Website: http://www.immersion.com/medical/

Kaplan Medical Kaplan Medical is a unit of Kaplan’s Test Preparation division, offering preparation courses for licensure exams for U.S. Medical students, International Medical Graduates, and Nursing, Dental, and Pharmaceutical students. With more than 30 years of experience, Kaplan Medical programs are focused on providing high-yield, exam-relevant review. The classroom-based USMLE courses utilize U.S. medical school faculty and practitioners who are acclaimed lecturers in their respective fields. The online courses allow students flexible access and customizable exams. As the world leader in test preparation, Kaplan Medical also creates review and curriculum tools for Institutional use. Contact: Mrs Cheri Julien, Kaplan Medical, 820 West Jackson, Suite 550, Chicago, IL 60612, USA Tel: 305-361-1103 Email: [email protected] Website: www.kaplanmedical.com

Kyoto Kagaku Co Ltd Kyoto Kagaku is a manufacturer of anatomy models and medical training simulators in Japan. Our products are utilized in nursing schools and medical schools. We exhibit various kinds of simulators for medical education. Simulator “K”, Cardiology Patient Simulator, offers the practice in auscultation of cardiac diseases (99 findings) and palpation. LSAT, Lung Sounds Auscultation Trainer, allows you to improve the skill of auscultation of lung sounds. In addition, we will demonstrate simulators for injection training and prostate examination, and exhibit phantom that has an image close to human chest in radiography. Contact: Mr Toshiyuki Takayama, Mr Tamotsu Katayama, Mr Hiroyuki Yamauchi and Mr Mikinori Ishioka, Kyoto Kagaku Co. Ltd, 35-1 Shimotoba Watarise-cho, Fushimi-ku Kyoto 6128393, JAPAN Tel: 81 75 605 2520; Fax: 81 75 605 2529 Email: [email protected] Website: http://www.kyotokagaku.co.jp/english/

Limbs & Things Limbs & Things supplies training and demonstration materials for healthcare professionals, incorporating synthetic soft tissue models, multimedia training systems and a design and build service. Our products and services have been specifically designed for ‘hands-on’ structured and staged clinical, surgical and medical skills training. They offer variation in anatomy, and provide for increasing levels of technical and procedural difficulty, meeting the needs of education and trainees. Contact: Mr Nick Gerolemou and Mr Alex Halliday , Limbs & Things Ltd, Sussex Street, St Phillips, Bristol BS2 0RA, UK Tel: +44 117 311 0500 Fax: +44 117 311 0501 Email: [email protected] Website: www.limbsandthings.com

– 1.10 – Section 1

Academic Exhibitors

Association for Medical Education in Europe (AMEE)

Association for the Study of Medical Education (ASME), UK

Association of Health Care Professionals (AHCP), UK

Best Evidence Medical Education (BEME)

British Heart Foundation Harvey Project, UK

Centre for Medical Education, University of Dundee, UK

Harvard Medical International (HMI), USA

International Association of Medical Science Educators (IAMSE), USA

International Medical University, Malaysia

IVIMEDS – An International Virtual Medical School

Medical Teacher, UK

National Association of Clinical Tutors (NACT), UK

National Board of Medical Examiners (NBME), USA

Ottawa Conference Barcelona 2004

South African Association of Health Educationalists (SAAHE), South Africa

New York University School of Medicine, USA

The Network: Towards Unity for Health, Netherlands

University of Bern, Switzerland

University of Wales College of Medicine, UK

World Federation for Medical Education (WFME), Denmark

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123456789012345678901234567 12345678901234567890123456Programme7 Overview 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561400-17007 – Special Interest Group Session University 123456789012345678901234567

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123456789012345678901234561900-21007 Opening Ceremony Kultur Casino

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12345678901234567890123456Mon 1 Sep 0830-10007 1 Plenary 1 Kultur Casino

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123456789012345678901234567 123456789012345678901234561000-10457 Coffee University – Tent 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561045-12307 2 Short communication 1 University 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561230-13307 Lunch University – Tent 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561330-15157 3 Short communication 2 University 123456789012345678901234567

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123456789012345678901234561545-17157 4 Workshops 1 University

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123456789012345678901234561800-23307 William Tell evening (optional extra)

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123456789012345678901234567 12345678901234567890123456Tues 2 Sep 0830-10007 5 Large Groups University 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561030-12157 6 Workshops 2 University 123456789012345678901234567

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123456789012345678901234561215-13157 Lunch University – Tent

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123456789012345678901234567 123456789012345678901234561510-16407 8 Poster sessions University 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561645-18157 9 Short communication 4 University 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234561930-24007 Conference Dinner (optional extra) Kursaal 123456789012345678901234567

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123456789012345678901234567 12345678901234567890123456Wed 3 Sep 0830-10157 10 Plenary 2 Kultur Casino 123456789012345678901234567

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123456789012345678901234567 – 1.12 – Section 1

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123456789012345678901234567 12345678901234567890123456Pre-Conference7 Workshops Sunday 31 August: 0930-1700 hours 123456789012345678901234567

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12345678901234567890123456Workshop Time7 Title Room (University)

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123456789012345678901234567 12345678901234567890123456PCW1 0930-17007 Finding and appraising evidence in am: -302 (Juristische Bibliothek) 123456789012345678901234567

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123456789012345678901234567 medical education pm: 212

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12345678901234567890123456PCW2 0930-17007 Preparing tomorrow’s educators for leadership 105

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123456789012345678901234567 123456789012345678901234567 roles in the health professions: an interactive, 123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 participatory workshop 123456789012345678901234567

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123456789012345678901234567 12345678901234567890123456PCW3 0930-12307 Basic faculty skills 204 123456789012345678901234567

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123456789012345678901234567 12345678901234567890123456PCW4 0930-12307 Mobile computing and medical education 115 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456PCW5 0930-12307 Why offer early clinical experience in 331

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123456789012345678901234567 123456789012345678901234567 undergraduate medical education? 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW6 0930-12307 Evaluation of medical education – 215 123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 methodological implications of new technologies 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW7 0930-12307 Setting defensible performance standards on 304 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 OSCEs and clinical skills examinations: a user’s

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 guide from A to Z 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456PCW8 0930-12307 Designing Study Guides 212

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12345678901234567890123456PCW9 1400-17007 Vertical integration in the medical curriculum 331

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123456789012345678901234567 12345678901234567890123456PCW10 0930-12307 Using computers to prepare students for ‘real’ 106 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 clinical experiences

123456789012345678901234567

12345678901234567890123456PCW11 0930-12307 Designing multiple choice questions that serve 214

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123456789012345678901234567 123456789012345678901234567 a purpose 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456PCW12 1400-17007 Fostering and assessing medical professionalism: 208

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 challenges and strategies 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW12a 0930-12307 Fostering and assessing medical professionalism: 208 123456789012345678901234567

123456789012345678901234567 12345678901234567890123456(extra7 session) 123456789012345678901234567 challenges and strategies

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW13 1400-17007 Clinical evaluation exercises (MINI-CEX): how to 304 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 improve oral examinations in medical practice

123456789012345678901234567

12345678901234567890123456PCW14 1400-17007 Developing learning objectives catalogues 214

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW15 1400-17007 Making small group teaching work 215 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW16 1400-17007 Programmatic evaluation – how to evaluate your 106 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 course/clerkship

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW17 1400-17007 Enhanced faculty skills 204 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456PCW18 1400-17007 E-learning – what do I need to know about it to 115 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 get started?

123456789012345678901234567

123456789012345678901234567 – 1.13 – Section 1

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456Short Communications/Large7 Group Sessions Overview 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 N 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456304 7

12345678901234567890123456Room 7

123456789012345678901234567 Selection 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 M

123456789012345678901234567 115

123456789012345678901234567

123456789012345678901234567 Room

123456789012345678901234567 Outcome based education Special subjects in the curriculum 123456789012345678901234567 Research and Critical Thinking The Core Curriculum

123456789012345678901234567

123456789012345678901234567 L L

12345678901234567890123456L 7 L L

123456789012345678901234567

123456789012345678901234567 105

123456789012345678901234567 Room

123456789012345678901234567 Professionalism 2 Postgraduate multiprofessional education 123456789012345678901234567 Undergraduate Multiprofessional education Professionalism 1

123456789012345678901234567

123456789012345678901234567 K

123456789012345678901234567

123456789012345678901234567 206 123456789012345678901234567 Room 123456789012345678901234567

123456789012345678901234567 Clinical training in different settings Is the graduate competent? Clinical Skills Training Clinical and Teaching the Patient

123456789012345678901234567

123456789012345678901234567 J 123456789012345678901234567

123456789012345678901234567 106 123456789012345678901234567

12345678901234567890123456Room 7

123456789012345678901234567 Management of clinical training Rewarding teaching Teaching and Teaching assessing attitudes Progress Test

123456789012345678901234567

123456789012345678901234567 I

123456789012345678901234567

123456789012345678901234567 114

123456789012345678901234567

123456789012345678901234567 Room

123456789012345678901234567 Evaluation of problem based learning Patient simulation Problem based learning PBL and computers 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 :

123456789012345678901234567

123456789012345678901234567 H

123456789012345678901234567 215 123456789012345678901234567

123456789012345678901234567 Room

123456789012345678901234567 Short comm Student learning Student diversity Student support 123456789012345678901234567 OSCE 1 OSCE 2

123456789012345678901234567

123456789012345678901234567 : 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 G 123456789012345678901234567

12345678901234567890123456120 7

123456789012345678901234567 Room

123456789012345678901234567 Please note room change for this session only

123456789012345678901234567 Short comm Community- based education Different approaches to staff development Courses for medical teachers Staff development – training needs Assessment of teaching * 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 :

123456789012345678901234567

123456789012345678901234567 F

123456789012345678901234567

12345678901234567890123456101 7

123456789012345678901234567 Room 123456789012345678901234567

123456789012345678901234567 Short comm Postgraduate Assessment (Room 304)* Assessment of the practising doctor Clinical training – Leonardo project International medical education 1 International medical education 2

123456789012345678901234567

123456789012345678901234567 :

123456789012345678901234567

123456789012345678901234567 E 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456205 7

12345678901234567890123456Room 7

123456789012345678901234567 Large Group Complex Adaptive Systems and Medical Education Continuing Professional Development CPD needs assessment Teaching and learning and Teaching learning communication skills 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 : 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456D 7

123456789012345678901234567

12345678901234567890123456220 7

123456789012345678901234567 Room

123456789012345678901234567 Making medical education relevant to medical practice Large Group Postgraduate training in the early years Assessment and delivery of postgraduate education Curriculum evaluation Training and Assessment for GP/FM 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 :

123456789012345678901234567

123456789012345678901234567 C

123456789012345678901234567

12345678901234567890123456201 7

123456789012345678901234567 Room

123456789012345678901234567 Large Group BEME review of high fidelity simulation Curriculum 1 Curriculum 2 123456789012345678901234567 Curriculum planning 1 Curriculum planning 2

123456789012345678901234567

123456789012345678901234567 :

123456789012345678901234567

123456789012345678901234567 B 123456789012345678901234567

12345678901234567890123456110 7

123456789012345678901234567 Room 123456789012345678901234567

123456789012345678901234567 Large Group Cognitive perspective on learning: Implications for teaching Final exam Assessing communication skills Examiner’s toolkit Computer based assessment

123456789012345678901234567

123456789012345678901234567 :

123456789012345678901234567

12345678901234567890123456A 7

123456789012345678901234567 210

123456789012345678901234567

12345678901234567890123456Room 7

123456789012345678901234567 Large Group Standard Setting Computer based teaching Computers in the curriculum E-learning Virtual learning environment

123456789012345678901234567

12345678901234567890123456Room 7

123456789012345678901234567 Session 5 Large Groups and Short Comm 3 Tuesday 0830-1000 Session 7 Short Comm 4 Tuesday 1315-1445 Session 9 Short Comm 5 Tuesday 1645-1800 Session 2 Short Comm 1 Monday 1045-1230 Session 3 Short Comm 2 Monday 1330-1515 Note: all of the above are short communications, with exception five large groups in Session 5. 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 – 1.14 – Section 1

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456Poster Sessions7 Tuesday 2 September: 1510-1640 hours 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456Session Title7 Location of Boards

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234568A Assessment7 General Dome/Kuppelsaal, 5 Floor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 th

123456789012345678901234568B Clinical7 Assessment Dome/Kuppelsaal, 5 Floor

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234568C The Curriculum7 (1) (including Multiprofessional Education) Dome/Kuppelsaal, 5 Floor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234567

123456789012345678901234568D The Curriculum7 (2) Dome/Kuppelsaal, 5 Floor

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234568E Evaluation7 of the Curriculum Dome/Kuppelsaal, 5 Floor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234567

123456789012345678901234568F Teaching7 Clinical Skills (1) Dome/Kuppelsaal, 5 Floor

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234568G Teaching7 Clinical Skills (2) Dome/Kuppelsaal, 5 Floor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234567

123456789012345678901234568H International7 Medical Education Dome/Kuppelsaal, 5 Floor

123456789012345678901234567

123456789012345678901234567 th 123456789012345678901234568I Problem7 Based Learning Dome/Kuppelsaal, 5 Floor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 nd 123456789012345678901234567

123456789012345678901234568J Postgraduate7 Education 2 Floor, East Corridor

123456789012345678901234567

123456789012345678901234567 nd 123456789012345678901234568K Staff 7Development 2 Floor, East Corridor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234567

123456789012345678901234568L Students7 Foyer of Dome, 4 Floor

123456789012345678901234567

123456789012345678901234567 nd 123456789012345678901234568M Teaching7 and Learning (1) 2 Floor, West Corridor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 nd 123456789012345678901234567

123456789012345678901234568N Teaching7 and Learning (2) 2 Floor, West Corridor

123456789012345678901234567

123456789012345678901234567 st 123456789012345678901234568O E-learning7 and the Internet 1 Floor, East Corridor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 st 123456789012345678901234567

123456789012345678901234568P Computer7 Assisted Learning 1 Floor, West Corridor

123456789012345678901234567

123456789012345678901234567 st 123456789012345678901234568Q Learning7 Management Systems and Computer Based Assessment 1 Floor, West Corridor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234567

123456789012345678901234568R Continuing7 Professional Development Foyer of Dome, 4 Floor

123456789012345678901234567

123456789012345678901234567 st 123456789012345678901234568S Management7 and Selection 1 Floor, East Corridor 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 th 123456789012345678901234567

123456789012345678901234568T Outcomes,7 Professionalism, and Research and Critical Thinking Foyer of Dome, 4 Floor

123456789012345678901234567

123456789012345678901234567 – 1.15 – Section 1

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456Conference7 Workshops Monday 1 September: 1545-1715 hours 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456See pages 4.40-4.457 for Abstracts.

123456789012345678901234567

12345678901234567890123456Workshop Title7 Room

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.1 ‘A doctor7 who knows only Medicine doesn’t even know Medicine’. 208 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456Teaching7 ethics and attitudes: a global challenge for medical education

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.2 Why7 fix assessment? 215 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.3 Learning7 in the new job: how to maximise educational opportunities in 114 123456789012345678901234567

123456789012345678901234567 12345678901234567890123456shifts7 and other new patterns of working 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.4 Depression7 in clinical practice: educating medical students and primary 101 123456789012345678901234567

123456789012345678901234567 12345678901234567890123456care7 physicians 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.5 Trials,7 tribulations and triumphs: supervising a dissertation in 304 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456medical7 education

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.6 Peer7 teaching 120 123456789012345678901234567

123456789012345678901234567

123456789012345678901234564.7 Usability7 in computer-assisted learning programmes 117

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.8 Assessing7 PBL group activity 206 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.9 Scenarios7 for PBL on the web – triggers for learning 331 123456789012345678901234567

123456789012345678901234567

123456789012345678901234564.10 Creating7 cases to promote integration into undergraduate medical education 205

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.11 IFMSA7 Student workshop: Outcome-based education 106 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.12 Developing7 a teaching or examination event using Simulated Patients: 214 123456789012345678901234567

123456789012345678901234567 12345678901234567890123456form7 and case materials development 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.13 Assessment7 methods – what works, what doesn’t 105 123456789012345678901234567

123456789012345678901234567

123456789012345678901234564.14 Scenario-based7 teaching and learning – an innovative and relevant 115

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456concept7 in medical education 123456789012345678901234567

123456789012345678901234567

123456789012345678901234564.15 Verbal7 reflection-on-action as a tool in consultation training 204

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.16 Central7 and East European/Eurasian Taskforce – local issues 220 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234564.17 Professionalism7 – large group 110 123456789012345678901234567

123456789012345678901234567

123456789012345678901234564.18 Using7 a Collaborative Work Space in a rich media educational 201

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456environment7 – large group 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 – 1.16 – Section 1

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456Conference7 Workshops Tuesday 2 September: 1030-1215 hours 123456789012345678901234567

123456789012345678901234567

12345678901234567890123456See pages 4.51-4.567 for Abstracts.

123456789012345678901234567

12345678901234567890123456Workshop Title7 Room

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.1 The7 nature of curriculum change: complicated and complex 105 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.2 Enhancing7 student learning in your lectures 115 123456789012345678901234567

123456789012345678901234567

123456789012345678901234566.3 A new7 approach to curriculum mapping 212

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.4 How7 to build a Comprehensive Integrated Puzzle as a method of assessment 205 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.5 Assessment7 in PBL medical schools: what are we measuring? 208 123456789012345678901234567

123456789012345678901234567

123456789012345678901234566.6 Creating,7 implementing and evaluating the personal and professional 331

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456development7 curriculum 123456789012345678901234567

123456789012345678901234567

123456789012345678901234566.7 Bridging7 the gap between curriculum development and delivery 206

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.8 Reach7 out and “teach” someone: instructional methods in the classroom 215 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.9 Medical7 education – trainer or trainee’s responsibility? 120 123456789012345678901234567

123456789012345678901234567

123456789012345678901234566.10 Looking7 towards the future: what’s in store for medical education? 304

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.11 Didactics7 for beginners 204 123456789012345678901234567

123456789012345678901234567

123456789012345678901234566.12 Enriching7 curriculum through Standardized Patient-based programs 114

123456789012345678901234567

123456789012345678901234566.13 Mastering7 the scholarly process 214

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.14 Ibero-American7 Group – local needs and institutional accreditation (large group) 220 123456789012345678901234567

123456789012345678901234567

123456789012345678901234566.15 IVIMEDS:7 The International Virtual Medical School (large group) 201

123456789012345678901234567

123456789012345678901234567 123456789012345678901234566.16 Standards7 in Medical Education (large group) 110 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 – 1.17 – Section 1

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456Personal Diary7 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 12345678901234567890123456START 7 MONDAY TUESDAY WEDNESDAY START 123456789012345678901234567

123456789012345678901234567

123456789012345678901234560830 7 0830

123456789012345678901234567

123456789012345678901234567 123456789012345678901234560845 7 0845 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 Plenary 1 Plenary 2

123456789012345678901234560900 7 0900 123456789012345678901234567 (Kultur Casino) 123456789012345678901234567(Kultur Casino)

123456789012345678901234567 123456789012345678901234560915 7 0915 123456789012345678901234567

123456789012345678901234567

123456789012345678901234560930 7 0930 & Short Comm 3 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 Large Group Sessions 123456789012345678901234560945 7 Discussion 0945 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567Walk to University 123456789012345678901234561000 7 1000 123456789012345678901234567 Coffee 123456789012345678901234567

123456789012345678901234567 123456789012345678901234561015 7 1015 123456789012345678901234567 123456789012345678901234567 Coffee Coffee 123456789012345678901234567

123456789012345678901234567 123456789012345678901234561030 7 1030 123456789012345678901234567

123456789012345678901234567

123456789012345678901234561045 7 1045

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561100 7 1100 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 Workshops and

123456789012345678901234567

123456789012345678901234561115 7 1115

123456789012345678901234567 Groups 2

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561130 7 Plenary 3 1130 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 (Kultur Casino)

123456789012345678901234567

123456789012345678901234561145 7 1145

12345678901234567890123456Short Comm 1 7

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561200 7 1200 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 Discussion 123456789012345678901234561215 7 1215

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561230 7 Lunch and 1230 123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 General Assembly 123456789012345678901234567

123456789012345678901234561245 7 1245 123456789012345678901234567 Lunch 123456789012345678901234567 123456789012345678901234567 Close of meeting 123456789012345678901234561300 7 1300 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561315 7 1315 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561330 7 1330 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561345 7 1345 123456789012345678901234567

123456789012345678901234567

123456789012345678901234561400 7 1400

123456789012345678901234567

123456789012345678901234567 Short Comm 4 123456789012345678901234561415 7 1415 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234567 Discussion 123456789012345678901234561430 7 1430

123456789012345678901234567 Short Comm 2

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561445 7 1445 123456789012345678901234567 123456789012345678901234567 Coffee 123456789012345678901234567 123456789012345678901234567 Discussion 123456789012345678901234561500 7 1500

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561515 7 1515 123456789012345678901234567 123456789012345678901234567 Coffee 123456789012345678901234567

123456789012345678901234567

123456789012345678901234561530 7 1530

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561545 7 Posters 1545 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 (1510-1640)

123456789012345678901234567

123456789012345678901234561600 7 1600

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561615 7 1615 123456789012345678901234567 12345678901234567890123456Workshops7 and Groups 1 123456789012345678901234567

123456789012345678901234567 123456789012345678901234561630 7 1630 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561645 7 1645 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561700 7 1700 123456789012345678901234567

123456789012345678901234567

123456789012345678901234561715 7 1715

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561730 7 1730 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 Short Comm 5

123456789012345678901234561745 7 1745

123456789012345678901234567

123456789012345678901234567 123456789012345678901234561800 7 Discussion 1800 123456789012345678901234567

123456789012345678901234567

123456789012345678901234561815 7 1815

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12345678901234567890123456Note: While you 7are free to move between short communication and poster sessions, we hope

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12345678901234567890123456you will stay7 in one session and join in the discussion.

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123456789012345678901234567 – 1.18 – Section 1 123456789012345678901234567

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123456789012345678901234567 12345678901234567890123456Map of Bern7 123456789012345678901234567

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123456789012345678901234567 12345678901234567890123456Plan of University7 Area (top left in above map) 123456789012345678901234567

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123456789012345678901234567 123456789012345678901234567 ▼ Bus No.12 123456789012345678901234567

123456789012345678901234567

123456789012345678901234567 – 1.19 – Section 1 123456789012345678901234567

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123456789012345678901234567 12345678901234567890123456Plan of Conference7 Building 123456789012345678901234567

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123456789012345678901234567 – 1.20 – Section 2: Sunday

Saturday 30 August

1200-1700 Registration (University of Bern – see location on pages 1.14 and 1.19) Setting up of posters and exhibits

Sunday 31 August

0830-1600 Registration University of Bern Setting up of posters and exhibits

0930-1700 Pre-conference workshops Location: University of Bern (Refreshments will be available in the tents between 1045-1115 and between 1515-1545)

0930-1230 Morning session

PCW1 Part 1 (workshop continues after lunch) Finding and appraising evidence in medical education Alex Haig (NHS Education for Scotland) and Marshall Dozier (University of Edinburgh, UK) Location for morning: Room -302 (Juristische Bibliothek – 3 floors down) Location for afternoon: Room 212

PCW2 Part 1 (workshop continues after lunch) Preparing tomorrow’s educators for leadership roles in the health professions: an interactive, participatory workshop Miriam Friedman Ben-David (Israel) and Stewart Mennin (University of New Mexico, USA) Location: Room 105

PCW3 Basic faculty skills Anita Duhl Glicken (University of Colorado, USA) Location: Room 204

PCW4 Mobile computing and medical education Ulrich Woermann (University of Bern, Switzerland) and Michael Schmidts (University of Vienna, Austria) Location: Room 115

PCW5 Why offer early clinical experience in undergraduate medical education? Tim Dornan, Christine Bundy and Lis Cordingley (University of Manchester Medical School, UK) Location: Room 331

– 2.1 – Section 2: Sunday

PCW6 Evaluation of medical education – methodological implications of new technologies R Peter Nippert and Bernhard Marschall (IfAS, Munster, Germany) Location: Room 215

PCW7 Setting defensible performance standards on OSCEs and clinical skills examinations: a user’s guide from A to Z André de Champlain (National Board of Medical Examiners, USA) and Jack Boulet (Educational Commission for Foreign Medical Graduates, USA) Location: Room 304

PCW8 Designing Study Guides Jennifer M Laidlaw (University of Dundee, UK) Location: Room 212

PCW10 Using computers to prepare students for ‘real’ clinical experiences Joe Henderson and Christof Daetwyler (Dartmouth College, USA) Location: Room 106

PCW11 Designing multiple choice questions that serve a purpose René Krebs (University of Bern, Switzerland) Location: Room 214

PCW12A* Fostering and assessing medical professionalism: challenges and strategies Sharon Krackov (New York University School of Medicine, USA) Location: Room 208 (* additional session – same content as PCW12 to be held in the afternoon session)

1230-1400 Lunch break Lunch is not provided – see page 1.3 for suggestions for lunch.

1400-1700 Afternoon session

PCW9 Vertical integration in the medical curriculum Eugene Custers and Olle ten Cate (University Medical Centre, Utrecht, Netherlands) Location: Room 331

PCW12 Fostering and assessing medical professionalism: challenges and strategies Sharon Krackov (New York University School of Medicine, USA) Location: Room 208

PCW13 Clinical evaluation exercises (MINI-CEX): how to improve oral examinations in medical practice John Norcini (FAIMER, USA) and Reinhard Westkämper (University of Bern, Switzerland) Location: Room 304

PCW14 Developing learning objectives catalogues Ralph Bloch (University of Bern, Switzerland) and Hans Bürgi (SMIFK, Switzerland) Location: Room 214

– 2.2 – Section 2: Sunday

PCW15 Making small group teaching work Phil Race (York, UK) Location: Room 215

PCW16 Programmatic evaluation – how to evaluate your course/clerkship Steven J Durning, Paul A Hemmer and Louis N Pangaro (Uniformed Services University of the Health Sciences, USA) Location: Room 106

PCW17 Enhanced faculty skills Anita Duhl Glicken (University of Colorado, USA) Location: Room 204

PCW18 E-learning – what do I need to know about it to get started? Peter Cantillon and Nic Fenlon (National University of Ireland, Republic of Ireland) Location: Room 115

Special Interest Group Meeting

1400-1700 National Groups of Health Science Educators Organised by The South African Association of Health Educationalists (SAAHE) (for details, see abstract on page 4.3) Athol Kent and Trevor Gibbs (University of Cape Town, South Africa) Location: Room 114

1800-2100 Registration Location: Kultur Casino, Bern (see map on page 1.19)

1900-2100 Opening ceremony at Kultur Casino, Bern: A minimum of formality and plenty of opportunity to meet each other. A mixture of classical and jazz music, followed by cocktail reception. (Please note: this is intended as a light snack, not a full meal)

– 2.3 – Section 2: Monday

Monday 1 September

0730-0900 Registration Kultur Casino, Bern (see map on page 1.19)

1030-1730 Registration University of Bern (see map on page 1.19)

0830-1000 Session 1 Plenary 1: Social responsibility of medical education

Presentations from various viewpoints in the Swiss context, in a plenary organized by the University of Bern Chairperson: Ralph Bloch (University of Bern) Location: Kultur Casino, Bern

0830-0840 What does society expect from its physicians in general and from their training in particular? An anonymous health politician

0841-0851 A view from the trenches: what are the essential elements in the education of future physicians? H H Brunner (President, Swiss Medical Association FMH)

0852-0902 What do medical students want out of their six years? Janine Scherrer and Teresa Hidalgo-Staub (Medical Students, University of Bern)

0903-0913 Education or training? What is the role of the University in medical education? Ch. Schäublin (President, University of Bern)

0914-0924 Squaring the circle: research, teaching, clinical service and management – what else should professors do? P Suter (Dean, Faculty of Medicine, University of Geneva)

0925-1000 Discussion

1000-1045 Walk to University (approximately 900 metres/13 minute walk - see page 1.19. A regular public bus service connects the two venues). Coffee at University, in tents.

– 2.4 – Section 2: Monday

1045-1230 Session 2 Short Communications 1: Simultaneous themed sessions

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12345678901234567890123456789012123456789012345 1234567890123456789012345678901212345678901234 2A E-learning 5 12345678901234567890123456789012123456789012345

12345678901234567890123456789012123456789012345 Chair: Ina Treadwell, South Africa Discussant: David Dewhurst, UK Location: Room 210

1045 2A 1 Virtual patients are go! N K McManus*, R M Harden & S Smith ( IVIMEDS, Dundee, UK)

1100 2A 2 Lessons learned in developing online curricula: five tips for success David A Cook* & Denise M Dupras (Mayo Graduate School of Medicine, Department of Internal Medicine, Rochester MN, USA)

1115 2A 3 The Swedish Net University supports net based medical and healthcare education Goran Petersson (Council for Renewal of Higher Education, Swedish Net University Agency, Harnosand, SWEDEN)

1130 2A 4 Evaluating interactivity in on-line postgraduate education David N Brigden* & Andrew D Sackville (Mersey Deanery, University of Liverpool, Liverpool, UK)

1145 2A 5 Reusable learning objects, content syndication and resource discovery David A Davies (University of Birmingham, Medical Education Unit, Birmingham, UK)

1200 2A 6 Semantic web based knowledge management by UMLS T Schroter*, T Richter & R Schumann (Charité, Medizinische Fakultät der Humboldt Universität, Berlin, GERMANY)

1215-1230 Discussion

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1234567890123456789012345678901212345678901234567890123456789012B The Examiner’s Toolkit 2

1234567890123456789012345678901212345678901234567890123456789012 Chair: Hettie Till, South Africa Discussant: Diana Dolmans, Netherlands Location: Room 110

1045 2B 1 Credibility of portfolio assessment as an alternative for reliability evaluation Erik Driessen*, Cees van der Vleuten & Jan van Tartwijk (Maastricht University, Faculty of Medicine, Maastricht, NETHERLANDS)

1100 2B 2 Medicine clerkship pre-test: the role of an early clerkship examination to identify clerkship students at risk of final examination failure Alan Wimmer, Dodd Denton, Paul A Hemmer* & Louis Pangaro (Uniformed Services University, USUHS - EDP, Bethesda, USA)

1115 2B 3 Feasibility of portfolio Kirsten Bested (Vejle Hospital, Department of Anaesthesiology, Vejle, DENMARK)

– 2.5 – Section 2: Monday

1130 2B 4 The educational utility of the “don’t know” response added to a five-options item format Yolanda Marin-Campos*, Lizbeth Mendoza-Morales, Jaime Navarro & Eusebio Contreras-Chaires (National Autonomous University of Mexico, Departmento de Farmacologia, Mexico City, MEXICO)

1145 2B 5 Creating creative assessments L A Allery*, J MacDonald & L A Pugsley (University of Wales College of Medicine, School of Postgraduate Medical and Dental Education, Cardiff, UK)

1200 2B 6 Evaluation of open-book exams in an undergraduate biochemistry course Nadia Al Wardy*, Syed Rizvi & Sean McAleer (Sultan Qaboos University, Department of Biochemistry, SULTANATE OF OMAN)

1215-1230 Discussion

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1234567890123456789012345678901212345678901234567890123456789012 1234567890123456789012345678901212345678901234567890123456789012C Curriculum Planning 1 2 1234567890123456789012345678901212345678901234567890123456789012

1234567890123456789012345678901212345678901234567890123456789012 Chair: To be announced Discussant: To be announced Location: Room 201

1045 2C 1 Complementary and alternative medicine in the undergraduate medical curriculum: a needs analysis J Skinner & A D Cumming* (University of Edinburgh, Medical Teaching Organisation, Edinburgh, UK)

1100 2C 2 Mapping the surgical curriculum Anne Ellison (Royal Australian College of Surgeons, Melbourne, AUSTRALIA)

1115 2C 3 An innovative method of delivery of the core curriculum in Obstetrics and Gynaecology – the Leeds model Vikram Jha*, Jayne Shillito, Judith Moore, Alison Wright & Sean Duffy (St James’s University Hospital, Academic Dept of Obstetrics & Gynaecology, Leeds, UK)

1130 2C 4 Developing curricula based on learning needs: genetics education for specialist registrars in non-genetics specialities Sarah Wakefield*, Hywel Thomas, Peter Farndon & Julie Bedward (Centre for Research in Medical & Dental Education, School of Education, Birmingham, UK)

1145 2C5 The current medical program at the American University of Beirut: problems and solutions Farid Saleh*, Nadim Cortas & Ibrahim Salti (Department of Human Morphology and Medical Education Unit, American University of Beirut, LEBANON)

1200 2C 6 A survey of people’s complaints against physicians during a five year period in Fars province L Bazrafkan*, Z Tabeie & M Saberfirozi (Shiraz University of Medical Science, Shiraz, IRAN)

1215-1230 Discussion

– 2.6 – Section 2: Monday

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1234567890123456789012345678901212345678901234567890123456789012 1234567890123456789012345678901212345678901234567890123456789012D Curriculum Evaluation 2 1234567890123456789012345678901212345678901234567890123456789012 Chair: Pedro Herskovic, Chile Discussant: Stewart Mennin, USA Location: Room 220

1045 2D 1 Keep the customer satisfied: quality control in a medical curriculum M Maelstaf*, I Vandenreyt & M Vandersteen (LUC, Limburgs Universitair Centrum, Faculty of Medicine, Diepenbeek, BELGIUM)

1100 2D 2 Evaluating MOET Mike Davis (Edge Hill, Ormskirk, UK)

1115 2D 3 A student centred approach to course evaluation using the norminal group technique William Murdoch* & John Skelton (University of Birmingham, Interactive Skills Unit, Birmingham, UK)

1130 2D 4 Teaching about the family in the community: purposeful, coherent, integrated and well-informed? P G Cawston*, K Mullen, M Nicholson & R A Robertson (Glasgow University, General Practice and Primary Care, Glasgow, UK)

1145 2D 5 Correlation between students’ GPA and evaluation score of the teacher A Malayeri, A Alidadi & P Afshari* (Ahvaz Medical Science University, Nursing and Midwifery School of Medical Science, Ahvaz, IRAN)

1200 2D 6 Teachers’ points of view about evaluation S Iranfar*, B Izadi, F Monsori & M Rezaie (E.D.C, Kermanshah, IRAN)

1215-1230 Discussion

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1234567890123456789012345678901212345678901234567890123456789012E Teaching and Learning 2

1234567890123456789012345678901212345678901234567890123456789012 Chair: Nehad El-Sawi, USA Discussant: Brownell Anderson, USA Location: Room 205

1045 2E 1 Factors influencing final year students’ learning climate in Thai Medical Schools Danai Wangsaturaka* & Sean McAleer (The Faculty of Medicine, Chulalongkorn University, Department of Pharmacology, Bangkok, THAILAND)

1100 2E 2 Evaluation of different lecture types in medical education S Holler*, N De Cono, A Mehrabi, S Schurer, E Gazyakan, M Kadmon & J Schmidt (Department of Surgery, University of Heidelberg, Heidelberg, GERMANY)

1115 2E 3 Clinical teachers and the new medical education Tim Dornan*, Albert Scherpbier, Nigel King & Henny Boshuizen (Hope Hospital, Manchester, UK)

1130 2E 4 Student-teachers are not better learners than their peers Angel M Centeno*, Cecilia Primogerio and Martin O’ Flaherty (School of Biomedical Sciences, Universidad Austral-Medicina, Buenos Aires, ARGENTINA)

– 2.7 – Section 2: Monday

1145 2E 5 Interactive large group teaching is an alternative to small-group teaching in a dermatology practical course F R Ochsendorf*, A Boer, W H Boehncke & R Kaufmann (Zentrum Dermatologie und Venerologie, Klinikum der J W Goethe-Universitat, Frankfurt, GERMANY)

1200 2E 6 Using a game format as a teaching strategy in CME: does it work? Maja Bujas-Bobanovic (Aventis Pharma Inc, Laval, Quebec, CANADA)

1215-1230 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234562F International Medical Education (1) 7

123456789012345678901234567890121234567890123456789012345678901212345678901234567 Chair: Marina Mrouga, Ukraine Discussant: Jack Boulet, USA Location: Room 101

1045 2F 1 Presentation of European Medical Students’ Association (EMSA) Filip Stoma*, Anna Michalak & Tomasz Kucmin (EMSA, Lublin, POLAND)

1100 2F 2 Cultural probity in medicine R C Gupta*, S Lingam, M I Memon & D Brigden (Lancashire Teaching Hospitals NHS Trust, Chorley, UK)

1115 2F 3 Possibilities for change? Iskender K Akylbekov, Christian Guksch* & Chinara Mambetova (Modellstudiengang Medizin, Universitatsklinikum, Hamburg, GERMANY)

1130 2F 4 Increasing the relevance of health professions education and health services: The Network: Towards Unity for Health Gerard D Majoor (Faculty of Medicine, Maastricht University, Maastricht, NETHERLANDS)

1145 2F 5 Global survey on geriatrics in the medical curriculum I Keller, N Borojevic*, A Makipaa, T Kalenscher & A Kalache (International Federation of Medical Students’ Associations, Zagreb, CROATIA)

1200 2F 6 Not just another changed medical school Trevor Gibbs* & David Taylor (Faculty of Health Sciences, University of Cape Town, Cape Town, SOUTH AFRICA)

1215-1230 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234567 123456789012345678901234567890121234567890123456789012345678901212345678901234562G Staff Development – Training Needs 7 123456789012345678901234567890121234567890123456789012345678901212345678901234567

123456789012345678901234567890121234567890123456789012345678901212345678901234567 Chair: Jørgen Nystrup, Denmark Discussant: Janet Grant, UK Location: Room 120

1045 2G 1 Strategic direction for staff development: ensuring relevance in times of change Faith Hill (University of Southampton, Medical Education Development Unit, Southampton, UK)

1100 2G 2 Educational needs of a programme director in Denmark Bente Malling (Videreuddannelsessekretariatet, Aarhus AMT, Hoejbjerg, DENMARK)

– 2.8 – Section 2: Monday

1115 2G 3 A new preparation for dental trainers Alexander Stewart (NHS Education for Scotland, Turriff, UK)

1130 2G 4 The effect of ‘Teaching the Teacher’ courses for doctors Sune Rubak*, Lene Mortensen, Bente Malling & Charlotte Ringsted (Aarhus Amt, Hojbjerg, DENMARK)

1145-1230 Discussion

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123456789012345678901234567890121234567890123456782H The OSCE (1) 9

123456789012345678901234567890121234567890123456789 Chair: To be announced Discussant: André de Champlain, USA Location: Room 215

1045 2H 1 Are standardized patients able to identify poorly performing medical students in OSCE? Pirkko Heasman, Kaisu Pitkala, Taina Hatonen, Niina Paganus and Kirsti Lonka* (University of Helsinki, Faculty of Medicine, Helsinki, FINLAND)

1100 2H 2 Neonatology OSCE: certification of expertise J Arnau*, T Esque, A Zuasnabar, A Fina, A Moral, F Raspall, N Barragan & J M Martinez-Carretero (Institute of Health Studies, Barcelona, SPAIN)

1115 2H 3 A computer-based Medline objective structured clinical examination (OSCE) for third year medical students: aims, methods and outcomes M Dozier*, S Yewdall, R Ellaway & H Cameron (University of Edinburgh, Edinburgh, UK)

1130 2H 4 Evaluating physician CanMEDS competencies using Objective Structured Clinical Examination (OSCE) in neonatal-perinatal medicine Brian Simmons*, Ann Jefferies, Marc Blayney, Kyong Lee, Henry Roukema, Martin Skidmore, Jodi McIlroy & Diana Tabak (University of Toronto, Sunnybrook & Women’s College of Health Sciences Centre, Toronto, CANADA)

1145 2H 5 A comparison of several methods for setting passing scores on an OSCE Ernest N Skakun*, Stephen Aaron, Fraser Brenneis, Narmin Kassam, Ramona Kearney and Peggy Sagle (University of Alberta, Division of Studies in Medical Education, Edmonton, CANADA)

1200 2H 6 Catalan Family Medicine OSCE: professional career consequences J M Martinez-Carretero*, C Blay, R Vilatimo, C Lopez Sanmartin, J Arnau, S Juncosa and J M Vilseca (Institute of Health Studies, Barcelona, SPAIN)

1215-1230 Discussion

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12345678901234567890123456789012123456789012345678901234567890122I Problem Based Learning 1

12345678901234567890123456789012123456789012345678901234567890121 Chair: To be announced Discussant: Geoff Norman, Canada Location: Room 114

1045 2I 1 Achieving the best of both worlds by Integration of PBL in PBT (Problem Based Teaching) during the clinical years N G Patil*, Mary Ip & J Wong (Faculty of Medicine, University of Hong Kong, HONG KONG)

– 2.9 – Section 2: Monday

1100 2I 2 Formative assessment of problem-based learning tutorial sessions using a criterion-referenced system Leticia Elizondo-Montemayor* & Araceli Hambleton Fuentes (School of Medicine Tecnologico de Monterrey, Nuevo Leon, MEXICO)

1115 2I 3 How medical students’ satisfaction with a problem-based curriculum relates to their perceptions about learning and future career (and the relevance of learning about wider issues) G Maudsley*, E M I Williams & D C M Taylor (University of Liverpool, Department of Public Health, Liverpool, UK)

1130 2I 4 Assessment of students in PBL tutorials improves attendance and correlates with academic performance Salah Kassab*, Hafiz Shazali & Hossam Hamdy (College of Medicine and Medical Sciences, Arabian Gulf University, Manama, BAHRAIN)

1145 2I 5 Medical students’ ways of learning Are Holen (NTNU, Department of Neuroscience, Trondheim, NORWAY)

1200 2I 6 Group process and learning outcome in PBL: a new assessment tool identifies the crucial role of the tutor Stefan Herzig, Jan Matthes*, Alexander Look, Amina K Hahne, Kain Afhakama and Ara Tekian (University of Cologne, Department of Pharmacology, Cologne, GERMANY)

1215-1230 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789012345 1234567890123456789012345678901212345678901234567890123456789012123456789012342J Teaching and Assessing Attitudes 5 1234567890123456789012345678901212345678901234567890123456789012123456789012345 Chair: To be announced Discussant: Elizabeth Armstrong, USA Location: Room 106

1045 2J 1 Using digital video to teach attitudes: gain or pain? C Chiado* & A Pereira da Silva (Faculty of Medicine, Laboratorio de Genetica, Lisboa, PORTUGAL)

1100 2J 2 Development and validation of the Beersheva Survey of Attitudes and Knowledge in international health A Gaaserud*, A Jotkowitz, Y Gidron, C Baskin, J Urkin, M Alkan & C Margolis (Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, ISRAEL)

1115 2J 3 Assessment of attitude and conduct - is it feasible? Helen Sweetland*, Lorna Tapper-Jones, Ania Korszun, Peter Winterburn & Helen Houston (University of Wales College of Medicine, University Department of Surgery, Cardiff, UK)

1130 2J 4 “To be a Doctor”: Teaching attitudes using commercial films for raising the discussion on ethical dilemmas M F Patricio*, A P Lacerda, P Sa & J Gomes-Pedro (Faculdade de Medicina de Lisboa, University of Lisbon, Lisboa, PORTUGAL)

1145 2J 5 Evaluation of attitude achievement in “doctor-patient relationship” PBL sessions Orhan Odabasi, Melih Elcin, Iskender Sayek*, Murat Akova & Nural Kiper (Hacettepe Universitesi, Ankara, TURKEY)

1200-1230 Discussion

– 2.10 – Section 2: Monday

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1234567890123456789012345678901212345678901234567890123456789 1234567890123456789012345678901212345678901234567890123456782K Clinical Skills Training 9 1234567890123456789012345678901212345678901234567890123456789 Chair: Jean Ker, UK Discussant: Debra Nestel, Australia Location: Room 206

1045 2K 1 Establishment of a British Heart Foundation UK Harvey Resource Centre Shihab E O Khogali*, Ronald M Harden, Jennifer M Laidlaw, Barbara E Scott & Stewart Pringle (University of Dundee, Department of Cardiology, Dundee, UK)

1100 2K 2 Simulation-based large scale emergency preparedness training programs – The national role of the Israel Center for Medical Simulation Amitai Ziv*, Tali Yohanes, Shuli Banita, Ariel Bentancur, Daphna Barsuk, Amir Vardi, Inbal Levin & Haim Berkenstdt (The Israel Center for Medical Simulation, Chaim Sheba Medical Center, Ramat- Gan, ISRAEL)

1115 2K 3 Does systematic undergraduate training of resuscitation-skills influence postgraduate performance of resuscitation-skills? F O Weisser*, B Dirks & M Georgieff (Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm, GERMANY)

1130 2K 4 Multimedia driven education significantly improves medical students’ understanding of operative procedures in heart surgery R Friedl, H Hoppler, S Stracke* & A Hannekum (University of Ulm, Dept. Heart Surgery, Ulm, GERMANY)

1145 2K 5 The educational impact of bench model fidelity on the acquisition of technical skills Ethan D Grober, Stanley J Hamstra*, Kyle R Wanzel, Keith A Jarvi, Edward D Matsumoto, Rivindar S Sidhu & Richard K Reznick (University of Toronto, Centre for Research in Education - University Health Network, Toronto, CANADA)

1200-1230 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567 1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234562L Undergraduate Multiprofessional Education 7 1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567

1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567 Chair: Trudie Roberts, UK Discussant: Steffen Eychmueller, Switzerland Location: Room 105

1045 2L 1 Multiprofessional education: would a taxonomy help? C Segouin & B Hodges* (Assistance Publique - Hopitaux de Paris, Service de la Formation Continue des Medecins, Paris, FRANCE)

1100 2L 2 JUMP2 shared learning for undergraduates in practice Fanny Mitchell* & Gill Young* (Faculty of Health and Human Sciences, Thames Valley University, London, UK)

1115 2L 3 Communication skills in a multiprofessional critical illness course Alan Thomson*, Rachelle Arnold & Jennifer Cleland (Aberdeen Royal Infirmary, Department of Anaesthetics, Aberdeen, UK)

1130 2L 4 Inter-professional healthcare ethics programme for undergraduate students of pharmacy, nursing and medicine: developing and evaluating a model for learning and teaching Deirdre McAree*, Mairead Boohan & Sue Morison (Queens University Belfast, School of Pharmacy, Belfast, IRELAND)

– 2.11 – Section 2: Monday

1145 2L 5 Medical proteomics – from bench to bedside: an interprofessional course in molecular medicine at the undergraduate level Annelie Brauner*, Ewa Ehrenborg*, Marie Henriksson* & Maria Sunnerhagen (Karolinska Institutet, King Gustaf V Research Institute, Stockholm, SWEDEN)

1200 2L 6 Community-based interprofessional education: do the outcomes justify the effort? Ruth McNair*, Nick Stone, Jane Sims & Caroline Curtis (The Department of General Practice, The University of Melbourne, Carlton, AUSTRALIA)

1215-1230 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789 1234567890123456789012345678901212345678901234567890123456789012123456782M Research and Critical Thinking 9 1234567890123456789012345678901212345678901234567890123456789012123456789

1234567890123456789012345678901212345678901234567890123456789012123456789 Chair: Florian Eitel, Germany Discussant: Georges Bordage, USA Location: Room 115

1045 2M 1 Peer education workshop on research during medical studies E Zimmermann*, E Schoenenberger & M Dewey (Charité, Humboldt University Berlin, Berlin, GERMANY)

1100 2M 2 An evaluation of scientific comprehension among Swedish medical students G Edgren*, J Adami, O Akre and G Petersson (Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, SWEDEN)

1115 2M 3 Can our students think, and do they care? Lynne C Hvidsten*, James R Hulbert & Warren L Moe (Northwestern Health Sciences University, Department of Clinical Education, Bloomington, USA)

1130 2M 4 Is self-directed learning an illusion? – an evaluation of a new student- centered course in EBM P Frey*, K Huwiler & M Battaglia (University of Bern, IAWF, Bern, SWITZERLAND)

1145 2M 5 A program for medical research integrated in the medical curriculum A Waage*, R Austgulen, A Brubakk, U Sonnewald, T Lindmo, M Rekvig, O J Iversen & T Vik (Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, NORWAY)

1200-1230 Discussion

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12345678901234567890123456789012123456789012N Selection 2

12345678901234567890123456789012123456789012 Chair: John Clarkson, USA Discussant: Shimon Glick, Israel Location: Room 304

1045 2N 1 Teaching outcomes vs students’ former experience and background Jadwiga Mirecka (Department of Medical Education, Medical College of Jagiellonian University, Krakow, POLAND)

1100 2N 2 Selection and admission to medical schools in Europe and USA Ara Tekian (University of Illinois at Chicago, Department of Medical Education, Chicago, USA)

– 2.12 – Section 2: Monday

1115 2N 3 Major side effects of the introduction of entrance selection in a medical school in Flanders (Belgium) J Van der Veken*, A Derese, J de Maeseneer & B Morlion (Universitair Ziekenhuis Gent, Gent, BELGIUM)

1130 2N 4 Involving lay assessors in the selection of GP Registrars: an evaluation from the West Midlands Stephen Kelly*, Sarah Wakefield, Celia Brown & Marilyn Hammick (West Midlands Deanery, Institute of Research & Development, Birmingham, UK)

1145 2N 5 Changing profile of people who want to follow medical studies in Romania Horatiu D Bolosiu (University of Medicine & Pharmacy “I. Hatieganu”, Centre for Medical Education, Cluj-Napoca, ROMANIA)

1200 2N 6 Motivation and insight of school students considering a career in medicine Adrian Blundell*, Rick Harrison & Ben Turney (RAFT, Hazel Grove, Cheshire, UK)

1215-1230 Discussion

1230-1330 Lunch – buffet served in tents (see map on page 1.19) Note: name badges must be worn to gain admission

1230-1330 Private lunch: Harvard Macy Alumni Location: Room 028 (Senatszimmer)

1330-1715 Best Evidence Medical Education Workshop (closed session). An opportunity for those involved in BEME Reviews to discuss progress Location: Room 212

1330-1515 Session 3 Short Communications 2: Simultaneous themed sessions

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123456789012345678901234567890121234567890123456789012345678901212345678901234 123456789012345678901234567890121234567890123456789012345678901212345678901233A The Virtual Learning Environment 4 123456789012345678901234567890121234567890123456789012345678901212345678901234 Chair: Goran Pettersen, Sweden Discussant: David Davies, UK Location: Room 210

1330 3A 1 Sustainable development and integration of ICT-supported learning Annette Langedijk*, Christian Schirlo & Wolfgang Gerke (Medical Faculty, University Hospital Zurich, Zurich, SWITZERLAND)

1345 3A 2 E-learning tools on a small campus I Vandenreyt*, M Vandersteen & M Maelstaf (Limburgs Universitair Centrum, Dept of Physiology, Diepenbeek, BELGIUM)

1400 3A 3 Managing the learning environment in undergraduate medical education: The Sheffield approach Chris Roberts*, Mary Lawson, David Newble & Asley Self (Department of Medical Education, University of Sheffield, Sheffield, UK)

1415 3A 4 Virtual Learning Environments and Communities of Practice R Ellaway*, D Dewhurst & A Cumming (The University of Edinburgh, MVM Learning Technology Section, Edinburgh, UK)

– 2.13 – Section 2: Monday

1430 3A 5 Electronic learning: premises, skills and preferences of medical students – results of the Meducase-Charité-E-learning survey on 630 medical students Stefan Hoehne*, Goetz Bosse & Ralf R Schumann (Charité, Institut für Mikrobiologie & Hygiene, Berlin, GERMANY)

1445 3A 6 Electronic submission and delivery of student feedback R Ellaway, A Cumming, H Cameron & K Wylde* (University of Edinburgh, Edinburgh, UK)

1500-1515 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345673B Computer Based Assessment

Chair: To be announced Discussant: To be announced Location: Room 110

1330 3B 1 Response times as a function of examinee ability and item difficulty in the context of a testlet-based computer-administered adaptive examination D R Miller, A P Boulais, D E Blackmore* & T J Wood (Medical Council of Canada, Ottawa, CANADA)

1345 3B 2 CASEPORT – an integrative learning platform for case-based learning M R Fischer for the CASEPORT Consortium (University of Munich, Medizinische Klinik, Munich, GERMANY)

1400 3B 3 Virtual ethics in a Masters’ course Bryan Vernon (The Medical School, School of Population and Health Sciences, Newcastle, UK)

1415 3B 4 Electronic MEQ – a computer based assessment tool at the University of Witten/Herdecke, Germany Marzellus Hofmann* & Brigitte Strahwald (University of Witten, Faculty of Medicine, Witten, GERMANY)

1430 3B 5 Use of on-line summative assessment in medical education: experience from a pilot trial at the University of Melbourne Samy A Azer (FEU, Faculty of Medicine, Dentistry and Health Sciences, Victoria, AUSTRALIA)

1445 3B 6 Use of web-based cases for teaching and assessment in a medical school curriculum Debra A Newell*, L Felipe Amador, Mukaila A Raji, Karen A Rasmussen & Robert E Beach (University of Texas Medical Branch, Office of Educational Development, Galveston, USA)

1500-1515 Discussion

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123456789012345678901234567890121234567890123456789012345678901 123456789012345678901234567890121234567890123456789012345678903C Curriculum Planning (2) 1 123456789012345678901234567890121234567890123456789012345678901 Chair: Gonul Peker, Turkey Discussant: To be announced Location: Room 201

1330 3C 1 Basic sciences learning in an integrated, Primary Care oriented curriculum Fernando Mora-Carrasco*, Rosalinda Flores-Echavarria & Irina B Lazarevich (Universidad Autonoma Metropolitana (Xochimilco), MEXICO)

– 2.14 – Section 2: Monday

1345 3C 2 Postgraduate course – “ Palliative Medicine for doctors” – the ‘Fix-Flex- Design’ S Eychmueller* & H Neuenschwander (Kantonsspital St. Gallen, Palliativstation, St Gallen, SWITZERLAND)

1400 3C 3 Structuring basic science teaching around clinical cases: experiences at GKT Mary Seabrook*, Philip Aaronson & John Rees (Department of Medical and Dental Education, Sherman Education Centre, London, UK)

1415 3C 4 Topsy-turvey teaching: trauma as teaching tool T E Sommerville (University of Natal, Dept of Anaesthetics, Durban, SOUTH AFRICA)

1430 3C 5 A novel, integrated, practice-based, curricular approach Hettie Till (Canadian Memorial Chiropractic College, Toronto, CANADA)

1445-1515 Discussion

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890 Chair: Stephen Field, UK Discussant: Gellisse Bagnall, UK Location: Room 220

1330 3D 1 Formative assessment of family medicine residents in Catalonia: features and feasibility J M Fornells*, M Ezquerra, M Bundo, D Fores, F Cordon, J M Cots, A Casasa, J M Martinez & A Martin (IES/ ACEM, Institute of Health Studies, Barcelona, SPAIN)

1345 3D 2 The new scheme for specialist training of GPs in Denmark – best in Europe?? Roar Maagaard (Aarhus Amt, Hojbjerg, DENMARK)

1400 3D 3 Continuity of care in family practice residency training Mary Alice Parsons (Accreditation Council for Graduate Medical Education, Chicago, USA)

1415 3D 4 “Looking through students eyes” – Evaluation of the examinees’ comments in a short-answer examination Thomas Link* & Michael Schmidts (University of Vienna, Institute for Medical Education, Vienna, AUSTRIA)

1430 3D 5 Tutorship for family medicine students: care for the inner world L Debaene*, L Ferrant, R Remmen & J Denekens* (University of Antwerp, Department of General Practice, Antwerp, BELGIUM)

1445-1515 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567893E Teaching and Learning Communication Skills 0

1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567890 Chair: Gill Clack, UK Discussant: Knut Aspegren, Denmark Location: Room 205

1330 3E 1 Undergraduate students’ attitudes towards communication skills teaching J Cleland* & K N Foster (University of Aberdeen, Department of General Practice and Primary Care, Aberdeen, UK)

– 2.15 – Section 2: Monday

1345 3E 2 Veterinary medical communication skills curricula: “What’s up Doc?” C L Adams & S M Kurtz* (University of Guelph, Ontario Veterinary College, Guelph, CANADA)

1400 3E 3 Designing and implementing communication skills curriculum for medical students L Kongkam* & N Wiwutworapan (Maharat Nakhon Ratchasima Hospital, School of Medicine, Nakhon Ratchasima, THAILAND)

1415 3E 4 Practical experiences and pitfalls in teaching communication skills Martina Schlunder*, Britta Jonitz, Margareta Kampmann & Ulrich Schwantes (Institut für Allgemeinmedizin, Charité, Berlin, GERMANY)

1430 3E 5 Early experience of video taping encounters with patients Paul Bradley*, Charlotte Rees & Pamela Bradley (Peninsula Medical School, Plymouth, UK)

1445 3E 6 A survey of real versus simulated patients’ opinions of 1st year students’ communication skills Pamela Bradley*, Charlotte Rees & Paul Bradley (Peninsula Medical School, Clinical Skills Resource Centre, Plymouth, UK)

1500-1515 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234 123456789012345678901234567890121234567890123456789012345678901212345678901233F International Medical Education (2) 4 123456789012345678901234567890121234567890123456789012345678901212345678901234

123456789012345678901234567890121234567890123456789012345678901212345678901234 Chair: Ioan Bocsan, Romania Discussant: Hans Karle, Denmark Location: Room 101

1330 3F1 International recruitment of general practitioners into the UK workforce – an educational approach from West Yorkshire, England Peter Dickson* & Lynn Stinson (Bradford City Teaching PCT, Bradford, UK)

1345 3F2 Results of a clinical bridging course for overseas trained doctors in Australia Elma Avdi (University of Melbourne, School of Medicine, Melbourne, AUSTRALIA)

1400 3F3 Listserv analysis as a tool for evaluation of an on-line international medical education program W P Burdick*, P S Morahan, L M Johnson & J J Norcini (FAIMER, Philadelphia, USA)

1415 3F4 An overview of the characteristics and performance of candidates who take the ECFMG clinical skills assessment: 5 years of testing J Boulet*, G Whelan, W Burdick & J Norcini (Educational Commission for Foreign Medical Graduates, CSA, Philadelphia, USA)

1430 3F5 The assessment of global physician competence David T Stern*, Andrzej Wojtczak & M Roy Schwarz (University of Michigan Health System, Ann Arbor, USA)

1445 3F6 Perceived stress and stress sources for Chilean and American medical students Meghan McKeever*, Pedro Herskovic & Daniel Hunt (University of Washington, Seattle, USA)

1500-1515 Discussion

– 2.16 – Section 2: Monday

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12345678901234567890123456789012123456789012345678901234567890121 12345678901234567890123456789012123456789012345678901234567890123G Assessment of Teaching 1 12345678901234567890123456789012123456789012345678901234567890121 Chair: To be announced Discussant: Lynne Allery, UK Location: Room 120

1330 3G 1 Feedback to faculty using the SETOC instrument – student evaluation of teaching in outpatient clinics Rukhsana W Zuberi* & Georges Bordage (Department of Family Medicine, The Aga Khan Uni, Karachi, PAKISTAN)

1345 3G 2 Does ‘expert review’ of teaching practice lead to increased effectiveness of teachers in the healthcare professions? Kay Mohanna (Staffordshire University, Stoke on Trent, UK)

1400 3G 3 OSTE: Objective Standardized Teaching Examination for a ‘residents as teachers’ course Jesus Ibarra-Jimenez*, Ismael Piedra-Noriega, Monica del Angel-Reyes & Jorge Gonzalez (Instituto Tecnologico y de Estudios Superiores de Monterrey, School of Medicine, Monterrey, MEXICO)

1415 3G 4 Challenges in implementing a computer-based collaborative platform in staff development Klara Bolander* & Kirsti Lonka* (Karolinska Institutet, Stockholm, SWEDEN)

1430 3G 5 Attitudes towards teaching in a newly founded medical school: 2 years later Araya Khaimook* & Boonyarat Warachit (Hatyai Hospital, Songkla, THAILAND)

1445 3G 6 Feedback for physicians supervising students during patient contacts D H J M Dolmans*, H A P Wolfhagen, W H Gerver & A J J A Scherpbier (University of Maastricht, Department of Educational Development and Research, Maastricht, NETHERLANDS)

1500-1515 Discussion

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1234567890123456789012345678901212345678901234563H The OSCE (2) 7

1234567890123456789012345678901212345678901234567 Chair: Josep-Mariá Martinez-Carretero, Spain Discussant: Nivritti Patil, Hong Kong Location: Room 215

1330 3H 1 Keeping standardized patients standardized Tony Errichetti* & John Boulet (Philadelphia College of Osteopathic Medicine/National Board of Osteopathic Medical Examiners, Philadelphia, USA)

1345 3H 2 Psychometric challenges associated with standardized patient assessments Danette W McKinley, John R Boulet* & Ronald K Hambleton (Educational Commission for Foreign Medical Graduates, CSA, Philadelphia, USA)

1400 3H 3 Using a standardized patient assessment to measure professional attributes Marta van Zanten*, John R Boulet, John J Norcini & Danette McKinley (Educational Commission for Foreign Medical Graduates, Philadelphia, USA)

1415 3H 4 Evaluating the effectiveness of a two-year curriculum in a surgical skills centre D J Anastakis*, K R Wanzel, M H Brown, J McIlroy, S J Hamstra, J Ali, C R Hutchison, J Murnaghan, G Regehr & R Reznick (University of Toronto, Toronto Western Hospital, Toronto, CANADA)

– 2.17 – Section 2: Monday

1430 3H 5 Weighted OSCE checklists: the practice at the Medical Council of Canada D E Blackmore*, S M Smee, T J Wood & W D Dauphinee (The Medical Council of Canada, Ottawa, CANADA)

1445 3H 6 Self and peer assessment of history taking skills Caroline Boggis*, S Cooke, M Holland & H Richardson (South Manchester University Hospitals’ NHS Trust, Manchester, UK)

1500-1515 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234567890123 123456789012345678901234567890121234567890123456789012345678901212345678901234567890123I Problem Based Learning and Computers 3 123456789012345678901234567890121234567890123456789012345678901212345678901234567890123 Chair: Roger Koment, USA Discussant: To be announced Location: Room 114

1330 3I 1 Successful implementation of Blackboard in PBL-tutorials P Room*, A H J Dierssen & F G M Kroese (FMW RuG, Department for Educational Development and Quality Assurance, Groningen, NETHERLANDS)

1345 3I 2 CAMPUS-Pediatrics: a flexible, interactive, case-oriented, web-based training program for multi-purpose use in pediatric medical education S Huwendiek*, S Koepf, B Hoecker, R Singer, F J Leven, G F Hoffmann & B Toenshoff (University Children’s Hospital Heidelberg, Heidelberg, GERMANY)

1400 3I 3 DIPOL-Edit – a new system supporting the WWW-based delivery of course content at Dresden Medical Faculty Oliver Tiebel*, Katja Liesebach, Annett Mitschick, Michael Balzer, Rene Lange, Matthias Hinz, Ronny Hesse, Gabriele Mueller & Hildbrand Kunath (Institute of Clinical Chemistry & Laboratory Medicine, Medical Faculty Carl Gustav Carus, Dresden, GERMANY)

1415 3I 4 Cases in problem based learning (PBL) presented on intranet Torstein Vik & Andreas Haaland* (Norwegian University of Science & Technology, Department of Community Medicine, Trondheim, NORWAY)

1430 3I 5 “Don’t disturb my circles” – or the use of the computer in problem-based small group learning F Ruderich*, R Faber, C Goggelmann, C Roth, C Nikendei, D Schellberg, R Singer, S Riedel, F J Leven & J Junger (University of Heidelberg, Medizinische Universitatsklinik und Poliklinik, Heidelberg, GERMANY)

1445 3I 6 Problem based learning on the Web – an outreach to Norwegian Medical Students abroad Roar Johnsen*, Toralf Hasvold, Karin Straume, Zoltan Tot & Geir Jacobsen (Norwegian University of Science and Technology (NTNU), Department of Community Medicine, Trondheim, NORWAY)

1500-1515 Discussion

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12345678901234567890123456789012123456789012345678901234 12345678901234567890123456789012123456789012345678901233J The Progress Test 4 12345678901234567890123456789012123456789012345678901234 Chair: Donald Melnick, USA Discussant: Miriam Friedman Ben-David, Isreal Location: Room 106

– 2.18 – Section 2: Monday

1330 3J 1 Progress testing of two different medical curricula at one faculty – an outreach to Norwegian Medical Students abroad preliminary results K Duske*, S Fuhrmann, S Hanfler, J Hoffmann, S Koelbel, D Mueller, Z Nouns, P Wieland, S Zacharias & A Mertens (Charité Berlin, Progress Test Medizin, Berlin, GERMANY)

1345 3J 2 Progress testing with short-answer questions J Rademakers*, Th J ten Cate, P R Bar & J M M van de Ridder (UMC Utrecht, Onderwysinstituut, Utrecht, NETHERLANDS)

1400 3J 3 Does Maastricht-style progress testing work in the UK? The Manchester Experience G K Mahadev*, A C Owen, P A O’Neill & G J Byrne (Manchester University, South Manchester University Hospitals Trust, Manchester, UK)

1415 3J 4 Towards a joint progress test: more quality for less Euros J Cohen-Schotanus*, L W T Schuwirth, D J Tinga, A J N M Thoben & C P M van der Vleuten (Institute for Medical Education (OWI-OK), Department for Development and Quality Assurance, Groningen, NETHERLANDS)

1430 3J 5 Cross-institution comparison of student achievement using a progress test A M M Muijtjens*, J Cohen-Schotanus, A Thoben, M M Verheggen & C P M van der Vleuten (University of Maastricht, Department of Educational Development and Research, Maastricht, NETHERLANDS)

1445-1515 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901 123456789012345678901234567890121234567890123456789012345678901212345678903K Clinical Teaching and the Patient 1 123456789012345678901234567890121234567890123456789012345678901212345678901

123456789012345678901234567890121234567890123456789012345678901212345678901 Chair: Laurence Gardner, USA Discussant: Roger Kneebone, UK Location: Room 206

1330 3K 1 The gynecological patient in a teaching session Mette Haase Moen (Norwegian University of Science and Technology, Faculty of Medicine, Trondheim, NORWAY)

1345 3K 2 Effectiveness of communication and basic clinical skills’ curriculum in internal medicine C Nikendei*, C Roth, A Zeuch, S Schafer, M Benkowitsch, B Auler, D Schellberg, W Herzog & J Junger (University of Heidelberg, Medizinische Universitatsklinik, Heidelberg, GERMANY)

1400 3K 3 Bachelor degree profession and learning in practice – student nurses’ learning and development of competence in psychiatric practice Linda Kragelund (The Danish University of Education and The Psychiatric Hospital of the County of Roskilde, Roskilde, DENMARK)

1415 3K 4 Early student-patient interactions: the views of patients regarding their experiences JE Thistlethwaite* & E A Cockayne (Academic Unit of Primary Care, Leeds, UK)

1430 3K 5 Training in intimate physical examinations: a challenge in Antwerp K Hendrickx*, B De Winter, B Selleslags, L Debaene, F Mast, W Tjalma, P Buytaert & J J Wyndaele (Skillslab, University of Antwerp, Wilrijk, BELGIUM)

1445 3K 6 Enhancing reflection in communication skills training with simulated patients Eeva Pyorala* and Anni Peura (University of Helsinki, Research and Development Unit for Medical Education, Helsinki, FINLAND)

1500-1515 Discussion

– 2.19 – Section 2: Monday

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12345678901234567890123456789012123456789012345678901234 12345678901234567890123456789012123456789012345678901233L Professionalism (1) 4 12345678901234567890123456789012123456789012345678901234 Chair: To be announced Discussant: Stewart Petersen, UK Location: Room 105

1330 3L 1 Experiences of medical students with regard to aspects of ethics, cultural awareness and legal issues (ECL) during clinical rotations Netta Notzer*, Roni Dadao-Harari, Henri Abramowitz & Avraham Rudnick (Sackler Faculty of Medicine, Tel Aviv University, ISRAEL)

1345 3L 2 Laying the foundation for professionalism – case presentations in the first year of study Brigitte Grether (Faculty of Veterinary Medicine, University of Zurich, Zurich, SWITZERLAND)

1400 3L 3 Gross anatomy curriculum as a framework to teach professionalism Wojciech Pawlina*, Thomas R Viggiano & Stephen W Carmichael (Mayo Clinic, Mayo Medical School, Rochester, USA)

1415 3L 4 How to develop professionalism in medical education: the Faculty Development approach Ichiro Yoshida* & Kazuhiko Fujisaki (Office of Medical Education, Kurume University, Kurume, JAPAN)

1430 3L 5 Are our tutors promoting professionalism through their behavior? Pedro Herskovic*, Eduardo Cosoi, Jocelyn Manfredi, Karen Sepulveda Paola Contreras, Esteban Munoz, Roberto Verdugo, Veronica Fuentes & Anabella Aguilera (University of Chile, Medical School, Santiago, CHILE)

1445-1515 Discussion

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123456789012345678901234567890121234567890123456789012345678 123456789012345678901234567890121234567890123456789012345673M The Core Curriculum 8 123456789012345678901234567890121234567890123456789012345678

123456789012345678901234567890121234567890123456789012345678 Chair: Borghild Roald, Norway Discussant: Tim Dornan, UK Location: Room 115

1330 3M 1 Physicians’ and basic scientists’ opinions about the required depth of biomedical knowledge for medical students Franciska Koens*, Eugene J F M Custers & Olle Th J ten Cate (School of Medical Sciences, University of Utrecht, Universitair Medisch Centrum, Utrecht, NETHERLANDS)

1345 3M 2 Incorporation of ability-based pharmacology education in an integrated medical school curriculum K L Franson*, E A Dubois, J M A van Gerven, J H Bolk & A F Cohen (Centre for Human Drug Research, Leiden, NETHERLANDS)

1400 3M 3 Effective communication: an essential component of professionalism Hannah Kedar (The Hebrew University - Hadassah, Faculty of Medicine, Jerusalem, ISRAEL)

1415 3M 4 Health promotion in medical undergraduate curricula: its relevance may depend on definition Ann Wylie (Guy’s, Kings and St Thomas’ School of Medicine, Department of General Practice and Primary Care, London, UK)

– 2.20 – Section 2: Monday

1430 3M 5 Role definition, task analysis and educational needs assessment of general practitioners in I.R. Iran Shirin Niroomanesh, Haboballah Peirovi & Shahram Yazdani* (Educational Development Center, Shaheed Beheshti University of Medical Sciences and Health Services, Tehran, IRAN)

1445-1515 Discussion

1515-1545 Coffee – served in the tents

1545-1715 Session 4 Workshops 1 A selection of workshops and two large groups. Please note that numbers of participants in the workshops (indicated with an asterisk *) are strictly limited and admission is by ticket only. See page 1.9 for information on how to reserve a place.

4.1* ‘A doctor who knows only Medicine doesn’t even know Medicine’. Teaching ethics and attitudes: a global challenge for medical education Madalena Patrício (University of Lisbon, Portugal) Location: Room 208

4.2* Why fix assessment? Phil Race (York, UK) Location: Room 215

4.3* Learning in the new job: how to maximise educational opportunities in shifts and other new patterns of working: an ASME Workshop Frank Smith, Clair du Boulay and Sarah Blacklock (on behalf of the Association for the Study of Medical Education (ASME), UK) Location: Room 114

4.4* Depression in clinical practice: educating medical students and primary care physicians Eliot Sorel (School of Medicine and Health Sciences and School of Public Health and Health Services, George Washington University, USA) Location: Room 101

4.5* Trials, tribulations and triumphs: supervising a dissertation in medical education Lesley Pugsley & Janet MacDonald (University of Wales College of Medicine, UK Location: Room 304

4.6* Peer teaching Athol Kent and Trevor Gibbs (University of Cape Town, South Africa) Location: Room 120

4.7* Usability in Computer-Assisted Learning programmes Brigitte Grether (University of Zurich, Switzerland) Location: Room 117

4.8* Assessing PBL activity Christine Bundy & Lis Cordingley (University of Manchester, UK) Location: Room 206

4.9* Scenarios for PBL on the web – triggers for learning Bjorn Bergdahl, Per Hultman & Elvar Theodorsson (Faculty of Health Sciences, University of Linköping, Sweden) Location: Room 331

– 2.21 – Section 2: Monday

4.10* Creating cases to promote integration into undergraduate medical education Nehad El Sawi (University of Health Sciences, Kansas City, USA) Location: Room 205

4.11* Outcome Based Education: an International Federation of Medical Students’ Associations Workshop Ozgur Onur, Nikola Borojevic and colleagues (IFMSA) Location: Room 106

4.12* Developing a teaching or examination event using Simulated Patients: form and case materials development Graceanne Adamo (Uniformed Services University of the Health Sciences, Bethesda, USA) & Heiderose Ortwein (Charité, Humboldt University, Berlin, Germany) Location: Room 214

4.13* Assessment methods: what works, what doesn’t Geoff Norman (McMaster University, Canada) Location: Room 105

4.14* Scenario-based teaching and learning – an innovative and relevant concept in medical education Roger Kneebone (Imperial College London, UK) & Debra Nestel (Centre for Medical and Health Sciences Education, Monash University, Australia) Location: Room 115

4.15* Verbal reflection-on-action as a tool in consultation training Anders Bärheim and actress Torild Jacobsen Alraek (Institute for Public Health and Primary Health Care, University of Bergen, Norway) Location: Room 204

4.16 Central and East European/Eurasian Task Force – local issues Ioan Bocsan, Romania (on behalf of AMEE) & Stewart Mennin (University of New Mexico, USA) Location: Room 220

4.17 Professionalism – Large Group Moderator: John Bligh, (Peninsula Medical School, UK) Presenters: Hank Slotnick and Marianna Shershneva (University of Wisconsin, USA) and Sean Hilton (St George’s Hospital Medical School, UK) Location: Room 110

4.18 Using a collaborative work space in a rich media educational environment – Large Group Sharon Krackov (New York University, USA) Location: Room 201

Evening Optional evening entertainment Performance of Schiller’s William Tell in the open air theatre at Interlaken, preceded by dinner at Gwatt on Lake Thun. Coaches depart at 1800 hrs and will return to Bern Railway Station at approximately 2330 hrs. Please see the University of Bern Conference website for further information on this very attractive excursion (http://amee03.unibe.ch/social_programm.htm) Tickets still available from AMEE Office. Theatre option without dinner also available (see page 3.1).

– 2.22 – Section 2: Tuesday

Tuesday 2 September

0800-1800 Registration University of Bern

0830-1000 Session 5 Eight simultaneous sessions Five Large Group Sessions and three Short Communications

Large Group Sessions

5A Standard Setting Chair: Ronald Nungester (National Board of Medical Examiners, USA) Panel: André de Champlain (National Board of Medical Examiners, USA), Miriam Friedman Ben-David (Israel), Arno Muijtjens (Maastricht University, Netherlands), John Norcini (FAIMER, USA) Location: Room 210

5B A cognitive perspective on learning: implications for teaching Geoff Norman (McMaster University, Canada) Location: Room 110

5C A BEME Review of High-fidelity Simulation in Medical Education Barry Issenberg (University of Miami Centre for Medical Education, USA), Bill McGaghie (Northwestern University, Feinberg School of Medicine, Chicago, USA) Location: Room 201

5D Making medical education relevant to medical practice: medical schools in the continuum of lifelong learning Chair: Hans Karle (World Federation for Medical Education, Denmark) Panel: Lew Miller (Alliance for Continuing Medical Education, USA), Dennis Wentz (American Medical Association, USA) Location: Room 220

5E Complex Adaptive Systems and medical education: a new look at how we do what we do Stewart Mennin (University of New Mexico, Albuquerque, USA) Location: Room 205

Three Short Communications Sessions

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1234567890123456789012345678901212345678901234567890123456789012125F Postgraduate Assessment 3

1234567890123456789012345678901212345678901234567890123456789012123 Chair: Amindra Arora, USA Discussant: David Blackmore, USA Location: Room 101

0830 5F 1 Assessment of specialist registrars in obstetrics and gynaecology in the Netherlands F Scheele*, M Schutte, B Wolf, J Th M van der Schoot and “Commissie Onderwijs NVOG” (St Lucas Andreas Hospital, Department of Mother and Child Care, Amsterdam, NETHERLANDS)

– 2.23 – Section 2: Tuesday

0845 5F 2 Improving the RITA process Robert Palmer*, Zoe Nuttall & David Wall (West Midlands Deanery, Birmingham, UK)

0900 5F 3 Educational impact of in-training assessment (ITA) in postgraduate education C Ringsted*, A H Henriksen, A M Skaarup & C van der Vleuten (Copenhagen Hospital Corporation Postgraduate Medical Institute, Bispebjerg Hospital, Copenhagen, DENMARK)

0915 5F 4 Validity of the Royal College of Ophthalmologists part III Clinical Examination P A Johnstone (Ninewells Hospital and Medical School, Postgraduate Department, Dundee, UK)

0930 5F 5 Measurement of knowledge, attitudes and practice of medical interns about common ambulatory pediatric diseases in teaching hospitals of Shiraz University of Medical Sciences Mitra Amini*, Ali Sadeghi Hassanabadi & Abdolah Karimi (Jahrom Medical School, Jahrom, IRAN)

0945-1000 Discussion

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12345678901234567890123456789012123456789012345678901234567890121234567 12345678901234567890123456789012123456789012345678901234567890121234565G Community Based Education 7 12345678901234567890123456789012123456789012345678901234567890121234567 Chair: Jacques des Marchais, Canada Discussant: To be announced Location: Room 120

0830 5G 1 Partnership teaching in community medical education: a study to investigate the advantages and disadvantages of partnership teaching as perceived by tutors Jo Brown*, Annie Cushing & Dason Evans (Barts and the London, Queen Mary’s School of Medicine and Dentistry, Clinical Communication and Learning Skills Unit, London, UK)

0845 5G 2 Negative views of general practice: where do they come from and where to do they go? Jan Illing*, Tim van Zwanenberg, Bill Cunningham, Richard Prescott, George Taylor & Cath O’Halloran (University of Newcastle, Postgraduate Institute for Medicine & Dentistry, Newcastle upon Tyne, UK)

0900 5G 3 Participatory community-based health education: identification of barriers to family planning Regina Petroni-Mennin*, Celia Iriart, Saverio Sava, Rebecca Radcliff, Rachel Evans, Leah Steimel & Dan Derksen (University of New Mexico School of Medicine, Center for Community Partnerships, Albuquerque, USA)

0915 5G 4 Using student confidence questionnaires to validate placement recruitment procedures R J W Phillips (Department of General Practice and Primary Care, GKT School of Medicine, London, UK)

0930 5G 5 Bringing the “Real World” of the patient into the medical curriculum Jean Quinn* & Lyn Brown (University of Liverpool, Department of Primary Care, Liverpool, UK)

0945-1000 Discussion

– 2.24 – Section 2: Tuesday

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1234567890123456789012345678901212345678901234567890123456 1234567890123456789012345678901212345678901234567890123455H Students’ Learning 6 1234567890123456789012345678901212345678901234567890123456 Chair: Anne Garden, UK Discussant: Ozgur Onur, Germany Location: Room 215

0830 5H 1 How do students with different learning styles perform in formative and summative exams in the first year of a new curriculum? H G Kraft* & M Heidegger (University of Innsbruck, Institute for Med. Biology, Innsbruck, AUSTRIA)

0845 5H 2 Locus of control and companion measures in a longitudinal study of medical students in a southwestern US Medical School Thomas Stewart*, Ann Frye, Stephanie D Litwins & Christine A Stroup-Benham (School of Medicine, University of Texas Medical Branch, Galveston, USA)

0900 5H 3 Impact of continuous clinical on-duty hours in medical students’ academic performance: a comparative study Enrique Saldivar* & Antonio Davial (ITESM, Monterrey, MEXICO)

0915 5H 4 The educational programmes developed and offered by medical students Radim Licenik*, Lenka Doubravska, Vit Gloger, Jarmila Indrakova, Daniela Jelenova, Petr Jindra, Barbora Krajzlova, Pavel Kurfürst, Marie Pecuchova, Jarmila Potomkova, Jan Strojil, Renata Simkova & Cestmir Cihalik (Palacky University Faculty of Medicine, Olomouc, CZECH REPUBLIC)

0930 5H 5 Celebrated movie viewing and semi-structured interactive discussions In neuroscience block highly contribute to reinforcement of instruction GO Peker*, S Amado, S Sorias, O Akyurekli, SA Caliskan, U Seyfioglu, C Terek, EO Koylu & Ege Medical Students Movie Club (Ege University, Faculty of Medicine, Izmir, TURKEY)

0945-1000 Discussion

1000-1030 Coffee

1030-1215 Session 6 Workshops 2: A selection of workshops and large group sessions Please note that numbers of participants in the workshops indicated with an asterisk (*) are strictly limited and admission is by ticket only. See page 1.9 for information on how to reserve a place.

6.1* The nature of curriculum change: complicated and complex Stewart Mennin (University of New Mexico, Albuquerque, USA) Location: Room 105 Note: this workshop is linked to large group session 5E above.

6.2* Enhancing student learning in your lectures Sally Brown (Institute for Learning and Teaching in Higher Education, UK) Location: Room 115

6.3* A new approach to curriculum mapping Nick Ross (University of Birmingham Medical School, UK) Location: Room 212

6.4* How to build a Comprehensive Integrative Puzzle as a method of assessment Rosalie Ber (B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Israel) Location: Room 205

– 2.25 – Section 2: Tuesday

6.5* Assessment in PBL medical schools: what are we measuring? Ara Tekian (University of Illinois at Chicago, USA) & Mathieu Nendaz (University of Geneva, Switzerland) Location: Room 208

6.6* Creating, implementing and evaluating the personal and professional development curriculum Iain Robbé and Kate Drysdale (University of Wales College of Medicine, UK) & Debra Nestel (Centre for Medical and Health Sciences Education, Monash University, Australia) Location: Room 331

6.7* Bridging the gap between curriculum development and delivery Celia Popovic and Bev Merricks (University of Birmingham Medical School, UK) Location: Room 206

6.8* Reach out and “teach” someone: instructional methods in the classroom Steve Johnson (Carolinas Healthcare System, Charlotte, USA) Location: Room 215

6.9* Medical education – trainer or trainee’s responsibility? Directors of Postgraduate Medical Education Group, led by Alistair Thomson (South Cheshire Postgraduate Medical Centre, UK) Location: Room 120

6.10* Looking towards the future: what’s in store for medical education? Elizabeth Kachur (Medical Education Development, New York, USA) Location: Room 304

6.11* Didactics for beginners Brigitte Grether (Faculty of Veterinary Medicine, University of Zurich, Switzerland), E Brenner (Faculty of Medicine, University of Innsbruck, Austria), German Clénin (Sportwissenschaftliches Institut SWI, Magglingen, Switzerland) & Martina Kadmon (Department of General Surgery, Heidelberg University, Germany) Location: Room 204

6.12* Enriching curriculum through Standardized Patient-based programs Anja Robb, Nancy McNaughton & Diana Tabak (University of Toronto, Centre for Research in Education, Toronto, Canada) Location: Room 114

6.13* Mastering the scholarly process William McGaghie (Northwestern University, Feinberg School of Medicine, Chicago, USA) Location: Room 214

6.14 Ibero-American Group: local needs and institutional accreditation (large group) Margarita Barón-Maldonado, Spain (on behalf of AMEE) Location: Room 220

6.15 IVIMEDS: The International Virtual Medical School (large group) Ronald Harden (Dundee, UK) Location: Room 201

– 2.26 – Section 2: Tuesday

6.16 Standards in Medical Education (large group) Chair: Hans Karle (World Federation for Medical Education, Denmark) Presenters: Hans Karle (WFME, Denmark), Jorgen Nystrup (Roskilde, Denmark), Lief Christensen (WFME, Denmark), Hossam Hamdy (Arabian Gulf University, Bahrain) & Ramaz Khetsuriani (Tbilisi State Medical University, Georgia) Location: Room 110

1215-1315 Lunch Buffet served in tents Note: name badges must be worn to gain admission

1215-1315 AMEE Members’ lunch and Annual General Meeting Lunch will be provided in the room – members only please. Location: Room 101

1315-1445 Session 7 Short Communications (3): Simultaneous themed sessions

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1234567890123456789012345678901212345678901234567890123456789012123 1234567890123456789012345678901212345678901234567890123456789012127A Computer Based Teaching 3 1234567890123456789012345678901212345678901234567890123456789012123

1234567890123456789012345678901212345678901234567890123456789012123 Chair: Martin Fischer, Gemany Discussant: To be announced Location: Room 210

1315 7A 1 Attitude of medical students towards computer-based learning – effects of a randomized, controlled exposure A K Hahne*, R Benndorf, P Frey & S Herzig (University of Cologne, Department of Pharmacology, Koeln, GERMANY)

1330 7A 2 Teaching glomerulonephritis using the multimedia online system LaMedica S Stracke*, R Friedel, C Aymanns, N Kadlec, B Lindemann, S Huettner & F Keller (University of Ulm, Nephrology, Ulm, GERMANY)

1345 7A 3 Application of an Icon Language for clinical pharmacology education throughout an integrated curriculum E A Dubois*, K L Franson, J M A van Gerven, J H Bolk & A F Cohen (LUMC, Onderwijscentrum IG, Leiden, NETHERLANDS)

1400 7A4 Making the virtual real: the true challenge of digital learning Michael Begg* & Rachel Ellaway (University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, UK)

1415 7A 5 Comparing lecture and e-learning as pedagogies for new and experienced professionals in dentistry Liz Browne* Shalin Mehra, Raj Rattan & Gary Thomas (Westminster Institute of Education, Oxford Brookes University, Oxford, UK)

1430-1445 Discussion

– 2.27 – Section 2: Tuesday

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123456789012345678901234567890121234567890123456789012 123456789012345678901234567890121234567890123456789017B The Final Exam 2 123456789012345678901234567890121234567890123456789012 Chair: Hossan Hamdy, Bahrain Discussant: To be announced Location: Room 110

1315 7B 1 CLEO component of the Medical Council of Canada qualifying examination Part 1: a four-year appraisal of its incorporation Jacques Etienne Des Marchais*, T J Wood, D E Blackmore & W D Dauphinée (Medical Council of Canada, Montreal, CANADA)

1330 7B 2 Ideas for assessing educational objectives from different domains within the anatomical dissection course Erich Brenner*, Bernhard Moriggl, Axel Pomaroli & Herbert Maurer (Institute for Anatomy, Histology and Embryology, University of Innsbruck, Innsbruck, AUSTRIA)

1345 7B 3 A comparative study of measures to evaluate medical students’ performances Samkaew Wanvarie* & Boonmee Sathapatayawongse (Ramathibodi Hospital, Faculty of Medicine, Bangkok, THAILAND)

1400 7B 4 Manifestation of professional competence: is it context-dependent or skill- dependent? M Mrouga* & Iryna Bulakh (Testing Board, Kyiv, UKRAINE)

1415 7B 5 The first experience of conducting the Joint Clinical Graduation Examination (JCGE) in a medical higher educational institution of Ukraine G V Dzyak, T A Pertseva* & G V Gorbunova (Dnipropetrovsk State Medical Academy, Dnipropetrovsk, UKRAINE)

1430 7B 6 The design and implementation of the professional exam at the Dn. Santiago Ramony Cajal Medical School, Universidad Westhill Julio Cesar Gomez*, Pilar Talayero & Todd W Ellwein (Universidad Westhill, Mexico City, MEXICO)

Note: there is no time for discussion in this session

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123456789012345678901234567890121234567890123456789012347C The Curriculum (1) 5

123456789012345678901234567890121234567890123456789012345 Chair: David Wiegman, USA Discussant: Olle ten Cate, Netherlands Location: Room 201

1315 7C 1 Curricular Quality Assurance (CQA): twenty-five years of curricular evolution S Scott Obenshain*, Stewart Mennin & Arthur Kaufman (University of New Mexico, School of Medicine, Albuquerque, USA)

1330 7C 2 What can interns teach their junior year teachers? Soledad Campos, Cecilia Primogerio & Angel M Centeno* (School of Biomedical Sciences, Universidad Austral-Medicina, Buenos Aires, ARGENTINA)

1345 7C 3 Evaluation and quality development of clinical clerkships Jorgen Hedemark Poulsen (University of Copenhagen, Copenhagen, DENMARK)

1400 7C 4 Focus group approach to evaluation – a useful addition to the written format C Schirlo*, F Wirth, W Vetter and W Gerke (University of Zurich, Office for Educational and Student Affairs, Zurich, SWITZERLAND)

– 2.28 – Section 2: Tuesday

1415 7C 5 Changing trends in undergraduate medical education in Turkey Iskender Sayek* & Bülent Kýlýç (Hacettepe University, Faculty of Medicine, Ankara, TURKEY)

1430-1445 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789012345678907D Postgraduate Training in the Early Years 1

1234567890123456789012345678901212345678901234567890123456789012123456789012345678901 Chair: Anna Bukovinszky, Hungary Discussant: To be announced Location: Room 220

1315 7D 1 An evaluation ‘of practice, in practice’ of the GPPS curriculum for SHOs (UK) S J Brigley* & M J Golby (School of Postgraduate Medical & Dental Education, University of Wales College of Medicine, Cardiff, UK)

1330 7D 2 Learning to work with patients: innovative programme design promotes the rapid acquisition of mature clinical skills with minimal requirement for staff resources Richard Hift* & Rae Nash (University of Cape Town, Faculty of Health Sciences, Cape Town, SOUTH AFRICA)

1345 7D 3 The relevance of nurse involvement in the proposed Foundation Programme for new medical graduates (PRHOs) in the UK Jo Vallis*, E Anne Hesketh, Mica Allen & Stuart Macpherson (NHS Education for Scotland, Edinburgh, UK)

1400 7D 4 Supporting poorly performing trainees in their first postgraduate year through ward simulation F Anderson*, D Snadden, E A Hesketh, J Ker & J Foulis (NHS Education for Scotland, Dundee, UK)

1415 7D 5 Obtaining the informed consent of patients: a study into the educational and training needs of doctors Lois Parker & Steve Field* (West Midlands Deanery and CRMDE, Birmingham, UK)

1430-1445 Discussion

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12345678901234567890123456789012123456789012345678901234567890121234567890123456787E Continuing Professional Development 9

12345678901234567890123456789012123456789012345678901234567890121234567890123456789 Chair: Frank Smith, UK Discussant: Dennis Wentz, USA Location: Room 205

1315 7E 1 Bringing pharmaceutical representatives into the educational loop Craig Campbell, Jean Claude Dairon, Paul Davis, Francois Goulet, Gilles Lachance, Celine Monette, Joan Sargeant, Robert Thivierge & Jane Tipping* (Markham, Ontario, CANADA)

1330 7E 2 Implementation of a new education and training of medical management for consultants Eva Zeuthen Bentzen, Annette Plesner Steenstrup & Helle Nielsen* (Danish Medical Association, Copenhagen, DENMARK)

1345 7E 3 Meeting the needs in continuing education of paediatricians in Oltenia Region, Romania C Gheonea*, A Cupsa, D Bulucea & S Dinescu (Postgraduate Department, Centre for Medical Education, Craiova, ROMANIA)

– 2.29 – Section 2: Tuesday

1400 7E 4 Impact of a new accreditation system on specialists’ learning habits Linda Snell* & Rejean Laprise (Aventis Pharma, Department of Professional Education, Laval, CANADA)

1415-1445 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678907F Assessing the Practising Doctor 1

123456789012345678901234567890121234567890123456789012345678901212345678901 Chair: James Hallock, USA Discussant: John Pitts, UK Location: Room 304

1315 7F 1 Sheffield Peer Review Assessment Tool (SPRAT) for Consultants: screening for poorly performing doctors J C Archer* & H A Davies (University of Sheffield, Postgraduate Medical Education Centre, Sheffield, UK)

1330 7F 2 Blueprinting case based discussions for the assessment of poorly performing doctors in the UK General Medical Council’s performance procedures L Southgate*, Pauline McAvoy & Jim Cox (Academic Centre for Medical Education, London, UK)

1345 7F 3 Piloting the link between revalidation and appraisal for the UK GMC Pauline McAvoy*, Lesley Southgate, Jim Crossley & Brian Jolly, Malcolm Campbell and Alan McKay (University of Newcastle, Northern Postgraduate Deanery, Newcastle upon Tyne, UK)

1400 7F 4 Remedial training for doctors identified as “poorly performing” in communication skills – an update on the Birmingham experience Jo Piercy*, John Skelton & David Wall (Department of Primary Care and General Practice, University of Birmingham, Birmingham, UK)

1415-1445 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234567890123457G Different Approaches to Staff Development 6

123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456 Chair: To be announced Discussant: Juerg Steiger, Switzerland Location: Room 120

1315 7G 1 Professionalising teaching: Scottish Clinical Teaching Fellowships J Syme-Grant* & P A Johnstone (NHS Education for Scotland, Dundee, UK)

1330 7G 2 The development of medical teachers: interviews with ten experienced medical teachers Jane MacDougall* & Mary Jane Drummond (Addenbrooke’s Hospital, Department of Obstetrics and Gynaecology, Cambridge, UK)

1345 7G 3 Webcast audio seminars as a technique for international faculty development Roger W Koment*, Peter G Anderson & Julie K Hewett (International Association of Medical Science Educators (IAMSE), Springfield, USA)

– 2.30 – Section 2: Tuesday

1400 7G 4 Hunting for medical education references – search strategies compared E K Kachur*, M Schwartz, C Gillespie, M Yedidia, P Kinnersley, A Kalet, R Janicik, L Altshuler, K Mukohara & T Comerci (The ROCAT Topic Review Group) (Medical Education Development, New York, USA)

1415 7G 5 Anaesthetists as teachers Michael Clapham* & Alison Bullock (West Midlands Deanery, Postgraduate Medical and Dental Education, Birmingham, UK)

1430-1445 Discussion

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123456789012345678901234567890121234567890123456789012 123456789012345678901234567890121234567890123456789017H Student Diversity 2 123456789012345678901234567890121234567890123456789012

123456789012345678901234567890121234567890123456789012 Chair: Danai Wangsaturaka, Thailand Discussant: Ara Tekian, USA Location: Room 215

1315 7H 1 Valuing diversity: working class students and doctors Barry Ewart* & Jill Thistlethwaite (University of Leeds, Medical Education Unit, Leeds, UK)

1330 7H 2 An educational strategy to develop disadvantaged students into health professionals Elmi Badenhorst*, Rachel Alexander & Trevor Gibbs (Department of Public Health and Primary Health Care, Cape Town, SOUTH AFRICA)

1345 7H 3 What students think are the reasons for their academic failure in our physiology course Nancy Fernandez-Garza (Facultad de Medicina, Universidad Autónoma de Nuevo Leon, Monterrey, MEXICO)

1400 7H 4 Are there personality differences between students who drop out of medical school and those who remain? Gillian B Clack*, Derek Cooper & Susan Standring (King’s College London, London, UK)

1415 7H 5 Does the choice of elective clerkship predict specialty training? Willemina M Molenaar*, Jan Jaap Reinders, Janke Cohen-Schotanus (Institute of Medical Education, University of Groningen, Groningen, NETHERLANDS)

1430-1445 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234567890 123456789012345678901234567890121234567890123456789012345678901212345678901234567897I Evaluation of Problem Based Learning 0 123456789012345678901234567890121234567890123456789012345678901212345678901234567890

123456789012345678901234567890121234567890123456789012345678901212345678901234567890 Chair: Ibraham Alayed, Saudi Arabia Discussant: Bjorn Bergdahl, Sweden Location: Room 114

1315 7I 1 Pre-Registration House Officers (PRHOs) assess their undergraduate education Simon Watmough*, Anne Garden & David Graham (University of Liverpool, Department of Primary Care, Liverpool, UK)

1330 7I 2 Comparison of three instructional methods of teaching for medical students Eiad Al-Faris (Department of Family and Community Medicine, King Saud University, Riyadh, SAUDI ARABIA)

– 2.31 – Section 2: Tuesday

1345 7I 3 Does PBL work? Does Music? Side 2: scenario design Brian Bailey (Napier University, School of Community Health, Edinburgh, UK)

1400 7I 4 Evaluation of a PBL curriculum in comparison to a parallel conventional course at the Medical Faculty of the University of Hamburg, Germany Ralf Wieking, Christian E Guksch, Olaf Kuhnigk & Monika Bullinger* (University of Hamburg, Modellstudiengang Medizin, Hamburg, GERMANY)

1415-1445 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678907J Management of Clinical Training 1

123456789012345678901234567890121234567890123456789012345678901212345678901 Chair: Larry Grupen, USA Discussant: Stephen Aaron, Canada Location: Room 106

1315 7J 1 The county hospital – what can it offer medical students and what does it get in return? Berit Eika (University of Aarhus, Unit of Medical Education, Aarhus, DENMARK)

1330 7J 2 An academy model for medical education – the student perspective Julia Sanday, David Mumford & Clive Roberts* (Bristol University Medical School, Centre for Medical Education, Bristol, UK)

1345 7J 3 Changing perceptions in medical education: the emergence of rural clinical schools as levers for change Judi Walker (University of Tasmania, University Department of Rural Health, Tasmania, AUSTRALIA)

1400 7J 4 Evaluation of a web-based project to improve the quality of clinical attachments in North Devon Richard Ayres (North Devon District Hospital, Medical Education Centre, Barnstaple, UK)

1415 7J 5 Development of information system to monitor the long-term achievement of the collaborative project to increase production of rural doctors Suwat Lertsukprasert & Waraporn Eoaskoon* (Office of the Collaborative Project to Increase Production of Rural Doctors, Nonthaburi, THAILAND)

1430-1445 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345678901234567K Clinical Training in Different Settings 7

123456789012345678901234567890121234567890123456789012345678901212345678901234567 Chair: Jack Boulet, USA Discussant: Paul Bradley, UK Location: Room 206

1315 7K 1 Modelling clinical competence in a medical internship: the impact of variation in actual clinical experiences P F Wimmers*, T A W Splinter & H G Schmidt (University Medical Centre Rotterdam, Erasmus MC, Rotterdam, NETHERLANDS)

1330 7K 2 Innovations in the clerkship of internal medicine JCG Jacobs*, S Bolhuis, JA Bulte & RSG Holdrinet (University Medical Centre Nijmegen, Department of Medical Education, Nijmegen, NETHERLANDS)

– 2.32 – Section 2: Tuesday

1345 7K 3 Inter-site consistency as a measurement of programmatic evaluation in a medicine clerkship with multiple, geographically separated sites Steven J Durning*, Louis N Pangaro, Gerald D Denton, Paul A Hemmer, Alan Wimmer, Thomas Garu, Margaret Gaglione & Lisa Moores (Uniformed Services University, Dept of Medicine, Bethesda, USA)

1400 7K 4 A student-organized introduction to the clinical rotation of medical education, Karolinska Institutet, Stockholm H Brauner*, P Grenholm, I M Petermann, M Nystrom & J Bjorklund (Medical Students Association, Stockholm, SWEDEN)

1415 7K 5 Acquiring clinical competence during clerkships Gitte Wichmann-Hansen* & Berit Eika (Aarhus University, Unit of Medical Education, Aarhus, DENMARK)

1430-1445 Discussion

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123456789012345678901234567890121234567890123456789012345 123456789012345678901234567890121234567890123456789012347L Professionalism (2) 5 123456789012345678901234567890121234567890123456789012345 Chair: Marianna Shershneva, USA Discussant: Hank Slotnick, USA Location: Room 105

1315 7L 1 Advancing professionalism in medical education: a view from the margins Viv Cook* & Sandra Nicholson (Department of General Practice and Primary Care, Barts and The London, London, UK)

1330 7L2 What is professionalism? A pilot study of Danish Internal Medicine SHOs’ views D J Davis, A M Skaarup* & C Ringsted (Copenhagen Hospital Corporation Postgraduate Medical Institute, Copenhagen, DENMARK)

1345 7L 3 Student perceptions of the strengths and possible improvements of a personal and professional development (PPD) curriculum Kate Drysdale* & Iain Robbe (University of Wales College of Medicine, Cardiff, UK)

1400 7L 4 Towards assessment of professional behaviour in vocational GP trainees: the development of the Professional Behaviour in General Practice instrument K van de Camp*, M Vernooij-Dassen, R Grol & B Bottema (UMC St Radboud, University Medical Centre Nijmegen, NETHERLANDS)

1415 7L 5 A systematic approach to assessing professionalism Patricia M Surdyk* and Susan R Swing (Accreditation Council for Graduate Medical Education, Chicago, USA)

1430-1445 Discussion

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123456789012345678901234567890121234567890123456789012345678901217M Outcome-based Education 2

123456789012345678901234567890121234567890123456789012345678901212 Chair: To be announced Discussant: John Simpson, UK Location: Room 115

1315 7M 1 The Tecnológico de Monterrey School of Medicine’s competence-based curriculum with emphasis in professionalism: design and implementation of longitudinal and integrative development of professionalism competencies Claudia Hernández Escobar, Leticia Elizondo Montemayor*, Graciela Medina Aguilar, Antonio Dávila Rivas & Angel Cid García (Tecnologico de Monterrey School of Medicine, Nuevo Leon, MEXICO)

– 2.33 – Section 2: Tuesday

1330 7M 2 The Competence-based Curriculum Concept of Cologne (4C) – a curriculum mapping procedure to integrate discipline, problem, and outcome-based learning S Herzig*, C Stosch, S Kruse, M Eikermann & R Mosges (University of Koeln, Department of Pharmacology, Koeln, GERMANY)

1345 7M 3 Required levels of competence in clinical skills at different stages of the undergraduate medical curriculum I Treadwell*, J D Makin, J Blitz-Lindeque & P T Kenny (University of Pretoria, Skills Laboratory, Pretoria, SOUTH AFRICA)

1400 7M 4 Development of a National Framework of Needs-based Competency Standards: The CanMEDS project Jason R Frank*, Nadia Mikhael & Gary Cole (Royal College of Physicians and Surgeons of Canada, Ottawa, CANADA)

1415 7M 5 Designing the undergraduate medical curriculum to reflect postgraduate competencies and societal needs P Niall Byrne, Ian L Johnson, Anita Rachlis, Jay Rosenfield*, Xerxes Punthakee, Katherine MacRury & Barbara McRobb (University of Toronto, Toronto, CANADA)

1430-1445 Discussion

1445-1510 Coffee

1510-1640 Session 8 Posters: Simultaneous themed sessions Presenters and participants should assemble by the poster boards of the relevant session (see summary on page 1.15)

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12345678901234567890123456789012123456789012345678901234567 12345678901234567890123456789012123456789012345678901234568A Assessment General 7 12345678901234567890123456789012123456789012345678901234567 Chair: Ernest Skakun, Canada Location of Boards: Dome/Kuppelsaal, 5th Floor

8A 1 Quality assurance in developing multiple choice questions Andreas Stein*, Waltraud Georg, Kira Flemming and Katharina Crolow (Humboldt Universitat, Reformstudiengang Medizin, Berlin, GERMANY)

8A 2 The first partial test note as an assessment tool of performance in first year medical students Carlos E de la Garza-Gonzalez*, Maria Esthela Morales Perez & Norberto Lopez Serna (Facultad de Medicina, Universidad Autónoma de Nuevo Leon, Monterrey, MEXICO)

8A 3 Knowledge acquisition and forgetfulness in health sciences students Maria Escriva, David Cid, Eva Bailles, Mireia Valero & Jorge Perez* (Facultat de Ciencias de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, SPAIN)

8A 4 Assessing medical students’ communication skills by using drama students as simulated patients Jorgen Urnes*, Hilde Grimstad & Bjorn Rasmussen (NTNU, Faculty of Medicine, Trondheim, NORWAY)

8A 5 What contributes to the variance in NBME subject exam scores and recommended grades from teachers? A 10-year clerkship analysis Steven J Durning*, Louis N Pangaro, Paul A Hemmer and Gerald D Denton (Uniformed Services University, Dept of Medicine, Bethesda, USA)

– 2.34 – Section 2: Tuesday

8A 6 Are medical students’ examination results affected by their gender and ethnicity? S Kilminster*, K Boursicot, V Wass & T E Roberts (Medical Education Unit, University of Leeds, Leeds, UK)

8A 7 Gender differences as observation in the assessment of performance Regina Conradt* & Ed Peile (University of Oxford, Department of Primary Health Care, Oxford, UK)

8A 8 Matching criterion-based student self-assessment with teacher assessment: is there coherence? Araceli Hambleton-Fuentes*, David Cantu & Leticia Elizondo-Montemayor (School of Medicine, Tecnologico de Monterrey, Nuevo Leon, MEXICO)

8A 9 Developing an in-training examination for gastroenterology fellows Amindra S Arora (Mayo Clinic, Department of GIH, Rochester, USA)

8A 10 Clerkship preceptor handbook of core students skills Paul Hemmer (USUHS Educational Programs Division) (Uniformed Services University, Bethesda, USA)

8A 11 Assessment of postgraduate medical courses: the question of how to improve their quality Beatriz Graciela Borenstein (on behalf of Pedagogical Dept) (Sociedad Argentina de Terapia Intensiva (SATI), Buenos Aires, ARGENTINA)

8A 12 Empathy as a function of gender and levels of undergraduate and graduate medical education in Mexico Adelina Alcorta G-Gonzalez*, Mohammadreza Hojat, Juan-F González-G, Jesús Ancer-R, María-V Bermúdez, Juan Montes-V, Marco-V Gómez-M, A-Enrique Alcorta-G, Silvia Tavitas-H & Sheila-M Garza (University Hospital, Mexico City, MEXICO)

8A 13 Assessment of basic practical skills in an undergraduate medical curriculum S Elango*, J C Ramesh, T Motilal, L C Loh, P Kandasami & C L Teng (International Medical University, Seremban, MALAYSIA)

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123456789012345678901234567890121234567890123456789012345678 123456789012345678901234567890121234567890123456789012345678B Clinical Assessment 8 123456789012345678901234567890121234567890123456789012345678 Chair: Brian Hodges, Canada Location of Boards: Dome/Kuppelsaal, 5th Floor

8B 1 A new approach to a clinical final examination C Carvajal*, M Bustamante, R Dalmazzo, J Olivos & J Vukasovic (Universidad de Chile, Facultad de Medicina, Santiago, CHILE)

8B 2 The relationship of examination candidate performances between the Medical Council of Canada’s (MCC) computer-based examination and the MCC clinical skills examination D E Blackmore*, T J Wood, W D Dauphinee, S M Smee & A P Boulais (The Medical Council of Canada, Ottawa, CANADA)

8B 3 The role of the observed long case in postgraduate medical training Nicholas Pavlakis and Rodger Laurent* (Department of Rheumatology, Royal North Shore Hospital, Sydney, AUSTRALIA)

8B 4 Medical students perceive the OSCE as a fair re-sit assessment tool Jonathan Syme-Grant* & P A Johnstone (NHS Education for Scotland, Dundee, UK)

– 2.35 – Section 2: Tuesday

8B 5 Easy as ‘pie’ – improving OSCE instructions Cynthia Yiu, Martin Mueller* & Michael Marsh (Guy’s, King’s and St Thomas’ Medical School, London, UK)

8B 6 Re-using an OSCE station and its re-take Leila Niemi-Murola, Pirkko Heasman*, Markku Kaipainen, Timo Kuusi & Kirsti Lonka (Research and Development Center for Medical Education, Helsinki University, Helsinki, FINLAND)

8B 7 Assessing nurses’ clinical skills with OSCE A Molins*, M Sola, A M Pulpon, S Juncosa and J M Martinez-Carretero (Institute of Health Studies, Barcelona, SPAIN)

8B 8 Introduction of objective structure clinical examination (OSCE) at TashPMI and subsequent evaluation Dilbar A Mavlyanova* and Muazam A Ismailova (Tashkent Pediatric Medical Institute, Tashkent, UZBEKISTAN)

8B 9 Analysis of questionnaire survey of raters, students and standardised patients on the 12-station OSCE used at the Kurume University School of Medicine Takato Ueno*, Ichiro Yoshida, Hiroki Inutsuka & Michio Sata (Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, JAPAN)

8B 10 Clinical skills assessment at medical schools – Catalonia (Spain), 2002 E Kronfly, L Gracia, X Julia, J Majo, J Prat, A Castro, J A Bosch, A Urrutia, J L Gimeno, C Blay & R Pujol* (Institute of Health Studies, Barcelona, SPAIN)

8B 11 The relationship between performance on a third-year medical student OSCE and performance on the USMLE step 1 examination Kelly Kirby Ortega*, Neena Natt, Robert Tiegs & Jay Mandrekar (Mayo Graduate School of Medicine, Mayo Clinic, Rochester, USA)

8B 12 Professional exam: an integral clinical exam with real patients Maria Eugenia Ponce de Leon*, Armando Ortiz Montalvo and Maria del Carmen Ruiz (National Autonomous University of Mexico Medical School, Camino Santa Teresa, MEXICO)

8B 13 Rater disagreement in OSCE J M M van de Ridder*, V Batenbrug, J Buis, V Eijzenbach, F J M Grosfeld & M M Kuyvenhoven (University Medical Centre Utrecht, Utrecht, NETHERLANDS)

8B 14 Practical assessments used in preparing students for their clinical year G Till* & H Till (Canadian Memorial Chiropractic College, Toronto, CANADA)

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901238C The Curriculum (1), including Multiprofessional Education 4

12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234 Chair: Nick Ross, UK Location of Boards: Dome/Kuppelsaal, 5th Floor

8C 1 Oncology – an interdisciplinary course C Haag*, H Alheit, M Baumann, O Hakenberg, U Wehrmann, M Wirth & G Ehninger (Medical Faculty, Dresden University of Technology, Dresden, GERMANY)

8C 2 Palliative care in the medical curriculum at Bern, Switzerland: when and how S Eychmueller (Kantonsspital St. Gallen, Palliativstation, St Gallen, SWITZERLAND)

– 2.36 – Section 2: Tuesday

8C 3 Survey of clinical epidemiology teaching program need in the Thai medical curriculum Pairoj Boonluksiri (Hatyai Hospital, Songkhla, THAILAND)

8C 4 From classic to modern: developing a new teaching strategy in epidemiology Irina Brumboiu*, Ioan S Bocsan, Amanda Radulescu and Ofelia Suteu (Iuliu Hatieganu University of Medicine and Pharmacy, Epidemiology Department, Cluj-Napoca, ROMANIA)

8C 5 Community based education: strategies for effective student commitment R G Souza, F Menezes*, L M Camarotti & J Araujo (Federal University of Roraima, Roraima, BRAZIL)

8C 6 Biologic threats to society: successful integration of a longitudinal theme into the medical school curriculum John F Mahoney*, Kathleen D Ryan & Steven L Kanter (University of Pittsburgh School of Medicine, Office of Medical Education, Pittsburgh, USA)

8C 7 Early professional contact (EPC) for medical students: Gothenburg experience Gunilla Hellquist*, Bernhard von Below, Stig Rodjer & Gudny Sveinsdottir (Department of Primary Care, Goteborg, SWEDEN)

8C 8 Early introduction of family medicine during undergraduate medical training M I Nurjahan*, CL Teng, K Y Loh, A R Yong Rafidah, S K Kwa, M L Young, L C Lai, KY Ong & P C Y Chen (International Medical University, Clinical School, Negeri Sembilan, MALAYSIA)

8C 9 Defining the content of a physiotherapy program in Switzerland – a needs assessment Markus Schenker (Health Education Centre AZI, School of Physiotherapy, Berne, SWITZERLAND)

8C 10 The team profile – the development of assessment criteria for an interprofessional ward simulation exercise J S Ker*, L J Mole, C L Stewart, J Syme-Grant, E Gray, S Benvie & P Johnstone (University of Dundee, Clinical Skills Centre, Dundee, UK)

8C 11 Interprofessional education of first-year medical and nursing students Pekka Kaapa*, Jaakko Kytola, Susanna Vierre, Paivi Erkko & Kirsti Ellonen (University of Turku, Research Centre of Applied and Preventive Cardiovascular Medicine, Turku, FINLAND)

8C 12 Transforming a clinical team in primary care into a community of practice (COP): the Delta project in CME/CPD M A Raetzo & R L Thivierge* (University of Montreal, Montreal, CANADA)

8C 13 Integration of the dental students into the Dresden PBL – Curriculum (DIPOL): highlights of the emergency medicine course M Muller*, S Weber, I Nitsche, P Dieter & T Koch (Department of Anaethesiology and Intensive Care Medicine, University Hospital Dresden, Dresden, GERMANY)

8C 14 Not just another multi-professional course Lorna Olckers, Trevor Gibbs*, Melanie Alperstein, Madeleine Duncan, Licia Karp, Pat Mayers & Ermien van Pletzen (University of Cape Town, Department of Public Health, Cape Town, SOUTH AFRICA)

8C 15 A pilot exercise in multi-professional learning H McKenzie* & J Harper (Medical Education Unit, Aberdeen University Medical School, Aberdeen, UK)

8C 16 Interprofessional Education: making it happen Hazel Chalmers (NUTS, Newcastle upon Tyne, UK)

– 2.37 – Section 2: Tuesday

8C 17 Narrowing the gap in health – beyond the NHS? Linda Leighton-Beck (Aberdeen University, Dept of General Practice and Primary Care, Aberdeen, UK)

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123456789012345678901234567890121234567890123456789012348D The Curriculum (2) 5

123456789012345678901234567890121234567890123456789012345 Chair: Torstein Vik, Norway Location of Boards: Dome/Kuppelsaal, 5th Floor

8D 1 Effectiveness of first batch of graduates at Maharat Nakhon Ratchasima Hospital School of Medicine Ritthiya Littirong (Maharat Nakhon Ratchasima Hospital, School of Medicine, Nakhon Ratchasima, THAILAND)

8D 2 The transition from student to doctor: a small step or a big leap? K Prince*, A Scherpbier, E Boshuizen & C van der Vleuten (Maastricht University, Skillslab, Maastricht, NETHERLANDS)

8D 3 New curriculum of the School of Medicine of the University of Concepcion, Chile: training physicians capable of responding to the demands and challenges of the new century Octavio Enriquez* & Mario Munoz (University of Concepcion, Concepcion, CHILE)

8D 4 Using modified Delphi technique to prioritise problems in curriculum development N Sirisup, S Limpongsanurak, C Ittipanichpong*, A Srikiatikhachorn, S Patumraj, D Wangsaturaka & P Kamolratanakul (Department of Pharmacology, The Faculty of Medicine, Bangkok, THAILAND)

8D 5 Structuring the first 3 blocks or semesters in the school of medicine – Monterrey Tec – Mexico in accordance with objectives of courses and competencies the student must acquire Graciela Medina*, Demetrio Arcos, Enrique F J Martinez, Jorge Valdez and Ricardo Trevino (School of Medicine - Monterrey Tec, ITESM, Monterrey, MEXICO)

8D 6 Restructuring the undergraduate medical curriculum at the Medical Faculty Skopje, Macedonia: comparison with some other European models Z Gucev*, J Saveski, M Soljakova and K Boskoski (Medical Faculty Skopje, Skopje, MACEDONIA)

8D 7 Transfer appropriate processing and schema formation in first year students Mary Kelly*, Aileen Patterson, Bernard McCartan & Diarmuid Shanley (Dublin Dental Hospital, Dublin, IRELAND)

8D 8 Competencies as teaching and learning goals Monika Beck*, Hansruedi Kaiser*, Beat Keller* & Stefan Knoth* (BZG Kanton Solothurn, Bildungszentrum fur Gesundheitsberufe, Olten, SWITZERLAND)

8D 9 A comparison between the instructors’ viewpoints and students’ viewpoints on the current situation of clinical education in SUMS L Bazrafkan & M Alizadeh* (Shiraz University of Medical Sciences, Internal Medicine Department, Shiraz, IRAN)

8D 10 First grade students’ interviews as physicians in the community model Carlos Rojas Mora*, Robles Garcia Lucia & Cura Garcia Norma (School of Medicine Tecnologico de Monterrey, Monterrey, MEXICO)

8D 11 Physiotherapists’ “clinical reasoning” as a main educational strategy Peter Eigenmann* & Helena Luginbuhl (Feusi Physiotherapieschule, Bern, SWITZERLAND)

– 2.38 – Section 2: Tuesday

8D 12 Evaluation as dialogue between stakeholders – a tool for learning and content development of medical education Mona Fjellstrom (Umea University, Centre for Teaching and Learning, Umea, SWEDEN)

8D 13 One year experience with the new curriculum at Heidelberg Medical School N De Cono*, E Gazyakan, S Holler, J Schmidt & M Kadmon (Heidelberg Medical School, Schriesheim, GERMANY)

8D 14 Problems and perspectives of the teaching of primary care under the new law on medical education in Germany M Ehrhardt, H van den Bussche* & H Kaduskiewicz (Institute of General Practice, Institut fur Allgemeinmedizin, Hamburg, GERMANY)

8D 15 The social service year in medical education: a Mexican case study Julio Cesar Gomez, Pilar Talayero & Todd W Ellwein (Universidad Westhill, Mexico City, MEXICO)

8D 16 Evaluation of a new model of senior clerkship in an undergraduate medical curriculum J C Ramesh*, A L Mohamed, T Motilal, M I Nurjahan, R Khuzaiah & P Kandasamy (International Medical University, Selangor, MALAYSIA)

8D 17 Teaching case management for chronic illness care in an undergraduate general practice course Jochen Gensichen* & Ferinand Gerlach (Institute for General Practice, University Hospital Schleswig-Holstein, Kiel, GERMANY)

8D 18 Assessment of student attitudes and knowledge about aging: a longitudinal comparison of medical student cohorts Debra A Newell*, Anthony DiNuzzo, L Felipe Amador & Ann W Frye (University of Texas Medical Branch, Office of Educational Development, Galveston, USA)

8D 19 The survey of medical students’ and graduates’ awareness about concepts and benefits of community-oriented medical education in Iran Sedighe Najafipour*, F Azizi & M Saberfiroozi (Mottahri Clinic, Shiraz, IRAN)

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1234567890123456789012345678901212345678901234567890123456789012123456 1234567890123456789012345678901212345678901234567890123456789012123458E Evaluation of the Curriculum 6 1234567890123456789012345678901212345678901234567890123456789012123456 Chair: Peter Nippert, Germany Location of Boards: Dome/Kuppelsaal, 5th Floor

8E 1 Teaching evaluation as part of interactive quality management at the Medical Faculty of Freiburg V Peus*, G Valerius, H D Hofmann & M Berger (Studiendekanat der Medizinischen Fakultat Freiburg, Freiburg, GERMANY)

8E 2 Faculty attitudes: a straight way to faculty evaluation Abdolreza Jahanmardi, Morteza Haghirizade Roodani*, Hayat Membeini, Roya Jahanmardi (Ahvaz Medical Sciences University, Educational Development Center (EDC), Ahvaz, IRAN)

8E 3 Think bigger than “happy sheets” Jane Ross, Sandy Stewart* and Patrick McKinlay (NHS Education for Scotland, Turriff, UK)

8E 4 Evaluating the quality of a problem-based medical training: experiences at the University of Hamburg Monika Bullinger (Institute and Clinic for Medical Psychology, Centre for Psychosocial Medicine, Hamburg, GERMANY)

– 2.39 – Section 2: Tuesday

8E 5 Students’ evaluation of the undergraduate curriculum I Rumba* and U Vikmanis (University of Latvia, Riga, LATVIA)

8E 6 Evaluation strategy for the Hybrid-curriculum at the Faculty of Medicine, University of Basel G Voigt*, B Roeers, V Exner and K Pierer (Educational Dean’s Office, Faculty of Medicine, Basel, SWITZERLAND)

8E 7 Registrars in paediatrics demand more personal interest from their teaching professors D G van Vuurden*, F Scheele, J van de Lande and B H M Wolf (St Lucas Andreas Hospital, VU Medical Centre, Amsterdam, NETHERLANDS)

8E 8 Focus group as tool for quality assurance in communication skills training and standardized patient contact Isabel Muehlinghaus*, Heiderose Ortwein and Claudia Kiessling (Universitaetsklinikum Charité Berlin, HU zu Berlin, Berlin, GERMANY)

8E 9 Evaluation of undergraduate medical education as a part of the European Union access process – an experience at the Jessenius Medical Faculty of Comenius University in Martin, Slovakia Lukas Plank*, Jan Danko, Eva Rozborilova, Peter Galajda & Karol Dokus (Jessenius Faculty of Medicine, Martin, SLOVAK REPUBLIC)

8E 10 Analysis of educational evaluation at the Faculty of Medicine Lenka Doubravska*, Radim Licenik, Vit Gloger, Miroslav Herman, Jarmila Indrakova, Daniela Jelenova, Petr Jindra, Barbora Krajzlova, Pavel Kurfurst, Ivana Oborna, Katherine Ruzicka, Jan Strojil &Cestmir Cihalik (Medical Faculty of Palacky University, Olomouc, CZECH REPUBLIC)

8E 11 The role of evaluation and accreditation in improving medical education quality Fereshted Farzianpour and colleagues (Education Development Centre, Tehran, IRAN)

8E 12 A survey about probable factors affecting the academic staff’s evaluation by the students R Rezaie*, A Bazargani & M Amini (EDC Center, Shiraz, IRAN)

8E 13 Quality improvement in medical student assessment Supawadee Prakunhungsit*, Boonmee Sathapatayavongs and Tharntip Malaisirirat (ENT Department, Ramathibodi Hospital, Bangkok, THAILAND)

8E 14 Students’ evaluation of an undergraduate course in the community Eva Rasky (Institute of Social Medicine and Epidemiology, Karl-Franzens-University Graz, Graz, AUSTRIA)

8E 15 The most pleasant and the most unpleasant in the first year in the University according to students’ opinions of the Faculty of Medicine University of Chile in 2001 Ilse Lopez, Zulema Vivanco, Manuel Castillo & Enrique Mandiola (presented by Beatriz Saavedra) (Facultad de Medicina, Universidad de Chile, Santiago, CHILE)

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123456789012345678901234567890121234567890123456789012345678901218F Teaching Clinical Skills (1) 2

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– 2.40 – Section 2: Tuesday

8F 1 Does the Paediatric Advanced Life Support (PALS) course improve confidence in knowledge and performance of paediatric resuscitation? Jos M Th Draaisma* & Nigel McBeth Turner (Dutch Foundation for the Emergency Medical Care of Children, Nijmegen, NETHERLANDS)

8F 2 “Paper cases” help to organize a dermatology practical course A Boer & F Ochsendorf* (Universitats-Hautklinik, d.j.w. Goethe-Universitat, Frankfurt am Main, GERMANY)

8F 3 Skills training in obstetrics Jette Led Sorensen*, Morten Lebech & Tom Weber (The Clinic of Obstetrics, Rigshospitalet, Copenhagen, DENMARK)

8F 4 Evaluation of modified case-based-learning-lessons R Faber*, C Nikendei, D Schellberg, C Roth, A Zeuch, B Auler, W Herzog & J Juenger (Department of Internal Medicine, University of Heidelberg, Heidelberg, GERMANY)

8F 5 Student perceived benefit from a surgical specialty theatre attendance Michael S W Lee*, Mary-Louise Montague & S S Musheer Hussain (Ninewells Hospital and Medical School, Dundee, UK)

8F 6 Experience of first ever batch of senior clerkship in International Medical University Malaysia Esha Das Gupta*, Nurjahan Mohd Ibrahim, Dr Motilal and Teng C L (International Medical University, Seremban, MALAYSIA)

8F 7 Providing artificial experience through integrated, case-based, multidisciplinary forum presentations Hettie Till*, Oryst Swyszcz & Peter Cauwenbergs (Canadian Memorial Chiropractic College, Toronto, CANADA)

8F 8 Peer tutoring success in clinical skills Clare Stewart*, Joy Crosby & Jean Ker (Dundee University, Clinical Skills Centre, Dundee, UK)

8F 9 The 5W-H reflective approach to patient assessment Joyce Mothabeng (University of Pretoria, Akasia, SOUTH AFRICA)

8F 10 Learning in the clinical environment of district and university hospitals in the Netherlands K B Boor*, F Scheele, C van Aken, J Dronkert, J Th M van der Schoot & Bart Wolf (SLAZ, Department of Women and Child Health, Amsterdam, NETHERLANDS)

8F 11 Strengths and weaknesses of graduate medical clinical training in Ghent, according to 2nd year postgraduates M van Winckel, B Morlion*, S van de Moortele, A Derese & M Valcke (Universitair Ziekenhuis Gent, Gent, BELGIUM)

8F 12 Integration of learning situations in primary health care: experiences from the Berlin Reformed Track at the Charité, Germany Claudia Kiessling*, Margareta Kampmann, Dagmar Rolle & Ulrich Schwantes (Arbeitsgruppe Reformstudiengang Medizin, Charité, Berlin, GERMANY)

8F 13 Redefining the role of a Learning Resource Centre in a medical school Bruce Holmes (Learning Resource Centre, Dalhousie University, Faculty of Medicine, Halifax, CANADA)

– 2.41 – Section 2: Tuesday

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123456789012345678901234567890121234567890123456789012345678901212 123456789012345678901234567890121234567890123456789012345678901218G Clinical Skills (2) 2 123456789012345678901234567890121234567890123456789012345678901212 Chair: To be announced Location of Boards: Dome/Kuppelsaal, 5th Floor

8G 1 Student satisfaction with standardized patient encounters in an emergency medicine class at Charité Medical School, Humboldt University, Berlin Heiderose Ortwein*, Torsten Schroeder & Claudia Kiessling (Charité Medical School, Humboldt University of Berlin, Berlin, GERMANY)

8G 2 Medical students’ communication abilities prior to training Nicola Brown*, Kathryn Peace & John Campbell (Department of Psychological Medicine, University of Otago, Dunedin, NEW ZEALAND)

8G 3 Consultation skills never made easy A Skott*, M Wahlqvist, C Bjorkelund, I Gause-Nilsson, B Dahlin & B Mattsson (Sahlgrenska Academy at Goteborg University, Department of Public Health, Goteborg, SWEDEN)

8G 4 Obligatory training of communication skills in the regular curriculum of the Charité, Berlin Margareta Kampmann*, Britta Jonitz, Martina Schlunder & Ulrich Schwantes (Charité Berlin, Institut für Allgemeinmedizin, Berlin, GERMANY)

8G 5 Consultation and communication skills for overseas doctors: culture, training and reward Alison Henry*, William Murdoch and Mohammed Arafa (Department of Primary Care and General Practice, Primary Care Sciences and Learning Centre, Birmingham, UK)

8G 6 Course for breaking bad news Daniela Jelenova*, Renata Simkova, Lenka Doubravska, Vit Gloger, Jarmila Indrakova, Petr Jindra, Barbora Krajzlova, Pavel Kurfurst, Radim Licenik, Jarmila Potomkova, Jan Strojil, Iveta Zedkova & Cestmir Cihalik (Medical Faculty of Palacky University, Olomouc, CZECH REPUBLIC)

8G 7 New High Frequency Oscillatory Ventilator Simulator Abdulla Al Thari*, C A S Melville, Y Wickramasinghe & A Al Shihri (Keele University, North Staffs Hospital, Centre for Science and Technology in Medicine, Stoke on Trent, UK)

8G 8 Patient safety and high fidelity simulation in undergraduate medical education: learning the skills of Crisis Resource Management Brendan Flanagan, Debra Nestel*, Michele Joseph, Michael Bujor, Julia Harrison & Orla Lacey (Monash University, Centre for Medical & Health Sciences Education, Victoria, AUSTRALIA)

8G 9 Training of simulated patients: the effect of a self-written scenario on performance and feedback quality Kenichi Mitsunami*, Masahiko Terada, Hiroki Tamura, Hidetoshi Matsubara and Tadao Bamba (Shiga University of Medical Science, Department of General Medicina, Shiga, JAPAN)

8G 10 Incorporating a newly developed heart sound simulator into medical student education Katsuya Yoshida, Yoichi Kuwabara, Keiichi Nakagawa, Masahiro Tanabe* and Issei Komuro (Chiba University Graduate School of Medicine, Chiba, JAPAN)

8G 11 Simulator based course in emergency management for primary care dental practice teams S Weber*, M Muller, E Armstrong and T Koch (Department of Anaethesiology and Intensive Care Medicine, University Hospital Dresden, Dresden, GERMANY)

– 2.42 – Section 2: Tuesday

8G 12 Attitudes and ability: is there a relationship? Merilyn Liddell* & Sandra Davidson (Monash University, Department of General Practice, East Bentleigh, AUSTRALIA)

8G 13 The changes in attitudes to death and dying among medical students Ming-Liang Lai*, Jung-Jong Chen, Hsing-Hsing Chen & Chantal Co-Shi Chao (Tzu Chi University, Hua- lien, TAIWAN)

8G 14 Survey of staff attitudes to the daily otolaryngology ward round Mary-Louise Montague*, Michael S W Lee and SS Musheer Hussain (Ninewells Hospital and Medical School, Department of Otolaryngology, Dundee, UK)

8G 15 Assessment of quality of morning report Akbar Derakhshan (Mashhad University of Medical Science, EDC, Mashad, IRAN)

8G 16 Bedside tutorial-based formative assessment promotes learning in clinical clerkships V C Burch*, T Gibbs and J L Seggie (University of Cape Town, Department of Medicine, Cape Town, SOUTH AFRICA)

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123456789012345678901234567890121234567890123456789012345678901212345678901 123456789012345678901234567890121234567890123456789012345678901212345678908H International Medical Education 1 123456789012345678901234567890121234567890123456789012345678901212345678901

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8H 1 Implementing a womens’ sexual health curriculum for St Petersburg, Russia L Southgate*, P Toon, S Pavinski & O Kuzatova (Academic Centre for Medical Education, London, UK)

8H 2 Evaluation of a new program in international health A Jotkowitz*, A Gaaserud, Y Gidron, J Urkin, Y Henkin & C Z Margolis (Ben-Gurion University, The Moshe Prywes Center for Medical Education, Beer Sheva, ISRAEL)

8H 3 Programme for integration of third world medical doctors Mette Valbjoern (Office for Postgraduate Medical Education, Hoejbjerg, DENMARK)

8H 4 Experience of improving the neonatal teaching at the pediatric faculty M A Ismailova*, D A Mavlyanova & Z G Rachmankulova (Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan)

8H 5 Expanding the boundaries of medical education: evidence for cross-cultural exchanges Ian S Mutchnick, Cheryl A Moyer and David T Stern* (University of Michigan Health System, Ann Arbor, USA)

8H 6 The effect of international medical rotations on students’ attitudes: a qualitative study Cheryl A Moyer & David T Stern* (University of Michigan Health System, Ann Arbor, USA)

8H 7 Assessing global essential competencies in the leading Chinese medical schools: The IIME Project Andrzej Wojtczak*, David T Stern & M Roy Schwarz (Institute for International Medical Education, New York, USA)

8H 8 A Harvard program for German final year students H Baschnegger*, A S Peters, H T Aretz & F Christ (Ludwig Maximilians University, Klinik fuer Anaesthesiologie, Munich, GERMANY)

– 2.43 – Section 2: Tuesday

8H 9 Internationalisation of medical education in the Netherlands Gerard D Majoor* & Susan Niemantsverdriet (Maastricht University, Faculty of Medicine, Maastricht, NETHERLANDS

8H 10 English taught semester in medicine at the University of Oslo Borghild Roald*, Sverre Bjerkeset & Babill Stray-Pedersen (University of Oslo, Department of Pathology, Oslo, NORWAY)

8H 11 Correlations to attitudes and knowledge about international health A Gaaserud*, A Jotkowitz, Y Gidron, C Baskin, M Alkan, Y Henkin & C Margolis (Ben Gurion University of the Negev, Faculty of Health Sciences, Beer Sheva, ISRAEL)

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12345678901234567890123456789012123456789012345678901234567890128I Problem Based Learning 1

12345678901234567890123456789012123456789012345678901234567890121 Chair: To be announced Location of Boards: Dome/Kuppelsaal, 5th Floor

8I 1 The correlation between students’ perceptions of PBL session and their scores on MCQ exams at the end of the session Melih Elcin, Orhan Odabasi, Iskender Sayek*, Murat Akova & Nural Kiper (Hacettepe Universitesi, Ankara, TURKEY)

8I 2 PBL: what do students think about it? R Davidova, St Jochkova, P Moushatova, N Narlieva & D Dimitrov* (Medical University, Pleven, BULGARIA)

8I 3 Putting it all together: Medical students’ understanding of the curriculum Agnes Dodds*,Mosepele Mosepele, Glen Evans, Susan Elliott & Jeanette Lawrence (The University of Melbourne, Faculty Education Unit, Melbourne, AUSTRALIA)

8I 4 Students show increased confidence in supported PBL David C M Taylor* & Trevor J Gibbs (University of Liverpool, Faculty of Medicine Office, Liverpool, UK)

8I 5 Plenary session as a tool for standardization of objectives and conclusions in a diversified environment where heterogeneity of small groups and tutors’ expertise are the rule Enrique F J Martinez*, Graciela Medina, Demetrio Arcos, Ricardo Trevino & Jorge Valdez (School of Medicine - Monterrey Tec, ITESM, Monterrey, MEXICO)

8I 6 Improving the quality of PBL cases – experiences with the implementation of quality criteria Ragna Raschke*, Walter Burger, Claudia Kiessling, Rita Leidinger, Dagmar Rolle & Kai Schnabel (Reformstudiengang Medizin, Charité, Berlin, GERMANY)

8I 7 Critical assessment of factors affecting the exam performance and study motivation of preclinical phase medical and dental students in integrated PBL teaching Tiina Immonen*, Kirsi Sainio, Sanna Partanan, Tuula Nurminen, Juha Okkeri & Timo Sorsa (Institute of Biomedicine, Developmental Biology, University of Helsinki, Helsinki, FINLAND)

8I 8 Problem based learning at Marilia Medical School Ricardo Shoiti Komatsu (Marilia Medical School/Famema, Marilia, BRAZIL)

8I 9 Is unprofessional behaviour recognised by first year problem-based learning students? M McLean & J Botha* (Department of Experimental and Clinical Pharmacology, Nelson R Mandela School of Medicine, Congella, SOUTH AFRICA)

– 2.44 – Section 2: Tuesday

8I 10 Teaching and learning for what? Curriculum change and the challenge to produce doctors better equipped to serve community health needs M Alperstein & J Grossman (University of Cape Town, Faculty of Health Sciences, Cape Town, SOUTH AFRICA) (presented by Trevor Gibbs)

8I 11 DIPOL® (Dresden Integrative Problem-Oriented Learning): a problem-based, interdisciplinary patient and student-oriented curriculum covering Year 1 and 2, Medical Faculty, TU Dresden A Morgner, M Witt, M Kasper, A Deussen, V Zuerich, T Kriegel, R Scheibe, J Oehler, H E Krinke, S Albrecht, F Schonhofer, G Tchitchekian & P Dieter* (Medical Faculty TU Dresden, Dresden, GERMANY)

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12345678901234567890123456789012123456789012345678901234567890121 12345678901234567890123456789012123456789012345678901234567890128J Postgraduate Education 1 12345678901234567890123456789012123456789012345678901234567890121

12345678901234567890123456789012123456789012345678901234567890121 Chair: To be announced Location of Boards: 2nd Floor, east corridor

8J 1 Progress in paradigm shift: the RCPSC CanMEDS implementation survey J R Frank*, G Cole, C Lee, N Mikhael & M Jabbour (Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, CANADA)

8J 2 Specialist registrars’ views on training in non-clinical competencies Kathryn Gunn*, David Wall & Robert Palmer (West Midlands Deanery, Birmingham, UK)

8J 3 Introduction of an e-learning course of health economy in Hungarian Postgraduate Medical Education Anna Bukovinszky*, Gabor Biro, Tibor Ertl & Arpad Gogl (Centre for Postgraduate Education, University of Pecs, Pecs, HUNGARY)

8J 4 New ways of teaching basic surgical trainees: the experience of the Yorkshire School of Surgery Margaret Ward*, Zoe Fleet, Mark Lansdown & Mike Gough (Postgraduate Department, St James’ University Hospital, Leeds, UK)

8J 5 Administration of the postgraduate doctors’ evaluation of educational functions supplied by clinical wards Mette Engholm Dremstrup (Aarhus AMT, Hojbjerg, DENMARK)

8J 6 An evaluation of the role of the Pre-registration House Officer tutor Pramod Luthra* and Catherine Smith (North Western Deanery, The University of Manchester, Manchester, UK)

8J 7 The tasks of an internist: how well prepared are trainees? D J Davis*, A M Skaarup and C Ringsted (Copenhagen Hospital Corporation Postgraduate Medical Institute, Copenhagen, DENMARK)

8J 8 A new and innovative post-graduate programme in clinical pharmacology J Botha*, A Gray and M McLean (Department of Experimental and Clinical Pharmacology, Nelson R Mandela School of Medicine, Congella, SOUTH AFRICA)

8J 9 Post-graduate training in dermatovenereology in Belarus: current status and problems Uladzimir Adaskevich (Medical University, Department of Dermatovenereology, Vitebsk, BELARUS)

8J 10 Assessment of the medical sign-out in postgraduate training in obstetrics and gynaecology Jeroen van Bavel*, Fedde Scheele, Casper Jansen & Bart Wolf (St Lucas Andreas Hospital, Haarlem, NETHERLANDS)

– 2.45 – Section 2: Tuesday

8J 11 Assessment of the medical sign-out in postgraduate training in pediatrics Casper Jansen*, Bart Wolf, Jeroen van Bavel & Fedde Scheele (St Lucas Andreas Hospital, Department of Pediatrics, Amsterdam, NETHERLANDS)

8J 12 The role of the logbook in the training of gynaecologists in the Netherlands: time for change? S Mahesh*, F Scheele & B H M Wolf (St Lucas Andreas Hospital Amsterdam, Department of Gynaecology and Obstetrics, Amsterdam, NETHERLANDS)

8J 13 Pitfalls in postgraduate mentoring B Wolf*, F Scheele, J Roord & J van der Schoot (SLAZ, Amsterdam, Department of Mother and Child Health, St Lucas Andreas Ziekenhuis, Amsterdam, NETHERLANDS)

8J 14 Continuity clinic in gynecology and obstetrics Antonio Davila* & Claudia Hernandez (Escuela de Medicina-Tecnologico de Monterrey, Monterrey, MEXICO)

8J 15 A study on prescription-writing of the interns in Bandar Abbas School of Medicine O Safa, Sh Zare & R Amini* (Hormozgan University of Medical University, Office of Vice-Chancellor for Education and Research, Hormozgan, IRAN)

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12345678901234567890123456789012123456789012345678901238K Staff Development 4

12345678901234567890123456789012123456789012345678901234 Chair: William McGaghie, USA Location of Boards: 2nd floor, east corridor

8K 1 Training of teachers in general/family practice – 20 years of experience M Vrcic-Keglevic*, W Betz, P Heyerick, Z Jaksic, P Owens, H Tiljak & I O Virjo (“A.Stampar” School of Public Health, Medical School, Zagreb, CROATIA)

8K 2 Enhancing learning and teaching in veterinary medicine Sarah Marshall (LTSN-01, Learning and Teaching Support Network, Subject Centre for Medicine, Dentistry and Veterinary Medicine, Newcastle, UK). Gill McConnell is presenting

8K 3 Individual and institutional impact of professional development courses for physicians as educators F Christ*, O Genzel-Boroviczeny, T Aretz, E Armstrong & R Putz (Ludwig Maximilians University, Dept of Anesthesiology, Munich, GERMANY)

8K 4 Changing teachers’ roles and responsibilities in a new interdisciplinary learner-centered curriculum at the Higher Medical Institute – Pleven, Bulgaria Z Radionova*, T Pencheva, R Gindeva & B Rousseva (University School of Medicine - Pleven, Department of Physiology, Pleven, BULGARIA)

8K 5 Broadening medical teachers’ pedagogical thinking – an interdisciplinary challenge Anni Peura*, Juha Nieminen, Eeva Pyorala & Aija Helander (University of Helsinki, Research and Development Unit for Medical Education, Helsinki, FINLAND)

8K 6 Challenging the ‘what works’ culture in medical education: what kind of research might support the development of teaching in clinical contexts? Kath Green (Postgraduate Medical and Dental Education, The KSS Deanery, London, UK)

8K 7 Competence Centre for University Teaching in Medicine: Tuebingen – Freiburg – Ulm: concept and experiences with the cooperation project Maria Lammerding-Koeppel*, U U Haering, Kerstin Mueller, H D Hofmann, Hubert Liebhardt & T Mertens (University of Tuebingen, Faculty of Medicine, Tuebingen, GERMANY)

– 2.46 – Section 2: Tuesday

8K 8 To determine faculty members’ information and practice about validity and reliability in exams P Abedi* & S H Najar (Ahwaz Medical University, Nursing and Midwifery School, Ahwaz, IRAN)

8K 9 The effect of an educational program based on PRECEDE model on the level of academic advisors’ ability and the medical students’ satisfaction S M M Hazavehei (Department of Health Education and Health Promotion, School of Health, Isfahan, IRAN)

8K 10 Registrars still in favour of teaching professors with sufficient personal attention J van de Lande*, F Scheele, B Wolf, D van Vuurden & J Th M van der Schoot (MCVU, Amsterdam, NETHERLANDS)

8K 11 Identifying the training and development needs of teachers in a medical school Mairead Boohan (Queen’s University of Belfast, Medical Education Unit, Belfast, UK)

8K 12 The effects of educational workshops held by EDC of Tehran University of Medical Sciences on the participant faculty S Soheili* & A A Zeinanaloo (Tehran University of Medical Sciences, Tehran, IRAN)

8K 13 Which faculty teaching skills require improvement? – a comparison of faculty and student perceptions Neena Natt*, Charles H Rohren & Jayawant N Madrekar (Mayo Graduate School of Medicine, Mayo Clinic, Rochester, USA)

8K 14 Assessment of academic staff evaluation program N Zarghami, B Rahimi* & R Mokari (Tabriz University of Medical Sciences, Medical Education Development Centre, Tabriz, IRAN)

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12345678901234567890123456789012123456789018L Students 2

12345678901234567890123456789012123456789012 Chair: Reg Dennick, UK Location of Boards: Foyer of Dome/Kuppelsaal, 4th floor

8L 1 To cure or not to cure? Career choices of final year medical students in Germany Goetz Fabry* & Niko Michaelis (Department of Medical Psychology, University of Freiburg, Freiburg, GERMANY)

8L 2 The motivation of medical students for their university career M Diez, A F Compan*, J Medrano, R Calpena & M T Perez Vazquez (University Miguel Hernandez, Departamento de Patologia y Cirugia, San Juan de Alicante, SPAIN)

8L 3 Students’ expectations of medicine, the doctor’s role and training: 1998-2002 Ana Marchandon A (Universidad de Chile, Santiago, CHILE)

8L 4 Ethnic diversity and intercultural medical experience at Erasmus Medical Centre Rotterdam V J Selleger*, B Bonke & Y A M Leeman (Department of Educational Sciences, University of Amsterdam, Baarn, NETHERLANDS)

8L 5 Women with authority, men with empathy – gender equality in medical school in Uppsala, Sweden Karin Grave & Christine Werner (Uppsala Medical School, Uppsala, SWEDEN)

– 2.47 – Section 2: Tuesday

8L 6 Significance of scientific competitions between medical students M M Jafarov* & J J Ergashev (The Department of International Cooperation, Tashkent Pediatric Medical Institute, Tashkent, UZBEKISTAN)

8L 7 Academic underachievement of junior medical students Mohamed B Awad (Faculty of Medicine, Zagazig University, Zagazig, EGYPT)

8L 8 Student Scientific Society – background of clinical education A Kuimov*, K Popov, A Antonov & I Kuimova (Novosibirsk, RUSSIA)

8L 9 The role of the Office of Medical Education in the Faculty of Medicine of the University of Porto as the interface between high and secondary education in the medical course M A F Tavares* & A Bastos (Office of Medical Education, Faculty of Medicine of the University of Porto, Porto, PORTUGAL)

8L 10 PROAC – Psychological and Pedagogical Orientation Program for medical students Eunice de Freitas, Benedito Carlos Weltson, Decio Lourenco Reimao, Sandra Lopes Mattos e Dinato & Julio Cesar Massonetto* (Medical School of Santos, Centro Universitario Lusiada, Santos, BRAZIL)

8L 11 Students’ research: learning advantages and benefits achieved by students. Polish experience Anna Michalak*, Tomasz Kucmin & Filip Stoma (Medical University of Lublin, Lublin, POLAND)

8L 12 Anxiety and distress experienced by medical students during preclinical training Beata Tobiasz-Adamczyk* & Agnieszka Penar (Dean’s Office, Medical Faculty, Cracow, POLAND)

8L 13 Promoting reflection and self-evaluation across the first clinical course Adela Virginia Contreras & Toni Peters* (La Reina, CHILE)

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12345678901234567890123456789012123456789012345678901234567890121234 12345678901234567890123456789012123456789012345678901234567890121238M Teaching and Learning (1) 4 12345678901234567890123456789012123456789012345678901234567890121234 Chair: Fernando Mora-Carrasco, Mexico Location of Boards: 2nd floor, west corridor

8M 1 Tumor prevention program of medical students at Szeged University Katalin Barabas* & Melinda Lakos (University of Szeged, Szeged, HUNGARY)

8M 2 A novel approach to blood and immunity in undergraduate medical studies in a new medical school of Beira Interior – Portugal A Macedo*, A Izarra, P Tavares and L Taborda-Barata (Universidade da Beira Interior, Department of Medical Sciences, Covilha, PORTUGAL)

8M 3 Anatomical cadaveric hearts – integrated horizontal and vertical study Samar Al Saggaf*, Fawzia Nayeem, Soad Shaker Ali, Amira A Elhaggagy & Khadra Soliman (King Abdul Aziz University, Faculty of Medicine and Allied Sciences, Jeddah, SAUDI ARABIA)

8M 4 What kind of theory is needed? Experiences with a course on constructivism in medicine Rita Leidinger* & Claudia Kiessling (Arbeitsgruppe Reformstudiengang Medizin, Charité, Berlin, GERMANY)

8M 5 Coaching in medicine Sam Lingam*, R C Gupta, D Gormley & D Brigden (Potters Bar, UK)

– 2.48 – Section 2: Tuesday

8M 6 Reflective learning in undergraduate medical students: what is the evidence? Andrew Grant*, Elizabeth Metcalf & Paul Kinnersley (University of Wales School of Medicine, Department of General Practice, Cardiff, UK)

8M 7 A study of public opinion on use of tissue samples from living subjects for clinical research and medical student teaching M L Goodson* & B G Vernon (University of Newcastle, Newcastle Upon Tyne, UK)

8M 8 Evaluation of a voluntary lecture where a medical student examines a healthy infant at the Skills Training Centre H Storm*, R Bentehaugen, A Lippert & E Hanko (The Skills Training Centre, IKLIN, Oslo, NORWAY)

8M 9 Attitudes towards Psychiatry and Psychotherapy (ATP) of medical students from different years at the University Medical School in Essen, Germany during the Summer of 2002 O Kuhnigk*, B Strebel & J Schilauske and M Jueptner (Universitatsklinikum Hamburg-Eppendorf, Modellstudiengang Medzin, Hamburg, GERMANY)

8M 10 Physician training in child development to meet basic needs of children and families in medical practice Wendy Roberts* & Elizabeth Thompson (Hospital for Sick Children, Child Development Centre, Toronto, CANADA)

8M 11 Innovative module for training of medical students as promoters of prevention of drug abuse Regina Komsa-Penkova*, Sonali Vaid, Emil Filipov, Dobromir Dimitrov and Zlatina Georgieva (Higher Medical Institute - Pleven, International Relations’ Office, Pleven, BULGARIA)

8M 12 The arts in medicine – evaluating a new special study module P A Lazarus* & F M Rosslyn (University of Leicester, Division of Medical Education, Leicester, UK)

8M 13 Injury epidemiology, prevention and treatment: an integrated curriculum Peter Barss (United Arab Emirates University, Department of Community Medicine, Al Ain, UNITED ARAB EMIRATES)

8M 14 Community Empowerment Project – promote smoking cessation M I Memon*, R C Gupta, D Brigden & M A Memon (Preston PCT & Bolton Institute, Bolton, UK)

8M 15 Team working for a reflective medical education resource L A Paterson*, J Ker & P Davey (University of Dundee, Clinical Skills Centre, Dundee, UK)

8M 16 The role of the Ghanaian medic in preventive medicine E Moses Fynn* & I Osei (Kwame Nkrumah University of Science and Technology, School of Medical Sciences, Kumasi, GHANA)

8M 17 What items should be taught and assessed in a longitudinal curriculum of emergency medicine? F O Weisser*, B Dirks & M Georgieff (Sektion Notfallmedizin, Universitätsklinik für Anästhesiologie, Ulm, GERMANY)

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123456789012345678901234567890121234567890123456789012345678901212 123456789012345678901234567890121234567890123456789012345678901218N Teaching and Learning (2) 2 123456789012345678901234567890121234567890123456789012345678901212 Chair: Are Holen, Norway Location of Boards: 2nd floor, west corridor

– 2.49 – Section 2: Tuesday

8N 1 The proposed use of ‘participatory video’ techniques in undergraduate veterinary education C E Bell (University of Glasgow Veterinary School, Division of Farm Animal Medicine and Production, Glasgow, UK)

8N 2 Comparison of lecturing with and without lecture notes in learning for medical student virology teaching Sohrab Najafipour* & Sedighe Najafipour (Fasa Medical School, Fasa, IRAN)

8N 3 Monitored self-study: how do students use the guidelines? M Vandersteen*, M Maelstaf & I Vandenreyt (Limburgs Universitair Centrum, Universitair Campus, Dipenbeek, BELGIUM)

8N 4 Introducing changes in the education of medical students: a course on study skills in the Faculty of Medicine of the University of Porto E Loureiro*, M J Martins, D Neves, M A Tavares & A Bastos (Office of Medical Education, Faculty of Medicine, University of Porto, Porto, PORTUGAL)

8N 5 Working with feedback Reuben M Gerling (Nihon University School of Medicine, Tokyo, JAPAN)

8N 6 The cognitive challenges of learning from medical text: an intervention for undergraduates Iona I-Wesso (Department of Medical Biosciences, University of Western Cape, Bellville, SOUTH AFRICA)

8N 7 A survey of the perceived impact of study guides designed to support student learning during intermediate clinical rotations in a revised undergraduate medical curriculum F J Cilliers*, B B van Heerden & E Wasserman (University of Stellenbosch, Division for University Education, Tygerberg, SOUTH AFRICA)

8N 8 Student learning profiles in the health sciences A Patterson* & M Kelly (Faculty of Health Sciences, Trinity College Dublin, Dublin, IRELAND)

8N 9 Technology in a medical lecture – how relevant? Ujjal Choudhuri*, Rachelle Arnold & Hamish McKenzie (University of Aberdeen, Medical Faculty Office, Aberdeen, UK)

8N 10 Comparison of the impact of traditional and multimedia independent teaching methods on the skills of administration of medication by nursing students Khadijeh Ranjbar (Shiraz University of Medical Sciences, Faculty of Nursing, Shiraz, IRAN)

8N 11 Building a learning culture in primary care: ideas from a Teaching PCT in Bradford, England David Pearson*, Lynn Stinson & Peter Dickson (Bradford City Teaching PCT, Bradford, UK)

8N 12 Characteristics of a good medical teacher: opinions of first year undergraduate medical students J F C Figueiredo*, M L V Rodrigues & C E Piccinato (University of Sao Paulo, Faculty of Medicine of Ribeirao Preto, Ribeirao Preto, BRAZIL)

8N 13 Does formative, in-clerkship counseling of students with marginal knowledge improve pass-fail performance on an end-of-clerkship examination? Alan P Wimmer, Paul A Hemmer*, Thomas C Grau & Louis N Pangaro (Uniformed Services University, USUHS - EDP, Bethesda, USA)

8N 14 Complexity and Educating the Health Professional Jim Price (CMEC, St Richards Hospital, Chichester, UK)

– 2.50 – Section 2: Tuesday

8N 15 Extracurricular activities of undergraduate students enrolled in a special training programme Maria de L Veronese Rodrigues*, Elizabeth Meloni Viera, Guilherme L Martinez, Luciana de M Vicente, Nelson F Gava & Priscilla G Lira (Hospital das Clínicas - Oftalmologia, Faculdade de Medicina de Ribeirao Preto, Ribeirao Preto, BRAZIL)

8N 16 Students’ satisfaction with the improvement of introduction to medicine course. A Nitiapinyasakul, S Lermanuwararat & R Littirong (Maharat Nakon Ratchasima Hospital, School of Medicine, Muang, Thailand)

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12345678901234567890123456789012123456789012345678901234567890121234 12345678901234567890123456789012123456789012345678901234567890121238O E-learning and the Internet 4 12345678901234567890123456789012123456789012345678901234567890121234 Chair: Barry Issenberg, USA Location of Boards: 1st floor, east corridor

8O 1 Active learning on the web: seven steps to effective e-learning David A Cook* & Denise M Dupras (Mayo Graduate School of Medicine, Department of Internal Medicine, Rochester, USA)

8O 2 Comparison of learning outcomes with a WebCT course and a conventional web-site learning material Kalle Romanov* & Anne Nevgi (University of Helsinki, Research and Development Unit for Medical Education, Helsinki, FINLAND)

8O 3 Quality management in e-learning: the use of standards in medicMED at the University of Witten/Herdecke B Strahwald (University of Witten, Project medicMED, Witten, GERMANY)

8O 4 Evaluating a web-based video program for undergraduate clinical skills instruction S Aaron*, M Brisbourne, S Varnhagen & D Begg (University of Alberta, Department of Rheumatology, Alberta, CANADA)

8O 5 Integration of e-learning in the curriculum: concept, realisation and evaluation of medicMED at the University of Witten/Herdecke B Strahwald, K Kempe & M Hofmann* (University of Witten, Project medicMED, Witten, GERMANY)

8O 6 A survey of internet using status in academic members of Oromiyeh University of Medical Sciences B Rahimi*, A Rashidi & N Zarghami (Educational Development Center, Oormiyeh University of Medical Sciences, Oormiyeh, IRAN)

8O 7 Patient rights in e-learning environments: a model for informed consent in medicMED at the University of Witten/Herdecke K Kempe*, B Strahwald & M Hofmann (University of Witten/Herdecke, Project medicMED, Witten, GERMANY)

8O 8 WASP – a generic web-based, interactive patient simulation system Nabil Zary* & Uno G H Fors (LIME, Karolinska Institutet, Stockholm, SWEDEN)

8O 9 Faculty members’ computer and internet technology skill Hassan Gholami*, Mahmoud Dezhhkam & Nasser Valaee (Mashhad University of Medical Sciences, Education Development Centre, Mashhad, IRAN)

8O 10 Blended learning in a Health Informatics Course Jens Dorup (Section for Health Informatics, Department of Biostatistics, Aarhus, DENMARK)

– 2.51 – Section 2: Tuesday

8O 11 Using handheld computers for mobile experiential learning R Kneebone*, H Fry, C Sorensen, G Wiredu & J Younger (Imperial College School of Science, Technology and Medicine, Department of Surgical Oncology and Technology, London, UK)

8O 12 Teaching ALS in remote and rural areas: a case for teleconferencing J Mardon*, L Hislop, S Wilkie & M Boyd (Glasgow, UK)

8O 13 Implementation of a teaching programme in accident and emergency medicine via teleconferencing J Mardon* & L Hislop (Glasgow, UK)

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1234567890123456789012345678901212345678901234567890123456789012123456 1234567890123456789012345678901212345678901234567890123456789012123458P Computer Assisted Learning 6 1234567890123456789012345678901212345678901234567890123456789012123456

1234567890123456789012345678901212345678901234567890123456789012123456 Chair: To be announced Location of Boards: 1st floor, west corridor

8P 1 Computer-Assisted Learning in undergraduate psychiatry (CAL-PSYCH): evaluation of a pilot programme Allys Guerandel*, Patrick Felle & Kevin Malone (St Vincent University Hospital, Department of Psychiatry, Dublin, IRELAND)

8P 2 Evaluation of an interactive multimedia training module in surgery A Mehrabi*, A Gohring, D Leisenberg, J Zumbach, E Gazyakan, S Holler, N De Cono, M Kadmon, J Schmidt, F Kallinowski & M W Buchler (CBT- Laboratory, Chirurgische Univ, Heidelberg, GERMANY)

8P 3 Students’ response to CBT modules in surgical education A Gohring*, A Mehrabi, J Zumbach, E Gazyakan, S Holler, N De Cono, M Kadmon, J Schmidt, F Kallinowski & M W Buchler (CBT - Laboratory, Chirurgische Univ, Heidelberg, GERMANY)

8P 4 The Virtual Practicum – a model for comprehensive technology based education Joe Henderson* & Christof Daetwyler (Interactive Media Lab, Dartmouth College, Hanover, USA)

8P 5 Virtual interviews and simulation-based learning Olivier Courteille*, Uno Fors, Rolf Bergin and Kirsti Lonka (Karolinska Instituet/LIME, Stockholm, SWEDEN)

8P 6 E-learning in medicine: www.meducase.de Peter Langkafel, Stefan Hoehne and Ralf F Schumann (Charité, Dept of Obstetrics, Faculty of Medicine, Berlin, GERMANY)

8P 7 Interactive CPN: evaluation phase: a didactic computer program Evelyn Palominos and Beatriz Saavedra* (School of Nursing, Faculty of Medicine, Santiago, CHILE)

8P 8 Dynamic patient simulations® for residents in dermatology S Eggermont*, W Bergman & P M Bloemendaal (Leiden University Medical Center, Leiden, NETHERLANDS)

8P 9 Flexible multi-level knowledge integration in computer-based medical teaching cases R Singer*, I Martsfeld, J Heid, S Kopf, S Huwendiek, B Tonshoff & F J Leven (Hygiene Institut, Labor “Computergestutzte” Lehr/Lernsysteme in der Medizin, Heidelberg, GERMANY)

8P 10 3D pelvic floor: a tool for understanding topographical anatomy David Ortoft*, Hanna Reuterborg, Bjorn Meister & Staffan Cullheim (Institution for Learning Informatics, Management and Ethics, Medicinsk Visualisering, Stockholm, SWEDEN)

– 2.52 – Section 2: Tuesday

8P 11 The computer literacy profile of incoming 1st year health sciences students at the University of Cape Town, and the effect of pre-course IT intervention Gudrun Oberprieler*, Ken Masters & Trevor Gibbs (University of Cape Town, Academic Development Programme (ADP), Cape Town, SOUTH AFRICA)

8P 12 Prize for implementing the new technologies in the teaching of the health sciences at the Rovira I Virgili University – from lectures to active learning A Castro, R Descarrega, MR Fenoll-Brunet*, M Giralt, R Miralles, MR Nogués, V Piera, T Sempere, R Solà & F Vidal (Universitat Rovira I Virgili, Facultat de Medicina I Ciencies de la Salut, Reus, Tarragona, SPAIN)

8P 13 Symposiaware for improving information dissemination in visceral surgery M R Ahmadi*, A Mehrabi, K Gawad, A Gohring, J Schmidt, F Kallinowski & M W Buchler (CBT Laboratory, Chirurgische Univ, Heidelberg, GERMANY)

8P 14 Stimulating interest in the tutorial – what is it worth? P G Devitt*, E Palmer & N De Young (University of Adelaide, Department of Surgery, Adelaide, AUSTRALIA)

8P 15 Using a Computer-aided Learning program in an integrated Problem-based Learning medical course: role in formative assessment Samy A Azer (Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, AUSTRALIA)

8P 16 PBL with a case-based e-learning program: experiences and developments Kai Sostmann* & Kai Schnabel (Medical Faculty of the Humboldt University, Reformstudiengang Medizin, Berlin, GERMANY)

8P 17 Residents as teachers: development of a new course using e-learning and face-to-face teaching Jesús Ibarra-Jiménez*, Ismael Piedra-Noriega and Maria de los Ángeles Jiménez-Martinez (ITESM, Monterrey, MEXICO

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123458Q Learning Management Systems and Computer Based Assessment 6 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456

12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123456 Chair: Peter Cantillon, Ireland Location of Boards: 1st floor, west corridor

8Q 1 Criteria list of a case-based computer-supported examination system in medicine C Goetz*, D Neumann & J Neuser (German Institute for Medical and Pharmaceutical Examination, Mainz, GERMANY)

8Q 2 Students’ reflections on a web-based evaluation system Frank Sjoblom* & Vitikka Annu (University of Helsinki, Research and Development Unit for Medical Education, Helsinki, FINLAND)

8Q 3 Using e-learning cases for learning and assessment in an OSCE B Koerner*, M R Fischer, M Holzer and S Schewe (Med Klinikum Innenstadt der LMU, Munich, GERMANY)

8Q 4 Assessment with the case-based e-learning system CASUS: acceptance and pilot validation V Kopp and M R Fischer* (University of Munich, Klinikum der Universitat Munchen, Munich, GERMANY)

– 2.53 – Section 2: Tuesday

8Q 5 Open source software technologies in medical education Stefan Hoehne*, Peter Langkafel and Ralf R Schumann (Charité, Institut für Mikrobiologie & Hygiene, Berlin, GERMANY)

8Q 6 Discussion Board in Blackboard software platform as an additional support at tutorial session in PBL Demetrio Arcos*, Enrique F J Martinez, Graciela Medina, Ricardo Trevino and Jorge Valdez (Monterrey Tech School of Medicine, Monterrey, MEXICO)

8Q 7 The Virtual Medical University (VMU) Project: development of an e-learning platform at the International Medical University, Malaysia Kamal Salih*, Gregory J S Tan & Anwar Kamal (International Medical University, Kuala Lumpur, MALAYSIA)

8Q 8 Virtual curriculum map and navigation in the International Medical University ILMU Learning System Anwar Kamal*, Gregory J S Tan & Kamal Salih (International Medical University, Kuala Lumpur, MALAYSIA)

8Q 9 The Interactive Learning Modular Unit: challenges to students’ learning Gregory J S Tan*, Anwar Kamal & Kamal Salih (International Medical University, Kuala Lumpur, MALAYSIA)

8Q 10 Should virtual learning environments be proactive communities? Michael Begg (University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, UK)

8Q 11 Comprehensive electronic portfolio I Treadwell (University of Pretoria, Skills Laboratory, Pretoria, SOUTH AFRICA)

8Q 12 A content-management framework application for postgraduate paediatric education C Melville*, R Melville & D Collins (City General, Academic Dept of Paediatrics, Stoke-on-Trent, UK)

8Q 13 Integration of IT in the study of medicine at the University of Oslo Silje M Rosseland (The Faculty of Medicine the University of Oslo, OSLO, NORWAY)

8Q 14 The ACETS Project: putting ‘usable’ into the reusable learning object R Ellaway*, D Dewhurst & D Leeder (The University of Edinburgh, MVM Learning Technology Section, Edinburgh, UK)

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789 12345678901234567890123456789012123456789012345678901234567890121234567890123456788R Continuing Professional Development 9 12345678901234567890123456789012123456789012345678901234567890121234567890123456789 Chair: To be announced Location of Boards: Foyer of Dome/Kuppelsaal, 4th floor

8R 1 An on-line, interactive workshop for small-groups – key success factors Francine Borduas*, Christine Lamoureux and Michel Rouleau (Laval University, Clinique Medicale de Meutchatel, Laval, CANADA)

8R 2 Using electronic resources to support CPD Andrew Sackville and David Brigden* (Mersey Deanery, University of Liverpool, Liverpool, UK)

8R 3 General physician opinions of continuing medical education (CME) programs in Ahwaz, Iran Abdolhossain Shakurnia* and Mohammad Smaeel Motlagh (Ahwaz University of Medical Sciences, Educational Development Center (EDC), Ahwaz, IRAN)

– 2.54 – Section 2: Tuesday

8R 4 Gender and CME: female specialists’ perceptions of CME practices Jane Tipping* & Jill Donahue (Markham, Ontario, CANADA)

8R 5 An evaluation of the use of a workbook: ‘A framework for professional development in primary care (the Wessex way)’ in planning CPD Anthony Curtis*, Robin While, John Pitts, Rosemary Ramsay, Margareth Attwood & Vicky Wood (Primary and Community Care, Wiltshire Shared Services NHS Consortium, Devizes, UK)

8R 6 The COP Pilot Project: a project to study information exchange among specialists and other members of selected clinical communities of practice R Laprise*, M Hotvedt, J Parboosingh, R L Thivierge, J Toews, R Lemay, C Campbell, L Samson & T Gondoscz (Aventis Pharma, Department of Professional Education, Laval, CANADA)

8R 7 Self evaluation in continuing medical education (CME): a rheumatological perspective Christine Beyeler*, Reinhard Westkämper and André Aeschlimann (University of Bern, Department of Rheumatology, Bern, SWITZERLAND)

8R 8 Comparing two snapshots over time: UK Medical Royal College CPD Policy Development Francesca Johnson*, Stephen Brigley, Tom Hayes, Howard Young, Stephen Hunter and Gladys Tinker (University of Wales College of Medicine, Cardiff, UK)

8R 9 National Clinical Guidelines: educational programme of rheumatoid arthritis in Finland 2001-2002 Mari Anttolainen*, Ritva Peltomaa, Liisa-Maria Voipio-Pulkki and Juha Pekka Turunen (The Finnish Medical Society, Helsinki, FINLAND)

8R 10 Continuing Medical Education introduction in Serbia Sinisa Gradinac*, Nebojsa Lalic and Djordje Radak (Belgrade University Medical School, Dedinde Cardiovascular Institute, Belgrade, SERBIA AND MONTENEGRO)

8R 11 Teaching Preventive Pediatric Care (PPC): an innovative approach to integrate evidence-based medicine across the medical curriculum Martin Labelle*, Robert L Thivierge, Gilles Brunet, Dominique Cousineau and Daniele Lemieux (University of Montreal, CME Office, Montreal, CANADA)

8R 12 Using individual practice profiles as a guide in medical training for physicians involved in the Toward Excellence in Asthma Management (TEAM) Program Michel Turgeon, Louis-Philippe Boulet, Robert Thivierge*, Eileen Dorval & Peirre Raiche (University of Montreal, Montreal, CANADA)

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1234567890123456789012345678901212345678901234567890123456789012123456 1234567890123456789012345678901212345678901234567890123456789012123458S Management, and Selection 6 1234567890123456789012345678901212345678901234567890123456789012123456

1234567890123456789012345678901212345678901234567890123456789012123456 Chair: To be announced Location of Boards: 1st floor, east corridor

8S 1 Setting research priorities in a medical university: building up a partnership Saeed Asefzadeh (Qazvin University of Medical Science & Health Services, Qazvin, IRAN)

8S 2 Introducing quality culture in the Tbilisi State Medical University R Khetsuriani, Z Avaliani*, G Simonia & Z Vadachkoria (Tbilisi State Medical University, Tbilisi, GEORGIA)

8S 3 Administrative staff opinions on the problems of meeting ISO in medical education P Afshari* & P Assadullahi (Ahvaz Medical Science University, Nursing and Midwifery School of Medical Science, Ahvaz, IRAN)

– 2.55 – Section 2: Tuesday

8S 4 Longitudinal research in medical education: possibilities and challenges Ann W Frye*, Christine A Stroup-Benham, Stephanie A Litwins & Steven A Lieberman (University of Texas Medical Branch, Office of Educational Development, Galveston, USA)

8S 5 In METRO-land: developing a controlled vocabulary for medical education R Ellaway*, A Haig & M Dozier (The University of Edinburgh, MVM Learning Technology Section, Edinburgh, UK)

8S 6 Linking the undergraduate medical curriculum with resource utilization and performance management Judith Hadfield*, Tim Dornan, Tim Johnson & Daniel Powley (Hope Hospital, Department of Undergraduate Education, Salford, UK)

8S 7 A system to support medical students’ experiential clinical learning Tim Dornan*, Dan Powley, Judy Hadfield, Stephen Brown & Martin Brown (Hope Hospital, Manchester, UK)

8S 8 Highlands Schools Medical Mentoring Scheme: Improving applicants’ chance of selection to medical school Mandy Hunter & Malcolm Laing* (University of Aberdeen, Undergraduate Teaching Centre, Inverness, UK)

8S 9 Impact of writing a personal statement on residency candidates Angel M Centeno*, Cecilia Primogerio & Alejandra Blanco (School of Biomedical Sciences, Universidad Austral-Medicina, Buenos Aires, ARGENTINA)

8S 10 Gender difference in training for medical specialise of Thai physicians Chusak Uewichitrapochana (Buddhachinaraj Hospital Medical Centre, Department of Surgery, Phitsanulok, THAILAND)

8S 11 The collaborative project to increase production of rural doctors: equity of student selection Suwat Lertsukprasert (Office of the Collaborative Project to Increase Production of Rural Doctors, Nonthaburi, THAILAND)

8S 12 The medical admissions interview: comparison of individual unstructured interviews and semi-structured panel interview C A Courneya*, K Wright, V Finton & G Pachev (University of British Columbia, Department of Physiology, Vancouver, CANADA)

8S 13 A preferential access program to a Faculty of Medicine for outstanding socially disadvantaged students: lessons learned in two years Verónica Gaete*, Gloria Riquelme, Jorge Las Heras, Cristina Zuñiga, Carolina López & Fabio Sáenz (University of Chile, Santiago, CHILE)

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890128T Outcomes, Professionalism, and Research and Critical Thinking 3 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567890123 Chair: To be announced Location of Boards: Foyer of Dome/Kuppelsaal, 4th floor

8T 1 Good characteristics of doctors according to a perception and self-assessment of the 6th year medical student practising in Khon Kaen Hospital, Thailand Surachai Saranrittichai*, Sirijitt Vasanawathana & Mungkon Noimay (Medical Education Center, Khon Kaen Regional Hospital, Khon Kaen Province, THAILAND)

– 2.56 – Section 2: Tuesday

8T 2 Effective multidisciplinary education and training in child abuse and neglect M J Bannon* & Y H Carter* (London Deanery, Medical Education Dept, Harrow, UK)

8T 3 Students’ perception of the medical profession at different stages of medical training M G H Nieuwhof*, M M Kuyvenhoven, M B M Soethout & Th J ten Cate (University Medical Center Utrecht, Onderwijsinstituut, School of Medical Sciences, Utrecht, NETHERLANDS)

8T 4 Which medical skills are important? Clinical skills questionnaire J Schulze*, S Drolshagen & F Nurnberger (Dean’s Office, JWG Universität, Frankfurt/Main, GERMANY)

8T 5 A compendium of tools to assess professionalism Deirdre C Lynch, Patricia M Surdyk* & Arnold R Eiser (Accreditation Council for Graduate Medical Education, Chicago, USA)

8T 6 Self-reported attitudes and behaviours of undergraduate medical students regarding professional integrity D E E Rizk & M A Elzubeir* (United Arab Emirates University, Faculty of Medicine and Health Sciences, Al-Ain, UNITED ARAB EMIRATES)

8T 7 How does postgraduate medical training in general practice affect the trainers? Niels Kjaer* & Charlotte Tulinius (Department of Research and Postgraduate Medical Education, Sonderborg, DENMARK)

8T 8 Ethics and professionalism: where do students obtain their value systems? Helen Maxwell-Jones*, Ash Samanta & David Heney (Leicester Medical School, Division of Medical Education, Leicester, UK)

8T 9 Developing 360 degrees feedback in UK postgraduate clinical tutors’ professional development Kit Byatt* & A Long (Hereford Country Hospital, Hereford, UK)

8T 10 Evaluation of students’ professionalism at Medical Faculty, Palacky University in Olomouc, Czech Republic – a pilot study Petr Jindra*, Radim Licenik, Lenka Doubravska, Vit Gloger, Jan Strojil, Renata Simkova, Iveta Zedkova & Cestmir Cihalik (Palacky University, Faculty of Medicine, Olomouc, CZECH REPUBLIC)

8T 11 Student scientific activities at Jessenius Faculty of Medicine CU in Martin – present state and how to improve it Juraj Mokry*, Daniela Sevecova, Branislav Kolarovszki, Rudolf Zach and Miroslav Sulaj (Jessenius Faculty of Medicine, Comenius University, Martin, SLOVAKIA)

8T 12 Medical students’ performance on a Medline OSCE: does an intercalated degree help? M Dozier*, H Cameron and S Yewdall (University of Edinburgh, Erskine Medical Library, Edinburgh, UK)

8T 13 A controlled comparison study of the efficacy of training medical students in literature searching skills Larry D Gruppen*, Gurpreet K Rana & Theresa S Arndt (Department of Medical Education, The University of Michigan Medical School, Ann Arbor, USA)

8T 14 Problems and impediments of implementing Best Evidence Medical Education (BEME) strategy in Shaheed Beheshti University of Medical Sciences (SBUMS) Shahram Yazdani* (Educational Development Center, Shaheed Beheshti University of Medical Sciences and Health Services, Tehran, IRAN)

– 2.57 – Section 2: Tuesday

1645-1815 Session 9 Short Communications (4): Simultaneous themed sessions

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1234567890123456789012345678901212345678901234567890123456789012123459A Computers in the Curriculum 6

1234567890123456789012345678901212345678901234567890123456789012123456 Chair: Brigitte Grether, Switzerland Discussant: To be announced Location: Room 210

1645 9A 1 Does the computer add anything to a tutorial? P G Devitt*, E Palmer & N De Young (University of Adelaide, Department of Surgery, Adelaide, AUSTRALIA)

1700 9A 2 Systematic integration of information technology within a medical school curriculum Cam Enarson* & John Boehme (Wake Forest University School of Medicine, Winston-Salem, USA)

1715 9A 3 Introducing George: initial evaluation of a new teaching method designed to enhance the integration of knowledge and understanding across a 5 year medical course Patricia M Warren*, Mike Porter, Rachel H Ellaway*, Phillip Evans, A John Simpson, Gordon B Drummond & Simon Maxwell (The University of Edinburgh, Medical Teaching Organisation Office, Edinburgh, UK)

1730 9A 4 Wash-out of the innovation frenzy? A longitudinal evaluation of case-based e-learning in internal medicine with the CASUS systerm M Adler*, A Simonsohn and M R Fischer (Klinikum der univ Munchen, Med Klinik Innenstadt, Munich, GERMANY)

1745-1815 Discussion

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12345678901234567890123456789012123456789012345678901234567890121234567890123 12345678901234567890123456789012123456789012345678901234567890121234567890129B Assessing Communication Skills 3 12345678901234567890123456789012123456789012345678901234567890121234567890123

12345678901234567890123456789012123456789012345678901234567890121234567890123 Chair: Ronald Nungester, USA Discussant: Elizabeth Kachur, USA Location: Room 110

1645 9B 1 Medical students’ communication skills, from the supervisor’s perspective – assessment in the final year of undergraduate medical education in Goteborg, Sweden M Wahlqvist*, B Mattsson, G Dahlgren, B Hamark, M Hartvig-Ericsson, B Henriques, U Hostery- Ugander (Department of Primary Health Care in Goteborg, Goteborg, SWEDEN)

1700 9B 2 Identifying and improving preclinical students with unsatisfactory communication skills Jon Dowell* & John Dent (Tayside Centre for General Practice, Dundee, UK)

1715 9B 3 Communicating information – knowledge and risk Connie Wiskin*, Phil Croft, Selene Burn and Dawn Dodwell (University of Birmingham, Dept of Primary Care & GP, Birmingham , UK)

1730 9B 4 Which communication skills are learnt in practice and which need to be taught? Knut Aspegren* and Peter Loenberg Madsen (Copenhagen School of Medicine, National Board of Health, Copenhagen, DENMARK)

– 2.58 – Section 2: Tuesday

1745 9B 5 Communication skills performance in an OSCE depends on clinical context and cannot be assessed in isolation A M S Chesser*, J Cleland, Z Miedzybrodzka and M R Laing (University of Aberdeen, Undergraduate Teaching Centre, Inverness, UK)

1800-1815 Discussion

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123456789012345678901234567890121234567890123456789012345 123456789012345678901234567890121234567890123456789012349C The Curriculum (2) 5 123456789012345678901234567890121234567890123456789012345

123456789012345678901234567890121234567890123456789012345 Chair: To be announced Discussant: To be announced Location: Room 201

1645 9C 1 Is self-efficacy in clinical skills of medical students a tool to monitor curricular changes? J Juenger*, D Schellberg, C Nikendei, M Benkowitsch, S Schaefer, R Faber, C Roth, B Auler & W Herzog (Department of Internal Medicine, University of Heidelberg, Heidelberg, GERMANY)

1700 9C 2 Problems encountered in changing a clinical curriculum – and their solutions Sigrid Harendza*, Rolf Stahl, Gerard Majoor & Wim Gijselears (Universitätsklinikum Hamburg- Eppendorf, Zentrum für Innere Medizin, Hamburg, GERMANY)

1715 9C 3 Evaluation of a new curriculum (HeiCuMed) – comparison before and after implementation Martina Kadmon*, E Gazyakan, Susann Holler, Nina Latham and J Schmidt (Surgery Clinic, University of Heidelberg, Heidelberg, GERMANY)

1730 9C 4 Bottom-up innovation to improve medical education in surgery M K Widmer*, T Carrel & J Steiger (University of Berne, Department of Cardiovascular Surgery, Berne, SWITZERLAND)

1745 9C 5 Drama and medicine – a Special Study Module Connie Wiskin, Selene Burn* & John Skelton (University of Birmingham, Department of General Practice, Birmingham, UK)

1800-1815 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567890121234569D Assessment and Delivery of Postgraduate Education 7

1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567890121234567 Chair: Clair du Boulay, UK Discussant: Alistair Thomson, UK Location: Room 220

1645 9D 1 Patient outcomes for colon resection according to training and certification J B Prystowsky & G Bordage* (Department of Medical Education, University of Illinois at Chicago, Chicago, USA)

1700 9D 2 Accuracy of medical staff assessment of operative performance A M Paisley* & S Paterson Brown (University Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK)

1715 9D 3 Evaluation of key skills: a new initative within vocational training in West Midlands Dentistry Vickie Firmstone, Julie Bedward*, Alison Bullock, John Hall & John Frame (CRMDE, School of Education, Birmingham, UK)

– 2.59 – Section 2: Tuesday

1730 9D 4 A comparison of inpatient teaching evaluations by resident and peer physicians: Who’s more reliable? Thomas J Beckman*, Mark C Lee and Jayawant N Mandrekar (Mayo Clinic, Division of General Internal Medicine, Rochester, USA)

1745 9D 5 Strategic planning for developing Postgraduate Medical and Dental Education in Wales S A Smail* and H L Young (School of Postgraduate Medical and Dental Education, University of Wales College of Medicine, Cardiff, UK)

1800-1815 Discussion

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234569E Continuing Professional Development – Needs Assessment 7

12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901234567 Chair: To be announced Discussant: To be announced Location: Room 205

1645 9E 1 An effective learning needs assessment process for GPs Derek Gallen and Glynis Buckle* (Oxford PGMDE, Albany House Medical Centre, Wellingborough, UK)

1700 9E 2 Training needs in sexual health: evidence from GP trainers in the West Midlands, UK Alison Bullock*, Wolf Markham, Philippa Matthews & Stephen Kelly (Centre for Research in Medical & Dental Education, School of Education, Birmingham, UK)

1715 9E 3 Using multisource feedback for physicians: report of a pilot study Joan Sargeant*, Karen Mann, Suzanne Ferrier, Donald Langille, Philip Muirhead and Douglas Sinclair (Faculty of Medicine, Dalhousie University, Halifax, CANADA)

1730 9E 4 BEME Collaboration Systematic Review: feedback and physician performance Jon Veloski, James Boex* and Daniel Wolfson (Office of Health Services Org & Res, NE Ohio University College of Medicine, Rootstown, USA)

1745-1800 Discussion

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12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678909F Clinical training: new guidelines to a common approach 1 12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901

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1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234567890121234567890Leonardo da Vinci Project 1

12345678901234567890123456789012123456789012345678901234567890121234567890123456789012345678901212345678901 Chair: Paulo Costa, Portugal Discussant: Mathieu Nendaz, Switzerland Location: Room 101

(Please note: the presentations times in this session will not be synchronised with the other sessions)

1645 Introduction to the Project P M Costa (Faculdade de Medicina de Lisboa, University of Lisbon, Portugal)

9F 1 Clinical training: new guidelines to a common approach: A Leonardo da Vinci multi centered project at the University of Lisbon, Faculty of Medicine M F Patricio*, J G Jordao & P M Costa (Faculdade de Medicina de Lisboa, University of Lisbon, Lisboa, PORTUGAL)

– 2.60 – Section 2: Tuesday

9F 2 Clinical training: new guidelines to a common approach: A Leonardo da Vinci multi centered project at the University of Wales College of Medicine, Cardiff Howard Young*, Helen Houston, Helen Sweetland & Richard Mills (School of Postgraduate Medical & Dental Education, University of Wales College of Medicine, Cardiff, UK)

9F 3 Clinical training: new guidelines to a common approach: A Leonardo da Vinci multi centered project at the School of Medicine, University of Granada C Campoy, J M Peinado*, J Canizares, C Chung & B Gil (Department of Paediatrics, School of Medicine, University of Granada, SPAIN)

9F 4 Clinical training: new guidelines to a common approach: A Leonardo da Vinci multi centered project at the University of Extremadura, Faculty of Medicine C Pizarro*, J M Moran & J A G Agundez (Extremadura University - Faculty of Medicine, Badajoz, SPAIN)

9F 5 Clinical training: new guidelines to a common approach: A Leonardo da Vinci multi centered project at the Pecs University Faculty of Medicine Peter Szekeres* & Anna Bukovinszky* (Pecs Medical University, Department of Trauma, Pecs, HUNGARY)

1800-1815 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345679G Courses for Medical Teachers 8

123456789012345678901234567890121234567890123456789012345678901212345678 Chair: Angel Centeno, Argentina Discussant: To be announced Location: Room 120

1645 9G 1 Results from the evaluation of a faculty development program for 414 physicians as educators for a large German medical school O Genzel-Boroviczeny*, F Christ, T Aretz, E Armstrong & R Putz (LMU Innenstadt, Neonatology, München, GERMANY)

1700 9G 2 Studies on doctors and dentists taking university educational qualifications David Wall* & Zoe Nuttall (West Midland Deanery, PMDE, Birmingham, UK)

1715 9G 3 Developing skills in educational appraisal: from theory to practice Gellisse Bagnall*, William Reid & Chris Morran (NHS Education for Scotland - West Region, Glasgow, UK)

1730 9G 4 Changing teachers’ learning skills – a pilot study L Nasmith* & Y Steinert (University of Toronto, Department of Family & Community Medicine, Toronto, CANADA)

1745 9G 5 The Physician-as-Teacher rule: hypothesis or fact? Jamiu Busari (Emma Childrens Hospital, Academic Medical Center, Amsterdam, NETHERLANDS)

1800-1815 Discussion

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12345678901234567890123456789012123456789012345678909H Student Support 1

12345678901234567890123456789012123456789012345678901 Chair: Margarita Barón-Maldonado, Spain Discussant: Nikola Borojevic, Croatia Location: Room 215

– 2.61 – Section 2: Tuesday

1645 9H 1 Academic support Norma Susswein Saks (UMDNJ-Robert Wood Johnson Medical School, Piscataway, USA)

1700 9H 2 Stressors and coping strategies in nursing students, Shiraz - 2000 Farkhondeh Sharif*, Reza Zighamiee, Hamid Ashkani and Alireza Ayatollahi (Shiraz University of Medical Sciences, Shiraz, IRAN)

1715 9H 3 Influence of studying students’ health Ozgur Onur (IFMSA, Aachen, GERMANY)

1730 9H 4 Student support mechanisms – implementing Best Evidence Medical Education R Arnold* & J G Simpson (University of Aberdeen, Department of Old Age Psychiatry, Aberdeen, UK)

1745 9H 5 Impact of a mentoring program in a Brazilian Medical School: changes acknowledged by the students Patricia Lacerda Bellodi* & Milton de Arruda Martins (University of Sao Paulo, BRAZIL)

1800-1815 Discussion

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12345678901234567890123456789012123456789012345678901234 12345678901234567890123456789012123456789012345678901239I Patient Simulation 4 12345678901234567890123456789012123456789012345678901234 Chair: Amitai Ziv, Israel Discussant: Graceanne Adamo, USA Location: Room 114

1645 9I 1 A portable skills lab for scenario-based training R Kneebone*, D Nestel, B Lo, R King, J Kidd, A Barnet, L Poore, R Brown, L Edwards, G Z Yang & A Darzi (Imperial College School of Science, Technology and Medicine, Department of Surgical Oncology and Technology, London, UK)

1700 9I 2 Interpretation of three-dimensional structure from two-dimensional endovascular images: how experience and training affect perception R S Sidhu*, S J Hamstra, D Tompa, R Jang, E D Grober, R K Reznick & K W Johnston (University of Toronto, Centre for Research in Education, Toronto, CANADA)

1715 9I 3 Teaching clinical reasoning with the Dynamic Patient Simulator S Eggermont*, P M Bloemendaal and J M van Baalen (Leiden University Medical Center, Leiden, NETHERLANDS)

1730 9I 4 The impact of computer-based learning in training cardiopulmonary resuscitation Helle Thy Ostergaard*, Doris Ostergaard, Anne Lipper, Alice Drenthe and Jan van Dalen (The Danish Institute for Medical Simulation, Department of Anaesthesiology, Vaerlose, DENMARK)

1745 9I 5 On-site, hands-on simulation training program using a mid-fidelity simulator for crisis resource management and teamwork training Kitoji Takuhiro*, Hisashi Matsumoto, Toru Mochizuki, Yuji Kamikawa, Yuichiro Sakamoto, Yoshiaki Hara, Kunihiro Mashiko & Yasuhiro Yamamoto (CCM Nippon Medical School, Chiba Hokuso Hospital, Chiba, JAPAN)

1800-1815 Discussion

– 2.62 – Section 2: Tuesday

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12345678901234567890123456789012123456789012345678901234567 12345678901234567890123456789012123456789012345678901234569J Rewarding Teaching 7 12345678901234567890123456789012123456789012345678901234567 Chair: To be announced Discussant: Sally Brown, UK Location: Room 106

1645 9J 1 Mayo Clinic Clinician Educator Award Program Thomas R Viggiano* & Roger W Harms (Mayo Clinic, Mitchell Student Center, Rochester, USA)

1700 9J 2 Financial incentives to improve teaching R P Nippert*, U Grawe, B Marschall & A Bockers (Institut für Ausbildung und Studienangele- genheiten, der Medizinischen Fakultät (IfAS), Munster, GERMANY)

1715 9J 3 Developing tomorrow’s leaders of healthcare education in the UK Stewart Petersen* & Judy McKimm (Leicester Medical School, Department of Medical and Social Care Education, Leicester, UK)

1730 9J 4 An algorithm for distributing faculty funds on the basis of quality of teaching H van den Bussche*, M Ehrhardt & H Kaduskiewicz (Department of General Practice, University Hospital, Hamburg, GERMANY)

1745 9J 5 Faculty recruitment and retention M R Sandhya Belwadi (M S Ramaiah Medical College & Teaching Hospital, Bangalore, INDIA)

1800-1815 Discussion

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123456789012345678901234567890121234567890123456789012345678901212345 123456789012345678901234567890121234567890123456789012345678901212349K Is the Graduate Competent? 5 123456789012345678901234567890121234567890123456789012345678901212345

123456789012345678901234567890121234567890123456789012345678901212345 Chair: Michele Groves, Australia Discussant: Rosalie Ber, Israel Location: Room 206

1645 9K 1 Anxieties and fears facing general residency: are we preparing students commencing clinical practice? Antonio Pais de Lacerda*, Paulo Seca & Maria Jose Metrass (Hospital de Santa Maria, Lisboa, PORTUGAL)

1700 9K 2 Postgraduate education for hospital based midwives in the Netherlands A Zuidinga*, W v d Meijs & F Scheele (St Lucas Andreas Hospital, Amsterdam, NETHERLANDS)

1715 9K 3 Is the clinical study appropriate? Students’ views J Schulze*, S Drolshagen & P Schmucker (Dean’s Office, Frankfurt/Main, GERMANY)

1730 9K 4 Informed consent in clinical practice: experiences, knowledge and views of Pre-registration House Officers Jan Schildmann*, Annie Cushing, Len Doyal & Jochen Vollmann (Institute of Medical History and Medical Ethics, Friedrich-Alexander University, Erlangen, GERMANY)

1745 9K 5 A formal assessment of the practical skills of South African medical graduates on entry to their pre-registration year: evidence that key skills are lacking Rae Nash*, Vanessa Birch, Tuvia Zabow, Trevor Gibbs & Richard Hift (University of Cape Town, Department of Medicine, Cape Town, SOUTH AFRICA)

1800-1815 Discussion

– 2.63 – Section 2: Tuesday

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1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234 1234567890123456789012345678901212345678901234567890123456789012123456789012345678901239L Postgraduate Multiprofessional Education 4 1234567890123456789012345678901212345678901234567890123456789012123456789012345678901234 Chair: To be announced Discussant: To be announced Location: Room 105

1645 9L 1 Evaluation of a faculty program in palliative care education and practice Amy M Sullivan, Antoinette S Peters* & Susan D Block (Harvard Medical School, Dana-Farber Cancer Institute, Boston, USA)

1700 9L 2 Into the unknown: the development of a new multidisciplinary health care professional Kath Start (Kingston University/St George’s Hospital Medical School, Kingston upon Thames, UK)

1715 9L 3 Knowledge increase following an evidence-based multiprofessional education program aimed at service improvement Kirsty Foster* & Janet Vaughan (RPA Newborn Centre, Royal Prince Albert Hospital, Camperdown, AUSTRALIA)

1730 9L 4 Team communication in the operating theatre: observations and interviews Debra Nestel*, Jane Kidd, Krishna Moorthy & Yaron Munz (Monash University, Centre for Medical & Health Sciences Education, Clayton, AUSTRALIA)

1745 9L 5 What makes the operating theatre an effective teaching and learning environment? A multi-professional perspective Jane Kidd*, Debra Nestel, Krishna Moorthy & Yaron Munz (Imperial College London, London, UK)

1800-1815 Discussion

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1234567890123456789012345678901212345678901234567890123456789012123456789012349M Special Subjects in the Curriculum 5

1234567890123456789012345678901212345678901234567890123456789012123456789012345 Chair: Eliot Sorel, USA Discussant: Athol Kent, South Africa Location: Room 115

1645 9M 1 Preparing preclinical medical students for brief smoking cessation interventions Linda Z Nieman*, Lewis E Foxhall, Mary M Velasquez and Janet Y Groff (UT Houston Health Science Center, Family Practice and Community Medicine, Houston, USA)

1700 9M 2 Medical students’ perceptions of the relevance of behavioural and social sciences towards their medical education Christine Bundy, Lis Cordingley, Andrea Pilkington* & James Urquhart (University of Manchester, Medical School, Manchester, UK)

1715 9M 3 Medical students’ sexual history-taking behaviour one year on from an educational intervention Annie Cushing* & Dason Evans (St. Bartholomews & The Royal London Queen Mary’s, School of Medicine and Dentistry, London, UK)

1730 9M 4 Teaching leadership and management to medical students – perspectives from UK and Portugal H M G Martins*, D E Detmer & E Rubery (University of Cambridge, The Judge Institute of Management, Cambridge, UK)

1745 9M 5 Teaching complementary and alternative medicine (CAM) to internists M G Hewson*, J E Fox, H L Copeland & E Topol (The Cleveland Clinic Foundation, Cleveland, USA)

– 2.64 – Section 2: Tuesday

1800-1815 Discussion

Evening Optional entertainment Conference Dinner at Kursaal Bern

Address: Kornhausstrasse 3, CH-3000 Bern 25 Directions: On foot: From the Railway Station take Spitalgasse and into Marktgasse. Turn left at Zytglogge (old clock tower), over the bridge (Kornhausbrucke) and you will see the entrance to Kursaal (total walking time 15 minutes). Places still available – contact the AMEE Office. See page 3.2 for details.

– 2.65 – Section 2: Wednesday

Wednesday 3 September

0800-1330 Registration Desk open Location: Kultur Casino Bern

0830-1015 Session 10 Plenary 2: Professionalism of medical education Chair: Ronald Harden, UK

0830-0855 Identifying and rewarding excellent teaching Sally Brown (Institute of Learning and Teaching in Higher Education, York, UK)

0900-0925 Is evidence-based teaching and learning really possible? Philip Davies (Cabinet Office, London, UK)

0930-0955 21st century physicians’ social accountabiity and professional responsibility: the implications for medical education and for the medical teacher Eliot Sorel (School of Medicine and Health Sciences and School of Public Health and Health Services, The George Washington University, Washington, D.C., USA)

1000-1015 Discussion

1015-1045 Coffee at Kultur Casino

1045-1300 Session 11 Plenary 3: Teaching and Learning in the Healthcare Professions Chair: Margarita Barón-Maldonado (University of Alcalá, Alcalá de Heneres, Spain)

1045-1100 The PBL paradox – a lighthearted view of medical education Geoff Norman (McMaster University, Canada) and Ralph Bloch (University of Bern)

1100-1135 Born to be good, train to be great Richard K Reznick (University of Toronto, Canada)

1135-1145 Discussion

1145-1235 Putting the learning into e-learning Phil Race (York, UK)

1235-1245 Discussion

1245-1300 Announcement of Medical Teacher Poster Prize and AMEE Poster Quiz Winner

1300 Close of Conference, and a look ahead to AMEE 2004 in Edinburgh.

Please remember to complete and return your Conference and Workshop Evaluation Forms, either to the registration desk on departure or by sending them to the AMEE Office following the Conference.

– 2.66 – Section 3

Accommodation

Please direct all reservations (on Form C, available on the AMEE website) and all queries relating to reservations to: Bern Tourismus P O Box CH-3001 Bern Switzerland Tel: +41 31 328 12 28 Fax: +41 31 328 12 99 Email: [email protected]

A map of Bern showing all the Conference hotels is available on the University of Bern AMEE Conference website: http://amee03.unibe.ch/accomodation.htm

Conference Social Programme

Tickets are still available from the AMEE Office for the social events and tours (contact Tracey Martin: [email protected]). See University of Bern AMEE Conference website for pictures: http://amee03.unibe.ch/social_programm.htm

Sunday 31 August (1900-2100 hours) Opening Ceremony and Reception Location: Kultur Casino, Herrengasse 25, CH-3011 Bern (see map on page 1.19) A short welcome address, followed by a recital of classical and jazz music, and a cocktail reception with canapés (please note, only a light snack will be provided). (No charge – included in the registration fee for participants and registered accompanying persons.)

Monday 1 September Option 1: Schiller’s William Tell Bus trip to the Open Air Theatre at Interlaken for a performance of Schiller’s William Tell, including a buffet meal at the lakeside at Gwatt On the live open-air stage in the wood near Interlaken, with covered seating for spectators, you won’t miss any authentic detail of the hardship and suffering of the Swiss people some 800 years ago in this exciting drama by Friedrich Schiller, with over 180 actors dressed in historical national costumes, the knights on horses at a gallop or the traditional alpine procession. The play is in German, but each scene will be summarized in English by an actor. See the website for more information: (http://www.tellspiele.ch) On the way to Interlaken we stop at a beautiful location on the shore of Lake Thun. You can enjoy a Swiss garden buffet meal, and if you wish, take a short walk by the picturesque lakeside (http://www.gwatt-zentrum.ch) Depart University and City Centre: 1745 Return arrival at Railway Station: 2330 Price: Euros 77; £49

– 3.1 – Section 3

Option 2: Theatre performance only, without meal Depart University and City Centre: 1915 Return arrival at Railway Station: 2330 Price: Euros 50; £32

Tuesday 2 September (1930-2400 hours) Conference dinner with entertainment and dancing Location: Kursaal Bern, Kornhausstrasse 3, CH-3000 Bern 25 (see map on page 1.19) Price: Euros 65; £41

We meet on the terrace of Kursaal Bern (http://www.kursaal-bern.ch/) where hopefully there will be a wonderful view over the city and the Alps. Enjoy a three course dinner in the Arena and relax and laugh at the new and highly unusual performance of the LYNX visual theatre and dance performance group (http://www.mattis.ch/) Afterwards there will be an opportunity to dance until midnight (for those participants not presenting at 0830 on Wednesday!).

Tours

Please either reserve using Form A (the AMEE registration form) enclosed with the provisional programme, or contact the AMEE Office. Payment is required at the time of booking.

Saturday 30 August (0840-1830 hours) Jungfraujoch - the top of Europe (an excursion not to be missed!) After travelling by private coach through the famous Bernese Oberland, you will take the railway from Grindelwald Grund to Kleine Scheidegg and then the world famous Jungfrau Railway to Jungfraujoch with spectacular mountain scenery. After lunch in Jungfraujoch you will go on by rail to Lauterbrunne and then by coach to Interlaken for some shopping. Return to Bern by coach. Price includes all transport, lunch and an English-speaking guide. (Please note: occasionally, adverse weather conditions mean that less time is spent on Jungfraujoch and more time spent in Interlaken.) Price: Euro 180; £113

Sunday 31 August (1000-1240 hours) City tour by coach Meeting your guide at the Main Railway Station, join the coach for a tour of the city, through Bern’s attractive Old Town, with its delightful arcades, monuments and fountains. Visit the rose garden, the bear pits, the impressive cathedral, the parliament buildings and the famous clock tower, followed by the Old Tramdepot for a performance of the Bern Show – an encapsulated history centred around an animated model of the city. Price includes coach transport, entry to the Bern Show and an English-speaking guide. Price: Euro 22; £14

– 3.2 – Section 3

Sunday 31 August (1400-1620 hours) City tour on foot Explore Bern’s attractive Old Town, with its delightful arcades, monuments, fountains, Cathedral and Clock Tower. Visit the Old Tramdepot for a performance of the Bern Show – an encapsulated history centred around an animated model of the city. Price includes entry to the Bern Show and an English-speaking guide. A maximum of 20 persons to each guide will ensure you hear the interesting commentary. Price: Euro 11; £7

Monday 1 September (0900-1640 hours) Lake Thun Depart Bern by train to Thun, to meet the boat for Spiez. Enjoy a delicious Swiss cocktail of cheese and wine on board. Visit the Heimat- und Rebbau museum of the native land and cultivation of vines, and the home of carpenter Christen Linder, built in 1728. Following lunch, travel on to Thun by train, for a guided tour through the village, with time for shopping. Return to Bern by train. Price includes 1st class train and boat fare, Swiss cocktail, lunch (without drinks), entrance to Spiez museum and an English-speaking guide. Price: Euro 103; £65

Tuesday 2 September (0800-1800 hours) Lausanne and Gstaad Leave Bern by coach to Lausanne, to visit the Olympic Museum with its beautiful gardens and statues. Move on to the charming village of Chexbres for wine tasting at the Caveau des Vignerons followed by lunch at la Pinte du Paradis, next to the Castle of Aigle. After lunch travel through the beautiful landscape to Gstaad, famous for its “high society” visitors from all over the world. After a guided tour of the village, enjoy the shops and the scenery before returning to Bern via the Simm valley and its typically Swiss villages. Price includes coach transport, entry to the Olympic Museum, Wine tasting and cocktail, lunch (without drinks) and an English-speaking guide. Price: Euro 127; £80

Wednesday 3 September (0830-1215 hours) Emmental Leave Bern by coach for Emmental, a charming region rich in tradition and renowned for its cheesemaking. Look around the dairy and enjoy a Swiss cocktail with bread and cheese. Take in the scenery on the leisurely drive back to Bern. Price includes coach transport, entry to the dairy, Swiss cocktail and an English-speaking guide. Price: Euro 55; £35

Information for Students The University of Bern medical students are looking forward to meeting you. Please see their website for information on activities for students during the Conference. http://amee03.unibe.ch/students.htm

– 3.3 – Section 3 123456789012345678901234567

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123456789012345678901234567 – 3.4 – Section 4

Abstracts

Pre-Conference Special Interest Group ...... 4.3

Session 1: Plenary 1 ...... 4.3

Session 2: Short communications 1 2A E-learning ...... 4.4 2B The examiner’s toolkit ...... 4.5 2C Curriculum planning 1...... 4.6 2D Curriculum evaluation ...... 4.8 2E Teaching and learning...... 4.9 2F International medical education 1 ...... 4.11 2G Staff development – training needs ...... 4.12 2H OSCE 1 ...... 4.13 2I Problem based learning ...... 4.15 2J Teaching and assessing attitudes ...... 4.16 2K Clinical skills training ...... 4.17 2L Undergraduate multiprofessional education ...... 4.19 2M Research and critical thinking ...... 4.20 2N Selection ...... 4.21

Session 3: Short communications 2 3A Virtual learning environment ...... 4.23 3B Computer-based assessment...... 4.24 3C Curriculum planning 2...... 4.25 3D Training and assessment for general practice/family medicine .. 4.27 3E Teaching and learning communication skills ...... 4.28 3F International medical education 2 ...... 4.29 3G Assessment of teaching ...... 4.30 3H OSCE 2 ...... 4.32 3I Problem-based learning and computers ...... 4.33 3J Progress test ...... 4.35 3K Clinical teaching and the patient ...... 4.36 3L Professionalism 1 ...... 4.37 3M The core curriculum ...... 4.38

Session 4: Workshops ...... 4.40

Session 5: Large Group Sessions and Short Communications 3 5A Standard setting (LGS) ...... 4.46 5B Cognitive perspective on learning: implications for teaching (LGS) .. 4.46 5C BEME review of high fidelity simulation (LGS) ...... 4.46 5D Making medical education relevant to medical practice (LGS) .. 4.46 5E Complex adaptive systems and medical education (LGS) .. .. 4.46 5F Postgraduate assessment (Short communications) ...... 4.46 5G Community-based education (Short communications) .. .. 4.48 5H Student learning (Short communications) ...... 4.49

Session 6: Workshops ...... 4.51

– 4.1 – Section 4

Session 7: Short Communications 4 7A Computer-based teaching ...... 4.57 7B The final exam...... 4.58 7C Curriculum 1 ...... 4.59 7D Postgraduate training in the early years ...... 4.61 7E Continuing Professional Development ...... 4.62 7F Assessment of the practising doctor ...... 4.63 7G Different approaches to staff development ...... 4.64 7H Student diversity ...... 4.65 7I Evaluation of problem-based learning ...... 4.67 7J Management of clinical training ...... 4.68 7K Clinical training in different settings ...... 4.69 7L Professionalism 2 ...... 4.70 7M Outcome-based education ...... 4.71

Session 8: Posters 8A Assessment – general ...... 4.73 8B Clinical assessment ...... 4.76 8C Curriculum 1 (including Multiprofessional education) .. .. 4.79 8D Curriculum 2 ...... 4.83 8E Evaluation of the curriculum ...... 4.87 8F Teaching clinical skills (1) ...... 4.90 8G Teaching clinical skills (2) ...... 4.93 8H International medical education ...... 4.97 8I Problem-based learning ...... 4.99 8J Postgraduate education ...... 4.102 8K Staff development ...... 4.106 8L Students ...... 4.109 8M Teaching and learning (1) ...... 4.112 8N Teaching and learning (2) ...... 4.115 8O E-learning and the internet ...... 4.119 8P Computer-assisted learning ...... 4.122 8Q Learning management systems and computer-based assessment .. 4.126 8R Continuing Professional Development ...... 4.129 8S Management/Selection ...... 4.132 8T Outcomes/Professionalism/Research and critical thinking .. .. 4.135

Session 9: Short Communications (5) 9A Computers in the curriculum ...... 4.139 9B Assessing communication skills ...... 4.140 9C Curriculum (2) ...... 4.141 9D Assessment and delivery of postgraduate education .. .. 4.142 9E CPD needs assessment ...... 4.143 9F Clinical training – Leonardo project ...... 4.144 9G Courses for medical teachers...... 4.146 9H Student support ...... 4.147 9I Patient simulation ...... 4.148 9J Rewarding teaching ...... 4.149 9K Is the graduate competent? ...... 4.150 9L Postgraduate multiprofessional education ...... 4.152 9M Teaching special subjects ...... 4.153

Session 10: Plenary 2 ...... 4.155

Session 11: Plenary 3 ...... 4.155

– 4.2 – Section 4 Special Interest Group Meeting: National Groups Of Health Science Educators

Purpose: The purpose of this meeting will be to discuss ways that Subjects for discussion: national groups of health science educators can communicate • Conference diary with conference dates and post conference with each other. resumes or proceedings. Many countries have national organisations that co-ordinate the • Medical student exchanges between countries. efforts of health science educationalists. At this meeting we will • The advertisement of health science education jobs. discuss how information from one group could be usefully sent to others. • Joint projects such as health science specialisation. • Units of medical education offering degrees. Agenda: • Links to websites of national and other organisations. 1 Which groups should be contacted to collaborate? Who should attend: Anyone interested in an information exchange 2 Who would co-ordinate this effort and how? between health science educators on an international level. 3 What topics would be for distribution? Representatives of health science organisations, journals or interested individuals will be welcome to attend. Suggestions: The following organisations should be invited: It would be helpful if people intending to be present would AMEE, ANZME, ASME, BEME, coHEHre, SAAHE, WFME, groups communicate with Athol Kent ([email protected]) in advance from Canada, Holland and the US, and special interest groups. of the meeting to coordinate ideas. Perhaps the Journals of Academic Medicine, Medical Education, Medical Teacher and ASHE

Apart from national groups others such as IVIMEDS, the Ottawa Conferences or Medical Education Centres might be interested in collaborating.

Session 1: Plenary 1

Social responsibility of medical education Medical curricula are determined by a variety of coherent as well as of conflicting social forces. Firstly there is society’s need for a • What does society expect from its physicians and their training? continuous supply of qualified health professionals fit to function within the local health care system. National health priorities and An Anonymous Health Politician societal expectations, therefore, must strongly shape the educational goals. The corps of physicians already established in • A view from the trenches: what are the essential elements in the education of future physicians? practice has a stake in the quantity and quality of budding colleagues. Students as immediate consumers of education are Dr. H.H. Brunner, President Swiss Medical Association (FMH) concerned not only with the adequacy of the educational outcomes but with the personal experience of the educational process as • What do medical students want to get out of their six years? well. The universities see themselves as the guardians of academic J. Scherrer & Th. Hidalgo, medical students standards and as champions of pure science. They are also confronted with medical faculties’ almost insatiable need for • Education or training: what is the role of the university in medical resources, many of which vanish again in the black hole of health education? care delivery. The dean sits at the centre of this maelstrom and has Prof. Ch. Schäublin, President, University of Bern to balance the opposing tugs of health care, research, education and individual careers, while at the same time responding to all the • Squaring the circle: research, teaching, clinical service and requirements listed above. Add to this the complication of federal management – what else should professors do? systems, where different levels of government vie for control, while at the same time trying to avoid taking on expenses. The above Prof. P. Suter, Dean Faculty of Medicine, Geneva constitutes a challenge for medical education.

– 4.3 – Section 4 Session 2A: E-Learning

2A 1 Virtual patients are go! Aim: To present the first year´s experiences from N K McManus*, R M Harden and S Smith (IVIMEDS, Tay Park House, coordination of net based courses within the Swedish Net 484 Perth Road, Dundee DD2 1LR, UK) University. Summary of work: The Swedish Net University started The International Virtual Medical School is a collaboration March 2002 and is a consortium of all universities and of institutions round the world that are willing to share university colleges in Sweden. The Netuniversity aims to curriculum development and learning materials. By pulling promote the use and development of IT-based distance together these resources from different schools, education. Universities may register their net based course comprehensive learning packages can be created by any at the database of the Netuniversity thereby marketing it for of the partner institutions. One method of delivering these the users. The government supports the universities directly resources is by a problem-based approach, where the to develop IT-based courses. For the autumn semesters learning experience is based on Virtual Patients, in the year 2002 there were 1300 registered courses of which context of a ‘Virtual Clinic’. By developing methods for 160 were within the medical and health care sector. The describing Virtual Patients, learning resources from the courses originated from all universities. At the Swedish Net materials ‘bank’ can be seamlessly integrated with the University Agency the courses are coordinated and special delivery of the virtual clinic experience. By developing an needs are met. The agency also identified areas and needs XML Schema, case builder tool and XSL/Servlet delivery not covered by the existing courses. mechanisms, both static and interactive presentations can be created and delivered using the same bank of resource Conclusions/take home messages: The Swedish Net materials. University fulfils a need for collaboration and promotion of net based courses within medicine and health care and has the potential to improve quality and effectiveness. 2A 2 Lessons learned in developing online curricula: five tips for success David A Cook* and Denise M Dupras (Mayo Graduate School of 2A 4 Evaluating interactivity in on-line postgraduate Medicine, Department of Internal Medicine, 200 First Street SW, education Rochester MN 55905, USA) David N Brigden* and Andrew D Sackville (Mersey Deanery, University of Liverpool, Hamilton House, 24 Pall Mall, Liverpool Aim of presentation: We encountered successes and L3 6AL, UK) challenges while developing two online curricula. Highlighting lessons learned may assist others developing Background: This presentation draws on evidence from online learning activities. an external evaluation of a supported online distance learning programme, leading to a Postgraduate Certificate Summary of work: Our first project, an automated online in Teaching and Learning in Clinical Practice. This is curriculum for residents in an acute care clinic, has delivered by the Mersey Deanery for Postgraduate Medical successfully completed fourteen cycles. Our second online and Dental Education and Edge Hill College of Higher curriculum, teaching internal medicine residents Education in North-West England. The programme has fundamentals of ambulatory care, is being compared with been designed to support five different types of interactivity: an existing curriculum in a randomized trial. • Interactivity between student and the course material Summary of results: • Interactivity between students and tutors • Lesson 1: Secure commitment from all participants, • Interactivity between students and other course including administrators, faculty, and learners. Identify participants and address barriers among all parties. Consider incentives for participation (and consequences for non- • Interactivity between students and online technology participation). • Interactivity between students and their professional • Lesson 2: Employ active learning. Stimulate critical community thinking, knowledge application, and self-directed Summary of results: The research found that a sample of learning. students graded their interaction with the course material • Lesson 3: Up-front time investment will pay off later. and with the online technology as successful or highly Create and follow a timeline. successful; interactivity with tutors was generally graded • Lesson 4: Make the website accessible and user- as successful; interactivity with other course participants friendly. Poor page design, “burying” the site under was graded as partially successful; whilst interactivity with multiple web pages, excessive passwords, and their professional community received the widest variety of dysfunctional hyperlinks frustrate learners and grading – from highly unsuccessful to highly successful! discourage use. Conclusions/take home messages: These results • Lesson 5: Provide scheduled time for learning. Do not demonstrate the importance of evaluation in assisting the simply append the course to existing learning design process. The presentation will conclude by commitments, nor fill the time freed by an online discussing these findings, and the steps that the course curriculum with other activities. team has taken to strengthen interactivity in areas which received a lower grading. Conclusions/take home messages: These tips will facilitate successful development of online curricula. 2A 5 Reusable learning objects, content syndication and resource discovery 2A 3 The Swedish Net University supports net based medical and healthcare education David A Davies (University of Birmingham, Medical Education Unit, School of Medicine, Edgbaston, Birmingham B15 2TT, UK) Goran Petersson (Council for Renewal of Higher Education, Swedish Net University Agency, PO Box 194, SE-871 24 Learning objects are small quanta of e-learning materials Härnösand, SWEDEN) that can be reused in contexts other than the original learning context for which they were created. Reuse of learning objects can also be between institutions, in which case partner institutions must adopt common educational

– 4.4 – Section 4

and technological interoperability standards if true reuse (Kuhlen 1991). To support this tendency of human thinking of learning objects is to be achieved. The aim of this the connecting of content units is essential. In this presentation is to outline some of the educational and presentation we will show how to implement a web of technical requirements for sharing reusable learning learning objects using the Unified Medical Language objects (RLOs). Particular emphasis will be placed upon System (UMLS). resource discovery and the creation of an economy of RLOs and syndicated medical education materials. The Summary of work: Within the project Meducase we presentation will draw upon experience gained during a developed several strategies to use the UMLS collaborative project between 4 UK medical schools to Metathesaurus - and Semantic Web – data. A special share learning objects between their institutional virtual software, the Link-List-Generator, is able to network the learning environments and with other national and contents of the Meducase e-learning platform according international datasets. Those attending this presentation to these proceedings. will gain an understanding of the current state of the art of Summary of results: The results show the automatic sharing RLOs, the syndication of medical education connection of contents is efficient and excludes the content and resource discovery. appearance of “Broken Links” completely. Furthermore, the network of learning objects, built on semantic relations, provides for every knowledge object associative links to 2A 6 Semantic web based knowledge management by other relevant topics. UMLS Conclusions/take home messages: Semantic networking T Schröter*, T Richter and R Schumann (Charité, Medizinische especially of complex issues is an ideal alternative to static Fakultät der Humboldt Universität, Berlin, GERMANY) learning paths. The Unified Medical Language System as medical ontology with its data variety and wide scope is Aim of presentation: “The human mind... operates by predestined to achieve this goal. These efforts are association. With one item in its grasp, it snaps instantly to important steps on the way to an intelligent tutorial system. the next that is suggested by the association of thoughts,...”

Session 2B: The Examiner’s Toolkit

2B 1 Credibility of portfolio assessment as an alternative of 50%. Lower pretest scores are associated with higher for reliability evaluation final examination failure rates. The pre-test provides information comparable to knowing the student’s E Driessen*, C van der Vleuten and J van Tartwijk (Maastricht preclinical GPA and/or USMLE Step 1 score. When University, Faculty of Medicine, Department of Educational combined with teacher’s comments, it improves the Development and Research, PO Box 616, 6200 MD Maastricht, sensitivity and specificity for identifying students with NETHERLANDS) inadequate knowledge. Counseling identified students When portfolios are used for summative assessment might be an insufficient intervention. reliability becomes a concern. The inter-rater reliability of Conclusion: A clerkship pre-test is a feasible and valid portfolio assessment gives rise to this concern. We plead method to help identify students at risk of failure on the end for another strategy to deal with the subjective nature. This of clerkship NBME subject examination in medicine. strategy involves building safeguards into the integral Collaborative studies on the appropriate intervention are judgement process. It includes timely feedback loops to needed and we would like to discuss sharing our pretest the student, preventing unexpected judgemental with other clerkships. outcomes, and a sequential rating procedure that increases the number of raters in case of doubt. We will illustrate the usefulness of this strategy by describing the 2B 3 Feasibility of portfolio judgemental process in a first year medical school. The strategy has general relevance for any form of professional Kirsten Bested (Vejle Hospital, Department of Anaesthesiology, judgement in assessment. Instead of looking exclusively Kabbeltoft 25, DK-7100 Vejle, DENMARK) at consistency across repeated assessments (reliability) Specialist examination will not be implemented in one strives for adding information to the judgemental postgraduate education in Denmark in the near future. process until saturation of information is achieved. This Instead portfolios will be implemented and are expected cannot be expressed in straightforward reliability indices. to document trainees’ achieved competencies and to We move from reliability of the measurement to credibility document achieved progress in training. In this study the in the assessment procedure. feasibility of portfolio as a learning instrument during internship-periods was examined. Nine trainees in six months of internship used three reflective pedagogical 2B 2 Medicine clerkship pre-test: the role of an early tools: Personal Educational Plans, Written Patient clerkship examination to identify clerkship students Descriptions and Learning Diaries. The trainees’ at risk of final examination failure evaluation of the three tools’ feasibility was assessed during semi-structured interviews. The tools were shown to Alan Wimmer, Dodd Denton, Paul A Hemmer* and Louis Pangaro enhance educational value of internship. Before portfolio (Uniformed Services University, USUHS - EDP, 4301 Jones Bridge can be successfully implemented in postgraduate Road, Bethesda MD 20814, USA) education in Denmark certain conditions will have to be Aim: Using a clerkship examination for early identification fulfilled. The clinical supervisors need education in how to of insufficient knowledge. use learning strategies and in how to use clinical assessment methods. The supervisors’ educational needs Summary of work: On the first day students take a 100- and the difficulties in implementing portfolio will be item, faculty developed, MCQ examination. Students who discussed in the presentation. It is important that both score –1 SD below the mean or lower are notified and trainers and trainees get familiar with reflective learning counseled about active, goal-directed learning that strategies from their first employment. Portfolios have to be emphasizes common and serious problems. carefully specified to the unique circumstances that each Summary of results: The pre-test has a reliability of 0.69, speciality has and have to support learning to be a doctor and a positive predictive value for final examination failure by being a doctor.

– 4.5 – Section 4

2B 4 The educational utility of the “don’t know” response questioning and oral feedback was identified by the group added to a five-options item format as a strategy which could be valuably adapted to provide a summative assessment with strong formative elements. It Yolanda Marin-Campos*, Lizbeth Mendoza-Morales, Jaime is suggested that these various approaches to assessment Navarro and Eusebio Contreras-Chaires (National Autonomous could be designed within programmes to ensure they meet University of Mexico, Departmento de Farmacologia, Facultad de the learning outcomes and best serve the overall Medicina, Edificio D, primer piso, Apdo. Postal 70-297, Mexico experiences and strengths of the individual student 04510 DF, MEXICO) enhancing their learning experience. Knowledge test using multiple-choice questions is an Conclusions/take home messages: efficient alternative for schools that handle a large number • Educators often rely on the tried and trusted written of students. Advantages of using five-option items format assignment as a means of assessing students’ levels of have been reported in the literature such as: wide coverage knowledge and intellectual capacity; of content domain, measurement of higher-order cognitive abilities, familiarity to most examinees. Nevertheless it is • Creative thinking can produce a variety of different, considered second best because the probability of creative and more holistic assessments which can truly guessing the correct answer is high (20%). We present the inform both the learner and the teacher as to the efficacy results of using five-options item questions adding a sixth of the programmes delivered. alternative: “don’t know”. Participants were 600 students of a Pharmacology program at the National University of Mexico. A total of 100 five-options questions were applied 2B 6 Evaluation of open-book exams in an as part of the formative assessment of the course. The undergraduate biochemistry course stimulus for the students to chose the “don’t know” response Nadia Al Wardy*, Syed Rizvi & Sean McAleer (Sultan Qaboos was that wrong responses would be subtracted from the University, Department of Biochemistry, College of Medicine and sum of the correct ones. Results show the educational Health Sciences, PO Box 35, 123 Al Khod, SULTANATE OF OMAN) utility of the “don’t know” response because the high and low performance students indicate what they do not know. The use of open-book examinations in a course in This information is highly valuable because it allows us Biochemistry, Metabolism, given to third year not only to decrease the probability of guessing, but also to undergraduate medical students, was evaluated. The aims know which contents should be reinforced, are difficult to of the study were: learn or should be addressed through other teaching 1 to assess the content and predictive validity of the open- methods. book examinations, and, 2 to assess students’ satisfaction with this form of assessment. 2B 5 Creating creative assessments Content validity was studied by comparing the outcomes L A Allery*, J MacDonald and L A Pugsley (University of Wales assessed by open-book examinations with the outcomes College of Medicine, School of Postgraduate Medical and Dental of the course. For this, the content of ten open-book Education, Academic Department of Medical & Dental Education, examinations and the course objectives were analysed in Heath Park, Cardiff CF4 4XN, UK) terms of Bloom’s taxonomy for educational objectives. Predictive validity was studied by correlating performance Aim: To consider some creative alternatives to written of students in these 10 open-book exams with their assessments. performance in the final examination of the course. Summary: To report the results of an academic review Students’ perception of this form of assessment was group considering a variety of strategies to provide creative studied by using questionnaires that contained both open alternatives to written summative assessments. and closed questions. Summary of results: The results of the review provided a The results showed that open-book exams assessed range of alternatives for assessment incorporating creative higher order thinking skills rather than the lower level called use of portfolios, individual presentations, group tasks, peer for by the course objectives; that there was a significant and self assessment. Key issues were identified related to positive correlation between students’ performance in reflective diaries and their place and value for summative open-book exams and the final; and that although students work, the reliability of video and teaching observation as enjoyed this form of; assessment, they required more snapshots of teaching competence. The use of case guidance in performing it. studies as an assessed presentation followed by

Session 2C: Curriculum Planning 1

2C 1 Complementary and Alternative Medicine in the were developed. These strategies were used as the basis undergraduate medical curriculum: a needs analysis for a modified Delphi process involving staff. The results of this process were used to generate overall aims and strategy J Skinner and A D Cumming* (University of Edinburgh, Medical regarding CAM in the curriculum. Teaching Organisation, College of Medicine and Veterinary Medicine, Teviot Place, Edinburgh EH8 9AG, UK) Summary of results: The needs analysis revealed general overall support for integration of CAM into the curriculum, Aim: With the growing popularity of Complementary and but with concerns about issues of efficacy, credibility and Alternative Medicine (CAM) there has been increasing regulation. Teaching staff was largely in favour of providing pressure to include this in the undergraduate medical students with a broad familiarisation with CAM, using an curriculum. We therefore conducted a local needs analysis evidence and efficacy-based approach to teaching. in Edinburgh for the integration of CAM into the curriculum. Conclusions/take home messages: Our results support the Summary of work: The needs analysis gathered both careful integration of CAM into the undergraduate medical quantitative and qualitative data. An initial literature review curriculum. and focus group discussions revealed the broad need for change. Questionnaires were distributed to 1,714 medical students and members of teaching staff. A seminar was held and 4 strategic approaches to CAM in the curriculum

– 4.6 – Section 4 2C 2 Mapping the surgical curriculum Aim: The presentation will outline the development of Anne Ellison (Royal Australasian College of Surgeons, Surgeons’ genetics curricula for specialist registrars in dermatology, cardiology and neurology, based on perceived learning Gardens, Spring Street, Melbourne 3000, AUSTRALIA) needs. Traditionally, surgery has been taught through the Summary of work: Curriculum development was informed apprentice system as opposed to following a predetermined by two sets of data. Firstly, a mapping exercise of current curriculum. Recent developments in medical education genetics education, including curricula analysis, interviews have resulted in the need to develop an articulated surgical with educators, and a survey of specialist registrars in the curriculum. The task of ‘mapping’ a curriculum for selected specialties. Secondly, an analysis of data from apprenticeship style training raises a number of challenges meetings with specialist registrars in the selected for educators. Using Harden’s concept of curriculum specialties in the West Midlands and South Western mapping (Harden 2001), the Royal Australasian College deaneries, and an online adapted Delphi survey of a of Surgeons commenced the process of mapping the basic national sample of consultant geneticists and specialty and advanced surgical training programs. We developed consultants. a generic template based on Harden’s model to ensure that all involved were working with the same mental map. Summary of results: Collection of the two sets of data Processes and structures were developed to steer enabled an evaluation of the synergy between current curriculum development. A computer program for concept teaching of genetics up to specialist registrar grade and mapping was used to translate the map into an online their identified learning needs in the modern health service. format. While curriculum maps were being developed they This evaluation then formed the basis for the development were published on-line but were password protected until of a genetics curriculum for each of the three specialties. they were complete. Curriculum mapping facilitated Conclusions/take home messages: Curriculum collaboration and coordination of curriculum development. development is often based on the opinions of a small Some modifications to Harden’s model were required due number of experts. This project demonstrates an to particular features of College education and training alternative model, in which curriculum development draws programs. Greater emphasis was placed on the philosophy on a wide range of data sources. and evaluation of the curriculum. Combined with computer technology Harden’s model is a useful management tool to facilitate collaboration and coordination of curriculum development. 2C 5 The current medical program at the American University of Beirut: problems and solutions Farid Saleh*, Nadim Cortas and Ibrahim Salti (Department of 2C 3 An innovative method of delivery of the core Human Morphology and Medical Education Unit, Faculty of curriculum in Obstetrics and Gynaecology - the Medicine, American University of Beirut, PO Box 11-0236, Beirut, Leeds model LEBANON) Vikram Jha*, Jayne Shillito, Judith Moore, Alison Wright and Sean Aim: To share with the international community on medical Duffy (University of Leeds, Academic Dept of Obstetrics & education our thoughts and plans regarding developing Gynaecology, St James’s University Hospital, Level 9, Gledhow the existing medical curriculum at the American University Wing, Leeds LS9 7TF, UK) of Beirut (AUB). Aim: A model to deliver the core curriculum in Obstetrics Background: Our medical program consists of seven years and Gynaecology was developed in Leeds against the of didactic university education, three of which are spent background of attempting to concentrate core teaching on covering pre-medical courses. The fourth and fifth years into designated sessions to increase time for clinical contain the bulk of the knowledge offered in the whole experience in a problem-oriented curriculum. program and students are expected to “digest” and “absorb” such knowledge for later clinical application. Seventeen Summary of work: The curriculum, based on the SPICES non-integrated basic medical science courses are offered model, ensures a consistent standard of teaching. The during the fourth and fifth years. core topics are covered in three units: 1. Introductory week: lectures, small group work and ward-based work and Summary of work: Based on the feedback obtained from covers basic topics including history taking and both students and Faculty regarding an overcrowded examination, benign gynaecology and obstetric curriculum, we mapped the curriculum of the fourth and emergencies; 2. ‘Theme’ sessions: interactive half-day fifth years in order to assess the issue of content overlap sessions covering other core topics in Gynaecology such among the courses, and to develop the curriculum in a as infertility and menopause; and 3. Student-led tutorials: way that would create a better learning environment for the covering core topics in Obstetrics. These units work students. We conducted such mapping by first obtaining together to cover the core curriculum over the course of an updated and detailed content of each course offered in the eight-week attachment. these years. A computer macro was then written to serve the purpose of both database management and searching Summary of results: Evaluation of the curriculum has tool. The mapping task was a demanding one and it provided positive feedback from students who feel that it required 378 hours of work. enhances enjoyment of the clinical attachment as they feel better prepared. Summary of results: We searched the database for concepts, topics, and even key words (7,458) and the Conclusions/take home messages: Quality assurance in outcome of such search confirmed the presence of content delivery of the core topics might be difficult in short clinical overlap and lack of cross bridging among the courses. attachments and the Leeds model represents an innovative Moreover, the students were found to be exposed to a total framework that may be used by other Medical Schools. of seventy exams that are fully based on recall of facts. Conclusions/take home messages: Horizontal and vertical 2C 4 Developing curricula based on learning needs: integration of the medical curriculum at AUB is a necessity genetics education for specialist registrars in non- rather than a luxury. It provides solutions for both content overlap and lack of teaching in a context. We identified 13 genetics specialities clinical disciplines within which such integration could Sarah Wakefield*, Hywel Thomas, Peter Farndon and Julie Bedward evolve, and Problem Based Learning could be the (Centre for Research in Medical & Dental Education, School of approach for delivering the content of the new integrated Education, University of Birmingham, Edgbaston, Birmingham curriculum. B15 2TT, UK)

– 4.7 – Section 4

2C 6 A survey of people’s complaints against physicians private hospitals, private offices and clinics. Most of these during a five year period in Fars province complaint were made against gynecologists, ophthalmologists, orthopedists and general surgeons. Nine L Bazrafkan*, Z Tabeie and M Saberfirozi (Shiraz University of per cent (33 cases) of the cases were related to death, Medical Science, Zand Avenue, Shiraz, IRAN) 15% (56 cases) to disability and 50% (183 cases) related Background: One of the methods of determining the to inattention to communication skills. In 26% (95) of the objectives of medical education in general practice is cases the physicians were at fault and 16% (59 cases) of needs assessment and one of the prominent sources of them have been settled by arbitration. In 48% (177) of cases needs assessment is a survey of complaints and medical physicians were found to be at fault. errors. Conclusions/take home messages: The results of this study Summary of work: We attempted to survey people’s indicate that the majority of the complaints were due to a complaints against physicians in Fars province in a 5-year lack of a proper relationship between physician and patient, period. A questionnaire was prepared and the collected mostly behavioral. Considering the fact that a person’s data were categorized and analyzed using SPSS statistical behavior reveals his/her attitude, there is a severe package. deficiency in medical education with regard to affective and attitudinal objectives. Summary of results: The results revealed that 368 complaints were filed over 5 years against public hospitals,

Session 2D: Curriculum Evaluation

2D 1 Keep the customer satisfied: quality control in a • Reaction of participants medical curriculum • Collection of data on new knowledge and skills of M Maelstaf*, I Vandenreyt and M Vandersteen (LUC, Limburgs participants Universitair Centrum, Faculty of Medicine, Universitair Campus, • Transfer from educational setting to real life Gebouw D, B - 3590 Diepenbeek, BELGIUM) • Impact on wider community Aim of presentation: Quality assurance is monitored each Participants attending courses from March to October this year by the Educational Management Team in a ‘plan-do- year will complete pre- and post-test MCQs, be surveyed check-act’ cycle. The objectives cover the learning attitudes after the course and will subsequently be invited to of the students, the programme content and the complete an online questionnaire at course + six months. organisation and performance of the staff. Quality control This will be supplemented by interviews and self reports means shared responsibility of students and staff for by self selected course members. The overall design is to curriculum development and evaluation. develop a robust evaluation strategy for this and other provider courses in order to inform continued refinement Summary of work: Several procedures have been of the curriculum and modes of delivery. developed to improve the quality of the curriculum. Basic conditions are staff development and coaching of the student representatives. A compulsory format for the study guidelines is issued for the implementation of the 2D 3 A student centred approach to course evaluation programme. Registration of study time, analysis of using the norminal group technique examinations, interviews and questionnaires provide more William Murdoch* and John Skelton (University of Birmingham, information. The management team summarizes the Interactive Skills Unit, Department of Primary Care and General information and recommends changes. Practice, Primary Care and Clinical Sciences Building, Edgbaston, Summary of results: We diagnosed strengths (solution of Birmingham B15 2TT, UK) bottle-necks, uniform guidelines, transparent assessment) Aim: To increase awareness of a novel technique in and weaknesses (unclear efficacy of teaching methods, evaluation and to reinforce positive aspects of teaching no collaborative learning, no assessment of general Community Based Medicine competences). Lack of time and insufficient logistic support has jeopardized the results. At this moment we have Summary of work: A focus group of final year medical completed half the quality plan. students was used to develop 3 stimulus statements for a nominal group session. The nominal group is a non- Conclusions/take home messages: Changing ambitions confrontational method of generating participant-centred are inevitable. As faculty pleads for an integral approach opinions and allows voting on priorities. The group priorities the cycle be will spread over three years. Three years of were then submitted to the whole year in a Likert scale quality control will result in a general plan for optimization. questionnaire to ensure that the group opinion represented that of the year as a whole. 2D 2 Evaluating MOET (Managing Obstetric Emergency Summary of results: 18 students attended the nominal group Treatment) session and they developed 124 opinions. They voted for the top 21 (7 in response to each statement). A Mike Davis (Edge Hill, Southport Road, Ormskirk, UK) questionnaire of these 21 opinions was submitted to 165 Managing Obstetric Emergency Treatment (MOET) is a medical students. The response rate was 82% and there three day residential course aimed at registrar and was majority agreement with 20/21 of the opinions. consultant obstetricians. It was developed under the Conclusions/take home messages: The nominal group auspices of Advanced Life Support Group (ALSG) in order technique is effective and easy to perform. It has shown to improve the competence of staff dealing with obstetric that community based medicine has many attributes, emergencies and to supplement the work of Advanced Life especially its role in increasing clinical confidence and it Support in Obstetrics (ALSO), aimed at General has an important role in professional development and Practitioners, Midwives, Obstetricians and other staff bridging the gap from being a student to becoming a doctor. involved in the provision of maternity care. The purpose of this presentation is to outline a strategy for evaluation of the course using the 4 level Kirkpatrick Hierarchy, thus:

– 4.8 – Section 4 2D 4 Teaching about the family in the community: Summary of work: This was a descriptive research study purposeful, coherent, integrated and well-informed? and the population included 1,734 students in 16 academic disciplines from 7 colleges. A five scale questionnaire (very P G Cawston*, K Mullen, M Nicholson and R A Robertson (Glasgow poor to very good) with 16 items and Cronbach á 0.95 was University, General Practice and Primary Care, 4 Lancaster delivered to students in the class and then collected after Crescent, Glasgow G12 0RR, UK) completion. Analyses were performed by SPSS and Aim: Medical schools in a number of countries use home descriptive-inferential statistics were used. visits to teach about the family. Our aim is to discuss lessons Summary of results: Overall, Pearson test with 2 way (p = that are broadly applicable to community-based teaching 0.05) showed a small and negative relationship between about the family in other medical schools. students’ GPA and the evaluation score of the teacher, Summary of work: An evaluation instrument for the Glasgow which was practically not significant. Analysis of variance University Family Project was constructed using analysis and factor analysis indicated no significant difference of free-text data collected from students. The baseline between the student evaluation score of the teacher and 3 survey led to a number of changes being introduced, groups of GPAs low (<14), moderate (14-17) and high (>17). including: revision of documentation, tutor training, flexibility The comparison of correlation intensity between teacher in visits and information for the families involved. The evaluation score and male and female students’ GPA by instrument was used to re-evaluate whether these had Fisher Z showed no significant difference. impacted on student perceptions of the project. Conclusion: The study showed no significant difference Summary of results: A response rate of 59.8% of all students between high GPA and 2 GPA groups of moderate and low in the relevant year (144/241) was achieved for the baseline in relation to SET and also no relationship acquired evaluation. Despite a median rating for both overall content between GPA and SET. and format of ‘4’ (1=poor, 5=excellent), significant weaknesses were identified around the themes of purpose, coherence, integration and information. Data on how 2D 6 Teachers’ points of view about evaluation students evaluated the course after changes were S Iranfar*, B Izadi, F Monsori and M Rezaee (Medical Sciences of introduced in these areas will be included in the Kermanshah, E.D.C., Central Library of Kermanshah University presentation. of Medical Sciences, Sheed Beheshti Bolv, Kermanshah, IRAN) Conclusions/take home messages: Case studies involving Background: In spite of faculty evaluation designed to sequential visits to families of more than one generation improve the faculty program, it is difficult to achieve this are a useful means for teaching about the family. Students goal. identified significant weaknesses in one such programme. The lessons learned from their evaluation may be Aim: The purpose at this research is to determine teachers’ applicable to other medical schools. points of view about evaluation in Kermanshah University of Medical Sciences. Summary of work: A qualitative study using group discussion 2D5 Correlation between students’ Grade Point Average was carried out on faculty members at random in 5 groups. (GPA) and evaluation score of the teacher 6-8 persons participated (men, women, M.S, Ph.D and A Malayeri, A Alidadi and P Afshari* (Ahvaz Medical Sciences specialise degree) in each of group. A discussion guide University, Nursing and Midwifery School of Medical Science, was designed and the pilot study was carried out to University of Ahwaz, Ahwaz, IRAN) determine validity and reliability of the tool. Note-taking was used by colleagues from teachers’ ideas about evaluation. Background: Evaluation is a process for merit assessment After each session all the ideas were collected and noted. and quality improvement. During the past three decades one of the most important challenges has been student Summary of results: The research showed the majority of evaluation of teachers in higher education. Over the past faculty members believed that it is necessary to carry out decade studies have shown that evaluation of teachers evaluation but in a suitable setting. They did not know has correlation with some variables such as teacher anything about evaluation goals and they thought that enthusiasm, teacher rank, student expected grade etc. evaluation is used only for personnel decisions. Aim: To determine the relationship between students’ Conclusions/take home messages: It is necessary to academic performance and student evaluation of the evaluate education activities but teachers’ points of view teacher, and also to compare correlation intensity of male are most important for improvement. The best way to and female students’ GPA. achieve evaluation goals is through teachers, not by institute.

Session 2E: Teaching and Learning

2E 1 Factors influencing final year students’ learning rate the items according to their importance to the learning climate in Thai Medical Schools climate using a 5 point Likert scale ranging from 0 (not important at all) to 4 (absolutely important). The result Danai Wangsaturaka* and Sean McAleer (The Faculty of Medicine, showed that the 50 most important items related to: Chulalongkorn University, Dept of Pharmacology, Rama IV Road, teachers (9 items); residents (3); friends (3); nurses and Patumwan, Bangkok 10330, THAILAND) medical personnel (2); patient care (4); learning experience The study aimed to identify factors influencing final year (7); assessment (2); educational resources (4); physical students’ learning climate in Thai medical schools. environment (4); self-confidence and motivation (5); Teachers from 5 schools and final year students from 8 personal life and support (6); and life after graduation (1). clinical training centres in Thailand were asked to describe In conclusion, to provide a good learning environment for the characteristics of good and bad learning environment final year medical students, many aspects need to be using individual and group interviews, respectively. The considered. Once the most important factors are identified, data obtained were then arranged into a 143-item we can develop a diagnostic instrument to provide a more questionnaire. 323 medical students from 11 clinical valid measure of students’ learning environment and to training centres were selected by stratified sampling to subsequently enhance their learning.

– 4.9 – Section 4

2E 2 Evaluation of different lecture types in medical Background: Educators tend to think that being a teacher education improves their own learning. The purpose of this study is to determine if undergraduate peer teachers learn better than S Holler*, N De Cono, A Mehrabi, S Schürer, E Gazyakan, M Kadmon their peers. and J Schmidt (Department of Surgery, University of Heidelberg, Medical School, Im Neuenheimer Feld 110, 69120 Heidelberg, Summary of work: We compared the academic records of GERMANY) 42 students acting as teacher assistant to their junior peers. These students had completed a course on teaching skills It seems difficult to satisfy students’ needs in didactic for a whole year. The median of their records before and lectures. We compared three different lecture types. Key- after the course was compared with the median of the symptom-oriented lectures (KOL) were introduced a year group not participating in the program. They were matched ago with our new surgical curriculum at Heidelberg by academic performance, and compared using the University. This lecture is a one-hour daily class held by Wilcoxon signed rank test. different academic teachers. The data were compared with the evaluation of classical disease-oriented lecture Summary of results: Both groups increased their marks (DOL) held by various teachers, and case-based lectures with a statistically significant difference the year before and (CBL) held by a single teacher concentrating on differential after the program. The increase was higher in the non diagnosis. Our aim was to compare the differences in participant group (delta .625 vs .875). motivation, presentation, interaction and overall grade of Conclusions/take home messages: As students advance these three lecture types. During the academic year a in their career, they increase their academic grades. prospective study with a standardized questionnaire (seven- However, increase in the participating group is smaller in point Likert scale) was completed after each lecture by comparison to the non participant group. These data do third-year students. We used statistical methods to compare not confirm that peer teachers learn better than their peers. the differences of the three lecture types (ANOVA-analysis, This raises many questions: are grades a good measure t-test, p<0.05). We evaluated 1,071 questionnaires (323 of learning? Do participants have less time to spend on disease-oriented, 52 case-based, 696 key-symptom- their own study? What other variables should be explored oriented). The data show that the KOL lecture scored in all to measure learning in these groups? evaluation criteria significantly better than the DOL (p<0,001). The CBL is even better accepted among students than the KOL. Our study showed that two criteria 2E 5 Interactive large group teaching is an alternative to improve students’ satisfaction of didactic lectures. The lectures should be key-symptom-oriented and held by a small-group teaching in a dermatology practical single teacher. course F R Ochsendorf*, A Böer, W H Boehncke and R Kaufmann (Zentrum Dermatologie und Venerologie, Klinikum der J W Goethe- 2E 3 Clinical teachers and the new medical education Universität, Theodor-Stern-Kai 7, D-60590 Frankfurt/M, Tim Dornan*, Albert Scherpbier, Nigel King and Henny Boshuizen GERMANY) (Hope Hospital, University of Manchester School of Medicine, In a dermatology practical course small group teaching Stott Lane, Salford, Manchester M6 8HD, UK) was found to be superior (AMEE 2001, 8J2). Due to lack of Background: Clinical disciplines, their traditions, and the personnel this could not be offered to the whole class. We mastery of practitioners are taking second place to investigated an interactive large group teaching approach integrative educational objectives in modern medical as a possible alternative. The class was divided in two education. parts. While one half received small group bed-side teaching in the ward, the other half had interactive teaching Aim: Explore a) how clinicians perceive their roles and b) in the lecture-hall. Here one tutor acted as the content how those perceptions link to the official curriculum. expert and presented a simulated patient. A second tutor Summary of work: All 14 physicians in a teaching hospital led the learning. He led the discussion, stimulated and were interviewed and their narratives analysed involved all students using a microphone. The groups phenomenologically. The method included: Debating changed the next week. 6 topics were discussed in 12 alternative interpretations; systematically identifying bias weeks. The students (n=206) rated this course 1.6 ± 0.6 and disconfirmatory instances; retaining respondents’ (mean ± SD; 1=excellent – 6=very poor). This rating phraseology through the process of data reduction; back- matched the evaluation of the small group teaching given referencing interpretations to the original manuscripts. the year before (AMEE 2001, 8J2). The results of MC-tests improved significantly. The part in the lecture hall was rated Summary of results: Hospital wards were seen as the better than the bed-side teaching. Interactive large group primary context for learning. Pressures of practice were teaching was accepted, easier to organize, needed only felt to limit outpatient learning. Most interviewees conceived few more personal and partly solved the problems of of clinical learning as clerking interesting patients on wards standardization. and receiving bedside teaching. They saw it as impracticable for students to see patients that matched their system-based learning or to participate in practice. 2E 6 Using a game format as a teaching strategy in CME: Problem-based learning, whilst accepted, was seen as having undue priority over clinical teaching. Evidence of does it work? crossover between the two processes was scant. There Maja Bujas-Bobanovic (Aventis Pharma Inc, 2150 St. Elzear Blvd. were strong expressions of empathy towards students. West, Laval, Quebec H7L 4A8, CANADA) Conclusions/take home messages: Objective-based Aim: to demonstrate how educational games can promote education and problem-based method had permeated learning and at the same time provide enjoyment and clinicians’ thinking to a surprisingly limited extent. encourage participants to be more creative in their CME Teaching, like learning, has to be ‘reinvented’ when a programs. curriculum changes. Summary of work: A literature search on gaming, as a teaching strategy, was performed with MEDLINE, ERIC, 2E 4 Student-teachers are not better learners than their and CINHAL. Additional articles were identified from the peers bibliographies of the retrieved articles and from Web sites. Angel M Centeno*, Cecilia Primogerio and Martin O’ Flaherty Summary of results: Educational games are beneficial to (School of Biomedical Sciences, Universidad Austral-Medicina, both children and adult learners. However, very few reports Av Juan Peron 1500, B1629 AHJ Derqui, Pilar, Pov Buenos Aires, identify gaming as a teaching strategy in CME. It is well known that games can incorporate concepts and ARGENTINA) principles of adult learning and meet a variety of educational

– 4.10 – Section 4

objectives. They can also involve repetition, reinforcement, material in a dynamic, innovative manner is a constant association and use of multiple senses. Unlike many other challenge for medical educators. The use of games, as tools, they can bring fun and enjoyment in the learning an aid to teaching, can results in more stimulating and experience. Therefore, games could significantly appealing CME programs. This session demonstrates contribute to the development of a wider repertoire of how games can easily be implemented in everyday teaching methods in CME. learning activities. The only limit is our own creativity and imagination. Conclusions/take-home messages: Presenting educational

Session 2F: International Medical Education 1

2F 1 Presentation of European Medical Students’ 2F 3 Possibilities for change? Association (EMSA) Iskender K Akylbekov, Christian Guksch* and Chinara Mambetova Filip Stoma*, Anna Michalak and Tomasz Kucmin (European (Universitätsklinikum Hamburg-Eppendorf, Modellstudiengang Medical Students’ Association, ul. Narutowicza 33/8, 20-016 Medizin, Martinistr. 52, N16, D-20246 Hamburg, GERMANY) Lublin, POLAND) Within the East/Central European and Eurasian Task Force The European Medical Students’ Association (EMSA) there is a high consensus that in order to facilitate changes integrates medical students in geographical Europe in the medical education of most universities that have through activities organised for and by medical students. been dominated by a Soviet canon of learning with its early The idea of EMSA was created at the European Medical specialization, efforts must include teacher training, skills Students’ Congress in Leuven (the Netherlands) in 1990 development and changes in medical education. Drawing and founded at its first General Assembly in Brussels in on my experiences as an advisor to the Commission on 1991. EMSA creates a European network for Science and Education under the Kyrgyz President in communication between medical students. What is also Bishkek, and in cooperation with Kyrgyz scholars, we would important, EMSA acts upon gathered information on social, like to present some aspects that need to be taken into cultural, academic, economic and ethical aspects of account to make changes possible for teachers and Europe. Furthermore, it provides a platform for all medical students. The students‘ possibilities to study successfully students in Europe in order to defend their interests and to with full access to medical information require permanent ensure the quality of medical education in Europe. The internet access and computers. Furthermore, it is our view Committee for Medical Education is working on a that a PBL-based curriculum will make a difference with permanent improvement of medical education in Europe regard to the way the students are studying. And changes through reflection on the European core curriculum and within the subjects will lead the students towards an through discussions of medical education techniques and integrative perspective of what a medical doctor should be other health issues. able to handle when facing patients. Medical doctors as teachers on the other hand need access to research and should receive training at selected centers not only within 2F 2 Cultural probity in medicine their medical speciality but also in new ways of teaching. R C Gupta*, S Lingam, M I Memon and D Brigden (Lancashire Teaching Hospitals NHS Trust, Preston Road, Chorley, Lancashire PR7 1PP, UK) 2F 4 Increasing the relevance of health professions education and health services: The Network: Aims and Objectives: This paper introduces the concept Towards Unity for Health of cultural probity in clinical practice. An increasing number of doctors and healthcare professionals travel widely to Gerard D Majoor (Faculty of Medicine, Maastricht University, serve the community of different cultures. Increasingly, Office of International Relations, PO Box 616, NL-6200 MD nations are becoming multicultural practising multiple Maastricht, NETHERLANDS) faiths. It is important that the healthcare practitioners should Aim of presentation: Sharing the rationale of a new strategy be prepared to deliver care to their patients without adopted by an international network committed to compromising their cultural values and religious beliefs. improvement of community health. Summary of work: This paper will highlight reasons for Summary of work: As one of the strategies to implement delivering a culturally competent service, define cultural WHO’s Alma Ata “Health for All” declaration, in 1979 a probity, discuss its practical implications on the Network of Community-Oriented Educational Institutions organisations responsible to commission and deliver for Health Sciences was established to promote training healthcare including empowering the local communities. of health personnel orientated to the new paradigm. The methods of developing this essential competency Although this Network has been instrumental in advocating include making them aware of medico-legal human rights new educational approaches like problem-based learning, and by including aspects of cultural awareness in the community-oriented, community-based and curriculum. Small projects on socio-economic status and multiprofessional education, the impact of graduates from its implications on health can be given to students. They Network member institutions on reorientation of health should be encouraged to spend an elective period in other services has not met the expectations. Presumably, countries. innovations in health professions education must be Results/Conclusions: This will develop an essential implemented in concert with changes in health services competency of cultural probity amongst the healthcare to yield synergy. Therefore, in 2002 The Network professionals. In this way we are preparing them to be ready amalgamated with WHO’s “Towards Unity for Health” to practice in a multicultural society and this should have a (TUFH) project. This project has aimed to promote equity, positive impact on improving global health. relevance, quality and cost-effectiveness in community- oriented health services by stimulating partnerships among key stakeholders like communities, health services, health managers, health professionals and educational institutions.

– 4.11 – Section 4

Conclusions/take homemessages: Activities of The No country with a low percentage of older persons among Network: TUFH combining expertise in reorientation of the population/good training in geriatric education was health services and health professions education are identified in the study. Action is recommended to both expected to act synergistically towards “Health for All”. increase training and to harmonize its general availability through national standard curricula. 2F 5 Global survey on geriatrics in the medical curriculum 2F 6 Not just another changed medical school I Keller, N Borojevic*, A Makipaa, T Kalenscher and A Kalache Trevor Gibbs* and David Taylor (Faculty of Health Sciences, (IFMSA, P. Heruca 10, HR-10000 Zagreb, CROATIA) University of Cape Town, Barnard Fuller Building, Anzio Road, Observatory, 7925 Cape Town, SOUTH AFRICA) In response to rapid population ageing world-wide, the WHO Ageing and Life Course Programme devised the Aim: To share with others faced with similar problems how “Teaching Geriatrics in Medical Education, TeGeME” curricula can be adapted to address individual needs. survey and invited the International Federation of Medical Background: Medical curricula the whole world over are Students’ Association (IFMSA) as a partner. TeGeME’s changing, with medical schools adapting to meet the main goal was to gain insight on if and how issues on demands of modern-day health care practice. Most ageing and geriatric medicine are incorporated into schools adopt similar models based upon tried and tested medical curricula world-wide. Two questionnaires were educational theory and practice. In debate is the argument used, one focused on the organisation of medical education as to whether a standard approach using these methods at national level and the other on assessing the training is applicable to all, specifically to those schools in the third offered at medical school level. Data have been received world. from 268 universities in 64 countries, of which only data from countries with an overall participation of more or equal Summary of work: Using two experiences, from one UK to 50% of all medical schools have been analysed (data based medical school and one South African medical from 161 schools and 36 countries). Individual analysis school, this paper will suggest how they worked together, from every school and analysis according to development how two schools cooperated, and by sharing and status has been done. These groups of countries were comparing their programmes were able to adapt modern identified: day learning technologies to suit their individual A few training possibilities/high proportion of older persons environment. among the population The result is a medical programme that uses educational B few training possibilities/low proportion of older persons theory in an adaptive, practical way. C good training/high proportion of older persons Conclusion/take home message: These techniques should be applicable to all those attempting to deliver medical curricula in third world countries.

Session 2G: Staff Development – Training Needs

2G 1 Strategic direction for staff development: ensuring 2G 2 Educational needs of a programme director in relevance in times of change Denmark Faith Hill (University of Southampton, Medical Education Bente Malling (Silkeborg County Hospital, Mollerupvej 5, DK Development Unit, School of Medicine, Biological Sciences 8600 Silkeborg, DENMARK) Building, Bassett Crs East, Southampton SO16 7PX) The purpose of the study was to describe the educational Aim: This presentation will share our experience of needs of a programme director in the postgraduate determining strategic direction for education staff educational system in Denmark. A description of the development in the School of Medicine, University of qualifications needed and the qualifications the Southampton, UK. It will report on the benefits of adopting programme directors actually have revealed a gap, defining a consultative approach and highlight some of the the educational needs. The needs assessment was difficulties involved. obtained through focus group interviews with doctors at different educational levels and coming from different Summary of work: During 2001-2 a review of staff specialities, combined with semi-structured interviews with development was undertaken to ensure maximum chiefs of hospitals and departments. The results are relevance at a time of student expansion and curriculum concentrated around the themes: Responsibility and Tasks, change. As we have more than 800 teachers (mostly Qualifications, Job-description, Time, Education - now and employed by other organisations), we set up a in the future and Suggestions for improvement. The study representative task-group to identify and prioritise staff has revealed an urgent necessity for educating the development needs. Recommendations from the group programme directors in Denmark in order to improve were subject to wider consultation. postgraduate education and to implement the reform in Summary of results: Staff development in 2002-3 has specialist training. According to the study the educational followed the direction determined by the task-group and programme for future programme directors will have to consultation exercise. In particular, the main focus has involve management, administration and leadership skills shifted from training for new teachers (which still continues) besides pedagogic knowledge. The study proposes towards the needs of our course coordinators. Leadership themes for an upcoming educational course. Together training and other new courses for coordinators have been with future blueprints and job descriptions the results of delivered and evaluated during the year. this study can be used to create the educational programme for future programme directors. Conclusion: The Southampton experience suggests that strategic direction for staff development is most relevant when it is embedded in the expressed needs of the staff concerned.

– 4.12 – Section 4 2G 3 A new preparation for dental trainers Aim: A review of the literature documents a rising demand Alexander Stewart (NHS Education for Scotland, 6 High Street, for education in counselling and guidance in postgraduate medical education and many institutions make attendance Turriff, Aberdeenshire AB53 4DS, UK) at Teaching the teachers courses compulsory for Aim: To describe a preparation process for trainers derived programme directors and clinical supervisors. A few studies from an outcome based curriculum developed by a show that Teaching the teachers courses have limited representative group of trainers. effect on clinical teaching and training, despite high satisfaction with the courses and high perceived need for Summary of work: The curriculum was the basis for a the course. The present study evaluates the effect of a training needs assessment of Scottish trainers. A database Teaching the teachers course for doctors at four levels: was created. A large proportion of outcomes for trainers level of reaction (participants assessment), level of learning was rated as essential core for all trainers. An extended (assessment of skills), level of behaviour (use of principles preparation for new trainers was piloted. This comprised in daily practice) and level of organisation (departments’ a total of ten days of courses, devised in line with the core attitude towards clinical teaching and training). outcomes, and linked by coursework. The final two days were designed as an assessment of participants, who Summary of work: The study design is a controlled trial presented evidence of their development on the course. with intervention (Teaching the teachers course) to all The assessment process for this course offers a doctors at medical/surgical departments of one hospital, mechanism for accreditation of all trainers. The database Aarhus Municipal University Hospital (N=100 doctors), will direct existing trainers to training modules required to compared to the control group of doctors from medical achieve accreditation. In time all trainers will achieve and surgical departments at Aalborg University Hospital accreditation. (N=130 doctors). Effect on level of reaction, learning and behaviour will be tested by a questionnaire and a Summary of results: Work on results will progress as new Knowledge of Skills test performed at baseline, immediately trainers begin training in the next academic year. after intervention and 6 month after intervention. Semi- Conclusions: The development of a curriculum for dental structured interviews with chiefs of departments/ trainers has facilitated: departmental programme directors will be performed at baseline and 6 month after intervention to reveal possible • An assessment of trainers needs confounders like changes in structure, organisation and • Development of assessed courses for new trainers culture. • Needs-assessed training for existing trainers • Accreditation process for existing trainers Perspective: The study begins in June 2003, with intervention during autumn 2003 and follow-up in spring 2004. It may provide the evidence needed to conclude that Teaching the teachers courses are beneficial and cost- 2G 4 The effect of ‘Teaching the Teachers’ courses for effective and should be compulsory. doctors Sune Rubak*, Lene Mortensen, Bente Malling and Charlotte Ringsted (Aarhus University, Aakjaervej 40, Falling, 8300 Odder, DENMARK)

Session 2H: OSCE 1

2H 1 Are standardized patients able to identify poorly 2H 2 Neonatology OSCE: certification of expertise performing medical students in OSCE? J Arnau*, T Esqué, A Zuasnabar, A Fina, A Moral, F Raspall, N Pirkko Heasman, Kaisu Pitkälä, Taina Hätönen, Niina Paganus and Barragán and J M Martínez-Carretero (Institute of Health Kirsti Lonka* (University of Helsinki, Faculty of Medicine, P O Box Studies, Balmes, 132-136, 08008 Barcelona, SPAIN) 63, PL 41, 00014 Helsingin Yliopisto, FINLAND) The Neonatology Group of the Catalan Paediatrics Society This study investigates final year medical undergraduate and the Institute of Health Studies have conducted 3 OSCE students’ assessment by standardized patients (SP) in examinations in the last three years (2001-2003). 48 comparison to faculty assessment during an objective professionals have been evaluated by means of this structured clinical examination, OSCE. We had eighty assessment tool. Neonatology in Spain is not a medical medical students participating in a 7-clinical station OSCE specialty, and for this reason a professional competence including depression, eating disorder, lung cancer etc. After certification for that particular expertise had to be a two minute introduction to background history of the case developed. The Catalan Public Health System is interested the consultation takes place for 10 minutes. The students in assessing the competences of those professionals for were assessed by the faculty check lists, communication specific job applications in the Catalan public hospital skills rating scale and global ratings and by SP rating scales network. The clinical competence profile and the results which included interest shown by the student doctor, by competence components are currently being analysed listening and shared understanding of the patient´s and will be displayed. The first 3 editions of Neonatology problem. A key finding is that SPs are not good at recognizing OSCE have proved their reliability, validity and feasibility as poor performance, only one in four failures being detected well as the highly valuation by participating professionals (failure is less than 50% correct on the clinician check of that certification tool. list). None of the students rated excellent by SPs failed at the clinicians’ assessment. The results indicate the content specificity of communication skills, also shown in other 2H 3 A computer-based Medline objective structured studies. SPs are more consistent in their assessments than clinical examination (OSCE) for third year medical the clinicians. We will discuss the topic of who should students: aims, methods and outcomes assess the medical students’ clinical performance and the implications for the development of communication M Dozier*, S Yewdall, R Ellaway and H Cameron (University of skills training at the medical school. Edinburgh, Erskine Medical Library, George Square, Edinburgh EH8 9XE, UK)

– 4.13 – Section 4

Aim: To share the arrangements and outcomes of an OSCE 2H 5 A comparison of several methods for setting measuring third year students’ aptitude in searching passing scores on an OSCE Medline and selecting sources for evidence-based information to support clinical management decisions. Ernest N Skakun*, Stephen Aaron, Fraser Brenneis, Narmin Kassam, Ramona Kearney and Peggy Sagle (Division of Studies in Summary of work: In the OSCE students were presented Medical Education, 2J3.00 Walter Mackenzie Centre, Faculty of with a short scenario from which they extracted relevant Medicine and Dentistry, University of Alberta, EDMONTON, concepts, performed a search on Medline and selected Alberta,T6G 2R7, CANADA) two results suitable for addressing the scenario. The exams were set in computer labs normally used for teaching, One of the problems associated with assessments used therefore requiring special logistical arrangements for for decision-making, that is, pass/fail purposes is exam security. The OSCE was assessed on the search determining the passing score. With respect to setting strategy and two selected records. The marking criteria passing scores on an objective structured clinical were based on the relative effectiveness and accuracy of examination (OSCE), the methods are rooted in search terms, as well as publication type and subject modifications of either the Angoff method or the borderline- content of selected records. group method. The purpose served by the present study is to compare the passing scores and the resulting success Summary of results: The exam results showed a good rates derived from the station-author/reviewer, the spread of marks, and compared well with other OSCE borderline-group, and the station-examiner methods used stations. The logistical issues with timing and delivery and for a twelve-station OSCE administered to 103 final year the marking criteria went well for such a new exam, and medical students in May 2003. Station-authors/reviewers show that this OSCE format can be flexible. will be asked to establish a passing score for their Conclusions/take home messages: Exam results and respective stations. At the conclusion of each student- student feedback show that students’ confidence in using standardized patient interaction, examiners will be asked Medline does not necessarily match competence. The to rate each student’s competence as either satisfactory Medline exam promises to drive student learning and inform or unsatisfactory each defined by three levels (satisfactory curriculum development in an important clinical skill. – borderline, good, excellent; unsatisfactory – borderline, needs to improve, needs to improve a lot). At the conclusion of the exam, station examiners will also be asked to 2H 4 Evaluating physician CanMEDS competencies using establish a passing score for the station in which they Objective Structured Clinical Examination (OSCE) in examined. Passing scores, success rates and evidence for the validity of each passing score will be presented for neonatal-perinatal medicine each station and the total exam. Brian Simmons*, Ann Jefferies, Marc Blayney, Kyong Lee, Henry Roukema, Martin Skidmore, Jodi McIlroy and Diana Tabak (University of Toronto, Sunnybrook & Women’s College of Health 2H 6 Catalan Family Medicine OSCE: professional career Sciences Centre, Department of Newborn and Developmental consequences Paediatrics, 76 Grenville Street, Room 476, Toronto, Ontario M5S J M Martínez-Carretero*, C Blay, R Vilatimó, C López Sanmartin, 1B2, CANADA) J Arnau, S Juncosa and J M Vilseca (Institute of Health Studies, Background: The Royal College of Physicians and Balmes, 132-136, 08008 Barcelona, SPAIN) Surgeons of Canada defined 7 CanMEDS competencies The Institute of Health Studies and the Catalan Society of – medical expert, communicator, collaborator, manager, Family Medicine have jointly conducted 14 editions of the health advocate, scholar and professional. Training Family Medicine OSCEs for certification purposes. 387 programs are challenged to assess these competencies. family physicians have been assessed during the last 7 Objective: Design an OSCE for neonatal-perinatal (NP) years (1997–2003). In those OSCEs, participants have medicine trainees incorporating these competencies. been family physicians exercising their specialty as well Development: Ten 12-minute stations. Six stations used as tutors of family and community medicine residents from standardized parents(SPs) and 4 health care workers different teaching units of residency programmes. The (simulated health professionals -SHPs). Examiners clinical competence profile and the results by competence completed station specific checklists, CanMEDS global components are currently being analysed and will be and overall global rating scales. SPs/SHPs completed displayed. The consequences related to their professional communication global ratings. career for family physicians and tutors who have participated in the OSCEs are relevant, both to get a job in Results: 24 trainees participated. Each station assessed the public health system and to fulfil the criteria to obtain 4-6 competencies. There was significant correlation and maintain accreditation as tutors at family medicine between the checklists (67 +/-9, mean +/-SD) and residency units. The Family Medicine OSCE has examiners overall global scores (66+/-14, r = 0.97), the demonstrated its validity, reliability and feasibility and its checklists and medical expert global scores (70 +/-12, r = good acceptability on the part of candidates who went 0.96), communicator global scores (72 +/-15, r=0.92) and through that assessment tool. That is why, henceforth, 8 the SPs overall global ratings (62 +/-14, r = 0.92). Inter- new editions of the OSCE are foreseen on a regular basis, station alpha coefficient range was 0.80-0.88. for some 240 participants each year. The Institute of Health Conclusions: Using the OSCE, CanMEDS competencies Studies and the Catalan Society of Family Medicine are were evaluated with a high degree of reliability/validity. working to establish a conceptual framework for the Medical expert and communicator were the easiest to recertification, every 5 or 10 years, of those professionals incorporate; scholar the most challenging. The OSCE who have passed the OSCE certification process. allowed assessment of competencies not easily assessed through traditional examinations.

– 4.14 – Section 4 Session 2I: Problem Based Learning

2I 1 Achieving the best of both worlds by Integration of clinical reasoning and judgment and decision making PBL in PBT (Problem Based Teaching) during the skills; 3) To foster self-directed study and, 4) To promote clinical years collaborative work. Specific criteria for each objective were defined and integrated with the course objectives. A fifth N G Patil*, Mary Ip and J Wong (Faculty of Medicine, University of rubric, professional behavior, was added to the list, one of Hong Kong, HONG KONG) the outcomes we are emphasizing throughout the Background: The introduction of PBL tutorials during the curriculum. A marking system to judge each of the criteria clinical years has been controversial. This is due to the was developed as well as a summative marking scale. unfortunate perception that ‘Wards’ and other clinical Three checklists were developed: 1) A checklist to assess settings present difficulties to conduct PBL tutorials in a daily student achievement, performed by the tutor; 2) A structured format. PBL tutorials are, therefore, thought by checklist for self-assessment and 3) A checklist for peer- some institutions to be only suitable for paper/video/web- assessment. This criterion reference checklist system based scenarios, all of which are best held in purpose- considering the PBL objectives makes formative built tutorial rooms. assessment of tutorial sessions less subjective, more congruent and valid. Summary of work: In 1997, PBL tutorials were introduced by the Faculty of Medicine, The University of Hong Kong, in the then new medical curriculum. Since then, the role of 2I 3 How medical students’ satisfaction with a problem- PBL is now well established in the clinical years. This was based curriculum relates to their perceptions about achieved through its integration into the traditional bedside and outpatient teaching (PBT - Problem Based Teaching) learning and future career (and the relevance of from year III onwards. This integration was achieved in the learning about wider issues) following manner: G Maudsley*, E M I Williams and D C M Taylor (University of Tutorial 1: Liverpool, Department of Public Health, Whelan Building, Quadrangle, Liverpool L69 3GB, UK) • Students see a selected patient and discuss the case in a PBL tutorial format using the patient’s history, clinical Background: The Liverpool undergraduate medical findings, investigations etc. to identify the learning issues curriculum uses a problem-based philosophy to integrate in absence of a tutor. Students who have experienced students’ learning around clinical relevance. the paper/video case PBL tutorials in the first two years Aim: To explore interrelationships between students’ of the system-based blocks are well versed with the PBL satisfaction with a problem-based medical curriculum and process, and can manage them without a tutor. their perceptions about learning, career expectations, and • Students do self- and group-studies related to the relevance of wider issues (e.g. learning public health learning issues. Access to side rooms, internet ports and concepts). libraries are given at the clinical setting. The duration between the first and second tutorials can be as short Summary of work: The participants comprised the Year 1 as two hours for students to work on their learning issues (beginning and end) and Year 3 (mid-year) medical in a busy clinical setting - and to meet their equally busy students in 2001/02. Each cross-sectional, self-completion clinician tutor! questionnaire survey included: 1 closed items about learning style (18-item Short Tutorial 2: Entwistle Approaches and Study Skills Inventory); ideal • Students meet their tutor to discuss the case in the problem-based learning (PBL) tutors (38 items); good presence of the patient or in the side-room as doctors (1 item)*; satisfaction with problem-based appropriate. The tutor, who is usually a subject expert, approach (3 items)*; career intentions (1 item); acts as a facilitator as and when necessary. It is, therefore, 2 an open item (excluding entry-study of 1999 cohort) crucial that all clinicians involved in this exercise must exploring the relevance of a population perspective to know the process of PBL. their future work. Conclusions: Summary of results: 201/283 (71.0%) and 198/279 (71.0%) • Students can cope very well with PBL related to real Year 1 students, and 159/204 (77.9%) Year 3 students patients. responded. There were complex interrelationships between these variables. Students’ satisfaction with PBL • The culture of PBL could be promoted in clinical years approaches was associated with their preferred learning by its integration with traditional problem based styles, expectations of tutors, and career expectations. teaching. • Clinicians as ‘subject-experts’ should also be Conclusion/take home messages: The practical encouraged to become ‘PBL process-experts’. implementation of a problem-based philosophy should heed such interrelationships.

2I 2 Formative assessment of problem-based learning 2I 4 Assessment of students in PBL tutorials improves tutorial sessions using a criterion-referenced system attendance and correlates with academic performance Leticia Elizondo-Montemayor* and Araceli Hambleton Fuentes Salah Kassab*, Hafiz Shazali and Hossam Hamdy (College of (School of Medicine Tecnológico de Monterrey, Ave Morones Prieto Medicine and Medical Sciences, Arabian Gulf University, PO Box #3000, Pte., Colonia Los Doctores, Monterrey, Nuevo León CP 22979, Manama, BAHRAIN) 64710, MEXICO) Aim: College of Medicine and Medical Sciences (CMMS), At the School of Medicine Tecnológico de Monterrey, PBL Arabian Gulf University (AGU) adopted PBL in 1982. is the predominant instructional strategy. Thus, formative Evaluation of students in tutorials was introduced in 1999 assessment of the tutorials is most important. To assure its as part of the continuous assessment of students in the validity, assessment must be focused on student pre-clerkship phase. We aimed to test the impact of achievement of the objectives sought and offered by this evaluating students in the PBL tutorials on their attendance strategy. Objectives of the Nutrition and Metabolism course and to examine the correlation between the tutorial were considered, as well as the four main objectives of evaluation and students’ academic performance. PBL: 1) To apply a base of knowledge; 2) To develop

– 4.15 – Section 4

Summary of work: Correlation was tested between tutorial textbooks, the second was related to notes, and the third evaluation of year 2, 3 and 4 students (n=242) and the was an ad hoc way of learning. students’ performance in different components of end of unit examinations. In addition, tutorial attendance was Conclusions/take home messages: The three ways of compared in these students and another group of students learning will be presented in more detail and discussed as (n=153) who were not exposed to the tutorial evaluation well as the implications for academic success. system in their pre-clerkship phase. Summary of results: Assessment of students in tutorials 2I 6 Group process and learning outcome in PBL: a new significantly reduced the percentage of absenteeism from assessment tool identifies the crucial role of the tutor 12.7% to 7.2% in tutorials. Tutorial evaluation significantly (p<0.01) correlates (r) = 0.597, 95% confidence interval Stefan Herzig, Jan Matthes*, Alexander Look, Amina K Hahne, 0.40 – 0.59) with overall academic performance of all Kain Afhakama and Ara Tekian (University of Cologne, Department medical students in the “end of unit” examinations in the of Pharmacology, Gleueler Str.24, 50931 Cologne, GERMANY) pre-clerkship phase. The level of tutor qualification was found to affect process Conclusions/take home messages: These data indicate quality of learning groups in a PBL-course of basic medical that the system currently used for evaluation of pre-clerkship pharmacology. This did not translate into different learning medical students by tutors at the CMMS at AGU, besides outcomes in a traditional exam (Matthes et al., 2002, improving students’ attendance, could also be a reliable Naunyn-Schmiedeberg’s Arch Pharmacol 366: 58-63). We assessment instrument in PBL medical schools. now developed an assessment tool (Semi-structured Triple Jump, STJ), which merges process-orientation with the key feature format. Thirty-two randomly-assigned 2I 5 Medical students’ ways of learning learning groups of 259 3rd-year medical students were Are Holen (Norwegian University of Science and Technology, enrolled in two sequential pharmacology courses. Process variables were measured by a 35-item questionnaire, Department of Neuroscience, MTFS, NO-7489 Trondheim, containing reliable (Cronbach’s alpha=0.64-0.89) scales NORWAY) on self-study, team work, tutors‘ subject-matter and Aim: To inform about the development of a questionnaire teaching-method expertise, PBL, MCQ preparation, and that detects medical students’ ways of learning outside pharmacology. Outcome was measured by one-case STJ didactic sessions and PBL groups. (inter-rater r=0.93 and 0.84) and 30-item MCQ tests (r=0.59 and 0.61). Multivariate linear regression revealed no Summary of work: Students in the PBL curriculum were correlation between total scores of STJ or MCQ and the asked to write down their individual ways of learning. The process variables. However, exploratory analysis of test descriptions were analysed qualitatively and a group of components showed that tutors’ subject-matter expertise items was derived. In a preliminary questionnaire, these affects STJ step 1, reflecting application of factual items were given to students and rated on a scale from 1- knowledge (r=0.42, p<0.05, n=32). Step 3 (revision of 9. The items which correlated the most with the extracted hypothesis on drug therapy, giving literature evidence) factors were included in a final questionnaire and tested depends on tutors’ teaching-method expertise (r=0.80, separately. p<0.01, n=16) when assessed by an external supervisor. Summary or results: Three factors emerged indicating Thus, the influence of the tutor on process quality affects three ways of learning: the first was related to work with learning outcome in PBL groups.

Session 2J: Teaching and Assessing Attitudes

2J 1 Using digital video to teach attitudes: gain or pain? 2J 2 Development and validation of the Beersheva Survey A Chiado* and A Pereira da Silva (Faculty of Medicine, Laboratorio of Attitudes and Knowledge in international health de Genetica, Faculdade de Medicina de Lisboa, Piso 3, Av. Prof Egas A Gaaserud*, A Jotkowitz, Y Gidron, C Baskin, J Urkin, M Alkan Moniz, 1649-028 Lisboa, PORTUGAL) and C Margolis (Ben Gurion University of the Negev, Faculty of Aim: To describe the simplest technological and Health Sciences, The Moshe Prywes Center for Medical Education, educational forms to make an educative videoCD (VCD)/ PO Box 653, Beer Sheva 84105, ISRAEL) DVD/Digital video (DV) and to demonstrate its applicability Aim: To describe the development and validation of the in the field of teaching attitudes. Beersheva Survey of Attitudes and Knowledge in Summary of work: The development of computer International Health (IH), which can be used for medical technology makes it possible to build a VCD/DV as a support student assessment. for communication. We are using this instrument to teach Summary of work: Development: A panel experienced in IH attitudes. We identified the whole material type and formulated attitude, general knowledge items and clinical necessary methods to its construction: hardware, DV cases based on personal experience, literature review and cameras and software, as well the educational structure texts. A previously validated questionnaire on openness to of an VCD/DV and its applicability for teaching attitudes. experience, a personality factor, was incorporated. The Summary of results: A video built by the authors will be survey was reviewed by two outside IH experts. Likert scales presented, showing the educational structure, the new graded openness and attitude while multiple choice technology materials and process, and demonstrating its questions scored knowledge. The survey was piloted on applicability to the teaching of attitudes. Cost is low and it the students of the BGU MD program in International Health will be very easy to modify the contents when teaching and Medicine. updates are needed. Validation measurements: Internal reliability, test-retest Conclusions/take-home messages: The use of an reliability of attitudes section, construct validity, sensitivity. educative structured VCD/DV allowing the insertion of text, Summary of results: Cronbach ù“ #ø“ s á was 0.87. Test- video, photos and sounds may be an important contribution retest reliability of attitudes, R= 0.87 (P< 0.001). Correlation to the teaching of attitudes, motivating attendance and of openness to attitudes, R= 0.376 (P<0.001). 3rd year IH facilitating learning, making this instrument a promising students scored higher than incoming students on IH and relevant auxiliary for teaching attitudes. This technique knowledge and clinical cases (P< 0.05). will be the subject of a formal evaluation in future studies, to identify the main strengths and weaknesses.

– 4.16 – Section 4

Conclusion/take home messages: The survey is a reliable Summary of work: The 3 hour lecture attended by 240 and valid tool to assess and compare medical students’ students was under the responsibility of two doctors and knowledge and attitudes toward International Health. This one educationalist. Key messages were selected and then survey can be used to evaluate curricular innovations in illustrated through the video. The students were asked to the field. identify them and to discuss respective underlying ethical dilemmas. A voting process using cards of different colours allowed teachers and students to be immediately aware of 2J 3 Assessment of attitude and conduct – is it feasible? the assembly’s ideas. Helen Sweetland*, Lorna Tapper-Jones, Ania Korszun, Peter Summary of results: Results of the content analysis applied Winterburn and Helen Houston (University of Wales College of students’ evaluation questionnaires (n=232) on the “impact Medicine, University Department of Surgery, Heath Park, Cardiff of the session” showed that the essential messages they CF14 4XN, UK) got as future doctors was: Aim: To demonstrate a proforma used to assess attitude • Doctors must see the patient as a person/humanization and conduct, to evaluate its role and the problems it has of Medicine 41% detected. Tomorrow’s Doctors (2002) states that medical • Medicine can’t be reduced to scientific competency 26% students should develop suitable attitudes and behaviour, i.e. qualities that are appropriate to their future • Altruistic values and idealism are crucial in the Medical responsibilities to patients, colleagues and society. Attitude profession 26% and professional behaviour need to be monitored to detect • Other different messages 22% (The percentage total students showing traits that may not be appropriate for exceeds 100% because some students expressed more future professional practice. than one idea) Summary of work: A proforma was designed, based on Conclusions: The video technique seems to be a powerful criteria outlined in Tomorrow’s Doctors. It includes tool to “teach attitudes” because it facilitates learning statements relating to respect for patients and staff, bringing to classroom real situations capable of raising confidentiality and consent. Professional development is conflicts and dilemmas. The discussion by different monitored by assessment of reliability, initiative, honesty, teachers with different perspectives and life experiences attendance and approach to learning. This has been used seems to be another crucial element for the teaching of since 2001 for year 4 and 5 students on all clinical attitudes. attachments. The form is completed by one assessor, taking into account comments from other team members. Summary of results: This form has allowed identification 2J 5 Evaluation of attitude achievement in “doctor- of students with inappropriate conduct and acute problems patient relationship” PBL sessions such as illness or psychological problems affecting their Orhan Odabasi, Melih Elcin, Iskender Sayek*, Murat Akova and studies. Student progress has been halted to allow remedial Nural Kiper (Hacettepe University, Tip Fakultesi Tip Egitimi ve action to be taken before the situation deteriorates further. Bilisimi AD, 06100 Sihhiye, Ankara, TURKEY) When the form is used for the 3 year clinical period, trends in student behaviour should become apparent to enable Respect, responsibility, communication and self- detection of students with chronic poor attendance, lack awareness are the main topics of professional behaviours of motivation and attitude problems. that are expected in medical students. The doctor-patient relationship is central to the delivery of high quality medical Conclusion/take home messages: Formative assessment care and has been linked to a variety of other bio-psycho- and monitoring of attitude and conduct is feasible, using social outcomes. Many faculties have implemented some this simple proforma. curricular changes to teach communication skills, professional values, humanistic attitudes and behaviours to medical students. In Hacettepe University Faculty of 2J 4 “To be a Doctor”: Learning-teaching attitudes using Medicine, we prepared a 12 hour module for year I students commercial films for raising the discussion on on the doctor-patient relationship. We gave students a ethical dilemmas questionnaire on the first and the last day of sessions. The M F Patricio*, A P Lacerda, P Sá and J Gomes-Pedro (Faculty of aim of this study is to evaluate the achievement of students’ Medicine, University of Lisbon, Av Prof Egas Moniz, Piso 1, 1649- attitudes. 028 Lisboa Codex, PORTUGAL) There were 294 students in year I and 172 of them Aim: To describe the methodology for the teaching of completed both questionnaires. There were 7 statements attitudes in the subject Introduction to Medicine (at the and students had 5 choices for their answer. We evaluated FML). The process and evaluation of one specific lecture the results using Wilcoxon tests and the positive change in dedicated to the theme “To be a Doctor” where a video attitudes for all 7 statements was analysed as meaningful technique based on commercial films like Patch Adams, (p<0.05). We concluded that it was an important outcome Awakenings and Lorenzo’s Oil was used as a learning tool. for year I students to achieve such attitudes in the beginning of their medical career. They would feel themselves more prepared for further years.

Session 2K: Clinical Skills Training

2K 1 Establishment of a British Heart Foundation UK the cardiology patient simulator, and ‘UMedic’, a computer Harvey Resource Centre assisted interactive instruction programme, into UK medical schools. The Harvey Resource Centre will help Shihab E O Khogali*, Ronald M Harden, Jennifer M Laidlaw, Barbara maximize the potential use of ‘Harvey’ simulators in the UK E Scott and Stewart Pringle (University of Dundee, Department of medical schools by: Cardiology, Ninewells Hospital & Medical School, Dundee DD1 9SY, • Disseminating throughout the UK, information about the UK) use of Harvey The British Heart Foundation has funded the establishment • Providing assistance and advice to centres with Harvey of a UK Harvey Resource Centre in Dundee to support the if required introduction, by the British Heart Foundation, of ‘Harvey’,

– 4.17 – Section 4

• Encouraging and facilitating the full use of Harvey (79.4%) were completed. During undergraduate education simulators in the curricula of UK medical schools 113 participants (29.4%) were trained in Ulm, 104 • Establishing a network of Harvey users in the UK postgraduates (27%) had any other Mega-Code training and 168 (43.6%) had no Mega-Code training at all. The • Contributing to further developments and research in students who were trained in Ulm showed a significant the use of Harvey. better performance than the two other groups. Students who received unstructured Mega-Code training did not This presentation: perform better than students without training. • describes the range of activities of the Harvey Resource Centre. The initiatives include: Conclusions/take home messages: Resuscitation skills after a sophisticated undergraduate training program • establishment of a network of UK ‘Harvey’ users showed the highest postgraduate benefit. Unspecified • publication of Harvey newsletters mega-code training in undergraduate education did not • establishment of a Harvey helpline improve resuscitation skills of postgraduates significantly. • development of a UK Harvey website • discusses the need for such a national group to support 2K 4 Multimedia driven education significantly improves the introduction of new (especially complex) technologies in medical education. medical students’ understanding of operative procedures in heart surgery R Friedl, H Höppler, S Stracke* and A Hannekum (University of Ulm, 2K 2 Simulation-based large scale emergency Dept. Heart Surgery, Steinhovelstr.9, Ulm 89075, GERMANY) preparedness training programs – The national role Aim: An online multimedia teaching program about the of the Israel Center for Medical Simulation operative technique of aortic valve replacement addresses Amitai Ziv*, Tali Yohanes, Shuli Banita, Ariel Bentancur, Daphna medical students (www.lamedica.de). We assessed the Barsuk, Amir Vardi, Inbal Levin and Haim Berkenstat (The Israel impact of the system in improving knowledge and skills as Center for Medical Simulation, Chaim Sheba Medical Center, Tel required during operative procedures. Hashomer, Ramat-Gan 52621, ISRAEL) Summary of work: In a prospective study, we randomized Simulation-based medical education is recognized as a 43 students to either use multimedia (n=20) or a text- powerful emergency training tool. Simulators expose version (n=23), displaying the same content. Afterwards, clinicians to high-risk scenarios, in an effort to increase both groups participated in an aortic valve replacement health professionals’ competency. Global reality of terror/ during which they answered a 28 questions knowledge- war challenges health professionals to prepare for threats interview. A psychometric evaluation scoring from 1 (poor) including non-conventional – as confronting Israel. The to 7 (excellent) was accomplished at the end of the study. Israel Center for Medical Simulation was established as a Summary of results: Mean percentage of correct answers comprehensive, multidisciplinary facility to lead a during the operation was 85 ± 4.5% in the multimedia group nationwide effort to introduce innovative approaches to and 61 ± 4.7% in the text group (p<0.0001). The health–care training. Designed as a virtual hospital, multimedia group needed significantly less study time (101 equipped with multiple simulation modalities, the center ± 16 min) than the text group (121 ± 17 min), (p<0,001). rose to the challenge of urgent national needs. In Self-reported competency in the multimedia group was collaboration with health-care authorities, the center has 6.2 ± 0.7 and 5.5 ± 0.5 in the text group (p<0.05). Both developed cutting-edge, simulation-based courses to groups felt that the respective method they used facilitated increase Israel’s preparedness. Trauma management understanding (online group: mean scoring 5.9 ± 0.4; text courses were designed to train military and civilian medical group: mean scoring 5.8 ± 0.9). teams. Over 1800 Military doctors and medics and 200 ER team members were exposed to authentic scenarios, Conclusions/take home messages: Multimedia based recorded and debriefed constructively by trauma experts. teaching is time-efficient and significantly improves Furthermore, chemical warfare threats led to development education in heart surgery, where understanding of of an original training program for over 1000 military and complex temporal and spatial events during operations is hospital-based professionals to treat victims of chemical essential. agents while wearing full protective gear. The important challenges/lessons learned from implementation of these national programs and an analysis of the very positive 2K 5 The educational impact of bench model fidelity on trainee feedback will be presented. the acquisition of technical skills Ethan D Grober*, Stanley J Hamstra, Kyle R Wanzel, Keith A Jarvi, 2K 3 Does systematic undergraduate training of Edward D Matsumoto, Rivindar S Sidhu and Richard K Reznick resuscitation skills influence postgraduate (University of Toronto, Centre for Research in Education - performance of resuscitation skills? University Health Network, 565-1 Eaton Wing South, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, CANADA) F O Weisser*, B Dirks and M Georgieff (Universitätsklinik für Anästhesiologie, Klinikum der Universität Ulm, Prittwitzstr., Aim: To evaluate the impact of bench model fidelity on the 89070 Ulm, GERMANY) acquisition of technical skill. Aim: We are training medical students and postgraduates Summary of work: Fifty junior surgical residents participated in resuscitation skills using a systematic curriculum. We in a microsurgical training course. Subjects were were interested in the difference of the performance of our randomized to 1of 3 groups: 1) high-fidelity model training postgraduate participants: (1) students who were trained (live rat vas deferens, n=21); 2) low-fidelity model training in our curriculum (Ulm/Germany); (2) students who were (silicone tubing, n=19); or 3) didactic training (n=10). trained Mega-Code without a special curriculum; (3) Following training, technical performance was assessed students without Mega-Code training, during on the high- and low-fidelity bench models. Outcomes undergraduate medical education. measures included procedure times, blinded, expert assessment of videotaped performance using checklists Summary of work: The undergraduate training of all and global rating scales, immediate and delayed participants of our postgraduate training programs was anastomotic patency and the presence of sperm on evaluated. The evaluation data and the postgraduate results microscopy. of the performance-based assessment of resuscitation skills were correlated. Summary of results: Following training, checklist (p<0.001) and global rating scores (p<0.001) were higher among Summary of results: In 1998 and 1999, 484 postgraduates subjects who received hands-on training, irrespective of completed our training. The data of 385 participants

– 4.18 – Section 4

model fidelity. Immediate anastomotic patency rates of the who received didactic training (p=0.039), but did not differ rat vas deferens were higher with increasing model fidelity among subjects who received hands-on model training (p=0.048). Delayed anastomotic patency rates were higher (p=0.32). among subjects who received bench model training, irrespective of model fidelity (p=0.02). Rates of sperm Conclusions/take home messages: Surgical skills training presence on microscopy were higher among subjects who on low-fidelity bench models appears to be as effective as received high-fidelity model training compared to subjects high-fidelity model training for the acquisition of technical skill.

Session 2L: Undergraduate Multiprofessional Education

2L 1 Multiprofessional education: would a taxonomy help? • Strengthens partnerships between participating C Segouin and B Hodges* (Assistance Publique - Hopitaux de Paris, universities who are working together and sharing AP-HP, Service de la Formation Continue des Médecins, 3 Avenue responsibility for assessment and evaluation. Victoria, 75004 Paris, FRANCE) The paper explores a taxonomy that might help organize 2L 3 Communication skills in a multiprofessional critical the field of multiprofessional education (MPE). The concept of MPE is based on two statements: the first one is illness course that better healthcare is provided by teamwork than by a Alan Thomson*, Rachelle Arnold and Jennifer Cleland (Aberdeen sum of individual efforts. The second one is that good Royal Infirmary, Department of Anaesthetics, Grampian functioning of the healthcare team supposes a University Hospitals NHS Trust, Foresterhill, Aberdeen AB25 multiprofessional education environment. Two problems 2ZD, UK) arise: the first one is that there is little evidence that MPE leads to better healthcare or even that it improves that much Background: The importance of evidence-based healthcare teamwork. The second is that there is no communication skills teaching is increasingly clear, as is accepted or unique definition of MPE in the literature. integration with clinical skills teaching. Almost all the experiences described involve physicians Summary of work: We describe integration of a and other “allied” health professionals. But the courses communication “skills station” into a multi-professional (5th differ with regards to the topics, the length of the course, year medical students, junior staff nurses) one-day “Care the timing of curriculum delivery (initial or continuing of the Critically Ill” Course, developed after evidence education) etc. More than that, the objectives are usually highlighted the need to improve ward care of critically ill of different kinds. Most of the experiences involve “learning patients. Poor team-working and communication failure together” courses. Few deal with “learning from each other” has repeatedly been shown to contribute to error and sub- or “learning about each other”. Further, few evaluations of optimal outcome. Course evaluation (a six-point Likert- effectiveness have been carried out and most are confined scale “very useful” to “not useful”) over 4 sessions, involving to satisfaction or a subjective evaluation of the improvement 23-36 participants, underpinned the development of the of participants in their practice. Finally, we have only got session from a didactic mini-lecture to interactive the “intuition” that it works. multiprofessional small group (6 students) sessions involving vignettes, role-play and discussion. This format supported students to a) actively identify communication 2L 2 JUMP2 shared learning for undergraduates in practice breakdown, resulting in sub-optimal care, and b) generate Fanny Mitchell* and Gill Young* (c/o General Office, Central solutions to minimise communication breakdown and Middlesex Hospital, North West London Hospitals NHS Trust, improve team-working. Acton Lane, Park Royal, London NW10 7N, UK) Summary of results: Aim: This session will outline how shared learning in a) the active learning environment for communication skills practice can be successfully organised, and the benefits and team-working was preferred to the original, didactic and challenges of this approach. lecture Summary of work: The joint universities Multi-Professional b) medical students and nurses rate learning specific Programme (JUMP2) is an ambitious programme for all communication skills as equally useful as learning the undergraduates at four West London Universities during necessary clinical skills their placement/attachments to learn together in interactive c) nurses and medical students regard the session useful small groups, being taught by clinicians who work together in approximately equal measure. in patient care. Following successful piloting of a local devised model funded by the DoH Medical Education Unit, funding is now being continued by the Workforce 2L 4 Inter-professional healthcare ethics programme for Development Confederation to roll it out of their trusts. undergraduate students of pharmacy, nursing and Key features include: medicine: developing and evaluating a model for • Development of a common assessment tool used by all learning and teaching universities. Deirdre McAree*, Mairead Boohan and Sue Morison (Queens • A highly supportive organisational structure including University Belfast, School of Pharmacy, 97 Lisburn Road, Belfast senior university and NHS staff and implementation BT9 7BL, IRELAND) groups in each trust. Although the development of an inter-professional • An interactive evaluation process. education (IPE) healthcare ethics programme is not • Development of an inter-professional teaching pack for unique, there is little published evidence showing the facilitators. benefit of this approach compared with uni-professional • Findings and results to date: learning. The Schools of Medicine, Nursing and Pharmacy • Facilitators/staff are working together in new ways and at Queen’s University Belfast have developed an inter- learning about/from each other in non-threatening ways. professional course in healthcare ethics for their final year students. This course was delivered between January and • Provides forum for developing other inter-professional April 2003. The aim of the course was to provide students initiatives within trusts. with a basic knowledge and understanding of moral values,

– 4.19 – Section 4

ethical theories and principles of human rights. A team of Conclusions/take home messages: A higher level of educators and practitioners from each profession acted learning was achieved by allowing for openness in the as facilitators at nine live workshop sessions. Working in choice of problem and methods, as well as for unexpected inter-professional groups, students debated a series of results. Furthermore, interprofessional learning increased clinical case-based scenarios. Taking account of student the understanding, importance and relevance of having and facilitator perspectives, this project explored the translational projects in molecular medicine. perceived impact of teaching healthcare ethics in an IPE environment and evaluated their views to inform future educational approaches. Initial results suggest that 2L 6 Community-based interprofession education: do students from all professions could relate this learning to the outcomes justify the effort? situations which could arise in their future professional practice. The majority indicated that ethics was a suitable Ruth McNair*, Nick Stone, Jane Sims and Caroline Curtis (The subject for IPE. Learning was enhanced by case-based Department of General Practice, The University of Melbourne, 200 scenarios. Facilitators indicated that the sessions provided Berkeley Street, Carlton 3053, AUSTRALIA) an excellent forum for debate. Aim: The presentation will describe a pilot undergraduate health care education placement, the challenges and barriers to the implementation of such a program, and the 2L 5 Medical proteomics – from bench to bedside: an outcomes elicited using a wide range of evaluation interprofessional course in molecular medicine at the methods. undergraduate level Summary of work: The Rural Interprofessional Education Annelie Brauner*, Ewa Ehrenborg*, Marie Henriksson* and Maria (RIPE) program has been running in Victoria, Australia for Sunnerhagen (Karolinska Institutet, King Gustaf V Research 2 ½ years. Students from different health disciplines are Institute, Karolinska Hospital, SE 171 76 Stockholm, SWEDEN) placed together for 2 weeks in multi-disciplinary, rural primary health care settings. Students observe and engage Background: Interprofessional collaborations are essential in interprofessional practice whilst working together on a in order to obtain top-class research as well as excellent range of activities including a community-based project. health care. Thus, it is important to offer interdisciplinary Both qualitative and quantitative data have been collected courses in molecular medicine already at the to evaluate student interprofessional learning including the undergraduate level. This course was for students from development of related attitudes, skills and knowledge. biomedicine, medical and engineering programmes. Evaluation includes analysis of pre- and post-placement Aim: To promote interprofessional relations between questionnaires, tutorial transcripts, student online clinically and experimentally oriented students by working discussion and reflective journals. with disease-related projects. Summary of results: The evaluations indicate that the Summary of work: The course was project oriented and experience has led to significant interprofessional learning based upon case methodology. It contained lectures, for both students and preceptors. Interprofessional attitudes patient demonstrations, seminars and laboratory work. In and knowledge show a positive shift as a result of the the laboratory work students studied disease causing placements. proteins with basic experimental techniques and related Conclusions/take home messages: The demonstrated their results to clinical findings. The aim was to increasingly outcomes of this experiential education program, put the responsibility for learning on the students, particularly the degree of attitudinal change, would be encouraging them to formulate their own hypothesis and difficult to obtain in a class-room based activity, and make devise a method for testing it. This aim was reached, as such a program worthy of inclusion in core curricula. evaluated by a version of the Inquiry Matrix. At the examination the students presented research project proposals combining clinical and experimental aspects of a disease.

Session 2M: Research and Critical Thinking

2M 1 Peer education workshop on research during students to participate in the workshop. None of them medical studies recommend against taking the class. Students’ assessment of their own skills for pursuing a dissertation E Zimmermann*, E Schoenenberger and M Dewey (Charité, before and at the end of the workshop (range: 1=very good Humboldt University Berlin, Fachschaftsinitiative Medizin, to 5=unsatisfying) was 3.4 ± 0.8 and 1.8 ± 0.5, respectively Campus Charité Mitte, Schumannstr 20/21, 10117 Berlin, (p<0.001). No student believed that his skills had not GERMANY) improved. Eighty-eight per cent of the respondents wanted Aim: We sought to address the lack of adequate preparation the workshop to continue being optional. of students to pursue original research through a peer Conclusions/take home messages: This peer-education education workshop. approach enjoys high acceptance among students and Concept: The workshop lasted 16 hours. The improves research skills among participants. chronological sequence of a dissertation served as the main structure and was supported by a handout. The following topics were addressed: (1) Search for a 2M 2 An evaluation of scientific comprehension among dissertation (2) Legal regulations (3) Literature research Swedish medical students: An evaluation of scientific and Statistics (4) Scientific writing (5) Practical work and comprehension among Swedish medical students (6) Revision of the dissertation. The participants gained G Edgren*, J Adami, O Akre and G Petersson (Karolinska knowledge about and started working with the appropriate computer applications for these issues. Institutet, PGSCS, Department of Medical Epidemiology, SE-171 77 Stockholm, SWEDEN) Summary of results: Sixty students have so far participated in four workshops. Fifty-six students responded to an Aim: The purpose of this study is to compare how medical anonymous questionnaire (93%). Ninety-eight per cent of students in their second and tenth semesters at two Swedish the respondents would definitely recommend other medical universities read and assess a scientific report from a peer-reviewed medical journal.

– 4.20 – Section 4

Summary of work: The article of choice was sent to 350 the processes and problems of clinical research and EBM. students together with instructions on how to answer Each of the six modules started with an initial homework questions about the study via a web-based questionnaire. on the web and ended with a lecture. The students had to The questions concerned specific statistical and answer questions and small-group-work was methodological elements of the methods and results recommended. Also learning resources were referenced sections of the report. Questions were also asked about on the web. Two weeks later the answers were put on the the students’ academic background as well as about other web and the groups had to compare their answers with the important scientific methods not found in the article. Finally, right ones. Each group had to formulate open questions the students were asked to appraise the internal validity of about the learning issue and put it on a discussion e-forum the study. The information obtained from the background on the web. One week later the teacher prepared a lecture questions was used to appreciate the students’ exposure consulting the questions of the groups. A written survey to scientific training. The exposure was then compared to evaluated this new program. The results are disillusioning. how well the student scored on the questions and how The initial homework was stimulating, but most students accurately the internal validity was appraised compared learned by themselves and not in groups. 82% of the with a gold standard. students did not learn until the answers were available. After 2 years of pbl experience more self-directed and group-oriented learning was expected. More results will 2M 3 Can our students think, and do they care? be presented. Lynne C Hvidsten*, James R Hulbert and Warren L Moe (Northwestern Health Sciences University, Department of Clinical Education, 2501 West 84th Street, Bloomington, MN 55431- 2M 5 A program for medical research integrated in the 1599, USA) medical curriculum A Waage*, R Austgulen, A Brubakk, U Sonnewald, T Lindmo, M This presentation is directed to faculty and administrators Rekvig, O J Iversen and T Vik (Faculty of Medicine, Norwegian of clinical education programs. Ever worried that your clinical program produces robotic technicians instead of University of Science and Technology, Department of Medicine, St caring clinicians? This presentation reviews Northwestern Olavs University Hospital, N-7006 Trondheim, NORWAY) Health Sciences University’s systematic data collection and Aim: To describe a research program offered to third year, analysis to answer this challenging, yet necessary, undergraduate medical students. question. The background, objective, methods, results, and discussion of a recent study attempting to measure Design: The program includes 40 credits in addition to the the ineffable skills of clinical thinking and interpersonal full curriculum. A research project includes 30 and specific interactions will be discussed. Three theory-based sub- research courses 10 of the credits. To achieve this, the scales (information gathering, clinical thinking, and medical curriculum is extended from 6 to 7 years and interactive skills) will be reviewed. Results of standard students are supposed to spend two summer periods, psychometric scale-construction analysis, Cronbach’s weekends and evenings on their research projects. After 6 alpha, confirmatory factor analysis and Pearson’s ½ year the students will finish the project with a written correlation will be discussed. summary preferably including a published paper. After 7 years and a qualifying examination the student receives Take-home from this presentation is two-fold: one model his Medical Degree diploma stating the research of systematic data collection and evaluation of clinical skills experience, but there is no specific degree achieved. and motivation for non-research faculty to become involved However, the student has covered 30-50% of the work for in research, specifically, the scholarship of assessment. the degree Doctor of Medicine and is supposed to continue the research to achieve this degree. In 2002, thirteen students and in 2003, 9 students have been admitted to 2M 4 Is self-directed learning an illusion? – an evaluation the program. of a new student-centered course in EBM Conclusion: The experience with the research branch is P Frey*, K Huwiler and M Battaglia (University of Bern, IAWF, so far very positive. The program means a more effective Department of Instructional Media (AUM), Inselspital 38, CH - utilization of resources allocated to research and a research 3010 Bern, SWITZERLAND) class for discussions of more specific student problems By using a new teaching method, third year medical related to research. students in a pbl curriculum should become familiar with

Session 2N: Selection

2N 1 Teaching outcomes vs students’ former experience response rate to the initial test is meant to reflect chiefly and background the prior educational experience of students, whereas the results of the second test are supposed to reveal some Jadwiga Mirecka (Department of Medical Education, Medical cultural differences between the groups as well as an input College of Jagiellonian University, Str. Kopernika 19E/1, 31-501 of the teachers and school. Krakow, POLAND) Investigation was aimed at defining to what extent students’ background and former experience determine their 2N 2 Selection and admission to medical schools in progress in the first year of medical studies. Three different Europe and USA cohorts of students trained in Medical College of Ara Tekian (University of Illinois at Chicago, Department of Jagiellonian University were compared: Polish students Medical Education (m/c 591), 808 S. Wood St, Rm 986, Chicago attending regular 6-year program, Norwegian students attending an English version of the 6-year program and IL 60612, USA) North American/Canadian students attending 4-year The process of selecting medical students varies greatly program in English. Students from all three groups were across international borders. In any discussion about given the test comprising knowledge from anatomy, medical student selection, it is important to consider the histology and embryology at the beginning of the respective criteria against which candidates are judged - in other courses. The same test will be given after completion of words, what do selection committees look for in applicants? the courses, at the end of the spring semester. The Criteria for selection of medical students include “cognitive”

– 4.21 – Section 4

and “non-cognitive” abilities. Cognitive factors are often the largest single professional group being practice associated with academic achievement, while the majority managers. This is a major factor in their motivation for of non-cognitive factors can be categorized as involvement (which is high), but raises the issue of whether demographic, personal qualities and geographical factors. they represent ‘lay’ views. Training was praised, and the This study reviews the policies, criteria and measurement majority of respondents (85%) felt valued within the of these criteria in selection and admission, and the actual process. process of decision-making. Furthermore, it explores the effectiveness of the selection process by examining the Conclusions/take home messages: The West Midlands admission practices in European countries, and experience demonstrates that lay people can be comparing and contrasting these practices and policies successfully included in selection processes. with those of U.S. and Canadian medical schools. The United States and Canada are unique from an admissions 2N 5 Changing profile of people who want to follow perspective in that only these countries require applicants to have educational experience beyond secondary school. medical studies in Romania General differences between European and U.S. medical Horatiu D Bolosiu (University of Medicine and Pharmacy “I. school admission systems include mean age of the Hatieganu”, Centre for Medical Education, Clinica Medicala II, 2- applicant, the number of available positions, the role of 4 Clinicilor Street, 3400 Cluj-Napoca, ROMANIA) achievement tests and letters of recommendation, utility of admission interview, value of personal statements and prior Aim: In the last 10 years the number of candidates to be professional experience of applicants. admitted to medical schools in Romania constantly and dramatically decreased. We were interested in finding out what is the motivation of students-to-be in our University. 2N 3 Major side effects of the introduction of entrance Summary of work: An enquiry among 150 candidates selection in a medical school in Flanders (Belgium) randomly selected from about 500 who applied for J Van der Veken*, A Derese, J de Maeseneer and B Morlion admission has been made. They have been asked to fill in (Universitair Ziekenhuis Gent (3K3), De Pintelaan 185, B-9000 anonymously a 13 item questionnaire and to return it on Gent, BELGIUM) the last day of the admission procedure. The response rate was 75%. Belgian higher education is freely accessible for those who have proper qualifications. Admission to medical school Summary of the results: Most of our candidates came from has been limited by the Flemish government through a urban areas of the country (89%) and were females (68%). central examination. This was decided in 1997. In order to Only 14% of them previously attempted to be admitted to detect influences of this measure, two cohorts of students studies other than medical ones. Sixty two percent did well, were identified in Ghent University, one of the two most but not exceptionally, with their high school studies and important Universities in Flanders. The first cohort (n=112) about 80% underwent paid preparatory courses. The contains students born in 1978 who started their medical recognized reasons to be a doctor were as follows: education before the introduction of entrance selection. willingness to help people (75%), the need to be respected The second one (n=70) is the birth cohort of 1980. These by others (50%), the possibility to work abroad (36%), students had to pass the selection procedure. In order to material reasons (30%), and parents’ advice (22%). make both cohorts comparable, success in attaining a Conclusions: Our data support the idea that, in spite of bachelor degree was included as a second criterion. fewer people who want to study medicine, the reasons for Information was collected from about 90% of these doing so are still of higher value. With the tendency we students. The influence is studied in terms of differences observed, in the near future our problem should be how to in educational level and occupational prestige of parents recruit rather than how to select students. and in terms of effect on secondary school choice of the candidates. On both items we found significant differences. More students came out of secondary school without 2N 6 Motivation and insight of school students classic languages but with more mathematics in the considering a career in medicine second cohort. The higher prestige index of parents (especially the higher representation of physician relatives) Adrian Blundell*, Richard Harrison and Ben Turney (RAFT, 12 warrants a contextual profound analysis of better Mostyn Road, Hazel Grove, Cheshire SK7 5HL, UK) understanding. Aim: Previous studies have demonstrated that many medical students lack insight into medical careers and many regret their choice. This study aimed to determine 2N 4 Involving lay assessors in the selection of GP motivation and awareness of British school students Registrars: an evaluation from the West Midlands considering medical career. Stephen Kelly*, Sarah Wakefield, Celia Brown and Marilyn Summary of work: Attendees at a medical careers Hammick (West Midlands Deanery, Institute of Research & conference were asked to complete a questionnaire (prior Development, Birmingham Research Park, Vincent Drive, PO Box to the conference commencement) comprising 9771, Edgbaston, Birmingham B15 2SQ, UK) demographics, awareness of differing aspects of medical Aim: In the West Midlands, lay assessors have been careers and motivations for considering a medical career. included on the interview panels for the selection of GP Summary of results: 106 respondents, age range 16-18, Registrars since October 2000. This presentation will 78% female, 8% stated parental occupation as medical outline the key findings of an evaluation of their involvement, (6% fathers/2% mothers). 66% felt supported in their including the impact of their inclusion on selection scores. decision to study medicine. 100% were aware of the 5- Summary of work: The evaluation adopted a triangulated year training, 86% realising of postgraduate exams. Few approach, comprising: analysis of interview scores responders were aware of recent changes in doctors’ pay, awarded; questionnaire to lay assessors (84% response 1% perceived doctors as “overpaid”. The strongest rate; n=47); and case studies of two lay assessors motivators were; “job satisfaction”, “working with people” participating for the first time, each interviewed three times and “desire for challenge”, whilst the strongest demotivators (before training, after training, and after involvement). were “risk of litigation”, “poorly run Healthcare system” and “long working hours”. The three most popular career Summary of results: Analysis of selection scores reveals choices were surgery (46%), paediatrics (41%) and GP no significant differences between mean scores given by (21%). medically qualified and lay assessors, and score distributions for all questions are almost identical. The Conclusions: Whilst awareness of medical careers was majority of questionnaire respondents (87%), whilst not high, ignorance concerning some key aspects was medically trained, work in professions related to medicine, lacking, and several factors seem to strongly demotivate potential medical students.

– 4.22 – Section 4 Session 3A: The Virtual Learning Environment

3A 1 Sustainable development and integration of ICT- We aim to describe a model for e-learning in undergraduate supported learning medical education. To manage any learning environment there must be integration of the networked learning Annette Langedijk*, Christian Schirlo and Wolfgang Gerke environment (NLE) within the teaching and learning strategy (Medical Faculty, University Hospital Zurich, Frauenk- of the educational institution. Sheffield medical school has linikstrasse 10, CH 8091 Zurich, SWITZERLAND) undergone a major revision of its undergraduate Aim: The faculty of medicine of the University of Zurich curriculum, the educational strategy being contained in a promotes the integration of ICT-supported learning vision statement. The Sheffield Networked Learning environments into the curriculum. The aim of the present Environment (NLE), a web-based flexible database study is to outline a perspective for e-learning projects in solution, was developed initially to provide more efficient terms of resources (funding) and their role in the administration of the old course in collaboration with the curriculum. University of Newcastle. The new outcome focussed curriculum will be intensively supported by a purpose built Summary of work: In August 2002 a survey was held among NLE, which has been extensively tested and modified the current 21 e-learning projects to determine (1) the level through pilot studies in the old curriculum. Features include of the curricular integration, (2) the budget spent for the a core curriculum database developed from 95 core development and (3) an estimation of the resources problems, forming the heart of the NLE with an necessary for the continuous operation of ICT-supported underpinning relationship with course outcome objectives learning. developed at the strategic level to learning objectives Summary of results: The e-learning projects presently cover contained in study guides that are to be achieved by approximately 6.6% of the total curricular teaching/learning students and supported by teachers at designated stages time. However, not all projects yet compensate the time in the curriculum. The core curriculum links to a variety of needed to work through the program or define credits for other learning objects including assessment records, the students. learning resources, and self-directed problem based learning activities, thus realising the vision statement. The personal resources needed for development of all projects were 26 full-time positions. The estimated resources needed for project operation would diminish by 3A 4 Virtual Learning Environments and Communities of 15% only if the projects continue to work independently of Practice each other. There would be a shift from programming to content management and tutoring tasks. R Ellaway*, D Dewhurst and A Cumming (The University of Edinburgh, MVM Learning Technology Section, The Medical Conclusions/take-home messages: For a sustainable and School, Hugh Robson Link Building, George Square, Edinburgh, cost-effective operation of ICT-supported learning, we EH8 9XD, UK) propose a central ICT-coordination using synergies between projects. Integration of e-learning in the medical Aim: The use of online support systems is now widespread curriculum requires a close interaction between ICT- in medical education. Usually taking the form of some kind developers and curriculum planners. of virtual learning environment (VLE), they interact with their courses in many ways. Only part of the utility and value that VLEs provide may be educational. It is therefore important 3A 2 E-learning tools on a small campus when evaluating VLEs, whether prospectively or in use, to look at the holistic relationship between a VLE and a course. I Vandenreyt*, M Vandersteen and M Maelstaf (Limburgs A VLE’s utility does not lie in the intrinsic properties of its Universitair Centrum, Department MBW, Physiology, software but rather lies in the unique relationship between Universitaire Campus, Gebouw D, B-3590 Diepenbeek, BELGIUM) a VLE and the course it has to support. Aim: After implementation of Blackboard we wanted to Summary of work: This paper will set out how the usefulness check how electronic tools are accepted by pre-clinical of VLEs may be understood and modelled in similar terms medical students. and how this can provide new ways of looking at medical learning communities in general. Summary of work: We interviewed five students in each year and questionnaires were submitted to all students. Summary of results: In order to evaluate the medical VLE in use at the University of Edinburgh, the authors have Summary of results: All freshmen have private access to a created a framework that analyses the VLE in a course computer, either during the week or during the weekend or context by evaluating the degrees to which the course both. Accessibility on the campus is 100%. Ninety percent community of practice is supported. of the students connect to the Internet at least once a week. Although all students have an email address, they do not Conclusion: A ‘community of practice’ model has been login on a regular basis. On a small campus “beating the found useful in evaluating the holistic components of an drums” is a better communication tool. Educational educational environment. software is greatly appreciated by the students, except the statistical program SAS (“press the button”). Blackboard courses are used mainly to make announcements and to 3A 5 Electronic learning: premises, skills and preferences offer learning content. of medical students – results of the Meducase- Conclusions/take-home message: Although teachers are Charité-E-learning survey on 630 medical students pleased with the multiple possibilities Blackboard offers, it Stefan Höhne*, Götz Bosse and Ralf R Schumann (Charité, Institut is not used in the optimum manner. The reason for this is für Mikrobiologie und Hygiene, Project Meducase, Dorotheenstr. an overloaded staff. Discussion board and assignments 96, 10117 Berlin, GERMANY) have to be explored in the future. Aim: Electronic learning has an increasing influence on academic medical education. Post-time evaluations of 3A 3 Managing the learning environment in undergraduate software usually have been performed after development was completed. The use of electronic learning software at medical education: the Sheffield approach the Charité medical school still is low, although numerous Chris Roberts*, Mary Lawson, David Newble and Asley Self programs are available. The survey presented here is (Department of Medical Education, University of Sheffield, aimed at examining the premises, skills and preferences Coleridge House, Northern General Hospital, Sheffield, UK) of medical students regarding future electronic learning software. – 4.23 – Section 4

Summary of work: A survey was performed with 700 (90%, Aim: Student feedback is an essential component of course n=630, valid returns) medical students of the Charité evaluation and plays a key role in the measurement of medical school in 2002. teaching quality. Here we describe the introduction of an online feedback system at the University of Edinburgh Summary of results: The desire to use electronic learning Medical School and its impact on the quality of student exceeds the actual use. Learning environments should feedback. contain the following features: a well structured layout, ease of use, free choice of learning paths, and inclusion of Summary of work: The online student feedback system clinical procedures and practically relevant content. Self- has been developed and deployed for the MBChB course directed learning received top evaluation results. Medical and created as part of the Virtual Managed Learning students showed little interest in collaborative learning Environment (VMLE). The new student feedback system elements like chat and online learning groups. targets students at the end of a module and generates a questionnaire that, if active and uncompleted by the Conclusions/take home message: There is a need for student, will pop-up each time they login to the system. computer-based learning in medical education. Medical students feel capable of self-directed learning. The Summary of results: The new system has led to major Meducase project will implement the results of this survey improvements in response rates along with the speed and when developing their electronic learning program. quality of the reports that are generated automatically. Each question is scored apart from those with free text comments. The detail of reports is also greater. 3A 6 Electronic submission and delivery of student Conclusions: The system is completely anonymous and feedback all members of the MBChB course community can access R Ellaway, A Cumming, H Cameron and K Wylde* (University of the reports. The improvement in the quality of the feedback Edinburgh, ACT Office, Doorway 3, College of Medicine and means that courses can be evaluated quickly, leading to Veterinary Medicine, Teviot Place, Edinburgh EH8 9AG, UK) more rapid implementation of curriculum improvements.

Session 3B: Computer Based Assessment

3B 1 Response times as a function of examinee ability single entry point for both students and teachers is missing. and item difficulty in the context of a testlet-based CASEPORT integrates five case-based e-learning systems computer-administered adaptive examination through an open server-sided architecture; other case- based systems will be added. An open-source learning D R Miller, A P Boulais, D E Blackmore* and T J Wood (Medical management system ILIAS was integrated for Council of Canada, 2283 Saint Laurent Blvd, Ottawa, Ontario K1G communication and course administration functions. 3H7, CANADA) CASEPORT allows access to more than 250 learning Aim: The Medical Council of Canada (MCC) administers modules from internal medicine, surgery, pediatrics, a computer-based examination known as the Part I of the neurology and psychiatry. Cases have been contributed MCC Qualifying Examination (MCCQE Part I). The from 12 medical faculties in Germany plus international multiple-choice (MCQ) component of this examination is partners from Switzerland, the US and Brazil. They administered in 7 sections (segments) of 28 questions underwent a review process for didactical, content and each. Each examination section completed by the technical quality assurance. Courses for all of these content examinee is marked in real time and the next section is areas are used and jointly evaluated within the constructed on the basis of the examinee’s score in each undergraduate curricula of partner schools. Studies on the of six disciplines. The MCCQE Part I is a self-paced use of cases for formative and summative assessment examination, i.e., examinees themselves determine how were carried out. We report on CASEPORT´s integrative much time to spend on each section within the overall technical approach and our experiences with the case- time limit. creation and quality assurance process. Furthermore, we present evaluation data on acceptance and motivation of Summary of work: The MCCQE Part I has been students and teachers in various integration scenarios. A administered via the computer since the fall of 2000. Time sustainability concept will finally be discussed. records have been kept for each examinee for each section of the examination. Ability estimates based on the total examination as well as for each of the above disciplines 3B 3 Virtual ethics in a Masters’ course have been computed. Bryan Vernon (School of Population and Health Sciences, The Summary of results: Candidates’ scores will be presented Medical School, University of Newcastle-upon-Tyne, Newcastle- as a function of examination section, time and estimated upon-Tyne, NE2 4HH, UK) ability on the MCQ examination. I shall describe the development of the Ethics module for Conclusion/take home messages: Examinees of varying the world’s first web-based MSc in Oncology and Palliative abilities may differ in their time-management strategies on Care from conception to delivery, aiming to inform individual examination sections and across the colleagues about the benefits and drawbacks of online examination as a whole. Consequently, one cannot Ethics teaching and learning from the perspective of both assume that examinee ability should drive the time allotted teacher and learner. Using Blackboard and accessible for a computer-based examination. web-based resources, I have developed interactive course materials. I shall discuss the way these were selected, the course outline and its learning outcomes. I shall reflect on 3B 2 CASEPORT – an integrative learning platform for the work-based summative student assessments which case-based learning are due in May and the student feedback, both formal and informal. I shall discuss ways of building and sustaining an M R Fischer for the CASEPORT Consortium (University of Munich, online relationship between learners and teacher and Medizinische Klinik, Klinikum Innenstadt, Ziemssentr 1, 80336 reflect on my experience of delivering the course. Initial Munich, GERMANY) indications are that students are satisfied and appreciative Various case-based learning systems for medical and that most are highly motivated. Engagement with the education have been developed with substantial financial discussion board has been mixed. This is a challenging resources over the last years. A synergistic approach with a method of delivering ethics teaching. As a domain it is

– 4.24 – Section 4

largely uncharted and unresearched. Those who hear the delivery systems (TopClass vs. Test pilot) and (5) to train paper will be inspired and encouraged to experiment with our team in running on-line examinations. some web-based teaching in their own practice, building Summary of work and results: In the presentation, the on the successes and failures of a colleague. process adopted by the team to prepare the on-line assessment, challenges and actions taken and outcomes 3B 4 Electronic MEQ – a computer based assessment of the pilot trial will be discussed, as well as students’ feedback and examples of multiple-choice questions that tool at the University of Witten/Herdecke, Germany suit the needs of the new curriculum and the use of on-line Marzellus Hofmann* and Brigitte Strahwald (University of testing. Witten, Faculty of Medicine, Projekt medicMED, Alfred- Herrhausen-Strasse 50, Witten 58448, GERMANY) Conclusions: Where students have access to computers and are able to use the intranet to retrieve curriculum The Faculty of Medicine at the University of Witten/ material and learn using computer-aided learning Herdecke has more than ten years of experience with PBL programs, there is a good opportunity to introduce on-line in its curriculum. Within this educational construct, students tests as an alternative to paper assessment. Use of coloured learn by working in an interdisciplinary manner on different images in the stem of questions and multiple-choice medical subjects using paper-patient cases. Assessment questions that test cognitive skills is a useful strategy in on- techniques applied at the University of Witten/Herdecke line assessment. (e.g. MEQ, OSCE, PT) mirror this educational concept by focusing on problem solving and decision making skills. MedicMED (Multimedia Education – Internet Campus 3B 6 Use of web-based cases for teaching and Medicine) is a research project at the University of Witten/ assessment in a medical school curriculum Herdecke, sponsored by the German Ministry for Education. The main focus of MedicMED is the Debra A Newell*, L Felipe Amador, Mukaila A Raji, Karen A development and implementation of an Internet based Rasmussen and Robert E Beach (University of Texas Medical learning and training system. Within this system students Branch, Office of Educational Development, 301 University Blvd, will be supported by PBL-case simulations. In addition Galveston TX 7755-0408, USA) MedicMED transfers existing problem-based assessment Aim: To demonstrate the effectiveness of web-based methods (e.g. MEQ, OSCE) into computer-based clinical decision-making cases as tools for learning and examination tools. The uniqueness of MedicMED lies in assessment. the complete integration of this internet-based multimedia learning system into the existing curriculum. We report on Summary of work: Geriatric web-based cases are utilized the educational concept, development and in both courses and clerkships to standardize content implementation of a computer-based MEQ-Test. delivery, teach integrated clinical decision-making (CDM) Examination setting and curricular integration will be skills, facilitate PBL small group discussions and assess illustrated. Examination results as well as evaluation and mastery of various concepts. The ability to access the cases acceptance will be presented. from on or off-campus is also a plus. Assessment is done in two ways: 1) feedback from students on logistics of case; and 2) student responses to clinical decision-making 3B 5 Use of on-line summative assessment in medical questions are recorded and routed to the course or education: experience from a pilot trial at the clerkship director for comparison against a levelled rubric. University of Melbourne Student comparisons from the same course as well as between courses are evaluated and utilized for modification Samy A Azer (University of Melbourne, FEU, Faculty of Medicine, of CDM questions and case content. Dentistry and Health Sciences, Medical Building, Level 7, Parkville, Victoria 3010, AUSTRALIA) Summary of results: Results from one case piloted in a 1st year course and 4th year clerkship show that student Aim: To ensure successful implementation of an on-line responses to CDM questions are consistent within the summative assessment for our first year medical students, same course/clerkship; differences are observed in the it was decided that a pilot test should be run. The aims of complexity of the responses between groups. the test trial were (1) to ensure that students are oriented to on-line assessment and the style of questions to be Conclusion/take home messages: Web-based cases, with included in the actual test, (2) to ensure that the real pre-set CDM scoring rubrics are effective in teaching examination will operate smoothly, (3) to receive feedback standardized concepts and assessing content mastery. from students on the trial test and use issues raised in Discussion will focus on implications for application in a improving the actual test, (4) to explore the advantages variety of medical education settings. and disadvantages of delivering the test using two different

Session 3C: Curriculum Planning (2)

3C 1 Basic sciences learning in an integrated, primary specific knowledge regarding basic sciences is well care oriented curriculum understood by the graduates of the program. Fernando Mora-Carrasco*, Rosalinda Flores-Echavarria and Summary of work: There has been controversy in the forms Irina B Lazarevich (Universidad Autónoma Metropolitana by which BBSc knowledge is best incorporated into the (Xochimilco), Calzada del Hueso 1100, Colonia Villa Quietud, C P students’ understanding of medical problems. In our 04960 Distrito Federal, MEXICO) program BBSc are incorporated at all levels of learning, and we do not have a basic science training in preclinical Aim of presentation: The medical curriculum at the years. It was expected that the level of basic science need Metropolitan University is an integrated program oriented would increase as the student proceeded towards towards primary care. Basic biomedical sciences (BBSc) graduation. Most medical graduates in the country take are not taught as such, but are presented as necessary the National Examination for Medical Residences, and elements to understand clinical or epidemiological this includes a section of BBSc. We compared the results problems that are the main focus of the curriculum. For of our students, with no independent BBSc training, with several reasons it is of interest to determine whether those that had two years of BBSc teaching.

– 4.25 – Section 4

Summary of results: Although the difference is small, our Conclusions/take home messages: The case-based students perform better in the section of basic science approach was successful in demonstrating the relevance questions than those with specific training in these. of the basic science and preparing students for future clinical work. This approach will be applied more widely Conclusions/take home messages: Learning concepts and in the new GKT curriculum. methods in BBSc can be achieved with innovative forms that seek to integrate them with applied medical courses. 3C 4 Topsy-turvey teaching: trauma as teaching tool 3C 2 Postgraduate course – “ Palliative Medicine for T E Sommerville (University of Natal, Department of Anaesthetics, Doctors” – the ‘Fix- Flex- Design’ Faculty of Medicine, Private Bag 7, Congella, Durban 4013, SOUTH AFRICA) S Eychmueller* and H Neuenschwander (Kantonsspital St. Gallen, Palliativstation, Rorschacherstr. 95, 9007 St Gallen, Aim of presentation: Discussion of an unusual use of a SWITZERLAND senior field of study to stimulate learning of elementary subjects. Aim of presentation: To demonstrate how ‘vertical’ integration beyond medical school could be performed, Summary of work: We inverted the traditional way of teaching and how a ‘Fix- Flex- Design’ helps to meet participants’ trauma to senior students/postgraduates as an integration needs. of material previously encountered. A Trauma theme was placed in the first year, stimulating students to investigate Summary of work: Over 3 years a new course in basic basic sciences. Cardiovascular, respiratory and renal Palliative Medicine was evaluated targeting physicians physiology, pain, principles of head injury pathology and from different working backgrounds. The design is a two management, intravenous resuscitation, haemostasis, use one-and-half-day modules design (module 1 = fixed of blood products, ethical and forensic aspects are objectives, module 2 = chosen objectives by participants: proffered. At the same time as elementary anatomy, ‘Fix-Flex-design’). For individual achievement a formative physiology, pathology and pharmacology are being (self-rating VAS Scales before and after the course) and presented, the clinical background ensures that, while we summative format (MCQ questions) were chosen; semi- do not produce accomplished traumatologists, students’ structured questionnaire for course- evaluation. interest is aroused in a field which, in national medical Summary of results: 45 “packages” were evaluated. Self- schools, has not enjoyed such prominence as its incidence rating before and after the course showed that (a) the course warrants. objectives met the needs of the participants adding the Summary of results: Students find the theme challenging right things for their practice, and (b) highest improvement and enjoy the hands-on aspects of ambulance service, occurred in the control of rather difficult symptoms like learning to suture, etc. The Trauma theme’s place within complex pain syndromes and bowel obstruction (p< the undergraduate curriculum, the elements which make 0.0001). The “Fix- Flex- Design’ was rated highest in the up the cases week by week and our learning objectives course evaluation. will be presented. Conclusions/Take-home messages: A continuous Conclusions/take-home messages: An extremely complex educational plan connecting the under- and postgraduate yet topical subject can be ‘deconstructed’ so as to provoke level helps to allocate reasonable learning objectives. The interest in its components without fear of frustration at not ‘Fix- Flex- Design’ in a two module course enhances seeing all of the bigger picture. interest, individual contributions and individual outcome.

3C 5 A novel, integrated, practice-based, curricular 3C 3 Structuring basic science teaching around clinical approach cases: experiences at GKT Hettie Till (Canadian Memorial Chiropractic College, 1900 Bayview Mary Seabrook*, Philip Aaronson and John Rees (GKT School of Avenue, Toronto ON M4G 3E6, CANADA) Medicine, Department of Medical and Dental Education, Sherman Education Centre, 4th Floor, Thomas Guy House, Guy’s Hospital, The aim of this curricular reform was to help senior students St Thomas Street, London SE1 9RT, UK) integrate their course material and develop their clinical skills in preparation for the clinical year. A climate study by Aim of presentation: To describe a pilot programme in means of the DREEM* Inventory indicated that the 3rd year which basic science teaching was reorganised around students found it difficult to see the relevance of course clinical cases. content to clinical practice, and they were anxious about Summary of work: Clinicians and basic scientists worked their clinic performance in the 4th year. They felt that they together to develop clinical cases relevant to the were covering a large amount of new and disparate cardiovascular/respiratory systems, around which teaching material and that they were not able to integrate this was structured. A clinician presented each case; related material without help. It was decided to change the basic science teaching took place; and the clinician then curriculum to become outcome-base and practice-based returned and continued the case history, showing how the and focused around 9 central themes. A new modular knowledge and understanding students had gained was approach providing focal points around which integration used in practice. A 6-month evaluation of the pilot was could occur was superimposed upon the existing systems undertaken using ethnographic methods to elicit teachers’ approach of the 3rd year of study. For each of the 9 resulting and students’ perceptions. modules an integrated Study Guide was developed. Each module concluded with a Grand Rounds Forum Summary of results: Students were very enthusiastic about presentation and 3 days of performance-based the cases and supported their use throughout the basic assessment – both theory and practical. Feedback from science curriculum. Benefits included greater motivation faculty and students are positive and indicate better to study, and insights into how doctors think and work. preparation for the clinical experience. It is anticipated Students also picked up implicit messages from the cases, that this format will assist with deep learning and better e.g. the trial and error nature of prescribing. Educational retention and application of course material. issues arising included uncertainties about the role of cases in assessment, and the extent to which other teaching should relate to them.

– 4.26 – Section 4 Session 3D: Training and Assessment for General Practice/Family Medicine

3D 1 Formative assessment of family medicine residents a discussion of the evolution of the original concept over in Catalonia: features and feasibility the 30 years of specialty training in family practice and the adaptations that are being made in program requirements J M Fornells*, M Ezquerra, M Bundo, D Fores, F Cordón, J M Cots, in response to the realities of the healthcare system. A Casasa, J M Martinez and A Martin (Institute of Health Studies, c/Balmes, 132-136, 08022 Barcelona, SPAIN) Every year 200 residents start their vocational training in 3D 4 “Looking through students’ eyes” – evaluation of family medicine in Catalonia, which means that 600 examinees’ comments on a short-answer examination residents are currently trained in 60 primary health centres, Thomas Link* and Michael Schmidts (University of Vienna, distributed among 15 teaching units, each one led by a Institute for Medical Education, Vienna General Hospital, PO Box coordinator under the general guidance of a general 10, A1097 Vienna, AUSTRIA) coordinator. Two years ago, it was decided to launch a formative assessment strategy to improve the quality of The Austrian GP Licensing Examination consists of case training by identifying and correcting the residents’ presentations with short-answer questions. As a means for weaknesses during the learning process where feedback improving the examination, the candidates are given the provided by tutors plays a key role. At the beginning of 2002 opportunity to write down objections to, in their view, first actions were implemented after a pilot test and problematic questions. A multi-method evaluation of the according to the following steps: 1) Define the competence candidates’ responses shows that (1) some candidates level to be achieved at every learning stage; 2) Identify the have difficulties to understand what a specific question is best tools to be used to measure these competences; 3) aiming at or what the precise difference between two Assure the necessary participation of all people involved in subsequent questions is. (2) Examinees who make the process, especially teaching coordinators; 4) Establish comments tend to have higher scores. (3) Better and assure the necessary resources and logistics to apply examinees’ comments are longer and more complex. This the assessment procedures. After the first assessment could point to better problem description capabilities that meeting based on a clinical case, residents and tutors would make their comments more valuable for identifying completed a questionnaire in order to assess satisfaction ambiguities. On the other hand, comparably more of their and perceived usefulness of the new evaluation system. remarks do not refer to the case presentation but to their Based on a Likert scale, items measured were: organization, own answers, which could be understood as a subliminal comfort during the assessment, representativeness of the effort to influence the assessors. Especially in the context clinical case related to daily practice, information received of an open short-answer examination, ambiguities in the and good assessment method for tutors. Results will be question wording substantially reduce the candidates’ presented. opportunity to name the correct answer. A critical and systematic review process of the candidates’ comments helps us to revise the case presentations from an 3D 2 The new scheme for specialist training of GPs in examinee’s point of view. Denmark – best in Europe?? Roar Maagaard (GP, Skoedstrup and County of Aarhus, Plantagen 3D 5 Tutorship for family medicine students: care for the 22, DK-8541 Skoedstrup, DENMARK) inner world A new Danish scheme for specialist training in General L Debaene*, L Ferrant, R Remmen and J Denekens* (University of Practice (GP) is launched in August 2003. This new Antwerp, Department of General Practice, Faculty of Medicine, scheme – a dramatic revolution! – will be presented and discussed. Total training time is expanded from 3½ years Universiteitsplein 1, 2610 Antwerp Wilrijk, BELGIUM) to 5 years. The training period in hospitals changes from 3 In Flanders the vocational training for general practice years to 2½ years. The training in GP goes from ½ year starts in seventh year of the core curriculum. We offer them until 1999, to 1 year in the period 1999-2002 and to 2½ one semester in which they acquire basic knowledge and years from 2003 – a five-fold increase! Training goes from skills for our discipline. This presentation offers details of primarily being based on time to being based on content: the pedagogical concepts and the organizational aspects the acquisition of 119 defined competences. New of tutorship. This period is very intense. At the inner world strategies for training and assessment are described in level of each student many things go on: in the near future the new blueprint for GP/family medicine. A 12 week period they will be a real doctor which allows them to work (partly) of research training is included. The number of training independently with growing responsibility. This creates fear practices in Denmark must be more than doubled to be and uncertainty. Furthermore they have to apply for a able to meet this challenge. The ideas behind this revolution training practice. To deal with these uncertainties we offer will be presented, the implementation process and the a didactical format: tutorship. Here care is given for the obstacles discussed. We are sure it will mean better trained feelings arising in the last months of their education. The GPs in Denmark – and no doubt: our vision is to create the tutors (all staff members of our department) have a series best training scheme for GPs in Europe. of discussions with a group of four pupils (students in family medicine). How do they cope with uncertainty? What are their choices, what is their motivation and inspiration? They 3D 3 Continuity of care in family practice residency training look at illness, suffering, pain, death, violence, but also Mary Alice Parsons (ACGME, 515 N. State Street, Suite 2000, growth, birth, healing and love. Do students allow Chicago IL 60610, USA) themselves to be touched in this inner level? These tutorial sessions increase the vitality of students. We expect the Continuity of care has been one of the two major features young doctors to cope with themselves and their inner world of training in family practice residencies in the U.S., the in a more healthy way. In addition they become more other being comprehensive care. This session will present sensitive to the inner world of others.

– 4.27 – Section 4 Session 3E: Teaching and Learning Communication Skills

3E 1 Undergraduate students’ attitudes towards describe the development and design of the medical skills communication skills teaching program at a veterinary school, generalizability of the CCOG, evaluation of the program and the nature of the J Cleland* and K N Foster (University of Aberdeen, Department of collaboration between human and veterinary medicine. General Practice and Primary Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, UK) Tomorrow’s Doctors (GMC, 1993, 2002) emphasises the 3E 3 Designing and implementing communication skills importance of medical students demonstrating proficiency curriculum for medical students in communication skills, as well as appropriate attitudes L Kongkam* and N Wiwutworapan (Maharat Nakhon Ratchasima and behaviour towards patients. Few studies have explored Hospital, School of Medicine, Family and Community Medicine medical students’ attitudes to communication skills Department, Muang District, Nakhon Ratchasima 30000, teaching although 1) this is a core skill in the new medical curricula and 2) teaching often encounters student apathy THAILAND) (Benbassat, Israel J Med Sci 1996; 32: 217-221). This study Aim: To present a communication skills course for year III- used the Communication Skills Attitude Scale (CSAS) VI medical students at Maharat Nakhon Ratchasima (Rees, Sheard & Davies, Med Educ 2002; 36: 141-147). Hospital, School of Medicine. The CSAS was administered to all medical undergraduates in Years 1-3 at the University of Aberdeen. Summary of work: We developed outcomes and a set of Students from different years had varying degrees of patient skills that students should acquire in a communication contact and communication skills teaching. Demographic skills course. Then we narrowed down the communication and education-related data were also collected from the skills competencies according to rotations of clinical year students. 86.2% of students completed the survey. We clerkship. present the findings from our survey, comparing data from 1 Year III: Curriculum emphasis on the basic students at different stages in undergraduate training. The communication skills. relationships between medical students’ attitudes towards 2 Year IV: emphasis on information, explaining and communication skills learning and their demographic and influencing skills. education-related characteristics are explored. Responses are identifiable from student number so we can follow 3 Year 5 and 6: emphasis on the difficult patients such as these students throughout under- and post-graduate breaking bad news. training to explore how attitudes towards communication We prepared teaching method, developed study guides skills teaching evolve. and resources. The students were evaluated both formatively and summatively. The outcomes of students 3E 2 Veterinary medical communication skills curricula: and curriculum assessment were used for course “What’s up Doc?” development. C L Adams and S M Kurtz* (University of Guelph, Ontario Summary of results: Some problems about course management occurred but over 90% of students were Veterinary College, Department of Population Medicine, Guelph, satisfied. Ontario N1G 2W1, CANADA) Conclusion: We are in the initiating phase and developing Aim: To describe an innovative communication skills this curriculum. The data from this course evaluation will program, developed over the past 3 years, at a veterinary be used as input for future course development. school that is based on well established programs in human medicine. Background: Research indicates that veterinarians lack 3E 4 Practical experiences and pitfalls in teaching communication skills necessary for success in practice. communication skills Empathy and compassion toward the client have been identified by clients of veterinarians as 2 of the top 5 Martina Schlünder*, Britta Jonitz, Margareta Kampmann and attributes they look for when seeking a doctor for their pet. Ulrich Schwantes (Institut fur Allgemeinmedizin, Charité Berlin, Veterinary curricula are under scrutiny as they attempt to Berlin, GERMANY) better prepare entry-level practitioners for societal and Aim: Two years ago we implemented training in professional standards. One area that is poised for communication skills as an obligatory course in medical development is communication. education at the Charité. In this time we trained about 1300 Summary of work: In September 2000 the Ontario Veterinary students in small groups. We will present our experiences College mounted a new curriculum with 26 hours per and reflect on the pitfalls we encountered. academic semester for the 4 year program allocated for Summary of work: A lot of logistical problems had to be communication skills education. We have seen the overcome: 45 tutors had to be found and then they had to efficiency of working with well established models from be taught. A conception of the courses acceptable to the human medicine in that the Calgary-Cambridge students had to be found and simulated patients trained. Observation Guides (CCOG) serve as the framework for in class and laboratory teaching and learning regarding Summary of results: The courses are now popular with the medical consultations. A simulated client and patient students. Crucial for successful acceptance are suitable program has proven to be a significant method for teaching space in the students’ timetable, a firmly established integration of communication and medical competencies. organisational structure, and excellent, qualified teachers Veterinary practitioners and faculty have been recruited to and simulated patients. Some students are bewildered by instruct students. the lack of “objectivity” that is a pertinent property of communication processes. Their self-perception as a Conclusions: This is the first veterinary medical physician is determined by patriarchal clichés. communication skills curriculum of its kind in North America. We have learned that the development of this Conclusions: Beyond the training of medical program was contingent on administrative, industry, faculty communication skills, essential components in medical and practitioner support. The Calgary-Cambridge education are contact with patients right from start as well Observation Guides have high applicability to veterinary as a reflection of role models in medical profession. medicine, with minor modifications. This presentation will

– 4.28 – Section 4 3E 5 Early experience of video taping encounters with 3E 6 A survey of real versus simulated patients’ opinions patients of 1st year students’ communication skills Paul Bradley*, Charlotte Rees and Pamela Bradley (Peninsula Pamela Bradley*, Charlotte Rees and Paul Bradley (Peninsula Medical School, ITTC Building, Tamar Science Park, Davy Road, Medical School, Clinical Skills Resource Centre, 3rd floor, Mary Plymouth PL6 8BX, UK) Newman Building, University of Plymouth, Plymouth, UK) Communication skills learning at Peninsula Medical Much criticism has been expressed regarding the inability School (PMS), UK, is introduced at the beginning of the of junior doctors to communicate effectively with their course and remains a longitudinal theme that continues patients. Indeed, patients describe dissatisfaction with throughout the program. Each week students attend a consultations, often because the interview is driven almost Clinical Skills Resource Centre for 2 hours for clinical and entirely by the doctor’s agenda with minimal regard for the communication skills learning. Approximately a quarter of patient’s. At Peninsula Medical School students this time is devoted to communication skills. Reinforcement commence communication skills training from the first of this learning takes place during the community week. It is integrated with clinical skills training, problem- attachments. Video taping of patient encounters for analysis based learning and community placements and continues and feedback represents a gold standard for throughout the five year undergraduate programme. The communication skills learning, although this has largely communication skills training programme is based on the been confined to postgraduate healthcare education. We skills-based Cambridge-Calgary model (Silverman et al. have introduced video taping as a tool in the 1996), which emphasises to students the importance of communication skills learning early in the undergraduate exploring the patient’s agenda. This qualitative study will course. Furthermore, we have used this to record student contrast the views of real and simulated patients of 1st year interviews with real patients, thus allowing observation and medical students about their communication skills. Both feedback of communication in vivo from peers and tutors. real (n=8) and simulated patients (n=8) will participate in This paper describes an evaluation of students’ perception semi-structured, telephone interviews to elicit their views. of the benefits of this activity. The interviews will be audiotape recorded, transcribed in full and analysed using what theme analysis (Vaughn et al. 1996). This paper will present the preliminary results of this data analysis.

Session 3F: International Medical Education (2)

3F1 International recruitment of general practitioners Overseas trained doctors (OTDs) seeking medical into the UK workforce – an educational approach registration in Australia must pass the Australian Medical from West Yorkshire, England Council (AMC) clinical examination. Approximately one third of AMC candidates from countries with training Peter Dickson* and Lynn Stinson (Bradford City Teaching PCT, systems different from Australia’s undertake a 10-26 week Joseph Brennan House, Sunbridge Road, Bradford BD1 2SY, UK) clinical bridging course (ARTD, 1999). The objective of In England, there is a Government directive to increase the Victorian Medical Postgraduate Foundation’s (VMPF) the general practitioner (GP) workforce (Dept of Health, clinical bridging program is to prepare OTDs to undertake 2000). GPs recruited from the European Union is one the AMC clinical examination. Differences in participants’ aspect of this. These doctors have reciprocal rights to primary medical qualifications and language and cultural practise medicine in England without further formal background make the bridging program a challenging qualifications being necessary (Council directive 93/16/ course to conduct. The Research Study on Bridging EEC, 5 April 1993). In West Yorkshire the overseas Courses for Overseas Trained Doctors (1999) found that recruitment initiative has postgraduate medical education between 1992-1998 48% of candidates pass the clinical at its core. The Department for Postgraduate GP Education examination at the first attempt and that 73% pass within (Yorkshire) and Bradford City Teaching Primary Care Trust two attempts. The results of the VMPF’s bridging course of are co-ordinating the recruitment process, with other key 2000-2001 were outstanding with 82% passing on their partners. The process involves: first attempt. The possible reasons for this significant increase in the pass rate will be explored in this paper. • Initial interview in host country, assessing medical Participants received medical and surgical bedside experience and language skills; tutorials as well as tutorials in obstetrics and gynaecology • Weekend residential in West Yorkshire, addressing and paediatrics. The Language Coordinator provided medical and social aspects. An Observed Structured extensive English language and communication skills Clinical Examination (OSCE) helps to determine their tuition at clinical sites. educational needs. More detailed assessment of language skills; • Three/four month induction period within a teaching 3F3 Listserv analysis as a tool for evaluation of an on- practice environment. Personal Development Plans line international medical education program (PDPs) are agreed from the OSCE. Previous experience has shown these will include clinical management W P Burdick*, P S Morahan, L M Johnson and J J Norcini topics and extra language tuition. Extra attention is being (Foundation for Advancement of International Medical Education paid to the social aspects of doctors and their families and Research (FAIMER), 3624 Market Street, 3rd Floor, moving to England, wherever possible involving GPs Philadelphia, Pennsylvania 19104-2685, USA) from their country of origin. Aim: To evaluate the effectiveness of an international The presentation will give an update on this process, medical education listserv, we analyzed postings and including experiences of successful applicants. responses over a 2-year period on a listserv aimed at sharing medical education knowledge and professional progress. 3F2 Results of a clinical bridging course for overseas Summary of work: An international medical education trained doctors in Australia fellowship has been conducted for 12 fellows each year Elma Avdi (University of Melbourne, School of Medicine, Faculty composed of a 2.5 week on-site component followed by of Medicine, Dentistry and Health Sciences, Room 234, Level 2, 11 months of on-line discussion, with fellows returning for Melbourne 3010, AUSTRALIA) 1 week at the end of the year. Discussion topics have

– 4.29 – Section 4

included medical school selection criteria, community- Aim of presentation: As globalization forces physicians, based education, student perception of mistreatment and patients and communities into closer proximity, the distance learning. Postings were analyzed by type of importance of ensuring the possession of competency of information requested, subdivided into curriculum, faculty all physicians becomes paramount. Using an international development, research, program evaluation, human network of experts, the Institute for International Medical resources, as well as response to information requested, Education (IIME) created both an international outcome professional progress, and feedback on professional standard and a means for evaluating it. progress. Summary of work: The IIME convened a task force of Summary of results: 22 Fellows and 7 faculty posted 1187 international experts on assessment, reviewed the Global messages. With 386 postings analyzed, professional Minimum Essential Requirements for graduating progress was posted by 96% of fellows, with response to physicians, identified 75 potential assessment tools, then professional progress by one third of fellows and 61% of focused on three that could be used most effectively. faculty. Requests for information were made by 10% of fellows and constituted 8% of all postings. 16% of the Summary of results: Of the sixty items, 36 are assessed postings were responses to requests for information. using a 150-item multiple-choice examination (MCQ), 15 are assessed using a 15-station Objective Structured Conclusions/take home messages: Quantitative analysis Clinical Examination (OSCE), and 17 are assessed using of listserv postings can be an effective tool for program a 15-item faculty observation form. (Some assessed by evaluation. more than one instrument). With the aid of international consultants, and in cooperation with eight leading medical schools in China, the MCQ, OSCE, and faculty observation 3F4 An overview of the characteristics and performance form were developed for an examination scheduled to be of candidates who take the ECFMG clinical skills given simultaneously to all 7-year Chinese students in assessment: 5 years of testing October, 2003. J Boulet*, G Whelan, W Burdick and J Norcini (Educational Conclusions/take home messages: Global essential Commission for Foreign Medical Graduates - CSA, 3624 Market competencies can be agreed upon and evaluated. Further Street, 4th Floor, Philadelphia, PA19104-2685, USA) research on reliability and international standard-setting will be needed. The Educational Commission for Foreign Medical Graduates (ECFMG) has been administering a high-stakes standardized patient clinical skills assessment (CSA) for 5 3F6 Perceived stress and stress sources for Chilean and years. The purpose of this assessment, amongst other American medical students certification requirements, is to determine the readiness of graduates of international medical schools (IMGs) to Meghan McKeever*, Pedro Herskovic and D Daniel Hunt (University enter graduate training programs in the United States. To of Washington, 5017 40th Avenue NE, Seattle WA 98105, USA) date, almost 29,000 candidates from over 150 countries Medical school is recognized as stressful; studies have and 1,000 different medical schools have taken the CSA at shown the deleterious effects of stress on student well- one of two test centers. The purpose of this paper is to being. Our project intends to evaluate the level of perceived provide an overview of this high-stakes standardized patient stress in Chilean and American medical students and to examination, concentrating on the characteristics, determine factors contributing to stress within each group. performance, and educational outcomes of the candidates Second year students at the University of Chile and the who complete this assessment. Over the past 5 years there University of Washington were asked to participate in a has been a steady increase in the number of IMGs testing, survey assessing demographics, perceived stress level, including over 3,000 repeat administrations. Based on the and specific stressors during a period of similar academic cohort of individuals who passed CSA in the initial 4 years pressure. A total of 197 Chileans (84.5%) and 142 of operation and were certified, over 75% eventually Americans (83.5%) responded. Average ages were 20.1 +/ obtained residency training positions in the United States. - 1.69 yrs (Chile) and 26.3 +/- 3.57 yrs (US) (p< .0001). In Similar to other organizations that use clinical skills Chile, 99% of the students are single/non-cohabiting, versus assessments for certification and licensure decisions, the 52% of American students (p< .0001). Seventy-nine percent ECFMG has found the CSA to be a useful tool for assessing of Americans live in rented housing while 84% of Chileans the clinical skills of graduating medical students. live in their parental home (p<.0001). Chilean students scored significantly higher than Americans on the perceived stress scale. For Chileans, the highest ranked 3F5 The assessment of global physician competence stressors included academic issues, while American David T Stern*, Andrzej Wojtczak and M Roy Schwarz (University students felt more stress from personal concerns. In of Michigan Health System, 300 North Ingalls, Room 7E10, Ann summary, American and Chilean students have significant Arbor, MI 48109-0429, USA) demographic differences and this contributes to the sources of stress that they identify.

Session 3G: Assessment of Teaching

3G 1 Feedback to faculty using the SETOC instrument – of establishing a learning milieu, clinical teaching skills, student evaluation of teaching in outpatient clinics general teaching skills, clinical competence, and a global- rating item for effectiveness. The SETOC was administered Rukhsana W Zuberi* and Georges Bordage (Department of Family to students through course coordinators across disciplines Medicine, The Aga Khan University, Stadium Road, PO Box 3500, with outpatient experiences, at the Aga Khan University Karachi 74800, PAKISTAN) Medical College. Student ratings were anonymous. Faculty Aim: A faculty evaluation form (SETOC), that would reflect names were coded by departments. Inter-rater challenges in outpatient clinic teaching, was developed to generalizability coefficients of student ratings were 0.92 provide feedback to faculty for improvement. The reliability for the SETOC and >0.89 for each subscale. Frequency of student responses was determined before highlighting tables and bar charts of total-scale and subscale mean ways to make feedback meaningful. scores for each instructor were computed. Repeated Measures design was used to study differences in Methods: The 15-item SETOC had a 7-point Likert-type subscales. rating scale and five subscales (SS1-5), which consisted

– 4.30 – Section 4

Results: Nine of the 87 instructors obtained >85% score Conclusions/take home messages: An objective on the SETOC, while four obtained >90% scores on all standardized teaching examination (OSTE) can serve well subscales. 14 had unsatisfactory scores. No significant the purpose for objective assessment of teaching skills in difference was found between the means of SS1 and 2, or residents from different specialties. It requires a significant the means of SS4 and 5. However, each of the means of investment in time, effort, and personnel. SS1, 2, 3 was significantly lower than the means of SS4 or 5 (p = .0000). Conclusion: The SETOC can provide individualised 3G 4 Challenges in implementing a computer-based feedback to faculty members, identifying overall teaching collaborative platform in staff development excellence or weakness or smaller areas of excellence or Klara Bolander* and Kirsti Lonka* (Karolinska Institutet, weakness. It can also identify areas for faculty development. Berzeliusgarden 1, S-171 77 Stockholm, SWEDEN) Messages: Only reliable student responses should be used Since 2002 all teachers at the Karolinska Institute are for feedback. Even competent clinicians need teaching required to undertake three weeks of educational training skills. to become an associate professor. This presents staff developers with challenges of course design to motivate course participants with a range of educational 3G 2 Does ‘expert review’ of teaching practice lead to backgrounds within the medical field. In this short increased effectiveness of teachers in the communication we will describe the new teacher-training healthcare professions? program at the Karolinska Institute, Stockholm, Sweden (www.lime.ki.se/cul). By introducing a learning platform Kay Mohanna (Staffordshire University, 19 Wyndham Wood Close, called Knowledge Forum along with using activating Fradley, Lichfield, Staffs WS13 8UZ, UK) instruction in teacher training, social construction of Aim: To present early results evaluating the process of knowledge in a networked computer-based environment ‘expert review’ as a way to increase teaching effectiveness. course participants were given the opportunity to collaboratively build and elaborate on new ideas to facilitate Summary of work: Expert review of teaching in the clinical reflection on their learning. Preliminary results show that setting is one of the assessment strategies in the using the Knowledge Forum in this context was helpful in postgraduate certificate in medical education at encouraging reflection on theory and practice. We present Staffordshire University. ‘Real-life’ teaching sessions are two groups of teachers – those who found this way of assessed by an expert assessor according to strict criteria. learning to be helpful, and those who did not – and discuss This project aimed to develop an evaluation tool to show the reasons why these two groups differed in their that expert review, and the reflective practice that the experiences. This presentation will also show how the feedback from it engenders, is capable of increasing the participating teachers’ ideas of learning developed during effectiveness of clinical teachers. Participants were the course. Further analyses of the results of the teacher- graduates of the award. A control group who had not training program are still in progress. participated in a process of peer review was recruited from those who have gone through the Teaching the Teachers program at Staffordshire University. The main, university 3G 5 Attitudes towards teaching in a newly founded dependent, unmatched variable was the process of expert medical school: 2 years later review Araya Khaimook* and Boonyarat Warachit (Hatyai Hospital, Dept Summary of results: Teachers who have been through a of Surgery, 182 Rattakarn Road, Hatyai, Sonkhla 90110, process of expert review show greater insight into their THAILAND) strengths as a teacher and their areas for development. They are able to demonstrate the skills of a reflective To enhance the quality of medical teaching, it is important practitioner and can recognise what constitutes effective to appreciate the existing attitudes of teachers and also teaching. This provides a good foundation for them to the changing of their attitudes by time and experience. develop as effective teachers. Our aim was to compare attitudes towards teaching and teacher training before and after undergraduate medical Conclusion/take home message: Expert review in the education had started at Hatyai Hospital (Thailand) in April clinical setting can increase the effectiveness of teachers. 2001 under Collaborative Project to Increase Production of Rural Doctors. We used a questionnaire assessing attitudes to teaching and teacher training developed by 3G 3 OSTE: Objective Standardized Teaching Finucane (1994) to survey our staff in January 2001 and Examination for a ‘residents as teachers’ course February 2003 respectively. The responses showed Jesús Ibarra-Jiménez*, Ismael Piedra-Noriega, Monica del Ángel- significant differences in two attitudinal statements. There Reyes and Jorge González (Instituto Tecnológico y de Estudios was more agreement on “I find teaching as satisfying as Superiores de Monterrey (ITESM), School of Medicine, other activities” (x1 = 4.0, s.d. = 1.4, x2 = 4.9, s.d.=1.5, p = Departamento de Desarrollo Académico - DCS, Ave I Morones .01, Mann-Whitney U test) and less agreement on “Sufficient Prieto, 3000 pte, Col. Doctores, Monterrey, N.L. CP 64710, priority is given to teaching in this hospital” (x1 = 4.4, s.d.= 1.2, x2 = 3.7, s.d. = 1.2, p = .01). These differences might MEXICO) be attributed to the fact that physicians had more Background: When training residents on how to teach, it is confidence in teaching after one year’s experience but the necessary to assess the results of the course efforts. Only hospital needed to consider “teaching role” as one of its a few studies have reported the use of objective measures. important missions as well. Aim: To develop the foundation for an objective standardized teaching examination (OSTE), for a ‘residents as teachers’ course in Monterrey, México. 3G 6 Feedback for physicians supervising students during patient contacts Summary of work: Learning outcomes were identified, eight stations were designed, an instruction book was designed, D H J M Dolmans*, H A P Wolfhagen, W H Gerver and A J J A and participants were trained. An exit survey was applied, Scherpbier (University of Maastricht, Department of Educational and results were analysed. Development and Research, PO Box 616, 6200 MD Maastricht, NETHERLANDS) Summary of results: Seventeen residents underwent an eight station OSTE, in order to measure the achieved goals Aim: To demonstrate the development of an instrument for learning how to teach. Satisfaction was high, 1.7 (scale providing physicians with feedback on their performance 0=maximum to 5=minimum), including residents, in supervising students during patient contacts fitted to standardized students, and teachers. physicians’ personal needs.

– 4.31 – Section 4

Summary of work: In a situated learning environment in theories of effective apprenticeship learning. Choi and which students are involved with patients, it is all too often Hannafin (1995) distinguish several forms of facilitating assumed that students learn by imitation. However, although student learning in these situated learning environments: role modelling is a powerful means, physicians should role modelling, scaffolding, coaching, collaborating and focus the supervision to the student’s level of self-directed fading. It is demonstrated how physicians can be provided learning. Instruments providing physicians with feedback with feedback fitted to their personal performance as about their strengths and weaknesses in supervising supervisor. students could help them to reflect upon how they supervise Take home message: Physicians should be able to deal students and could help them improve their teaching with different forms of facilitation of student learning. (Copeland & Hewson, 2000; Litzelman et al., 1998). At the Providing them with feedback on their performance in this Maastricht Medical School, an instrument has been respect could help to improve teaching. developed for this purpose. The instrument is based on

Session 3H: The OSCE (2)

3H 1 Keeping standardized patients standardized specifically outline issues related to the test development Tony Errichetti* and John Boulet (Philadelphia College of and case selection process, the comparability of candidate scores, and potential threats to the validity of assessment Osteopathic Medicine/National Board of Osteopathic Medical decisions. This overview of key psychometric issues will Examiners, 4170 City Avenue, Suite 108, Philadelphia PA 19131, be useful to other organizations that wish to build and/or USA) refine existing performance-based assessments. Aim: To outline methods that can be used to enhance the accuracy and consistency of SP portrayal and scoring. 3H 3 Using a standardized patient assessment to Summary of work: The use of performance-based standardized patient (SP) assessments is widespread, and measure professional attributes currently a part of certification and licensure examinations Marta van Zanten*, John R Boulet, John J Norcini and Danette in several countries. A major challenge facing high-stakes McKinley (Educational Commission for Foreign Medical performance examination centers and medical schools is Graduates, 3624 Market Street, 4th floor, Philadelphia, PA 19104, to ensure that the standardized patients are truly USA) standardized, i.e. consistently accurate in case portrayal and skills documentation. If this is not the case, the validity Background: The instruction and assessment of of any resultant scores could be compromised. professionalism is an important topic in medical education today. While much work has focused on defining Summary of results: The results of an initial pilot study professionalism and teaching medical students the indicated that the fidelity of patient portrayals was related appropriate behaviours, relatively little research has looked to scoring errors. In addition, the variability in some SP at meaningful ways of assessing professional attributes. performances was sufficient to warrant in depth observation Summary of work: The ECFMG® Clinical Skills and study of selected individuals. Assessment (CSA®) uses standardised patients (SPs) to Conclusions/take home messages: As a result, we focused evaluate the readiness of graduates of international on issues related to screening standardized patients for medical schools (IMGs) to enter medical training in the employment, training and training methods, and the proper United States. Physician interpersonal skills (IPS), including physical conditioning of SPs to ensure focus and professional qualities such as rapport, are evaluated as concentration. While there are many reasons why the part of the CSA. Attentiveness, attitude and empathy are standardization of SPs may not be perfect, with proper specifically targeted in the assessment. To date, over training, selection and feedback, the consistency and 230,000 candidates have tested, encompassing more than accuracy of portrayals and scoring can be improved. 320,000 individual SP encounters. Summary of results: The reliability of the SP rapport ratings, over encounters, was 0.72. Average rapport ratings for 3H 2 Psychometric challenges associated with female candidates were significantly greater than those standardized patient assessments for males (effect size = 0.20). Rapport ratings were negatively associated with candidate age (r = -0.07) and Danette W McKinley, John R Boulet* and Ronald K Hambleton positively associated with spoken English proficiency (r = (Educational Commission for Foreign Medical Graduates, 0.40). Professional qualities were only marginally related Research and Evaluation, 3624 Market Street, 4th Floor, to measures of basic science and clinical science Philadelphia PA 19104, USA) proficiency. Standardized patient (SP) assessments are being used Conclusions: While numerous professional behaviours are with increasing frequency in medical education, and are probably best measured using formats such as surveys, often part of certification and licensure decisions. These self and peer assessment and critical incident techniques, assessments can provide valuable formative and certain aspects of professionalism can be reliably and summative information regarding examinee performance validly measured in SP examinations. in a clinical setting. Amongst the challenges presented in implementing these assessment programs are those that potentially affect the validity of scores and associated 3H 4 Evaluating the effectiveness of a two-year decisions. Several factors can affect examinee performance and outcomes on these assessments, curriculum in a surgical skills centre including choice of case content, selection of raters, and D J Anastakis*, K R Wanzel, M H Brown, J McIlroy, S J Hamstra, J various administrative factors. This paper will focus on Ali, C R Hutchison, J Murnaghan, G Regehr and R Reznick various challenges encountered in administering a large- (University of Toronto, Toronto Western Hospital, 399 Bathurst scale standardized patient assessment. For the past 5 Street, 4FP-140, Toronto, Ontario, M5T 2SB, CANADA) years, the Educational Commission for Foreign Medical Graduates (ECFMG) has been administering a Clinical This study describes an evaluation of a two-year, biweekly, Skills Assessment (CSA) to graduates for international structured surgical skills curriculum. To assess the quality medical schools. Based on over 30,000 administrations, of individual skills sessions, residents and faculty completed encompassing over 320,000 SP encounters, we will evaluation forms after each session. To assess surgical

– 4.32 – Section 4

skill acquisition as a function of the curriculum, 50 residents on how to develop item weights and incorporate them into participated in the same Objective Structured Assessment a scoring algorithm that leads to a pass/fail decision. of Technical Skills (OSATS), at one of two time intervals. In 1998, 31 residents who had not completed the curriculum Conclusions/take home messages: Weights can be an were tested as historical controls and in 2000, 19 residents important aspect of examination development in that who completed the curriculum were tested as the treatment varying the weights will affect which specific examinees group. Participants completed 6 standardized surgical pass or fail. This is most evident around the pass/fail cut procedures on human cadavers and were assessed using point. task-specific checklists and global-rating scales. Most comments reflecting areas requiring improvement were directed at the syllabus and surgical models. OSATS scores 3H 6 Self and peer assessment of history taking skills were not significantly different between treatment and Caroline Boggis*, S Cooke, M Holland and H Richardson (South control groups on either checklist or global-rating scores. Manchester University Hospitals’ NHS Trust, Undergraduate Further comparisons between groups on individual OSATS Medical Education, 1st Floor Education and Research Centre, stations revealed no significant differences. Although Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, session evaluations indicated the curriculum was useful UK) and worthwhile, this did not manifest as a general improvement in surgical skills, as evaluated by an OSATS Aim: Self and peer assessment skills underpin life-long examination. Further investigation is required to better learning and are used in medical practice post- understand the benefits of such curricula and how best to qualification. Also students engage better with task-based evaluate them. learning when involved with its assessment. We explored self and peer assessment based on history-taking and presenting in the OSCE setting. The following research 3H 5 Weighted OSCE checklists: the practice at the questions were applied: (1) How do the students assess Medical Council of Canada their abilities? (2) What is the relationship of the students’ assessment and tutors’ assessment in final examination? D E Blackmore*, S M Smee, T J Wood and W D Dauphinée (The Medical Council of Canada, 2283 St. Laurent Blvd, Ottawa, Ontario K1G Summary of work: Examination marking schemes were 3H7, CANADA) explained to final-year medical students who then determined their own assessment criteria. The students Aim: The use of checklists with Objective Structured practised communication skills in small groups, using role- Clinical Examinations (OSCE) is widespread in the play scenarios. Following each scenario the students gave assessment of medical students, residents and physicians each other feedback, and recorded scores on themselves in practice. The checklist is most often used to record and their peers as examiner or observer. Following the whether or not an examinee adequately performed a salient session students were asked to provide written reflection. aspect of a given patient encounter/case. For scoring purpose, the common practice is not to assign weights to Summary of results: Preliminary analysis shows that self- the individual checklist items; i.e. each item carries the assessment scores were significantly lower than peer same weight and contributes equally to the pass/fail assessment (p<0.01). Correlation with the tutor assessment decision for that case. The practice of the Medical Council at final examinations (May 2003) will be presented. Many of Canada is to apply weights. students found the programme beneficial in developing consultation skills and increasing their understanding of Summary of work: This paper outlines the reasons why the OSCE examiner’s role. checklist item weights are felt to be important in the context of a high stake licensing examination. Conclusions/take home messages: As research shows student dissatisfaction with the OSCE system it is important Summary of results: Several data sets are presented to to increase awareness and transparency of this support the use of item weights as well as a short discussion assessment process.

Session 3I: Problem Based Learning and Computers

3I 1 Successful implementation of Blackboard in PBL- be paid to the instruction of the teachers with regard to the tutorials implementation of Blackboard in the tutorial, especially the use of the archive-options of Blackboard. The lack of P Room*, A H J Dierssen and F G M Kroese (FMW RuG, Department broadband connections at the students’ homes reduced for Educational Development and Quality Assurance, Faculty of the efficacy of the communication in Blackboard. Medical Sciences, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, NETHERLANDS) Working in PBL-tutorials is the backbone of the Groningen 3I 2 CAMPUS-Pediatrics: a flexible, interactive, case- Medical Curriculum. Small groups (7/8 students) reflect oriented, web-based training program for multi- on patient presentations and analyze study tasks related to purpose use in pediatric medical education the patient problems. Study tasks are assessed in oral S Huwendiek*, S Koepf, B Hoecker, R Singer, F J Leven, G F Hoffmann examinations. All activities and results are drawn in a logbook. In 2002 the course management program and B Toenshoff (University Children’s Hospital Heidelberg, Im Blackboard was introduced in the medical curriculum and Neuenheimer Feld 150, D-69120 Heidelberg, GERMANY) 50% of the tutorial rooms was equipped with ICT facilities Creating an effective problem-based learning environment (PC and beamer). The effect of Blackboard on the learning for small groups can be both expensive and time- process and communication in the tutorials was consuming. A properly designed case-oriented, web-based investigated. First results of the evaluations among students training system will help to develop, organize and reuse and teachers indicate that both groups appreciate working well-structured multimedia cases in a flexible way. The with Blackboard. The cooperation among members in the CAMPUS educational computer program addresses these tutorials was stimulated, the quality of the presentations requirements by covering the needs of different user groups and study tasks improved. No significant differences were in different application scenarios (e.g. self-study, learning found in the results of the written and oral examinations of group, examination) to get the maximum benefit of students in the groups using Blackboard or not. integrated medical cases. Various degrees of interactivity Furthermore, the study reveals that special attention should

– 4.33 – Section 4

during case presentations can be chosen. The most time used for the first session was evaluated as appropriate interactive form is ideal for students to learn basic clinical by ten groups, whereas one group considered the case skills and problem solving competence. Here the user took too much time to complete. Nine groups felt that the cares for his patient in a virtual Children’s Hospital by taking number of videos used was appropriate, whereas two a full medical history, ordering all required physical, groups found that there were too many videos. laboratory or technical examinations and making diagnostic and therapeutic decisions. Less interactive Conclusions/take home messages: PBL-cases presented presentation forms are suitable for continuing medical on intranet may offer pedagogical advantages. The faculty education and other types of training where it is not has decided that from the fall 2003, all PBL-cases shall be desirable to overburden the user. It is planned within the available on intranet. collaborative project CASEPORT to set up a comprehensive learning and teaching platform for paediatrics on the web that can be accessed by all medical 3I 5 “Don’t disturb my circles” – or the use of the faculties. Taken together, CAMPUS-Paediatrics is a computer in problem-based small group learning valuable and flexible supplement to traditional teaching F Ruderich*, R Faber, C Göggelmann, C Roth, C Nikendei, D methods in paediatrics. Schellberg, R Singer, S Riedel, F J Leven, J Jünger (University of Heidelberg, Medizinische Universitätsklinik und Poliklinik, Innere Medizin II, Bergheimer Strasse 58, D-69115 Heidelberg, 3I 3 DIPOL-Edit – a new system supporting the WWW- GERMANY) based delivery of course content at Dresden Medical Faculty In classical problem-based small group learning (PBL), students work with paper sheets. We investigated the Oliver Tiebel*, Katja Liesebach, Annett Mitschick, Michael Balzer, introduction of working with a computer within PBL, which Rene Lange, Matthias Hinz, Ronny Hesse, Gabriele Mueller and makes the cases come alive due to working with Hildbrand Kunath (Institute of Clinical Chemistry & Laboratory multimedia-based elements. An evaluation of paper sheet Medicine, Medical Faculty Carl Gustav Carus, TU Dresden, versus computer-aided PBL with 135 students of internal Fetscherstr 74, 01307 Dresden, GERMANY) medicine was carried out. Over a period of ten weeks the students worked in small groups alternatively dealing with In order to prepare physicians for the changing demands five cases on paper sheets and five cases on computer of future developments in medicine, the Dresden Medical using the simulative learning software CAMPUS. The data Faculty is restructuring its curriculum by implementing of the CAMPUS-cases were projected onto a wall, while elements of problem-based learning. From the early days one specially instructed student ran the computer. At the of the reform process the faculty worked on the creation of end of the term students’ opinions about the two kinds of a web based system for support of the PBL courses. At the small-group learning were evaluated. The majority of the beginning of the reform - with a limited number of courses students refused the computer-aided small-group learning. - it was very easy to satisfy all course-organizers with an The main argument was that the computer would disturb adequate course-webpage. the communication within the group. On the other hand, However, with a growing number of courses throughout some students favoured the integration of multi-media the curriculum it became a nearly unmanageable based elements and the possibility of the connection with endeavour to provide sufficient support. In cooperation with self-study by using CAMPUS. Therefore, in the next term, the Institute for Software and Multimedia Technology at we are offering it again to volunteers and will compare the Dresden Technical University a maintenance-tool for this new data with the present results. system was designed and created, which seems easy enough to be handled by faculty members without any knowledge of programming and database management. 3I 6 Problem based learning on the Web – an outreach The result is a MySQL-based System using HTML, PHP to Norwegian medical students abroad and JavaScript called DIPOL-Edit. This Editor enables nearly everybody to create and maintain webpages by Roar Johnsen*, Toralf Hasvold, Karin Straume, Zoltan Tot and Geir themselves. It is the basis of future implementations for Jacobsen (Norwegian University of Science and Technology collecting evaluation data, self-assessment tools and a (NTNU), Medical Faculty, NO 7489 Trondheim, NORWAY) communication tool supporting the transfer of information Aim: Before internship registration, Norwegian graduates between the faculty and affiliated teaching hospitals. from foreign universities must document skills in national health legislation, organisation and economy. To meet this requirement we organised a problem based learning 3I 4 Cases in problem based learning (PBL) presented course, web-based, and with use of MEQ in groups. on intranet Summary of work: Goals were defined for four separate Torstein Vik and Andreas Haaland* (Norwegian University of modules that focus on aspects of regular medical practice. Science & Technology, Department of Community Medicine, Faculty All information may be accessed from relevant web-sites. of Medicine, Medical Technical Center, Olav Kyrres gt 3, N-7489 Hence, no textbooks are deemed necessary. Challenges Trondheim, NORWAY) are presented as cases with combinations of live and still captions and written text. Groups of 6-8 students throughout Aim: To study if PBL-cases presented on intranet may offer Europe and Australia and a tutor communicate via a closed pedagogical advantages. web forum. Each clinical scenario requires group answers Summary of work: The case, including 8 videos of gait and to learning objectives defined by the students under tutor neurological examination of a child with cerebral palsy, supervision. Several individual assignments are also each video lasting approximately 15 seconds, was required. A final one week seminar includes a visit to a presented to second year medical students. MR images of district health centre and an individual written exam. the brain and a brief case history were also presented. Summary of results: Twenty students completed the course Students were supposed to choose learning goals in successfully. They found challenges relevant, tutor feed- neuroanatomy and neurophysiology. back adequate, workload greater than expected, and Summary of results: At the second group meeting 11 groups technical solutions suboptimal. The seminar was a must (8 students and one facilitator in each) evaluated the for the positive outcome. functionality of the learning management system in use as Conclusions/take home messages: Undergraduates fair. However, the pedagogical gain of the case was abroad may benefit from medical problem solving in groups evaluated as being ‘considerable’ (five groups) or ‘much’ via the web, even when prior subject knowledge is limited. (six groups) compared with traditional paper cases. Ten groups wanted more cases presented on intranet. The

– 4.34 – Section 4 Session 3J: The Progress Test

3J 1 Progress testing of two different medical curricula at Summary of results: Each student cohort improved on their one faculty – preliminary results previous average (p=.004). Moreover, during each round of testing, senior students scored higher than less senior K Duske*, S Fuhrmann, S Hanfler, J Hoffmann, S Koelbel, D Mueller, students ({year 4 > year 3, p = .045}, {year 5 > year 3, p = Z Nouns, P Wieland, S Zacharias and A Mertens (Charité Berlin, .002}, {year 5 > year 4, ns}). Progress Test Medizin, Zahnklinik, Schumannstr. 20/21, 10117 Berlin, GERMANY) 5 Tests 5 Exam Taking Cohorts At the Medical Faculty Charité in Berlin, a PBL-based reformed medical curriculum was started in 1999 parallel 1997 1998 1999 2000 2001 to the traditional German curriculum. In 2002 a mandatory Test 1 Year3 Jan 33.1 31.0 30.3 20.4 24.5 progress test was integrated in the traditional curriculum as well, which gave us the chance to compare students’ Test 2 Year3 Jun 43.3 32.0 44.9 32.4 39.7 progress. Each progress test consists of 200 one-best- Test 3 Year4 Jan 45.3 49.6 35.8 42.0 42.3 answer MCQ, reflecting the level of knowledge at the time of graduation. The test is performed once per semester. Test 4 Year4 Jun 41.9 57.9 45.1 51.7 48.2 Preliminary results show significant difference in the Test 5 Year5 Jun 63.9 51.9 55.8 57.7 increase of correct answers over the first 4 semesters of medical studies, favouring the PBL-course. The presentation will discuss possible causes and emphasize Conclusion: When used in Manchester, progress testing the problems in comparing two different curricula. demonstrates that on average cohorts improve on performance over the three clinical years of the problem 3J 2 Progress testing with short-answer questions based undergraduate medical curriculum. J Rademakers*, Th J ten Cate, P R Bär and J M M van de Ridder (UMC Utrecht, Onderwijsinstituut, Postbus 85060, (Stratenum 3J 4 Towards a joint progress test: more quality for less 0.304), 3508 AB Utrecht, NETHERLANDS) Euros In 1999 a new 6-year medical curriculum was introduced J Cohen-Schotanus*, L W T Schuwirth, D J Tinga, A J N M Thoben at the University Medical Center Utrecht. In 2002/03 a and C P M van der Vleuten (Institute for Medical Education (OWI- progress test was initiated in year 4, meant to be taken OK), Faculty of Medical Sciences, University of Groningen, Ant. twice yearly in year 4 and 5. The test consists of 40 cases, Deusinglaan 1, 9713 AV Groningen, NETHERLANDS) each with a clinical and a biomedical short-answer key feature question. The test focus is on core knowledge, An important factor in high quality assessment is the emphasising clinical reasoning. The test differs from the incorporation of quality control measures in the test Maastricht Progress Test in the use of open-ended production by means of test review panels. These panels, questions, the philosophy of mastery level testing and the however, are quite expensive, because careful screening deliberate linking of biomedical concepts to clinical case of items is time consuming. A seemingly simple method to vignettes. Analysis of the first test results shows a high lower the costs would be by establishing inter-institutional internal consistency (Cronbach’s alpha 0.87) and co-operation in test production. In 1999 the medical satisfactory item parameters. The effort of marking answers schools of Groningen, Nijmegen and Maastricht have is reasonable, the effort of writing case vignettes with short- decided to join forces and construct an interfacultary answer items is far less than writing MC-items if similar progress test. The Progress Test is an integrated factual- test reliabilities are to be achieved. The process of blueprint knowledge orientated test of which the blueprint is based construction, rigorous question design, quality procedure on the Dutch National Blueprint for the medical study. The and marking of answers will be discussed. test is administered four times per year, and all medical students of all year classes of the three faculties sit this test simultaneously. The benefits of this collaboration are 3J 3 Does Maastricht-style progress testing work in the beyond the financial aspects, they include better quality control, an improved sharing of experiences and more UK? The Manchester Experience multicentre research. Precautions are careful drawing of G K Mahadev*, A C Owen, P A O’Neill and G J Byrne Manchester contracts, building an item bank capable of storing items University, South Manchester University Hospitals Trust, Atrium and test results of different centres, and good care to 4, Education and Research Centre, Wythenshawe Hospital, maintain a sense of ownership by all the partners. Southmoor Road, Manchester, UK) Aim: The progress test, developed in Maastricht, examining 3J 5 Cross-institution comparison of student knowledge acquisition across the undergraduate medical curriculum has been a benchmark for the Manchester achievement using a progress test clinical undergraduate curriculum since 1997. We A M M Muijtjens*, J Cohen-Schotanus, A Thoben, M M Verheggen hypothesized that in Manchester each undergraduate and C P M van der Vleuten (University of Maastricht, Department cohort would perform better on each successive test, and of Educational Development and Research, Faculty of Medicine, that senior students would score higher than less senior PO Box 616, NL-6200 MD Maastricht, NETHERLANDS) students. Aim: To discuss test score differences for three medical Summary of work: A retrospective analysis of progress test schools taking the same progress test. performance for five clinical undergraduate student cohorts of the Manchester clinical curriculum years Summary of work: Three Dutch medical schools between 1997 and 2001 (n=1947) was performed. Each (Universities of Maastricht, Nijmegen, Groningen) student took five progress tests over the three clinical years cooperatively constructed a progress test that is taken four of the MBChB course. Each progress test consisted of 250 times a year by all medical students. Each test consists of True/False questions representative of the 4 taught 250 true/false items that may concern any medical subject. modules within the problem-based curriculum. For each Average test scores for students of different classes indicate student cohort, mean and standard deviations were growth of medical knowledge, and the effects of different calculated and mean scores compared (students t-test). curricula may be compared. Knowledge growth is measured at 24 moments (six classes, four times a year).

– 4.35 – Section 4

Summary of results: For academic years 2000-2001 and decrease, and b) Maastricht results tend to be the highest. 2001-2002 average scores (% correct-incorrect) increase However, at this stage the majority of test items is from 6 to 33, resp. 4 to 32 for moments 1 to 24. Between contributed by Maastricht staff, which might be university differences were statistically significant at 14 resp. advantageous for the Maastricht results. This imbalance 9 moments, the highest mean score being 10, 9 resp. 4 complicates the interpretation of the differences, but it times obtained by Maastricht, Groningen resp. Nijmegen. certainly will encourage the staff of Nijmegen and Groningen to increase their item production. Conclusions/take home messages: The results indicate that a) test score differences between universities tend to

Session 3K: Clinical Teaching and the Patient

3K 1 The gynecological patient in a teaching session of the traditional curriculum. Mette Haase Moen (Norwegian University of Science and Conclusion/take home messages: Curriculum changes Technology, Faculty of Medicine, St Olav’s University Hospital, promoting communication and basic clinical skills are Department of Obstetrics and Gynecology, 7006 Trondheim, highly effective and lead to an improved practical education NORWAY) of tomorrow’s physicians. Aim: To report how female patients can be motivated to participate in the training of medical students performing 3K 3 Bachelor degree profession and learning in practice pelvic examinations. – student nurses’ learning and development of Summary of work: 136 women referred to the gynecological competence in psychiatric practice outpatient clinic were by a letter invited to take part in a teaching session. They were informed that a medical Linda Kragelund (The Danish University of Education and The student should perform the pelvic examination together Psychiatric Hospital of the County of Roskilde, Roskilde Amts with the senior lecturer. A questionnaire was enclosed by Sygehus Fjorden, Smedegade 10-16, DK-4000 Roskilde, which they could explain why they agreed to participate or DENMARK) why they refused. The aim of the presentation is to study the following Summary of results: The response rate was 97% (132 of questions: 136). 113 (85.6%) accepted the invitation, but 26 (23%) of 1 How do student nurses learn psychiatric nursing in them asked for a female student. 19 (14.4%) refused to practice? participate. In the same period 415 women were ‘in the 2 Which learning opportunities do they have during their door’ asked to permit a medical student to take part in the training period in psychiatry? consultation. In this group 100 (24.1%) refused, and this is 3 Which learning processes give them the best significantly higher than the 14.4% refusal rate among the possibilities to reach the objectives for training in the women who were invited by a letter (p<0.02). With this psychiatric ward? experience we have later composed a letter of invitation sent to women selected for this teaching outpatient clinic In the nursing profession an essential part of education and only about 10% refuse to take part. takes place in practice. Interaction (relations) and communication is a major part of professional practice. Conclusion/take home messages: An explanatory letter with Based on a pilot project studying learning opportunities for the possibility to refuse may motivate the women to accept nurses in psychiatry, I will present empirical material the presence of a medical student actively taking part in derived from interviews with students and through the gynecological consultation. participant observation. I am using a model of learning processes developed by a Professor in Continuing Education, Peter Jarvis. Through the field observation I 3K 2 Effectiveness of communication and basic clinical will try to delineate potential learning opportunities and skills’ curriculum in internal medicine circumscribe factors that may have an effect on the student C Nikendei*, C Roth, A Zeuch, S Schäfer, M Benkowitsch, B Auler, nurses’ learning processes. The pilot study is a preparation D Schellberg, W Herzog and J Jünger (University of Heidelberg, for a larger scale study that will be briefly outlined in order Medizinische Universitätsklinik, Abteilung fur Allgemeine to receive feedback for further planning. Answers to the questions might make it possible to draw up guidelines for Klinische Medizin und Psychosmatik, Bergheimerstrasse 58, learning processes that qualify clinical learning as a part 69115 Heidelberg, GERMANY) of education for bachelor degree professions. Aim: The aim of curriculum changes in medical education is to improve the students’ clinical and social skills. However, there are contradicting results regarding the 3K 4 Early student-patient interactions: the views of effectiveness of measures taken. patients regarding their experiences Summary of work: A study of internal medicine students JE Thistlethwaite* and E A Cockayne (University of Leeds, was implemented in a two term group-control design. The Academic Unit of Primary Care, 20 Hyde Terrace, Leeds LS2 9LN, intervention group, consisting of 77 students, participated UK) in seven lessons of communication training, seven lessons of skills-lab training and seven lessons of bedside-teaching. Aim: To investigate the attitudes of patients to being The control group of 66 students had equally as many interviewed by first year medical students during the lessons but was only offered bedside-teaching. Students’ Personal and Professional Development (PPD) course. cognitive and practical performance was assessed with a One aim of these interviews is to help students to begin to MC-test and an OSCE with blinded examiners. gain an insight into a patient-centred approach. Summary of results: The intervention group had a Summary of work: A questionnaire was sent to 120 patients significantly better OSCE performance (p<0.0001) than the who have been interviewed during the last four years. We control group, whereas both groups did not differ in their asked patients what they felt about the process of being results of the conducted MC-test (p<0.15). This indicates interviewed, what they understood was the purpose of the that specific training in communication and basic clinical exercise, if they felt they had benefited in any way from the skills enables students to perform better in an OSCE, interview, whether they had any worries about the process whereas its effects on knowledge do not differ from those and if they could suggest any improvements in the course.

– 4.36 – Section 4

Summary of results: There was a 75% response rate. The Conclusion/take home messages: Trust and mutual majority of respondents felt they had benefited themselves respect were positive outcomes of our setting of combined from the process (82%), describing the experience as training of technical and communication skills. As the useful and interesting. However only a third thought the students reported themselves: “It will certainly help us in interview was stimulating. Some students were classified our future careers.” as ‘boring’ if they did not talk much during the interview. Conclusions/take home messages: Patients enjoy being involved in the early education of medical students. As 3K 6 Enhancing reflection in communication skills patients prefer students to be well prepared it is important training with simulated patients that the students are adequately briefed before the exercise. Eeva Pyörälä* and Anni Peura (University of Helsinki, Research and Development Unit for Medical Education, PO Box 63, 00014 Helsinki, FINLAND) 3K 5 Training in intimate physical examinations: a Aim: This paper suggests enhancement of different levels challenge at the University of Antwerp of reflection (reflection-in-action, reflection-on-action, K Hendrickx*, B De Winter, B Selleslags, L Debaene, F Mast, W reflection-for-action) in communication skills training. Tjalma, P Buytaert and J J Wyndaele (Skillslab, University of Antwerp, 2610 Wilrijk, BELGIUM) Summary of work: In the Faculty of Medicine in Helsinki, Finland, a communication skills study programme was Aim: Teaching intimate physical examinations in medical started in 1994. New, innovative methods of learning such schools generates practical, didactical and ethical as patient simulations with professional actors were problems. We created a “safe” environment where fifth- adopted, and have since then become an established part year undergraduates can learn these skills in healthy of the curriculum. The courses with simulated patients volunteers. Technical, communicative and attitude are today among the most popular courses in the faculty. aspects are taken into account. After each patient simulation a feedback discussion follows. Instructions for giving and receiving constructive feedback Summary of work: Twenty volunteers were trained as have been given to the teachers, actors and students. In Intimate Examination Assistants (IEAs) to serve both as order to further develop the communication training with patient and teacher after 8 hours of training. Medical staff simulated patients we suggest enhancement of the was trained in supervising and coordinating. The students different levels of reflection in these studies: first, to expand trained in the technical skills first on manikins. Students the practices of reflection in feedback discussions; second, performed three sessions (urological, gynaecological, to promote reflection across the learning situations in order breast). Each setting consisted of two students, one IEA to support the learning processes; third, to activate the and one doctor. Students, IEAs and supervisors had the teachers’ reflection while planning and developing the opportunity for immediate feedback. Attention was focused courses. on personal attitude, technical and communication skills. Conclusions: Enhancing reflection is a challenge for Summary of results: The program was evaluated at 3 levels modern communication skills training. Reflection is a multi- (students, IEA, supervising staff) by questionnaires, personal level process which takes place before, during, after and reflections and round-table conferences. The results show across the simulations, the courses and the entire a very positive appreciation of the training. The feedback curriculum. moments were of utmost importance for mutual understanding and appreciation. Workload and costs were considered heavy but rewarding.

Session 3L: Professionalism (1)

3L1 Experiences of medical students with regard to between the E.C.L. aspects and the quality of training were aspects of ethics, cultural awareness and legal positive but rather weak (below 0.5), yet significant. issues (ECL) during clinical rotations Conclusions: The students in the clinical phase lack basic Netta Notzer*, Roni Dadao-Harari, Henri Abramowitz and experiences, important for their professional life as Avraham Rudnick (Sackler Faculty of Medicine, Tel Aviv University, physicians. It was noted that especially during General ISRAEL) Surgery, students’ ethical behavior (i.e. preserving patient privacy and asking for informed consent), should be Background: In most medical schools professional aspects monitored. The relationship between the quality of training of medicine are formally being taught during pre-clinical especially of their role models - the department head and training. However, they are needed most in the clinical the tutor – to E.C.L behaviors should be further studied. phase. In this study we looked at students’ actual experiences – exposures and involvement with common behaviors, emphasizing respect for patient autonomy, 3L2 Laying the foundation for professionalism – case beneficence/non-maleficence and justice, as well as legal presentations in the first year of study and cultural awareness. Brigitte Grether (Faculty of Veterinary Medicine, University of Aims: The aims of this study are: 1) to assess the extent of Zurich, Winterthurerstrasse 204, CH 8057 Zurich, medical students’ experiences with E.C.L. during the SWITZERLAND) clinical training, 2) to compare experiences across clinical rotations, i.e., Internal Medicine and General Surgery. 3) to In the general opinion of many medical educators, small examine the relationship between students’ experiences group sessions are the most adequate way to teach to students’ reports on the quality of their clinical training. attitudes and professionalism. A low cost but high impact Summary of work: A questionnaire was circulated (18 items project in Veterinary Medicine showed that this is not always on 4 point scale) to students at the end of the clinical the case. A weekly series of clinical case presentations for rotations during 2002. 175 students (85%) responded. students who just had started their course of study was performed and evaluated. In spite of the high number of Summary of results: The majority of the items scored below students, the lessons were highly interactive. The students 3.00 (out of 4.00). The Internal Medicine students scored appreciated the encouraging atmosphere and the their exposure in most aspects significantly higher than occasion to activate their previous knowledge. Not only those of the General Surgery students. All correlations did they consider the course highly motivating, but they

– 4.37 – Section 4

also declared that they had learned a lot about professional beginning we introduced the definition of professionalism. attitudes, e.g. the importance of systematic approach to After ice-breaking, participants were divided into 8 small clinical cases, ethical and monetary considerations, and groups. Each group discussed the strategy of how to “the way vets feel” when they manage a case and deal with develop professionalism among medical students using dilemmas. We think that from interacting with the lecturers KJ (Kawakita Jiro) method. After one hour of group work, when solving a case, students benefit even more than from all participants gathered together again. Each group was periods of practical training where they spend most of their given 3 minutes to present the product from each group time watching the vet and occasionally lending a hand. It discussion. is also a means to make the most of the transitory phase when students change from high school to university to Summary of results: The strategy to develop professionalism convey professional attitudes and values. for medical students includes: good teacher as role model, early exposure to clinical setting and community health service, more introduction of PBL, improvement of 3L 3 Gross anatomy curriculum as a framework to teach admission policy to medical school, increase in the professionalism number of medical teachers in each medical school, and, paradoxically, encounter with bad teachers. The barrier to Wojciech Pawlina*, Thomas R Viggiano and Stephen W Carmichael the development of professionalism is the teacher’s (Mayo Clinic, Mayo Medical School, Department of Anatomy, 200 indifference to medical education, immaturity of medical First Street SW, Stabile Building 9-38C, Rochester MN 55905, students and poor resource including shortage of teachers, USA) and unsatisfactory budget. Rise of managed care and corporate transformations of Conclusion/take-home message: FD is a good tool to the health care system threaten to undermine the develop professionalism. professional behaviors of physicians. Erosion of professionalism in medical educators has a negative impact on medical students. Students’ behaviors are 3L 5 Are our tutors promoting professionalism through influenced by role models in many different disciplines. their behavior? Currently, almost 90% of medical schools offer formal Pedro Herskovic*, Eduardo Cosoi, Jocelyn Manfredi, Karen activities to teach professionalism. For most students, initial Sepúlveda Paola Contreras, Esteban Muñoz, Roberto Verdugo, contact with professional role models occurs during the gross anatomy course. The gross anatomy course provides Verónica Fuentes and Anabella Aguilera (University of Chile, the first opportunity for students to reflect on altruism through Medical School, PO Box 13898, Correo 21, Santiago, CHILE) the gift of the human body that is assigned to them. Aim: Professionalism is taught formally and informally. A Experience of working in a small dissection group allows six week clerkship in a pediatrics outpatient clinic was students to develop skills in cooperative learning, used to explore how our students perceived their tutors communication and team building. As they participate in practised professionalism. team dynamics, students learn to observe and evaluate professional behavior in their classmates. The Mayo Summary of work: Seven groups of students, with their tutors’ Medical School gross anatomy faculty has created an knowledge, rated weekly if they had observed them environment in which professionalism is acknowledged, practising the criteria of the Amsterdam Attitude and evaluated, and rewarded while unprofessional behavior Communication Scale: 1. Courteousness and respect, 2. results in negative consequences. In the medical Adequate information gathering, 3. Adequate information curriculum gross anatomy should be viewed not only as giving, 4. Handling emotions, empathy, 5. Structuring the basic science course to teach structure of the human communication, 6. Insight into one’s own emotions, norms, body but also as the first attempt to teach professionalism values and prejudices, 7. Adequate cooperation with nurses to students entering the medical profession. and colleagues, 8. Knowing one’s own limits, willingness to critically assess one’s own behavior, adequate handling of feedback, 9. Display of dedication, sense of responsibility 3L 4 How to develop professionalism in medical education: and engagement. the Faculty Development approach All ten tutors that supervised students were rated. Ichiro Yoshida* and Kazuhiko Fujisaki (Office of Medical Education, Summary of results: Six exhibited all the expected attitudes Kurume University, School of Medicine, 67 Asahi-machi, Kurume during their time with students. Five exhibited, at least once, City, 830-0011, JAPAN) attitudes opposed to the desirable competences: lack of Aim: Professionalism is a very important concept and courteousness, inappropriate handling of emotions, lack outcome in medical education. However, the strategy to of insight into own emotions, lack of cooperation with develop professionalism and assessment of nurses and colleagues and lack of knowledge of own limits. professionalism is still not popular in Japan. To develop Since students were supervised by two tutors, all were able professionalism in undergraduate medical education, we to see all the competences being practised. held faculty development (FD) on professionalism. Conclusion/take home message: There is room for Summary of work: Forty-nine participants from throughout improving the informal teaching of professionalism. Japan, including medical students, attended the FD. At the

Session 3M: The Core Curriculum

3M 1 Physicians’ and basic scientists’ opinions about the Summary of work: A sample of basic science (N=11) and required depth of biomedical knowledge for medical clinical teachers (N=20) at the University Medical Center students Utrecht, The Netherlands, rated to what extent students at graduation should have active, passive or no knowledge at Franciska Koens*, Eugène J F M Custers and Olle Th J ten Cate all about biomedical topics. Respondents rated 80 (School of Medical Sciences, University of Utrecht, Universitair biomedical questions. The questions were derived from Medisch Centrum, Stratenum 0.304, Onderwijsinstituut ten organ systems and aimed at four levels of knowledge: Geneeskunde, AB Utrecht, NETHERLANDS) clinical, organ, cellular and molecular. Aim: Do physicians and basic scientists agree on the Summary of results: Analysis revealed that basic science required depth of biomedical knowledge graduating and clinical teachers agree upon medical graduates’ medical students should possess? – 4.38 – Section 4

required knowledge at the clinical level, but at the organ, by feedback and discussion. Scenarios of the role-plays cellular and molecular levels, basic science teachers judge related to topics such as: Dealing with angry or anxious that more knowledge is required than clinical teachers do. patients or family members; breaking bad news; enhancing As expected, both groups consider active knowledge patient compliance. At the end of each workshop, increasingly less necessary at the organ, cellular and participants evaluated it. Results of this evaluation, which molecular level, respectively. reflected high appreciation of the workshop, will be presented. Conclusions: Two possible explanations for these results are suggested: either basic science teachers have less insight into the depth of knowledge medical graduates should have to become a physician, or clinical teachers 3M 4 Health promotion in medical undergraduate are more willing to accept shallow biomedical knowledge curricula: its relevance may depend on definition from graduates. Ann Wylie (Guy’s, Kings and St Thomas’ School of Medicine, Department of General Practice and Primary Care, 5 Lambeth Walk, London SE11 6SP, UK) 3M 2 Incorporation of ability-based pharmacology education in an integrated medical school curriculum Aims: This paper argues that health promotion, as an integral aspect of medical undergraduate curricula, K L Franson*, E A Dubois, J M A van Gerven, J H Bolk and A F Cohen presents a challenge to curricula developers, in contrast (CHDR, Zernikedreef 10, 2333 CL Leiden, NETHERLANDS) to the other newer themes such as communication skills. Aim: To develop an abilities-based method of teaching By applying a working definition of health promotion, based clinical pharmacology that is incorporated throughout an on an ethnographic study, learning outcomes relevant to integrated curriculum. medical undergraduate curricula can be developed. Summary of work: Five ability outcomes (understanding Summary of work: The ethnographic study, conducted pharmacological mechanisms; understanding between 1997-2000, involved three groups of protagonists, pathophysiological mechanisms; critically analyse drug namely health promoters, medical educators and a indications based on pathophysiology; selecting therapy; selected group of medical students, who participated in a and monitoring therapy) were identified and assigned health promotion special study module. Multiple qualitative levels by the clinical pharmacology group. Self-study methods were used. The framework for the study involved learning strategies and assessments by which the students questions about the rationale, anticipated outcomes, could practise and evaluate their performance of the content and level of health promotion teaching; what are outcomes were developed. The strategies were offered to the theories, the skills and evidence base relevant to health course co-ordinators and included active learning and promotion; and how can they be integrated into curricula, computer database programs as well as patient evaluation which is assessment driven? and plan writing assignments. Summary of results: Interpretative data analysis suggested Summary of results: After two years, at least one of the that health promotion is a contested field but a pragmatic outcomes was incorporated into 60% of the curriculum. definition is embedded in the data, enabling concepts The lowest level outcome of pharmacological familiar to health promoters to be explored within the understanding was adopted in 100% of these blocks. context medical education. Higher level outcomes and assessments, which include Conclusions/take home messages: The paper argues that the ability to select and monitor drug therapy based on health promotion can be relevant to undergraduate pharmacotherapeutic principles was incorporated in 47% curricula, if this working definition is applied, and discusses of the blocks. Student evaluations have been positive suggested learning outcomes. regarding the learning strategies and indicated a preference for higher level assessments and integration. Conclusions/take home messages: By developing and 3M 5 Role definition, task analysis and educational needs using learning strategies that consistently focus on selected assessment of general practitioners in Islamic outcomes, we are able to successfully incorporate clinical Republic of Iran pharmacology education throughout the integrated curriculum. Shirin Niroomanesh, Haboballah Peirovi and Shahram Yazdani* (Shaheed Beheshti University of Medical Sciences and Health Services, Tabnak Street, Shaheed Chamran Avenue, Evin, 19395 3M 3 Effective communication: an essential component of Tehran, IRAN) professionalism Information overload, increased complexity of the health Hannah Kedar (The Hebrew University, Hadassah Faculty of system, the rising cost of healthcare, the altered pattern of Medicine, Centre for Medical Education, PO Box 12272, Jerusalem disease burden, emerging diseases, globalization, the post- 91120, ISRAEL) revolution baby boom, increasing attention to quality of care, more market orientation and emerging technologies Background: In recent years, the dialogue between predict a basically different future environment for the physicians and patients has undergone some major health system in I. R. Iran. Therefore healthcare providers changes. Most notably, patients and/or their families search including general practitioners should assume new roles the internet and come up with questions and doubts; and (e.g. manager, community leader, gatekeeper etc) to cope more often frustrated patients react to health professionals with requirements of the new environment. Undertaking in an aggressive manner. The competent physician must these new roles requires new knowledge, skills and develop awareness as well as specific techniques for competencies that should be considered in the dealing with patients demonstrating these behaviors. In undergraduate medical education (UME) curriculum. This addition, the contemporary focus on patient-centered article is the progress report of a joint project between (1) approach requires physicians to improve their effectiveness Educational Deputy of Ministry of Health and Medical of history taking and attainment of patient compliance. In Education, (2) Shaheed Beheshti University of Medical light of the growing emphasis on “professionalism” in Sciences, and (3) Management and Planning Organization medicine, the present paper suggests a model for teaching of I.R. Iran. In this national project, requirements and needs empathic communication. of the health system are connected to educational objectives of the UME program through a sequential Summary of work: Residents were offered a 1½ day process of community needs assessment, role definition, workshop, consisting of 3 parts: (a) Recording of personal task analysis and educational needs assessment. experiences of difficult encounters with patients or their family members. (b) Presenting the model of empathic Different stages of the project, the problems confronted communication. (c) Role-plays by the participants followed and initial results are discussed.

– 4.39 – Section 4 Session 4: Workshops 1 (including two large groups)

4.1 ‘A doctor who knows only Medicine, doesn’t even 4.2 Why fix assessment? know Medicine’ Teaching ethics and attitudes: a Phil Race (Newcastle, UK – [email protected]) global challenge for Medical Education Background: Assessing students’ work is the most important Madalena Patrício (Faculty of Medicine, University of Lisbon, Av thing we do for them – however, students can escape bad Prof Egas Moniz, Piso 1, 1649-028 Lisbon, Portugal) teaching, but they can’t escape bad assessment! (David Background: Back in the sixties Bloom organized learning Boud). Also it takes us a great deal of time and energy to into three main domains: the cognitive, the psycho-motor get it right. This workshop will explore the premise that our and the relational concerning attitudes and values. Forty assessment is ‘broken’ – overloaded, not always as valid years later I wonder how many Medical Schools include in or reliable as it should be, and with students often not their curriculum the dimension of values and attitudes that knowing where the goalposts are. More importantly, the should be the framework of good practice besides the workshop will look at ways of ‘fixing’ assessment – in other necessary techno-scientific bio-medical knowledge. Some words making it more ‘fit for purpose’ and more studies conducted last year in our Faculty indicate that manageable for our students and ourselves. medical students do not always value these types of Objectives: By the end of the workshop, you should be better competencies. They show that students strongly value the able to: material aspects in professional career decisions and the • recognise the problems of the status quo regarding instrumental qualities in the ideal teacher. The concern assessment – and accept that it is not very healthy! with the development of ethical attitudes in medical students is, we believe, of major importance. Emphasis on • explore how to make assessment more valid, reliable teaching attitudes may be one of the “turning points” in and transparent to students. medical education with the value dimension walking side • find ways of involving students in their own, and each by side with the techno-scientific competencies. As Abel others’ assessment. Salazar (1889 -1946), a great professor of the University of Oporto, already said, “a doctor who knows only Medicine Proposed structure: doesn’t even know Medicine”. • Group brainstorm – symptoms of our ‘diseased’ Objectives : (1) to raise the awareness of the importance assessment – and prioritisation of symptoms. of learning-teaching and assessing attitudes in basic • Presentation – ‘Why is assessment ‘broken’?’ education; (2) to share participants’ experiences in that • A short exam (to illustrate some of the things wrong with field; (3) to identify key messages, plus facilitator factors exams – and have some fun!). and barriers to the learning-teaching of attitudes; (4) to • Ways forward, including involving students in their own describe, as a working example, ten years of methodology and each others’ assessment. of teaching and assessing attitudes in the Discipline of Introduction to Medicine at the Faculty of Medicine of Lisbon; • Action planning. (5) to motivate participants to think about the future Who should attend: development of competencies in that area. • Anyone who spends a significant amount of time Proposed Structure: A forum of discussion on teaching designing assessment and/or marking students’ work. and assessing attitudes will be developed with the following structure. • Anyone who suspects that not all is healthy in the world of assessment. 10m Welcome Introduction to participants Organizer & • Anyone who is perfectly satisfied with the health of and to the workshop structure participants assessment! 15m Briefing on teaching and assessing Brainstorming Outcomes/Take home messages: attitudes at each faculty • Assessment is really important (not least to students); 20m Learning-Teaching and assessing Short lecture attitudes at the FML. Some ideas supported by • Assessment is becoming much more ‘public’ (if we get with concrete examples just as power point & it wrong, we’re ever more likely to be sued!); as a “starting point” video • We still have a long way to go to make assessment really 30m Identifying priority actions to Small Group fit for purpose. undertake in each Faculty: barriers Work • There ARE ways forward! and facilitator factors 20m Report back from groups. Present Group situation in each faculty: what is discussion 4.3 Learning in the new job: how to maximise education already done /what is still missing opportunities in shifts and other new patterns of 10m Synthesis and conclusions. Take Organizer & working: an ASME workshop Home messages participants Frank Smith ASME Secretary & Director of GP Education Structure is flexible. Participants are free to propose changes if Winchester (care of ASME Office, 12 Queen Street, Edinburgh EH2 accepted by the group 1JE, UK), Clair du Boulay (Director of Medical Education Southampton UK), Sarah Blacklock (Education Project Officer Who should attend: All involved with or interested in this Southampton UK) thematic area, including teachers, students, curriculum Background:The changes imposed on doctors’ hours by experts, medical educators, etc… new contracts and the European Working Time Directive Take home message: Attention to learning-teaching and has meant for many the traditional ‘firm’ system of clinical assessing attitudes is crucial in the curricula of medical work has moved to a partial or full shift. This has sometimes courses. This implies considering concrete actions and meant the disruption of the traditional apprenticeship role other teaching scenarios, namely teaching in the with a perceived negative impact on learning. How might community within the perspective of social accountability. education be best managed and delivered for doctors in training? What new strategies are required by the learner?

– 4.40 – Section 4

Structure: The literature surrounding working patterns and supervising a student or students engaged in educational learning will be briefly summarised and a review presented research. These will be explored with colleagues in small of some proposed learning strategies, based on a survey group settings. and a consensus statement from a UK meeting, and an Who should attend: Anyone who is currently supervising ongoing project in a large teaching hospital (30 minutes). postgraduate dissertations in Medical Education or whose Groups will then be set up to discuss the delegates’ own careers plans may lead to this role in the near future, experiences (40 minutes). A plenary will be held to pull together the group discussions (20 minutes). Outcomes: The product of this workshop will be an appreciation of some of the challenges inherent in Who should attend: Training programme supervisors and supervising students undertaking a postgraduate managers; Teachers; Trainees. qualification in Medical Education, and the development Outcomes: Delegates will receive a copy of the literature of a set of guidelines for good practice for both the learner review and project synopsis. A synthesis from the workshop and the teacher in the supervision process. output will be emailed after the conference. 4.6 Peer teaching 4.4 Depression in clinical practice: educating medical Athol Kent and Trevor Gibbs (Faculty of Health Sciences, students and primary care physicians University of Cape Town, Anzio Road, Observatory, 7925 Cape Eliot Sorel (School of Medicine and Health Sciences and School of Town, South Africa) Public Health and Health Services, The George Washington Background: Peer is defined as a person of equal social University, Washington DC, USA) standing or rank or in the group setting a group of individuals Depression is one of the most prevalent medical conditions of similar age. The current emphasis on small group encountered in primary care in the 21st century. It is present learning has spotlighted the students’ role in educating as a distinct and/or as a comorbid condition. Most patients themselves and their peers. However the more formal in need of care for this condition consult their primary care involvement of students in teaching each other, especially physician. Reliable and specific diagnostic tools, as well in the small group context has not been widely explored. as treatment interventions, are currently available, with Objectives: The objective of the workshop is to better effective outcomes, on a par with other medical treatments. understand the place for and value of peer teaching for Participants in this workshop will learn about: medical students. The workshop will draw from participants their experiences of peer teaching within their own 1 The epidemiology of depressive disorders institutions. The focus will be on the (dis)advantages of 2 Clinical symptoms, signs, and prevalence of depression medical students participating in the education of their in primary care peers. Given the dearth of literature on the subject it will be 3 Diagnostic criteria one of the objectives of the workshop to compile, 4 Complementary treatment strategies, including electronically, an archive, for participants to use for psychotherapy, pharmacotherapy, patient and family reference. Although peer evaluation and mentoring are education important aspects of peer education the workshop will concentrate the actual instruction and benefit derived by 5 Choice(s) of treatment students from students. 6 Assessing potential risk to self and/or others Structure: The workshop will begin with the introduction of There will be ample opportunity for discussion, questions, the participants and the facilitators, followed by a brief and answers. resumé of what will and what will not be explored. There will be a trigger presentation of peer teaching to first year students by senior students in the field of HIV/AIDS 4.5 Trials, tribulations and triumphs: supervising a education at the University of Cape Town. Attendees will dissertation in medical education then break into small groups to discuss the following questions: Lesley Pugsley and Janet MacDonald (School of Postgraduate Medical and Dental Education, University of Wales College of • What areas of medical student education are amenable Medicine, Heath Park, Cardiff CF4 4XN, UK) to peer teaching? • Are there means of collecting data on the effectiveness Background: There are ever increasing commitments to and acceptability of peer teaching? Continuing Professional Development and Life Long • Is small group learning actually peer teaching? Learning for Health Professionals expressed at the levels of both policy and practice. These have been matched by • Is peer teaching useful in the learning of communication a concomitant expansion of postgraduate courses in or the formulating of attitudes? Medical Education and an increase in the numbers of • A report back will then draw together the conclusions students undertaking educational research within this and a summary will be made for follow–up distribution setting. These factors raise a number of issues which need to participants by means of a pre-constructed listserv. to be addressed in terms of the roles and responsibilities of both the tutor and the tutee in this setting. Outcomes: Attendees will have a clearer grasp of what can and cannot be achieved by peer teaching and hopefully Objectives: By the end of the Workshop participants will be inspired to try peer teaching in their own institutions. have: • Taken part in a highly interactive workshop focussing Who should attend: All conference attendees with an on challenges for supervisors in Medical Education. interest in students teaching students, not exclusively medical students, are welcome to participate. • Explored dilemmas relevant to this role by means of case based scenarios • Identified areas of concern and potential conflict in the 4.7 Usability in computer-assisted learning programmes student/tutor relationship Brigitte Grether (Dean’s Office, Faculty of Veterinary Medicine, • Formulated a set of working guidelines which might be University of Zurich, Winterthurerstrasse 204, CH 8057 Zurich, applied within a supervisory setting. Switzerland) Proposed structure: This highly interactive session will Background: Usability, defined as “The effectiveness, require participants to bring with them a case based efficiency, and satisfaction with which specified users scenario of a dilemma which they have encountered, or a achieve specified goals in particular environments” is an scenario which they anticipate could arise when important factor that determines learning outcomes in

– 4.41 – Section 4

computer-assisted education (CAE). Caring for usability Group 1 from the beginning of CAE development and following a) determine the essential aspects to assess simple rules will save time and money and avoid frustration. b) watch a clip of PBL video Objectives: Participants will learn: c) rate an individual according to the global rating • what Usability is d) list 5 main areas to improve • how Usability influences learning outcomes in CAE (Computer-assisted education) Group 2 • to apply the most important rules/to avoid the most a) read the checklist common errors of Usability b) watch a clip of PBL video • how to assess Usability c) rate an individual according to the checklist • where to get further information about Usability d) list 5 main areas to improve Proposed structure: Re-convene to give feedback on the use of global v checklist Part 1: Definition and importance of Usability in CAL Who should attend: Anyone with an interesting programmes (25 min) psychometrics or assessment of PBL group and individual Introduction; Definition of Usability skills. Part 2: The Do - Don’t – Approach (30 min) Small group work; Synthesis in plenary Break (5 min) 4.9 Scenarios for PBL on the Web – triggers for learning Part 3: Topic selected by participants (Navigation or Bjorn Bergdahl, Per Hultman and Elvar Theodorsson (Faculty of Fonts) (25 min); Short presentation; Discussion Health Sciences, University of Linköping, 581 85 Linköping, Part 4: Assessing Usability (15 min); Plenary discussion; Sweden) Short lecture Part 5: Conclusion (5min) Background: Scenarios should give a relevant context for the learning and increase students’ motivation. Web-based Who should attend: Educators who are producing or scenarios increase realism by means of a variety of triggers planning to produce CAE-programmes; Educators who are (video-films, sounds, pictures, and texts) that stimulate deep responsible for purchasing CAE-programmes and learning in a broad range from molecule to community. integrating them into curricula. Our faculty introduced such scenarios in 2001 in the EDIT project (Educational Development using Information Take home message: Usability is crucial for the success of Technology). About 100 scenarios for seven undergraduate computer-assisted learning programmes; do not neglect programs have been produced, the majority in the medical it! program (semesters 4-7). A computer and a data-projector, Further reading: handled by the students, are used to show the scenarios J. Nielsen: Designing Web Usability. New Riders on a white board. Publishing, 2000. Objectives: To discuss and share views about how www.useit.com http://www.usableweb.com/ scenarios and triggers on the web can be constructed to http://rnvs.informatik.tu-chemnitz.de/proseminare/www01/ achieve learning, pros, and cons with web-based doku/usability/ (in German) scenarios. Proposed structure: EDIT will be presented with examples of scenarios and triggers for clinical medicine and basic 4.8 Assessing PBL Activity science. Groups of participants can work through Christine Bundy and Lis Cordingley (University of Manchester scenarios and are also invited to bring their own examples Medical School, G711 Stopford Building, Oxford Road, Manchester of scenarios on the web. M13 9PT, UK Who should attend: Those interested in the construction of scenarios on the web as well on paper. Background: There is a lack of good literature on the analysis of either group or individual PBL skills. The two Outcomes/take home messages: Web-based scenarios most common forms of assessment are global ratings of should stimulate students to establish their learning goals. competence and behavioural checklists (scales). There In-going documents should be short and be simple to are strengths and weaknesses to both methods. There is grasp. Scenarios should not be overloaded with information no established scale measuring PBL skills in common and learning materials. As students like excitement, use and many scales have unknown psychometric solutions to a problem should be withheld as long as properties. In Manchester UK, we are developing methods possible as the case develops. Our project has revitalised to assess PBL skills as part of our assessment suite and PBL, changed the structure of “EDIT semesters”, and this workshop is part of the on-going research programme. initiated a pedagogical dialogue. Aim: to introduce the evaluation of two methods of assessment of individual PBL activity 4.10 Creating Cases to Promote Integration into Outcomes: Undergraduate Medical Education • to identify some advantages and disadvantages of global Nehad El-Sawi (University of Health Sciences, 1750 Independence rating scales v behavioural checklists Avenue, Kansas City, MO 64106, USA) • to construct a global measure Background: Medical students are expected to master a • to use the global and specific measure to rate an constantly increasing amount of information in order to individual’s PBL activity provide high quality care for their patients. Integrating basic • to use the global and specific measure to offer feedback and clinical sciences during educational efforts should to an individual allow for enhanced learning by providing context and clinical relevance for basic science concepts while Method: assuring more than rote memorization of clinical • Introduction to assessing PBL in Manchester Medical algorithms. The emphasis on integration is recognized, School but many basic science and clinical faculty members find • Break into small groups it difficult to create resources that allow faculty to easily integrate both basic science and clinical concepts throughout all the years of undergraduate medical

– 4.42 – Section 4 education. This workshop will present a brief review of the 4.12 Developing a teaching or examination event using literature, description of a method for case development Simulated Patients (SPs): form and case materials and hands-on experience creating a case for use in development integration efforts. Graceanne Adamo (Clinical Skills Teaching and Assessment, Objectives: National Capital Area Medical Simulation Center, Uniformed 1 Describe common barriers to integration efforts and Services University of the Health Sciences, 4301 Jones Bridge identify strategies to overcome the barriers. Road, Bethesda, MD 20814, USA), Heiderose Ortwein 2 Explain the concepts needed to design an effective (Reformstudiengang Medizin, Charité, Humboldt University, integrative case. Berlin, Germany) 3 Develop an integrative case that could be used anywhere Content/structure: Once the decision has been made to in the medical school curriculum. utilize simulated or standardized patients in the educational 4 Describe strategies for successful implementation of process, the task of program design and materials integrative cases. development begins. This “how-to”, hands-on workshop will provide an opportunity for participants to develop a Proposed structure: This workshop will include a brief theoretical or actual program, project, or event with didactic presentation followed by application of the emphasis on developing a case mix (form) and/or knowledge and concepts learned to the development of complete case materials. Examples from successful an integrative case during the workshop. The didactic programs and sample templates will be provided. component will include: Presenters will guide workshop participants in individual • A brief review of the literature regarding integration and and small group activities as they build forms and cases. learning Break out groups will be conducted in English and German • A description of important concepts that need to be using examples from German and American medical considered during case development school programs. • Presentation of examples of integrative materials already Outcomes: Workshop participants will develop and in use address program goals for operationalizing and maximizing potential for the use of SPs in their settings. Participants will then work in small groups to identify opportunities for integration using a common clinical Who should attend: Attendees may include anyone problem. Depending on the type of participants, groups interested in establishing, expanding or enhancing the will include basic science faculty, clinicians and educators. integration of SPs into a program to train health The workshop faculty will facilitate the small groups to aid professionals including program directors, medical them in using their own knowledge and skills to identify educators, educational researchers and administrators. possible case connections to basic and clinical science concepts. The small groups will then present their connections to the large group and discuss other 4.13 Assessment methods: what works, what doesn’t opportunities for integration. Geoff Norman (McMaster University Medical School, 1200 Main Who should attend: Basic science AND clinical faculty Street West, Hamilton, ON L8N 3Z5, Canada) members, educators, medical students and graduate In this workshop I will review the literature on assessment students. and its implications for the choice of particular assessment Outcomes/take home messages: methods. • At the end of the session, the draft case will be made Background: There is an extensive literature on available for use to participants. assessment in medical education, dating back over three • Consensus on strategies for implementing the use of decades. From this literature, it is possible to systematically the case and critically examine our use of various approaches. Regrettably, much of this literature appears to be ignored by educational practitioners. 4.11 Outcome-Based-Education: an International Objectives: Federation of Medical Students’ Associations • To familiarize participants with the literature on Workshop assessment Ozgur Onur, Nikola Borojevic and colleagues ([email protected]) • criteria for assessing an assessment method Background: Every change and improvement of the medical • general “axioms” regarding desirable and undesirable education system should lead to a better outcome, ie better properties of an assessment method physicians. In most cases this aim is just a vision and this • To review various methods currently in use, both old focus is not taken in to consideration. Although everyone and new, from this perspective involved in faculty development recognizes the need for an outcome-based approach, not many succeed in its Structure: I will present a framework for critical examination implementation. of various methods. I will then critically review existing methods, both old and new, with a view to examining the Objectives: This session will look at how you can structure evidence of effectiveness. From this, I will make some the development of your faculty to make it outcome-based, general inferences about the usefulness of various how you can overcome obstacles and what the students’ methods. While there will be no “hands-on” exercises, there role could be in this process. Questions to be discussed will be ample opportunity for discussion and sharing of will be: What is outcome-based education? How can experiences outcome-based education be organised? What role can students and young doctors play in outcome-based Who should attend: Individuals with responsibility for the education? implementation of student assessment methods. Who should attend: Students and teachers Take home message: Choice of an assessment method should be based on evidence of effectiveness. From this evidence, it is possible to identify specific essential characteristics necessary for credible assessment

– 4.43 – Section 4

4.14 Scenario-based teaching and learning – an innovative the consultation process should be resumed. The and relevant concept in medical education participant-in-action may decide on one of the possibilities, or another participant may take his place trying out Roger Kneebone (Imperial College School of Science, Technology something else. During the process the actor will also be and Medicine, Faculty of Medicine, 10th Floor, QEQM Wing , St available in the “hot-seat” for interaction with the Mary’s Hospital, Praed Street, London W2 1NY, UK), Debra Nestel participants. (Centre for Medical and Health Sciences Education, Monash University, Australia) Who should attend: Teachers and students training in communication/consultation. In a clinical setting, doctors have to combine communication skills with technical skills when carrying Take home message: Hopefully inspiration for further out ward-based procedures on conscious patients. development of participants’ own teaching/learning in Although indivisible in practice, these components of safe, communication/consultation. patient-centred care are often taught separately. We have developed an innovative scenario-based approach to teaching and learning, using inanimate models attached 4.16 Central and East European/Eurasian Task Force to simulated patients (SPs) to create an illusion of reality. Ioan Bocsan, on behalf of AMEE Executive (Iuliu Hatieganu Within the setting of a skills lab, students carry out practical University of Medicine & Pharmacy, 13 Emil Isac St, RO-3400 Cluj- procedures such as wound closure and urinary Napoca, Romania) and Stewart Mennin (University of New Mexico, catheterisation on a model while interacting with the Albuquerque, USA) ‘patient’. Performances are watched remotely and assessed in real time by expert faculty. Students receive Another meeting of this group, to discuss issues of structured feedback from tutors and SPs, then immediately relevance to the region. review their recorded performance in private, at a time of ‘readiness to learn’. Qualitative evaluation (observation and interview studies) with more than 120 procedures by 4.17 Professionalism medical students and nurses provides strong support to 4.17.1 Evidence of professional development in the the concept and have identified several problems. learning activities of medical students, house 1 Scenarios in the skills lab take place in an abstracted officers, and practicing physicians context. Transplanting SP-based scenarios into the H B Slotnick* University of Wisconsin, 2715 Marshall Court, clinical environment would heighten realism. Madison, WI 53705, USA) and Sean Hilton (St George’s Hospital 2 A portable alternative to our current audiovisual facilities Medical School, London UK) is therefore needed. Aims: This paper reports results of a qualitative study 3 The prototype model/SP interface requires modification designed to explore how medical students, residents, and to eliminate visible joins which reduce the effectiveness practicing clinicians learn. of the illusion. Summary: Interviews with forty medical students, residents, Our solution combines customised models (for rapid and clinicians sought to identify the ways in which these attachment to an SP) with a portable recording system individuals approached learning – a set of competencies (the ‘Virtual Chaperone’, developed at Imperial College central to professionalism. Interviewees described the ways London). Two miniature video cameras on a discreet free- in which they approached a variety of aspects of standing mount resembling a drip stand record a digital professionalism including (1) mastery of the esoteric skills audiovisual output directly onto disc (DVD) within a small and knowledge required of physicians, (2) recognizing the computer located in an adjoining room. The procedure is problems patients brought to physicians for solution, and watched in real time by observers who subsequently provide (3) balancing the need to remain up-to-date with the focused feedback. The procedure is played back on a exigencies of day-to-day practice. Information on laptop computer or Virtual Chaperone with headphones. psychosocial development appeared in the same By eliminating the need for specialised viewing facilities, interviews and was related to the above information. the entire process is self-contained and can take place within a clinical setting. Results: Findings confirm that human psychosocial development is part and parcel of the progress medical In this workshop we will present our concept and students cum residents cum practitioners make in striving summarize the data which underpin it. Using the equipment toward medical practice that can be described as described above, we will demonstrate the process of professional. Evidence of professionalism comes after setting up a scenario, performing a procedure, recording knowledge and skills development and in concert with and assessing it, and providing feedback to the learner. physicians’ developing an appreciation of the human This will be followed by a group discussion. condition. The findings of this study suggest changes can be made to medical education to better appreciate and achieve the limits of professionalism achievable at each 4.15 Verbal reflection-on-action as a tool in consultation stage of training. training Anders Baerheim and actress Torild Jacobsen Alræk (Institute 4.17.2 Exploring professionalism in physician-to- for Public Health and Primary Health Care, University of Bergen, physician consultation Ulriksdal 8c, N-5009 Bergen, Norway) M B Shershneva* and G C Mejicano (University of Wisconsin- Background: Training medical students in communication/ Madison Medical School, 2715 Marshall Court, Madison, WI consultation has become an essential as a part of most medical curricula. 53705, USA Objectives: By an interactive approach to let the participants We sought evidence of professionalism in physician-to- experience how verbal reflection-on-action may be a tool physician consultation as shown by mature, competent in consultation training. physicians and examined the development of behaviors and attitudes related to consultation. We interviewed eight The structure of the workshop: A consultation will be carried physicians with 8 to 28 years of experience in Internal forth step-by-step, and be modulated according to the Medicine finding evidence of professionalism and proto- participants’ reflection-on-action. An actress provides professionalism in physicians’ understanding of the referral patient role figures, and a participant starts the consultation system (e.g., referral patterns), the consultation process as a doctor. A tutor will provide frequent time-outs, where (e.g., consultation initiation), and personal attributes (e.g. the participant-in-action and the audience reflect on which physicians’ attitudes and beliefs). Physicians reported that possible next steps may be profitable, and at which point consultation attitudes and behaviors developed most

– 4.44 – Section 4 intensively during residency, fellowship, and the first years medical professionalism and the educational aspects of of practice, and involved use of clinically-oriented, those stages. immediately available, and familiar resources. They also reported that reflection on experience, senior colleagues and peers, mentorship, and observation were central to 4.18 Using a collaborative work space in a rich media becoming skilled as both consultants and referring educational environment physicians. Changes in the health care system, physiological changes, and life experiences also Sharon K. Krackov*, Richard I. Levin (New York University School influenced those attitudes and behaviors. Our overall of Medicine, 550 First Ave, New York 10016, USA), Mike Uretsky conclusion is that physicians use consultation to address (Center for Advanced Technology), Martin Nachbar and Melvin their psychosocial needs by helping physician-colleagues Rosenfeld (New York University School of Medicine) and their patients satisfy their needs. We end by Aim: We will present a new interface to enhance recommending changes to medical education to facilitate collaborative learning in medical education. physicians’ moving through proto-professional stages to professionalism within the domain of physician-to- Summary of work: Like many leading medical schools, NYU physician consultation. is evaluating the appropriate use of technology to improve quality and cost effectiveness of educational programs. A university-wide research group is developing the 4.17.3 Professionalism and proto-professionalism: Infrastructure for Rich Media Educational Environments a new view of Professionalism in physicians- (IRMEE), which leverages emerging advances in learning in-training and physicians sciences and information technology http://richmedia.med. Sean Hilton* (St George’s Hospital Medical School, Cranmer nyu.edu/. This work is based on several assumptions. The Terrace, London, SW17 0RE, UK) and H B Slotnick (University of new program must: complement and offset difficulties in teaching clinical medicine; build on educational and digital Wisconsin, USA) library efforts taking place at many institutions; contain a Because current views of professionalism underestimate problem-based student assessment component; and be what medical professionals do for individuals, for society, deliverable on a broad range of existing and future and for the profession itself, we propose a technology platforms. One aspect of IRMEE is a conceptualisation of medical professionalism arising from ‘collaborative table,’ jointly developed by the NYU School humanistic psychology. Medical professionalism is a of Medicine and the NYU Center for Advanced Technology. central feature of practice exhibited by the mature, Using this table, groups of students at the same or different competent practitioner. This view preserves received locations can collaborate while: accessing remote digital concepts such the ‘social contract,’ while adding that library and educational materials; sharing files; using a psychosocial development is required before medicine’s cybermicroscope to examine specimens; carrying out esoteric skills and knowledge can be skillfully used to simulated laboratory investigations, and working with address problems for society. This idea then leads to proto- simulated patient case studies. professionalism – stages in medical training where the Summary of results: Early prototypes include surgical learner develops the skills and knowledge, and gains teaching modules and a growing library of histology and experience and maturity needed to satisfy the new definition pathology images. Relevant School of Medicine of professionalism. Proto-professionalism asserts that departments and units are providing content and quality knowledge, skills, and experiences taught to medical control. Faculty responses are enthusiastic. A formal students and house officers are insufficient preparation for evaluation is being implemented to assess student medical professionalism. ‘Protoprofessionals’ nevertheless performance and program impact. act in ways consistent with their status and anticipate to prepare them to be professionals later on (e.g., primo no nocerum). This paper examines the stages leading to

– 4.45 – Section 4 Session 5: Large Group Sessions

5A Standard Setting effect on learning. This session will also highlight Miriam Friedman Ben-David (Israel), André de Champlain (NBME, potential problems that can be avoided when using USA), Arno Muijtjens (University of Maastricht, Netherlands), simulation throughout the medical curriculum. John Norcini (FAIMER, USA) and Ronald Nungester (NBME, USA) • Demonstrate that these conclusions can be based on evidence reached through a BEME systematic review An international panel with expertise in the area will present • Provide ideas for future research in medical education their views and address participants’ questions on a range using high-fidelity simulation of issues. Approaches to standard setting for testing purposes in education in general and in medical education Also included will be the following handouts for participants in particular will be reviewed. The recent most promising to review and provide feedback: developments in the field will be discussed. • A bibliography of high-fidelity simulation studies used in the BEME review 5B A Cognitive Perspective on Learning: Implications • An algorithm showing how studies were selected for for Teaching review Geoff Norman, McMaster University Medical School, Dept of • Practice tips for teachers on the best practices of high- Clinical Epidemiology, 1200 Main Street West, Hamilton, ON L8N fidelity simulation in medical education. 3Z5, Canada Cognitive psychology has provided many insights into how 5D Making medical education relevant to medical practice: people learn that can inform our teaching strategies. In medical schools in the continuum of lifelong learning this presentation I will review findings from the psychology of learning in five domains: memory (learning and Lewis Miller (Alliance for Continuing Medical Education, USA), remembering), transfer (using old concepts to solve new Dennis Wentz (American Medical Association, USA) and Hans problems), deliberate practice and its critical role in transfer, Karle (World Federation for Medical Education, Denmark) experiential knowledge as a component of expertise, and (American Medical Association, 515 North State Street, Chicago the role (if any) of general strategic skills (problem-solving, IL 60610, USA) critical thinking, reflection, etc.). In each area, I will begin The objectives of the session are: with examples, review the evidence, then draw implications for more effective teaching. • To review the opportunities available to medical schools in Europe and elsewhere to assist practising doctors in their continuing professional development; 5C A BEME Review of High-fidelity Simulation in Medical • To examine the role of faculty in needs assessment, Education delivery, and evaluation of programs of continuing Barry Issenberg (University of Miami, USA) and Bill McGaghie medical education; (Northwestern University Medical School, USA) (University of • To identify how medical schools can become part of Miami School of Medicine, Centre for Research in Medical the process of determining the impact of medical Education, 1430 NW 11th Avenue, D41, PO Box 01690, Miami, FL education on medical outcomes. 33101, USA) High-fidelity simulation (that is, a simulator that depicts a 5E Complex Adaptive Systems and medical education: three-dimensional person, diagnostic test or procedure with a new look at how we do what we do specific elements that can adapt and provoke responses from the user), is being used more often in medical Stewart Mennin (University of New Mexico School of Medicine, 915 education. This session will explore the use of high-fidelity Camino de Salud NE, Albuquerque, NM 87131-5134, USA) simulation and provide opportunity for audience feedback Complexity science and complex adaptive systems offer and discussion. new approaches and ways to think about medical Aims of this session: education and the organization of medical schools and • Provide practice advice on the high-fidelity simulation health care systems. They enable us to gain new insights in medical education to medical teachers, deans and about strategies for change and management in a rapidly administrators. This will include suggestions about expanding world. The presentation will compare and when high-fidelity simulation is most appropriately used contrast linear and nonlinear thinking in relation to and how it can be implemented to have the greatest integration, curriculum, collaboration and leadership.

Session 5F: Postgraduate Assessment (Short Communication)

5F 1 Assessment of specialist registrars in obstetrics general choices to be made for amongst others the and gynaecology in the Netherlands redesign of assessment procedures, based on contemporary educational science. The Committee of F Scheele*, M Schutte, B Wolf, J Th M van der Schoot and Education of the Dutch Society of O&G has made a rough “Commissie Onderwijs NVOG” (St Lucas Andreas Hospital, proposal for a summative assessment of their SpRs in the Department of Mother and Child Care, Jan Tooropstraat 164, Post first two years of training. Box 9243, 1061 AE Amsterdam, NETHERLANDS) Summary of results: An assessment system is designed Aim: To show the national redesign of assessment based on (1) the wish to assess clinical competencies, (2) procedures for specialist registrars (SpRs) in Obstetrics the wish to be compatible with the European log book and Gynaecology (O&G). (European Board and College in O&G), (3) the use of the Summary of work: Three Dutch working parties concerning CANMEDS 2000 roles, (4) the use of multiple approaches the improvement of the education of SpRs have reported of assessment and (5) the introduction of a portfolio with

– 4.46 – Section 4 regular strength-weakness analyses and description of 5F 4 Validity of the Royal College of Ophthalmologists remaining tasks to be fullfilled within the training module. part III Clinical Examination Conclusions/take home messages: The training of Dutch P A Johnstone (Ninewells Hospital and Medical School, SpRs in O&G is increasingly based on educational Postgraduate Department, Level 7, Dundee DD1 9SY, UK) science. A portfolio based assessment procedure is being designed for the SpRs. Aim: To report a study on the face validity and content validity of the MRCOphth. part III clinical examination. Summary of work: Questionnaires using a 7-point Likert- 5F 2 Improving the RITA process scale were used to survey the opinion of candidates and Robert Palmer*, Zoe Nuttall and David Wall (West Midlands examiners. Content validity was evaluated by comparing Deanery, PO Box 9771, Birmingham Research Park, 97 Vincent Drive, the clinical cases examined with the curriculum for basic Birmingham B15 2XE, UK) surgical training (BST). Aim: The annual assessment of Specialist Registrars, the Summary of results: The response rate for the questionnaire RITA (Record of In-Service Training Assessment) process, was 92% for candidates and 96% for examiners. requires a meeting between trainee and trainers. This study Candidates and examiners agreed with the majority of determines the types of assessment that are used to inform statements regarding the examination in the the RITA and acquires information on the training needs of questionnaires. Candidates did not agree that the BST consultants involved. curriculum objectives list was helpful in preparing for the exam. They were unconvinced about the fairness of the Summary of work: Questionnaires were completed by 50 exam, whether it was an accurate measure of ability or a of 53 (94%) Chairs of Specialty Training Committees. All good assessment of competence as a future but three specialties use written trainers’ reports and many ophthalmologist. Examiners were concerned at the lack review log books, publications and audit activities. OSCEs of clinical variety and whether the exam was a good and 360 degree assessments are seldom arranged. Royal assessment of communication skills. Content analysis College examinations informed the process in half the revealed a disproportionately large amount of anterior specialties. Personal portfolios, examination of CV and segment cases and relatively little vitreoretinal or ocular communications skills were assessed by some. There were motility cases. concerns that the process was not robust or rigorous enough, especially for border-line trainees. Some reports Conclusions: The MRCOphth. Part III examination has from supervisors were too vague. All respondents good face validity. However, concerns remain. Therefore, considered further training to be necessary for chairs and a new multi-station clinical exam including a consultant colleagues, particularly assessing attitudes, communication skills station is to be adopted. behaviour and communication skills. Chairs thought their colleagues were in greater need of training than they were themselves (p<0.05). Half- and whole-day workshops were 5F 5 Measurement of knowledge, attitudes and practice the preferred format for delivery. of medical interns about common ambulatory Conclusions/take home messages: The RITA process pediatric diseases in teaching hospitals of Shiraz varies between specialties and is not a robust tool. There University of Medical Sciences is a significant training need for those involved. Mitra Amini*, Ali Sadeghi Hassanabadi and Abdolah Karimi (Jahrom Medical School, IRAN) 5F 3 Educational impact of in-training assessment (ITA) Aim: The present study was designed to measure in postgraduate education knowledge, attitude and practice of medical interns about four common ambulatory paediatric diseases (diarrhoea, C Ringsted*, A H Henriksen, A M Skaarup and C van der Vleuten acute respiratory infection, fever and abdominal pain) in (Copenhagen Hospital Corporation Postgraduate Medical Shiraz Medical University. Summary of work: For each Institute, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400 disease a checklist was prepared and completed by the Copenhagen NV, DENMARK) researcher. Aim: The aim of this study was to explore what impact the Summary of results: The results revealed that the behaviour introduction of ITA had on the educational process: what of interns was favourable with children and their families. was the effect on training, teaching and learning, and what Female interns do better than males (p<0.05). Regarding were the users’ experiences and thoughts about the benefits history taking by interns, the maximum grades were and drawbacks of the programme in practice. The ITA- obtained in the approach to diarrhoea and abdominal pain programme was for first year trainees in anaesthesiology and the minimum grades were obtained in the approach and included 21 individual elements spread out through to respiratory diseases and fever. The difference between the first year of training. The elements included tests on groups was statistically significant (p<0.05). In the context clinical performance, interpersonal skills, log of experience of performing a good physical examination the highest and reflective assignments. scores were related to approach to diarrhoea and Summary of work: Semi-structured interviews were abdominal pain and the lowest scores were related to performed with three programme directors, nine approach to respiratory diseases and fever. The difference supervisors, and fourteen trainees. Interviews were audio was statistically significant (p<0.05). In the context of taped and transcribed. Content was coded and analysed diagnosis, results were favourable in all four conditions. In according to the questions and organised into a framework the context of prescribing drugs and especially not to of categories. prescribe a drug when it is not necessary the highest grades were obtained in cases of diarrhoea and abdominal pain Summary of results: The results demonstrate that the and the lowest grades were in respiratory infection and programme was beneficial in making goals and objectives fever. The difference was statistically significant (p<0.05). clear, in structuring training, in fostering teaching and The interns did not spend enough time for providing learning, monitoring progress and handling problem preventive recommendation and explaining the course of trainees. Three factors influenced the perceived value of disease for children and their families. assessment: 1) The link to patient safety and practice; 2) The perceived challenge and effect on learning; 3) The Conclusions/take home messages: There is deficiency in assessors’ attitude and rigorousness. teaching ambulatory medicine to medical interns and there is a need for revising the educational program for training Conclusions/take home messages: The administration in interns about these common diseases, especially the most practice must be tailored to the trainees’ professional common ambulatory disease, the common cold. development, be used as part of the learning process and linked to quality of practice.

– 4.47 – Section 4

Session 5G: Community Based Education (Short Communication)

5G 1 Partnership teaching in community medical referrals to hospital’. Following the placement, house education: a study to investigate the advantages officers reported that general practice had different and disadvantages of partnership teaching as demands and dealing with uncertainty was difficult. House officers were less critical of general practice and conversely perceived by tutors became more critical of hospital doctors who made Jo Brown*, Annie Cushing and Dason Evans (Barts and the London, disparaging comments about general practice. Queen Mary’s School of Medicine and Dentistry, Clinical Conclusion/take home messages: Increased exposure to Communication and Learning Skills Unit, Room 232, Robin Brook general practice led the house officers to revise their Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A attitudes and to hold more positive views of general 7BE, UK) practice. Aim: The study looked at the tutor view of the advantages and disadvantages of partnership teaching between general practitioners and community tutors. Medical 5G 3 Participatory community-based health education: education will increasingly be exploring this kind of identification of barriers to family planning educational partnership for the future. Regina Petroni-Mennin*, Celia Iriart, Saverio Sava, Rebecca Summary of work: The Medicine in Society module provides Radcliff, Rachel Evans, Leah Steimel and Dan Derksen (University teaching for 1st year medical students. The study aimed to of New Mexico School of Medicine, Dept of Family and Community undertake qualitative research to inform the design of a Medicine, School of Medicine, 900 Camino de Salud NE, questionnaire which was sent to all 42 tutors. Semi Albuquerque NM 87131-5091, USA) structured interviews were carried out to establish themes and views. From these a questionnaire was constructed. Aim: To demonstrate the use of participatory community- based education and research for undergraduate and Summary of results: postgraduate medical students. • Relationships between partnership tutors were positive Summary of work: Using questions and “problematization,” and supportive and helped individuals to gain insight medical students and residents worked and learned in a into each other’s work. community-based clinic, its surrounding community and • This method of teaching provides positive role models at the university medical center. Learners worked within for students. the real-life context of human problems in the community. • Tutors found working with students very rewarding and Summary of results: Key issues included cultural and felt that partnership teaching offered a richer learning religious barriers to family planning for Hispanic women environment for students. exemplified by husbands prohibiting wives from seeing • Tutors felt partnership teaching offered a more holistic physicians and obtaining family planning. Other barriers view of healthcare to students. included scheduling of appointments, payment for services, • GPs took the lead role in the majority of teaching pairs. discriminatory attitudes and misinformation about services offered. University barriers to learning about these issues • Half of the tutors wanted more training on how to teach included a predominance of subspecialty teachers and a and a majority wanted to meet with other teaching pairs. heavy emphasis on mechanistic approaches to illness. Conclusions/take home messages: Partnership teaching Conclusions/take-home messages: Using participatory was positively and warmly viewed by tutors and is an research as a learning strategy provides an approach to example of collaborative learning that embraces modern education that collectively empowers students, community educational theory and models the multi-perspective view women, university faculty and clinic health providers. of healthcare in a respectful way. It also models the Outcome goals include enhanced access for women to multiprofessional team working practices that will be the family planning at the community-based clinic and to the normal working environment of tomorrow’s doctors. use of contraception methods. The long-term goal is to decrease unplanned pregnancies within a defined population of Hispanic women. Secondary data from the 5G 2 Negative views of general practice: where do they community clinic and State Health Department will be come from and where to do they go? utilized in this approach to education and research. Jan Illing*, Tim van Zwanenberg, Bill Cunningham, Richard Prescott, George Taylor and Cath O’Halloran (University of Newcastle, Postgraduate Institute for Medicine and Dentistry, 10- 5G 4 Using student confidence questionnaires to validate 12 Framlington Place, Newcastle-upon-Tyne NE2 4AB, UK) placement recruitment procedures Generally in the UK, doctors only gain experience in R J W Phillips (Department of General Practice and Primary Care, general practice when they start vocational training. GKT School of Medicine, King’s College London, 5 Lambeth Walk, Therefore, the vast majority of hospital doctors have never London SE11 6SP, UK) worked in general practice. While medical students hold Aim: To present data from questionnaires to students about positive views on general practice, these become more their self-confidence, comparing new placements with negative when they become junior hospital doctors. established ones. Aim: To determine if working as a general practitioner Summary of work: Final year undergraduate medical results in a change of view or attitudes towards general students at GKTSM spend eight weeks in General Practice practice. & Community. Half attend local established teaching Summary of work: Interviews were conducted with 22 house practices; alternatively, students may find practices officers who were spending four months in general anywhere in the UK given guidance about simple criteria, practice. Data were collected before and after the then a practice questionnaire is used to select those offering placements. Interviews were recorded and transcribed. an appropriate learning environment. Practices have also Data analysis was qualitative, using grounded theory to been recruited in two satellite centres, by local contacts, identify themes and an overall theory. not using the practice questionnaire. Students complete a self-assessment questionnaire at the beginning and end Summary of results: Before the placement, negative views of their placement; rating their self-confidence against 24 were expressed: ‘general practice was the easy option’; learning objectives, on a 5-point scale. ‘general practitioners were lazy’ and ‘sent inappropriate

– 4.48 – Section 4

Summary of results: For 2001-2, there were 176 pairs of to describe a change in the course which addresses these self-assessment questionnaires, showing no difference in issues. increments in confidence between students in “local” practices (on average an increase of 1.39+/-0.6) compared Summary of work: The course will run for 22 weeks during with new ones (1.28+/-0.6), or with those recruited in which time 280 second year medical students will split satellites (1.2+/-0.6). into 2 groups which will rotate: 1 Health related community profiling and focused work Conclusions/take home messages: The students have groups which includes community placements; comparably increased their confidence; there seems no disadvantage to those in new practices vetted by a one- 2 Patient centred community review work where pairs of page questionnaire. We believe our practice questionnaire students identify hospitalized patients and follow these is a useful tool in vetting new practices. patients into the community and interview patients, carers and voluntary or statutory agencies involved. Learning objectives have been designed to help students 5G 5 Bringing the “Real World” of the patient into the gain a broader view of health and disease. Assessment medical curriculum will be by oral presentation and written report. Jean Quinn* and Lyn Brown (University of Liverpool, Community Summary of results: The new course has been developed Studies Unit, Department of Primary Care, Harrison Hughes to address the issues raised by the original evaluation and Building, Brownlow Hill, Liverpool L69 3GB, UK) in addition to look at the hospital/community interface and Aim: Community placements are an integral component its relationship to health in the community. Evaluation of our curriculum. Previous evaluation indicated students results will be available for the Conference. learnt about multidisciplinary team working and Conclusion: The evaluation will be discussed in relation to interpersonal skills but reported insufficient time and lack the educational process and outcomes. of focus in some large group work. The aim of this paper is

Session 5H: Students’ Learning (Short Communication)

5H 1 How do students with different learning styles student characteristics (age, gender and race-ethnicity) perform in formative and summative exams in the with RLOC results are presented. Additionally, the first year of a new curriculum? relationship of the RLOC with companion measures probing student perceptions of the medical school H G Kraft* and M Heidegger (University of Innsbruck, Institute environment (Medical School Learning Environment for Med. Biology, Schoepfstr.41, 6020 Innsbruck, AUSTRIA) Survey) and selected cognitive orientations (measured by In 2002 a new medical curriculum started with a new the Mitchell Cognitive Behavior Survey) is described. An assessment system. The number of students in the 2nd analysis of the RLOC and selected indicators of student year of the curriculum is limited to 275 whereas the academic performance (including the National Board of entrance to medical school has no limits. Students´ Medical Examiners, USMLE Step 1 Examination) provides performance in the exams in the first year is the major a basis for discussing this measure’s utility as a predictive criterion for the selection. The aim of this study was to or educational diagnostic tool, particularly in regard to self- verify that the complete variation of medical students is directed and Problem-Based Learning. Finally, the topic preserved. of use of the RLOC in medical education across cultures and languages is introduced (the RLOC has been applied To represent the variation of the students a learning style in Arabic, Danish, English, Hebrew, Hindi, Swedish and test was used (comparable to Kolb’s LSI). During a “learn Spanish). how to learn” course 254 medical students participated in this test. 27% presented with the “Diverging” learning style, 58% were “Assimilators”, 9% “Convergers” and 6% 5H 3 Impact of continuous clinical on-duty hours in medical “Accommodators”, respectively. 345 students did not students’ academic performance: a comparative study participate. The achievement of all students in the summative and formative exams of the 1st year will be Enrique Saldivar* and Antonio Davial (ITESM, 3000 Morones presented and discussed. Significant differences were Prieto Desp 206 Col Los Docotores, Monterrey NL. CP 64710, detected between the different learning types. Converging MEXICO) and assimilating learning types had higher points when The following is a comparative analysis of the amount of compared with “divergers” and “accommodators”. Those hours a 5th year medical student spends in clinical activities who did not participate in the “learn how to learn” course and how much these continuous hours of duty affect his/ performed worst in 2 exams. Hence a selection to specific her academic, professional and personal development. learning types seems to occur. We compared two groups of 5th year students, one with on call schedule every 3rd day and an other with on call schedule ever 4th day. Our results show that more on call 5H 2 Locus of control and companion measures in a hours do not necessarily translate into better academic longitudinal study of medical students in a performance. The amount of hours a student “works” in southwestern US Medical School our obstetric wards rounds up to approximately 75 to 108 Thomas Stewart*, Ann W Frye, Stephanie D Litwins and Christine hours per week, with approximately 33 hrs of continuous sleep-deprived work. We compared the test scores of A Stroup-Benham (School of Medicine, University of Texas Medical medical students with different working schedules and the Branch, Office of Educational Development, Suite 1.302, Graves ones with a lighter schedule consistently scored better in Building, Galveston Texas 77550, USA) similar testing formats. Their overall personal well-being, This session presents a rationale for and results of the use their willingness to study and their disposition to patient of the Rotter Locus of Control (RLOC), a brief measure of care in a lighter working schedule were far better when an individual’s orientation toward action and control in life, compared to on call schedule ever third day. We conclude with medical students. The 30 year history of the RLOC’s with this analysis that a lighter working schedule will permit use in medical education is reviewed. Its application in an a student to perform far better at academic, professional extensive longitudinal study of medical students in a large and personal level than an overworked and underslept U.S. medical school is described. The relationships of student.

– 4.49 – Section 4 5H 4 The educational programmes developed and 5H 5 Celebrated movie viewing and semi-structured offered by medical students interactive discussions In neuroscience block Radim Licenik*, Lenka Doubravska, Vit Gloger, Jarmila Indrakova, highly contribute to reinforcement of instruction Daniela Jelenova, Petr Jindra, Barbora Krajzlova, Pavel Kurfürst, G.O. Peker*, S. Amado, S. Sorias, O. Akyurekli, S.A. Caliskan, U. Marie Pecuchova, Jarmila Potomkova, Jan Strojil, Renata Simkova Seyfioglu, C. Terek, E.O. Koylu and Ege Medical Students Movie and Cestmir Cihalik (Palacky University Faculty of Medicine, Club (Ege University, Faculty of Medicine, Izmir, TURKEY) Hnevotinska 3, 775 15 Olomouc, CZECH REPUBLIC) Background: Medical education in Turkey is a 6-7 year In December 2001, Palacky University Medical Students’ program following high school and a very competitive Association established a section concerned with central selection/placement exam. A horizontally- undergraduate medical education. Through various coordinated, high-load curriculum and a teacher-centered activities, the Section for Medical Education primarily aims and conference-based instruction have been conducted to contribute to medical education improvements: in the preclinical years in classes of 140-420 students at • Educational Programmes: Training Programme to the Ege University Faculty of Medicine for the last 15 years. Support Medical Students’ Scientific Research – The Aim: We have intended to improve active, conceptual, programme corresponds to the respective steps of the durable, and relevant-to-real life learning, collective scientific research process. We offer 18 workshops and problem-solving, bio-psycho-social awareness, early seminars, Nurse-Physician Communication Course, vertical integration, class attendance and scholastic Breaking Bad News Course; achievement, and also extend basic neurosciences to • Educational Research: Educational Evaluation Analysis, clinical, behavioral, community health, ethical and higher Nurse-Physician Communication, Evaluation of intellectual levels in a big picture. Students’ Professionalism; Procedure: In addition to providing the very first authentic • Communication Skills Group: In September 2002, a student guide/syllabus, revision for better horizontal working group for communication skills in medicine was integration, developing rich -cast and –dramatization founded as an interdisciplinary group comprising cases/scenarios, introduction of clinical skills, neuro - students, physicians, nurses, clinical psychologists, a anthropological, -evolutional, -philosophical and -ethical lawyer and a foreign language consultant. It is concerned issues; we have more recently included the movies, “The with various aspects of communication in general as Awakenings”, “My Left Foot” and “Birdie” with definite well as communication in medicine; learning objectives, relevant neuroscientific and clinical • Guidelines to Enhance Undergraduate Medical introductions, artistic and cinematographic reflections and Education: Test-Making and Test-Evaluating, with provocative, inspirational semi-structured discussions. Educational Evaluation, Teaching Skills, Psychology of Results: Attendance was impressive, end-block exam Attitudes – guidelines for measurement, Instructions for reflected higher achievement and student feedback Completing a Practice Standard Review – developed revealed profound appreciation with requests for more by the American International Health Alliance. movie sessions. Conclusion: Selectively “authentic and correct” celebrated movies can and should be utilized for neuroscience learning and teaching, and also for development of good humanistic, social, scientific and professional conduct as well as highly aesthetic and artistic perceptions.

– 4.50 – Section 4 Session 6A: Workshops 2

6.1 The nature of curriculum change: complicated and Proposed structure: This highly participative workshop will complex include individual and group tasks, elements of presentation, discussion of short case studies and plenary Stewart Mennin (University of New Mexico, Albuquerque, 915 activity. Camino de Salud NE , New Mexico, NM 87131-5134 USA) Who should attend: New and experienced staff who are Background: Curriculum change is a complex process. interested in making lecturing as effective as possible. How can leaders and educational “change agents” promote and facilitate sustainable curriculum change? Outcomes/take home messages: Lecturing is a means of New insights and strategies that inform and support curriculum delivery that has been around a long time and leadership for curriculum change can be gained from the will continue to be widely use for the foreseeable future. application of principles of complexity science. Let’s make sure that it is an efficient and effective means of fostering student learning! Objectives: At the end of this interactive workshop, participants will be able to: • Define and apply core concepts of adaptive leadership, 6.3 A new approach to curriculum mapping the change process and complex adaptive systems; Nick Ross (University of Birmingham Medical School, Edgbaston, • Apply specific strategies for sustainable curriculum Birmingham B15 2TT, UK) change drawn from the domains of adaptive leadership, organizational development, the change process Background: Mapping is an effective means of representing applied to medical education and complexity science; the curriculum. Unlike lists of modules or learning outcomes, it has the potential to show linkages and • Recognize and distinguish between complicated and contributions as well as the particular topics covered. The complex situations in curriculum change. major publication on curriculum mapping to date is Ronald Proposed Structure: The workshop will combine case Harden’s AMEE Guide (No 21). analysis, small-group discussion, dialogue, role play and Objectives: To explore ways in which the potentials of didactics. It will be fast-paced and practical. curriculum mapping may be maximised in medical Who should attend: Individuals engaged in curriculum education. Drawing on the theoretical basis of graphics change in medical and other health professions schools, and cartography, it will illustrate the special significance of leaders, change agents in medical and health professions the map as a non-directional communication form, which education and medical educators. can aid self-directed, exploratory learning within a course in which the eventual achievement of centrally determined Outcomes/Take home messages: Complicated solutions outcomes is crucial. The workshop will consider the impact and approaches to complex problems will not work. of computers on mapping and the specification for a Adaptive leadership techniques are an essential strategy computer generated curriculum map that will be reflexive for building broad-based ownership for curriculum change. to the achievement, needs and interests of individual There are clear, well defined stages to the change students. process. Each stage presents its own barriers and challenges and requires different strategies and forms of Proposed structure: The workshop will include Powerpoint leadership. Understanding complex adaptive systems can presentations, facilitated group exercises and debate. help leaders to plan, shape and guide the use of available Who should attend? The workshop is designed for anyone resources to interpret and address challenges involved in interested in curriculum development and implementation curriculum change. and the student experience of education. Although the role Note: It is strongly recommended that participants wishing of computers will be considered, this will not be a technical to participate in the above workshop attend Stewart workshop. Mennin’s Large Group Session: Complex Adaptive Systems Take home messages: We are only at the beginning of and Medical Education: a new look at how we do what we exploring the huge potential of curriculum mapping for do, scheduled on Tuesday from 0830-1000 in the session planners, providers and consumers of education. immediately preceding the workshop.

6.4 How to build a CIP as a method of assessment 6.2 Enhancing student learning in your lectures Rosalie Ber (B. Rappaport Faculty of Medicine, Technion - Israel Sally Brown (Institute for Learning and Teaching in Higher Institute of Technology, P O Box 9649, Haifa 31096, Israel) Education, Genesis 3, Innovation Way, York YO10 5DQ, UK) Background: The comprehensive integrative puzzle (CIP) Background: Lectures continue to be a principal means by is a novel assessment tool, aimed at assessing students’ which the higher education curriculum is delivered in many (and physicians’) clinical reasoning and diagnostic universities internationally. However, with the increasing thinking. It is basically an “extended matching” crossword use of Communication and Information technologies and puzzle. Its answering sheet is a grid comprised of rows and distance/off campus learning methods, many today are columns. The left-hand column contains brief clinical questioning the purposes and value of lectures in a vignettes or diagnoses (for beginning students) to which changing pedagogic environment. This workshop will the student is required to match, stepwise, the various explore some of these issues and will encourage “disciplinary investigations/findings”. When the puzzle is participants to consider how best to make lectures a positive completed each horizontal row reflects a coherent medical learning experience. case, i.e., integrative ability, (diagnostic-thinking and Objectives: By the end of this workshop, participants will clinical-reasoning) and the vertical columns measure the have had the opportunity to: student’s proficiency in interpreting medical history data, physical examination findings, laboratory test results, ECG, • discuss the purposes of lectures; imaging, special tests, pathology and pharmacology. The • share experiences of how to build interactive elements dual scoring system stresses the integrative elements of into their lectures; diagnostic thinking and clinical reasoning, while • evaluate a range of techniques to integrate student preserving the ability to discern proficiency in various learning into the lecturing process. disciplinary elements.

– 4.51 – Section 4

Objectives: Provide the participants with guidelines and Objectives : practice for preparing CIPs for assessment of students (at different levels of study), interns and residents. • To share experiences of undergraduate PPD curricula placing emphasis on the four phases Proposed structure: Demonstration of an interactive • To review case studies of PPD curricula in order to computerized webCIP on the internet. In groups of 4-5, identify strengths and weaknesses participants will be guided how to build a CIP. Written guidelines and reprints of Medical Teacher 25:171-176, Outcomes : 2003 paper will be provided. • To highlight key issues in PPD curricula so that Who should attend: Educators, clinicians and members of participants could use this knowledge to make the pre-clinical divisions involved in assessment/evaluation of: curricula more effective in their institutions integration of preclinical and clinical studies, clinical • To facilitate research in PPD curricula reasoning and diagnostic thinking. Outcomes: Confidence in heading a team for preparing Who should attend? All those involved in the PPD CIPs. curriculum whether as teachers or as learners Content/Structure: Participants will explore their experiences of PPD individually, in small groups and in 6.5 Assessment in PBL medical schools: what are we plenaries under the guidance of the facilitators. measuring? Introductions and background (10 minutes) Ara Tekian (University of Illinois at Chicago, Department of Medical Education (m/c 591), 808 S. Wood St, CME 986, Chicago Reflections and critical thinking on PPD (20 minutes) IL 60612, USA) and Mathieu Nendaz (University of Geneva, Prioritised issues in PPD based on experiences (10 Switzerland) minutes) Background: PBL has been implemented in many medical PPD from the students’ perspectives (Cardiff, UK), and from schools; however, the match between the assessment a case-based curriculum (Monash, Australia) (20 minutes) methods and the educational objectives associated with PBL curricula continues to be a major challenge. The four phases of PPD and challenges therein (30 minutes) Objectives: At the completion of this workshop, participants will be able to: Summary, reflection and evaluation (10 minutes) 1 Identify and classify measurement instruments as a) outcome-oriented, or b) process-oriented, 6.7 Bridging the gap between curriculum development 2 Examine the characteristics of these instruments, and discuss other related issues, such as criteria setting, and delivery scoring, grading, reporting results, and frequency of Celia Popovic and Bev Merricks (University of Birmingham Medical assessment, School, Edgbaston, Birmingham B15 2TT, UK) 3 Critique the outcomes of the assessment methods used Background: In 1999, 3 positions called ‘Education/IT at their institutions and examine if they match the Facilitator’ were created at Birmingham University Medical philosophical tenets of PBL, School because the management identified the need to 4 Select appropriate instruments for each type of objective. bridge the gap between the design of the course in the Medicine School and the delivery in NHS hospitals and Proposed structure: Short presentations, group work, and GP Surgeries. Following a 3 year pilot project, the posts in-depth discussion. Handouts will be distributed. were made permanent and expanded to 5 positions. Who should attend: This is an intermediate level workshop Objectives: We will use our posts as a case study to for educators with some experience of assessment interactively explore the problems and opportunities methods in PBL medical schools. Especially appropriate experienced by this project. We will show how these posts for course directors and curricular deans. proved to be a successful answer to a common and Outcomes/take home messages: Participants will reflect growing problem that may be experienced by Schools of on their own assessment practices in light of the Medicine and associated clinical teachers. knowledge acquired during the workshop, and list two take Proposed structure: Short presentation followed by a small home points that will improve the overall assessment group exercise, then a final summary of the key lessons system in their own institution. learnt in the Birmingham case. Who should attend: Anyone involved in teaching 6.6 Creating, implementing and evaluating the personal undergraduate medical students. and professional development curriculum Outcomes/take home messages: With the pressures of Iain Robbé and Kate Drysdale (University of Wales College of increasing student numbers, more stringent quality assurance procedures, and the professionalisation of Medicine, Temple of Peace & Health, Cathays Park, Cardiff, CF10 medics as teachers, it is important that all those involved in 3NW, UK) and Debra Nestel (Centre for Medical and Health Sciences teaching (and learning) on a Medical undergraduate Education, Monash University, Australia) course know about and are enabled to deliver what a Background : Undergraduate curricular outcomes are central body has planned and expects. We are suggesting based on explicit principles of professional practice. In that this is achievable by recruiting Education medical education, knowledge and skills outcomes are Technologists who understand the pressures that clinicians well recognised and their teaching occupies a high face and who are able to work with them to provide timely proportion of the curriculum. The personal and professional support and advice. development (PPD) curriculum is particularly relevant to outcomes concerned with attitudes and behaviour e.g. self directed learning to maintain clinical competence, effective 6.8 Reach out and “teach” someone: instructional communication, reflective learning. This workshop will methods in the classroom explore the four phases of the PPD curriculum i.e. development, implementation, assessment and evaluation Steve Johnson (Carolinas HealthCare System, 10 Alexander Drive, in different undergraduate courses. #514, Asheville, NC 28801, USA) Education of adult learners in the classroom setting can be difficult. This session is designed to discuss the ways in

– 4.52 – Section 4

which adults learn: cognitive, affective, and psychomotor. Background: Recent conferences have prognosticated The session will provide insight into how to apply each of future approaches to health care. These are, for example, these domains into a well-rounded educational the movement towards “Prospective Medicine” with experience. These principals apply to all teaching areas. emphasis on risk factor identification and prevention Emphasis will be placed on scenario based education, as (Association of American Medical Colleges, 2002) and the well as motivational techniques that may be used during effects of the Internet and e-mail on the doctor-patient the educational session, presentation organization, audio relationship (International Conference on Communication visual selection, distance learning, and preparation for in Healthcare, 2002 & American College of Physicians/ speaking to a targeted audience. The focus of this Institute of Medicine, 2002). In order to prepare medical presentation will be allied health providers transitioning trainees for their future work, we need to keep pace with from care provider to dynamic presenters and educators. imminent changes as well as with those projected down the road. Equally we need to look into instructional and Outline: assessment strategies that may be required to adapt to 1 Three Ways Adults Learn and the Myths changes in the health care environment. The theme of the 2 List the 8 Steps of Presentation Organization AMEE 2000 conference was devoted to medical education 3 Audiovisual Selection in 2020. This workshop will be an opportunity to explore 4 Classroom, media, and learning methods future trends further, and to draw conclusions for the 5 Hakuna Mattata present. Objectives: By the end of the workshop participants will be Objectives: able to: 1 Understand the way adults learn and the myths that surround them a) describe the complexities of change in medical education 2 Discuss the use or misuse of multimedia in the classroom b) discuss how future trends in health care could require 3 Discuss Motivational Techniques and Scenarios adjustments in medical education 4 Understand topic delivery and transition from health care c) contemplate how changes in medical education could provider to dynamic educator. affect heath care d) create a personal plan for incorporating future trends in Teaching methods: Lecture; PowerPoint presentation; current practices Open discussion/audience participation; Video Structure: 5 min Introduction and orientation 6.9 Medical education – trainer or trainee’s responsibility? 10 min Past experiences with change (exercise in pairs with Workshop for Directors of Postgraduate Medical Education discussion) (DPGME) 10 min The complexities of change in medical education Dr Alistair Thomson, Dr Andrew Long and Dr Kit Byatt (National (presentation) Association of Clinical Tutors, 1 Wimpole Street, London W1M 20 min Health care in 2023 (small group exercise and 8AE, UK) discussion) 10 min Integrating future projections into medical education Background: In the 1990s systems of appraisal and planning (presentation) assessment for doctors in training usually required 30 min Medical education in 2023 (small group exercise and centrally-held copies of documentation. With training discussion) portfolios and personal development plans, trainees have 20 min Creation of a personal strategic plan (exercise and been given the responsibility for collating and storing their discussion) own educational documentation, for presentation when required. These will become increasingly important as Who should attend: Individuals involved in developing tests of competency and revalidation are introduced.. educational programs Objectives: This workshop aims to identify the issues and Outcomes/take home messages: develop a model for good practice to assist Directors of • Changes in medical education are influenced by many PGME (DPGME). factors Proposed structure: Participants will explore the issues • Strategic planning requires a courageous look at the surrounding responsibilities for PGME in plenary and small future and a critical examination of the present group work, under the guidance of experienced facilitators. • Everyone can take part in creating the future of medical Who should attend: Primarily, those with strategic and education operational responsibility for postgraduate medical education. Outcomes/take home messages: If education proceeds 6.11 Didactics for beginners smoothly trainee responsibility works well. If problems arise Brigitte Grether (Dean’s Office, Faculty of Veterinary Medicine, trainers may have to approve trainees whose competence University of Zurich, Winterthurerstrasse 204, CH 8057 Zurich, they doubt. This implies risk to trainer, trainee and ultimately Switzerland), E Brenner (Institute for Anatomy, Histology and the patient. Trainees’ responsibility for their own education Embryology, Faculty of Medicine, University of Innsbruck, and records is paradoxically arriving at a time when Austria), German Clénin (Sportwissenschaftliches Institut SWI, disputes about educational progress are increasing. Magglingen, Switzerland) and Martina Kadmon (Dept. General Resolution of these disputes may rest, in legal terms, on Surgery, Heidelberg University, Germany) the production of evidence of due process correctly conducted by trainers (e.g. Educational Supervisors, Background: The Alumni of the MME (Master of Medical Postgraduate Clinical Tutors). Such evidence may in future Education) Programme in Berne would like to share the only be available through the trainee if central copies are knowledge and skills they have acquired during the not kept. programme with those who have just – by coincidence or special interest – entered the community of medical educators, with those who are at the same point of their 6.10 Looking towards the future: What’s in store for career as medical educators as the MME participants were medical education? BEFORE they had entered the MME programme – the “Beginners”. Elizabeth Kachur (Medical Education Development, 201 East 21st Street, Suite 2E, New York NY 10010, USA)

– 4.53 – Section 4

Objectives of the workshop: Participants will: • Experience a broad range of SP activities including a • identify some fields of knowledge which are useful for formative Objective Structured Clinical Examination educators (OSCE) • acquire methods to interact with students in large plenary Proposed structure: We will use interactive and experiential sessions activities in large and small groups. These include: • compare different examination methods • reflective exercises which promote exchange of ideas • learn how to apply the most important rules/to avoid the most common errors in visualisation • problem solving exercises • be motivated to enter a MME or similar programme. • role playing • demonstrations, and presentations Proposed structure: 1 Introduction (5 min.) • participation in a formative OSCE 2 Interacting with students in lectures – it’s possible! (30 • question and answer opportunities min) Who should attend: anyone interested in starting to use 3 Visualisation – the clue to understanding (30 min) standardized patients or expanding their use of standardized 4 Which examination method for which purpose? (30 min) patients or anyone curious about what is possible using 5 Conclusion(10 min) SP methodology Methods: Short(!) presentations, a lot of participants’ activity Learning outcomes: Participants will: and a huge list of further reading • learn about the countless possibilities for enriching Who should attend: “Beginners”: Educators who are in curriculum through SP-based educational strategies charge of different educational tasks but who do not yet • gain insight into how SPs may be integrated into their have a systematic training in the various fields of didactics. own curriculum Educators who would like to know what you can learn in a • acquire basic knowledge of how to set up and maintain MME or similar programme. a SP Program • acquire practical skills needed to recruit and train SPs; Outcomes/take home message: We want to open a gate design and cost-out SP-based initiatives. for you. You are invited to enter and find the tools you need to improve teaching and learning in your environment. • develop confidence to proceed with initiation and implementation of SP-based programs See also the MME website: http://www.iawf.unibe.ch/mme/ (in German); University of Illinois at Chicago, College of Medicine, Master of Health Professions’ Education MHPE: 6.13 Mastering the Scholarly Process http://www.uic.edu/com/mcme/mhpeweb/Home.html William McGaghie (Northwestern University Feinberg, School of Medicine, Ward 3-130, Mail Code - W117, 303 E Chicago Avenue, 6.12 Enriching Curriculum Through Standardized Chicago, IL, USA) Patient-Based Programs Background: Medical schools worldwide are academic Anja Robb, Nancy McNaughton and Diana Tabak (University of environments, organizations where scholarship in several Toronto, Centre for Research in Education, Standardized Patient forms is advanced in many disciplines. Academic work Program, 200 Elizabeth Street, 1 Eaton S. Room 565, Toronto, done by medical school faculty – teaching, original Ontario M5G 2C4, Canada) research, research synthesis, application and consultation – is scholarly by definition and tradition. Individual faculty “For the things we have to learn before we do them, we members, especially those in early career, frequently learn by doing them.” Aristotle struggle at becoming productive scholars. This workshop Background: Standardized Patients (SPS) are more will address ways that medical faculty can increase the relevant today than ever before as a methodology for quality and quantity of their scholarly work. teaching and assessment in medical education. Times Objectives: Participants will: and attitudes have changed profoundly in healthcare and 1 Recognize that scholarship in medical schools is medical education in part as a result of extraordinary expressed in at least four ways: teaching, original advances in science and digitizing technology. In this ‘brave research, research synthesis, application and new world’ we must ensure that students still know how to consultation. relate to people and understand the therapeutic value of the doctor-patient relationship. Students must be 2 Practice skills of planning, organizing, self-management, adequately prepared to meet the complex responsibility of and networking toward the goal of increasing the quality patient care. Enterprising collaboration between faculty and quantity of their scholarly work. and standardized patients is yielding a broad spectrum of 3 Begin to form a collegial network with other faculty possibilities in teaching, assessment and research. SPs interested in medical education scholarship. are value added to teaching and assessment. They allow: 4 Increase their fund of “tacit knowledge” about a more systematic delivery of curriculum, more objective scholarship in medical schools. assessment of clinical skills, an enhanced learning environment for students, no harm to patients, and they Structure: promote better health outcomes. Most important of all, • Opening remarks, framing the session, introductions Standardized Patients help keep the face of medicine • Discussion: “tacit knowledge” about scholarship in human. medical schools Objectives: • Skill development: planning, organizing, self- • Stimulate participants’ ideas and understanding of the management, and networking vast possibilities in SP based medical education • Participant reports • Discover how to enrich curriculum through SP teaching • Wrapup and assessment Who should attend: • Demystify logistics of starting and maintaining a • Medical school faculty in early career Standardized Patient Program • Senior medical faculty (prospective mentors) • Learn practical skills needed to work with standardized patients Outcomes/take home messages: • Scholarship is expressed in several ways • Scholarly productivity does not occur by chance

– 4.54 – Section 4

• Planning, organizing, self-management, and networking The educational philosophy includes: are keys to success • ‘just-in-time’ learning; • Medical faculty should manage their careers actively • ‘just-for-you’ learning; • multiprofessional learning; 6.14 Ibero American Group • the continuum of learning. Margarita Barón-Maldonado, on behalf of AMEE The IVIMEDS programme offers significant advantages to students, to academics and professional institutions and Background: During the last decades medical education to society. has been the subject of considerable change in an attempt to improve its quality. The goal is to produce doctors capable of meeting the ever-evolving social demands who adapt to the very rapid progress in biomedical scientific 6.16 International work with Standards in Medical knowledge and technology. Furthermore, as a Education consequence of globalization and of strategic geopolitical Introduction: The session will deal with the development, agreements, the mobility of doctors is a fact. To meet these use and implementation of standards in all three phases challenges medical educators, health and educative of the continuum of medical education. In addition a small authorities and others with responsibility, strive to find the presentation of highlights from the recent WFME 2003 mechanisms leading to quality assurance and World Conference on Global Standards will be given. improvement of the whole process of making a doctor. Based on the presentations the participants will be invited Among those mechanisms, the evaluation of the process, to debate the experiences from the use of standards in structure and outcomes of medical education phases of medical education. the continuum seems to be a powerful tool to secure the adequate level of the training of a doctor. Thus, countries 6.16.1 Highlights from the WFME World are moving towards evaluation of the process and the Conference March 2003 outcomes and, consequently, institutional accreditation. Hans Karle (World Federation for Medical Education (WFME), At first, the movement lies in a voluntary institutional commitment of quality improvement which finally leads to University of Copenhagen, Panum Institute, Blegdamsvej 3, 2200 compulsory assessment and institutional accreditation. Copenhagen N, Denmark); Jørgen Nystrup (Roskilde, Denmark) and Lief Christensen (WFME, Denmark) Proposed content: The AMEE Ibero American group will discuss the specific health needs that should be taken into Working since 1997 with global standards in medical account to adapt the international projects of medical education the World Federation for Medical Education education assessment and institutional accreditation to a (WFME) recently published a Trilogy of Global Standards number of different countries from different continents and covering Basic Medical Education, Postgraduate Medical different socio-economic and cultural environments. Education and Continuing Professional Development (CPD). The Trilogy served as background material for the World Conference in Medical Education in Lund, Sweden 6.15 The International Virtual Medical School (IVIMEDS): a and Copenhagen, Denmark, March 2003, entitled: Global response to current challenges in medical education Standards in Medical Education For Better Health Care. Some 500 colleagues from 88 countries attended this first Ronald M Harden (IVIMEDS, Tay Park House, 484 Perth Road, open World Conference. The Trilogy represents the first Dundee DD2 1LR, UK) attempt by a representative body within medicine to develop Background: There are a number of challenges facing standards as a toolbox for quality development of medical medical education. These include a response to changing education and in response to the increasing medical and societal needs, opening access to medical internationalisation of the medical workforce. The training, providing a continuum of training through the standards received fully endorsement at the Conference. different phases, the training of doctors to work as a team Pilot projects conducted in a number of medical schools and the adoption of new approaches to curriculum in the six WFME Regions about the usefulness of the planning and the use of the new learning technologies. standards were presented, supporting the endorsement. The International Virtual Medical School (IVIMEDS) is a In reporting from the Conference WFME is informing about collaboration of more than 100 leading medical schools the concept and use of the Standards as a toolbox for internationally, committed to: quality development at the institutional level or at the national or regional level for accreditation purpose. • improving health and tackling human disease by providing a blend of high quality student-centred e- WFME hope to join forces with WHO in working worldwide learning and face-to-face learning for medical students, with medical schools and agencies responsible for trainees and doctors; postgraduate medical education and CPD to use the • setting new standards in education by drawing on WFME standards in combination with peer-support to innovative and established curriculum and assessment increase quality of medical education. practice of Partner Institutions and ensuring maximum benefit from new educational technologies; 6.16.2 WFME Standards for Continuing • providing a global perspective on medical practice that Professional Development takes account of the distinctive contributions by different members of the healthcare team. Jørgen Nystrup (Roskilde County Psychiatric Hospital, DK-4000 Roskilde, Denmark), Hans Karle (WFME) and Leif Christensen (WFME) Key elements in the IVIMEDS programme include: Early in 2003, the World Federation for Medical Education • e-learning and face-to-face learning opportunities; (WFME) completed its task in defining a set of global • a framework of learning outcomes; standards for Continuing Professional Development (CPD) • a bank of virtual patients; of Medical Doctors. The process leading towards these • tools for formative and summative assessment. standards was similar to the tasks of producing standards for Basic Medical Education and for Postgraduate Medical Facilitation of learning is achieved by: Education. The three sets of standards were published as • a curriculum map; a Trilogy serving as background material for the World Conference in Medical Education in Lund, Sweden and • electronic study guides; Copenhagen, Denmark, March 2003. The Trilogy • face-to-face and on-line tutor support; represents the first attempt by a representative body within • peer-to-peer learning. medicine to develop standards as a toolbox for quality development of medical education and in response to the increasing internationalisation of the medical workforce.

– 4.55 – Section 4

CPD is delineated from Postgraduate Medical Education It is well known that even the most sophisticated education and linked to the concept of life long learning, beginning at can not provide student with competence sufficient for his/ admission to the medical school. her professional life. Higher institution has to make a foundation for future professional training and continuous, A particular problem in CPD is the complex of agents life-long education. This practice is widely accepted involved, including the doctor her/himself, universities, worldwide including European countries. On contrary to industry, professional trade unions, private for-profit aforementioned, according to the existing Georgian providers, etc. Who can be responsible for quality legislation, postgraduate and continuous medical development and assurance? WFME succeeded in education has moved to the competence the Ministry of formulating a set of standards based on the same concept Health Care and Academy of Advanced Training of of two levels of attainment: (a) a basic level, which must be Physicians (track of old Soviet system). This has been met, and (b) a developmental dimension that provides a considered as the most significant and “painful” barrier for goal, which institutions should strive to achieve. Pilot the proper development of medical education. Despite projects are now warranted! resistance from high medical schools, they were “decapitated” by the regulations and orders issued by the 6.16.3 Profiles of Medical Schools: the use of Ministry of Health Care. Due to this improper legislation, WFME Standards in pilot studies the Tbilisi State Medical University, which has been the most competent high medical school in Georgia actually Leif Christensen (World Federation for Medical Education is loosing its main function - offering postgraduate and (WFME), University of Copenhagen, Panum Institute, Blegdamsvej lifelong education. 3, 2200 Copenhagen N, Denmark) In conclusion, it is suggested that AMEE has to elaborate Background: More medical schools expressed an interest recommendations concerning standards pf postgraduate and volunteered to test the WFME global standards for and continuous education regarding Post-Soviet countries. basic medical education than it was possible to accommodate within the originally planned pilot study. Consequently, WFME decided to conduct a second pilot 6.16.5 Accreditation criteria and minimum study. standards for undergraduate medical education in Gulf Council Countries: Methods: The medical schools in pilot study II also agreed implications on quality in medical education to carry out a self-evaluation based on the WFME standards and with the use of the accompanying guidelines. Hossam Hamdy (Arabian Gulf University, College of Medicine and Furthermore, the schools were asked to report the results Medical Sciences, P O Box 22979, Manama, Bahrain) of the exercise in a highly structured and standardized way Aim: The main aim of any accreditation process is to by using 2 questionnaires. For each standard the schools encourage improvement in medical education and ensure were asked to specify: that standards of quality in higher education are in practice. a) Information on the standard (coverage, existing or new The GCC Medical Colleges Deans Committee while information and the types of information used), addressing their responsibility towards improvement in b) Present status regarding fulfilment of the standard, medical education in the GCC, took the initiative of making the necessary recommendations and proposals for the c) Reactions towards result of appraisal (expected or development of guidelines on standards for accrediting surprising, indicating a strength or weakness), medical schools in the Arabian Gulf countries. d) Use of result in quality improvement (initiating considerations, planning or actions). Summary of work: Domains and standards were identified based on two concepts. The first about measuring input, Material: A total of 12 medical schools were included in the process, output and outcome of an educational pilot study II of which 10 schools has submitted their reports. programme. The second concept on evaluation of different curriculum dimensions which include “curriculum on Some preliminary results: From the point of view of WFME paper,” “curriculum in action,” “learned curriculum” and the purpose of the pilot study is not to evaluate the the “used curriculum”. participating medical schools but to test the standards and their usefulness. Only in a few cases has lack of information The standards were grouped into seven categories: made it impossible for a school to undertake an appraisal of its performance in relation to a standard. In most cases a) mission and vision existing information has been up to date and sufficient. b) the undergraduate medical education programme: (i) Also, it is rare that an appraisal is not undertaken because aims and objectives; (ii) learning strategy; (iii) curriculum the standard is regarded as less relevant. Differences in structure and organization; (iv) programme fulfilment of the standards seems to reflect differences implementation; (v) student assessment; (vi) programme between schools with regard to the national system they evaluation are a part of, the size, structure and age of the institution, c) the students etc. d) the faculty members From the point of view of the medical school the results of e) learning resources at teaching hospitals and training the exercise is of interest as an indication of its quality and centers possible needs for improvement. A profile of the medical f) management of the educational process school and its programme can provide an overview of the present status in relation to the WFME standards and draw g) scientific research attention to urgent needs and fruitful avenues for quality improvement. From the pilot study, it should be noted, that Results: A total of 50 standards related to the identified in almost every instance, where the basic standard is not categories were developed. A guide to the preparation of fulfilled or only partly fulfilled and this is regarded as a major an accreditation submission and the self-assessment weakness considerations of change and planning of action questionnaire was structured around the seven identified for quality improvement has been initiated. areas and their related standards. Conclusion: It is hoped that the approval of these standards by the authorities responsible for education and health in 6.16.4 Some issues concerning postgraduate the GCC countries, will have a significant impact on the education in Georgia quality of medical education in the region. R Khetsuriani, Z Avaliani and G Simonia (Tbilisi State Medical University, 33 Vazha Pshavela Ave, 380077 Tbilisi, GEORGIA

– 4.56 – Section 4 Session 7A: Computer Based Teaching

7A 1 Attitude of medical students towards computer- Conclusions/take home messages: We successfully based learning – effects of a randomized, controlled implemented LaMedica-Nephrology into the curriculum exposure where it is now routinely used. Knowledge gain was equal when using either print or online medium in a seminar A K Hahne*, R Benndorf, P Frey and S Herzig (University of Cologne, setting while the subjective assessment revealed a higher Department of Pharmacology, Gleueler Strasse 24, 50931 Koeln, motivation of the online group. ((Supported by the German GERMANY) Ministry of Research and Education) Few medical students deliberately use computer-based learning programs (CBL). Individual learner preferences 7A 3 Application of an icon language for clinical do not explain which students like CBL (Steele et al., Medical Education 2002;36:225-32). In our multi-centered pharmacology education throughout an integrated survey on 328 3rd-year students, learner strategies and curriculum characteristics were not associated with expectations or E A Dubois*, K L Franson, J M A van Gerven, J H Bolk and A F Cohen attitude towards CBL. However, (unspecified) experience (LUMC, Onderwijscentrum IG, C5-53, Albinusdreef 2, C5-Q, with CBL correlated with high attitude, expectations, and Postbus 9600, 2300 RC Leiden, NETHERLANDS) inclination to use CBL. Aim: To develop learning strategies that teach clinical Question: Does a well-defined exposure to CBL change pharmacological principles, which can be applied the CBL-attitude (possibly depending on individual learner throughout an integrated Medical School curriculum. properties)? Summary of work: These approaches must be 1) Design: Randomized, controlled exposure to a 66-module consistently presented across the curriculum, 2) usable cardiovascular pharmacology CBL-program, implemented for student self-learning, 3) integrated with other subjects, within 3rd-year courses in two medical schools. and 4) embraced by teachers. Consistent presentation was Primary endpoint: Attitude towards CBL (validated achieved by developing a uniform icon language. The icon questionnaire). language was consistently used throughout the curriculum, in all teaching materials addressing pharmacological Secondary endpoint: Specified learning outcome (30 mechanisms. The icons were incorporated into MCQ). n=167 of 262 course participants agreed to Macromedia Flash® programs, challenging students to participate, taking a full pre-test (questionnaire, MCQ). 70 interactively solve basic pharmacologic/physiologic gained access to CBL (97 controls). problems. Another computer program integrated basic Summary of results: Access to (n=69) or actual use of CBL pharmacological principles with physiological and (>1h,n=45) decreased CBL-attitude (p<0.05 vs. n=96 pathophysiological mechanisms (ie showing drugs controls). Learner properties and duration of CBL use did interacting with diseases). This program uses a Microsoft not quite explain the change in attitude (n=45,p=0.07). Access Treeview® database, and combines graphics, MCQ results were similar between CBL users and controls. explanation texts and formative feedback questions. However, duration of CBL use (b=0.24,p<0.05) and reading Summary of results: Assessment was achieved by students’ (b=0.37, p<0.01) explained test performance (R2=0.16, utilization of and comments on the programs. Students n=112), together with learner properties (interest, increasingly use the programs as they progress through independence, repetition-strategy). the curriculum. Students appreciate the teaching strategies Conclusions/take home messages: CBL exposure can and are successfully challenged by these self-study adversely affect attitude towards CBL. methods. Initial hesitation by teachers made way for widespread use of and contributions to the graphical materials. 7A 2 Teaching glomerulonephritis using the multimedia Conclusions/take home messages: Icon language online system LaMedica computer programs that are integrated throughout the S Stracke*, R Friedl, C Aymanns, N Kadlec, B Lindemann, S curriculum provide pharmacology knowledge on which both students and teachers increasingly rely. Huettner and F Keller (University of Ulm, Division of Nephrology, Robert-Koch-Str.8, Ulm 89081, GERMANY) Aim: Complex nephrological diseases like the 7A 4 Making the virtual real: the true challenge of digital glomerulonephritides are difficult to understand. The learning purpose of this study is to assess the impact of a newly developed online computer-system (www.LaMedica.de) Michael Begg* and Rachel Ellaway (University of Edinburgh, in improving student motivation and knowledge. College of Medicine and Veterinary Medicine, Learning Technology Section, Hugh Robson Link Building, 15 George Square, Edinburgh Summary of work: We used the system in a seminar setting. EH8 9XD, UK) A self-study time was followed by tutor-guided patient contacts. In a prospective study, we performed a This short communication shows how a study of immersion, psychometric evaluation (HILVE, SUCA, FAM) with 32 interaction and narrative within the context of computer medical students and an additional formative evaluation gaming provides base material for a focused study into in a double cross-over design with 12 students to compare learning applications for medical students. Medical the knowledge gain using either a print version or the education focuses, necessarily, on that which is real: real LaMedica online nephrological module. Frequent patients, real ethical issues, real experience of real confounders were carefully controlled. situations. However, it is not always possible to provide real patients, situations, or ethically complex scenarios to Summary of results: The system contains instructional undergraduate students. While virtual learning applications on the eight glomerulonephritides. The environments, simulations, reusable learning objects, and psychometric evaluation revealed that medical students other forms of digitally delivered learning content provide a are motivated to a higher degree and feel more pleasure plethora of alternatives to hands-on experience, it continues when learning with the nephrological online module of to maintain a peripheral role within the overall context of LaMedica. However, the formative evaluation of the online curricula. By comparing observations of simulation training versus print medium showed equal results in both groups in resuscitation technique with the conclusions of the study with no significant difference. of game environments, the communication suggests that

– 4.57 – Section 4

by offering the student a character context within a Method: One region’s VDPs and trainers received e- simulated, or virtual, environment, by controlling the balance learning; another’s received a traditional one hour lecture. of information input from both immediately physical and Retention and understanding were tested and compared. virtual sources, and by ensuring a good trade-off between Personal preference was assessed in group interviews. high quality consequential interaction (agency) and narrative momentum (the temporal aspect of immersion), Summary of work: Twenty-four trainers and their VDPs it is possible to make the virtual real, inasmuch as the undertook an e-learning module on clinical governance student experiences the application as a real event, and while another 24 trainers and VDPs received a traditional acts/reacts, and learns, accordingly. lecture. The groups were subsequently assessed for their relative retention and understanding of the key issues concerning the topic. There followed a group evaluation 7A 5 Comparing lecture and e-learning as pedagogies for that examined preferences and observation of the new and experienced professionals in dentistry respective learning experiences. Liz Browne* Shalin Mehra, Raj Rattan and Gary Thomas Summary of results: Significantly greater retention for the (Westminster Institute of Education, Oxford Brookes University, trainees occurred from lecturing rather than e-learning, Harcourt Hill, Oxford OX9 2AT, UK) and for the trainers e-learning was significantly more successful than lecturing. Aims: To disseminate the results of a research project that Conclusions/take home messages: Small numbers in this compared lecture and e-learning course delivery to a group study preclude wide generalisation. However, the results of Dentist trainers and their trainees. point to the benefits of face-to-face interaction for Objective: To evaluate the relative effectiveness of e- inexperienced staff, and the benefits of the speed and learning versus lecture learning in Vocational Dental manageability of e-learning for busy, more experienced Practitioners (VDPs) and trainers. staff. The need for a discussion facility to be incorporated into ICT innovations to CPD (via, for example, online Design: Experimental comparison of two groups’ learning ‘chatrooms’) is also highlighted, with the potential of greatly retention. enhancing e-learning efficacy. Setting: VDPs and trainers from two regions were assessed by independent researchers.

Session 7B: The Final Exam

7B 1 CLEO component of the Medical Council of Canada 7B 2 Ideas for assessing educational objectives from qualifying examination Part 1: a four-year appraisal different domains within the anatomical dissection of its incorporation course Jacques Etienne Des Marchais*, T J Wood, D E Blackmore and W D Erich Brenner*, Bernhard Moriggl, Axel Pomaroli and Herbert Dauphinée (Medical Council of Canada, 12420 rue Joseph- Maurer (Institute for Anatomy, Histology and Embryology, Edouard-Samson, Montréal, Québec H4K 2N9, CANADA) University of Innsbruck, Muellerstrasse 59, A-6010 Innsbruck, AUSTRIA) Background: The Medical Council of Canada (MCC) is one of the partners responsible for responding to emerging Anatomical dissection can contribute not only to objectives social needs within the medical community, such as the in the cognitive domain, but also to objectives in the affective need to be aware of legal and ethical issues in physician as well as psychomotor domain, and even to the domain practice. In 2000, the MCC incorporated a new component of professionalism. Therefore, adequate assessment called Considerations of the Legal, Ethical, and strategies will have to be used. For objectives in the Organizational Aspects of the Practice of Medicine (CLEO) cognitive domain, we suggest structured oral examinations. into the Qualifying Examination (MCCQE) Part I, content For objectives in the psychomotor and affective domain as of which is based on the MCC Objectives, made available well as in the domain of professionalism, we suggest three to medical schools and candidates. different forms of structured observations and a portfolio. Structured oral examinations should be individual Aim of presentation: The goal of this study is to determine assessments, where each exam comprises a distinct if the variability in scores between and within medical number of questions. Each question should be graded on schools will diminish as the CLEO becomes an established a three-point scale. Structured observations should be examination component. individual assessments and comprise structured Summary of work: Candidate scores for Canadian schools observations of (1) the students’ active contributions, (2) first time examination takers were compared across four their work’s product, the specimen, and (3) of (selected administrations of the MCCQE Part I. clinical) skills. Each structured observation should be graded on a three-point scale. Summary of results: Overall differences in scores between the CLEO and the MCQ components of the examination The portfolio should be a group assessment where all have diminished from 2000 to 2003. For individual schools, students working on one cadaver will have to contribute to the variability between CLEO and MCQ scores were large one portfolio. This portfolio should assess the students’ when the CLEO was first administered but have diminished teamwork and documentation, the usage of old and new over time. media, ethics and self-assessment. Each item of the portfolio should be graded on a three-point scale. Conclusions/take home messages: This study shows how a non-biological component of clinical competence takes time to be integrated into Canadian school curricula as measured by this examination. 7B 3 A comparative study of measures to evaluate medical students’ performances Samkaew Wanvarie* and Boonmee Sathapatayawongse (Ramathibodi Hospital, Rama VI Road, Bangkok, THAILAND) Aim of study: To assess how MCQ, MEQ and OSCE compare with each other and with cumulative GPA on graduation.

– 4.58 – Section 4

Summary of work: Medical students at the Faculty of The most important task is the objectivity of the evaluation Medicine, Ramathibodi Hospital, graduated in 2000-2002 of graduates’ preparation for practical activity. The decision (1994-1996 matriculated cohort) were assigned to take to conduct the JCGE was promoted, and a two-year the MCQ (5th year), MEQ and OSCE (6th year). The scores experience of conducting the Rector’s Examination, and cumulative GPA were analyzed for correlation using including testing in 22 main medical areas and clinical SPSS software. skills, was conducted in three steps. The first step is the licensed examination “KROK - General medical Summary of results: Of the 443 students, 95% completed preparation”, part of a state approved standard of medical the testing. The correlation coefficients (r) between education, conducted by the Ukrainian Test Center. The cumulative GPA on graduation with score of MCQ, MEQ, second step is the JCGE approved by the ethical committee and OSCE were 0.646, 0.603 and 0.601 respectively (all and the anticipated patient’s consent. It includes bedside p-values < 0.001). evaluation of the common clinical skills of a graduate. Conclusion: There was good correlation between score of This part was conducted in a multifunctional hospital and MCQ and GPA, possibly due to high objectivity and wider was led by a committee of four examiners: therapeutist, coverage of test discipline. The correlation between OSCE, surgeon, pediatrician, gynaecologist. The third step is the MEQ and GPA questioned the content validity of the tests testing of the graduate’s 25 required practical skills in a whether they were measuring skill/performances or factual specially equipped auditorium. The results of the JCGE knowledge. exposed areas for future improvement of the existing system of education and the quality of preparation of doctors. 7B 4 Manifestation of professional competence: is it context-dependent or skill-dependent? 7B 6 The design and implementation of the professional M Mrouga* and I Bulakh (Testing Board, Pushkinska St 22, Suite exam at the Dn. Santiago Ramon y Cajal Medical 307, Kyiv 01601, UKRAINE) School, Universidad Westhill Professional competence is a widely-used term which is Julio Cesar Gomez*, Pilar Talayero and Todd W Ellwein (Universidad structured under several domains (like scientific Westhill, Domingo Garcia Ramos, #56, Colonia Prados de la knowledge, clinical, communication skills, values, attitudes Montaòa 1, Santa Fe Cuajimalpa, Mexico DF 05610, MEXICO) etc). Particular structure of competence varies across different institutions. However, properties of competence In January 2004, the first generation of students of the Dn. are studied insufficiently. For example, it is not uniformly Santiago Ramon y Cajal Medical School at Universidad decided whether competence can be decontextualised Westhill will take the school’s Professional Exam, a final or not, whether competence is a stage in education/ student assessment required for graduation. A faculty profession or its final purpose and so on. The paper will committee was created to design and implement this final present research results that have evaluated whether student evaluation. The committee’s responsibilities are manifestation of physicians’ professional competence to design an assessment that will effectively measure each during assessment primarily depends upon medical graduating student’s clinical competence. This process context (diseases, symptoms) or the aspect of competence includes ensuring objectivity, knowledge integration, being evaluated. In Ukraine the requirements for instrument dependability and clinical reasoning in the physicians’ professional competence are specified by State evaluation process. The development of the Professional Standards of Higher Medical Education. Assessment is Exam involves two phases. The theoretical phase includes: partially done by medical licensing examination (testing integrating the faculty committee into the design process; exam) that mainly covers 4 aspects of professional steps taken to select test items; topic and clinical cases to competence: ability to diagnose, to cure patients, to apply include; the weight of exam questions; test item revision; preventive measures and to understand diseases relative and exam implementation. The practical phase requires: to various diseases and conditions. selecting the hospital settings; selecting examining board members in basic science, clinical science, and sociomedicine; and determining the instruments used by 7B 5 The first experience of conducting the Joint Clinical the examining board for student evaluation. Graduation Examination (JCGE) in a medical higher educational institution in Ukraine G V Dzyak*, T A Pertseva* and G V Gorbunova (Dnipropetrovsk State Medical Academy, 9 Dzerzhinsky Street, Dnipropetrovsk 49044, UKRAINE)

Session 7C: The Curriculum (1)

7C 1 Curricular Quality Assurance (CQA): twenty-five publications, kept our curriculum under constant review years of curricular evolution and facilitated the sharing of outcomes of innovations with others and in turn to learn from them. Dissemination of S Scott Obenshain*, Stewart Mennin, Arthur Kaufman (University lessons learned via workshops, scholarly works and of New Mexico, School of Medicine, Room 114 BMSB 1, Albuquerque publication assures the quality of our curriculum. Well- NM 87131, USA) developed program evaluation is an essential component Aim: To present elements of institutional culture that allows of grant applications that assists in competing for grants. for curricular improvement. Faculty members use data to support their academic (scholarly) advancement. Data from program evaluation Summary of work: The University of New Mexico School of are a necessary component of yearly educational retreats. Medicine has developed a system of continuously reviewing Collaboration with other programs and institutions provides and modifying its curriculum. The main feature of continuous stimulation and scholarship in education. Curriculum Quality Assurance results from a commitment to longitudinal program evaluation and scholarship in Summary of results: Our curriculum is continuously under education. Investing in program evaluation from the outset review and revision. has allowed for continuous short-loop feedback to Conclusions/take home messages: Program evaluation curriculum planners, provided data for scholarly works and and scholarship in education are necessary components

– 4.59 – Section 4

of a high quality institution curriculum planning and Aim of presentation: Evaluation with respect to process, implementation process. structure and outcome of the teaching and learning process is an essential element in curriculum planning and curriculum adaptation, particularly during a curriculum 7C 2 What can interns teach their junior year teachers? reform. The present paper reports experiences from a focus group approach in the evaluation of course modules in the Soledad Campos, Cecilia Primogerio and Angel M Centeno* undergraduate medical training. (University of Austral, School of Biomedical Sciences, Av Juan Peron 1500, B1629 AHJ, Pilar, Buenos Aires, ARGENTINA) Summary of work: According to a validated approach published by D. Nestel, students were asked to participate Aim: Basic science teachers are seldom aware of the in an evaluation session after the completion of course impact of their subjects on their students’ careers and modules in surgery in the first clinical year. Every focus development as professionals. Our purpose was to group comprised 7 students, the coordinator of the module overcome this situation by promoting meetings between and an educator. The evaluation session was structured interns and teachers. following the same items of the questionnaire administered Summary of work: Faculties from five out of eight basic during the written evaluation. sciences participated in four meetings with interns. The Summary of results: Students clearly indicated that the focus aim of these meetings was to ask students to describe and group approach is a valuable addition in the evaluation reflect on their internship experiences and to promote their system. With respect to different teachers and different self-assessment. Participating faculties were expected to hospitals engaged in the course module very specific observe and register the contents of the meeting. We information could be gathered. Moreover less personal conducted individual open interviews with these faculties and time resources were required. This evaluation to gain understanding of their reflections, and if they approach also allowed re-evaluation of the quality of the modified their teaching as a result of this. questionnaire items. Summary of results: All of the teachers were impressed Conclusions/take home messages: The focus group with the personal and professional development of the approach to evaluation is a useful addition to the written students and realized and regretted how far removed they format and should be discussed for integration in the had been from them. They reflected upon students’ evaluation system. learning needs and the impact of the disciplines they teach on their careers. The courses structure was reviewed. Conclusions/take home messages: Meeting with their 7C 5 Changing trends in undergraduate medical former students is a strong empowerment strategy for basic education in Turkey sciences teachers. Iskender Sayek* and Bülent Kylyc (Hacettepe University, Faculty of Medicine, Department of Medical Education, Ankara 06100, 7C 3 Evaluation and quality development of clinical TURKEY) clerkships Aim: The aim of this study is to highlight the changing Jørgen Hedemark Poulsen (University of Copenhagen, PUCS, Teilum trends in undergraduate medical education in Turkey. Building, Section 5404, Blegdamsvej 9, DK-2100 Copenhagen, Summary of work: The results of this study are based on DENMARK) the reports of the Turkish Medical Association prepared in 1997, 2000 and 2002. A questionnaire was sent to the Aim: To give an account of a recent attempt to enhance Deans of the medical schools and the evaluation was the educational quality of clinical clerkships at the hospitals performed. The return rate of the questionnaire was 100%. affiliated with University of Copenhagen. Summary of results: Currently there are 50 medical faculties Background: External and internal evaluations have in Turkey. The number of medical schools was 25 in 1990. revealed that the educational value of clinical clerkships The number of students in the medical faculties was 33,456 at this university not infrequently is less than optimal – and 31,738; the number of educators was 5,538 and 7,833 typically because the students participate in clinical work and the number of students per educator was 6.0 and 4.05 only to a limited extent. in 1997 and 2002 respectively. There has been a significant Therefore, a committee on quality development of clinical change in the models of education used from a pure clerkships has been appointed. Three members of the lecture base (68% integrated, 32% course based committee, a clinical professor, a medical student and an curriculum) in 1997, whereas in 2002 pure lecture based educationalist make site-visits to clinical departments. curriculum is used only in 57.5% (45% integrated, 12.5 % Before the visit the committee receives relevant written course based) problem based curriculum either in a hybrid material concerning the clerkship from the department’s model (37.5%) or pure model (5%). 12 departments of professor. During the visit clinical teaching staff and medical education have been established within the last students are interviewed (semi-structured) separately. three years and courses for “training the teachers” have Afterwards a report on the department as “host” of clinical been started in numerous schools. A national core clerkships is drafted by the committee. Eventually, specific curriculum is to be started in October 2003 for suggestions for improvement are made collaboratively by standardization which covers topics for knowledge, skills staff, students and the committee. The final report is sent and behaviour. to the vice-dean for medical education as well as the Conclusions/take home messages: Significant changes medical director of the teaching hospital in question. have taken place in Turkish undergraduate medical education. The integration of problem based learning in the curriculum is increasing and a national core curriculum 7C 4 Focus group approach to evaluation – a useful is to be used next year. There is a great effort to improve addition to the written format the quality in undergraduate medical education and C Schirlo*, F Wirth, W Vetter and W Gerke (Office for Educational standardization in Turkey. and Student Affairs, Faculty of Medicine, University of Zurich, Zurichbergstrasse 14, CH-8091 Zurich, SWITZERLAND)

– 4.60 – Section 4 Session 7D: Postgraduate Training in the Early Years

7D 1 An evaluation ‘of practice, in practice’ of the GPPS Conclusions/take home messages: It is possible to train curriculum for SHOs (UK) junior students to a high degree of clinical competence with limited calls on staff resources. S J Brigley* and M J Golby (School of Postgraduate Medical & Dental Education, University of Wales, College of Medicine, Heath Park, Cardiff CF4 4XN, UK) 7D 3 The relevance of nurse involvement in the proposed In 2003 the Royal College of Surgeons of England Foundation Programme for new medical graduates introduced a pilot curriculum General Professional Practice (PRHOs) in the UK in Surgery that emphasised reflective and learner-centred approaches to the training of senior house officers (SHOs). Jo Vallis*, E Anne Hesketh, Mica Allen and Stuart Macpherson The intentions and values of the curriculum required an (NHS Education for Scotland, The Lister, 11 Hill Square, Edinburgh evaluation ‘of practice, in practice’, i.e., one grounded in EH8 9DR, UK) the ‘lived realities’ of the surgical SHO. An adaptable Aim: To discuss the relevance of nurse involvement in the methodology was necessary if the evaluation was to capture new, proposed Foundation Programme for Pre-registration the diverse understandings and interactions of SHOs and House Officers (PRHOs). others in this on-the-job learning. The evaluation was conducted by a team of general educators and clinical Summary of work: This paper presents findings from a large, educators with a shared philosophy of teaching, learning, Scottish, national project which aimed to identify a curriculum, assessment. It was formative, trying to build on curriculum for the PRHO year. As part of this study, 40 semi- the strengths of the pilot curriculum. The evaluation sites structured interviews, each lasting about one hour, were comprised three district general hospitals and one held with senior nurses. Participants were from diverse university teaching hospital. The team worked specialties. Interviews covered their views on PRHOs’ collaboratively in the evaluation design, fieldwork, analysis, educational progress. Data were fully transcribed and interpretation and reporting. Qualitative methods, coded in N-Vivo software. principally non-participant observation and depth Summary of results: interviews, were applied at all sites. Familiarisation with the hospital environments and investigative case studies • Key themes emerging concerned the process of training generated key issues to be addressed in the GPPS as well as educational outcomes curriculum: • Nurses prioritised development of PRHOs’ ‘softer’ skills • The theory-practice relationship (e.g. communication and teamworking) as well as • Reflection and reflective practice knowledge and clinical skills • The influence of assessment on learning and teaching • Nurses themselves were skilled and guided the PRHOs • The qualities of surgeons, trainees, teams, informally in these areas departments, hospitals and deaneries that make for • However, nurses were concerned that their own effective education. extended roles were de-skilling PRHOs Conclusions/take home messages: UK PRHO education 7D 2 Learning to work with patients: innovative is currently undergoing change. There is also emphasis, within the British National Health Service, on inter- programme design promotes the rapid acquisition professional working. Nurses are increasingly gaining of mature clinical skills with minimal requirement for advanced professional and clinical skills and guide PRHOs staff resources informally in these. There may be scope for formalising Richard Hift* and Rae Nash (University of Cape Town, Faculty of their contributions to the Foundation Programme. Health Sciences, Department of Medicine, Observatory, 7925, SOUTH AFRICA) 7D 4 Supporting poorly performing trainees in their first Aim: We describe an innovative introductory programme postgraduate year through ward simulation for junior students’ first contact with patients which combines educational success with the efficient use of F Anderson*, D Snadden, E A Hesketh, J Ker and J Foulis (NHS clinical teachers. Education for Scotland, Level 7, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK Summary of work: Teaching of the foundation skills of interviewing, history-taking and examination technique, and Aim of Presentation: To highlight how a ward simulation the clinical skills of patient examination, recognition of exercise can support poorly performing medical trainees abnormality and clinical reasoning were explicitly in their first postgraduate year. separated. In the foundation skills tutorial, students learn Summary of work: Ward simulation exercises provide by discussion, demonstration and peer practice. In the realistic working conditions with the opportunity to practice clinical tutorial, a clinician guides students through patient in a safe, patient oriented environment. The exercise assessment and diagnostic reasoning. Students participate provides challenges in clinical judgement, practical, in both tutorials concurrently in a structured programme organisational and communication skills as well as promoting self-directed learning, supported by specifically professionalism and the ability to work within a developed learning material. multidisciplinary team. Pre-registration House Officers Summary of results: (PRHOs) are being screened through the PHAST process • An efficient system in which 200 junior students are (PRHO Appraisal and Assessment System) as described accommodated for a staff requirement of one tutor, and at AMEE 2002. This identifies those who require further a 90 minute tutorial from each of 10 clinicians weekly. assessment and their training needs. Ward simulation • Clinician-tutors are freed to concentrate on the exercises are being used to provide medical and nursing acquisition of cognitive skills. undergraduate training. (Ker et al 2003) Their use in the assessment and retraining of junior doctors is being • Learning objectives, examination techniques, tutorial developed. The ward simulation exercise for PRHOs, aims format and assessment are standardised. to 1) re-assess their performance in a practice setting, 2) • Students rapidly develop personal and clinical maturity. provide individual feedback in context, 3) promote reflective • A positive evaluation from students. learning and practice. Behaviour descriptors are being developed to assess different aspects of performance

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based on observations of PRHOs in practice and Summary of work: Multiple methods were used to elicit observations of students in a ward simulation. The PRHO views of patients, pre-registration house officers (PRHOs) will be given a global rating score for each performance and senior medical staff. A small sample of patients was area. interviewed; 113 PRHOs returned questionnaires; and their senior staff were surveyed by email or telephone. Summary of results: This is a pilot project where preliminary results will be available by July 2003. These will include Summary of results: For each of the groups, practice in data on design and early data on validity and reliability. obtaining informed consent was variable, both within and between hospitals. Obtaining consent was often delegated Conclusions/take home messages: This project to PRHOs and usually left to the individual clinician to demonstrates an innovative approach in the management develop, both in terms of personal skills and in the of poor performance. management of organisational issues. The PRHOs requested help in managing what they perceived to be a very complex area. Many felt that that they were 7D 5 Obtaining the informed consent of patients: a study inadequately trained in taking consent and that employers into the educational and training needs of doctors placed inappropriate demands on them. They also said Lois Parker and Steve Field* (West Midlands Deanery and CRMDE, that senior staff did not always have the skills, knowledge Postgraduate Medical and Dental Education, PO Box 9771, or attitudes required for effective practice in achieving Birmingham Research Park, 97 Vincent Drive, Birmingham B15 informed consent. 2XE, UK) Conclusions/take home messages: Two main areas of Aim: To explore the views of patients, PRHOs and senior educational need were identified: training in basic issues medical staff, identify their learning needs and use the for individual staff; and the need for organisations to develop results to design a training programme. and manage a supportive system.

Session 7E: Continuing Professional Development

7E 1 Bringing pharmaceutical representatives into the Summary of work: After thorough preliminary work there educational loop followed the planning process of a concrete education programme. including a translation of a research based Craig Campbell, Jean Claude Dairon, Paul Davis, Francois Goulet, theory approach and consultants’ own judgement of Gilles Lachance, Celine Monette, Joan Sargeant, Robert Thivierge learning needs. The result of this process was the and Jane Tipping* (10987 Warden Avenue, Markham, Ontario L6C development of a new module constructed teaching 1M9, CANADA) concept rooted in five management roles/core Background: The role that representatives play in competencies: (1) Personal leadership; (2) Management maintaining high standards of CHE traditionally is not in a political context; (3) Management of change; (4) acknowledged. Canadian pharmaceutical represent-atives Management of quality improvement; (5) Management of receive many opportunities to upgrade their knowledge of professionals. Subsequently a sequence of education disease states and management, but they receive little modules for medical managers has been planned training in the practice of CHE. Two years ago a Continuing consisting of basic and superimposed courses. The single Health Education course was created by a group of module can be chosen depending only on the needs and dedicated professionals from across Canada representing qualifications of the single consultant. academia, industry and the Council for Continuing Summary of results: Pharmaceutical Education. The outcome has been a high • Organisational structure: A flexible education, that may quality written document and an exam that is unique in its be followed when the doctor has recognised her/his own format and congruent with the philosophy of adult learning needs; A plurality of management roles to comply education. The coming together of the three stakeholder with the managerial core competencies of the individual groups represents an example of true partnership that manager; Establishing a flat structure depending on the promises to offer a high impact on raising and maintaining many tasks and needs of the individual consultant. standards of CE across the country. The presentation describes the course itself, collected comments of • Learning methods: Organisational learning meaning approximately 300 representatives that have taken the that the participants try out the theory within own praxis. course and grade ranges. The teaching outside the department is thus related back to learning in praxis; Common basis course to Conclusions: The goal of CHE remains consistent even establish a common experience and networking to though stakeholders may vary. Through pooling the create learning communities/small group learning; resources of differing groups an outcome of higher quality Establishing a circular, segmented learning process in can be achieved. Maintaining high standards of CHE is which professional progress and repetition link new the responsibility of all stakeholders. The greater the knowledge to the participants’ personal professional knowledge, skills and communication between these development and reality. stakeholders, the greater the outcome. Conclusions/take home messages: Life long learning involves life long development, meaning that the education 7E 2 Implementation of a new education and training in and the single elements will be revised continuously medical management for consultants among others on the basis of the result of a thorough evaluation. Eva Zeuthen Bentzen, Annette Plesner Steenstrup and Helle Nielsen* (Danish Medical Association, Dormus Medica, Trondhjemsgade 9, 2100 Kobenhaven O, DENMARK) 7E 3 Meeting the needs in continuing education of Aim: To present how a theoretical analysis of the conditions paediatricians in Oltenia Region, Romania of management within the health services, knowledge of C Gheonea*, A Cupsa, D Bulucea and S Dinescu (Postgraduate learning processes and a systematic needs analysis have Department, Centre for Medical Education, University of Medicine been translated into a concrete management education and Pharmacy of Craiova, 4 Petru Rares St, 1100 Craiova, programme for consultants. ROMANIA)

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To augment the effectiveness of CME programs in Aim: To present the results of a study assessing the impact Paediatrics, the University of Medicine and Pharmacy of of the Maintenance of Certification (MOC) program on the Craiova (main CME provider in Oltenia Region, with 70% learning habits and perceptions of specialists in a of the accredited activities) sponsored a study to assess university-affiliated hospital. the needs of practitioners. Summary of work: Comparison of the type and frequency Consensus qualitative technique by appraisal of a nominal of learning activities of the McGill University Health Center group was used, due to a favourable ratio between the specialists in the 12-month period before and after the time and costs needed to perform the study and the introduction of the program. significance of the results. The design of the participants’ profile covered a wide range of professional circumstances Summary of results: Before the introduction of the program, that influence their training needs (including particularities specialists perceived traditional activities such as attending of the setting, time from graduation, gender). Twenty-one formal educational programs and reading medical selected paediatricians completed a questionnaire on two literature as having the highest learning value. The lowest topics: 1) contents of CME programs and 2) the structure value was given to activities provided by non-medical and the planning of the activities. A scale that incorporated organizations or those remote from the clinical practice. the ranking and the number of nominations selected the The MOC program had a positive impact on the learning identified items for each topic (i.e. 26 and 18 items, habits. In the 12 months after its implementation, there respectively). Multivariable linear statistics showed a was a significant increase in the frequency of activities that significant correlation between the preferences expressed allowed specialists to get credits for learning opportunities and certain professional circumstances of the in the workplace and for reflection on their practice. paediatricians questioned. By adapting the offer of Conclusions/take-home messages: This study postgraduate courses to the results of the study, 43% more demonstrates that an innovative accreditation policy, which participants joined in the activities of the Department of rewards the most valuable learning activities, may have a Paediatrics than in the previous academic year. positive influence on physicians learning habits. It also suggests that non-medical organizations need to improve their educational activities if they want to influence medical 7E 4 Impact of a new accreditation system on specialists’ practice. learning habits Linda Snell* and Réjean Laprise (Aventis Pharma, Department of Professional Education, 2150 St Elzear Boulevard West, Laval, Quebec H7L 4A8, CANADA)

Session 7F: Assessing the Practising Doctor

7F 1 Sheffield Peer Review Assessment Tool (SPRAT) for Aim : To improve the blueprinting of discussions of clinical Consultants: screening for poorly performing cases (CBD) with established doctors undergoing doctors performance assessment in practice. J C Archer* and H A Davies (University of Sheffield, Postgraduate Summary of work: CBD is a core method for examining the Medical Education Centre, F Floor, Stephenson Wing, Sheffield practice of doctors within the UK General Medical Council Children’s Hospital, Western Bank, Sheffield S10 2TH, UK) procedures for assessing poorly performing doctors. The quality of the evidence included in assessors’ reports relies Assessment of doctors’ performance is rapidly developing on systematic selection of cases and rigorous planning in the United Kingdom. Peer feedback on consultants at and documentation of the discussion. This evidence must the Sheffield Children’s Hospital NHS Trust was collected stand legal challenge. Two workshops and enhanced using a questionnaire. The questionnaire was designed assessor training preceded the introduction of the new with twenty-five questions across the six main domains of approach. Lay people also participate in conducting the Good Medical Practice, the General Medical Council orals. framework for good practice for doctors. Twenty-four consultants were each asked to provide 15 names of staff Summary of results: The new framework will be presented, with whom they regularly worked. The mean response rate and anonymised evidence from three reports from was 12.95 raters (86%). The data collected were analysed assessments in three medical specialties, conducted using Variance Component Analysis in SPSS v.11.0. Using under the new approach, will be shown. Methodological Generalisibility theory, as few as seven raters (R = 0.69) problems resulting from the tension between reliability and are needed to assess consultants reliably. Only 13 are validity of the approach will be discussed. needed for high stakes assessment such as Revalidation Conclusions/take home messages: Planning improved the when raters are doctors, nurses or other health quality and relevance of the evidence for the assessors’ professionals combined (R = 0.80). Nurses were more report about practice performance. This evidence suits reliable as raters than consultant colleagues. Six nurses lawyers better, but still does not completely address are needed to achieve a reliability of 0.8 in contrast to 19 problems when reliability and case specificity are consultants. In conclusion SPRAT for Consultants is a considered. validated performance assessment instrument, which is both reliable and feasible. It could be used both as a screening tool for high stakes assessment and to provide 7F 3 Piloting the link between revalidation and appraisal formative feedback. for the UK GMC Pauline McAvoy*, Lesley Southgate, Jim Crossley, Brian Jolly, 7F 2 Blueprinting case based discussions for the Malcolm Campbell and Alan McKay (University of Newcastle, assessment of poorly performing doctors in the UK Northern Postgradute Deanery, Postgraduate Institute for General Medical Council’s performance procedures Medicine and Dentistry, 10-12 Framlington Place, Newcastle upon Tyne NE2 4AB, UK) L Southgate*, Pauline McAvoy and Jim Cox (University College London, Academic Centre for Medical Education, Holborn Union Aim: To describe the piloting of the General Medical Building, Archway Campus, Highgate Hill, London N19 3UA, UK) Council’s proposals for Revalidation for all doctors.

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Summary of work: Revalidation is the regular demonstration Aim: Since 1998, 59 doctors have been advised to attend that a doctor remains up to date and fit to practise. The training with the Interactive Skills Unit, University of GMC initially proposed a submission, on a 5 yearly cycle, Birmingham because they have been perceived as having of a folder of evidence demonstrating continued fitness to problems with communication skills. With the advent of practise. A technical group conducted a series of pilots to clinical governance we expect these numbers to rise. We test the feasibility of the model, to test the link with annual felt it was necessary to review the data on these doctors. appraisal, and to test methods for gathering the views of colleagues and patients regarding aspects of fitness to Summary of work: An SPSS database was established from practise. a review of correspondence and written reports. We concentrated on the following: gender, speciality, country Summary of results: Few doctors have ready access to of birth and training, native English language speaker or data about their performance. Views of colleagues and English learner, why they were referred and the results of patients are rarely sought. Examples of evidence our assessment. demonstrating fitness to practise have been specified. Sampling of revalidation submissions is recommended. A Summary of results: Rising numbers have been referred robust appraisal can provide adequate evidence for each year. Of the 59 doctors, 81% were male, 64% hospital- revalidation purposes. based, 29% UK born, 39% UK trained, 27% native English language speakers. 61% were referred with a perceived Conclusions/take home messages: Training and support communication skills problem, 20% for exam support, of appraisers is paramount. Views of patients and peers 9.5% for job interview coaching and 9.5% for English are a highly valued source of evidence. Royal Colleges language support. Our assessment was often different with have a responsibility to their members to publish criteria, very few having a pure communication skills problem. standards and evidence of good medical practice. The GMC must ensure adequate QA of its processes. Conclusion: The label “communication skills” is used as a “catch-all” term for many kinds of non-clinical problem. The initial perceptions of the referrers and doctors 7F 4 Remedial training for doctors identified as “poorly themselves are often unsophisticated or mistaken. performing” in communication skills – an update on the Birmingham experience Jo Piercy*, John Skelton and David Wall (Department of Primary Care and General Practice, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK)

Session 7G: Different Approaches to Staff Development

7G 1 Professionalising teaching: Scottish Clinical Aim: The aim of the study was to explore the different ways Teaching Fellowships in which doctors have learned to teach and train. J Syme-Grant* and P A Johnstone (NHS Education for Scotland, Context: There is no coherent theory of medical teacher Ninewells Hospital and Medical School, Postgraduate Office, Level development (Grant, 1998). Doctors are experts in what 7, Dundee DD1 9SY, UK) they teach; most have had little or no training in how they teach (Elton, 1998). Aim: Efforts to improve the quality of clinical teaching in the United Kingdom through teacher training programs for Summary of work: Semi-structured interviews with ten doctors have been criticised for failing to foster teaching experienced medical teachers. A literature review had professionalism. In an effort to address this, NHS Education suggested areas to explore. Interviews were transcribed, Scotland has established six Clinical Teaching Fellowship coded and thematic analysis and grounded theory used posts in conjunction with the Universities of Aberdeen and as the framework for qualitative analysis. Dundee. This presentation describes the posts and Summary of results: Four areas were identified as important presents the results of an evaluation in progress. in teacher development; acquisition of educational Summary of work: Within the two Deaneries offering knowledge and skills, modelling and practice of teaching Fellowships, Postgraduate Deans, Training Managers, skills, encouragement and motivation of teachers and Post Graduate Tutors and Fellows were asked to evaluate constraints on teaching and learning. Results suggest a the Fellowship posts using a questionnaire developed from model for teacher development that begins with doctors “A framework for developing excellence as a clinical as learners, learning to learn and watching teachers teach. educator” (Hesketh et.al. Medical Education 35(6);555- They then start to teach, acquiring and practising skills 564:2001). and subsequently move on to reflect on their teaching. They can be encouraged to teach but may also be prevented Summary of results: Fellowship design, appointment from teaching. criteria, anticipated outcomes, and funding are described. A combination of qualitative and quantitative evaluation is Conclusions/take home messages: This inductive study in progress. Early evaluation data are extremely positive. proposes a model for medical teacher development that attempts to explain how doctors learn to teach and train. Conclusion: Early results suggest that these Clinical More research is needed to clarify the findings. There are Teaching Fellowship posts contribute significantly to the implications for faculty development. professionalisation of medical teaching in Scotland and could act as a template for similar post creation elsewhere. 7G 3 Webcast audio seminars as a technique for international faculty development 7G 2 The development of medical teachers: interviews with ten experienced medical teachers Roger W Koment*, Peter G Anderson and Julie K Hewett (International Association of Medical Science Educators, 5535 Jane MacDougall* and Mary Jane Drummond (Addenbrooke’s Belfast Place, Suite A, Springfield, VA 22151, USA) Hospital, Department of Obstetrics and Gynaecology, Hills Road, Cambridge CB2 2AW, UK) The future of medical education can be described in two words: Faculty Development. This is the ongoing

– 4.64 – Section 4

professional training which allows teaching faculty to share medicine or only on education. This significantly broadens information, ideas, and techniques to enhance the the scope of any search. education of those in medical training. Traditionally, faculty development for many has meant attending national or Summary of work: As part of a Best Evidence Medical international conferences where they benefit from Education (BEME) Topic Review Group, a variety of interaction with experts and peers. However, over the years strategies were explored to identify articles that feature we have all witnessed the disturbing trend toward communication skills assessment tools. In the first reductions in medical school budgets which translate exploratory study results of a Medline search were directly into diminished funds for travel. At the same time, compared with references identified through review economic conditions are forcing increases in the cost of articles. The second investigation compared references creating and delivering such national and international from a general objective structured clinical exam (OSCE) meetings. Equally disturbing is the reality of heightened literature review with those of a communication skills- security and depressed travel in all countries due to specific OSCE review. The overlap in either inquiry was international terrorism. Fortunately during this time period limited, and revealed some of the current problems in we have seen technological advances that allow the use identifying medical education references. of the Internet and e-mail as modes of communication Conclusions: As BEME is moving towards becoming part and information gathering. In consideration of these of medical education culture, it will be necessary to develop circumstances, we in the International Association of resources that enable educators to quickly and reliably Medical Science Educators (IAMSE) have created a access the available literature. This will be a necessary system whereby individuals from various countries at very step before a full “quality and evidence debate” can unfold. low cost can participate with peers in 1-hour seminars delivered by recognized experts in their field, yet without leaving the convenience and security of their medical 7G 5 Anaesthetists as teachers school. Essentially a conference call, IAMSE Webcast Audio Seminars connect 27 individuals or conference Michael Clapham* and Alison Bullock (West Midlands Deanery, rooms with a Presenter who controls the display of Postgraduate Medical and Dental Education, Birmingham PowerPoint slides via Internet directly onto each attendee’s Research Park, 97 Vincent Drive, Birmingham B15 2XE, UK) computer. Programs are offered in thematic series of six Aim: Part of postgraduate medical training (UK) requires 1-hour seminars delivered at 2-week intervals. Examples trainees to teach other trainees. This presentation reports include (2002) Recent Trends in Basic Science Education the role of anaesthetic trainees in teaching and how they and (2003) Evaluation of Student Learning. http:// learn to teach. www.iamse.org/development/audioseminar_index.htm Summary of work: Data were gathered from semi-structured This presentation will discuss the mechanisms of Webcast interviews with senior anaesthetic trainees from a University Audio Seminars and demonstrate how faculty development Teaching Hospital. Interviews were recorded, transcribed can be implemented using affordable technology that is and analysed using grounded theory approach. Saturation available today. While face-to-face conferencing is still very point was reached after four interviews (2.5 hours; 12,500 desirable, Internet technology will become ever more words transcribed). important in meeting the evolving needs of individuals around the globe. Summary of results: All trainees taught medical students, anaesthetic assistants and/or other anaesthetists within their everyday work. Most teaching was informal, 7G 4 Hunting for medical education references – search opportunistic and undertaken in the workplace. It included theory and practical skills, usually related to the clinical strategies compared situation. However the trainees did not see this as teaching. E K Kachur*, M Schwartz, C Gillespie, M Yedidia, P Kinnersley, A They viewed teaching as formal, pre-planned and Kalet, R Janicik, L Altshuler, K Mukohara and T Comerci (The ROCAT structured and this was reflected in the ‘teaching the Topic Review Group, Medical Education Development, 201 East teachers’ courses they had undertaken. None had received 21st Street, Suite 2E, New York NY 10010, USA) any education in teaching within the workplace. How they had learnt about teaching, in these situations, had been Background: As medical education is moving towards through observation and modelling senior colleagues evidence-based practice, there will be an increasing need whom they viewed as good teachers, and by trial and error. to identify and access the literature in the field. Although there are special medical education journals, their indexing Conclusions: Trainee anaesthetists teach extensively and in common databases varies significantly. Relevant articles informally within the workplace. Many do not perceive this are also dispersed in journals that either focus only on as teaching and current training focuses only on formal teaching.

Session 7H: Student Diversity

7H 1 Valuing diversity: working class students and following three weeks students are given a choice of two doctors sessions to attend from a variety of topics. Sessions are interactive. Group size is up to 16. The suggestion for a Barry Ewart* and Jill Thistlethwaite (School of Medicine, workshop on social class came from a medical student. University of Leeds, Medical Education Unit, Level 7, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK) Summary of results: The workshop identified obstacles that may restrict working class participation in higher education Aim: Valuing diversity sessions are important to help in medicine. Participants explored possible obstacles students understand cultural and other differences across facing working class students whilst at university before the spectrum of the human population and to deal with discussing the possible benefits and disadvantages to all prejudice. Patients have a right to access healthcare from social classes of having working class doctors. professionals who understand diversity and who are able to treat them with respect, taking into account similarities Conclusion/take home message: We should treat all and differences. students at Medical School equally. We are preparing the doctors of tomorrow, whatever their backgrounds, so that Summary of work: The sessions begin with a lecture looking they will be able to work with all patients, whatever their at the subject from an ethical perspective and in the backgrounds.

– 4.65 – Section 4

7H 2 An educational strategy to develop disadvantaged Aim: To demonstrate personality differences between students into health professionals medical students who withdrew from the course and those who remained. Elmi Badenhorst*, Rachel Alexander and Trevor Gibbs (Department of Public Health and Primary Health Care, Fallmouth Summary of work: A prospective longitudinal study was Building Office 2.24, Faculty of Health Sciences, University of Cape conducted of 587 medical students who entered King’s Town, Observatory 7925, SOUTH AFRICA) College London between 1994-98 inclusive. The students completed an entry questionnaire giving demographic Aim: This paper will inform medical educators of an details, reasons for applying to medical school and what educational strategy the University of Cape Town has they hoped to contribute to the profession. They also designed to develop educationally disadvantaged students completed the Myers-Briggs Type Indicator (MBTI), which into health professionals. measures normal personality differences, i.e. how Summary of work: The Faculty of Health Sciences at the individuals prefer to use their minds. The MBTI profiles of University of Cape Town (UCT) is committed to redressing the students who subsequently withdrew were then past imbalances in South Africa, also recognising that a compared with those who continued their education. portion of prospective medical students, who are meeting Summary of results: 514 students completed both entrance requirements, might be educationally questionnaires (88% response rate). As at March, 2003, disadvantaged, but culturally advantaged in understanding 318 had qualified (61.9%), 4 had transferred to another the spectrum of health need from a social perspective. To medical school (0.8%), 34 (6.6%) had withdrawn from the compensate, an intervention program, redressing medical course and 158 (30.7%) are still in attendance. educational imbalances has been implemented. This The personality profiles of those who withdrew differed from programme follows a teach – test – intervene model, those who remained but not significantly so. Gender situated in an authentic academic environment, providing differences did, however, emerge. all students with an equal opportunity to prove academic skills. During the intervention programme fundamental Conclusions/take home messages: Whilst there were learning happens by addressing knowledge, skills, and differences between the personality profiles of the leavers attitudes; capitalising upon their social background whilst and the rest of the students, these were not statistically moving the students’ learning approach into a more significant. There were, however, interesting gender academic domain. The programme is a dynamic process differences. and constantly evaluated. Conclusion: We believe all prospective medical students 7H 5 Does the choice of elective clerkship predict meeting entrance criteria should be given an opportunity, specialty training? and through our programme it has become possible to develop educationally disadvantaged students into health Willemina M Molenaar*, Jan Jaap Reinders and Janke Cohen- professionals. Schotanus (Institute of Medical Education, University of Groningen, P O Box 196, Ant Deusinglaan 1, 9713 AD Groningen, NETHERLANDS) 7H 3 What students think are the reasons for their Aim: The elective clerkship is often considered academic failure in our physiology course determinative for specialty choice, but the actual Nancy Fernandez-Garza (Facultad de Medicina, Universidad relationship is unclear. Autónoma de Nuevo Leon, Nuno de Guzmán 309, Col. Cumbres, Summary of work: A cohort of 302 medical students that 3er Sector, Monterrey, N.L., c.p. 64610, MEXICO) entered medical school in 1992 or 1993 and graduated We have a high rate of students that fail our physiology before August 2002 was interviewed about their current course. In an attempt to know what they believe are the specialty, preferred specialty and acceptance for a specialty reasons for their academic failure, we apply a survey to training program. These data were compared with the students taking the course at a second or third attempt. elective clerkships previously chosen by the same students. The only question was: List three reasons for your failure in Summary of results: Complete data were available from this course. From 250 students, 179 answered the survey 283 students. Seventy percent of them did electives in one with a total of 502 reasons listed. From them, 57% were of 5 major specialties (internal medicine, paediatrics, attributed directly to student attitude (little time dedicated surgery, neurology or obstetrics/gynaecology) as compared to study, non-attendance in class, lack of motivation to to 2% in primary care (public health or general practice). study), 16% were related to the exam format (confused In contrast, 31% was currently employed in these major questions, too many clinical cases for a second year specialties and 30% in primary care. Of the subgroup of course), 12% were about the course methodology 196 students (69%) that was accepted for a training (basically they do not like to participate in class and find program, the vast majority (95%) declared that training was lectures better), 8% of the reasons were attributed to the in their preferred specialty, but in only 36% it was the same professor (the class material was not reviewed adequately), as their elective. and 12% were about others. These results encourage us to focus our work to motivate students to study and to think Conclusions: It appears that students choose other about the importance of their study for their future, as well specialties for their elective clerkship than they prefer for as about the time they are wasting because of their lack of their future career. Overall, the shift from major clinical interest in their professional preparation. specialties for the elective towards primary care for specialty training is impressive.

7H 4 Are there personality differences between students who drop out of medical school and those who remain? Gillian B Clack*, Derek Cooper and Susan Standring (King’s College London, c/o 51 Burbage Road, Herne Hill, London, SE24 9HB, UK)

– 4.66 – Section 4 Session 7I: Evaluation of Problem Based Learning

7I 1 Pre-Registration House Officers (PRHOs) assess 7I 3 Does PBL work? Does music? Side 2: scenario design their undergraduate education Brian Bailey (Napier University, School of Community Health, 13 Simon Watmough*, Anne Garden and David Graham (University Crewe Road South, Edinburgh EH4 2LD, UK) of Liverpool, Department of Primary Care, Quadrangle, 2nd Floor Models of learning in PBL posit that the quality of scenarios Whelan Building, Brownlow Street, Liverpool L69 3GB, UK) significantly influences tutorial group functioning and In 1996 Liverpool University changed its curriculum from a student achievement. Yet there has been little investigation traditional course to integrated problem-based learning. into the specific aspects of scenarios that stimulate debate Five focus groups with 31 PRHOs from the first cohort of and learning. the new PBL curriculum were arranged to gather their While there are a number of descriptive, scenario-design views on their undergraduate education. PRHOs felt they guidelines available, those, the author suggests, are had been well prepared for the role, saying that due to somewhat over-rationalistic and under-emphasise the certain changes in the course, noticeably the clinical skills importance of the emotions in learning. Scenarios that laboratory, “shadowing” and accident and emergency provoke emotional responses, as one exceptional study attachments, they knew how to do the job. They believed has shown, are powerful triggers for learning. Elaborating they were particularly strong in practical and on a music-metaphor approach to understanding PBL communication skills, but didn’t know as much basic (paper presented at last year’s AMEE conference) the science as the old curriculum graduates, although this author will apply a framework, derived from popular hasn’t affected their ability to perform as PRHOs and look musicology, for designing scenarios, the songs, as it were, after patients. They enjoyed their problem-based course at the heart of PBL. and would have preferred this to the traditional course although they wanted more structured teaching such as Using the song “Ode To Billy Joe” for illustration, the author lectures or tutorials or “directions” in the first couple of suggests that quality scenarios should, respectively: be set years of the course. This is a follow up to a paper presented in an evocative geographical and temporal context; contain at Lisbon in 2002 looking at the views of the last cohort multi-vocal viewpoints; shock; mobilise a sense of self- from the traditional curriculum to graduate from Liverpool agency; link with other discourses; provoke debate; and, with the PBL cohort seemingly feeling better prepared to importantly, arouse ‘mimetic’ desire. be PRHOs. 7I4 Evaluation of a PBL curriculum in comparison to a 7I 2 Comparison of three instructional methods of parallel conventional course at the Medical Faculty teaching for medical students of the University of Hamburg, Germany Eiad Al-Faris (Department of Family and Community Medicine, Ralf Wieking, Christian E Guksch, Olaf Kuhnigk and Monika King Saud University, PO Box 2925, Riyadh 11461, SAUDI Bullinger* (University of Hamburg, Modellstudiengang Medzin, ARABIA) Martinistrasse 52, 22761 Hamburg, GERMANY) Aim: To compare lectures, problem-based learning (PBL) Background: In 2001 the University of Hamburg and modified PBL regarding students’ topic implemented an experimental medical curriculum, based comprehension, knowledge recall and decision making. on PBL for the first three years of medical education. A study comparing structure, process and results of teaching Summary of work: 33 4th year medical students undertaking between the reformed and the regular curriculum is the Family Medicine (FM) rotation were divided into 3 combined with this. The intent is to show strengths and separate groups randomly. Each group was taught one of weaknesses of two didactic principles, taking place the clinical topics (headache, obesity and back pain) using simultaneously, from the perspective of both students and the lecture method in the first session. In the other two teachers. sessions they rotated on the clinical topics and were taught using the modified PBL in the second and the PBL methods Summary of work: The new curriculum was offered to all in the third session. first-year students joining the medical faculty: 110 out of 160 students applied, 40 were randomly taken. Two more Summary of results: In the immediate evaluation there was study-groups from the regular curriculum were formed: 40 a significant difference between the three instructional applicants for the new track who could not participate, and methods regarding the total score (P = 0.009261), the 40 who did not apply. Each semester students are evaluated clinical cases of management score (P = 0.002410) and by a standardised questionnaire that allows determination short answers questions (P = 0.000005) which was of the above-mentioned aspects. statistically significant in favour of PBL while for the MCQ score the difference was not significant (P = 0.155108). Summary of results: We report on the first three measuring Regarding the evaluation after two weeks, there was a points. The interpretation shows PBL students having statistically significant difference between the three higher satisfaction with their curriculum, difficulties coping instructional methods only for the short answer question with perceived higher workload, better learning strategies score (P = 0.1802). and better self-assessment of themselves as medical students. Conclusions/take home messages: There could be a case for opponents of modified PBL instead of the lecture Conclusions: As of today the analysis can only be seen as method. explorative, though it shows a positive students´ attitude towards the new curriculum. Further evaluation will allow for more precise interpretations.

– 4.67 – Section 4 Session 7J: Management of Clinical Training

7J 1 The county hospital – what can it offer medical funding to establish Rural Clinical Schools (RCS), has students and what does it get in return? become an agent for change in medical education. The challenge for RCS is to ensure that medical students, who Berit Eika (University of Aarhus, Unit of Medical Education, will spend at least half their clinical training in rural areas, Vennelyst Boulevard 9, 8000 Aarhus C, DENMARK) have access to quality resources and are supported by Aim: To describe the attitudes of clerkship directors in county local academic clinicians so that their clinical experiences hospitals about gains and costs associated with an early and academic coursework are recognised as equal to clinical clerkship, and to examine how they think county metropolitan clinical schools. This challenge is providing hospitals can contribute to the education of medical a unique opportunity for innovation in medical education. students. The critical issues to be explored are diffusion and integration of these innovations in rural medical education Summary of work: A questionnaire containing closed as into the wider medical school environment in such a way well as open questions was developed to collect data from that they are not constrained by the complex cultural and 31 clerkship directors during a face-to-face interview. organisational issues experienced in many medical Summary of results: The clerkships were perceived as an schools. The question is: ‘how do ideas and practices get overall benefit for the county hospital. The specific benefits from here to there?’ The answer will be explored through reported were academic stimulation, increased focus on description and analysis of a complex process. The rate education and a recruitment potential. The clerkship had of diffusion is the result of the interplay between the not strengthened the cooperation with the university around characteristics of the innovation, potential adopters and research and even less around patient care. Few the organisation into which that innovation has been disadvantages were reported but approximately half of the introduced. respondents saw the expenses of the clerkship as being time taken from patient care and education of other health care professionals. The specific beneficial characteristics 7J 4 Evaluation of a web-based project to improve the of the county hospital were believed to be its patient-mix, quality of clinical attachments in North Devon its size and the inter-personal atmosphere. Richard Ayres (North Devon District Hospital, Medical Education Conclusions/take home messages: The change of a county Centre, Raleigh Park, Barnstaple, Devon EX31 4JB, UK) hospital into an undergraduate teaching hospital is seen Aim: To report on a novel project (presented as a short as a welcome inspiration. The county hospital is believed communication at AMEE Berlin) to use a specialist website to exhibit attributes that make it suitable for the education to improve medical student attachments of medical students. Summary of work: We contact by email 2 weeks before arrival all students coming to N Devon for clinical 7J 2 An academy model for medical education – the attachments. We refer them to our website: www.medical student perspective ed.co.uk where they can find details of all learning experiences available (in both primary and secondary Julia Sanday, David Mumford and Clive Roberts* (Bristol care). Using a password, students can access their own University Medical School, Centre for Medical Education, 39-41 timetable and choose sessions. Several multi-disciplinary St Michael’s Hill, Bristol, UK) modules are available. Hospital-based students can Bristol medical school is undergoing 50% expansion whilst arrange experience (such as Diabetic or asthma clinics) clinical placements become constrained by the foundation in primary care. GP-based students can follow up patients of a medical school close-by. A model was developed to or attend sessions in the hospital. deliver the curriculum at high standard to an expanded Summary of results: The new system is popular with both school with reduced facilities involving investment in seven students and staff. Some qualitative evaluation will be clinical academies within 50 miles of Bristol. Such presented. academies consist of major general hospitals able to deliver most clinical units and to take students continuously Conclusions/take home messages: This project for periods up to 18 weeks. Following a briefing session encourages self-directed, multi-disciplinary and inter- the opinion was sought from the current cohort of 1st, 2nd sectoral learning. and 3rd year medical students by questionnaire. 55% of 378 respondents approved the model whilst 12% were against. 96% considered it would be disruptive to social 7J 5 Development of an information system to monitor lives. Over 50% of 3rd year students judged that clinical the long-term achievement of the collaborative teaching, opportunity for practising skills and developing a project to increase production of rural doctors sense of belonging to a clinical unit would be better in academies outside Bristol whilst 30% felt that for learning Suwat Lertsukprasert and Waraporn Eoaskoon* (Office of the facilities. However the majority of this group indicated that Collaborative Project to Increase Production of Rural Doctors, had the model been operative when they applied to Floor 9, Building 6, Office of the Permanent Secretary, Ministry medical school it would have had a negative influence on of Public Health, Tiwanon Road, Nonthaburi 11000, THAILAND) choice. The opinion of students throughout the transition Aim: To present a continuous, sustainable and efficient period has been invaluable to those responsible for its information system to support the management of the detail. collaborative project and to monitor/ evaluate the achievement regarding student education and long-term rural practice of the medical graduates. 7J 3 Changing perceptions in medical education: the emergence of rural clinical schools as levers for Summary of work: (1) To design a database and collect essential information using 10 forms on teaching staff, change medical students and graduates; (2) To design a computer Judi Walker (University of Tasmania, University Department of program and user manual for database; (3) To train users Rural Health, Locked Bag 1372, Launceston, Tasmania 7250, and system analysts of the OCPIRD in how to implement AUSTRALIA) the long term project. The aim of this presentation is to critically analyse how an Summary of results: (1) Baseline data on 3,000 medical imposed development, Australian Federal Government students, graduates and 1,500 teaching staff of 12 Medical

– 4.68 – Section 4

Education Centers; (2) Website relating to information Conclusion: (1) The data outcomes provide a framework linking OCPIRD, all MECs and informing the public; (3) for planning and monitoring the project; (2) evaluation of Systematic spot-check on student education, better CPIRD graduates on achieving the project plan. teaching vs. workload of staff and outcome of the project.

Session 7K: Clinical Training in Different Settings

7K 1 Modelling clinical competence in a medical 7K 3 Inter-site consistency as a measurement of internship: the impact of variation in actual clinical programmatic evaluation in a medicine clerkship experiences with multiple, geographically separated sites P F Wimmers*, T A W Splinter and H G Schmidt (University Medical Steven J Durning*, Louis N Pangaro, Gerald D Denton, Paul A Centre Rotterdam, Erasmus MC, Office Ff-223, Po Box 1738, Hemmer, Alan Wimmer, Thomas Garu, Margaret Gaglione and Lisa 3000 DR, Rotterdam, NETHERLANDS) Moores (Uniformed Services University, Dept of Medicine (NEP), 4301 Jones Bridge Road, Bethesda, MD 20814, USA) Dutch undergraduate education in medicine is a six-year program, which ends with a two-year internship. A medical Aim: To introduce “inter-site consistency” as a internship is based on “learning by the bedside.” The measurement of programmatic evaluation and to national objectives prescribe the necessary clinical demonstrate the feasibility and construct validity of this pictures (diseases) to be seen during that period. The measurement on a clinical clerkship. reason for it is the overall agreement that a sufficient range of clinical pictures is essential for learning medicine. Summary of work: We reviewed student clerkship data in However, analysis of student logbooks reveals a large our multi-site, geographically separated clerkship over a variation between individuals and between hospitals where 10-year period (1990-2000). We hypothesized that the those internships take place. The intention of this study is clerkship site should not contribute to a student’s clerkship to explore causes of the amount and variety in actual seen outcome. We calculated mean scores for each clerkship clinical pictures and what the consequences for clinical measurement and analyzed these data on both a yearly as competence are. The influence and quality of supervision, well as 10-year cumulative basis. Analysis of Variance size of the hospital department, internship exam grades, (ANOVA) and linear regression were used for determining and grades of former coursework are evaluated, and if clerkship site contributed to clerkship outcomes. structural equation methods are used to model Summary of results: Data for 1632 (98%) students were hypothesized causal processes. Results indicate a direct included in our study. During this 10-year study period, we relationship between quality of supervision and the amount had a total of 22 different on-site clerkship directors. ANOVA or variety of clinical pictures. Surprisingly, size of the hospital and linear regression of year-to-year and cumulative data department did not have any relationship with amount or did not demonstrate an effect of site on student clerkship variety of the clinical pictures. outcomes. In conclusion, supervision is the crucial aspect of internship Conclusions/take home messages: Inter-site consistency and has a direct impact on the clinical competence of the can be used as a measurement of programmatic student during that period. evaluation for multi-site clinical clerkships.

7K 2 Innovations in the clerkship Internal Medicine 7K 4 A student-organized introduction to the clinical J C G Jacobs*, S Bolhuis, J A Bulte and R S G Holdrinet (University rotation of medical education, Karolinska Institutet, Medical Centre Nijmegen, Department of Medical Education, PO Stockholm Box 9101 (224 KTC), 6500 HB Nijmegen, NETHERLANDS) H Brauner*, P Grenholm, I-M Petermann, M Nyström and J Curriculum innovations in the clerkships are Björklund (Medical Students’ Association, Artillerigatan 84, S- recommendable, but difficult to implement. One reason is 115 30 Stockholm, SWEDEN) the diversity of clerkships as learning environments: Background: A large part of the medical education at the different hospitals (university or affiliated), different wards, Karolinska Institutet, Stockholm is spent in hospital wards. several outpatient departments and the large number of The clinical rotation differs markedly from what the supervisors (residents and staff members). students have experienced during the first basic science The new curriculum in Nijmegen, started in 1995, included years. A great demand is placed on student initiatives, the clerkships. Important innovations in the clinical phase knowledge and attitudes. Students have felt the need of were the introduction of core learning goals, mid-way more introductions to the clinical rotation. formative interviews, final summative interviews, a logbook, Aim: To facilitate the process for students to find their role central clerkships with attention for reflection and at the clinic, and help them to invent strategies for getting preparation for the next clerkships, assignments based on the most out of their time. experiences and an explicit description of the supervising role of residents and staff members. Our study will focus Summary of work: Group discussions were arranged at on learning in the renewed clerkship Internal Medicine. two hospitals. During the first clinical weeks students met Interns can be placed in the university hospital or in one of senior students for discussions on clinically related five affiliated hospitals. In general they stay four weeks at problems and joys that they had experienced. Six cases the wards and four weeks on outpatient departments. covering aspects relevant to the goals of the course were Questions are: How can the learning environments be also used. described? To what extent are the innovations Summary of results: The course was evaluated by a written implemented? Are they helpful to interns’ learning, and how questionnaire. The students expressed a need for a course do residents and staff members appreciate these of this type, the topics discussed were considered relevant measures? The results of questionnaires completed by and the overall impression of the course was good. The interns, residents and staff members, at the six different course goals were partly fulfilled. hospitals, will be presented. Conclusions/take home messages: With very simple means we have created a complementary introduction to the clinical rotation of medical education, which could be made a regular part of the curriculum.

– 4.69 – Section 4

7K 5 Acquiring clinical competence during clerkships minimal direct supervision. We also found that students Gitte Wichmann-Hansen* and Berit Eika (Aarhus University, Unit are supposed to be responsible for their own learning processes, but they are not expected to take part in the of Medical Education, Vennelyst Boulevard 9, Bygning 611, DK production. This exclusive position excludes students from 8000 Aarhus, DENMARK) practice. To compensate for lack of active involvement in Aim of presentation: In this study we describe and evaluate patient-related activities, students develop a rich repertoire medical students’ opportunities for acquiring clinical of strategies to gain access to practice. We identified these competence during clerkships. strategies as an important part of the socialization process. Summary of work: We conducted a field-based multiple Conclusions/take home messages: We conclude that case study, based on observations, diaries, interviews and medical students’ opportunities for acquiring clinical document analysis. competence during clerkships is limited by lack of access to active involvement in patient-related activities. Our study Summary of results: We found that students rarely take an suggests that the clerkship may serve a socialization active part in the daily work with patients and receive purpose rather than a qualifying purpose.

Session 7L: Professionalism (2)

7L 1 Advancing professionalism in medical education: a Conclusions/take home messages: Despite the small view from the margins sample size, we wonder whether this reflects medical school admission/selection criteria, residents’ focus on Viv Cook* and Sandra Nicholson (Department of General Practice issues of importance in day-to-day tasks, cultural or and Primary Care, Barts and The London, Queen Mary’s School of geopolitical differences in healthcare delivery, or a Medicine and Dentistry, Medical Sciences Building, Mile End Road, dissonance between the Charter and views of today’s young London E1 4NS, UK) doctors. Further information on residents’ views about This presentation aims to summarise the current theories medical professionalism will be explored as the survey that underpin professionalism in medical education and proceeds. how collaborating with mainstream educators will facilitate a broader and deeper approach. Discourses on professionalism within medical education often focus on 7L 3 Student perceptions of the strengths and possible the necessity of undergraduate students acquiring the improvements of a personal and professional knowledge, skills and attitudes essential for their development (PPD) curriculum “professional development” that is judged by their clinical Kate Drysdale* and Iain Robbé (University of Wales College of competence. It is argued that professionalism in medical Medicine, Temple of Peace & Health, Cathays Park, Cardiff, CF10 teachers should be concerned with not only acquiring competence at teaching but also a consideration of the 3NW, UK) social and political frameworks in which medical educators Attitudes and behavioural outcomes are increasingly engage. Medical education can be viewed as emphasising important in medical education. PPD is a key element of the importance of teaching theory and methods whilst these outcomes. Using the Nominal Group Technique sometimes neglecting the context in which students learn (NGT) we sought the views of medical students concerning and teachers teach. The particular complexities of being their experiences of PPD in the undergraduate programme. both a doctor and a teacher and how this impacts on Students were grouped for the NGT meetings into first, professionalism also need consideration. It is with this middle and third phases of the course. Strengths of the agenda that mainstream educators can help. Collaborative curriculum with the highest scores across the three groups debates around the nature of professionalism drawing upon commonly involved aspects of self-determined learning, the work of medical and “mainstream” education will help clinical contact, interpersonal skills and reflection over at to inform and underpin teaching standards, evidence- least two months. The group from the first phase identified based practice and facilitate change in the learning collaborative learning with other healthcare students during environment of students. interprofessional education days as a high scoring strength. The other two groups, who had not experienced these days, identified this as an area for improvement. 7L2 What is professionalism? A pilot study of Danish Improvements regarding PPD that were identified by all Internal Medicine Senior House Officers’ views groups involved more personalised feedback relating to D J Davis, A M Skaarup* and C Ringsted (Copenhagen Hospital progress, wider choices and increased institutional Corporation Postgraduate Medical Institute, H:S PMI, Bispebjerg commitment to PPD. Further work is required to increase Bakke 23, 2400 Copenhagen NV, DENMARK) the validity and reliability of the results. However there is clear interest in PPD across all three phases. Interventions Aim: The aim of this pilot study was to identify what SHOs to improve the curriculum should be tailored to the differing in internal medicine associate with professionalism. maturity of learners that was apparent across the phases. Summary of work: We surveyed a convenience sample of SHOs in internal medicine. They were asked to write 5 words or phrases related to professionalism as well as the 7L 4 Towards assessment of professional behaviour in 3 most important attributes they would want in their own vocational GP trainees: the development of the physician. Summary of results: Twenty-five SHOs have Professional Behaviour in General Practice completed the survey. Answers were grouped using instrument qualitative methods. The most common associations with K van de Camp*, M Vernooij-Dassen, R Grol and B Bottema (UMC professionalism were competence (17), communication (10), empathy (10), self-appraisal/lifelong learning (6), St Radboud, University Medical Centre Nijmegen, Dept. VOHA 254, respect (5), decision-maker (4), knowledge/ PO Box 9120, 6500 HB Nijmegen, NETHERLANDS) knowledgeable (4). SHOs wanted competence and Aim: Discuss the development of the Professional empathy in their own doctors, but did not mention Behaviour in General Practice instrument. communication skills as frequently. The principles of primacy of patient welfare and social justice as described Summary of work: The development of the Professional in the ABIM/ACP/EFIM Physician Charter did not figure Behaviour in General Practice instrument consisted of highly. three phases: (1) selection of elements of professionalism

– 4.70 – Section 4

relevant for general practice based on the literature on Aim: To summarize recommendations for systematic professionalism, the overall educational objectives of assessment of professionalism in residency programs vocational training and competency models of general made by the Accreditation Council for Graduate Medical practice; (2) development of items composed of Education’s (ACGME) “Think Tank” group. behavioural examples from everyday practice indicative of the selected elements; (3) verifying the validity of the Summary of work: A group of experts convened by the instrument by an expert panel in two steps: a questionnaire ACGME recommended a multi-faceted, systematic survey and a consensus meeting. approach to assessing professionalism based on its essential components, principles for its development, and Summary of results: The instrument consists of four major practical considerations for its assessment. The approach themes: (a) professional behaviour towards patients; (b) outlines what components to assess, how to assess them, professional behaviour towards other healthcare and which assessment tools might be used. The proposed professionals; (c) professional behaviour towards the system includes tools for formative assessment of profession; and (d) professional behaviour towards oneself. knowledge and behaviours and a tool to measure values Within these four themes 25 elements of professionalism and norms transmitted in the educational environment. To are represented in separate scales, each consisting of at guide implementation, the Think Tank suggested that: 1) least 4 items. Examples of elements are respect, teamwork, residents and faculty work collaboratively to determine what accountability and resilience. professional behaviours to assess and how to assess them; 2) individuals from different roles, e.g., nurses, patients, Conclusions/take-home messages: We believe that the etc., provide input; and, 3) assessments occur on multiple strength of the instrument lies in the tight match with the occasions. GP’s daily routine. The development of our instrument gives the abstract concept of professionalism in general practice Conclusions/take-home messages: A systematic approach a recognizable face. to assessing professionalism requires summative and formative aspects. Residents must receive feedback on a regular basis and have the opportunity to alter unacceptable 7L 5 A systematic approach to assessing professionalism or undesirable patterns of behaviour before assessments Patricia M Surdyk* and Susan R Swing (Accreditation Council for of professionalism are used for summative evaluation. Graduate Medical Education, 515 No. State Street, Suite 2000, Chicago, IL 60610, USA)

Session 7M: Outcome-Based Education

7M 1 The Tecnológico de Monterrey School of Medicine’s Medical school curricula are either traditionally discipline- competence-based curriculum with emphasis in based, or use a problem-based (systems) structure, or an professionalism: design and implementation of outcome-oriented approach. At first glance, these concepts appear mutually exclusive. Taking into longitudinal and integrative development of consideration the multi-dimensionality of medical practice, professionalism competencies we developed a new curricular architecture integrating the Claudia Hernández Escobar, Leticia Elizondo Montemayor*, three dimensions. The existing discipline-based Graciela Medina Aguilar, Antonio Dávila Rivas and Angel Cid García curriculum was mapped and reconstructed according to (Tecnológico de Monterrey School of Medicine, Via Asinaria No interdisciplinarity and to the outcome-dimension (i.e. skills, 202, Col. Fuentes del Valle, San Pedro Garza García, Nuevo León attitudes, biopsychosocial continuum). Faculty described CP 66220, MEXICO) their currently offered instructional 1h-units, including title, free-text description, diagnostic coding (ICD-10 list) and We have an 11-outcome model where professionalism symptoms coding (list of 286 major health care problems). related competencies are gradually developed in a In addition, each unit could be rated by the respective longitudinal way through all the courses of the career. We chairperson whether it should preferably be placed into have established three levels of development: 1. The basic discipline context or multidisciplinary context, and whether level (BL), in which the student observes and imitates the it should be mandatory, elective or dismissed. Data from professional behavior set by his teachers; 2. The 2,960 instructional units (78% of entire program) containing intermediate level (IL), in which the depth of concepts 11,489 diagnostic/symptom codes were entered into a increases and the rationale of professional behavior Microsoft Access(R) database. Disciplines were inspected expected from the student by patients and society is met, regarding coding intensity and their use of the rating option. and 3. The advanced level (AL), in which the concept and Then, clusters of codes were extracted, yielding practice of professional behavior becomes part of the approximately 100 multidisciplinary (5-7 units) modules student’s career and professional life. The implementation (“competence fields”). Examples include “Myocardial of profess-ionalism competencies includes the following infarction II”, “Aging problems I: Osteoporosis, hip fracture”. activities: I. Design of working elements; II. Training and These competence fields will be longitudinally integrated inclusion of participants, longitudinal tutors and into the curriculum, running parallel to (and in partial establishment of a Professionalism Committee; III. Design overlap with) the revised discipline-based courses. of the evaluation system, and IV. The development of professionalism competencies in every course of the career. The curriculum considers professionalism 7M 3 Required levels of competence in clinical skills at competencies essential to the training of medical doctors different stages of the undergraduate medical and to the restoration of the distinctive vocation of Medicine. curriculum I Treadwell*, J D Makin, J Blitz-Lindeque and P T Kenny (University 7M 2 The Competence-based Curriculum Concept of of Pretoria, Skills Laboratory, Faculty of Health Sciences, PO Box Cologne (4C) – a curriculum mapping procedure to 667, Pretoria 0001, SOUTH AFRICA) integrate discipline, problem and outcome-based Aim: Compile a list of clinical skills required at the exit level learning of the undergraduate medical curriculum with their levels S Herzig*, C Stosch, S Kruse, M Eikermann and R Mösges of competence expected of students at different stages of (University of Cologne, Department of Pharmacology, Gleueler training. Strasse 24, 50931 Koeln, GERMANY)

– 4.71 – Section 4

Summary of work: Chairpersons of the academic blocks Manager, Scholar, Health Advocate, and Professional. The edited relevant parts of an existing skills list. The level of identified competencies were then implemented into the competence for each skill was rated from 1 to 4 (adapted standards for program accreditation, specialty training Nijmegen Scale). A pilot study was done to determine the objectives, and evaluations. We describe the rationale, perceptions of general practitioners (senior and junior) and methodology, and development of the CanMEDS final year medical students on the required level of competency framework. Lessons from this process and its competence at exit level for each of the listed skills. ongoing advances will be presented. Summary of results: The average competence rating per skill of each of the three sample groups showed differences from faculty’s rating for 38% (145) of the 380 listed skills: 7M 5 Designing the undergraduate medical curriculum to senior doctors’ (29%), junior doctors (23%) and students reflect postgraduate competencies and societal (23%). The block chairpersons reconsidered their ratings needs and in some instances were convinced to make changes P Niall Byrne, Ian L Johnson, Anita Rachlis, Jay Rosenfield*, Xerxes accordingly. Punthakee, Katherine MacRury and Barbara McRobb (University Conclusions/take home messages: Faculty members, of Toronto, Faculty of Medicine, Centre for Research in Education, students and medical practitioners have different views on at University Health Network, 200 Elizabeth Street, 1ES565, the levels of competence students should have at exit level. Toronto, Ontario M5G 2C4, CANADA) The study led to the reconsideration of skills and levels of competence expected by faculty and awareness of Social accountability implies a reciprocal relationship misconceptions students may have on the importance of between the Faculty of Medicine and the community. One of the major aims of this accountability is that the Faculty of learning certain skills. Medicine graduate physicians are capable of meeting societal needs through their changing roles and their knowledge, skills and attitudes. Within the past decade 7M 4 Development of a National Framework of Needs-based landmark initiatives defining the physician’s roles from a Competency Standards: The CanMEDS project societal perspective have stemmed from the Educating Jason R Frank*, Nadia Mikhael and Gary Cole (Royal College of Future Physicians for Ontario (EFPO) project, the Royal Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, College of Physicians and Surgeons CanMEDS 2000 Ontario K1S 5N8, CANADA) project and the College of Family Physicians of Canada Four Principles of Family Medicine project. The latter two Contemporary medical organizations worldwide are faced projects validated the roles of the physicians as medical with the challenge of reexamining their competency expert, communicator, collaborator, manager, scholar, standards to ensure that they meet the needs of the health advocate and professional. The University of societies they serve. The Royal College of Physicians and Toronto, Faculty of Medicine is reshaping the overall Surgeons of Canada is responsible for setting the standards objectives of its undergraduate medical curriculum based for all 59 medical and surgical specialties across the on the integration of the CanMEDS competencies and the country. Since 1996, the RCPSC has adopted a framework Family Medicine Principles. Two goals will be of core competencies that were systematically derived from accomplished: (i) The undergraduate and postgraduate the needs identified by experts and the public. These programs, having common objectives, will be integrated competencies were organized around seven “physician and (ii) graduates will be trained in roles that are responsive roles”: Medical Expert, Communicator, Collaborator, to societal needs.

– 4.72 – Section 4 Session 8A: Assessment General

8A 1 Quality assurance in developing multiple choice the Faculty of Health and Life Sciences of the Pompeu questions Fabra University in Barcelona. We created a 60 item MCQ test with two questions for each subject that the participants Andreas Stein*, Waltraud Georg, Kira Flemming and Katharina had studied. The questions were selected from previous Crolow (Humboldt Universität, Reformstudiengang Medizin, real exams and we chose those that appeared to be easier, Charité, Schumannstr 20/21, 10117 Berlin, GERMANY) in order to set an allegedly very easy exam. From the 60 Matching what is being learned and taught with what is students that form the group, 39 anonymous volunteers being assessed is of significant importance for the answered the test. The results confirm the existence of a relevance of assessment. Procedures with review remarkable forgetfulness since 31% of the students did commitees and internal workshops in developing multiple not attain 50% of the maximum mark and only 2 students choice questions were implemented at the reformed (5%) achieved 70%. Also, in most of the cases, the number medical curriculum (RMC) at Charité, Berlin. These of students who answered correctly each question was procedures are a means for quality assurance of the lower than in the previous exams. The forgetfulness was educational process. We present our faculty experience more or less important depending on the subject and the with structure, process and outcomes of these kind of question. implemented tools: 1 formation of review committees 8A 4 Assessing medical students’ communication skills 2 training of committee members by using drama students as simulated patients 3 evaluation of the quality of questions Jørgen Urnes*, Hilde Grimstad and Bjørn Rasmussen (NTNU, 4 feedback on item characteristics Faculty of Medicine, Department of Community Medicine and 5 introduction of periodical workshops for review General Practice, MTFS, N-7489 Trondheim, NORWAY) commitee members Aim: To present an assessment method of communication 6 introduction of periodical workshops for item writing. skills using drama students as simulated patients. Summary of work: Previous assessment of communication skills by evaluating a live interview with a patient demanded 8A 2 The first partial test note as an assessment tool of large logistic resources for the faculty, did not offer a good performance in first year medical students opportunity to test students’ skills in dealing with patients’ emotions and gave unequal conditions for the students. An Carlos E de la Garza-González*, Maria Esthela Morales Pérez and approach using simulation methodology was initiated in Norberto López Serna (Facultad de Medicina, Universidad co-operation between Faculty of Medicine and the Autónoma de Nuevo Leon, Administracion de Correos no 3, Department of Drama and Theatre. A drama professor and Apartado postal no 712, 64460 Monterrey N.L., MEXICO) a medical doctor instructed drama students to develop Aim: Analyze the effectiveness of the first partial test note as patient roles that matched their age and appearance. a predictor of performance. During the exam the drama students acted as patients. The medical students were asked to perform a medical Design: A retrospective, descriptive, transversal study. interview. Participants of the examination were asked to Summary of work: We analyzed the students’ first test results evaluate their experience in a questionnaire. (n=386). Nine subgroups were organized according to the Summary of results: Students (93%) and censors (92%) notes: experienced the simulations as “real”. Logistic workload • Group 1: 90 to 104 (n=15); Group 2: 80 to 88 (n=43); was reduced. Interaction between teachers at the Medical Group 3: 70 to 78 (n=49); Group 4: 60 to 68 (n=85); Faculty and Department of Drama and Theatre gave Group 5: 50 to 58 (n=79); Group 6: 40 to 48 (n=57); increased insight in role-play methodology for the purpose Group 7: 30 to 38 (n=36); and Group 8: 20 to 28 (n=18); of training and assessing communication skills. and Group 9: <20 (n=4). Conclusions: Drama students simulating patients are Summary of results: For group 1,100% passed the course; experienced as patients to a large degree. Our experience 98%, 96%, 86%, 76%, 40%, 31%, 17%, and 0%, encourages further co-operation. respectively for groups 2 through 9. 104 out of 107 (97%), passed the course when they obtained 70 or higher. 133 of 164 (81%) whose notes were between 50 and 68 also 8A 5 What contributes to the variance in NBME subject passed the course. When the note was below 50, the exam scores and recommended grades from number of those passing considerably decreased to 37 of teachers? A 10-year clerkship analysis 115 (32%). Steven J Durning*, Louis N Pangaro, Paul A Hemmer and Gerald D Conclusion: According to our results, we consider the note Denton (Uniformed Services University, Dept of Medicine (NEP), of the first partial test as an assessment tool for predicting 4301 Jones Bridge Road, Bethesda, MD 20814, USA) performance in embryology. Aim: To determine which measurements contributed to the variance in NBME medicine subject examination performance and recommended teacher grades (total 8A 3 Knowledge acquisition and forgetfulness in health teacher points). sciences students Summary of work: Prospective, 10-year study (1990-2000). Maria Escriva, David Cid, Eva Bailles and Jorge Perez* (Facultat Potential independent variables were categorized as pre- de Ciencias de la Salut i de la Vida, Universitat Pompeu Fabra, c/Dr clerkship, during-clerkship, and post-clerkship. We Aiguader 80, 08003 Barcelona, SPAIN) calculated mean scores for each measurement and Experts in education manifest the importance to achieve analyzed this data using ANOVA and linear regression. the ability to get information, that is, learn how to learn, Summary of Results: Data were available for 1,632 (98%) even more than acquiring concrete knowledge itself. One students. Total clinical points followed a normal of the most quoted reasons is that factual knowledge is distribution. easily forgotten. The aim of our study is to establish the forgetfulness of basic knowledge among the students of

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10 year stepwise linear regression (year-to-year range): Summary of results: In 14 statements female doctors rated their performance lower than male doctors did. The Total Teacher Points R2 patients, however, rated the female GPs similar, or in nine Pre-clinical GPA .18(0-.35) statements even higher, than male GPs. The co-factors, z-Multi-step +.04(0-.20) surgery and status of the GPs (registrar or principal), did z-NBME +.01(0-.01) not show significant influences of the response behaviour. Total .18-.35 Conclusion: We found a strong gender-related bias in the self-perception of performance, which was of variance with z-NBME Points R2 the perceptions of the patient group. Group differences GPA .27(0-.42) should be taken into account during the analysis or z-pretest +.07(0-.40) interpretation of self-assessment tools in education. z-lab +.02(0-.03) z-multi-step +.01(0-.02) Total-clin points +.01(0-.04) 8A 8 Matching criterion-based student self-assessment Total .07-.53 with teacher assessment: is there coherence? Conclusions: What a student “brings” to the clerkship (GPA) Araceli Hambleton-Fuentes*, David Cantú and Leticia Elizondo- is most strongly associated with these outcome Montemayor (School of Medicine, Tecnológico de Monterrey, Ave. measurements. NBME exam and recommended teacher Morones Prieto #3000 Pte, Colonia los Doctores, Monterrey, grades explained a small, but significant, amount of Nuevo León CP 64710, MEXICO) variance in both models, as perceived knowledge base Background: Self-assessment must be an integral part of contributes to teachers’ assessment of learners. An student training. Is there congruence between how examination posing questions based on a videotaped teachers perceive students and how they perceive encounter (multi-step) explained a significant amount of themselves? additional variance in both measures. Summary of work: At the School of Medicine Tecnológico de Monterrey, we performed a pilot study using a criterion- 8A 6 Are medical students’ examination results affected based 39-item checklist developed for the purpose of self- by their gender and ethnicity? assessment and tutor assessment of thirty-five 3rd grade medical students. Mann-Whitney test was used; P<0.05 S Kilminster*, K Boursicot, V Wass and T E Roberts (Medical was considered statistically significant. Education Unit, University of Leeds, Worsley Building, Level 7, Clarendon Way, Leeds LS2 9JT, UK) Summary of results: We found statistical differences in items 3, 9, 15 and 20, corresponding to rubrics of knowledge Aim: To present the findings and discuss the implications application, self-study and clinical reasoning and decision- of a study investigating the effects of gender and ethnicity making skills. The significant differences showed that on practical Objective Structured Clinical Examinations students rated themselves higher than their teachers did. (OSCEs) and written examination marks at three UK Through self-assessment, students identified weaknesses medical schools. in rubrics such as collaborative work, self-study and clinical Summary of work: OSCE and written examination results reasoning and decision making skills, and strengths in of nearly 800 third year students were analysed. The study areas such as professional behavior. One of our was instigated due to some concerns that the OSCE format responsibilities as teachers is to foster student’s self- might be disadvantageous for ethnic minority students. assessment skills and to induce them into reflective practice to identify strengths and weaknesses as well as future needs Summary of results: There were small but significant – life long learning skills they will need the rest of their differences, in some examination results, between male lives. Detailed results and the way ahead regarding self- and female students or white and non white students at assessments schemes will be presented. each school. However, the amount of variance explained by the relevant variable was small ( 3-6%). Combined results from all 3 schools show no difference in 8A 9 Developing an in-training examination for performance on written examinations between males and gastroenterology fellows females or between white and all other students. There was a small difference (1.7 marks) between male and Amindra S Arora (Mayo Clinic, Department of GIH, 200 First female students’ OSCE scores but very little of the difference Street SW, Rochester MN 55905, USA) was explained by the variable gender. The development of self-directed learning skills in our GI Conclusions: These results indicate that examination fellows is a career skill. Adult learning theory demonstrates marks are not affected by gender or ethnicity. that self-directed (ABIM) learning can result in deeper sustained understanding. Re-certification examinations are now aimed at stimulating this form of learning. 8A 7 Gender differences as observation in the Aim: Our aim was to develop a validated in-training multiple assessment of performance choice examination (ITE) for our GI fellows. Regina Conradt* and Ed Peile (University of Oxford, Department Summary of work: Patient management questions were of Primary Health Care, Institute of Health Science, Old Road, developed and presented to 8 faculty members for review Headington Oxford OX3 7LP, UK) and 55 questions were selected. The questions were Background: Life-long learning is accomplished by regular further validated by asking recent ABIM board diplomats to assessment, including self-assessment. However, self- review for the content of the questions and how the perception has no absolute assessment scale. Here we questions reflected those in the ABIM. Eight weeks after highlight the fact that a basic factor like gender can make the ITE, a survey was sent out to the GI fellows. a difference. Summary of results: Eighteen of the 24 GI fellows (75%) Summary of work: The effect of gender differences in completed the post ITE survey. Ninety-four percent agreed doctors’ self-evaluation of performance was compared to that the ITE stimulated them to read more, 78% perceived their patients’ perception. We asked 33 General that the ITE identified areas of weakness in their GI Practitioners (GPs) from seven surgeries to rate their own management skills, and 72% perceived that the content of performance and compared those with ratings of 255 the ITE reflected the GI curriculum. Conclusion: This study patients (4-15 patients per GP). Both groups rated 34 similar describes the development of a validated in-training statements on a 5-point-Likert scale. We used hierarchical- examination for Gastroenterology. The examination linear-models for statistical analysis (MLwiN, http:// highlighted deficiencies in our fellows’ knowledge and multilevel.ioe.ac.uk).

– 4.74 – Section 4 patient management skills. The study demonstrated that 8A 12 Empathy as a function of gender and levels of under- the ITE stimulated independent learning several weeks graduate and graduate medical education in Mexico after the test. Adelina Alcorta G-Gonzalez*, Mohammadreza Hojat, Juan-F González-G, Jesús Ancer-R, María-V Bermúdez, Juan Montes-V, 8A 10 Clerkship preceptor handbook of core students skills Marco-V Gómez-M, A-Enrique Alcorta-G, Silvia Tavitas-H and Sheila-M Garza (University Hospital, Palo Blanco 604, Valle de Paul Hemmer (USUHS Educational Programs Division) Uniformed Santa Engracia, San Pedro Garza García NL, CP 66260, MEXICO Services University, USUHS - EDP, 4301 Jones Bridge Road, Bethesda MD 20814, USA Aim: To investigate similarities and differences on empathy among Mexican medical students by gender and level of Aim: The Handbook of student skills helps clerkship medical education. students develop proficiency in core skills. Summary of work: Participants: 1095 medical students (529 Summary of work: Based on the model of microskills women, 566 men, 687 first-year, 183 third-year, 152 fifth- training, each of four modules is covered in a 30-minute year, and 73 residents in specialty training). The Jefferson session with 3-5 students during teaching meetings. Each Scale of Physician Empathy (JSPE, versions S (for students) module defines Goals, Objectives, and provides an easy and HP (for health professionals/residents) was used. It to follow outline. The modules begin with a poorly written was translated into Spanish, by “back-translation” for HPI for a patient presenting with chest pain. Through a accuracy, and is supported by psychometrics data. series of handouts, students critique the HPI, and formulate Analysis of variance was used for statistical analyses. a more developed HPI. They are given handouts that depict both a comprehensive and focused H&P. In subsequent Summary of results: Statistically significant differences on modules, students use these H&Ps to develop an oral the empathy scores were observed in the favor of women, presentation of the case (Module 2), a problem list (Module but only at the undergraduate medical education levels. 3), and an analysis (Module 4). The case is deliberately Also, significant differences on empathy scores were found complex (an acute anterolateral MI complicated by acute at different levels of medical education. Findings generally MR and CHF; HTN, DM, and an acute GI hemorrhage), to suggested that empathy scores increased with the level of help students grapple with complexity, yet act with a degree medical education. of simplicity. Conclusions: The gender difference observed in this study Summary of results: Student feedback has generally been is consistent with findings reported with American medical positive, but students in the latter part of the academic year students and physicians. However, our findings about the progress more rapidly. positive effect of medical education in improving empathy are inconsistent with those reported for American samples. Conclusion: Modules to develop core student skills can be Further research is needed to examine factors that implemented within the core medicine clerkship. Such contribute to the improvement of empathy in Mexican and modules may also be useful for those who teach ICM a decline of empathy in American samples. courses.

8A 13 Assessment of basic practical skills in an 8A 11 Assessment of postgraduate medical courses: the undergraduate medical curriculum question of how to improve their quality S Elango*, J C Ramesh, T Motilal, L C Loh, P Kandasami and C L Beatriz Graciela Borenstein (on behalf of the Pedagogical Teng (International Medical University, Jalan Rasah, 70300 Department) (Sociedad Argentina de Terapia Intensiva (SATI), Seremban, MALAYSIA) Charcas 3026 Piso 5, Ciudad Autónoma de Buenos Aires 1425, ARGENTINA) Aim: Basic practical skills are essential competencies that students should develop during undergraduate medical The aim of this communication is to present the training. Studies have shown that the undergraduate assessment program carried out by the Argentine Society curriculum often fails to fulfill these expectations. of Intensive Care (SATI) to evaluate the quality of the postgraduate intensive care course developed in different Summary of work: The International Medical University, provinces of our country. The biannual course that is run in Malaysia, has identified a list of basic practical skills that our Capital City was audited by the CONEAU (Comisión students should be competent in. These skills are taught Nacional de Evaluación y Acreditación Universitaria), entity using models and are assessed during the overall end-of- which has given that course a high mark. However, other semester examination. The study aims to evaluate the courses which are offered by SATI throughout the country effectiveness of teaching and learning in these basic should still be improved and to do so a program to evaluate practical skills. the course´s quality has been planned. Consequently, the Summary of results: The results of 244 students who following steps were taken: participated in the last three examinations were analysed. 1 Diagnosis: Identification and analysis of problems and The mean Objective Structured Practical Examination their causes; Ranking according to their importance; (OSPE) score for the practical skill stations was Structural causes; Changeable causes; Hypothetical significantly higher than the mean overall score of the causes; Cause and effect diagram. written, practical and clinical examinations. However, the 2 Improvement strategies: Positive and negative forces; failure rate in the practical skills stations was significantly Strategies and further actions; Statement of aims and higher than the overall failure rate. goals; Expected outcomes. Conclusion: In comparison with the overall performance, 3 Monitoring plan. generally, students either perform competently or poorly in 4 Biannual appraisal. the practical skills station. The study shows that OSPE was able to discriminate the students who have learnt these According to the results, the main strategy would be to skills from those who have not. However, it is recommended certify the quality of the places where students work or that independent summative assessment may be necessary have their clinical practice. That assessment will be to ensure that all students gain competency in practical conducted by a team formed both by members of the skills. Pedagogical Department of SATI and by its educational counsellor.

– 4.75 – Section 4 Session 8B: Clinical Assessment

8B 1 A new approach to a clinical final examination 8B 3 The role of the observed long case in postgraduate C Carvajal*, M Bustamante, R Dalmazzo, J Olivos and J Vukasovic medical training (Universidad de Chile, Facultad de Medicina, Camino de la Laguna Nicholas Pavlakis and Rodger Laurent* (Department of 13452, Lo Barnechea, Santiago, CHILE) Rheumatology, Royal North Shore Hospital, St Leonards, Sydney Aim: One author (CC) participated in the 2001-2002 2065, AUSTRALIA) FAIMER program (Foundation for Advancement of Aim: To determine the value of observing a long case International Medical Education and Research ), at examination in identifying problems in the clinical Philadelphia, USA. In that Institution knowledge and support assessment of patients by junior medical staff. were obtained in order to create a new method for medical students’ final assessment. The goal of this presentation Background: Assessment of long case examination is to describe the method and to show the results of a pilot technique emphasises problem identification and application. discussion of management. It assumes that history taking and physical examination skills are adequate. These can Summary of work: Six Standardized Patients (SP) portrayed only be assessed by directly observing the long case common diseases. Twelve students interacted with each examination. SP during a period of 15 minutes. A faculty member was present and completed a checklist during the encounter. Summary of work: We used a structured assessment form After, the student completed a clinical form. The checklists to observe and evaluate the overall long case performance and forms results were evaluated. The SP completed a of nineteen doctors in their fourth post graduate year. written survey after the experience. Summary of results: There were deficiencies in some part Summary of results: 68.7% of students correctly identified of the examination for the majority of doctors. These were the medical plan. 16.6% of students failed in history taking. not always detected during a formal presentation of the SP evaluation: 14% of SPs did not understand the medical case. Three had inadequate history taking skills and five language used by the students. 18% of SPs did not get had inadequate physical examination skills. The enough information related to their medical condition. commonest problems included poor time management, excessive time required to take the history and lack of Conclusions/take home messages: This method can organisation of questions. Physical examination was effectively identify students’ medical skills and abilities. It usually poorly organised, requiring the use of short cuts, is possible to use it in our medical school. It is necessary to particularly in the respiratory, musculoskeletal and use an objective method of assessment in order to obtain neurological systems. a medical degree. Conclusion/take home message: The observed long case allowed for detection of defects in history taking and 8B 2 The relationship of examination candidate physical examination skills and time management. These deficiencies are not often detected on formal presentation performances between the Medical Council of of the case. Canada’s (MCC) computer-based examination and the MCC clinical skills examination D E Blackmore*, T J Wood, W D Dauphinée, S M Smee and A P Boulais 8B 4 Medical students perceive the OSCE as a fair re-sit (The Medical Council of Canada, 2283 St. Laurent Blvd, Ottawa, assessment tool Ontario K1G 3H7, CANADA) J Syme-Grant* and P A Johnstone (NHS Education for Scotland, Aim: In order to receive the Licentiate of the Medical Ninewells Hospital and Medical School, Postgraduate Office, Level Council of Canada (LMCC), an examinee must successfully 7, Dundee DD1 9SY, UK) pass a one-day computer-based examination (MCCQE Aim: To report a paper on the perception of fairness of an Part I) and a 14-station OSCE known as the MCCQE Part OSCE as a re-sit examination. II. The MCCQE Part I is most often taken at the end of the MD degree while the MCCQE Part II is usually taken at the Summary of work: All candidates immediately following the end of 12 months of postgraduate training within a clinical 4th year resit OSCE at Dundee were canvassed for their setting. The aim of this presentation is to show that a written opinion. A simple questionnaire asked if they regarded the examination is not a clear predictor of performance on a OSCE as a fair assessment of their abilities. ‘Yes’ and ‘No’ clinical examination. categories were chosen. Those that answered ‘No’ were invited to explain why. Summary of work: Examinees (n = 2078) who have successfully passed the MCCQE Part I since the fall of Summary of results: Response rate was 100% (30 students). 2000 and attempted the MCCQE Part II were analyzed in 80% of students felt the OSCE to be fair. Of the six who felt order to ascertain if any systematic relationships were the OSCE to be unfair, three indicated time shortage as appearing on varying aspects of the two examinations. The their principle reason. Two students raised the possibility clinical skills results (communication skills, data gathering of poor performance on the day and only one felt the OSCE skills, and clinical decision making) were contrasted with included inappropriate material. Four students failed the discipline scores, written clinical reasoning/decision exam. The relationship between students’ perception of making skills, and total scores obtained from the MCCQE fairness and passing or failure is unlikely (p=0.788). Part I. Conclusion: Students feel well constructed OSCEs are a Summary of results: The results show that examinees with valid method of re-sit clinical assessment. moderately high knowledge may not possess the wherewithal to perform adequately in a clinical setting. Conclusion: Knowledge on a multiple-choice or written 8B 5 Easy as ‘pie’ - improving OSCE instructions examination is not a clear predictor of performance on a Cynthia Yiu, Martin Mueller* and Michael Marsh (Guy’s, King’s clinical examination. and St Thomas’ Medical School, 5 Lambeth Walk, London SE11 6SP, UK) Background: OSCE stations frequently assess integrated skills and it is important that, given the short time frame, students understand what is being assessed. Evaluation

– 4.76 – Section 4 from both students and examiners highlighted that students 8B 8 Introduction of objective structure clinical examination were sometimes not clear despite written instructions and (OSCE) at TashPMI and subsequent evaluation that there was a need to make the focus of the stations better understood. Dilbar A Mavlyanova* and Muazam A Ismailova (Tashkent Pediatric Medical Institute, J. Obidova Street 223, Tashkent Summary of work: We developed a pie chart to accompany 700140, UZBEKISTAN) station instructions which were coded to illustrate the proportion of marks allocated to skills divided: Aim: To improve the methods of assessment clinical skills communication, clinical examination, history taking and in medical education. practical skills. This was used in a Year 3 - first year clinical Summary of work: ‘Questionnaires to registrars (100), and OSCE. We chose a black and white format to avoid final year medical students (400) on the usefulness of the difficulties for colour blind students. We asked the students OSCE as a method of assessment. whether they found the charts useful in an evaluation questionnaire after the OSCE. Summary of results: 93% of respondents found the OSCE is many-sided and multipurpose. All of the registrars and Summary of results: 90.3% of the students responded. students evaluated the OSCE as being educational, 57.8% agreed the charts were useful whereas 14% enjoyable and “ remarkably different” from the former disagreed. Free text indicated that students found the black methods used in summative assessment. The major and white format difficult and would prefer colour. strengths of the OSCE organization mentioned were: Conclusion: The innovation was positively received but the Process of preparing OSCE is realized; OSCE sub-group issue of using colour coding which potentially is created; Examination process is provided by a bank of disadvantages some students remains unresolved. stations and necessary paperwork; Each station is designed to test a different skill; Direct discussion and the immediate verbal feedback face to face are provided after 8B 6 Re-using an OSCE station and its re-take each station. The considered areas for improvement were: Undetailed scenario of any problems; Short interval of time Leila Niemi-Murola, Pirkko Heasman*, Markku Kaipainen, Timo given on each station (10 minutes); Not many steps for Kuusi and Kirsti Lonka (Research and Development Center for realization of diagnostic procedures and tests. Medical Education, Helsinki University, PO Box 63, FIN-00014, FINLAND) Conclusions: The OSCE is a new and important element of assessment of clinical skills for medical students in Test security and sharing of information by students have Uzbekistan, but as it was estimated, its usefulness is been a concern when the OSCE stations are used several recognized not only by education professionals, but even times. We test the entire class of 90 fifth-year students and, by registrars and medical students. The considered areas for practical reasons, the test takes three days. According for improvement should be taken into account during wider to our experience, there have been no linear trends during dissemination of the formative and summative these days suggesting sharing of information. According assessments. to previous studies, stations testing communication skills are less affected by possible shared information than are stations testing clinical skills. Skills a student uses to 8B 9 Analysis of questionnaire survey of raters, students approach a patient should not change even if the patient’s and standardised patients on the 12-station OSCE complaints are known. Thus, we tested this hypothesis by having a re-used psychiatric OSCE-station in a re-take for used at the Kurume University School of Medicine those who had failed this particular station previously. The Takato Ueno*, Ichiro Yoshida, Hiroki Inutsuka and Michio Sata profiles of the stations in OSCEs 2001, 2002 and re-take (Research Center for Innovative Cancer Therapy, Kurume were very similar. The results are discussed in the University School of Medicine, 67 Asahi-Machi, Kurume 830- framework of developing expertise in medicine. 0011, JAPAN) Summary of work: Objective Structured Clinical Examinations (OSCE) covering 12 subjects were carried 8B 7 Assessing nurses’ clinical skills with OSCE out among fourth year medical students at the Kurume A Molins*, M Solà, A M Pulpón, S Juncosa and J M Martinez- University School of Medicine. The subjects were medical Carretero (Institute of Health Studies, Balmes 132-136, 08008 interviews, writing medical records, diagnostic imaging, Barcelona, SPAIN) physical examinations for head, neck, chest, heart sound, abdomen, neurological system and vital signs, basic Since 1995 the Insitute of Health Studies has been surgical skills, cross matching and resuscitation. After assessing clinical skills of Catalan nursing students. In the completion of the OSCE, a questionnaire survey directed 2002 OSCE experience, 144 students in the final year to raters, students, and standardised patients (SP) was nursing degree belonging to the Nursing Schools of performed. Barcelona University, Mar, Sant Pau, Tortosa, Blanquerna, Vic, Manresa and Girona took part in a 13 SP simulators- Summary of results: The results indicated that the 12-station based case (24 stations) OSCE. The clinical situations OSCE, in which each subject takes 5 minutes along with a were selected to reflect the settings in which nurses feedback time of 1.5 minutes, was generally well accepted normally practise and the competence components by raters, students, and SPs. Problems mentioned included analysed were: team work, history taking, identification of the content of subjects and the necessity for an patients’ problems and planning therapeutic strategies, intermediate break, and the possibility of requiring a clinical intervention, preventative activities, communication physical examination by SP as part of the OSCE was skills and teaching abilities. Ethics skills, research and considered. clinical knowledge were examined with a MCQ, to complete the individual total score. The mean percentage of scores obtained by students was 59.7 with a standard 8B 10 Clinical skills assessment at medical schools – deviation of 5.0. Identification of patients’ problems and Catalonia (Spain), 2002 planning and management of therapeutic plans were the components in which students obtained the lowest scores E Kronfly, L Gràcia, X Julià, J Majó, J Prat, A Castro, J A Bosch, A and the highest scores were found in team work. The Urrutia, J L Gimeno, C Blay and R Pujol* (Institute of Health purpose of that experience can guide further research in Studies, Balmes 132-136, 08008 Barcelona, SPAIN) order to: modify present cases, incorporate new cases and Background: The Institute of Health Studies jointly with the begin a formative OSCE with some nursing schools. Catalan Medical Schools have conducted several projects on Clinical Skills Assessment using OSCEs since 1994.

– 4.77 – Section 4

Summary of work: In 2002 an Objective Structured Clinical or by pathologies. The results from 927 practical exams Examination (OSCE) to assess clinical competences for were analyzed in 2001 and 610 practical exams in 2002. final year medical students was used in six Catalan Medical This was accomplished on the basis of the scores obtained Schools. A multiple-station examination, with 14 cases from the scoring guide that was used, as well as from the distributed in 20 stations, and a written test, composed of groups of pathologies faced by the students. 150 MCQ (20 questions with pictorials associated), was designed to assess medical competences. Summary of results: Results showed that regular students’ performance was higher than that from students whose Summary of results: The OSCE scored highly on internal academic history was longer than the five years taken by consistency with a Cronbach’s alpha = 0.82 for the multiple- the regular students. The confidence interval value was station examination and 0.76 for the written test. The global 0.987 and 0.944. The highest performance was obtained mean score for the test was 60.8% (sd: 5.9). The mean in the Pediatrics field. Pathologies with the highest scores, obtained by the 429 medical students who performance were the very common ones, such as completed the OSCE, for every specific competence diabetes and hypertension. A similar situation was found in assessed, were as follows: history taking 61.1% (sd: 9.2), the practical phase. It is concluded that professional physical examination 51.2% (sd: 8.8), communication skills exams allow the integral evaluation of clinical competence. 67.0% (sd: 6.3), knowledge 59.0% (sd: 8.7), diagnosis and problem-solving 59.7% (sd: 8.4), technical skills 72.2% (sd: 11.9), community health 59.4% (sd: 11.4), colleague 8B 13 Rater disagreement in OSCE relationship 47.8% (sd: 10.1), research 69.4% (sd: 17.8) and ethical skills 71.0% (sd: 14). J M M van de Ridder*, V Batenbrug, J Buis, V Eijzenbach, F J M Grosfeld and M M Kuyvenhoven (University Medical Centre Conclusions: OSCE based methodology has proved to be Utrecht, VaardigheidsOnderwijs B.00.118, PO Box 85500, 3508 a feasible, valid and reliable tool to evaluate final year GA Utrecht, NETHERLANDS) medical students in our context. Background: Often rater disagreement is a problem when using Objective Structured Clinical Examinations (OSCE). 8B 11 The relationship between performance on a third-year Aim: The aim of this study is to obtain more information medical student OSCE and performance on the about causes of interrater and intrarater reliability. Different USMLE step 1 examination sources of rater disagreement and methods of self- regulation used by raters during their observation of clinical Kelly Kirby Ortega*, Neena Natt*, Robert Tiegs and Jay Mandrekar skills will be discussed. Summary of work: 13 raters of (Mayo Graduate School of Medicine, Mayo Clinic, 200 First communication and physical examinations skills were Street SW, Rochester MN 55905, USA) subjected to an oral interview. Causes of rater Aim: To determine the relationship between performance disagreement were determined by evaluating their on a 3rd year medical school OSCE and performance on reactions to open-ended questions. Rater statements were the USMLE Step 1 examination. divided, selected, labeled and categorized according to the theory of Glaser & Strauss. Influencing factors were Summary of work: Eighty-eight Mayo Medical School defined out of 402 statements: students, subjects, time, students completed an eight station OSCE between March standardized patients, raters and methodological aspects. 2000 and July 2001. Their performance on this exam, If raters were aware of influences while rating they used represented by two scores (data gathering and different methods of self-regulation: they formulated own interpersonal skills), was compared with their 3-digit score rules and used personal standards. on the USMLE Step 1 examination. Conclusions: It is concluded that among raters of Summary of results: The distributions of OSCE scores in communication skills and physical examination skills the data gathering and interpersonal skills and the 3-digit influencing factors differed. The findings have resulted in USMLE step 1 score did not follow a normal distribution. improved instructions for both raters and standardized Hence Spearman’s rank correlation as a non-parametric patients correlation was calculated. Both the correlation between the OSCE data gathering scores vs. the 3-digit score on USMLE Step 1 and the correlation between the OSCE 8B 14 Practical assessments used in preparing students interpersonal skills scores vs. the 3-digit score on USMLE Step 1 (-0.04) were not statistically significant, at a 5% for their clinical year level of significance. G Till* and H Till (Canadian Memorial Chiropractic College, 1900 Bayview Avenue, Toronto ON M4G 3E6, CANADA) Conclusion: Performance on the USMLE Step 1 examination does not correlate with performance on a 3rd Students from the first year onwards at the Canadian year OSCE. This is not surprising given that the focus of Memorial Chiropractic College spend increasing amounts the USMLE Step 1 examination is on knowledge and of time observing interns in the clinic dealing with patients. interpretation of basic principles in health and disease, However, they get very little experience in working-up whereas the OSCE is designed to assess clinical skills patients themselves prior to their year of internship. It was such as history-taking and physical examination. therefore not surprising that students found it difficult to make the transition from classroom to patient care. Previous attempts to identify students’ preparedness for the clinic 8B 12 Professional exam: an integral clinical exam with had centered on clinic entrance OSCEs. However, these real patients summative assessments neither adequately identified those students lacking basic history-taking and physical Maria Eugenia Ponce de León*, Armando Ortiz Montalvo and Maria examination skills, nor did they leave sufficient time for del Carmen Ruiz (National Autonomous University of Mexico, remedial action prior to the start of the internship. Therefore, Medical School, Camino Santa Teresa 277 Casa 15, Bosques del a form of assessment that not only more closely simulated Pedregal, Delegación Tlalpán, CP 14010, MEXICO) the doctor/patient encounter, but which at the same time Summary of work: A descriptive, transversal study was gave the student experience in performing these tasks for carried out in order to analyze the results from two different clinical disorders, was developed. In this way, the professional exams (theoretical-practical) corresponding new assessments became formative in nature, and by to the years 2001 and 2002 in the School of Medicine being held about every 4 weeks, allowed ample time for (Facultad de Medicina) of the National Autonomous remediation throughout the course of the year. This paper University of Mexico (UNAM). 1185 students participated describes how these assessments are conducted, and how in these exams in 2001, and 1159 in 2002. The results they form part of a new integrated curriculum for the pre- from the theoretical exam are presented: confidence clinical year. intervals and total simple frequencies by field and subject

– 4.78 – Section 4 Session 8C: The Curriculum (1), including Multiprofessional Education

8C 1 Oncology – an interdisciplinary course curriculum; (2) To survey the physicians’ style of journal C Haag*, H Alheit, M Baumann, O Hakenberg, U Wehrmann, M reading. Wirth and G Ehninger (Medical Faculty, Dresden University of Summary of work: A structured interview was carried out Technology, Medizinische Klinik 1, Universitätsklinikum Carl among medical students and physicians at Hatyai Hospital Gustav Carus, Fetscherstr. 74, 01307 Dresden, GERMANY) (a 700-bed referral center). The questionnaire included (1) demographics of interviewee; (2) opinion on CE At Dresden’s Medical Faculty we implemented during the teaching program; (3) journal reading habits; (4) evaluation last years our DIPOL – programme (Dresden integrative of basic understanding in study design and statistical patient/problem oriented learning) for the students in the values. 3rd and 4th year. In 2002 we started to extend this programme for the 5th year students, beginning with a Summary of results: A total of 68 interviewees answered course in oncology. The aim of the course was to realise the questionnaire. 60.3% have learned the basic of CE. interdisciplinary teaching, combining the different aspects Most medical students have never learned it before, of cancer aetiology, diagnostic and therapy. The curriculum significantly different compared to physicians (<0.001). of this course included topics of basic and clinical science, 97.1% agreed with the implementation of this program. lectures in epidemiology, palliative care, medical The main advantages were: supporting evidence-based psychology and quality of life. The course consisted of medicine (EBM) 89.7%. The start of the program should lectures, tutorial, exercises in patient-doctor be in the preclinical level 39.7%; clinical level 54.4%; and communication and multistations. Each case in the post-graduate level 4.4%. Regarding behavior of journal tutorials had different major topics in aetiology and reading style, after reading the title and objective, the next principles of therapeutic procedures. The multistation favorite parts were results (35.3%) and conclusions sessions were focused on one cancer with minicases to (30.9%). The least favorite part was methodology (50%). teach the different diagnostic and therapeutic procedures However, they realized that it was the important part. The in the different stage of disease. Some of the lectures were contents of research methodology should include study interdisciplinary with two or three experts teaching together design (45.6%), biostatistics (33.8%). in a lecture, but each form his point of view. With this course Conclusions/take home messages: Most of the physicians we demonstrated, that it is possible to teach oncology agreed with the CE teaching program in the medical interdisciplinarily and to reflect with this approach the curriculum and the contents should include study design modern treatment of cancer. The complete course and and biostatistics. The journal reading style found that results the evaluation will be presented. and conclusions were read and research methodology was frequently skipped. 8C 2 Palliative care in the medical curriculum at Bern, Switzerland: when and how 8C 4 From classic to modern: developing a new teaching S Eychmueller (Kantonsspital St. Gallen, Palliativstation, strategy in epidemiology Rorschacherstr. 95, 9007 St Gallen, SWITZERLAND) Irina Brumboiu*, Ioan S Bocsan, Amanda Radulescu and Ofelia Aim: To demonstrate the use of the Palliative Education Suteu (Iuliu Hatieganu University of Medicine and Pharmacy, Assessment Tool (PEAT) for identifying Palliative Care (PC) Epidemiology Department, 13 Emil Isac Street, 3400 Cluj-Napoca, content in the existing curriculum, and to argue for an ideal ROMANIA) localisation and teaching methods. Aim: Teaching Epidemiology as a basic science in Summary of work: PEAT was administered on the internet- preventative medicine efficiently and attractively has been version of the medical curriculum of Berne. Methods and our main concern for the last decade. content of existing and future PC issues were elaborated with special focus on multiprofessional learning. Summary of work: In 1993 we started teaching Basic Epidemiology plus PHC (one semester in the second year), Summary of results: PEAT filtered out 17 different teaching followed by Epidemiology of communicable and non- sessions (> 33hours) from year 1 to 6. Specialities communicable diseases (one semester in the final year) responsible for the training range from family medicine to during 37 hours of lectures and 37 hours of practical psychiatry and there may be doubt that PC is taught in a training. New methods were also implemented (case comprehensive manner. An ideal blueprint would focus studies, PBL). (a) on a “palliative thread” integrated repetitively into clinical cases and problems in the 4th and 6th year, and (b) on a Summary of results: The very compliant and interested multiprofessional workshop in the 6th year in order to “use” students gained much higher marks then previously, despite PC as a vehicle to foster team-working skills. the MCQ method of exam replacing the formerly used oral examination. Every summer students voluntarily participate Conclusions/take home messages: PEAT is a useful in field trials (e.g. the trial on cardiovascular diseases risk instrument to uncover “hidden” content regarding PC. factors involving 10,000 inhabitants in 1997). The implicit Improved coordination of PC-content (symptom control) effort of involved faculties helped two of them to get an A and special attention to multiprofessional team-work could mark (the only CEE candidates getting A) when competing help to prepare students much better for a future for MPH scholarships in the USA in 1998. confrontation with far advanced disease and dying patients. Conclusions/take home messages: Our experience proved this reform can strengthen undergraduate community- oriented medical education and focused on prevention. 8C 3 Survey of clinical epidemiology teaching program Two other Romanian medical schools are successfully need in the Thai medical curriculum implementing the same model of teaching epidemiology. Pairoj Boonluksiri (Hatyai Hospital, 182 Rattakam Road, Hatyai, Songkhla 90110, THAILAND) Aims: (1) To survey the learning need of the clinical epidemiology (CE) teaching program in the Thai medical

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8C 5 Community based education: strategies for effective Aim: To describe the structure, content and evaluation of student commitment the undergraduate course “Early Professional Contact (EPC)”. R G Souza, F Menezes*, L M Camarotti and J Araujo (Federal Univesity of Roraima, Caixa Postal 495, Centro, Boa Vista- Summary or work: In 2001 the first EPC course started with Roraima, ZC- 69301-971, BRAZIL) the aim to introduce the students to the physician’s role and to everyday clinical work to give knowledge, skills and Summary: The Federal University of Roraima-Brazil, inspiration for their future work and motivation for their pre- changed its medical curriculum to a PBL/community clinical studies. The course is given during the first four oriented model, but there was some resistance of the terms and we use small-group learning with the intention students towards community practices. In order to change to introduce and improve skills such as observation, that, the school adopted a strategy of early commitment, description, empathy, problem-solving, cooperation and based on not letting the student become “contaminated” reflection. After each year a course evaluation by the hospital before arriving at the community. An questionnaire is made. integration between curricular content and the Brazilian Family Health program was created, based on a schedule Summary of results: Two questionnaires have been beginning in the first year, with progressive involvement on administered. The students have reported a high degree health actions. A symbolic approach was introduced using of satisfaction with their tutors and the possibility to meet the first day of medical school to enrol the new students in doctors, staff and patients. They also report increased tasks related to particular selected cases that would arouse confidence when meeting with patients. interest. Training of the Family Health Program Conclusion: First year medical students have been professionals on PBL principles permitted the presentation introduced into their future profession by working together of every day community health problems in a stimulating in small groups and with a tutor. The students have way. expressed a high degree of satisfaction with the course. Conclusions/take home messages: (1) Medical schools aiming at community based education should integrate their curriculum to the local community health program; 8C 8 Early introduction of family medicine during (2) Training of the community health team on PBL undergraduate medical training principles will allow the students to relate to the community M I Nurjahan*, CL Teng, K Y Loh, A R Yong Rafidah, S K Kwa, M L health program in a more stimulating way; (3) Delaying the Young, L C Lai, K H Ong and P C Y Chen (International Medical encounter with the community influences the student towards the hospital practice. University, Clinical School, Jalan Rasah, 70300 Seremban, Negeri Sembilan, MALAYSIA) Aim: This paper describes the objectives, educational 8C 6 Biologic threats to society: successful integration of processes, evaluation and challenges in implementation a longitudinal theme into the medical school of a pilot programme where International Medical University curriculum (IMU) medical students attend a five-day attachment to a John F Mahoney*, Kathleen D Ryan and Steven L Kanter (University general practice (GP) in year one. of Pittsburgh School of Medicine, Office of Medical Education, M- Summary of work: With changing trends, medical 211 Scaife Hall, 3350 Terrace Street, Pittsburgh PA 15261, USA) educationists recommend more emphasis on community- based education. This new programme implemented in Background: 21st century society faces emerging threats 2002 introduces family medicine early in the IMU to individual and societal health: biochemical/radiological undergraduate medical programme. Introductory lectures terrorism, emerging/resistant infections, food/water were given. The learning was mainly experiential where contamination, psychosocial effects of terrorism, and students carried out tasks at the GP and maintained a technologic threats (computer viruses). Successful simple portfolio. A debriefing was held after the attachment. mitigation of these threats depends on prompt recognition Evaluation of the programme using a semi-structured and reaction. The ultimate goal of this longitudinal questionnaire was obtained from both students and general curricular initiative is to prepare graduating medical practitioners. students to respond to the challenges posed by biologic threats to society (BTS). Topic-related principles are core Summary of results: Eighty-two percent of students provided elements of existing curricula: public health, epidemiology, feedback. Of these, 90.2% said they received satisfactory infectious diseases, pharmacology, toxicology, emergency supervision from GP tutors and about 88% felt they have a medicine. better understanding of family medicine. However, some reservations was expressed on the amount of clinical Summary of work: BTS is being integrated into existing teaching and learning that was possible at this early stage courses throughout the curriculum. Examples: of training but this was offset by positive response on the Neuroscience – chemical weapons agent and antidote ability to clerk “real” patients, learning communication mechanisms; Genetics – gene mutation-counting to skills, observing doctor-patient relationship and role- estimate radiation exposure; Ethics – quarantine dilemmas. modelling. At strategic points, students participate in simulations and exercises that promote content assimilation. Conclusion: Early introduction to family medicine is beneficial and should be incorporated into the medical Summary of results: Since 2000, BTS curricular integration curriculum. has been achieved by designing discrete instructional units relevant to the goals of existing courses. Students consider BTS content as relevant to their education and practice. BTS coursework was perceived to be more useful after 8C 9 Defining the content of a physiotherapy program in September 11. Switzerland – a needs assessment Conclusions: BTS theme integration requires limited Markus Schenker (Health Education Centre AZI, School of curriculum time yet is pervasive enough to enhance student Physiotherapy, Murtenstrasse 10, CH-3010 Berne, awareness. This approach is synchronous with US Centers SWITZERLAND) for Disease Control and AAMC recommendations. Background: The Physiotherapy education program in the Education Centre for Health Professions in Berne (Switzerland) is organized as an outcome based 8C 7 Early professional contact (EPC) for medical curriculum. Defining the needs of the society was a crucial students: Gothenburg experience step in the curriculum development process. One important Gunilla Hellquist*, Bernhard von Below, Stig Rödjer and Gudny step in this needs assessment (Kern) was to elaborate what Sveinsdottir (Department of Primary Care, Box 454, S-40530 type of patients will be treated by physiotherapists. Göteborg, SWEDEN) – 4.80 – Section 4

Summary of work: During a two month period, the diagnoses ECG registration and auscultation of the heart) and the of all patients referred for physiotherapy treatment were perceived effects of the course on these practical skills recorded by all physiotherapists in four regional hospitals, and attitudes towards future professional role and in the university hospital of Berne and in forty physiotherapy multiprofessional teamwork were assessed. practices in the Canton of Berne. The diagnoses were then screened for duplicates and synonyms. The proportion Summary of results: This interdisciplinary educational and the exact confidence limit (95%) of each diagnose approach was assessed to promote the learning of was calculated. The total frequencies of the three main cardiovascular practical skills in both groups. The physiotherapy domains were compared using a ?-square participants felt that these specific clinical skills should be test. learned in a multiprofessional setting. The course was further perceived to improve the role knowledge and Summary of results: A total of 458 diagnoses were recorded. interprofessional attitudes among both medical and nursing After screening for duplicates and synonyms, a final set of students. Interdisciplinary small group learning was finally 432 diagnoses was defined. The core set of diagnoses suggested to promote understanding of interaction skills consisted of 51 diagnoses, contributing 64.5% of all and emphatic patient care, especially among medical recorded diagnoses. The proportion of the three main students. physiotherapy domains in the three groups was significantly different (p < 0.01). Applying the step down method, the Conclusions: The results suggest that interdisciplinary false discovery rate was 0.012. Using this ?-level, 75 small group learning has beneficial effects on the diagnoses (77% of the analyzed 97 diagnoses) occurred educational quality and developing professional attitudes significantly more frequently in one group than in the other of undergraduate medical students. Development of further two groups. 21 diagnoses (21.6% of the analyzed 97 multidisciplinary undergraduate education programmes diagnoses) were seen mainly in private practices but not should be thus encouraged. in hospitals. Conclusions: The results of this study have an important 8C 12 Transforming a clinical team in primary care into a impact on the content and the structure of the new community of practice (COP): the Delta project in curriculum. The core set of diagnoses helps to describe CME/CPD the main competences of Swiss physiotherapists. M A Raetzo and R L Thivierge* (University of Montreal, 721 Hartland Avenue, Montreal H2V 2X5, CANADA) 8C 10 The team profile – the development of assessment Aim: This poster will present a model of healthcare delivery criteria for an interprofessional ward simulation team that has been transformed from traditional action- exercise driven operational team of clinicians to a learning-from- practice driven group: how to create a COP in primary J S Ker*, L J Mole, C L Stewart, J Syme-Grant, E Gray, S Benvie, P care medicine. Johnstone (University of Dundee, Clinical Skills Centre, Ninewells Hospital & Medical School, Level 6, Dundee DD1 9SY, UK) Summary of work: In 1998, a group of family physicians and specialists from the Greater Geneva area was invited Aim: This poster shares how assessment criteria have been to join a Project of healthcare delivery in a different manner developed and piloted for a ward simulation exercise to than had up to that date existed in Switzerland. A central provide a team profile to health care students. nucleus of physicians already practising in a specific set- The development of a structured realistic simulated clinical up where practice-reflection sessions were held regularly, environment for health care students provides a useful decided to lead and invite other physicians to join the Delta opportunity to develop both clinical competence and Project. confidence. In addition in preparation for practice, health Summary of results: We will discuss results in three main care students need to learn to collaborate in teams if they areas: 1-CME/CPD outcomes; 2-Healthcare delivery are to fulfil patients’ health care needs. outcomes; 3-Cost-benefit outcomes. Summary of work: A ward simulation exercise has been Conclusions: The Delta project represents an innovative developed at the University of Dundee, Clinical Skills Centre approach aimed at shifting paradigms in health care for junior nursing and medical students. Aims of the exercise delivery at both and simulteanously organisational level include enabling students to learn to work collaboratively and CME/CPD level of all the members involved in this as a team and providing an opportunity for students to practice set-up. More studies are under way to examine socialise interprofessionally. Written evidence from reports the CPD dynamics and different enabling tools to facilitate from interprofessional observers has been analysed over the perennity of a COP. a four year period and has been used to develop formative assessment criteria. Each of the agreed four criteria, (professionalism, use of universal precautions, 8C 13 Integration of the dental students into the Dresden communication and organisation) are now defined in terms PBL – Curriculum (DIPOL): highlights of the of observable behaviours to provide a profile for each team. emergency medicine course The results of the pilot will be shared and further modifications to the instrument highlighted. M Müller*, S Weber, I Nitsche, P Dieter and T Koch (Department of Anaethesiology and Intensive Care Medicine, University Hospital Dresden, Fetscherstr. 74, 01307 Dresden, GERMANY) 8C 11 Interprofessional education of first-year medical and Background: At Dresden Medical School a new curriculum nursing students was implemented in 2000, combining traditional elements Pekka Kääpä*, Jaakko Kytölä, Susanna Vierre, Päivi Erkko and (lectures), new PBL-tutorials and practical training. Dental Kirsti Ellonen (University of Turku, Research Centre of Applied and education has been separate from medical education with Preventive Cardiovascular Medicine, Kiinamyllynkatu 13, 20520 only a few courses for both medical and dental students in Turku, FINLAND) some basic science subjects. Aim: To promote learning of clinical skills and attitudes for Aim: The aim of this project was the integration of dental interdisciplinary teamwork in undergraduate medical and students into the medical clinical courses, better preparing nursing students. them for the growing elderly population with increasing numbers having chronic illnesses. Summary of work: A 4-hour small group teaching session of cardiovascular physiology was organized for 64 first- Summary of work: We present here an example of the four- year medical and 60 nursing students with guidance of week emergency medicine course. Dental students take multiprofessional staff. Small group learning was focused part in the tutorials (3 per week), the lectures (10 in 4 weeks) on basic cardiovascular practical skills (BP measurement, and the practical training which consists of 4 sessions,

– 4.81 – Section 4

two hours each. They have exercises in BLS, iv-lines and facilitated a discussion of a clinical scenario based on an volume therapy, ALS and immobilisation of trauma-patients. 80 year old female patient who lived alone and sustained a fractured neck of femur. Students were asked to discuss Summary of results: In the evaluation, overall mark was 4.2 the contribution of all healthcare professionals during the in a scale from 1 (worst) to 6 (best). Especially the cases patient’s treatment in hospital and after discharge back with direct relation to the dentist’s job were received very into the community. The problems of collaboration and well (anaphylaxia: 5.0), critical comments were made interaction between professional groupings were regarding the increased workload of the dental students discussed. Summary of results: Student evaluation was having to take part in clinical courses while simultaneously very positive and most groups were surprised by the range pursuing their dental work. of healthcare professionals involved. Many thought it would Conclusion/take home message: It is important that dental be useful to repeat the exercise in later years. students receive teaching in clinical subjects, especially Conclusion/take home message: Although successful, the in interdisciplinary emergency health care. logistics of planning, timetabling and implementing this exercise were considerable. 8C 14 Not just another multi-professional course Lorna Olckers, Trevor Gibbs*, Melanie Alperstein, Madeleine 8C 16 Interprofessional education: making it happen Duncan, Licia Karp, Pat Mayers and Ermien van Pletzen (University Hazel Chalmers (NUTS, Room A212, Coach Lane Campus (West), of Cape Town, Department of Public Health, Room 2.25, Falmouth Northumbria University, Benton, Newcastle upon Tyne, UK) Building, Faculty of Health Sciences, University of Cape Town, Observatory 7925, SOUTH AFRICA) Aim: To explore the potential and challenges of implementing multi, inter-professional postgraduate Aim: To inform educators of Health Science students about education. the Multi-professional core curriculum being offered within the Health Science Faculty at the University of Cape Town. Summary of work: In the UK vocational training for general practitioners is largely provided by general practitioners. Summary of work: Central to the Primary Health Care As an educationalist with a nursing background the approach and to effective healthcare delivery is the multi- challenge of setting up inter-professional education with professional team. It is, therefore, no longer sufficient for GP colleagues is exciting – if at times painfully slow. The Health Science Faculties to graduate students with ‘journey’ involves learning and re-learning the fundamental knowledge and skills related only to their specific tenets of education, reflection, creativity and at times sheer disciplines. Graduates need to be able to work effectively doggedness. The activity is on-going and some important in multi-professional teams, and with that comes the need pointers to success will be highlighted on the poster. for individual and interpersonal development. The Health Science Faculty at the University of Cape Town is Conclusions/take home messages: (1) Create the attempting to address these needs through the core faculty appropriate learning environment; (2) Start small; (3) curriculum of “Becoming a Professional” and “Becoming Collaboration is central to success; (4) Be creative. a Health Professional”. All first year Health Science students participate in these courses where small group learning, of a mostly experiential nature, assists students in their 8C 17 Narrowing the gap in health – beyond the NHS? intra-personal and interpersonal development. Linda Leighton-Beck (Aberdeen University, Dept of General Conclusion: This paper will attempt to reflect the Practice and Primary Care, NHS Grampian, 181 Union Street, excitements and challenges of students and staff who were Aberdeen AB11 6BB, UK) involved in the implementation of these courses in 2002. In Scotland, over the last two decades we continue to have significant inequality in health; and our health relative to many other Western European countries remains less good. 8C 15 A pilot exercise in multi-professional learning The Scottish Executive’s White Paper (2003) commits us H McKenzie* and J Harper (Medical Education Unit, Aberdeen to improving the health of all Scots and narrowing the gap University Medical School, Medical Faculty Office, University in health between our most advantaged and our most Medical Buildings, Foresterhill, Aberdeen AB25 2ZD, UK) disadvantaged communities. Recent planning initiatives have, for the first time, drawn health into the wider planning Aim: The aim of this exercise was to introduce students of frameworks for the community and charged Local medicine, nursing, pharmacy, social work, physiotherapy, Authorities and NHS Boards with becoming Public Health radiography and occupational therapy to the roles of Organisations. Our challenge is to ensure that, in building different health and social care professionals in the UK. public health capacity, the undergraduate and Summary of work: The relevant courses are taught at the postgraduate curricula reflect these changes and the University of Aberdeen (Medicine) and the Robert Gordon opportunities they create to revisit our conceptions of University (all others) and a joint teaching board from the health; to manage the clinical and non-clinical dimensions two faculties co-ordinated the exercise. First year students of health synergistically and with equal regard; and to (n=460) from these courses (second year for Social Work) support relevant disciplines within AND outside the NHS to participated, with eight students from at least five disciplines tackle their distinctive roles and (inter)related in each tutorial group. Tutors were from all disciplines and responsibilities to improve health.

– 4.82 – Section 4 Session 8D: The Curriculum (2)

8D 1 Effectiveness of first batch of graduates at Maharat the XX Century, USA 1984; SPICES Model, UK 1991; ACME- Nakhon Ratchasima Hospital School of Medicine TRIN Report USA 1983; Strategies for Innovating Medical Education, USA 1998; WFME Declaration, 1999) and Ritthiya Littirong (Maharat Nakhon Ratchasima Hospital, School national agreements (Chilean Association of Medical of Medicine, Medical Education Center, Muang District, Nakhon Schools). They, together with the changes in the practice Ratchasima 30000, THAILAND) of medicine, government health policies and the social Aim: Thai Medical education is based on sixth year high environment variables have been the referents for the school entry courses where the first three years emphasize process of curricular change at the School of Medicine of clinical learning. After leaving Mahidol University for the the University of Concepcion. In 2002 the School of first three years, the students undertake 3 years of clinical Medicine put into practice a New Curriculum. This years at Nakhon Ratchasima Hospital. We would like to curriculum will last 14 semesters, out of which the last four present the effectiveness of the first batch of graduates of correspond to internship. It reduces classroom time, Maharat Nakhon Ratchasima Hospital, Thailand. emphasizes problem based learning and problem solving, distance education, virtual classrooms and telemedicine, Summary of work: (1) The students have to take the student teacher relationships, small group work, knowledge comprehensive examinations which are divided into 3 integration, the use of standardized patients, ethics; it also parts: Part I: Basic Science at the end of third year; Part II: introduces integration of Biomedical Sciences, Clinical Sciences Theory at the end of fifth year; Part III: educational technologies of information and Evidence Clinical Sciences: at the end of sixth year. (2) The Based Medicine as key elements to assure the practice of assessment tools were developed by using standard medicine. The physician, as a result of this New criteria of the Thai Medical Council. Curriculum, will be able to offer the Chilean population the Summary of results: All students passed the Comprehensive new medicine that is required, contributing in this way to examinations I, II, III. The mean scores of comprehensive the development of the country. I,II and III show 69.69 [46.46%], 238.00 [47.60] and 435.85 [54.48] in order. 8D 4 Using modified Delphi technique to prioritise Conclusions: (1)The effectiveness of the first batch of problems in curriculum development Maharat Nakhon Ratchasima Hospital graduates is equal to graduates of medical school. (2) We will follow the N Sirisup, S Limpongsanurak, C Ittipanichpong*, A students after they have graduated at 1, 3 and 7 years later. Srikiatikhachorn, S Patumraj, D Wangsaturaka and P Kamolratanakul (Dept of Pharmacology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Patumwan, Bangkok 8D 2 The transition from student to doctor: a small step 10330, THAILAND) or a big leap? Aim: To prioritise problems in curriculum development at K Prince*, A Scherpbier, E Boshuizen and C van der Vleuten the Faculty of Medicine, Chulalongkorn University using (Maastricht University, Skillslab, Faculty of Medicine, PO Box 616, modified Delphi technique. 6200 MD Maastricht, NETHERLANDS) Summary of work: The draft of the 2002 undergraduate Aim: To present medical graduates’ evaluation of their first medical curriculum was presented to a panel of experiences in practice and their preparation for practice, stakeholders comprising all heads of departments and the and the implications of these findings for the medical curriculum committee. Each member was asked to identify curriculum. critical and potential problems of the new curriculum. The issues raised were then arranged into a 75-item Summary of work: Qualitative and quantitative data were questionnaire. The member was asked to rate the gathered (by focus group interviews and surveys, significance of each item from 1 (least) to 10 (most). The respectively) to explore junior doctors’ views about the results obtained in the second round were presented to transition from medical student to medical practitioner, in the panel before conducting the other round of rating. order to identify potential areas for curriculum development. Summary of results: Mean values of department-based Summary of results: Junior doctors experienced the sudden problems were lower than non-department-based increase in responsibility and workload as difficult. They problems in both rounds. Of the top 10 problems, there felt confident with regard to knowledge and skills, however, were no department-based problems in both rounds. they experienced difficulties with practical matters and their Repeating round of rating resulted in decreasing of mean role in the team. Never before did they work in a team like values of most problems except 7 non-department-based in practice, did they have responsibilities, nor did they direct and 2 department-based problems. other health care workers. They felt a need for more training in planning/organising the work and team leading skills. Conclusion: Modified Delphi technique can be used to prioritise problems in the curriculum development process Conclusions: Suggestions for improvement include the with the advantage of minimising confrontation between creation of a gradual increase of responsibilities during each member. the clerkships. Moreover, medical educators should pay more attention to other competencies than knowledge and skills, such as organising, teamwork and leadership 8D 5 Structuring the first 3 blocks or semesters in the qualities. school of medicine – Monterrey Tec – Mexico in accordance with objectives of courses and 8D 3 New curriculum of the School of Medicine of the competencies the student must acquire University of Concepcion, Chile: training physicians Graciela Medina*, Demetrio Arcos, Enrique F J Martínez, Jorge capable of responding to the demands and Valdez and Ricardo Treviòo (School of Medicine - Monterrey Tec, challenges of the new century ITESM, Av Eugenio Garza Sada 2501, Depto. Cs. Basicas Medicas. Ed. DACS-112, Monterrey NL 64849, MEXICO) Octavio Enríquez* and Mario Muòoz (Faculty of Medicine, University of Concepcion, Concepcion, CHILE) In the design of the new curriculum in the School of Medicine – Monterrey Tec, blocks and competencies were Regarding curricular change in medical education, designed for the first 4 years. Each semester had one worldwide agreements have been reached (Physicians for principal or core course and 4 or 5 support courses. All

– 4.83 – Section 4

activities and case-problem design have to be in relation Conclusion/take home message: Longitudinal monitoring to the content of the core course and competencies. The of the development of student information processing is content in the core courses were: cellular function, genetic, an essential part of curricular evaluation. muscle and bones, reproduction, digestive, Renal, Cardiovascular, Respiratory, Hematology and Immune Systems. To program all activities, we worked in 8D 8 Competencies as teaching and learning goals collaborative groups between tutors and teachers participating in these courses. The activities in which the Monika Beck*, Hansruedi Kaiser*, Beat Keller* and Stefan Knoth* students were engaged were designed in such a way that (BZG Kanton Solothurn, Bildungszentrum für Gesundheitsberufe, they will obtain the following competencies: health Areal Kantonsspital, CH-4601 Olten, SWITZERLAND) promotion, communication skills, medical information Aim: Proposing a potent way of describing teaching and skills, application of basic sciences to some diseases (in learning goals in health care education. accordance with morbidity and mortality in Mexico), personal and professional development. We used OSCE, Summary of work: We base our work on (1) a prominent checklist and written test to identify if the student attains concept of “competence” as “the adequate coping with a the competencies programmed. situation by means of relevant resources (knowledge, skills, attitudes)” and (2) an integrative model of different forms of human knowledge (declarative, procedural, sensomotoric 8D 6 Restructuring the undergraduate medical curriculum and situated knowledge). We describe competencies by elaborated descriptions of concrete situations to be coped at the Medical Faculty Skopje, Macedonia: comparison with and by lists of resources, that may help in coping with with some other European models the situations. We propose these descriptions of Z Gucev*, J Saveski, M Soljakova and K Boskoski (Medical Faculty competencies as the adequate description of teaching and Skopje, 50 Divizija BB, 1000 Skopje, MACEDONIA) learning goals: Learners have to learn competencies, teachers have to teach competencies. The Medical Faculty in Skopje started a Tempus Phare project with the Medical Faculty Victor Pachon in Bordeaux Summary of results: We will present the results of a project, (France) and with the Medical Faculty in Bilbao (Spain). that produces competence descriptions as the first - and The aim was to modernize the undergraduate curriculum. most important - step in curricula construction for two Differences were found among the faculties in: the number different levels of health care education in Switzerland: of lectures (none of them meeting the demands of the “Fachangestellte Gesundheit” and “Diplomierte European Community legislation (1994) for 5,500 lectures Pflegefachperson”. in theory, skills, and attitudes. No complete parallelism in Conclusion/take-home message: An adequate concept of the subjects taught was found (e.g. pathophysiology is “competence” is the best possible base for describing taught in Skopje, but not in the partner countries). Some teaching and learning goals of health care education. subjects are taught in different forms: internal medicine Learners get a clear picture of what to learn. Teachers are and surgery separately in Skopje, but urology and guided in the selection of content and in the evaluation of nephrology as one subject in Bordeaux. Some trends are the performance of the learners. The communication similar: more small group learning, active participation and about teaching and learning goals is facilitated. training towards application of knowledge. Also a similar trend towards: horizontal and vertical integration of studies, team teaching, early patient contact and clerkships, 8D 9 A comparison between the instructors’ viewpoints and horizontal integration was found in all 3 schools. Formative and summative assessments are found in all three schools. students’ viewpoints on the current situation of clinical However, competition among schools in regard to student education in SUMS success is impossible in Skopje since this is the only L Bazrafkan and M Alizadeh* (Shiraz University of Medical medical faculty in a small country. Such competition is Sciences, Zand Avenue, Shiraz, IRAN) desirable for all the Medical Faculties in the region. Aim: Regarding the importance of the clinical period in medical education, this study aims to compare the 8D 7 Transfer appropriate processing and schema students’ view and faculty’s view of clinical education. formation in first year students Summary of work: This is a descriptive-analytic study in Mary Kelly*, Aileen Patterson, Bernard McCartan and Diarmuid which a questionnaire has been used. The questionnaire Shanley (Faculty of Health Sciences, Faculty Office, Trinity concerns several variables in medical education: individual College, Dublin 2, IRELAND) characteristics of the clinical teacher (teacher as a role model), teaching methodology and the content of clinical Aim: This study aims to establish the capacity of first year education. The validity of the contents of the questionnaire students for (1) summarising and comparing test stories was determined using experts opinion and reliability of it (schema foundation) and (2) recognition of analogous by test-retest. The subjects of the study randomly selected problems, and application of their solution to previously comprised 160 academic members and 160 students. The unseen analogues (transfer appropriate processing). data obtained from the questionnaire were analyzed by computer and the Chi-square was employed to study the Summary of work: The study involved 329 students entering possible relation existing among the variables. the 6 schools of the Faculty. Students first read, summarised and compared two stories describing Summary of results: In this study no significant relation was analogical problems and their solutions. They then found between instructors’ view points score and their sex, completed three questionnaires (distractors). They were age and educational background (P>0.05). However, the next asked to provide appropriate solutions for a third scores attained by the students have been lower than those problem, which was analogous to the first two stories. of instructors’ in several variables and this difference was Students were informed only that we were seeking to significant (P<0.05). Conclusion: The results of this study interpret their thought process. show that there is a great gap between the present clinical education and an ideal condition. We believe that revision Summary of results: All students were competent at of clinical education in all areas and in staff development summarising stories, values ex 10 ranged from 8-6. The in the present curriculum are necessary. quality of the inter story comparison varied widely. Identification of the analogous solution was demonstrated in 50% of students in 3 of the 6 schools. Transfer of the solution to the third analogous problem was highest in medical students at 60%. No correlation was found between the ability to summarise and compare and the capacity to transfer.

– 4.84 – Section 4 8D 10 First grade students’ interviews as physicians in the Background: One important basis for content development community model of professional study programmes is the reception of graduated student qualifications. Normally there is no feed Carlos Rojas Mora*, Lucía Robles Garcia and Norma Cura Garcia back from the field until years after student graduation. (School of Medicine Tecnológico de Monterrey, Ave. Morones Prieto # 3000 Pte, Colonia Los Doctores, Monterrey, Nuevo León Summary of work: This presentation describes an C.P. 64710, MEXICO) evaluation strategy designed to support an ongoing reconstruction of a medical education programme through Background: Community orientation is one of the continuous dialogue with stakeholders about the criteria characteristics of the new curriculum 2001 of the School of excellent medical education. Since the premises of of Medicine Tecnológico de Monterrey. The spiral medical education are influenced by several stakeholders community model is based on students’ early, continuous (not only faculty, physicians and students) the evaluation and gradual exposure to community settings since first strategy includes ten different stakeholders. Initially we semester up to the seventh semester. asked the stakeholders what they wanted to know about Summary of work: During the Community Health course, the medical training. 70 first semester students performed their first medical Summary of results: We received 117 challenging and interview. A group of teachers accompanied them. Students sometimes unexpected questions. Receiving those were distributed in pairs. Each pair visited a family and questions generated a platform of learning. We realized applied a questionnaire, one of them playing the role of that there were aspects to consider that we hadn’t thought interviewer and the other of observer. Afterwards, each pair of. The stakeholders were informed about the questions of students inverted their roles and visited another family to received and also the multi-method strategy that was apply the questionnaire. Students were asked to write an decided for answering the crucial ones. individual report of their experience emphasizing personal reflection. Conclusion: So far the question bank has been used in workshops with faculty, in focus group evaluation with Summary of results: Reports show that this early experience senior students and in course and stage evaluations with enriched students’ service vocation, fostered their both faculty and students. New information is communication skills, made them aware of people’s communicated to the stakeholders and new questions for needs, of people’s opinion about the School of Medicine learning and educational development are generated. and about the profile of the physician that Mexican society needs. This experience also enhanced students’ sensitivity about caring for people in need and increased their 8D 13 One year experience with the new curriculum at motivation to become physicians since people expressed Heidelberg Medical School the very high opinion and faith they have in the medical professional. N De Cono*, E Gazyakan, S Holler, J Schmidt and M Kadmon (Heidelberg Medical School, Kleiner Mönch 6, 69198 Schriesheim, GERMANY) 8D 11 Physiotherapists’ “clinical reasoning” as a main Background: Heidelberg Medical School has been educational strategy engaged in a major curriculum reform to improve medical Peter Eigenmann* and Helena Luginbühl (Feusi Physiother- education. Our new curriculum, Heidelberg Curriculum apieschule, Effingerstrasse 15, 3008 Bern, SWITZERLAND) Medicinale (HeiCuMed), combines new approaches in medical education such as interdisciplinary seminars, Aim: Depiction of converting the auxiliary subject “Clinical problem-based-learning, skills-lab, standardized patients Reasoning in Physiotherapy” to the main educational and key-symptom-oriented lectures. strategy in the traditional and organ-based curriculum of the Feusi Physiotherapy School in Bern. Summary of work: One year after implementing HeiCuMed in the surgery rotation we evaluated the students’ Summary of work: “Clinical Reasoning in Physiotherapy” acceptance and compared the results with those gained has been emphasized in our school as an independent before the curriculum changed. A standardized subject since 1993. Students and supervisors of clinical questionnaire was answered by 130 students on a regular clerkships have always seen this facet of the curriculum basis. We used statistical methods to compare the as a strength. That made us consider converting the course differences between the former curriculum and HeiCuMed from a mere subject to the main educational strategy. The in the surgical specialties (student t-test, p<0.05). Both aims of this process were to reduce problems at the evaluations were based on the same questionnaire beginning of clinical clerkships and to positively integrate consisting of 22 questions asking for motivation, the theoretical knowledge into clinical practice. We also presentation, interaction, preparation and the overall grade. hoped for higher competency in the hypothetico-deductive clinical reasoning process. Summary of results: The new curriculum was rated higher with respect to all assessment criteria. The difference to Summary of results: The implementation of this educational the old curriculum reached statistical significance strategy has the advantage of embedding different clinical (p<0,01), especially for the criteria content and structure of courses in the common framework of the physiotherapeutic the lecture, interaction and subjective learning effect. reasoning process. This has implications on the formulation of objectives and the choice of teaching Conclusion: HeiCuMed represents among German methods in the single subjects. faculties the most significant curricular change in medical education. Our data show that the reform of medical Conclusions/take-home messages: The ability to clearly education at the Department of Surgery of University of convey your vision to your team is of prime importance. Heidelberg was an important and successful step towards Our experience indicates that faculty development is the improving students’ satisfaction and motivation. essential issue: promoting staff expertise and reaping the full benefits of instruments such as flowchart, checklists and glossary by fostering their availability. 8D 14 Problems and perspectives of the teaching of primary care under the new law on medical 8D 12 Evaluation as dialogue between stakeholders – a tool education in Germany for learning and content development of medical M Ehrhardt*, H van den Bussche and H Kaduskiewicz (Institute of education General Practice, Institut für Allgemeinmedizin, Universität- sklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Mona Fjellström (Umeå University, Centre for Teaching and GERMANY) Learning, 901 87 Umeå, SWEDEN)

– 4.85 – Section 4

Since the new law for medical education was passed in 8D 17 Teaching case management for chronic illness care 2000 every medical faculty in Germany is supposed to in an undergraduate general practice course develop a new curriculum. Primary care is now taking a bigger part in the curriculum. Every student will take a one Jochen Gensichen* and Ferinand Gerlach (Institute for General week full time clerkship in a surgery. Furthermore, students Practice, University Hospital Schleswig-Holstein, Christian- may choose primary care for a three months elective period Albrechts-University of Kiel, Arnold-heller-Strasse 8, D-24105 in the last year of the curriculum. General practice will Kiel, GERMANY) also participate in the teaching of other clinical subjects. Aim: Chronic illness care is an essential issue of the In reality, however, the position of primary care in a German German medical core curriculum proposed in 2002. curriculum is still fragile. In Hamburg university hospital Germany has no gate keeping. Patients select doctors of the development of a new curriculum on an interdisciplinary their choice. There is a lack of community-integrated basis has reached an elaborated stage of development. services. Students should be prepared to care for chronic Difficulties in shaping such a curriculum and promising illness in this context in a structured way. steps towards a better integration from the point of view of general practice will be described and discussed. Summary of work: To develop the attitude, skills and knowledge for chronic care management a two hour session takes place for undergraduate students as part of 8D 15 The social service year in medical education: a the general practice course. Contents: Chronic Care Model Mexican case study as a systematic, trans-sectoral and evidence-based approach for promoting continuous care for patients with Julio Cesar Gomez, Pilar Talayero and Todd W Ellwein (Universidad chronic diseases. Case management as a key-element Westhill, Domingo Garcia Ramos, #56, Colonia Prados de la including: 1) identification, 2) assessment, 3) planning, 4) Montana 1, Santa Fe Cuajimalpa, Mexico DF 05610, MEXICO) co-ordination, 5) monitoring. This addresses the “guiding All Mexican medical students must complete a year of function” of the GP. “servicio social” (social service) as part of their medical Summary of results: Students produce a depression training. This social service year is usually completed management programme including diagnostic, therapeutic during a student’s 6th year, and is required by Mexico’s and supportive procedure for outpatients in small group Ministry of Health. This poster exhibit provides a case study discussions. Students are promoted to understand that of how one medical school successfully placed its 6th year optimal chronic care is achieved, when a proactive practice students in social service positions throughout the country. team interacts with an activated patient. The Dn. Santiago Ramon y Cajal School of Medicine at Universidad Westhill established social service Conclusions/take-home messages: Medical students agreements with 4 Mexican states: Quintana Roo, Puebla, should be taught in Chronic Care Model as a new Mexico, and Guanajuato, and placed 13 medical students paradigm in caring for chronic illness. in 2002-03. The poster exhibit describes each step of Mexico’s social service requirements, and highlights the importance of 1) government and accreditation standards; 8D 18 Assessment of student attitudes and knowledge 2) selection of geographic location; 3) establishment of about aging: a longitudinal comparison of medical agreements with state ministries of health; 4) student student cohorts selection and placement; 5) student evaluation; and 6) Debra A Newell*, Anthony DiNuzzo, L Felipe Amador and Ann W student satisfaction. Frye (University of Texas Medical Branch, Office of Educational Development, Marvin Graves 1.302, 301 University Blvd, Galveston TX 77555 0408, USA) 8D 16 Evaluation of a new model of senior clerkship in an undergraduate medical curriculum Aim: To convey the value of incremental tracking and assessment of the impact of specific and varied curricular J C Ramesh*, A L Mohamed, T Motilal, M I Nurjahan, R Khuzaiah content infusion on measurable outcomes (e.g., students’ and P Kandasamy (International Medical University, 33 A Jalan beliefs and knowledge regarding aging). 17/1, Block A-3, Condo 5B, Astana Damansara, 46400 Petaling Jaya, Selangor, MALAYSIA) Summary of work: A longitudinal assessment was implemented within the School of Medicine’s ongoing Aim: A 6-month period of senior clerkship was incorporated initiative to determine the impact of incremental infusion within our 5-year medical programme. Commencing after of gerontology/geriatric curricular components on students’ the final examination at the end of 4½ years, the main attitudes and knowledge towards the elderly. A 71-item objective was to prepare students for internship, while at questionnaire was administered to two cohorts, pre- and the same time focusing on the educational outcomes. The post-geriatric content exposure. study aims to determine if these objectives were achieved. Summary of results: Total mean attitudes and knowledge Summary of results: Analyses of students’ responsee show scores increased between baseline and follow-up for each that they were provided with greater opportunities to take cohort. Attitude change for the 2000-01 cohort was striking independent responsibilities in patient management. Most with an 8-point average increase score (baseline=220.3, had a better perception of how the health care team worked follow-up=228.8). Individual mean item scores varied for and the majority felt confident to function as future interns. each cohort. A significant change was observed on 5 of 71 Achievements in the educational outcomes were through questions (7%) for the 2000 matriculating cohort, and on the development of portfolio consisting of 20 complete case 14 of the 71 questions (20%) for the 2001 cohort. commentaries assessed at end of the clerkship by portfolio review and viva. Most students perceived the portfolio as a Conclusion: Students demonstrated positive changes in very useful learning tool, however, they felt it was time attitudes and knowledge toward older adults when consuming with most of the portfolio work occurring exposed to defined geriatric curricular content. Differences towards the end of clinical attachments rather than as a in results between cohorts are associated with the density continuous process. and diversity of geriatric content and experiential exposure in the 1st year and 2nd year geriatric curricula. Discussion Conclusion: This programme prepares the students focuses upon curriculum implications in varied settings. adequately in terms of their abilities to function as interns. Although the assessment matches the educational outcomes, weaknesses do exist in the process of achieving 8D 19 The survey of medical students’ and graduates’ the outcomes through ward-based learning. awareness about concepts and benefits of community-oriented medical education in Iran Sedighe Najafipour*, F Azizi and M Saberfiroozi (Jahrom Medical School, Nemazi Mottahri Clinic, Shiraz 71935-1169, IRAN)

– 4.86 – Section 4

Background: World medical schools are shifting their policy Summary of results: 71.3% of graduates, 32% of from patient care in hospitals to the community. Iranian physiopathology students and 60% of clinical students medical schools take into account this community based stated education based on community health needs as a education in their curriculum. After one decade of a principle concept of community-oriented education. community based education program we have done this Knowledge of other concepts of community oriented study in order to determine students’ and graduates’ education was moderate to weak. 26% of physiopathology awareness about concepts of community-oriented students, 27% of clinical students and 70% of graduates education in Shiraz, Jahrom and Fasa medical schools. selected the index of decision making as an advantage of a community oriented program. Summary of work: 117 physiopathology students, 107 clinical students and 179 graduates have contributed to Conclusion/take home message: The students and our study. The viewpoint of all cases has been collected graduates’ points of view about benefits of community- based on questions about concepts, advantage and oriented education were moderate to good. doctors’ characteristics of community-oriented education. Collected data were analyzed by SPSS, version 9.1.

Session 8E: Evaluation of the Curriculum

8E 1 Teaching evaluation as part of interactive quality Summary of results: Overall, 64% of faculty responded and management at the Medical Faculty of Freiburg 96% of questionnaires and all of the interviews were completed. 80% of faculty believed that evaluation is V Peus*, G Valerius, H-D Hofmann and M Berger (Studiendekanat important (high + very high) in university whereas a few der Medizinischen Fakultät Freiburg, Studiendekanat Vorklinik, declared satisfaction with university success of teacher Medizinische Fakultät der Albert-Ludwigs-Universität, evaluation. Overall, the survey showed that faculty agree Elsässerstr 2m, 79110 Freiburg, GERMANY) relatively highly with evaluation through self-assessment, Background: Changed requirements and expectations excellent students and Student Evaluation of Teaching concerning a physician’s abilities and knowledge as well (SET) consecutively, but moderately with form of content as increasing international competition demand a of evaluation. Also the study indicated that there is significant reorganisation of the study courses at medical faculties in correlation between faculty rank and faculty views toward Germany. Within the scope of this change process SET. evaluation and quality assurance are of major relevance. Conclusions/take home messages: The motivation and Summary of work: At the medical faculty of Freiburg a attitude of some of the faculty presents a barrier to SET. So comprehensive evaluation-based system for quality teacher evaluation will require to be reconsidered on an assurance was developed over several years. It is based administrative approach and application of evaluation on summative and formative student-evaluations and results (feedback and encouragement). In this regard, allows differentiated statements about the actual teaching- cooperation of faculty in the setting of evaluation, close situation. The questionnaires were developed in a connection of the evaluation system to the academic reward perennial validation process. To maximise positive system, and establishment of a faculty teaching changes, the annual evaluation of the entire teaching development committee must be viewed as important establishment entails considerable consequences such factors. as the publication of results, teaching awards, specific trainings in didactics and additional formative evaluations. 8E 3 Think bigger than “happy sheets” Summary of results: Statistical analyses document continuous improvements with regard to both lessons and Jane Ross, Sandy Stewart* and Patrick McKinlay (NHS Education instructors and prove our evaluation system to be an for Scotland, The Lister, 11 Hill Square, Edinburgh EH8 9DR, UK) adequate means not only for status examination but also Aim: Historically training has been evaluated on conclusion for improving teaching quality. of the event, from the perspective of what transpired during Conclusions: Our experiences could serve as a model for the training episode. A great deal of training is not measured the establishment of similar concepts at other medical beyond such participants’ “happy sheets”. What is more faculties and thereby lead to a standardised structure of beneficial is the ability to evaluate the transfer of learning quality assurance in the area of medical teaching. to the work setting and the ongoing impact of such learning. The aim of this presentation is to describe an evaluation strategy developed to measure the impact of a new trainer, 8E 2 Faculty attitudes: a straight way to faculty training course for dental trainers in Scotland. evaluation Summary of work: A national Scottish trainer, training course Abdolreza Jahanmardi, Morteza Haghirizadeh Roodani*, Hayat was developed to prepare new trainers. An evaluation Mombeini and Roya Jahanmardi (Ahvaz Medical Sciences strategy was designed to focus on the measurement of University, Educational Development Center (E.D.C.), IRAN) knowledge and skills gained, the transfer of learning and the impact of this on the workplace. The strategy consists Aim: The aim of this study was to survey the attitudes of of four separate tools applied at key times pre, during and faculty members about different stages of faculty evaluation up to 12 months post completion of the course. system including: evaluation process, evaluation results (feedback and encouragement) and their comments. Summary of results: There has been a clear knowledge gain and evidence of positive training impact within the Summary of work: A five scale questionnaire 1 (very low) 5 workplace. (very high) with 26 items and á chronbach 0.83 was delivered to 150 non-clinical faculty member of Ahwaz Conclusion/take home messages: Evaluation of the transfer Medical Sciences University after content validation by of learning to the work setting and the ongoing impact of educational experts. At the time of distribution a such learning is essential to quality education experience. semistructured interview was held for those who did not We must think bigger than “happy sheets” answer the questionnaire, in which 30% took part. Analyses were performed on SPSS and frequency, frequency percentile, mean and chi-square analysis were used.

– 4.87 – Section 4 8E 4 Evaluating the quality of a problem-based medical 8E 6 Evaluation strategy for the hybrid-curriculum at the training: experiences at the University of Hamburg Faculty of Medicine, University of Basel Monika Bullinger (Institute and Clinic for Medical Psychology, G Voigt*, B Roeers, V Exner and K Pierer (Educational Dean’s Office, Centre for Psychosocial Medicine, University Hospital Hamburg- Faculty of Medicine, University of Basel, Klingelbergstrasse 23, Eppendorf, Martinistr. 52, S35, 20246 Hamburg, GERMANY) CH-4032 Basel, SWITZERLAND) The attempt at improving medical training by implementing Aim: Design of a comprehensive concept to evaluate the new curricula is a continuous challenge for medical undergraduate programme, reformed as a hybrid education. Such effort should be accompanied by a curriculum. The concept is based on control of the scientifically rigorous evaluation which would make it implementation process, the acceptance of new didactic possible to analyse the structure, process and outcome of methods by teachers and students and the estimation of the new curriculum as such and in comparison to a learning success. Furthermore these data are correlated traditional curriculum. Evaluation research is a topic within to students’ results in the examinations. the social behavioural sciences which has been recently introduced in health sciences and has gathered Summary of work: Questionnaires have been designed for importance especially in development of assurance and teaching units and special teaching formats. A coding of quality standards. The implementation of a new curriculum both the questionnaires and the examination forms and its comparison to traditional teaching mimics a clinical enables the evaluators to study the students’ progress in study, in which a new treatment is compared prospectively relation to their acceptance of various teaching methods. to a control treatment, even though a randomised Additionally lecturers are evaluated by a short comparison between two curricula is difficult. questionnaire. These results will be correlated with the implementation results of teaching formats and will be the Theoretical, methodological and practical issues of basis for further faculty development programmes. The evaluation will be focussed on in the paper. Using the crucial point is to balance the “fill in” load for each student example of the implementation of a problem-based and to meet the scientific requirements of questionnaire learning curriculum at Hamburg University medical school construction. Evaluation results are reported to the faculty. in comparison to a traditional curriculum, aims and design, The curriculum committee is in charge of quality variables and indicators, conduct and analysis of the improvement. evaluation study will be described and discussed. The 3- year problem based curriculum for Hamburg medical Conclusion: A reform is an ongoing process and its students is currently implemented in 2 cohorts of 40 evaluation will underline the need for further change and students, admitted yearly. Within each cohort comparisons improvement. The resulting workload in itself will influence are made between the new problem based learning the acceptance of the reform by the faculty. approach and the traditional curriculum. Indicators of structure, process and outcome from the perspective of students, medical teachers and the university organisation 8E 7 Registrars in paediatrics demand more personal are identified, operationalised and included in the study interest from their teaching professors design. On the basis of the first results relating to the D G van Vuurden*, F Scheele, J van de Lande and B H M Wolf (St outcome of teaching from the students’ perspective, the Lucas Andreas Hospital, VU Medical Centre, Nachtwachtlaan 181, specific strengths and weaknesses of such evaluation 1058 EG Amsterdam, NETHERLANDS) designs will be discussed. Aim: In the near future, Dutch teaching professors will have to improve their educational skills in post-graduate training. 8E 5 Students’ evaluation of the undergraduate We show the opinion of Dutch paediatric registrars on the curriculum essential characteristics of their teaching professors. I Rumba* and U Vikmanis (University of Latvia, Vesetas iela. 8- Summary work: A questionnaire was sent to 280 Dutch 24, Riga LV-1013, LATVIA) registrars in paediatrics who were asked to appraise the three most important characteristics of the ‘ideal’ teaching Background: The Faculty of Medicine, University of Latvia professor. The answers were divided into four categories: is in the 5th year of implementing a new innovative ‘knowledge’, ‘manual skills’, ‘educational skills’ and Curriculum. To know wheter the aim to improve the learning ‘personal interest and attitude towards the registrar’. enviroment has been achieved, an evaluation of medical training has been undertaken. Summary of results: 84 out of a total of 280 responded so far. 54% of the answers fell in the ‘interest and attitude’ Aim: To evaluate students, opinions about the curriculum category, 29% in the ‘educational skills’ category, 12% in and teaching itself. the ‘knowledge’ category and 0,5% in the ‘manual skills’ Summary of work: A set of questions was prepared. 70 category. 4.5% gave an answer that was intermediate students were interviewed by using a differentiated between ‘educational skills’ and ‘interest and attitude’. questionnaire. A 17 item questionnaire evaluated the Conclusion/take home message: Personal interest and general structure of the curriculum, content and availability attitude toward the registrar were found to be by far the of supporting teaching materials, both by closed and open most desired characteristics of paediatric teaching questions. Students answered about every study course professors. ‘Teach-the-Teachers courses’ should therefore immediately after training and about general aspects of focus primarily on the reinforcement of interest and attitude, teachers and their contributions in tutorials. next to the development of educational skills. Summary of results: 93% of students were satisfied with the curriculum in general. The remaining 7% of students were not satisfied by some aspects of curriculum planning. 8E 8 Focus group as a tool for quality assurance in Answering open questions students pointed out the communication skills training and standardized necessity to strengthen courses such as how to study patient contact medicine, psychology etc. The questions about teaching Isabel Muehlinghaus*, Heiderose Ortwein and Claudia Kiessling showed 80% of students favor teachers with general (Universitätsklinikum Charité Berlin, HU zu Berlin, knowledge of content and contribution to individual learning of students. Reformstudiengang Medizin, Trainingszentrum für Aerztliche Fertigkeiten (TAEF), Schumannstr. 20/21, 10117 Berlin, Conclusions: Evaluation and re-evaluation of the curriculum GERMANY) and teachers by students shows how to develop the curriculum and the teaching process itself. Background: The Reformed Track Curriculum at Charité Medical School in Berlin is a problem based curriculum and includes a continuous communication skills training employing standardized patients as an primary teaching

– 4.88 – Section 4

tool. The process is continuously evaluated by standardized Summary of work: Our model is based on questionnaires questionnaires. distributed to all students at the end of each course. The analysis of our evaluation model was performed with the Aim: Additional to quantitative evaluation we introduced a support from the dean, vice-deans and other faculty staff facilitated, videotaped focus group to gain further members. We performed systematic research of information since the first cohort students were dissatisfied documents and regulations issued by the faculty/university with some aspects of both coursework and methods. Our concerning the educational evaluation. We completed effort was to implement a method which would generate Practice Standard Review on topic educational evaluation results better applicable to the subjective worlds of using the Instructions for Completing a Practice Standard experience (the perception of problems and ways of Review (AIHA, Washington, D.C.) We performed a survey conceptualising). measuring the attitudes of students and their clinician- The aim was to discuss students‘ complaints and needs teachers towards a standard evaluation questionnaire. in order to increase their motivation. Furthermore we Statistical analysis of the survey using chi-square test was targeted improved realisation of teaching methods as well conducted. as a more effective embedding of the communication skills Summary of results: We found that the “standard” evaluation training within the entire curriculum. questionnaire now used is rather general and has its Summary of results: Identification of different categories limitations. Thus it cannot provide the teachers with with content analysis led to adjustments in the following appropriate feedback and the students cannot express their fields: faculty development, case selection and case opinions properly. The students and teachers also lack design, transparency of organisational facts and adequate background information concerning the whole possibilities, application of teaching-video, reinforced evaluation process. Statistical analysis showed significant integration of students’ needs for curriculum planning. differences in the students‘ attitudes from different years and in answer comparison of clinician-teachers and Conclusion: This poster will provide discussion of method- students. triangulation, findings and possible implications for further changes. 8E 11 The role of evaluation and accreditation in 8E 9 Evaluation of undergraduate medical education as a improving medical education quality part of the European Union access process – an Fereshted Farzianpour and colleagues (Education Development experience at the Jessenius Medical Faculty of Centre, East Nosrat Avenue, Tehran, IRAN) Comenius University in Martin, Slovakia Medical education that is compatible to community needs, Lukáš Plank*, Ján Danko, Eva Rozborilová, Peter Galajda and Karol and the training of skillful teachers, are important subjects Dókuš (Jessenius Faculty of Medicine, Dean’s Office, Comenius attracting the attention of experts and designers throughout University, Zaborskeho 2, 036 45 MARTIN, SLOVAK REPUBLIC) the world. Various suggestions have been proposed. One of the most significant suggestions is the role of assessment Aim: To report on our experiences with undergraduate and accreditation in improvement of medical education education evaluation conducted by the team of experts quality. The main objective of this kind of accreditation is from the EU countries to evaluate education and practice close supervision in teaching, control of care and treatment, of doctors in the light of EU sectoral directives. improvement of quality and also promotion of quality in medical education. This research is a type of survey Summary of work: The purpose of the EU mission was to research and also it is typically field research, based on evaluate the implementation and enforcement of relevant the latest research worldwide. Everything to be examined requirements in the field of professional recognition in should be subject to accreditation and comprehensive Slovakia. The discussions were based on a EU quality management. Survey results showed that designing questionnaire completed and elaborated by Slovak experts, a scientific assessment model, was a means to promote including those from our faculty. medical education quality, which itself has two basic Summary of results: For undergraduate education the principles: (1) enternal quality control system, and (2) following items were considered: conditions for admission, external quality control system. curriculum of the faculty, duration and structure of undergraduate courses, methods employed to test the knowledge and qualification attained on completion. 8E 12 A survey about probable factors affecting the Conclusions/take home messages: Results of the academic staff’s evaluation by the students evaluation were summarized in the document entitled R Rezaie*, A Bazargani, M Amini (EDC Center, Zand St University “Expert Mobilisation: Memorandum on the Profession of of Medical Science Building, Shiraz, IRAN) Doctors in Slovakia”. The document recognises commitment and effort at all levels to bring national Background: The most significant and popular method regulations regarding medical education and practice in used for determining the academic staff’s success in the accord with EU requirements, including new legislation university is students’ attitudes. There are different opinions being enacted. The undergraduate course of studies on the validity of this type of evaluation. Numerous factors complies with the EC directives and the credit system based affecting students’ evaluation of instructors are usually on the accepted European Credit Transfer System (ECTS) neglected in the evaluation process. is used. The proposals for changes stress the need to find Aim: This study was conducted to determine these factors. a correct balance between theoretical and practical General objective: determining probable factors affecting training. students’ evaluation of instructors. Specific objectives: (1) determining the effect of the number of students in class on their evaluation of instructors; (2) determining the effect 8E 10 Analysis of educational evaluation at the Faculty of of the subject to be taught on this evaluation. Medicine Summary of work: In this research, 15 instructors and 395 Lenka Doubravska*, Radim Licenik, Vit Gloger, Miroslav Herman, students were chosen to be surveyed. The classes were Jarmila Indrakova, Daniela Jelenova, Petr Jindra, Barbora categorized into small classes (less than 40) and large Krajzlova, Pavel Kurfurst, Ivana Oborna, Katherine Ruzicka, Jan classes (more than 40). The teaching environment was Strojil and Cestmir Cihalik (Medical Faculty, Palacky University, divided into basic sciences and clinical ones. The students’ Hnevotinska 3, 775 15 Olomouc, CZECH REPUBLIC) scores were surveyed in the courses such as rheumatology, medical physics, persion, microbiology, gastrology, kidney, Aim: We present two years’ experience with educational pathology, medical ethics, biochemistry, histology and evaluation carried out by students at the Medical Faculty, anatomy. The questionnaires were distributed among the Palacky University.

– 4.89 – Section 4

students and the mean of the scores were determined as Summary of work: The Medical Faculty at the University in 1-5. Graz started a new curriculum in October 2003. The curriculum starts with a new fifteen hour course in the Summary of results: There was no significant relationship community. Students had lectures by medical doctors and between the number of students participating in class and health workers from various organisations providing health the instructors’ evaluation scores. As to the comparison of care for patients and clients in Graz. evaluation scores in different courses, the results reveal that the instructors of clinical courses have obtained higher Aim: The aim was to provide students with insight into their scores than those of basic sciences. This might be due to future working fields. Students became accustomed to the the fact that students think clinical courses are more work load of health care workers and their working relevant to their field and basic science courses are not conditions. The affiliated taught according to guidelines directly related to their future profession. On the other hand, provided by the medical faculty. this might be due to the different methodologies in these courses. Basic science courses are usually presented as Summary of results: The results of the students’ evaluation lectures by the instructors. In this type of teaching, the of this newly established course will be presented. Students’ relationship is usually not mutual and the student is not feedback was based on standardised written actively participating in class shereas in clinical courses questionnaires. Overall students appreciated their the subjects are presented through group discussion, participation in the community settings. clinical rounds, problem based learning and active learning Conclusion: The students’ evaluation was not very helpful methods. These courses have more impact on students’ in relation to concrete suggestions for improving the motivation, creativity and participation. educational objectives of the course. The new challenge is working on a more detailed tool. Take home message: Satisfaction of the students and good 8E 13 Quality improvement in medical student assessment evaluation results are not always an adequate source for Supawadee Prakunhungsit*, Boonmee Sathapatayavongs and evaluating whether educational objectives are met. Tharntip Malaisirirat (Mahidol University, Medical Education Unit, Faculty of Medicine, Ramathibodi Hospital, Rama VI Road, Bangkok 10400, THAILAND) 8E 15 Students’ opinions of the most pleasant and the Aim: Internal quality assessment as a strategy for quality most unpleasant aspects of the first year in the improvement. Faculty of Medicine University of Chile in 2001 Summary of work: Fourteen courses in the Faculty of Ilse Lopez, Zulema Vivanco, Manuel Castillo and Enrique Mandiola Medicine, Ramathibodi Hospital MD program are (Facultad de Medicina, Universidad de Chile, Box 13898, Correo assessed using the new set of indicators and criteria in the 21, Independencia 1027, Santiago de Chile, CHILE). (presented by year 2001 and 2002. There are 13 indicators in the category Beatriz Saavedra) of student assessment The results of quality assessment Background: The first year in university means great are described into quality level 1-5. The basic standard changes and new challenges for the students. requirement is level 3. Level 5 stands for best practice, in which all indicators in the category are achieved. After Summary of work: In order to identify the most positive and yearly assessment, dissemination of best practice is the most unpleasant aspects, at the end of their first year a arranged. Expert consultation is offered for the substandard group of 496 students in the eight courses was asked to one, in order to set up improvement plans. register their experiences during the year. Summary of results: Compared to the year 2001, Summary of results: Among the positive aspects indicated assessment results of the year 2002 show that the number were: “ new friendships”, “to be in the desired career”; of courses with acceptable standard performance in “knowledge learned interesting in quantity and quality”; student assessment increased from 4/14 (28.57%) to 9/14 “personal development”; “value of the diversity and (64.38%). However, there are a few courses that cannot pluralism to share with students from others careers”; maintain their performance due to the discontinuation of “Medical students pointed out the early contact with the the quality improvement cycle from various reasons. This hospital and with patients”. The most unpleasant aspects problem needs further analysis and remedy. were “schedule too heavy with too many classes”; “poor distribution of the curriculum courses”; “inclusion of non- Conclusions: Internal quality assessment promotes quality useful content”; “lack of time to be with family and friends”; improvement and the learning organization. “deficient learning results”; “inconsequence between the teaching content and the evaluation content”; “some teachers show poor human quality”; “ill will”; “without 8E 14 Students’ evaluation of an undergraduate course in interest in teaching”; “arbitrarity in calification”. the community Conclusions/take home messages: Negative aspects need Eva Rasky (Institute of Social Medicine and Epidemiology, Karl- to be reviewed and corrected to favor the teacher-student Franzens-University Graz, Universitätsstrasse 6/I, A-8020 relationship and to promote a better well-being for the Graz, AUSTRIA) young students.

Session 8F: Teaching Clinical Skills (1)

8F 1 Does the Paediatric Advanced Life Support (PALS) Summary of work: On completion of the PALS-course, course improve confidence in knowledge and physicians, nurses and paramedics from across The performance of paediatric resuscitation? Netherlands took three tests (skill in basic life support, scenario-testing and a multiple choice (MCQ-test). The Jos M Th Draaisma* and Nigel McBeth Turner (Dutch Foundation pass-mark for the MCQ was 80% and for the practical for the Emergency Medical Care of Children, Weezenhof 29-54, tests a re-test was permitted. The candidates’ attitude 6536 HN Nijmegen, NETHERLANDS) towards the course was assessed by a standardised Aim: To determine whether the PALS course contributes to questionnaire which focused on content, relevance and impact of the various teaching sessions. the confidence in knowledge and performance of professionals.

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Summary of results: 112 professionals (29 physicians, 83 foetal blood sampling, showing that a systematic training nurses/paramedics) followed one of the 5 PALS courses programme is effective. in 2002. There was no statistically significant difference in the proportion of nurses/paramedics and physicians who passed the course, or passed after a retest. However, there 8F 4 Evaluation of modified case-based-learning-lessons was a significant difference in the MCQ-score. The course was regarded as very usefullfor the professional’s R Faber*, C Nikendei, D Schellberg, C Roth, A Zeuch, B Auler, W confidence in knowledge and performance. Scenarios Herzog and J Juenger (Department of Internal Medicine, University were regarded as the most useful, followed by skill-stations of Heidelberg, Medizinische Universitätsklinik, Bergheimerstr. and lectures. 58, 69115 Heidelberg, GERMANY) Conclusions: These results show that the PALS course Aim: To increase the learning-benefit of modified CBL- promotes self-confidence and that there is a significant groups for final year students it is important to improve difference between nurses/paramedics and physicians in students’ ability of self-directed learning as well as of stand- theoretical knowledge. alone decision making and the handling of clinical cases. Summary of work: CBL-groups consist of 6-8 last year students; the role of tutor, case presenter and secretary are 8F 2 “Paper cases” help to organize a dermatology taken over by students themselves. This hierarchic structure practical course promotes the above mentioned skills. In a repeated- A Böer and F Ochsendorf* (Universitäts-Hautklinik, D.J.W. measurement-design we evaluated subjective arousal, Goethe-Universität, Theodor Stern Kai-7, 60590 Frankfurt am valence, dominance, learning-benefit and level of teamwork using a SAM and a self-developed questionnaire Main, GERMANY after each lesson. A supervisor grades each student’s Background: A traditional dermatology practical course is activity and utility for the learning-benefit in every lesson. associated with a number of problems: 1) patients with Summary of results: After two lessons a non-parametric 2- typical clinically relevant dermatological disorders are often sample median test showed that students with a low level not available on the day of the course; 2) out-patients are of arousal grade their learning-benefit and self-efficacy often unreliable in terms of attendance; 3) in-patients towards case-solving (p<0.01) significantly better than present a rather limited spectrum of skin diseases; and 4) those with a high arousal. No relation could be found patients with worthwhile demonstrable findings have to between the grading of the supervisor and the self- tolerate examinations by many students. Consequently the assessment of the students. recruitment of patients proves to be difficult. The exact learning issues are determined by the available patients Conclusions: For a good learning-benefit it seems and are subject to chance. necessary that students feel comfortable during the lesson. The benefit is not dependent on students’ activity during Summary of work: To solve these problems written patient the lesson. scenarios were prepared (“paper-cases”) using high- quality color photographs. The students work on this case as on a live patient. These cases were used as an alternative in bed-side teaching if a suitable patient could 8F 5 Student perceived benefit from a surgical specialty not be found. 20% of patient demonstrations were theatre attendance substituted by “paper cases”. Michael S W Lee*, Mary-Louise Montague and S S Musheer Summary of results: Students (n=204) rated these cases Hussain (Ninewells Hospital and Medical School, Dept of with a mark of 1 (very good) in 21%, with 2 in 53%, 3 in16 Otolaryngology, Dundee DD1 9SY, UK) %, 4 in 8%, 5 and 6 each 1% (2,1 ± 0,9, mean ± SD). Aim: The value of theatre attendance by undergraduates is Conclusions: Paper cases helped to organize and run bed- uncertain. This study aims to evaluate the perceived benefit side teaching and allowed to teach practically relevant skin of attending operating theatre sessions during disorders otherwise neglected. undergraduate otolaryngology attachment. Summary of work: Fourth year medical students were asked to complete a questionnaire at the end of their 2 week 8F 3 Skills training in obstetrics attachment in otolaryngology. Jette Led Sørensen*, Morten Lebech and Tom Weber (The Clinic of Summary of results: 87 students returned completed Obstetrics, Rigshospitalet, University of Copenhagen, The Juliane questionnaires. 42 students attended 2 theatre sessions, Marie Centre, Section 4232, Blegdamsvej 9, DK 2100 Copenhagen 34 attended 1 session, and 9 attended 3 sessions (median O, DENMARK) 2). The three most common student expectations were to Aims: (1) Introduction of training in six obstetrical skills: see and learn common ENT operations, understand the vaginal delivery of breech presentations, shoulder dystocia, indications for these operations, and see the anatomy ventouse delivery, amnion infusion, foetal bloodsampling involved. 74% of students reported that their expectations and handling of postpartum haemorrhage. (2) Evaluation had been met. The most common operations observed of the effect of the training programme by registrars’ self- were tonsillectomy, myringotomy and ventilation tube assessment of confidence before and after training. insertion and septoplasty. Students rated their theatre Confidence was described as a score 1-5, where “1” meant teaching by surgeons to occur always (38%), occasionally not confident and always needing help, and “5” meant (55%), or rarely (7%). On an analogue scale from 1 (strongly confident and never needing help. disagree) to 7 (strongly agree), the importance of theatre Material: Participating registrars: 44. attendance as part of the curriculum was rated to be 5.2 (95% C.I. 4.85 to 5.46). Summary of results: Self-assessment scores before and after training were: Vaginal delivery of breech presentations: Conclusions/take home messages: Students perceive median 2 versus 4 – mean 2.23 versus 3.45; Shoulder attending otolaryngology theatre sessions to be beneficial. dystocia: median 3 versus 4 and mean 2.53 versus 3.68; This information is important in the planning of the Ventouse delivery: median 4 versus 4 and mean 4.0 versus otolaryngology undergraduate curriculum. 4.25; Amnion infusion: median 1 versus 4 and mean 1.84 versus 3.95; Foetal blood sampling: median 4 versus 5 and mean 3.81 versus 4.43; Postpartum haemorrhage: 8F 6 Experience of first ever batch of senior clerkship in median 4 versus 4 and mean 3.58 versus 4.0. International Medical University Malaysia Conclusion: The changes in median self-assessment Esha Das Gupta*, Nurjahan Mohd Ibrahim, D Motilal and C L Teng before and after training were statistically significant (Mann- (International Medical University, 1102 A Bukit Blossom, Whitney Test) for all skills except ventouse delivery and Seremban 70100, MALAYSIA)

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The theme of Senior Clerkship is novel in Malaysia. It was Conclusions/take home messages: Peer tutors value the first carried out in the International Medical University of opportunity to teach and are also known to benefit. Malaysia. The idea is to give the medical student a better Comparison will be made between the senior students exposure to working life. The first batch of 42 students who chose to teach and those who did not in their final graduated in November 2001. A questionnaire based study examinations. was conducted and the results were very encouraging. The students felt it was a very good system to get a hold on practical medicine before they became housemen. They 8F 9 The 5W-H reflective approach to patient assessment could manage to get study time along with ward work and the debriefing by the lecturers was very useful to them. Joyce Mothabeng (University of Pretoria, BOX 58213, Akasia Most of them found out their areas of interest during this 0118, Gauteng Province, SOUTH AFRICA) posting. During this period the 8 IMU outcomes were Background: This paper discusses an innovative method emphasized and over all it was a very gratifying experience. of teaching pre-clinical physiotherapy students how to About 75% of the students agreed with the usefulness of assess patients and plan effective management programs Senior Clerkship. as a result of the assessment. Historically, physiotherapy students at the University of Pretoria started clinical education in their 3rd year of study. With the changes in 8F 7 Providing artificial experience through integrated, higher education that led to curriculum restructuring, case-based, multidisciplinary forum presentations students started clinical education from 2nd year in 2002. Hettie Till*, Oryst Swyszcz and Peter Cauwenbergs (Canadian One of the biggest challenges the students faced was the Memorial Chiropractic College, 1900 Bayview Avenue, Toronto ON patient assessment. This challenge prompted me to try M4G 3E6, CANADA) and find ways of making it easier for the students to assess patients. Background: Integration and relevance of course material appear to be two of the most serious challenges facing our Summary of work: Using principles of adult education, I undergraduate students. Clinical cases help students to developed the 5W-H approach to patient assessment. The associate course material with real patient situations, but approach requires that students reflect each step of the arranging enough observations of the doctor-patient patient assessment, asking themselves the questions What, encounter, for a large number of undergraduate students, Why, How, When, Where and Who (hence 5W-H). The is a difficult task. theoretical underpinning of this approach is the educational principle that reflection is foundational to problem solving, Summary of work: In order to help solve this problem an thus reflective assessment should lead to good patient integrated, case-based, multidisciplinary forum teaching management. The paper will also present the results of a method was developed. The presentation is given to the pilot project on the approach. The approach will is being whole group of students at the same time and each taught to students, and their assesment skills evaluated at presentation takes the form of an elaborated clinical the end of their first clinical block in May 2003. problem demonstrated as an actual doctor-patient encounter making use of real or Standardized Patients. The presentation mimics the doctor-patient encounter in 8F 10 Learning in the clinical environment of district and history taking, physical examination, report of findings, plan university hospitals in the Netherlands of management and treatment/consent. It also reinforces K B Boor*, F Scheele, C van Aken, J Dronkert, J Th M van der Schoot all underpinning knowledge necessary for decision making as the encounters are interspersed with learning and B Wolf (SLAZ, Department of Women and Child Health, Van activities drawing disparate information together around Spilbergenstraat 6-3, Amsterdam 1057RG, NETHERLANDS) the patient problem. Aim: To compare the learning environment in the main Conclusions: These presentations have a number of clerkships in district and university hospitals in the advantages in that it is flexible, adaptable to the level of the Netherlands. student, and appears to be an inexpensive and effective Summary of work: For a period of three months junior alternative for “real” clinical observation. Initial quantitative doctors in several district and university hospitals will be as well as qualitative evaluations were positive and asked to fill out a validated five-point scale questionnaire significant positive effects on teaching and learning are that measures the medical students’ opinions on the anticipated. educational environment (the FREEM). Co-variables are gender and experience of the junior doctor and the type of clerkship (Internal medicine, Surgery, Gynaecology & 8F 8 Peer tutoring success in clinical skills Obstetrics, Neurology or Paediatrics). Clare Stewart*, Joy Crosby and Jean Ker (Dundee University, Summary of results: Data will be presented that should Clinical Skills Centre, Ninewells Hospital and Medical School, answer the question whether the teaching and learning Dundee DD1 9SY, UK) environment is related to a certain type of hospital and/or Aim: The aim of this study is to share the results of a peer type of clerkship. Preliminary data indicate that the use of tutoring scheme in clinical skills. the FREEM is feasible in this Dutch setting. Summary of work: Cross year peer tutoring is now Conclusions/Take-home messages: A validated commonplace, especially in problem based learning. In measurement of the learning environment in various our medical school theoretical system based peer led small clerkships might allow an objective evaluation of the group sessions have run successfully for two years as an clinical educational environment in various hospitals. adjunct to the curriculum delivered by staff tutors. Building on this experience we have implemented a peer tutoring programme to support the development of clinical skills 8F 11 Strengths and weaknesses of graduate medical within the core curriculum in the Ambulatory Care Teaching clinical training in Ghent, according to 2nd year Centre. This environment provides an ideal tutor/tutee ratio postgraduates with groups of five students per peer tutor. M van Winckel, B Morlion*, S van de Moortele, A Derese and M Summary of results: Structured satisfaction questionnaires Valcke (Ghent University, Universitair Ziekenhuis Gent (3K3), De completed by the senior students (tutors) and the junior Pintelaan 185, B-9000 Gent, BELGIUM) students (tutees) have shown the popularity of the scheme Aim: The aim of this study is to explore which and the advantage of enhancing learning for both groups. competencies have been insufficiently developed during Quantitative results of any change in the tutees’ graduate medical clinical training, according to second performance, especially proficiency in clinical skills, year post-graduate trainees in general practice or in different compared with last year’s course will be reported by specialties. comparing summative OSCE results.

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Summary of work: In February 2003, all 2001 graduates The work experience is weekly for 5 hours, one student from the Faculty of Medicine (Ghent University) received a attending one doctor. Objectives are to train clinical and postal questionnaire covering competencies in clinical communication skills as well as patient management and practice (26 items), professional behaviour and personal practical procedures. Although the course was always development (10 items), as defined in the general appreciated by students, they have been demanding clear objectives of the curriculum. They were also asked to standards for their activities in the course evaluation. To categorise characteristics of clinical rotations in order of meet the students’ needs, physicians were asked to frame importance. Respondents were contacted by phone to a practice profile, and students were asked to describe to acquire complementary in-depth information and to ask what extent they have trained specific activities. These for remedial suggestions. pieces of information were compared and are now the basis for the modification of the training and specification Summary of results: Preliminary results show that trainees of outcomes. Our presentation gives a critical survey of the feel insufficiently trained in prescribing skills, in learning scenario, considering the students’ evaluation as differentiating urgent from non-urgent problems, in tackling well as our own experiences and activities. emergencies, in writing referral and discharge letters, in keeping structured patient files and in performing administrative tasks. Half the items regarding professional behaviour and personal development scored insufficient 8F 13 Redefining the role of a Learning Resource Centre by most respondents. Almost all feel insufficiently prepared in a medical school to combine a busy job with a fulfilling personal life. The Bruce Holmes (Learning Resource Centre, Dalhousie University, presence of an enthusiastic stimulating clinical tutor was Faculty of Medicine, 5599 Fenwick Street, Lower Level, Halifax NS uniformly the most valued characteristic of clinical B3H 1R2, CANADA) rotations. These results will guide the implementation of a modular coaching tool for students during graduate clinical Aim: This presentation will describe a Learning Resource rotations. Centre (LRC) as a multi-functional facility offering learners a clinic-like atmosphere to learn procedural, diagnostic, We thank last year students in educational sciences who and communicative skills. performed the phone interviews. Summary of work: It is increasingly difficult to find appropriate patients for learners to practise their skills. This problem is 8F 12 Integration of learning situations in primary health compounded with increasing student enrolment and trends care: experiences from the Berlin Reformed Track at for competency-based learning. The LRC has progressively undertaken new initiatives to address this the Charité, Germany problem and redefine its role in the medical school. Claudia Kiessling*, Margareta Kampmann, Dagmar Rolle and Summary of results: Beyond procedural skills training using Ulrich Schwantes (Arbeitsgruppe Reformstudiengang Medizin, simulation and a growth in the use of simulated patients, Charité, H U Berlin, Augustenburger Platz 1, Schumann Str 20/ the LRC coordinates recruiting of hospital in-patients and 21, D-10117 Berlin, GERMANY) volunteer patients with stable positive findings. The LRC Undergraduate medical education in Germany is strongly now has a repertoire of programs where patients are based on learning scenarios in University hospitals. represented as: 1. paper cases as patients; 2. mannequins Physicians who teach medical students focus on patients as simulated patients ; 3. simulated patients trained for with difficult and complex diseases which are typical for roles; 4. volunteer patients with stable findings; 5. hospital highly specified university health care but not for the based patients with complex findings. When appropriately majority of patients’ complaints. To strengthen aspects of integrated, a broader choice of patients for learners to Community-Based Education, we implemented a training practise is available. period together with physicians practising ambulant Conclusions/take home messages: The presentation will treatment in the field of primary health care. Medical describe examples of the LRC role in the medical school students partake this training from semester two to five. continuum of medical education.

Session 8G: Clinical Skills (2)

8G 1 Student satisfaction with standardized patient satisfaction and self-perception of skills acquired because encounters in an emergency medicine class at we had not used checklists with them. Results of three Charité Medical School, Humboldt University, Berlin cohorts from the Traditional Track Curriculum and one cohort from the Reformed Track Curriculum will be Heiderose Ortwein*, Torsten Schroeder and Claudia Kiessling presented, compared and discussed in this poster. (Charité Medical School, Humboldt University of Berlin, Trainingszentrum fur Aerztliche Fertigkeiten (TAEF), Conclusion: Students satisfaction with the new EM Schumannstr. 20-21, 10117 Berlin, GERMANY) teaching OSCE was surprisingly high. Data suggest that SP feedback seems to help students to reflect and improve Background: Mega-Code-Training is a core component their communication skills in challenging situations. of Emergency Medicine (EM) for undergraduate medical Assessment of students’ skills with an assessment OSCE education at Charité Medical School in Berlin, Germany. is needed to further evaluate the benefit of the adapted program. Summary of work: We implemented two new stations in our teaching OSCE in Fall of 2001. The aim was to enhance students’ communication skills to handle critical situation and practical procedure skills in EM. The two 8G 2 Medical students’ communication abilities prior to cases were designed in order to portray frequent EM training problems. Experienced standardized patients (SP) were Nicola Brown*, Kathryn Peace and John Campbell (Department of selected and trained. Students were asked to do a focused Psychological Medicine, University of Otago, PO Box 56, Dunedin, history and emergency diagnostic procedures. Additionally NEW ZEALAND) they were required to develop treatment strategies. Facilitators provided formative feedback focussed on the Background: While the importance of proficiency in clinical reflection of communication skills and case management communication for medical professionals is widely strategies in the German EM system.We evaluated student accepted, little is known about the extent to which medical

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students are equipped with the skills required to as empathy, absolute acceptance of patients and involving communicate well with patients prior to receiving specific them in decision making to the level they wish. The training training in the field. This poster outlines findings from the is done in small groups. Supervised by a tutor the students initial stage of a longitudinal study into the development of perform role plays, including simulated and real patients. students’ communication skills throughout medical In a second course (semester 10) breaking bad news is training. The aim was to investigate students’ abilities to trained. By supervised peer-group-learning, students do perform a clinical interview prior to the commencement of role plays on this topic. Meanwhile medical communication training in communication. training is well accepted and evaluated by the students. It is an integrated part in the medical education of the Charité. Summary of work: Participants were 232 new entrants to the medical training programme who each completed a Conclusions/take home messages: It is essential and videotaped interview with a simulated patient. Interviews feasible to implement a communication training in medical were marked by trained raters, and students’ performances education. were assessed regarding listening skills, verbal and non- verbal skills, responsiveness to the patient’s needs, degree of interview structure and clinical content. 8G 5 Consultation and communication skills for overseas Summary of results: Results demonstrated that there was doctors: culture, training and reward considerable variability in students’ abilities to perform this Alison Henry*, William Murdoch and Mohammed Arafa task, suggesting that the communication skills required in (Department of Primary Care and General Practice, Primary Care clinical settings are not necessarily present in the majority Sciences and Learning Centre, University of Birmingham, of students prior to training. Areas of strength and weakness Edgbaston, Birmingham B15 2TT, UK) for students as a group will be outlined. Implications for medical communication skills training programmes will Aim: This poster aims to increase awareness of the needs be discussed in light of these findings. of overseas trained doctors recruited to work in the UK, highlighting the potential effectiveness of intensive communication/consultation skills training and the 8G 3 Consultation skills never made easy potential usefulness of the nominal group technique. A Skott*, M Wahlqvist, C Björkelund, I Gause-Nilsson, B Dahlin Summary of work: As part of the support offered to overseas and B Mattsson (Sahlgrenska Academy at Göteborg University, trained doctors in the West Midlands region, quarterly Department of Public Health, Box 454, SE 405 30 Goteborg, weekend workshops are offered to groups of up to 40 SWEDEN) participants with emphasis on communication and the culture of the National Health Service [NHS]. Featured Aim: Teaching and learning how to meet and respond to expert presenters, interactive forums and small group patients should take place in a clinical setting. The teaching using role-play are employed as methodologies. interaction between patients, students and tutors is of great To explore training requirements in greater depth a group importance. of doctors who had trained overseas were used to form a Summary of work: In 1993, a ten-week course called nominal group. They were posed stimulus statements to ‘Consultation knowledge’ started in undergraduate medical allow them to explore their general needs, their education in Göteborg. At the beginning of clinical communication needs and how these needs could be met clerkships students learn communication skills, clinical effectively. Key issues were identified. At the time of writing examination skills and documentation in a clinical context. we intend to submit these findings to a different group of Tutors were educated and supervised and also participated overseas doctors to test representation.. in the practical examination. Feedback from students was Summary of results: The West Midlands Deanery continues obtained from written evaluations and analyzed. Reports to develop sophisticated courses to prepare newly arrived from teachers’ follow-up meetings were used. Feedback overseas doctors for UK posts. Previous evaluations have data functioned as an instrument in evaluation and for shown these interventions to be successful. These development of the course. Learning objectives and core elements are confirmed by the use of the nominal group content were made clear by refining the examination and technique. by structured support to tutors. The advantages of repeated consultation skills training in the clinical curriculum are Conclusions/take home messages: Overseas doctors have discussed. Learning and teaching in a clinical setting is a complex needs. They need assistance in orientating never-ending story, which takes a considerate and caring themselves within the NHS. They require training in tutor and a student wanting to learn. communication/consultation skills and need to have their language skills confirmed. The nominal group technique Take home message: With ten years of experience we still is demonstrably an effective evaluative tool. find ways to change the process to enhance the learning procedures and as a means of recruiting and training tutors. 8G 6 Course for breaking bad news 8G 4 Obligatory training of communication skills in the Daniela Jelenova*, Renata Simkova, Lenka Doubravska, Vit Gloger, Jarmila Indrakova, Petr Jindra, Barbora Krajzlova, Pavel Kurfurst, regular curriculum of the Charité, Berlin Radim Licenik, Jarmila Potomkova, Jan Strojil, Iveta Zedkova and Margareta Kampmann*, Britta Jonitz, Martina Schlünder and Cestmir Cihalik (Medical Faculty of Palacky University, Ulrich Schwantes (Charité Berlin, Institut für Allgemeinmedizin, Hnevotinska 3, 77515 Olomouc, CZECH REPUBLIC) Berlin, GERMANY) Summary of work: In response to the absence of relevant Background: Good communication between patient and communication skills training in the regular curriculum doctor is the prerequisite for diagnosis and therapy. we decided to offer a course focused on patient-doctor Nevertheless medical communication training is not a well communication. The students’ interest in such a course established component in medical education of most was determined using a questionnaire. In creating the universities in Germany. Since October 2001 students of program of the course, we have consulted adult-learning the Charité are taught obligatorily. The curriculum is experts familiar with organizing similar courses for nurses. presented and the way we put it into practice. The students and young doctors involved in the future Summary of work: In the basic and first course (semester course organization took part in the pilot version of this 5) we train elements of “Health Oriented Talking” HOT, a course in October 2002. Clinical psychologists, special communication technique looking for patients’ experienced clinicians and a lawyer participated in this resources. It is focused on the doctor-patient-relationship, weekend series of lecturers and workshops containing the reasons and aims of the consultation, transference theoretical and practical parts. This course covered four phenomena, and self efficacy. Attitudes are demonstrated main topics – delivering the diagnosis, communication with dying people, communication with their relatives and

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crisis intervention. We used standard evaluation tools - 1) • The learning that occurs relates overwhelmingly to the expectations of participants before the course; 2) evaluation CRM issues, rather than the medical features of the after the course according to Pendleton’s rules of giving scenario. feedback; and 3) combined interview after 4 months evaluation. According to the results we rearranged the Conclusions/take home messages: A high-fidelity syllabus for a summer course intended for students of simulation learning environment is an effective means for General Medicine. If the evaluation of the course comes bridging the gap between theory and safe practice off positively, our faculty authorities promised to include providing valuable experience prior to graduation in a way this course into the regular curriculum of our school in the that has not been possible previously. future. 8G 9 Training of simulated patients: the effect of a self- 8G 7 New high frequency oscillatory ventilator simulator written scenario on performance and feedback quality Abdulla Al Thari*, C A S Melville, Y Wickramasinghe and A Al Shihri Kenichi Mitsunami*, Masahiko Terada, Hiroki Tamura, Hidetoshi (Keele University, North Staffs Hospital, Centre for Science and Matsubara and Tadao Bamba (Shiga University of Medical Technology in Medicine, Bio Medical Engineering, Thuronbrow Science, Department of General Medicina, Tsukinowa-cho, Seta, Drive, Hartshill, Stoke on Trent ST4 7QB, UK) Otsu, Shiga 520-2192, JAPAN) Summary of work: We have developed a Windows™-based Aim: Medical interview training with simulated patients simulator for training in the use of HFOV to support learning (SPs) has been recognized as essential in Japan to medical of clinical management strategies in the neonatal and students’ improvement in communication skills. Recently, pediatric intensive care settings. The simulator uses the it has been considered necessary to ensure not only the Windows™-based commercially-available Labview™ quantity but also the quality of SPs. In this paper, we have (National Instrument, Bristol, UK). This allows the creation examined the educational effects of self-scenario writing of a virtual ‘skin’ resembling control panel of an HFOV by SPs on both their performance and feedback quality. ventilator with the appropriate dials and gauges (Sensormedics™ 3100A). This is linked to underlying Summary of work: SPs wrote scenarios for role-play algorithms, which determine system response. A self- exercises by themselves following a medical teacher’s standing .exe file can be created for distribution. The trainee advice. Each SP exercised two role-play sessions with a can select from 6 Cases of respiratory diseases commonly student, one with her/his own scenario and the other with treated by HFOV. Each has a case presentation, plus chest that written by other SPs. After all of the role-play sessions X-ray and initial blood gases whilst on conventional ended, we performed group interviews with the SPs and ventilation. The challenge is to optimise settings to achieve the students separately in order to assess the effect of self- a target blood gas. When the user reaches the target of scenario writing on SP training. one stage, positive feedback is given and the scenario Summary of results: SPs indicated that self-scenario writing moves on 6 hours. The algorithms are based on real cases, made their performances more realistic, however, it made and there are 12 adjustments required for each case. their feedback quality more emotional. Meanwhile, Expert help provides guidelines for HFOV use and details students could not distinguish any clear differences on the pathophysiology of common paediatric diseases between the two settings. causing respiratory failure. Conclusions: Self-scenario writing may exert a favorable Summary of results: Initial feedback from 5 clinical HFOV effect on the reality of SP portrayals, but not on the feedback experts has been positive, and detailed evaluation is quality. underway.

8G 10 Incorporating a newly developed heart sound 8G 8 Patient safety and high fidelity simulation in simulator into medical student education undergraduate medical education: learning the Katsuya Yoshida, Yoichi Kuwabara, Keiichi Nakagawa, Masahiro skills of Crisis Resource Management Tanabe* and Issei Komuro (Chiba University Graduate School of Brendan Flanagan, Debra Nestel*, Michele Joseph, Michael Bujor, Medicine, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Julia Harrison and Orla Lacey (Monash University, Centre for JAPAN) Medical & Health Sciences Education, Faculty of Medicine, Nursing & Health Sciences, Building 15, Clayton, Victoria 3800, Aim: To incorporate a newly developed heart sound AUSTRALIA) simulator for medicalstudent education. Summary of work: Eighty-seven medical students Background: Undergraduate curricula provide limited participated in a 90-minute teaching program using the opportunities for medical students to develop an heart sound simulator, which was a thorax-manikin understanding of the significance of contextual factors in controlled by a Windows computer (Simulator “K”, Kyoto- ensuring safe practice. Crisis Resource Management Kagaku Co., Kyoto, Japan). Built-in speakers are set at five (CRM) using high-fidelity simulation offers this opportunity. sites in the thorax (aortic, pulmonic, tricuspid and mitral The presentation outlines this innovative educational areas). All heart sounds were recorded from actual patients intervention derived from aviation training and considers with various heart diseases. Students auscultated eight ways in which high fidelity simulation addresses the core kinds of heart sounds using their own stethoscopes. To issue of patient safety in undergraduate education by evaluate the achievement, the students were asked to bridging the gap between theory and practice. answer the name of the two heart sounds, which the teacher Summary of work: Final-year medical students at Monash had randomly chosen before and after the program. Four- University attend the Southern Health Simulation & Skills point self-rating of skill in auscultation was also performed Centre during which they participate in an evolving crisis. before and after the program. All participants complete written evaluations at the end of Summary of results: Mean numbers of the correct answer the year. (n=132). Thematic analysis of this qualitative data were significantly increased from 0.71 to 1.52 (p<0.00052, will be presented. MacNemar test) and the self-rating score was also Summary of results: improved for all kinds of the sounds (mean value from 1.05 • High fidelity simulation and CRM is an extremely relevant, to 2.49) after the program. and highly valued way to learn; Conclusion: The newly developed heart sound simulator • The most valuable element is the opportunity to practise “K” was useful to increase skill in auscultation of heart being responsible for a patient in a realistic emergency sounds for medical students. situation - a chance to put theory into practice.

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8G 11 Simulator based course in emergency management Summary of work: A questionnaire related to attitudes to for primary care dental practice teams death and dying in medicine and law was tested in 34 students both before and after 6-hour duration of course S Weber*, M Müller, E Armstrong and T Koch (Department of for evaluation the effectiveness of teaching in changing Anaethesiology and Intensive Care Medicine, University Hospital the attitude of clerks. The course included disturbance of Dresden, Fetscherstr. 74, 01307 Dresden, GERMANY) consciousness and brain death (1h), vegetative state and Aim: The aim of this project was to establish a new euthanasia (1h), introduction to hospice in adult and curriculum for a one-day course in the management of children (1h), DNR and related law status at Taiwan (1h), medical emergencies for primary care dental practice spiritual care (1h) and bereavement (1h). The evaluation teams. was performed before and after the medical students’ rotation clerkship at the department of neurology. Not only the dentist, but also its nursing staff should gain knowledge and skills in treatment of patients in acute life- Summary of results: The results indicated that the teaching threatening situations considering the rising life expectancy enhanced the reaction of fear and running away in the and comorbitity of the population. students. There were also significant changes of understanding in the regulatory law of the hospice in our Summary of work: In cooperation with the State Dental country, much approval of the legislative means, and much Council a course based on the ERC ALS guidelines was appreciation of the real meaning and performance in developed consisting of two main parts. The short lecture details of DNR orders. series (2 hours) focussed on CPR, airway management, cardiac and circulation emergencies and special Conclusion: The results suggested that a short course of emergency situations. The systematic skills-training teaching may inspire the students in the understanding of section (6 hours) performed in small groups addressed both medical and law aspects related to death and dying. the following subjects: BLS, airway management and ventilation, intravenous techniques, manual and automated external defibrillation, ALS and resuscitation routine in a 8G 14 Survey of staff attitudes to the daily otolaryngology typical dental practice setting. For all skills-training stations ward round life-like manikins and models were utilized and the Mary-Louise Montague*, Michael S W Lee and SS Musheer emergency scenarios were simulated by the use of a Hussain (Ninewells Hospital and Medical School, Department of universal patient simulator. Otolaryngology, Dundee DD1 9SY, UK) Summary of results: In the first course, 13 out of 32 Aim: The aim of this survey was to investigate the attitudes participants were dentists and 19 dental nurses. In the of medical and nursing staff towards the daily evaluation results 100% stated the course was appropriate otolaryngology ward round in a teaching hospital. and 97% stated that the simulator based training in practice teams was the most important experience. Summary of work: Open-ended questionnaires generated themes from which a structured questionnaire was constructed. Respondents indicated on a Likert scale the 8G 12 Attitudes and ability: is there a relationship? extent to which they agreed or disagreed with statements Merilyn Liddell* and Sandra Davidson (Monash University, concerning their attitudes towards the ward round and the Department of General Practice, 867 Centre Road, East Bentleigh, quality of care and teaching experience it provides. Vic 3165, AUSTRALIA) Summary of results: 18 medical staff and 17 nursing staff were surveyed. The overall response rate was 74.3% (n=26). Aim: Despite much emphasis on development of The majority of staff agreed that the ward round is a appropriate attitudes among medical students, the constructive use of their time and serves to promote team relationship of attitudes to behaviours is not clear. Many spirit. Both groups agreed that the ward round allows educators use student confidence as an appropriate adequate communication between medical and nursing outcome measure, with little evidence to support this. This staff but there was uncertainty about the provision of presentation aims to clarify the relationship between adequate patient communication on ward rounds. Nursing students’ value judgements, their confidence, and their staff agreed that the ward round provides a valuable assessed competence in a range of consultation skills. learning experience. There was uncertainty about this Summary of work: Questionnaires were developed to among medical staff. assess final year students’ views of importance of, and their Conclusions: These findings can be used to inform confidence in, demonstrating twenty-eight separate changes in the departmental ward round structure with consultation skills. These were administered before and specific attention directed to maximising educational after an attachment which focused on consulting skills. opportunities for junior medical staff. Results were compared with performance in relevant aspects of their final examinations. Summary of results: Following the teaching, students 8G 15 Assessment of quality of morning report viewed many of the skills as more important, and felt Akbar Derakhshan (Mashhad University of Medical Science, EDC, significantly more confident in displaying all of the skills. Daneshgah St, Mashad, IRAN) There was a direct correlation between the importance students placed on a skill (particularly pre-existing views), Aim: To assess educational quality and quantity of morning and their later performance. However there was no reports in Ghaem Hospital Medical School. relationship between students’ level of confidence (pre or Summary of work: This is a descriptive cross-sectional post) and their later performance. study performed through a questionnaire. The resulting Conclusions/take-home messages: 1. Positive pre-existing data were stored and analyzed by the statistical software attitudes to consulting skills are associated with better SPSS/7.5. performance, lending weight to the importance of selecting Summary of results: We received 330 filled out students who exhibit appropriate attitudes; 2. Increased questionnaires. The option showed lack of discipline, low confidence is not a valid surrogate for competence. participation of faculty, excess attention to the theoretical aspects, inappropriate selection of subject considering the students’ level, undesirable room situation and it was 8G 13 The changes in attitudes to death and dying among concluded that there was low educational efficacy of the medical students morning reports. Ming-Liang Lai*, Jung-Jong Chen, Hsing-Hsing Chen and Chantal Conclusions: Since morning report is considered an Co-Shi Chao (School of Medicine, Tzu Chi University, 701, Sec 3, education curriculum in the first place and takes Chung-Yang Road, Hua-Lien 970, TAIWAN) considerable time every day, it seems a necessity to re-

– 4.96 – Section 4

evaluate the current situation, set new objectives and adapt learning behaviour was determined from questionnaire novel methods in medical education. responses. Summary of results: 619 BPE were assessed. All CE (n=13) and 85% of 161 students returned completed 8G 16 Bedside tutorial-based formative assessment questionnaires. Students recognised BPE as a valuable promotes learning in clinical clerkships learning activity (96%) that improved clinical reasoning V C Burch*, T Gibbs and J L Seggie (University of Cape Town, skills (88%) and assessed progress in a fair manner (75%). Department of Medicine, J Floor, Old Main Building, Groote Schuur Feedback positively influenced factors driving learning: Hospital, Observatory 7925, SOUTH AFRICA) informed of own level of competence (69%), advised regarding learning needs (84%), and motivated to learn Aim: Because clinical clerkships are typically situated in independently, specifically, self-directed reading (81%) and environments that lack educational structure, there is an BPE (71%). Most CE (77%) integrated FA into their imperative to integrate formative assessment (FA) strategies educational practice, and agreed that it enhanced the to enhance learning. We describe a novel FA activity, and learning potential of bedside tutorials. demonstrate its impact on learning. Conclusions/take-home messages: (1) FA strategies can Summary of work: Clinician educators (CE) assessed be successfully integrated into bedside tutorials; (2) The student performance during bedside tutorials based on BPE-based tutorial is a useful FA strategy to promote “blinded” patient encounters (BPE) i.e. without prior learning. knowledge of the clinical diagnosis or review of patient records. Feedback was standardised using performance rating scales. The educational value and impact of FA on

Session 8H: International Medical Education

8H 1 Implementing a women’s sexual health curriculum students. The graduating students had significantly better for St Petersburg, Russia knowledge and performance on the clinical cases than the entering students and had significantly better L Southgate*, P Toon, S Pavinski and O Kuzatova (Academic Centre knowledge than the Israeli students but had equivalent for Medical Education, Holborn Union Building, 4th Floor, Archway knowledge and performance on the clinical cases as the Campus, Highgate Hill, London N19 2UA, UK) American students. Aim: To develop and implement a curriculum for women’s Conclusion: The students of the new program had uniformly sexual health to be delivered by Russian family doctors for positive attitudes toward IH that did not change during women in the environs of St Petersburg Russia. medical school but they did increase their knowledge in Summary of work: A programme of work between London IH. Their knowledge was superior to one cohort of students and St Petersburg, based on surveys, literature reviews, but not to another. Long-term studies are necessary to focus groups with patients and family doctors has been further document the effects of the program. underway since September 2002. A distance learning programme for Doctors in Vyborg is one element, combined with practical skills training for gynaecology and 8H 3 Programme for integration of third world medical STD. The doctors will undertake a formal assessment at doctors intervals during the programme. Mette Valbjoern (Office for Postgraduate Medical Education, Summary of results: The design of the distance learning Region North, Aarhus Amt, Lyseng Alle 1, 8270 Hoejbjerg, programme, the use of a journal to support it, the output DENMARK) from focus groups and the learning needs assessments Aim: The Office for Postgraduate Medical Education – for the family doctors will be presented. Region North, Denmark has focused on integration of Take-home messages: A curriculum for established doctors resident third country medical doctors with the purpose of must be based on the needs of the population they serve, obtaining permanent authorisation. The aim of the and their own learning needs. Communication about presentation is to give a description of the integration sexual health is a sensitive and difficult area for family programme. doctors and their patients. Summary of work: The programme focuses on medical doctors outside the EU/EEC countries. This included a total of 124 third world medical doctors. The integration 8H 2 Evaluation of a new program in international health programme includes the following items: A Jotkowitz*, A Gaaserud, Y Gidron, J Urkin, Y Henkin and C Z • Individual interview and recognition of qualifications: Margolis (Ben-Gurion University, The Moshe Prywes Center for Individual interview, during which the applicants’ future Medical Education, POB 653, Beer Sheva 84105, ISRAEL) possibilities are identified. The formal authorisation is Aim: Ben-Gurion University in collaboration with Columbia evaluated by the National Board of Health; University inaugurated a medical school in 1997 with the • Planning of practical training periods at a hospital and purpose of training physicians in International Health (IH). specific medical language instruction; In order to evaluate the program a previously validated • Probationary employment periods: Advisory guidance survey was used. relating to applications regarding probationary Summary of work: The survey consisting of questions employment periods. This requires a provisional relating toward attitudes, knowledge and clinical cases in authorisation from the National Board of Health. IH was given to all graduates, incoming students, a random • Specific training courses: Participating in language sample of American medical students and a group of Israeli courses, integration courses and practical medical skill medical students. Analysis of variances were conducted courses. followed by planned contrasts. • Examinations: Advisory guidance relating to the Summary of results: The graduating students had examinations, which third country medical doctors are significantly better attitudes toward IH than the American required to obtain permanent authorisation. and Israeli students but were equivalent to the incoming

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8H 4 Experience of improving the neonatal teaching at Summary of work: 15 medical students and residents at the pediatric faculty one medical center who rotated internationally during 2001-2002 were asked to participate in semi-structured M A Ismailova*, D A Mavlyanova and Z G Rachmankulova (Tashkent interviews about their experiences. Interviews assessed Pediatric Medical Institute, J. Obidova Street 223, 700140 logistical issues, day-to-day activities, and perceived value Tashkent, Uzbekistan) of the experience. Interviews were audiotaped and Aim: To study the effectiveness of the introduction of new transcribed, and open coding was conducted by two pedagogic technology into a modern medical school in investigators to identify common themes and develop a the pediatric faculty. conceptual framework. Member checking and review of results by a group of experts in bioethics were used to Summary of work: Experience of new methods of teaching validate the results. received from the international seminars with help of USAID, Zdravplus Project, Global Project and DFID were Summary of results: 10 medical students and 5 residents introduced into undergraduated medical education in were interviewed. Attitudinal changes that emerged Uzbekistan in 2001. included increased empathy for non-native language speakers, shifting point of view about Western medicine, Reforms in the Health Care System of Uzbekistan show a more positive attitudes toward public service, and personal great gap between the level of professional training of growth. students. There are some objective and subjective reasons for this problem, including conservative approaches of Conclusions: This preliminary study indicates that traditional medical schools and poor experience in using international rotations have diverse and powerful effects the advanced educational technologies. on the students who participate. These experiences are We applied the following active methods of training: brain expensive in time and resources, so as more students storming, problem based learning, small group discussion, chose them, further research is needed to measure their role play, interactive video. It gave the opportunity to increase effects. the level of knowledge and understanding in neonatology. Conclusions: New methods of teaching help to improve 8H 7 Assessing global essential competencies in the quality learning, to develop competence and performance leading Chinese medical schools: The IIME Project of teachers and to motivate student activity for individual practice. Exchange of experience with international Andrzej Wojtczak*, David T Stern and M Roy Schwarz (Institute colleagues is important support for developing medical for International Medical Education, 106 Corporate Park Drive, education in Uzbekistan. Suite 100, White Plains, New York NY 10604-3817, USA) Aim: The Institute for International Medical Education (IIME) was created to develop the global minimum 8H 5 Expanding the boundaries of medical education: essential requirements of medical education that are evidence for cross-cultural exchanges necessary to equip all physicians, regardless of where they Ian S Mutchnick, Cheryl A Moyer and David T Stern* (University are trained, with medical knowledge, skills and of Michigan Health System, 300 North Ingalls, Room 7E10, Ann professional attitudes of universal value. Arbor, MI 48109-0429, USA) Summary of work and results: The IIME Project consists of three phases. In phase I, sixty essential outcomes were Aim: Cross-cultural experiences are in increasing demand developed by an international panel of medical education by both graduate and undergraduate medical students, experts, categorized into seven major domains including yet the benefits of these experiences are not clearly professionalism, basic medical sciences, and information established. The aim of this study was to identify and management. In the phase II of the project, the graduates summarize the existing qualitative and quantitative data of the eight leading medical schools in China are being regarding the impact of international rotations on health evaluated for the presence of these outcomes in graduating care providers in training. medical students. Using the best available assessment Summary of work: We conducted a comprehensive review tools, guided by a team of international assessment of the literature to identify articles on the outcomes of cross- experts, this evaluation will occur in October 2003. In phase cultural experiences during medical training. Themes III, the lessons learned in China will be applied to other were identified and categorized into domains. medical schools worldwide. Summary of results: Forty-two studies were found; 27 Conclusions: Global agreement on outcome-based articles used qualitative methods, 9 used quantitative assessment of medical education is possible. International methods and 6 used both. Most (24) were from the nursing experts can agree on the content and assessment literature, 18 were from the medical literature. All studies measures of global medical competency. Results of this reported positive outcomes along four domains: students’ assessment can be used as part of a process to ensure professional development, students’ personal the quality of medical schools worldwide. development, medical school benefits, and host population benefits. 8H 8 A Harvard program for German final year students Conclusions: Studies reviewed were primarily case- controlled or case series. Future research is needed that H Baschnegger*, A S Peters, H T Aretz and F Christ (LMU Munich, more clearly defines outcome measures and uses more Klinik für Anaesthesiologie, Klinikum der Universität, 83177 rigorous methods. While results suggest positive outcomes Munich, GERMANY) in all domains, further research is needed before cross- Aim: Ludwig Maximilians University (LMU) and Harvard cultural rotations can be supported based on evidence. Medical International (HMI) formed an Alliance for Medical Education in 1996. To increase the momentum of the curricular reform LMU and HMI created a special program, 8H 6 The effect of international medical rotations on Introduction to American Medicine and Medical Education, students’ attitudes: a qualitative study for LMU’s best final year students. Cheryl A Moyer and David T Stern* (University of Michigan Health Summary of work: Each year 10 LMU students are enrolled System, 300 North Ingalls, Room 7E10, Ann Arbor, MI 48109- at Harvard for 6 months. In addition to clinical electives the 0429, USA) special program is held one afternoon per week as well as during two entire weeks. It covers learning theory, tutor Aim: To date, little is known about the impact of international training; case writing; lecturing and bedside teaching skills; rotations on the attitudes of medical students and residents. feedback; student and program evaluation; course design; This study aimed to identify how trainees who rotated academic leadership; patient-doctor communication; internationally were affected by the experience. palliative care and evidence based medicine.

– 4.98 – Section 4

Summary of results: After graduation, 41 of 55 former incoming non-Scandinavian exchange students, 2) program participants stayed at LMU. They have participated increase student competence in English and 3) stimulate in core course planning groups, as case writers, tutors teacher/researcher exchange. The basic idea is bilateral and instructors. Moreover, the class of 2001 developed a exchange. course to teach and reinforce skills in interviewing and examining patients. The class of 2002 designed a course Summary of work: In 2003 spring semester, 20 of 94 for ambulatory care. Both will be used to generate new students are exchange students. The same number of Oslo courses at LMU. students are in partner universities for equivalent ninth semester learning. All our students are thus exposed to Conclusion: So far 4 new problem based interdisciplinary English medical language in plenary teaching as well as courses have been successfully implemented at LMU. A contact with foreign students. The Faculty support teacher change in German law forces all universities to reform exchange with established and potential partner their curricula by fall 2003. LMU feels very well prepared universities. Pronunciation courses in English and help in for this challenge since it started this process ahead of preparing teaching material in English is offered. time with the help of HMI and its own final year students. Information and discussion meetings for the involved teachers aim to foster group identity and ownership to the project. 8H 9 Internationalisation of medical education in the Summary of results: The student evaluation after two Netherlands semesters identifies problems and areas for Gerard D Majoor* and Susan Niemantsverdriet (Maastricht improvements. The overall picture is however positive. The University, Faculty of Medicine, POB 616, NL 6200 MD teacher competence in English is crucial. Maastricht, NETHERLANDS) Conclusion: English as the language of instruction for a Aim: Description of the state of the art in internationalisation whole semester has increased student exchange into our of medical education in The Netherlands. Norwegian Medical Faculty. It additionally represents “Internationalisation at Home” for the non-exchanging Summary of work: Internationalisation co-ordinators of Norwegian students. seven out of the eight Dutch medical Faculties responded to a brief questionnaire. Summary of results: In 2000/2001 on average 107 students 8H 11 Correlations to attitudes and knowledge about per Faculty went abroad (range: 53-243) out of an average international health student population of 1506 (range: 1303-1679). Visiting A Gaaserud*, A Jotkowitz, Y Gidron, C Baskin, M Alkan, Y Henkin foreign students ranged from 12-77 (mean: 38). Research and C Margolis (Ben Gurion University of the Negev, Faculty of was the dominant activity for study abroad in industrialised Health Sciences, The Moshe Prywes Center for Medical Education, countries and clinical work in developing countries. All PO Box 653, Beer Sheva 84105, ISRAEL) Faculties have installed procedures to assure the quality of study periods abroad. Visiting students predominantly Aim: There is increasing awareness of the importance of participated in the regular educational programme and in international health (IH) but there is a paucity of data research. In the curricula of all Dutch Faculties attention is regarding medical students’ attitudes and knowledge given to international aspects of medicine, like training in towards IH. Furthermore there is little known about foreign languages (particularly English); intercultural students’ attributes that correlate with positive attitude and aspects of medicine; tropical (imported) diseases; and increased knowledge in IH. foreign health care systems. Most of these topics are not incorporated in the Faculties’ core curricula but offered as Summary of work: 126 medical students from 26 countries elective courses. Incentives for internationalisation provided were assessed using the Beersheva Survey of Attitudes and by the home University and Faculty were perceived as most Knowledge in International Health. Data were analyzed for effective. correlations between demographic, educational and occupational variables with attitudes and knowledge in IH. Conclusions: Student mobility is established in all Dutch medical Faculties although considerable quantitative Summary of results: IH knowledge positively correlated with differences exist. Internationalisation at home can be clinical IH knowledge (P<0.01). Previous IH work further advanced by incorporating more aspects of experience correlated with openness to experience, a internationalisation in core curricula. personality factor, (P<0.001) and with attitude (P<0.001). US-born students had more positive attitudes (P<0.05). Female gender shows more positive attitude (P<0.05). Attitude negatively correlated with number of languages 8H 10 English taught semester in medicine at the spoken R=-0.198 (P<0.05). University of Oslo Conclusion: Medical students’ attitudes toward IH are Borghild Roald*, Sverre Bjerkeset and Babill Stray-Pedersen positively correlated with female gender, US-born, and prior (University of Oslo, Department of Pathology, Medical Faculty, IH experience. General knowledge in IH was correlated Ullevål University Hospital, 0407 OSLO, NORWAY) with clinical IH knowledge but not attitude or openness. Aim: We present one year’s experience with semester 9 (of Further studies are needed to validate the importance of 12), “Reproduction, Women and Children’s diseases”, these findings on education in IH. taught in English. The aim is to 1) increase the number of

Session 8I: Problem Based Learning

8I 1 The correlation between students’ perceptions of Background: PBL is an effective way of delivering medical PBL session and their scores on MCQ exams at the education by motivating the students, encouraging them end of the session to set their own learning goals and giving them a role in decisions that affect their own learning. In PBL, true-to-life Melih Elcin, Orhan Odabasi, Iskender Sayek*, Murat Akova and clinical problems become the stimulus for learning in small Nural Kiper (Hacettepe University, Tip Facultesi Tip Egitimi ve group tutorials. Bilisimi AD, 06100 Sihhiye, Ankara, TURKEY)

– 4.99 – Section 4

Summary of work: In Hacettepe University Faculty of linked often diverged from the structure envisioned by the Medicine, we had one module in each committee and the course planners. A content analysis of the interviews and students had a MCQ exam at the end of each module. To curriculum structure task showed a wide range of reported evaluate their perceptions of PBL sessions, students are strategies for individual study using PBL cases. also asked to answer a questionnarie at the end of each module. The aim of this study is to investigate the Conclusion: We will argue for the need for curriculum correlation between perceptions and the exam scores. We designers to have access to more information about what have 24 groups with 13 students in year III. We evaluate the students do when they are working with the curriculum, results of the questionnaire and the exam scores by means and how they perceive the structure and linkages. of groups. We had 6 statements in the questionnaire and the students used a 5-point Likert scale to answer. We analysed the results using Pearson correlation coefficient. 8I 4 Students show increased confidence in supported PBL Summary of results: We got no significant correlation between perceptions and scores. David C M Taylor* and Trevor J Gibbs (University of Liverpool, Faculty of Medicine Office, Duncan Building, Daulby Street, Conclusion: We concluded that assessment methods used Liverpool L69 3GA, UK) in any educational approach should be appropriate to curriculum outcomes. It is hard to measure the outcomes Background: The Faculty of Health Sciences of the of PBL using MCQ examinations. University of Cape Town introduced a new medical curriculum in 2002, which is based around supported problem-based learning (PBL). 8I 2 PBL: what do students think about it? Summary of work: The students underwent a short PBL R Davidova, St Jochkova, P Moushatova, N Narlieva and D training programme before they embarked on the course Dimitrov* (31 Sergey Rumiantcev Str, Student Hostel, Room 80, and each student completed a 20-item questionnaire at Pleven 5800, BULGARIA) the start and the end of their first year. Background: A hybrid PBL program has been implemented Summary of results: From the start the students realised in the Medical University Pleven since 1999. It includes that they would need to be highly motivated, that PBL would PBL sessions, lectures and laboratory classes. develop them as active learners, and that they would need support. There was relatively little change in the students’ Summary of work: Eighty-two PBL students answered a responses to most of the items on the questionnaire when questionnaire concerning learning by PBL, student feelings it was completed again at the end of the year. The only and expectations about it. The answers were statistically major differences were that the students were less worried processed. The results are summarised in terms of: about PBL after experiencing it for a year, and they were knowledge of PBL method and reasons for participation; more confident that their knowledge of basic sciences was learning process management concerning student sufficient to enable them to do well in problem based selection, resource provision, teaching and assessment; learning. PBL curriculum – start time and subjects included; clinical cases; group dynamics; how PBL helps learning in Conclusion/take home message: It is clear from this that medicine. although training is important, experiencing PBL is at least as valuable in building confidence in the process. Summary of results: Students’ opinions are: The basic reasons for choosing the PBL method are curiosity and willingness to change, as well as disappointment in the 8I 5 Plenary session as a tool for standardization of conventional program; All disciplines should be studied by objectives and conclusions in a diversified PBL; Resource provision should be enriched with audiovisual techniques and more computers; Thematic PBL environment where heterogeneity of small groups and guidance will be helpful too; Assessment should be more tutors’ expertise are the rule related to PBL; Clinical cases are clear enough and suitable Enrique F J Martinez*, Graciela Medina, Demetrio Arcos, Ricardo for learning basic disciplines; The friendly group spirit Trevino and Jorge Valdez (School of Medicine - Monterrey Tec, improves learning; Continuing tutor training would increase ITESM, Av Eugenio Garza Sada 2501, Depto. Cs. Basicas Medicas. the quality of learning; PBL helps the acquired knowledge Ed. DACS-112, Monterrey NL 64849, MEXICO) to become deeper and long-lasting and to cultivate critical thinking. Summary of work: In the School of Medicine, Monterrey Tec, Mexico, tutors with different profiles participate in the tutorial courses. We classified the tutors regarding different 8I 3 Putting it all together: Medical students’ aspects in the teaching and learning process: content and understanding of the curriculum didactic technical (PBL) expert tutors, tutors expert in the topics but non-expert in PBL methodology and expert in Agnes Dodds*, Mosepele Mosepele, Glen Evans, Susan Elliott and methodology but non-expert in the topics. Therefore, to Jeanette Lawrence (The University of Melbourne, Faculty get feedback about the case problem, a tutorial guide, to Education Unit, Faculty of Medicine, Dentistry and Health learn from the others and homogenize all the steps in PBL, Sciences, Level 7, Medical Building, Victoria 3010, AUSTRALIA) we carry out a plenary session once a week. We join together 4 small groups in the classroom with the Background: Among the many papers reporting the respective tutor and give the case-problem to each small introduction of Problem Based Learning (PBL) in medical group. After that, each small group discusses for about 30 curricula, there is little reported research on how students minutes the different steps in PBL before self-study. After actually learn with these new curriculum tools. This that, one of them presents the results obtained during the presentation reports the results of a study into how students various steps and the others teams comment and discuss. take up the implicit and explicit messages of a hybrid PBL At the end of the discussion all teams and tutors know what curriculum in their own study. kind of the topics or objective must be studied and which Summary of work: Second and third year medical students conclusions were obtained. (n = 420) completed a 43 item questionnaire designed to Conclusion: The plenary sessions have demonstrated that elicit students’ preferred use of curriculum components in they help the students and teachers to improve their their independent study. A sub-set of 40 students were respective roles. interviewed and completed a computer-based curriculum structure task. Summary of results: Students reported high levels of satisfaction with the PBL course overall, but student understanding of how the parts of the curriculum were

– 4.100 – Section 4 8I 6 Improving the quality of PBL cases – experiences Background: This study attempts to observe physicians’ with the implementation of quality criteria education process and how to humanize students with the care of the elderly by looking at the actual observation made Ragna Raschke*, Walter Burger, Claudia Kiessling, Rita Leidinger, by students and the elderly themselves. Dagmar Rolle, and Kai Schnabel (Reformstudiengang Medizin, Charité, HU Berlin, Schumannstr. 20/21, 10117 Berlin, GERMANY) Aims: To analyze students’ perceptions of problem based learning (PBL) as it is used at FAMEMA and how it functions Background: The central teaching and learning method of as a space for training of doctors to be sensitive to care of the Reformed Curriculum at the Charité (Berlin, Germany) the elderly; and to analyze students’ and elderly people’s is problem-based (PBL). Thus the quality of the paper- impressions of what it is to be a doctor sensitive to the cases based on real patients is crucial for the learning aging process. process. Summary of work: We collected data through a Summary of work: In order to improve the quality of cases questionnaire applied to medical students finishing their continuously, a feedback process with PBL students and 4th year of medical education. In-depth interviews with experts of the review group has been implemented. Based elderly people and with students at the end of 6th year on a survey with nine quality criteria for construction of PBL were developed. Thematic analysis was used for data problems (Des Marchais, 1999), a self-developed modified inference. questionnaire was introduced to answer the following questions: Results and discussion: Students at the end of 4th and 6th years are coincident in relation to: quality and pertinence • Which cases have been rated as “good” by the students of Unit 17 – “Aging”. They also match in terms of the Unit’s and how many of the advised criteria do these cases contribution to personal development, acquisition of skills meet? and competences “to learn how to learn”, to reason, to • What are the differences in the evaluation done by rescue the human aspect of our lives, and to know how to students compared to the experts of the review group? provide care of the elderly. Still, the pathological-medical model prevails over the one that looks at illness, as a The modified questionnaire with 31 questions relating to 4 person’s ailment. Practice and theory remain poorly cases of an integrated block on ‘respiration´, was integrated. Paper problems, regardless of how well they completed by all students of the class and by the members have been developed or appropriately used in tutorials, of the case review team. cannot beat the real experience, especially for the Conclusion: The results of this evaluation provide useful development of professional skills required for proper information for further construction or modification of cases health care. Recognition for the need to rescue humane and thereby assist in assuring the quality of the PBL approaches in health care was identified, as this is not program. always included as an integral part of the care provided to the elderly. Elderly people expect to find a doctor who understands their illness as well as how this is manifested 8I 7 Critical assessment of factors affecting the exam in their life. The latter will permit a relationship based on hope and trust - key elements in health care - as well as performance and study motivation of preclinical what should be the proper care of health problems. How phase medical and dental students in integrated the elderly person looks at the doctor, and how the doctor PBL teaching looks at the elderly person, are mirror images: they will Tiina Immonen*, Kirsi Sainio, Sanna Partanan, Tuula Nurminen, project new ideas about the elderly, and of each other. Juha Okkeri and Timo Sorsa (Institute of Biomedicine, Developmental Biology, University of Helsinki, Biomedicum Helsinki CS14a, Po Box 63, 00014 Helsinki, FINLAND) 8I 9 Is unprofessional behaviour recognised by first year problem-based learning students? Summary of work: We followed the success of medical and dental students during the first two terms. The methods M McLean and J Botha* (Department of Experimental and Clinical included interviews, comparison of results from faculty Pharmacology, Nelson R Mandela School of Medicine, Pvt Bag 7, student selection and first year exams, analysis of student Congella 4013, SOUTH AFRICA) evaluations of courses, PBL sessions and teachers. Aim: To determine whether first year students in a problem- Educational skills of tutors were also evaluated. based learning (PBL) curriculum were able to recognise Summary of results: The differences in exam performance unprofessional behaviour among different individuals (e.g. between PBL groups were not explained by the skill or students, staff, health care workers) with whom they had popularity of the tutors. Instead, the results of medical contact during their medical studies. students were fairly consistent and were strongly correlated Summary of work: A PBL curriculum, with early clinical to their success in the faculty admission exam. The results exposure, was implemented at the Nelson R Mandela of dental students displayed much greater variation and School of Medicine in January 2001. At the end of the 2001 weaker correlation to the faculty student selection exam. and 2002 academic years, a survey was undertaken to The variation between PBL group performances was determine whether students had witnessed unprofessional mostly explained by differences in the results of their dental behaviour during their studies. Students were also asked student members. Some of the dental students to identify anyone who epitomised professionalism. experienced the teaching as medical student-centered and attitudes of some teachers discriminating. The dental Summary of results: Both cohorts of students recognised students had also poor knowledge of their possible unprofessional behaviour among their colleagues, senior professional tracks, which is reflected in their low interest students and Faculty staff members. They were particularly in Ph.D. education. critical of the disrespectful manner in which some health care workers treated patients. Of the individuals selected Conclusions/take home messages: Thus re-evaluation and as epitomising professionalism, students generally correction of attitudes among teachers and better identified Faculty staff members. integration of outstanding dental professionals in early education might have critical impact on the motivation and Conclusions/take home messages: With early exposure to success of the preclinical phase dental students. the practice of medicine in PBL, first year students need to be formally introduced to the concept of professionalism in medicine. Faculty should also recognise staff members 8I 8 Problem based learning at Marilia Medical School who are identified by students as epitomising professionalism, as these staff members could serve as Ricardo Shoiti Komatsu (Faculdade de Medicina de Marilia - role models. Directoria de Graduacao, Marilia Medical School/Famema, Rua Monte Carmelo 800, 17519-030 Marilia SP, BRAZIL)

– 4.101 – Section 4 8I 10 Teaching and learning for what? Curriculum change 8I 11 DIPOL® (Dresden Integrative Problem-Oriented and the challenge to produce doctors better Learning): a problem-based, interdisciplinary equipped to serve community health needs patient and student-oriented curriculum covering Trevor Gibbs* and J Grossman (University of Cape Town, Faculty Year 1 and 2, Medical Faculty, TU Dresden of Health Sciences, Cape Town, SOUTH AFRICA). To be presented A Morgner, M Witt, M Kasper, A Deussen, V Zürich, T Kriegel, R by M Alperstern. Scheibe, J Oehler, H E Krinke, S Albrecht, F Schönhöfer, G Introduction: In 1994 the Faculty of Health Sciences at the Tchitchekian and P Dieter* (Medical Faculty TU Dresden, University of Cape Town South Africa adopted a Primary Studiendekanat, Fetscherstrasse 74, D-01307 Dresden, health care approach as the guiding principle for its GERMANY) curriculum. In 1999 the Faculty adopted commitments to Aim: Years 3 to 6 of the Dresden medical curriculum have Problem Based Learning (PBL) as the primary method of been redesigned in alliance with Harvard Medical School, instruction and to systematic development of community- incorporating case-based PBL-, practical- and clinical based learning. These decisions represented decisive courses and primary care in an interdisciplinary way. Here, change and commitment to better serving the actual health we present the design of a problem-based, interdisciplinary, needs of the society around us. patient- and student-oriented curriculum covering Year 1 The Faculty claims a proud record of technically excellent and 2 (Basic Sciences). training, but has acknowledged historical complicity in Summary of work: The reform is focused on 3 main goals: prioritising the health needs of a privileged minority. 1) “Get Students Started” (finding/filling gaps of knowledge Aims: To explore the process of change in relation to the in Biology (B), Chemistry (C), Physics (P), 2) guiding principles, considering its challenges for both “Interdisciplinary Courses”, and 3) “Integration of Clinical teachers and learners. We pursue this aim in the context, Medicine (CM) and Medical Psychology/Sociology (MPS)”. since 2002, of implementation of a new PBL driven The design includes 4 modules, in which inappropriate curriculum. redundancies are eliminated, and topics, goals and teaching modes are coordinated. Module 1 (Basic Summary of work: Using surveys, design team reviews, Sciences) includes B, C, P; Module 2 (Patient & Doctor) participant observation, group discussions and interviews includes CM, MPS, Medical Terminology (MT) (training we consider the following: of students to gain communication skills and to obtain • what steps have been taken to ensure better-equipped patient’s history); Module 3 (The Human Body I) is run by teachers and learners; Anatomy (ANA), CM (combines anatomy with physical • what does the evidence to date suggest about the examination skills and clinical seminars); Module 4 (The effectiveness of those steps; Human Body II) is organized by Physiology (PHY), Biochemistry (BC), ANA, MPS with integration of specific • what major obstacles have become evident during the clinical aspects, and comprises interdisciplinary blocks implementation; with a) regulation of cell and organ function, b) • what steps are suggested in dealing with these obstacles. neurofunctions and behaviour, c) seeing, hearing, taste and smell, and d) applied physiology and biochemistry. Results and take-home message: There is a set of tensions between stated commitments and actual implementation. Conclusions: A “preclinical” curriculum is designed which These highlight continuing key obstacles in educating addresses potential starting problems of medical students medical students to better serve community health needs. with natural sciences, integrates structure- and function- oriented sciences, and links basic skills of clinical medicine with life sciences.

Session 8J: Postgraduate Education

8J 1 Progress in paradigm shift: the RCPSC CanMEDS their priority areas for further support. Qualitative analysis implementation survey of the 192 codable comments received identified 18% positive statements, 18% less favourable responses, and J R Frank*, G Cole, C Lee, N Mikhael and M Jabbour (Royal College 60% described needs or suggestions for further of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, implementation. Ontario K1S 5N8, CANADA) Conclusions: There has been significant progress in Background: In 1996, the Royal College of Physicians and implementing the new RCPSC CanMEDS framework in Surgeons of Canada (RCPSC) adopted a new framework Canada. for specialist education called the 7 CanMEDS Roles. This has come to be highly influential around the world, but little is known about its implementation in postgraduate 8J 2 Specialist registrars’ views on training in non-clinical programs in Canada. competencies Aims: To (i) evaluate the implementation of the CanMEDS Kathryn Gunn*, David Wall and Robert Palmer (West Midlands Roles in specialty programs in Canada, and (ii) identify Deanery, PO Box 9771, Birmingham Research Park, 97 Vincent Drive, priorities for support of further implementation. Edgbaston, Birmingham B15 2XE, UK) Summary of work: Web-based survey of Canadian specialty Background: The importance of training in non-clinical program directors (PDs), specialty committee chairs (SCs), competencies for junior doctors is being increasingly and postgraduate deans (PGs). Data were analyzed both recognised by trainers. This study has determined the views qualitatively and quantitatively. Proportions were compared of specialist registrars (SpRs) themselves. using the X2 statistic. Summary of work: A one in four sample of all SpRs in the Summary of results: The overall response rate was 62% (n West Midlands Deanery completed a questionnaire listing = 572). Perceived knowledge of the CanMEDS Roles was 10 competencies; they stated the importance of these greater among PGs than SCs and PDs (p<.05). skills, the best timing for training and the method of delivery. Implementation of the 7 physician Roles stratified into 3 The competencies included understanding of the NHS, tiers (p<.05 for all groups). Respondents rated educational management, leadership and team-building. objectives, teaching materials, and evaluation methods as

– 4.102 – Section 4 Summary of results: There were 164 responses (58%), 8J 5 Administration of the postgraduate doctors’ with good representation of the specialties and the different evaluation of educational functions supplied by years of training. Training in all competences was clinical wards considered important with interpersonal skills scoring higher than those relating to the organisation of the NHS. Mette Engholm Dremstrup (Aarhus AMT, Lyseng Alle 1, 8270 The proposed year for training and the importance of the Hoejbjerg, DENMARK) subject were inversely related (r=0.70, p<0.02). Training Background: The Office of Postgraduate Medical blocks of one or two days were preferred to other options. Education, County of Aarhus, Denmark, monitors the quality The preferred mode of delivery was the interactive seminar of postgraduate education of medical doctors. This with on-line learning being the least desirable. There was presentation describes one of several instruments: ambivalence about training in multi-professional groups. Administration of evaluation at clinical wards. Conclusions/take home messages: This study shows that Summary of work: Evaluation of the wards is based on a SpRs view non-clinical competency skills as core training. mandatory national standardized questionnaire filled out It is important that a curriculum is properly established and by postgraduates in specialist training. It passes through that the training and assessments match it closely. The different levels of administration, from the ward to the postgraduate deaneries have a central role in its delivery. political administration. Summary of results: 8J 3 Introduction of an e-learning course of health • Evaluation system from postgraduates to wards has been economy in Hungarian Postgraduate Medical established. Education • All levels of specialist training were involved by requesting Anna Bukovinszky*, Gábor Biró, Tibor Ertl and Arpád Gógl (Centre comments on results. for Postgraduate Education, University of Pecs, Medical Center, • Difficult to estimate response rate. Szigeti u. 12, 7624 Pecs, HUNGARY) • Anonymity in relation to wards was impossible. Background: The new residency programme was introduced in Hungary in 1999 and since then more than The administration procedure of the questionnaires has 1,500 physicians have participated in the obligatory course made it difficult to identify the response rate. This limits the of health economy. The course – in the form of traditional possibility of commenting on the actual impact of the lectures of 40 hours – has been delivered at 4 university evaluation on the clinical wards. sites. Since the residents are placed in more than 100 Conclusions/take home messages: The creation of the teaching hospitals, their travel expenses amount to a evaluation from postgraduates to wards has increased substantial sum, and it was most desirable to design a attention to the specialist training on all levels: The ward, unified and common curriculum with the participation of the hospital and the political administration. We expect the experts of the four Hungarian Medical Schools. this to have a positive influence on the education supplied Summary of work: Our aim is to present how we have by the wards. planned to introduce a new, e-learning course built in the trunk education of the residency programme. The course is based on the relevant topics of health management, 8J 6 An evaluation of the role of the Pre-registration health law, ethics, quality insurance and health House Officer tutor administration. The authors are requested to develop the Pramod Luthra* and Catherine Smith (North Western Deanery, The learning materials in an integrated, interactive form University of Manchester, 4th Floor, GMWDC, Barlow House, adopting information technology. The software/hardware Minshull Street, Manchester M1 3DZ, UK) environment for e-learning has already been established by a former project. Aims: This project aimed to evaluate the benefits to Pre- Registration House Officers (PRHOs) of the appointment Conclusion: In comparison with the traditional oral of a Tutor to address the specific needs of this grade of presentation, our course provides all the advantages of doctor in training. It evaluates the effect of the appointment distance learning. In addition, as the result of an inter- by the North Western Deanery of 14 PRHO Tutors at 13 university collaboration, it will be available for every hospital sites across the North West Region. PRHO Tutors Hungarian medical trainees. were introduced to support the existing role of the Postgraduate Clinical Tutor in managing PRHO education, training, and raising the profile of PRHOs and providing 8J 4 New ways of teaching basic surgical trainees: the pastoral support where necessary. The North Western experience of the Yorkshire School of Surgery Deanery recognised the high level of training and support Margaret Ward*, Zoe Fleet, Mark Lansdown and Mike Gough needed by PRHOs and the difficulty of Postgraduate (Postgraduate Department, 2nd Floor, Ashley Wing, St James’s Clinical Tutors in fully meeting these needs in addition to University Hospital, Leeds LS9 7TF, UK) those of the other training grades. Aim: To present alternative ways of providing teaching to Summary of work: Between March 2002 and December surgical SHOs on a regional basis. 2002, the impact of a PRHO Tutor was evaluated using structured interviews and questionnaires of key Summary of work: The Yorkshire School of Surgery was stakeholders in the 13 Trusts with a Tutor and a sample of set up in 2000 to provide formal supervision and a structured Trusts where no PRHO Tutor was appointed. Specific note educational programme to 150 SHOs on the 3-year was made of the impact of the Tutor on PRHO teaching rotation. Teaching took the form of half-day release. The programmes and attendance at teaching sessions. reduction in junior doctors’ hours and the move towards shift working meant these sessions were no longer viable. Summary of results/conclusions: The project has The new programme provides local teaching, together with concluded that the role of PRHO Tutor is generally centrally organised compulsory education weeks. Each considered to be sufficiently effective to be a worthwhile SHO attends 2 teaching weeks per year. Two pilots have addition to the Postgraduate Clinical Tutor in addressing been run to date, both of which were well evaluated. PRHOs’ educational and pastoral needs. Its conclusions have led to the formulation of a set of recommendations Conclusions: This is proving to be an effective method of for PRHO Tutors, to enable them to share their own best ensuring the SHOs receive appropriate teaching and may practice and use their role to maximum effect. These form the regional model for the surgery programme under conclusions and recommendations will also assist in the ‘Modernising Medical Careers’. decision as to whether to place PRHO Tutors at other teaching hospital sites. The introduction of the PRHO Tutor has impacted upon the quality of PRHOs’ education, the

– 4.103 – Section 4

extent and delivery methods of their teaching, the ability to 8J 9 Post-graduate training in dermatovenereology in address individual PRHO’ difficulties, and provided a Belarus: current status and problems specific forum for the discussion of all PRHO-related issues. Uladzimir Adaskevich (Medical University, Department of Dermatovenereology, Frunze str. 27, 210602 Vitebsk, BELARUS) The project has been supported by the North Western Deanery’s ‘Blending Service With Training’ Initiative. Background: Postgraduate training in the Republic of Belarus is conducted at five medical universities. The departments of dermatovenereology (DV) at these 8J 7 The tasks of an internist: how well prepared are educational institutions provide their residents with special programs for specializing in DV which last from 1 to 3 years. trainees? But in most European countries the program of D J Davis*, A M Skaarup and C Ringsted (Copenhagen Hospital postgraduate training in DV envisages a four year course. Corporation Postgraduate Medical Institute, H:S PMI, Bispebjerg Our aim was to work out approaches on the way of unifying Hospital, Bispebjerg Bakke 23, 2400 Copenhagen NV, DENMARK) the postgraduate training in DV in Belarus and bringing it into line with European guidelines. Summary of work: Danish postgraduate medical education is evolving to include training in 7 aspects of competency. Summary of work: A special questionnaire has been As a baseline to evaluate reforms, we surveyed trainees in designed and send to all educational institutions in Belarus Internal Medicine departments in Copenhagen. Trainees responsible for postgraduate teaching in DV. rated (scales 1-10) comfort levels and usefulness of the Summary of results: Replies were received from all medical introduction year as preparation for 23 tasks in internal universities. According to them 20-22 residents are annually medicine. specialized in DV under the guidance of experienced Summary of results: 162 trainees returned the survey (80 professors. The postgraduate training in DV is conducted men, 82 women). 103 had completed an introduction year. according to a unified program recommended by the Most respondents had comfort levels of >6 for acute illness, Public Heath Ministry. The training is exercised on the base inpatient care, heart and lung auscultation skills, and of corresponding DV dispensaries which are multi-profile neurological examination skills. Comfort with institutions. The respondents consider that the system of ophthalmoscopy was low. Trainees felt reasonably postgraduate training in DV must consist of two stages: 2 comfortable speaking with patients or relatives about year clinical intership + 3 year research studentship at the serious illness or stopping treatment, but less comfortable clinical base of the corresponding medical university. talking about palliative care, medical error, unexpected Conclusions: Postgraduate training which lasts for 1 or 2 events, or difficult ethical situations. Respondents felt years is not sufficient for being specialized in dermatology. reasonably comfortable with tasks related to the roles of A changeover to a four year training course is necessary health advocate, leader, manager, but less comfortable for which a special program it to be worked out. with the role of scholar. Comfort levels increased between training levels. Women had lower comfort levels than men in 9 tasks but found the introduction year more useful. 8J 10 Assessment of the medical sign-out in postgraduate Conclusions/take home messages: Overall, the introduction training in obstetrics and gynaecology year was not perceived as useful in preparation for most of the tasks addressed in this survey. Reforms in postgraduate Jeroen van Bavel*, Fedde Scheele, Casper Jansen and Bart Wolf (St medical education should improve some of these Lucas Andreas Hospital, Coornhertstraat 12, 2013 EW Haarlem, weaknesses. NETHERLANDS) Aim: To assure continuity of medical care, sign outs (morning rounds) are of increasing importance. We show 8J 8 A new and innovative postgraduate programme in our approach for an improvement of the quality of the clinical pharmacology clinical morning sign out in an Obstetrics & Gynaecology J Botha*, A Gray and M McLean (Department of Experimental and setting. Clinical Pharmacology, Nelson R Mandela School of Medicine, Pvt Summary of work: We designed a yardstick, reviewed by Bag 7, Congella 4013, SOUTH AFRICA) experts, for the assessment of the quality of the sign out measuring a combination of structure and medical Aim: In South Africa during 1998, drug expenditure content. The structure is composed of a general outline, accounted for 11.7 and 36.6% of the recurrent health prioritisation of patient cases and conciseness of budget in the public and private sectors, respectively. This presentation. The medical content is scored on lists with presentation reports on a Masters programme in Clinical minimally required clinical items of patients in the right Pharmacology aimed to promote the more rational and order. Sign outs were recorded on audiotape for two months cost-effective use of drugs. and analysed by two separate investigators. Co-variants Summary of work: The course, for doctors and pharmacists, were year of training and sex of the registrars. involves drug selection based on evidence of efficacy, Summary of results: An interim analysis of 24 sign outs safety, suitability and cost. It encourages problem-solving shows that the designed measurement instrument is a skills and clinical application of knowledge. Prescriptions useful tool. The overall quality of sign outs is moderate. of new students and those already in the programme were The lowest scored items were the general outline and the compared. prioritisation of patients. The order of the clinically required Summary of results: All 10 exposed students agreed with items scored fair. the statement “I found this new approach to learning very Conclusions: In particular the structure of the medical different from my undergraduate courses”. They all morning sign out deserves to be an important issue in the indicated that they had gained up-to-date pharmacology training of registrars. knowledge, which they were able to apply better. Ninety percent made use of computer resources (CDs and internet searches), compared with 54% of the 12 new students. Students exposed to the course cited their new 8J 11 Assessment of the medical sign-out in postgraduate competence to critically review papers and assess training in pediatrics evidence as highlights. They reported an improved ability Casper Jansen*, Bart Wolf, Jeroen van Bavel and Fedde Scheele (St to select drugs and prescribe rationally. Lucas Andreas Hospital, Department of Pediatrics, Postbus Conclusions: This programme appears to develop critical 9243, 1006 AE Amsterdam, NETHERLANDS) thinking and a more analytical approach to using drugs Aim: To assure continuity of medical care, the sign out rationally in the face of limited resources. (morning report) is of increasing importance. We show

– 4.104 – Section 4

our approach for an improvement of the quality of the sign and emotional care, a mentoring programme was started. out in a pediatric setting. Five years later, a written survey was performed amongst 21 and 14 mentors, and 22 and 13 registrars in Paediatrics Summary of work: We designed a measuring instrument, and O&G, respectively. reviewed by experts, for the assessment of the quality of the sign out. This tool measures a combination of both Summary of results: Responses were achieved from 10/21 structure and medical content. Points were given for and 7/14 mentors and from 14/22 and 9/13 registrars. Less general outline, priority of patient cases and conciseness than half of the contacts between mentor and registrar were of presentation. The medical content was evaluated by organised in a structural way. 81% of the mentors and 55% means of purpose-made lists with a minimum of required of the registrars experienced confidentiality. Differences in items in the right order. Twenty sessions were recorded on position did not affect the mentorship according to 88% of audiotape and analysed by two separate investigators. Co- the mentors and 56% of the registrars. In the Paediatric variates were year of training and sex of the registrars. department 80% of mentors and 42% of registrars answered that emotional reflection was adequate and 80% Summary of results: An interim analysis of 20 sign out of mentors and 29% of registrars believed that the sessions shows that the measuring instrument is a useful mentorship added to a safe educational environment. tool. The overall quality was moderate. The lowest scored items were the general outline of the sign out and the Conclusion/take home message: In order to succeed, a establishment of priority of patient cases. The order of the mentoring programme for registrars should be well clinically required items scored fair. structured and contain clear agreements on confidentiality. Achievable goals should be set and regularly evaluated. Conclusions/take-home messages: The structure of the medical sign out deserves to be an important issue in the training of registrars. 8J 14 Continuity clinic in gynecology and obstetrics Antonio Dávila* and Claudia Hernandez (Escuela de Medicina- 8J 12 The role of the logbook in the training of Tecnologico de Monterrey, Av Morones Prieto 3000 pte, gynaecologists in the Netherlands: time for change? Consultorio 206, CP 64710 Monterrey, MEXICO) S Mahesh*, F Scheele and B H M Wolf (St Lucas Andreas Hospital The continuity clinic in gynecology and obstetrics is an Amsterdam, Department of Gynaecology and Obstetrics, Jan academic-assistential program with the fundamental Tooropstraat 164, 1006 AE Amsterdam, NETHERLANDS) objective of providing to all residents in training an ambulatory private environment during their training period, Aim: To show the results of a survey concerning the use supervised by a highly qualified clinical professor-tutor. A and improvement of a logbook for Dutch registrars in consultant professor-tutor is assigned to residents from Obstetrics and Gynaecology. the first year of their residency and they will finish their Summary of work: All Dutch registrars in Obstetrics and ambulatory rotation when their residency program has been Gynaecology were asked to answer a questionnaire completed. The resident will be exposed to an excellent divided into 3 main categories: daily use, its role in ambulatory medical care model where he/she can assessment and possible improvement of the logbook. A intervene and manage, during the training period, a five-point scale was used. Co-variables were year of training preestablished population of patients. In addition the and type of teaching hospital. resident will acquire experience in the clinical and administrative procedures needed for the establishment Summary of results: 269 questionnaires were sent out. The of a private office for women’s healthcare. response rate after six weeks was 55% (156). The logbook was: (a) in 70% regularly updated, (b) in 55% never used for appraisal, (c) in 45% used for authorisation, (d) in 55% 8J 15 A study on prescription-writing of the interns in used for self-assessment and (e) in 70% used to evaluate the number of learning moments in a rotation. 80% of the Bandar Abbas School of Medicine registrars were in favour of its renewal. O Safa, Sh Zare and R Amiri* (Hormozgan University of Medical University, Office of Vice-Chancellor for Education and Research, Conclusions/take home messages: About half of the Dutch Shahid Mohammadi Hospital, Jomhoori Eslami Blvd, PO Box registrars in Obstetrics and Gynaecology do not use the logbook adequately. Our plan for the future is to introduce 79145-4545, Bandar Abbas, Hormozgan, IRAN) a portfolio. This study suggests that portfolio learning can Background: In Iran, medical students are taught only be introduced with proper guidance and motivation of pharmacology within the stage of physio-pathology through both registrars and teaching professors. a four-unit course. They get familiar with prescription-writing during training stage in hospital wards, however, they have difficulties in prescrption-writing. 8J 13 Pitfalls in postgraduate mentoring Summary of work: Since there is not a course entitled B Wolf*, F Scheele, J Roord and J van der Schoot (SLAZ, “prescription-writing”, the newly-admitted interns Amsterdam, Department of Mother and Child Health, St Lucas underwent a study in 2001. They were divided into two Andreas Ziekenhuis, PO Box 9243, 1006 AE Amsterdam, groups. The test-group was taught prescription-writing and NETHERLANDS) drug-interaction before begining the internship stage while the control group was not. Aim: To show the evaluation of a mentoring programme for registrars in Paediatrics and Obstetrics & Gynaecology Results and Conclusion: The comparison of the two (O&G) in Amsterdam. groups shows that students do not have enough information regarding drug-prescription and drug-interaction and Summary of work: As teaching professors were judged undertaking a course or a workshop before internship stage inadequate for the supervision of personal development is necessary.

– 4.105 – Section 4 Session 8K: Staff Development

8K 1 Training of teachers in general/family practice – 20 In conclusion, the poster seeks to raise awareness of the years of experience range of activities that LTSN-01 is involved in and how we can offer support to teaching staff in veterinary medicine M Vrcic-Keglevic*, W Betz, P Heyerick, Z Jaksic, P Owens, H Tiljak but also in dentistry and medicine too. and I O Virjo (“A.Stampar” School of Public Health, Medical School, University of Zagreb, Rockefellerova 4, 10000 Zagreb, CROATIA) The course “Training of Teachers in General/Family 8K 3 Individual and institutional impact of professional Practice”, is held annually at the Inter-University Centre in development courses for physicians as educators Dubrovnik. The course was established by the members F Christ*, O Genzel-Boroviczeny, T Aretz, E Armstrong and R Putz of the first Leeuwenhorst group in 1983. It offers the unique (LMU Anesthesiology, Marchioninistr.15, 81377 Munchen, opportunity for the teachers in General Practice (GP) GERMANY) coming from different countries with different health care systems and cultural backgrounds, to get together and Aim: To asses the impact of professional faculty share ideas in an environment that is as educationally development courses designed by the LMU Munich stimulating as it is visually stunning. The main aims of the Medical School and Harvard Medical International to course are: promotion of learning by experience, exploring create more self-directed teachers with a higher degree of the common ground of GP as a specific medical discipline commitment to the organizational change. and fostering social relationships to promote collaborative work. The format of the course is non-directive, and for Summary of work: A nine-question survey was sent to 414 some participants, GP teachers, this is their first exposure participants in the nine courses since 1997. to meaningful learning which is practice-based, where the Summary of results: All (92/92; 23% return rate) benefited content is tailored to the needs of an individual and draws from the workshop and would recommend it to others. Most on prior experience. Until now, seventeen different topics attended out of personal interest (64/73) or because of were discussed and 517 participants from 25 countries, recommendation by colleagues (39/73), whereas only (6/ mostly European, participated in the courses. 73) were sent by the department head. On a scale of 0 At the beginning, the topics are predominantly educational (strongly disagree) to 5 (strongly agree) the attendants stated that the course improved their teaching skills (3.7), – developing educational module by formulating objectives, choosing methods, tools, and defining evaluation and moderately influenced the network in the university (2.7) assessment. Afterwards, discussion is concentrated on and had advanced their career to some degree (2.4). It did teaching and learning about the working methods used in however not improve their interaction with patients (1.8). everyday GPs’ work. The last stage is concentrated on the The majority (70/73) would attend an advanced level content specific for GP. Different educational methods that workshop of faculty training. have been employed through the courses will be presented Conclusion: These findings indicate that there is a high and the collected experience will be shared with level of interest in faculty development workshops directed Conference participants. at teaching, resulting in significant perceived benefits to individual faculty members and change in teaching behavior. 8K 2 Enhancing learning and teaching in veterinary medicine Sarah Marshall (LTSN-01, Learning and Teaching Support 8K 4 Changing teachers’ roles and responsibilities in a Network, Subject Centre for Medicine, Dentistry and Veterinary new interdisciplinary learner-centered curriculum at Medicine, 16/17 Framlington Place, University of Newcastle, the Higher Medical Institute – Pleven, Bulgaria Newcastle NE2 4AB, UK). To be presented by Gill McConnell. Z Radionova*, T Pencheva, R Gindeva, B Rousseva (University LTSN-01 is the Learning and Teaching Support Network School of Medicine - Pleven, Department of Physiology, 1 St. subject centre for medicine, dentistry and veterinary Kliment Ohridsky str., 5800 Pleven, BULGARIA) medicine. The aim of this poster presentation is to highlight A survey of faculty in 2002 showed that the most important some of the worked carried out by LTSN-01 to enhance reason for teachers to work on a curriculum change was learning and teaching in veterinary medicine. LTSN-01 the challenge and interest in experiencing something new, aims to identify and promote innovation in veterinary compared to the boredom and disappointment with some education and share good practice by: traditional methods of education. The major difficulties • Answering email and telephone enquiries relating to faced in changing the curriculum from a teacher- to a L&T learner-centered approach were attitudes, and • A website highlighting upcoming educational funding coordination of programs across departments in an opportunities and events; features a good practice interdisciplinary, problem-based learning curriculum. database and educational news items Working together to create clinical cases that matched • Releasing small project grants instructional objectives was a new and difficult experience for most teachers. Mastering new methods of teaching • A workshop programme including veterinary public and stimulating students to participate actively in the health, virtual learning environments and extra mural learning process was another challenge. Three quarters studies of the teachers still have difficulty giving and receiving • A newsletter (3 per year) assessment/feedback. Workshops organized by the school • Organising conferences and national meetings have been the most useful way for developing practical • Involvement with national projects e.g. Disability in teaching skills. Infrastructure challenges, typical for our Veterinary Education Resources for Sustainable school, country and Eastern Europe (e.g. making copies Enhancement (DIVERSE); Optimising Computer and of cases, providing a learning environment for students, Traditional Assessment in Veterinary Education access to electronic media, etc.) had to be overcome in (OCTAVE); Computer-aided Learning In Veterinary the new settings. Strategies in faculty development and Education (CLIVE). coordinated leadership between the rector and departments have enabled significant progress to occur. Other resources that we offer are examples of evaluated Additional examples and details of strategies will be freely available on-line learning and teaching resources; presented. FAQs on teaching, assessment, learning environments, legislation.

– 4.106 – Section 4 8K 5 Broadening medical teachers’ pedagogical thinking Summary of work: Tuebingen started the statewide initiative – an interdisciplinary challenge in cooperation with the Faculties of Medicine of Freiburg and Ulm. The training network is affiliated with every dean’s Anni Peura*, Juha Nieminen, Eeva Pyörälä and Aija Helander office in the cooperating faculties in order to ensure that (University of Helsinki, Research and Development Unit for important functions in support of the training curriculum Medical Education, PO Box 63, 00014 Helsinki, FINLAND) will be performed. Aim: The Faculty of Medicine in Helsinki has arranged Summary of results: The faculty development program educational training for teachers since 1993. A renewed consists of three columns: (1) a basic training program course in university pedagogy aims to promote interplay including two 3-full days trainings, each followed by between educational sciences and medicine. The purpose (collegial) coaching in real practice; (2) workshops and was to awaken teachers’ pedagogical awareness, seminars for completion and reinforcement; (3) a special strengthen a community of teachers, and create offer of consultant and information service as well as opportunities for collaboration. special events. The successful attendance of the program Summary of work: It may be difficult for medical teachers to (200 units, 45 min each) is rewarded by a ministerial appreciate pedagogical ideas and to apply them. certificate. Another important incentive is to consider the Therefore, the goals were to help teachers 1) begin a participation in faculty development program for the process of reflection, 2) understand theoretical knowledge achievement-oriented funding. Since SS 2000 360 about learning and teaching, and 3) become familiar with persons were trained. Until 2005 we plan to train at least promising strategies of teaching. The training included 300 persons per year. seven one-day and one two-day workshops. The main Conclusions: Via the statewide network the available themes of the workshops were: conceptions of learning resources and expertise are used more effectively and and teaching, co-operation and interaction in learning efficiently. After successful implementation, sustained situations, and educational planning and evaluation. improvement and cooperation in medical teaching are Teaching methods and learning tasks were intended to widely spread. support the reflection of participants’ prior experiences and present competence in the light of educational theories. Conclusions/take home messages: A meaningful course 8K 8 To determine faculty members’ information about requires relevant topics and a confidential environment for and practice of validity and reliability of exams teachers to discuss teaching from theoretical, practical, and personal viewpoints. The structure of the course, P Abedi* and S H Najar (Ahwaz Medical University, Nursing and examples of the learning tasks, and evaluations of the Midwifery School, Ahwaz, IRAN) teaching methods will be presented. Aim: To determine awareness and practice of faculty members about validity and reliability in exams. 8K 6 Challenging the ‘what works’ culture in medical Summary of work: We used a questionnaire with 22 questions about validity and reliability on 100 faculty education: what kind of research might support the members in Ahvaz University. Descriptive statistics were development of teaching in clinical contexts? used for analysis. Kath Green (Postgraduate Medical and Dental Education, The KSS Summary of results: 80% of subjects had prior information Deanery, 7 Bermondsey Street, London, SE1 2DD, UK) about content validity and half of them closed with split It has been argued that, in order to improve the quality of halves; but only half of the subjects used these methods in teaching in medical education we need a more ‘rigorous’ exams. approach to research with many more randomised Conclusion: Despite the acceptable information about controlled trials to ‘prove’ which teaching methods ‘work’. validity and reliability, subjects did not use these methods. Within the literature, reports on the ‘results’ of various teaching interventions are common. However, any episode of teaching is not a stable intervention in its own right but an ongoing engagement between teacher and learner 8K 9 The effect of an educational program based on which, by its very nature, will vary for any group of learners. PRECEDE model on the level of academic advisors’ In this paper I will seek to argue that, if our aim is to improve ability and the medical students’ satisfaction the quality of teaching in clinical contexts, we need to S M M Hazavehei (Department of Health Education and Health develop more detailed and analytical accounts of the Promotion, School of Health, Isfahan University of Medical development of educational practice in these settings Sciences, Isfahan, IRAN) thereby allowing readers to gain insights about the complexities of any teaching encounter with a view to Background: Universities have responsibilities to train, becoming more intellectually engaged with their own educate and develop students, as well as prevent any practice as educators. In presenting these arguments I physical, emotional, social and academic problems during will be drawing on the written evidence of my observations their study. Therefore universities must offer effective of postgraduate medical teaching in a variety of clinical academic advisory services to students. The purpose of contexts over the last four years and my experience of this study was to investigate academic advisors’ (AAs) ability supporting the action research of educators working in and medical students’ satisfaction with academic these settings. guidance. Summary of work: All 90 AAs and about 2,500 students in Hamadan University of Medical Sciences (HUMS), 72 AAs 8K 7 Competence Centre for University Teaching in and 445 students from four colleges (Medicine, Health Medicine: Tuebingen – Freiburg – Ulm: concept and Sciences, Dentistry, Nursing and Midwifery) voluntarily experiences with the cooperation project participated in a pretest section of the study. 87 AAs and Maria Lammerding-Koeppel*, U U Haering, Kerstin Mueller, H-D 961 student students randomly participated in the Hofmann, Hubert Liebhardt and T Mertens (University of educational program. The AAs divided randomly into two groups (1) PRECEDE model Educational Workshop Tuebingen, Faculty of Medicine, Geissweg 5/1, D-72076 Tuebingen, Program and (2) Educational Material Program). Students GERMANY) divided into group 1 (n=363 - AAs participated in PRECEDE Aim: For promotion and reward of higher education, the workshop program), group 2 (n=408 - AAs received dean’s office of the Faculty of Medicine, University of educational material), and group 3 (n=190; students had Tübingen was mandated by the regional ministry in 2000 no AAs). Data collection was by questionnaires, pre- and to develop a faculty development program for medical post-test (after one academic semester of the intervention). teachers integrated with other universities in Baden- Württemberg.

– 4.107 – Section 4

Summary of results: Mean scores of knowledge Summary of results: Fifty two percent of the questionnaires (M=14.77,SD=3.01) and attitude (M=61.79,SD=5.78) of AAs were returned. Results indicate that the training needs of about offering effective academic advice to the students teachers have changed since 1994. While up to 30% of increased significantly in group I (n=43), which was more respondents requested workshops on small group teaching effective than group II (M=11.54,SD=2.76; and lecturing skills there was an increase in the demand M=59.23,SD=8.6) (n=44), when compared to the pre-test for workshops focusing on learning theories, (M=10.67,SD=4.2; M=57.2,SD=11.6). Comparison of communication skills and student motivation. The main students’ satisfaction (SS) indicated the level of SS between barrier to participation in training was lack of time. the 3 groups of students was significantly (p< 0.0001) different, but the difference in group I was more than in This paper will explore the reasons for the change in the other groups. Furthermore, students in group 1 significantly training requirements of teachers. had more consultation about academic, continuing education, and job seeking aspects compared to the other groups. 8K 12 The effects of educational workshops held by EDC of Tehran University of Medical Sciences on the Conclusion: The PRECEDE model educational workshop participant faculty program was more effective for changing AAs’ ability to give effective academic advice, guidance and consultation. S Soheili* and A A Zeinanaloo (Tehran University of Medical Sciences, Faculty of Medicine, Poursina Avenue, Tehran, IRAN) Aim: To determine the effects of educational workshops 8K 10 Registrars still in favour of teaching professors with held by EDC of TUMS on the participant faculty. sufficient personal attention Summary of work: The subjects of this cross-sectional J van de Lande*, F Scheele, B Wolf, D van Vuurden and J Th M van der descriptive study were 375 faculty members of TUMS and Schoot (MCVU, De Boelelaan 1117, 1081 HV Amsterdam, the tool for data gathering was a validated questionnaire. NETHERLANDS) Summary of results: About 73.2% of TUMS faculty members Aim: A previous needs assessment amongst registrars in participated in the Teaching/Learning Process workshop, Obstetrics and Gynaecology (O&G) in 1994 urged us to 55% Lesson Planning, 59.8% participated in Student assign mentors to care for more personal attention. The Evaluation and Test Construction, and 28.1% participated mentor system, however, received unfavourable criticism. in Designing the Educational workshop. In this presentation the results of a repeated needs assessment is shown. Summary of results: The faculty mentioned that they benefited more from the Teaching/Learning Process Summary of work: A questionnaire was sent to all 276 Dutch workshop, Lesson Planning and Student Evaluation and registrars in O&G. Three open questions were asked to Test Construction in their educational activities. Among appraise the skills and attitudes of their ‘ideal’ teaching the seven different teaching methods, they chose the professor. The answers have been divided in four workshop as the most suitable method. The faculty categories: clinical knowledge, surgical skills, educational members suggested that it would be better for them to skills and attitude, including giving personal attention to participate in workshops that were held in the morning the registrars. and in the summer. Summary of results: 110 out of 276 registrars responded: Conclusions: Adult learning is most effective when it is 67% of the answers fell in the attitude category, 22% in related to perceived needs, and the faculty members educational skills, 9.4% in clinical knowledge and 0 percent consider the workshop as a tool for the improvement of in surgical skills. Only 1.6% of the answers could not be their educational skills. evaluated. These results resemble those from the previous survey in 1994. Conclusion/take home message: The needs of the Dutch 8K 13 Which faculty teaching skills require improvement? registrars in O&G do not show important changes over – a comparison of faculty and student perceptions time. Sufficient personal attention remains the most wanted Neena Natt*, Charles H Rohren and Jayawant N Madrekar (Mayo quality in their teaching professor. Simply assigning Graduate School of Medicine, Mayo Clinic, 200 First St SW, mentors appeared to be an inadequate solution. Rochester MN 55905, USA Aim: To compare faculty and student perceptions of faculty 8K 11 Identifying the training and development needs of teaching skills that could benefit from further training. To teachers in a medical school use the results to design a faculty teaching skills course. Mairead Boohan (Queen’s University of Belfast, Medical Summary of work: A questionnaire addressing a broad range Education Unit, Room 145 Whitla Medical Building, 97 Lisburn of faculty teaching skills was sent to all medical students Road, Belfast BT9 7DL, UK) (n=168) and a random selection of medical school faculty (n=150). Using a 5-point Likert scale and open-ended Background: The School of Medicine at QUB offers a wide format, faculty and medical students were asked which range of faculty development programmes. This faculty teaching skills they believed would benefit from programme was developed following a survey of the further training. training needs of staff in the Medical School in 1994. Recent feedback from participants indicates that the programme Summary of results: 126 (75%) medical students and 95 is no longer meeting their training requirements. (63%) faculty returned completed questionnaires. When compared to faculty, medical students believed that faculty Summary of work: To identify the current training needs of could benefit from further training in the areas of test staff a 15 item postal questionnaire was sent to staff in the question-writing, giving lectures, and teaching in the Medical School. inpatient setting (p <0.05). Qualitative analysis of the The questionnaire was designed to identify the: opened-ended question revealed that almost 30% of students believed that over-use of technology in lectures • training needs of staff contributing to the design, delivery detracted from the learning. When compared to students, and evaluation of undergraduate medical education at faculty believed that they could benefit from further training QUB in the areas of promoting critical thinking and establishing • most convenient time(s) of the day to deliver workshops a positive learning environment (p <0.05). • optimum duration of workshops for clinical teachers Conclusion: The differences between faculty and student • barriers to participating in training programmes. perception of teaching skills highlights the importance of surveying both groups when designing faculty development courses.

– 4.108 – Section 4 8K 14 Assessment of academic staff evaluation program and open ended questions about the evaluation process. N Zarghami, B Rahimi* and R Mokari (Tabriz University of Medical To increase the reliability and validity of the questionnaire, it was piloted first. It was distributed and then collected by Sciences, Department of Medical Education Development Centre, the researchers. Tabriz University of Medical Sciences, Tabriz, IRAN) Summary of results: The findings of this study revealed that Background: The teaching capability of academic staff has 64% of academic staff was male and 36% was female. a significant relationship with their awareness of the 35.65% indicated no knowledge of an existing evaluation educational process and the evaluation program. It is process during teaching. 44.33% indicated lack of necessary that academic staff are aware of their own commitment for implementation of an evaluation process teaching capability and are able to improve continuously and 47.19% indicated lack of commitment of the authorities the quality of their practice. and disadvantages of evaluation. 63.5% of academic staff Aim: To determine an evaluation program for academic agreed to be evaluated at the end of courses and 70% staff. agreed to take part in educational workshops as a feedback system. Summary of work: The subjects of this analytical descriptive study include 70 of 150 academic staff of Urmia University Conclusion: It is speculated that evaluation could improve of Medical Sciences who responded to questionnaires. teaching skills. Initially a questionnaire was prepared, containing closed

Session 8L: Students

8L 1 To cure or not to cure? Career choices of final year for vocational reasons. In their opinion, doctors have a medical students in Germany professional position which, through their work, gives them humanistic and existential rewards. The majority of Goetz Fabry* and Niko Michaelis (Department of Medical students state that medical studies are difficult, complex, Psychology, University of Freiburg, Rheinstrasse 12, 79104 stressful but interesting and if they had the opportunity again, Freiburg, GERMANY) they would make the same choice. Aim: It is said that a growing percentage of medical students – roughly 50% at the moment – are not going to work clinically but in alternative fields e.g. pharmaceutical 8L 3 Students’ expectations of medicine, on the medical industry, business consultancy or media. By using a role and its formation: 1998-2002 questionnaire we asked medical students in their last year Ana Marchandón A (Universidad de Chile, Cesar Cascabel 4385, (“Praktisches Jahr” - PJ) if they had already decided where Dpto 51, Las Condes, Santiago, CHILE) they were going to work after their exams. We were especially interested in reasons and motives if students Background: With the aim of contributing to the decided to work in alternative fields and asked for attitudes methodological elements that guide the training of the to clinical work. medical student, an exploratory study was carried out on the sociodemographic characteristics of the young people Summary of work: Many different reasons might be who enter the educational experience during 1998-2002. responsible for the “brain drain” in alternative occupational fields. Deteriorating working conditions in hospitals and Summary of work: A sample of first year medical students private practices namely the increasing proportion of who took part in the annual course on ‘conceptual and bureaucratic tasks as well as the overall dominance of practical basis of medicine’ was obtained. financial considerations seem to blur the perspective of During this period quantitative and qualitative instruments working with patients. With our survey we want to clarify were applied and the results and conclusions will be how students come to career decisions. The results of our presented. presently accomplished survey will be presented and discussed. 8L 4 Ethnic diversity and intercultural medical experience 8L 2 The motivation of medical students for their at Erasmus Medical Centre Rotterdam university career V J Selleger*, B Bonke and Y A M Leeman (Department of M Diez, A F Compañ*, J Medrano, R Calpena and M T Pérez Vázquez Educational Sciences, University of Amsterdam, Spoorstraat 6, (University Miguel Hernández, Departamento de Patología y 3743 EG Baarn, NETHERLANDS) Cirugía, San Juan de Alicante, SPAIN) Aim: To discuss research on the influence of a mixed student population on intercultural curriculum experiences Aims: The main aim of this study is to find out what motivates of medical students. students to choose a medical career and if this motivation changes during the time they are at the Faculty of Medicine. Summary of work: In December 2001, first-year medical students filled out a questionnaire on ethnic background, Summary of work: A questionnaire was given to students at religion and mastery of languages. In March 2003, twelve the Faculty of Medicine of the University Miguel Hernández of these were interviewed extensively about how Erasmus during different academic years. We studied 260 valid Medical Centre deals with intercultural education and questionnaires. The results were analyzed using the Chi- about contacts between students of different backgrounds. square test. Summary of results: Response was 90% (277/308; 63% Summary of results: Many students had always thought females); 18% were first or second generation ‘non-western about choosing a career in Medicine (34.61%). The most immigrants’, which outrated the 5% found in a national important motive for studying medicine was vocational survey on medical students; 8% were ‘western immigrants’. (84.23%). When medical students get to know the Immigrants had their roots in 30 foreign countries and spoke professional medical world, for 53.07% of them, the image 26 different languages. 48% of responders had no religious they have of their professional role is the same as it was denomination, 33% were Christians, 7% Muslims and 3% before they started studying Medicine. Hindus. The interviewed students (6F/6M, with varying Conclusions: We concluded that the majority of medical backgrounds) mostly felt they were treated equally; several students from our Faculty decided on a career in Medicine feared they had lower chances to enter medical

– 4.109 – Section 4

specialisation. Most students wanted more education in the weak student-teacher relationship outside the intercultural medicine. They appreciated intercultural classrooms. Analysis of the Middlesex Questionnaires contacts in small scale education. Between lectures, showed that the psychological states, which satisfy the immigrants of different origins did mix, but less often than diagnostic criteria for a disorder, were not operative as a with native Dutch students. cause of the students’ underachievement. Conclusion: A mixed student population facilitates, but does Conclusions/take home messages: We recommend great not guarantee, professional intercultural experience. attention to students’ dwellings (‘students’ cities’) and additional and extensive courses in English language for junior medical students. Active participation of the students 8L 5 Women with authority, men with empathy – gender in the educational process and in cultural and social equality in medical school in Uppsala, Sweden activities with their teachers in the Faculty of Medicine is highly recommended. Karin Grave and Christine Werner (Uppsala Medical School, Uppsala, SWEDEN) Background: Earlier studies of undergraduate students in 8L 8 Student Scientific Society – background of clinical medical schools have found that women experience more education mistreatment and gender discrimination than men. A Kuimov*, K Popov, A Antonov and I Kuimova (Selesneva 52-20, Summary of work: All medical students in Uppsala, Sweden Novosibirsk 630112, RUSSIA) (n=680) were asked to fill out a questionnaire about gender Background: The student scientific society (SSS) is a very perspective and gender discrimination during education. important part of high medical education. Fifty-six percent answered; 60% were females and 40% males. Fifty-two percent of the women and 27% of the men Aim: To show different activities of SSS in the common believe that there are different requirements on male and and clinical education of high degree students. female doctors. A majority of the students think that this Summary of work: The students’ participation in SSS is a needs to be discussed more during education. Of the strong stimulus for intellectual and professional female students, 32% had experienced being ignored advancement. The options of SSS activity are the following: because of their gender, compared to 16% of the males. the examination of difficult patients, panel discussion on Seventy-eight percent of the students had at one or several different topics, students’ participation in trials of drugs, times experienced stereotypical comments about women personal scientific work and so on. The important part of and men. Over 90% of the students answered that biological SSS activity is the annual university conference of young differences between the sexes need to be addressed more scientists and students, with awards for the best ones. The during education. The results indicate that a gender best works are published in medical journals and issues. perspective needs to be integrated into medical education. Conclusions: SSS is a very effective faculty option to advance intellectual and medical education and to introduce the student to clinical practice. 8L 6 Significance of scientific competitions between medical students M M Jafarov* and J J Ergashev (The Department of International 8L 9 The role of the Office of Medical Education in the Cooperation, TashPMI, Tashkent, UZBEKISTAN) Faculty of Medicine of the The role of the Office of Medical Education in the Faculty of Medicine of the Medical scientific competitions were considered as a new University of Porto as the interface between high method in the process of education. The goal of this competition was to determine specialty knowledge. Since and secondary education in the medical course 1989 our Institute has been organising medical scientific M A F Tavares* and A Bastos (Office of Medical Education, Faculty competitions. Every year this competition takes place in of Medicine of the University of Porto, Alameda Hernani Monteiro, different scientific directions and subjects. This year the 4200-319 Porto, PORTUGAL) competition was devoted to surgery and the students of 4- 6 courses participated. The competition related to two Aim: This work demonstrates the role of the Office for areas: theoretical knowledge and practical skills. The Medical Education of the Faculty of Medicine of the winners were given presents and they were invited to the University of Porto (Gem-FMUP) in the promotion of the special surgically gifted groups of TashPMI. These assist quality of educational outcomes, by approaching the the acquisition of deeper professional knowledge. Such transition problems caused by the profound gap existing events have been giving beneficial results. between higher and college education. Summary of work: A multilevel approach and the disciplines of the study plan, were the foundations of a planned strategy. 8L 7 Academic underachievement of junior medical A course on study competences specifically directed to students freshman medical students was provided (200 students in groups of 25), before the start of the 2002-2003 academic Mohamed B Awad (Faculty of Medicine, Zagazig University, year. A preventive approach was developed in a dynamic Zagazig, EGYPT) sequence of study strategies, disciplines and Background: This study was carried out to explain the first idiosyncrasies leading to academic success. The year medical students’ underachievement. All the 1st year multilevel model considers general, specific and personnel students in Zagazig Faculty of Medicine were included in levels. Summary of results: The multilevel model was the study during the academic year 2001-2002. approached by general orientations, application and appropriation and the evaluation data support the Summary of work: Data were collected using a importance of this innovative activity that involved the questionnaire that included some socio-demographic and disciplines and academic staff of the first year. educational data about the students, the Eysenck Personality Inventory and the Middlesex Hospital Conclusions: Starting this course on study competences, Questionnaire to determine some of the students’ supporting from the very beginning physicians during their personality and psychological factors. long period of training, will accomplish the promotion of the quality of the educational outcomes Summary of results: Analysis of data showed that males and the older students were the lower achievers. Low Work supported by Calouste Gulbenkian Foundation, educational achievement of parents, low family social Lisboa, Portugal. class, students living without their families, difficulties in transport arrangements and English language, were factors causing underachievement. The study reflected

– 4.110 – Section 4

8L 10 PROAC – Psychological and Pedagogical Background: Medical students’ perception of anxiety and Orientation Program for medical students distress during basic sciences training has been assessed as a lack of coping strategy with expectations developed Eunice de Freitas, Benedito Carlos Weltson, Décio Lourenco by the medical university. Reimao, Sandra Lopes Mattos e Dinato and Júlio Cesar Massonetto* (Medical School of Santos, Centro Universitario Aim: The aim of the presentation is to assess the Lusiada, Rua Oswaldo Cruz, 179, CEP 11045-101 Santos SP, determinants of students’ negative emotions in the BRAZIL) preclinical curriculum. Aim: To offer psychological and pedagogic reference Summary of work: The results are based on data obtained support to the medical student. from self-administered questionnaires performed among I-III year medical students at the end of every basic course Summary of work: Started in 2000 February, the Program (anatomy, embryology, histology, biophysics, biochemistry, has participation of the Psychology and Psychiatry physiology). professionals in order to look after the students and provide them with evaluation and orientation. PROAC is installed Summary of results: The study showed that 53.3% of the inside the campus, in an exclusive place, and there is a students of 2nd year experienced anxiety or distress in secretary working full time and scheduling students’ comparison to 13.5% of Ist year students and 12.9% of 3rd appointments. The professionals that attend to them are years. Most of the students confirmed a high level of self- not professors of the course, but they are members of the learning associated with participation in preclinical Psychology and Psychiatry Department and are totally classes. Subjective positive assessment of self-learning integrated with the principles and aims of PROAC. has not been associated with decreasing the anxiety and distress, particularly during the class of physiology (86.2% Summary of results: From the beginning of the Program to of the students confirmed negative emotions). December 2002, 154 students were looked after, totaling 764 sessions, with 85.9% females. That corresponded to Conclusions: Data confirmed that the way of teaching 6.8% of the total of medical students on the course. The presented by tutor, communication skills of tutor, attitudes largest number of sessions (41.5%) occurred with students of teacher to students and personal relationships between of 2nd and 3rd years of the course. The more prevalent medical staff and students remained the main determinants diagnoses were psychoneurotic disorders with somatic of students anxiety and distress. symptoms linked to stress. Conclusion: The complete success of the Program is due 8L 13 Promoting reflection and self-evaluation across the to the professional character given to it, evaluating the first clinical course student without interfering in his participation in the PROAC. We believe that PROAC is an important instrument of Adela Virginia Contreras and Toni Peters* (Vicente Perez Rosales psychosocial behavior evaluation of our students and, for 1871, Casa A, La Reina, Santiago, CHILE) them, provides reference support in their human and Summary of work: This experience aimed at promoting professional training. reflection and self-evaluation among students by means of small group discussions that took place in parallel with the 2002 course of Semiology: 13 sessions of 120 minutes 8L 11 Students’ research: learning advantages and each, attended by 3 faculties and 57 students. At the first benefits achieved by students. Polish experience and last session, students answered a questionnaire on Anna Michalak*, Tomasz Kucmin and Filip Stoma (Medical Reflective Thinking. The mission of our Medical School, University of Lublin, ul. Izerska 15, 20-868 Lublin, POLAND) their professional expectations and some case analysis were the subjects discussed. Faculties answered a Background: Students at the Medical University of Lublin questionnaire on how they perceived reflective thinking do research in various basic and clinical domains. Most of among their students. the departments run a Students’ Research Association. Work offered and done at each of the associations varies Summary of results: Main outcomes: 42% of students did from one department to another. A university-based not give an anticipatory thought to the clinical activities association run by students – Medical Students’ Reasearch they were carrying out for the first time, 13% acted Association (MSRA) organises annually a conference automatically without thinking on what they were doing, where students present the outcome of their research and while 50% perceived group discussions as helpful in are judged according to their engagement in the research discovering their pitfalls and suggesting remedial strategies. process. Presentations are not only given locally, but young Faculties perceived an initial resistance of students to researchers also take part in students’ congresses and participate in group discussions: 50% of faculties agreed professional seminars, nationally and internationally. in the lack of a previous reflection before carrying out clinical activities, and 80% perceived a good disposition Summary of work: We have asked mediclal students towards change. Final grades were slightly higher than in involved in research at the Medical Univeristy of Lublin the 2001 Semiology course, suggesting that promoting what benefits they expect to achieve and what advantages personal reflection among students is a positive factor in they foresee. They also answered questions about what achieving academic goals. Case analysis was the they really learn and gain by doing the research. preferred subject for discussions.

8L 12 Anxiety and distress experienced by medical students during preclinical training Beata Tobiasz-Adamczyk* and Agnieszka Penar (Dean’s Office, Medical Faculty, Jagiellonian University, St Anny 12 St, 30-008 Cracow, POLAND)

– 4.111 – Section 4 Session 8M: Teaching and Learning (1)

8M 1 Tumor prevention program of medical students at this was reflected in adequate physiological reasoning for Szeged University the understanding of clinical problems. Katalin Barabás* and Melinda Lakos (University of Szeged, Conclusions: The integrated and comprehensive General Medical Faculty, Szentháromság u. 5, 6722 Szeged, approach and the strong links between Blood & Immunity HUNGARY) led to excellent knowledge acquisition and reasoning skills. Aim: By European standards the mortality rate of the Hungarian population due to tumour is the least favourable. In order to prevent the onset of tumour-related diseases a 8M 3 Anatomical cadaveric hearts – integrated horizontal new educational program has been launched within the curriculum of medical training, which enables medical and vertical study students of Szeged University to organise tumour prevention Samar Al Saggaf*, Fawzia Nayeem, Soad Shaker Ali, Amira A courses for secondary school children, their parents and Elhaggagy and Khadra Soliman (King Abdul Aziz University, teachers. Our objective is the development of the Faculty of Medicine and Allied Sciences, PO Box 4149, 21491 educational program, the demonstration of prevention Jeddah, SAUDI ARABIA) activity and efficacy of trained students. This work was performed in a trial to organize the learning Summary of work: Fourth and fifth year students participate process by focussing on the horizontal and vertical in integrated, ability and skill-development courses in small, integration of the medical curriculum particularly between student-centred groups (14 classes). After practising their the three main subjects: anatomy, histology and pathology. skills in a mock class, students will go to schools, where Human cadaveric hearts were anatomically and they will lead their own courses. They assess their efficacy histologically examined. The study has revealed different by using questionnaires and making interviews. clinical problems such as pericarditis, myocarditis, Summary of results: In the framework of the prevention endocarditis, fatty infiltration and hypertrophy. The above program, which works in the form of a project, the students diseases could be diagnosed by histopathological study have been undertaking health education, self-examination compared to normal findings. The objective of this paper courses for three years and at the same time they act as is to make medical students alert at the pre-clinical stage go-betweens with the specialists performing screenings. of their medical career to diagnose and handle clinical The results of screenings and the efficacy factors of their problems and to develop their ability to do further reading courses prove that their activity is instrumental in modifying on different subjects. This paper demonstrates a new way the attitude of the population towards health and making of teaching an integrated medical curriculum. Similar hidden morbidity data available. University instructors studies are not found in the available literature. assess the student’s work by portfolio method. Conclusions: Students are able to promote the aims of the 8M 4 What kind of theory is needed? Experiences with a Hungarian health program already during their course on constructivism in medicine undergraduate years. Medical training also benefits from Rita Leidinger* and Claudia Kiessling (Arbeitsgruppe this practice, because in response to social requirements Reformstudiengang Medizin, Charité, H U Berlin, Schumannstr a complex educational method has been elaborated, which conveys integrated knowledge and effectively 20/21, 10117 Berlin, GERMANY) improves communication skills, while developing a sense Summary of work: In Winter 2002 we offered a following of responsibility for the health of the population. course on Epistemology In Medicine, focusing on constructivism. It was part of the special study module “Basics of Medical Theory and Practice” at the reformed 8M 2 A novel approach to blood and immunity in medical track in Berlin. This section of the curriculum undergraduate medical studies in a new medical comprises a variety of disciplines (among them medical school of Beira Interior – Portugal ethics, theory of medicine, sociology, anthropology and A Macedo*, A Izarra, P Tavares and L Taborda-Barata alternative medicine) from which students can choose courses of interest. Our seminar aimed at sharpening the (Universidade da Beira Interior, Department of Medical Sciences, awareness for individual responsibility for own mental Faculty of Health Sciences, Avenida Marques d’Avila Bolama, constructions. Philosophical terms such as “truth” and 6200-001 Covilha, PORTUGAL) “reality” were discussed in the context of constructivist Aim: To develop an integrated teaching/learning approach theory thereby elucidating the role of subjective mental to Blood and Immunity constructions for medical conceptualisation, decision making and practising. Both the course concept and its Summary of work: In accordance with teaching/learning structure (discussions, literature studies, movies) proved methods implemented at our medical school, we used an successful. Our presentation gives a critical survey of the integrated approach to Blood and Immunity curricula. course, considering the students’ evaluation as well as Integrated curriculum included biochemistry, physiology, our own experiences. embryology, anatomy and histology. Blood and Immunity interactive curricular contents developed by the teachers were available on the intranet and included reciprocal links. 8M 5 Coaching in medicine Clinical problems were used to illustrate theoretical points. Practical sessions included: a) histology practice with Sam Lingam, R C Gupta, D Gormley and D Brigden* (One Billy Lows relevant slides; b) blood typing and latex agglutination Lane, Potters Bar, Herts EN6 1UT, UK) testing. Each student practised both techniques several Summary of work: Coaching as a tool for success in sports times, as well as the technique of venipuncture. Seminars and lately in management is well recognised. In medicine were held on a) Blood banks and b) HLA and we use the words monitoring, teaching, learning, transplantation, which were followed by workshops where counselling, tutoring etc and not coaching. We believe students had to present and discuss related papers and coaching in the context of medicine is appropriate. We the overall conclusions. recommend the concept of specialist medical coaches. Summary of results: Year 2 students were happy about the These are recognised expert consultants in their field who methodology utilized, and their marks reflected good take on coachee doctors (usually staff grade and associate knowledge acquisition. The close relationship between specialist) to give them top-up training to become theory and practice was well accepted by students, and consultants. In addition, postgraduate doctors who sit high-

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stake examinations need coaching rather than teaching Conclusions: In conclusion, greater research attention or tutoring. The coaches in these circumstances often use should be given to views of the general public on use of the surface approach to learning. This is possible because tissues for medical research and teaching before drafting most of the coaches have had some knowledge and skills new legislation. on the subject before they attend courses. In undergraduate and postgraduate (non-examination related) courses the teaching and tutoring should be the deep approach. 8M 8 Evaluation of a voluntary lecture where a medical Summary of results: We evaluate all our examination related student examines a healthy infant at the Skills clinical coaching courses in which we use the GROW Training Centre technique of coaching. There is a more than 90% H Storm*, R Bentehaugen, A Lippert and E Hankø (The Skills satisfaction rate in our courses, and 90% get 100% Training Centre, IKLIN, The National Hospital, 0027 Oslo, satisfaction. All 95 attendees (100%) said that they will NORWAY) recommend the course to their friends. Conclusions/take home messages: Coaching is valuable in medicine, Background: We established cooperation with the local coaching principles and techniques are available to health centre who requested mothers to bring their healthy doctors. infants (3 months to 1 year). A medical student (5th year) examined the infant for 30 minutes accompanied by an instructor (a last year medical student), followed by a 15 8M 6 Reflective learning in undergraduate medical minutes discussion with the instructor. students: what is the evidence? Aim: To evaluate this voluntary training from the perspective Andrew Grant*, Elizabeth Metcalf and Paul Kinnersley (University of the student. of Wales School of Medicine, Department of General Practice, Summary of work: The students filled in a written evaluation Llanedeyrn Health Centre, Llanedeyrn, Cardiff CF23 9PN, UK) form with answers scaled from 1 (very poor) to 10 (very Aims: To present our work on introduction of reflective good). Students were asked if they thought the session learning which demonstrated differences between theory was useful to improve their skills in communication and and practice, and to present the evidence underlying the examination technique. theory used to support reflective learning. Preliminary results: 21 students (50%) attained the Summary of work: All 230 students entering the third year at education. 74% of these students had examined an infant UWCM were invited to join a study into reflective learning. prior to the training. 37% had already accomplished their Taking part involved keeping a learning diary and attending mandatory training at the health centre. The usefulness of fortnightly tutorial groups. The study was evaluated by semi- the session applied to improvement in communication structured interviews with participants and non-participants skills and examination technique was rated as 7.3 (SD = 2.0) and 7.6 (SD = 1.8) respectively. All students were in Summary of results: Thirty (out of 230) students took part, favour of continuing this training opportunity. Moreover, the some described increased ability to choose what they instructors were rated by the medical students in learned and some said that the tutorial groups gave them communicational skills, 8.5 (SD=1.5), and examination the opportunity to gauge their progress against their peers. technique 8.4 (SD=1.2). All the mothers would recommend Nearly all students described sitting in lectures and taking this session to other mothers at the health station. notes, then memorising their notes for exams. When asked about their learning most students described how they Conclusion: The skills training centre want to make this revised for exams. They preferred small group and bedside training mandatory teaching to lectures. Conclusions: The way in which reflective learning is taken 8M 9 Attitudes towards Psychiatry and Psychotherapy up by students might be different from that predicted by the (ATP) of medical students from different years at the literature and by teachers who are persuaded by its claims. The context in which reflection is introduced will have a University Medical School in Essen, Germany during great influence on the way in which it is taken up by learners. the Summer of 2002 O Kuhnigk*, B Strebel and J Schilauske and M Jueptner (Universitätsklinikum Hamburg-Eppendorf, Modellstudiengang 8M 7 A study of public opinion on use of tissue samples Medizin, Martinistrasse 52, 20246 Hamburg, GERMANY) from living subjects for clinical research and Background: The attitudes towards psychiatry and medical student teaching psychotherapy by medical students are of significant M L Goodson* and B G Vernon (c/o B.G. Vernon, School of Population importance for a competent medical care of psychiatric and Health Sciences, The Medical School, University of Newcastle and non-psychiatric patients. Our study analysed students‘ Upon Tyne, UK) attitudes against year of education, gender and psychiatric and psychotherapeutical as well as teaching experiences. Background: Guidelines on tissue removal from living subjects for clinical research and teaching have recently Summary of work: To find out the attitudes towards psychiatry been issued by the Chief Medical Officer and the Royal and psychotherapy we asked students to fill out a translated College of Pathologists in response to public concern after and extended version of the ATP-30 questionnaire. The revelations at Alder Hey, but there has been little systematic ATP-30 makes statements about different aspects of and research on public attitudes. attitudes by using a Likert-scale. Aims: The aims of this study were to discover: (1) The Summary of results: The rate of return was 88% (n=508). percentage of the population prepared to donate tissues Attitudes towards psychotherapy were in comparison for research and teaching; (2) Tissue types individuals towards pyschiatry-related attitudes significantly positive. would be prepared to donate; (3) Types of research people Women as well as students with psychiatric experience would be happy to donate tissues for; (4) Whether adults showed a significantly more positive attitude than men. would consent for donation of a child’s tissues. 100 Neither the year of study nor teaching-experiences with volunteers completed a short questionnaire. patient contact produced any influence on attitudes. Summary of results: 18% of subjects would not consent for Conclusions: Global attitudes towards psychiatry and any research to be carried out on their tissues, 50% would psychotherapy were generally positive. Whereas the not consent for donation of a child’s tissues. 26% of subjects influence of gender and psychiatric experience is well would consent for research on genetic cloning, compared known, the year of study and traditional teaching methods to 82% for cancer research and 72% of subjects said they in our study produced no significant influence in would be happy for their tissues to be used to teach medical contradiction to other studies. students.

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8M 10 Physician training in child development to meet basic Background: This presentation shows the perceived value needs of children and families in medical practice of studying the Arts in Medicine. The theories behind and aims of this module were presented at the AMEE Wendy Roberts* and Elizabeth Thompson* (Hospital for Sick Conference in Berlin 2001. Children, Child Development Centre, 555 University Avenue, Toronto, Ontario M5G 1X8, CANADA) Summary of work: The authors have subsequently conducted an evaluation of students’ perceptions of the Aim: To increase physicians’ knowledge and practical benefits of taking this module, using both qualitative and skills as they identify and support parents managing quantitive analyses. children with developmental and behavioural difficulties. Summary of results: Results demonstrated a perception by Summary of work: Parents of children with developmental students that their professional development had been and behavioural difficulties typically seek help from their enhanced by taking time to study the Arts, and that they felt physician. Recognizing that physicians need greater they would continue to use the study of the Arts to this end. competence in these areas, an educational program has been developed at the University of Toronto. Program The presentation highlights the usefulness of medical development and curriculum have been informed by students using the Arts to enhance their professional surveys of practising physicians and community health knowledge, skills and attitudes. The data presented here professionals, student ratings, and feedback from faculty will be published in Medical Education prior to the and community teachers. Program delivery has included conference, and appear with the agreement of the editor. case based seminars, community site visits, home visits, interdisciplinary rounds and assessment in community practices, university hospital clinics and with other health 8M 13 Injury epidemiology, prevention and treatment: an professionals. Most meaningful areas of focus have integrated curriculum included typical child development, common child Peter Barss (United Arab Emirates University, Dept of Community behaviour problems and parenting skills, developmental disorders, early identification and intervention, school Medicine, Faculty of Medicine & Health Sciences, PO Box 17666, issues, and team building with physicians and community Al Ain, UNITED ARAB EMIRATES) health providers. Successful experiences have critically Aim: To describe an integrated medical curriculum for depended on faculty and community professional training injury. and preparation. For really effective programming a critical mass of academic and community teachers must be Summary of work: Injuries are a leading cause of mortality available. Our next step is to more comprehensively and morbidity. Nevertheless, injury epidemiology and evaluate the impact of the program on faculty development prevention are neglected in most medical curricula. In the and clinical practice. We are currently exploring the United Arab Emirates trauma is a priority of the Faculty of replication of the program with international sites. Medicine. Therefore a new curriculum was developed by the Department of Community Medicine, in collaboration with other departments. 8M 11 Innovative module for training of medical students Summary of results: The curriculum included two 20-hour as promoters of prevention of drug abuse units. Unit one introduced epidemiology and the Regina Komsa-Penkova*, Sonali Vaid, Emil Filipov, Dobromir epidemiologic basis for prevention. Students developed Dimitrov and Zlatina Georgieva (Higher Medical Institute - Pleven, comprehensive prevention strategies using injury matrices. International Relations’ Office, 1 Kliment Ohridski Street, Pleven Other topics included initial assessment of the injured, 5800, BULGARIA) triage, organization of trauma services, post-traumatic stress, risk-taking, and disability. Unit two focused on Background: Drug abuse is a major problem among youth epidemiology, prevention, and initial management of and is worsening due to the lack of professionals with specific unintentional injuries such as traffic injuries, falls, expertise in drug prevention. Unfortunately, the training of drowning, burns, poisoning, heat and cold, animal bites students in prevention of drug abuse does not exist in and disasters, as well as intentional injuries such as child traditional medical curricula. and spousal abuse, rape, suicide, urban and political violence. Due to success of 2 student presentations in unit Summary of work: We have started to develop a course for one, unit two was structured with 18 practical presentations training students as promoters of drug prevention utilizing to integrate all prior teaching on epidemiology, prevention, a new approach that motivates students to participate first aid, and CPR. actively in the training process. In the course development students are supposed to be the main active “force” guided Conclusions: Integration of all aspects of injury provides a by experts. An interactive model for learning will be used: relevant curriculum that is innovative and appealing for tutor-student, student-tutor, student-student, student-risk theory and practice. Since it is new in 2003, assessment group-student. This model directly involves the students in will be discussed at presentation. the teaching process through preparing interactive simulations and game based products aiming at better access to the psychology of the risk group. There will be 8M 14 Community Empowerment Project – a model to emphasis on the development of communication skills, promote smoking cessation in hard to reach use of informational technologies, development of Web sites, interactive computer based products. It will raise the community groups social activity of students and help them to win a greater M I Memon*, R C Gupta, D Brigden and M A Memon (Preston PCT confidence of the risk group by breaking down the & Bolton Institute, Oakwood, Whitehall Road, Darwen, Lancashire communication barriers. BB3 4LH, UK) Conclusion: The development of the course will contribute Aims: A health promotion project based on the Community to the traditional educational system and will be a first step Development Model was conducted in order to promote in training professionals for drug prevention. We plan to smoking cessation in South Asian Muslims. Aims were to introduce it as an optional course and as summer electives (i) reduce the overall level of smoking (ii) increase the for students from different universities. involvement of local representatives and (iii) empower individuals to make decisions about their health. 8M 12 The arts in medicine – evaluating a new special Summary of work: Activities involved establishing a steering group, training and awareness raising, the development of study module partnerships, the distribution of resources through a range P A Lazarus* and F M Rosslyn (University of Leicester, Division of of outlets, organisation of local events. The target groups Medical Education, Maurice Shock Medical Sciences Building, for this programme were middle-aged men and young Gwendolen Road, Leicester LE1 9HN, UK) men and women. This project was based on Community

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Development Model, community were empowered in the to almost all sectors including Health is inadequate. delivery of promoting smoking cessation. Consequently, diagnosis and treatment of diseases are not optimum. Considering the above, it is imperative for a Summary of results: Through this programme we were country like Ghana to place much emphasis on Preventive able to (a) raise awareness regarding the harmful effects Medicine. In the past decade, Ghanaian medical students of smoking; (b) provide support and advice to smokers who under the Federation of Ghana Medical Students’ wanted to quit; (c) increase the involvement of local Association have been educating the public on the representatives of the Muslim community in smoking methods of prevention of certain diseases. The cessation programmes; (d) develop effective methodology used involves the setting aside of a week in a communication and links between smokers, smoking year to educate the public on a chosen disease topic. For cessation services, local community and religious groups, the role of the Ghanaian medic in Preventive Medicine to and other relevant parts of the health services (e) increase be made more positively profound, there is the need to involvement of Primary Care Teams. modify the current methodology. These modifications Conclusions/take home messages: Adopt Community should include increasing the duration of educating the Development Model for diffusion to the grass-roots public and the organization of students into smaller groups community at appropriate places, to achieve maximum (clubs) with each group having the task of educating the impact. public on a particular disease topic. To monitor the progress and success of “the role of the Ghanaian medic in Preventive Medicine”, students should be encouraged 8M 15 Team working for a reflective medical education to undertake research with the aim of monitoring incidence resource of diseases of interest. L A Paterson*, J Ker and P Davey (University of Dundee, Clinical Skills Centre, Level 6, Ninewells Hospital and Medical School, 8M 17 What items should be taught and assessed in a Dundee DD1 9SY, UK longitudinal curriculum of emergency medicine? Background: All doctors prescribe antibiotics but 80% will F O Weisser*, B Dirks and M Georgieff (Sektion Notfallmedizin, be inappropriate or unnecessary, contributing to the public Universitätsklinik für Anästhesiologie, Klinikum der Universität health risk of antimicrobial resistance. The Scottish Ulm, Prittwitzstr., 89070 Ulm, GERMANY Executive provided funding for a joint initiative between the five Scottish Medical Schools for the development of a Aim: We are training medical student and postgraduates reflective medical education resource. in emergency medicine. Our training programs consist of skills-lab training, lecture, casuistries and end of course Aim: The aim of the project was to create a resource that assessment (e.g. OSCE, performance-based assessment). would not only educate medical undergraduates in There are only a few publications about the effect of training appropriate antimicrobial prescribing but also encourage in emergency medicine, so we looked at other methods to an informed and reflective approach to learning in clinical define our learning goals. Details of our curriculum will be practice. presented. Summary of work: We have created an experimental model Summary of work: We reviewed the literature with the to obtain consensus on the development of the structure of question “what is essential to know and what is nice to a reflective resource. The model employs elements of both know about emergency medicine?” focus groups and the Delphi technique to gather information and opinions from both the experts and the We used he following items to determine our goals: users. This method allows us to be confident that the Statistical data (morbidity, mortality); Urgency of therapy; resource is developed based on collaborative expertise, Representation of typical clinical problems; Requirements for both content and process. Once fully developed, the of the clinical job of a typical physician. resource can then be adopted by each Medical School to Summary of results: As a result of our review the training ensure that tomorrow’s doctors are appropriate reflective programs of the 3rd and 5th year medical students and of prescribers in their clinical practice. the postgraduates put the focus on essential goals. Conclusion/Take home message: The systematic review 8M 16 The role of the Ghanaian medic in preventive medicine of literature with the question “what is essential to know?” leads to a better curriculum of our training programs. Now E Moses Fynn* and I Osei (Kwame Nkrumah University of Science the learning goals of our curriculum hit better the tasks of and Technology, School of Medical Sciences, UST, Kumasi, GHANA) the real life than before. In countries like Ghana, where the annual budget of the nation is solely dependent on foreign assistance, cash flow

Session 8N: Teaching and Learning (2)

8N 1 The proposed use of ‘participatory video’ following each session, students would critique their own, techniques in undergraduate veterinary education and their colleagues performances, with the aid of a senior member of staff. At the end of the exercise, students would C E Bell (University of Glasgow Veterinary School, Division of Farm then be asked to produce a demonstration video for the Animal Medicine and Production, Veterinary Clinical Skills, education of their 3rd year undergraduate colleagues. It is Bearsden Road, Glasgow G12 9LP, UK) hypothesized that such an exercise will lead to the Aim: The introduction of ‘participatory video’ techniques education of students about communication and clinical into undergraduate education at the University of Glasgow skills. In addition, visual demonstration of an improvement Veterinary School is proposed, based on the hypothesis in skills may lead to empowerment of individual students. that these are likely to facilitate the education, and The requirement to assist in the teaching of undergraduate empowerment, of veterinary students. colleagues is also likely to result in a deep learning experience. The success of the technique would be Summary of work: Using a conventional camcorder, final evaluated both subjectively, based on students’ impressions year students would video each other taking clinical of the exercise, and objectively, based on evaluation of histories, and performing clinical examinations. This would skills demonstrated in the videos using a structured marking be performed at regular intervals throughout the year, and scheme.

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8N 2 Comparison of lecturing with and without lecture course on “how to prepare and succeed in the exams”, notes in learning for medical student virology teaching having as its main purpose to promote the academic performance. Sohrab Najafipour* and Sedighe Najafipour (Fasa Medical School, PO Box 71935-1166 Nemazi Square, Mottahari Clinic, Shiraz, Summary of work: In its structure the course starts with a IRAN) process of self-observation and evaluation. It is organized in two modules: how to prepare for exams and how to Background: It has been reported that the use of lecture perform in the exams. Both modules are supported by the notes for presenting curricular material to medical students active collaboration and participation of the teaching staff is both cost effective and well suited to the educational of the 1st year disciplines. milieu of basic science. Two groups of students matched with age and sex have been selected. Summary of results: The evaluation results can be split into strong and weak points. The strong points fall within Summary of work: In this study the authors examined the the scope of “Learning and Study Strategies”, “Behavioral efficacy of using the lecturing method with and without Strategies” and “Defining Objectives” (Dembo, 2000); the lecture notes.The present study evaluates the usefulness, weak points are mainly associated with the difficulty of fitting as perceived by students, of the lecturing method with and the strategy of the study to the type of assessment. without lecture notes by which virological information is presented during the preclinical part of the medical course. Conclusions: These results can provide support for new Assessments of these learning methods were elicited from educational interventions with the students emphasizing medical students at the Fasa Medical School based on not only the strong points but trying to overcome the weak their grades in the virology examination. Students rated points also identified, in order to promote a better academic some of 14 lectures in a virology course immediately after performance of the medical students. lectures and again all of lectures at the end of the course, Work supported by Calouste Gulbenkian Foundation, by questionnaire. Their views were sought on various Lisbon, Portugal aspects of medical education, including usefulness of lecture notes. Summary of results: The data were analyzed using T-test. 8N 5 Working with feedback Average course grades were higher in lecturing sections Reuben M Gerling (Nihon University School of Medicine, Nihon with lecture notes than in the lecturing sections without University School of Medicine, 423 Matatomi, Chonan, Chosei, lecture notes. Comparing the two groups, they were Chiba, JAPAN) significantly different. Students’ perceptions of course and instructor effectiveness were higher in the lecturing In order to maintain the momentum of progressive sections with lecture notes than in the lecturing sections education it is necessary to diversify and introduce new without lecture notes. Some implications of this study will ideas and methods on a continuous basis. To do that, we be discussed in the conference. need to know how effective we are as teachers as well as what are the students’ needs and expectations. This is where feedback comes in. There are a great many types 8N 3 Monitored self-study: how do students use the of feedback as well as methods of reaching them. Teachers guidelines? ought to be aware of the importance of feedback and take advantage of the information that it provides. M Vandersteen*, M Maelstaf and I Vandenreyt (Limburgs Universitair Centrum, Universitaire Campus, Gebouw D, B-3590 Dipenbeek, BELGIUM) 8N 6 The cognitive challenges of learning from medical Aim: We wanted to check the effect of self-study text: an intervention for undergraduates assignments on study strategy and efficiency after five years Iona I-Wesso (Department of Medical Biosciences, University of of monitored self-study. Western Cape, P/Bag X17, Bellville 7535, SOUTH AFRICA) Summary of work: We interviewed fifty students over the Background: While teaching and learning in the medical same period. sciences are becoming increasingly reliant on huge Summary of results: All students hang on painstakingly to volumes of e-information (mainly presented as text), it is the ‘instructions’ in order to save time. The freshmen use not clear whether effective e-learning is actually taking the ‘learning objectives’ of the assignment to determine place (Graesser et al. 2002). Part of this problem may be the intended study-results. In the second and third year, the ascribed to the fact that medical text (presented formulation of the objectives is too vague. The students electronically or otherwise) demands a specific cognitive define their own objectives using the instructions, the self- repertoire which students often lack. In the absence of test, the estimated study time and the information they get relevant cognitive frameworks into which students can from their predecessors. From the third term of the second assimilate textually presented information, effective year on, students drop out of the system due to too heavy learning is severely compromised (Wade & Schraw, 1991). subject matters. They get discouraged, start learning by Summary of work: An intervention is presented that integrates heart but manage to pass the exams. cognitive learning theories and instructional prescriptions Conclusions: The Guidelines are only a clear support for (Singer & Donlan, 1989) to improve students’ cognitive freshmen. abilities and provide them with relevant schemata to allow the construction of new knowledge. This intervention Take-home message: Students of the higher years should focuses specifically on a very successful cognitive strategy get formal feedback on the objectives they attain. A reduced for learning from medical text viz. the ability to reorganise studyload in the second and third years is inevitable. linearly represented information into organisational patterns that facilitate the construction of meaningful understanding. This allowed students to read systematically, establish 8N 4 Introducing changes in the education of medical relationships between concepts, identify important ideas, students: a course on study skills in the Faculty of summarise passages, readily retrieve information from Medicine of the University of Porto memory, go beyond the given information and very effectively monitor and evaluate their understanding. E Loureiro*, M J Martins, D Neves, M A Tavares and A Bastos (Office of Medical Education, Faculty of Medicine of the University of Porto, Alameda Hernani Monteiro, 4200-319 Porto, PORTUGAL) Aim: To present the results obtained in a course on study skills developed with 1st year students of the medical

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8N 7 A survey of the perceived impact of study guides Summary of work: A student survey was carried out amongst designed to support student learning during medical students at the University of Aberdeen to gauge intermediate clinical rotations in a revised their opinion about lectures. They were asked to record, in free text, five factors each that, in their view, contributed to undergraduate medical curriculum a good lecture and a bad lecture. A single investigator coded F J Cilliers*, B B van Heerden and E Wasserman (University of all the responses and analysed the data using Microsoft Stellenbosch, Division for University Education, P O Box 19063, Excel software. Tygerberg 7505, SOUTH AFRICA) Summary of results: 102 students submitted completed Aim: To evaluate study guides (SGs) created for forms with a total of 1043 comments – 594 relating to good intermediate clinical rotations in a revised undergraduate and 449 relating to bad lectures. The most frequent medical curriculum. comment related to the use of technology in lectures (39%). Students highly valued the availability of Powerpoint files Summary of work: Questionnaire surveys were on the student intranet, especially before the lecture, to administered to groups of students after completing 11 SG- enable them to print out the notes and annotate them during supported modules. Questionnaires comprised one the lecture (19%). The lecturer’s quality of delivery and closed and four open questions. their enthusiasm were noted in 26% of comments. Summary of results: 269/304 students from two classes Conclusions/take home message: Despite responses completed questionnaires. Coding of open questions being free text, common themes emerged stressing the yielded 100-369 responses per question. Between 0-68% value of the contribution of technology to the art of lecturing. of students found various SGs useful. Elements valued This study highlights the need to focus further educational included: logistical information; information on learning research on areas of student preference, to establish activities (indication of skills to acquire; information whether meeting these preferences results in educational indicating what is expected; guidelines on report writing); benefit. information on assessment. Elements criticised included: outcomes (poorly formulated); logistical information (inaccurate; incomplete). Suggestions for improvement addressed: logistical information (accurate, complete 8N 10 Comparison of the impact of traditional and timetables); outcomes (clear; specific; attainable), learning multimedia independent teaching methods on the activities (indication of relevant theory to learn; indication skills of administration of medication by nursing what students are expected to do); assessment (sufficient students information on expectations and format) and design/layout/ Khadijeh Ranjbar (Shiraz University of Medical Sciences, Faculty content. of Nursing, PO Box 71935-1314, Shiraz, IRAN) Conclusions: These results are similar to those of a previous Background: While there is an urgent need to find the ways survey on SGs for early clinical rotations and indicate that of providing cost-effective instruction for student nurses SGs do not optimally support student learning. Efforts to without adversely affecting performance outcome, it is ensure SGs that better support student learning have not necessary to find more efficient ways of teaching time- been successful, so other strategies are needed to achieve consuming psychomotor skills. This experimental study this. was conducted to compare the traditional and multimedia independent approach in teaching administration of 8N 8 Student learning profiles in the health sciences medication to the first year student nurses. A Patterson* and M Kelly (Faculty of Health Sciences, Trinity Summary of work: The participants were 86 nursing students who were randomly assigned to experimental and College Dublin, Dublin 2, IRELAND) control groups. The control group was taught by the Aim: To establish learning profiles (approaches and styles) traditional method (lecture demonstration with explanation) of a sample of 207 students at entry to each of the 6 schools and the experimental group had combination of lecture- of the Health Science Faculty in the 2002/2003 academic demonstration, film strip, text assignment, discussion and year in order to facilitate subsequent intervention in cases supervised group practice followed by independent study, of inappropriate learning profiles. The schools involved practice and hospital observation. Initial and retention of were: Clinical Speech, Dentistry, Medicine, Nursing & cognitive knowledge and psychomotor skill were Midwifery, Occupational Therapy and Physiotherapy. measured by a post test and standard checklist right after the instruction and one month later. Summary of work: Identification of learning profiles was based on administration of a set of three questionnaires: Summary of results: There was a significant difference in Learning Styles Questionnaire (LSQ); The Approaches and initial cognitive knowledge between control and Study Skills Inventory (ASSIST); The Learning and Studies experimental group (P= 0.0001, but the data related to Strategy Inventory (LASSI). retention of cognitive knowledge yielded no significant result by the use of 2 different teaching strategies. Analysis Summary of results: Overall the most preferred learning of data indicated that neither the treatments nor the methods style across the schools is Reflector (41-67%) while the were statistically different for the initial learning or the least preferred is Pragmatist (5-28%). The preference for retention of psychomotor skills. Both methods, however, adopting a deep approach to learning was less than 9% in were found to be effective. all schools with the exception of medicine (23%). Conclusion: It is essential that the curriculum is designed so as to encourage a deep approach to learning and so 8N 11 Building a learning culture in primary care: ideas that students are encouraged to learn from a variety of from a Teaching PCT in Bradford, England experiences in order to broaden their learning styles and complete the learning cycle. David Pearson*, Lynn Stinson and Peter Dickson (Bradford City Teaching PCT, Joseph Brennan House, Sunbridge Road, Bradford BD1 2SY, UK) 8N 9 Technology in a medical lecture – how relevant? Background: The NHS faces the challenge of trying to Ujjal Choudhuri*, Rachelle Arnold and Hamish McKenzie expand its workforce at a time of national shortage of (University of Aberdeen, Medical Faculty Office, Polwarth primary care professionals (Dept of Health, 2000). The Building, Foresterhill, Aberdeen AB25 2ZD, UK) problem is especially acute in areas of socioeconomic deprivation, precisely those areas with the highest morbidity Aim: To highlight the relevance of technology in the delivery and mortality (Sibbald et al, 2000). Teaching Primary Care of a medical lecture. Trusts (tPCTs) were established in 2001 with the aim of helping recruitment and retention of primary care staff in

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these areas (Dept of Health 2001). Bradford City tPCT has on the pretest (received counseling) with failure rates for developed as a think tank identifying, developing and those scoring –0.79 to –0.99 SD from the mean (not supporting educational initiatives. Since 2001 the tPCT counseled). Data were analyzed using Chi-Square. has been involved with several projects, outlined below. Our interactive poster will provide further information and Summary of results: Forty-two students received counseling data.Bradford tPCT initiatives: (pretest scores of –1.0 to –1.2 SD) and 12 (29%) subsequently failed the final exam. Of the 42 students who • Undergraduate medical education – widening access, were not counseled (pretest scores of –0.79 to –0.99 SD), expanding primary care learning opportunities, two (5%) failed the final exam. The difference between developing teaching practices. failure rates was significant (p < 0.007). • Interprofessional education – supporting research, Conclusion: Early counseling of students with marginal developing IP learning opportunities in primary care. knowledge may be an insufficient, and possibly harmful, • Higher professional education – regular facilitated intervention to improve final examination performance. education for those recently obtaining higher professional qualifications. • Continued professional education – “personal 8N 14 Complexity and Educating the Health Professional development without tears.” Jim Price (CMEC, St Richards Hospital, Chichester, PO19 4SE • Educational models to support international recruitment West Sussex, UK) and retention of GPs. Aim: Insights from the new ‘science’ of complexity are now We believe that through educational support and being used in many fields. Complexity thinking has been stimulation we are helping attract professional staff, and highly influential on major health policy (Institute of will improve future recruitment and retention. Our initiatives Medicine 2001). This poster charts how the changing are transferable to aid recruitment and retention in other educational needs of the modern health professional may settings. be linked with changing educational theory, and examines how insights from the notion of complexity might help both educators and health professionals in the dynamic 8N 12 Characteristics of a good medical teacher: opinions environment. of first year undergraduate medical students Methods: Drawing on many areas of educational research, J F C Figueiredo*, M L V Rodrigues and C E Piccinato (University the roles of interprofessional learning, small group and of Sao Paulo, Faculty of Medicine of Ribeirao Preto, Rua Guaranta problem-based learning are analysed from a complexity 64, Jardim Recreio, 14040-190 Ribeirao Preto - SP, BRAZIL) perspective. Methods which enhance non-linear and transformative learning are discussed, and the role of Aim: The aim of this study was to determine how first year anxiety and arousal related to educational and teaching students at Faculty of Medicine of Ribeirão Preto, University performance is also considered. of São Paulo, Brazil, characterize a good Medical Teacher and which values predominate in the beginning of the Conclusions: Insights from complexity act both as a guide medical course. for improving teaching and learning, and as a useful metaphor for the teaching environment in today’s health Summary of work: A self-administered questionnaire (5- services. point Likert scale), with 13 items related with the roles of a medical yeacher (Rodrigues et al., 2002), was applied to 56 students (56% of the class) in the first trimester of the 8N 15 Extracurricular activities of undergraduate students course. enrolled in a special training programme Summary of results: The most relevant characteristics in Maria de L Veronese Rodrigues*, Elizabeth Meloni Viera, Guilherme the opinion of the students were to be: a good physician; a L Martinez, Luciana de M Vicente, Nelson F Gava and Priscilla G researcher; a provider of information in medical practice; Lira (Hospital das Clínicas - Oftalmologia, Faculdade de Medicina a good lecturer; and to be able to act as a tutor/facilitator/ de Ribeirao Preto, 12 andar - Campus Universitario, 14048-900 assessor. In a previous study, the authors collected the Ribeirao Preto SP, BRAZIL) opinions of Faculty Members and Graduate Students (Rodrigues et al., 2002), using the same instrument and Background: Fourteen students of the Medical School of the main differences between the undergraduate students’ Ribeirão Preto, University of São Paulo (FMRP-USP), opinions and the subjects of the previous research were Brazil, are enrolled in an extra-curricular activity named observed in the items Model of Attitudes, Values and Beliefs Special Training Programme (Programa Especial de and the role of teacher as Student Evaluator. Treinamento-PET), supported by the Brazilian Ministry of Education (MEC) under direct tutorial of a Faculty Member Conclusions: These results may be related to the from the Social Medicine Department. educational system in Brazil, in which most of the first year medical students are teenagers. Summary of work: One of the planned activities of this group is to carry out a screening of visual problems among children, aged less than 3 years old, members of families 8N 13 Does formative, in-clerkship counseling of students assisted in the Family Medicine Programme of the with marginal knowledge improve pass-fail institution. The first step of this activity consists in the performance on an end-of-clerkship examination? acquisition, by the students, of cognitive and psychomotor skills in the area of Ophthalmology, in small group activities Alan P Wimmer, Paul A Hemmer*, Thomas C Grau and Louis N tutored by one Faculty Member of the Division of Pangaro (Uniformed Services University, USUHS - EDP, 4301 Ophthalmology. The objective of the present Jones Bridge Road, Bethesda MD 20814, USA) communication is to describe the contents, centered in visual acuity measurement and external ocular Aim: To examine the effect of formative, in-clerkship examination, and teaching/learning techniques used in counseling of medical students who have marginal these activities. knowledge. Summary of work: Third year medical students who score one standard deviation (SD) below the mean or lower on a 8N 16 Students’ satisfaction with the improvement of “pretest” at the start of the internal medicine clerkship are Introduction to Medicine course counseled on learning strategies to use during the clerkship. For students from 1994 through 2000 (n = 850), A Nitiapinyasakul, S Lermanuwararat and R Littirong (Maharat the authors compared pretest scores and final exam failure Nakhon Ratchasima Hospital, School of Medicine, Muang rates for those scoring –1.00 to –1.20 SD from the mean District, Nakhon Ratchasima 30000, Thailand)

– 4.118 – Section 4

Background: Introduction to Medicine is one of the the students in the year 2001 was used as input for the prerequisite subjects for Thai medical students before improvement. The course was changed to problem-based proceeding to their clinical year clerkship. Though it was learning, problem oriented learning and small group developed in a multidisciplinary fashion and covered the tutorial. New instruction materials were also developed cognitive, psychomotor and affective outcomes, it has been and appropriate assessment tools were used. taught in a traditional style. Summary of results: The results showed that the students Aim: To present the students’ satisfaction of the in the year 2002 were significantly more satisfied with the improvement of Introduction to Medicine subject in yearØ instruction materials (P<0.01) and the problem oriented medical students. learning (P=0.03) than those in the year 2001 Summary of work: In the pre-clinical phase curriculum at Conclusion: These results were very useful for the Maharat Nakhon Ratchasima Hospital School of Medicine, continuous development of the course and the adaptation the teaching method of this subject has been improved for of other clinical subjects. the students in the year 2002. The satisfaction survey of

Session 8O: E-Learning and the Internet

8O 1 Active learning on the web: seven steps to effective Summary of work: The study groups were third year medical e-learning students and they were randomly assigned to the WebCT group (n = 38) and the WWW group (n= 48). In this study David A Cook* and Denise M Dupras (Mayo Graduate School of the WebCT group students utilized discussion groups, Medicine, Department of Internal Medicine, 200 First Street SW, general discussions about lectures, quizzes and students’ Rochester MN 55905, USA) own notes. All students were initially tested for the Aim: Many instructional websites fail to employ principles computing skills and experience. No significant of effective learning. This practical guide will help differences were found in these variables between the study educators create effective learning websites. groups. Summary of work: Reviewing literature and analyzing our Summary of results: The learning outcomes were assessed experience, we developed seven questions to guide with an examination (38 items, max. score 77 points). The teachers creating instructional websites: results of the WebCT group were slightly better than in the WWW group (53.7 vs 49.7, one way t-test p = 0.03). Students’ 1 What will you teach? Perform a needs analysis. Specify learning experiences of Web-based learning were goals and objectives. Keep content focused and brief. measured after the course. No significant differences were Respect copyright laws. found between groups (67.3 vs 64.7, p = n.s.). 2 How will you exploit the Web’s unique capabilities? Do not simply copy text onto a webpage – shape content Conclusions: These preliminary results indicate that web- into an effective presentation. Use appropriate based learning may be more effective when students are multimedia (graphics, animation, audio, video), provided with special learning tools. hyperlinks, and online communication. 3 How will you encourage active learning? Promote critical thinking (reflection, self-assessment, and 8O 3 Quality management in e-learning: the use of application), independent learning (research and standards in medicMED at the University of Witten/ synthesis), and evidence-based learning. Support Herdecke learner interaction. Provide feedback. B Strahwald (University of Witten, Project medicMED, Alfred- 4 What are your technical needs? Web editors can help Herrhausen-Strabe 50, D-58448 Witten, GERMANY) create the site. Determine network requirements, Background: medicMED is a research project at the private available learning resources, and cost. University of Witten/Herdecke, sponsored by the German 5 How will you encourage use? Motivate and remind. Ministry for Education. The aim of the project is to develop 6 What will you evaluate? Address course objectives. and implement an internet-based learning system for Assess knowledge, skills, and attitudes. Evaluate the medical students. course itself. Summary of work: From the beginning we focused on 7 How will you maintain the course? Ensure technical strategies for a probable lastingness of the product. problems are resolved. Keep hyperlinks active and Therefore we have developed a quality management content updated. system. We have defined, described and documented each step of the process. The processes and products and the Conclusion: By integrating active learning with creative Web correlations between them have been gathered design, educators can craft effective online learning. simultaneously. We were looking for existing technical and educational standards, guidelines and best-practise- examples. But particularly within the educational range 8O 2 Comparison of learning outcomes with a WebCT substantial pent-up demand is existing. We developed an course and a conventional web-site learning own catalog of standards. Our cooperation in the national material working group “Quality in E-Learning” of the DIN had large influence on this process. We oriented as well on Kalle Romanov* and Anne Nevgi (University of Helsinki, Research international efforts towards standardisation. We report on and Development Unit for Medical Education, PO Box 63, FIN our quality mangement system with its detailled steps. 00014 Helsinki, FINLAND) Examples of the educational and procedural standards Aim: The purpose of this study was compare whether the and guidelines will be shown. learning outcomes would be better reached on a course Conclusions: The potential of e-learning can only be used of medical informatics in a designed learning environment if a comprehensive quality management system is (WebCT) than with the similar course material provided in concerned. The use of standards is obligatory. We report the conventional web-site (WWW) without special learning on the solutions found by our project. tools.

– 4.119 – Section 4

8O 4 Evaluating a web-based video program for Summary of work: This is a cross-sectional survey in three undergraduate clinical skills instruction colleges (medicine, nursing and health) in 2003. The population sample of the study was all of the faculty S Aaron*, M Brisbourne, S Varnhagen and D Begg (Department of members. Rheumatology, 562 Heritage Medical Research Centre, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Summary of results: Our findings showed that 58% were Alberta T6G 2S2, CANADA) satisfied with the information they found and 70% used the infomation. Background: A concern for our students is the quality and uniformity of physical exam teaching. Videotape and DVD Conclusions: Results of this study show that University teaching aids were difficult to use, did not demonstrate the managers must develop both software and hardware sequence of an entire exam, and were difficult to access. devices for internet accessibility, curriculum planning, change and a distance learning network for faculties and Summary of work: An interactive, video-based web site for students. learning physical examination was created. We combined navigational elements and a core sequence demonstrating a screening exam of all systems with detailed sequences 8O 7 Patient rights in e-learning environments: a model on each region obtained from a commercial source. for informed consent in medicMED at the University Evaluation of content and delivery was done using a variety of methods. A structured User Observation Protocol was of Witten/Herdecke included to assess ease of access, navigation between K Kempe*, B Strahwald and M Hofmann (University of Witten/ sequences and the flexibility of the web site to suit learners’ Herdecke, Project medicMED, Alfred-Herrhausen-Strasse 50, D- needs. Focus groups gauged relevance of the material to 58448 Witten, GERMANY) students’ learning objectives and the curriculum, and issues of technology and style. Clinical instructors and medicMED (Multimedia Education – Internet Campus: experts in the area of website design and medical education Medicine) is a research project at the private University of were interviewed. Finally, a questionnaire was sent to the Witten/Herdecke, sponsored by the German Ministry for entire class with specific questions about frequency of use, Education. The main focus of medicMED lies in the relevance to learning, and usefulness. development and implementation of an internet-based learning and training system for students in medicine. Conclusion: The evaluation has allowed us to make Within this system students will be supported by PBL-cases improvements to the existing site that may be used as a that are enriched by multimedia-elements, especially model for future development and evaluation of other novel authentic medical results. Soon we faced the problem that teaching tools. there are no existing standards for the use of patient-results in new media. A huge number of juridical, ethical and medico-legal questions are not yet answered. Which laws 8O 5 Integration of e-learning in the curriculum: concept, have to be taken into consideration, when results are shown realisation and evaluation of medicMED at the on the internet, even in an educational context? What are University of Witten/Herdecke the patient rights? Do we have to ask the patients in each and every case? We report on the development of a B Strahwald, K Kempe, M Hofmann* (University of Witten, Project standard for dealing with patient results. A special medicMED, Alfred-Herrhausen-Strasse 50, D-58448 Witten, information-form for patients will be introduced. GERMANY) Background: medicMED (Multimedia Education - Internet Campus: Medicine) is a research project at the private 8O 8 WASP – a generic web-based interactive patient University of Witten/Herdecke, sponsored by the German simulation system Ministry for Education. Nabil Zary* and Uno G H Fors (LIME, Karolinska Institutet, Summary of work: The aim of the project is to develop and Berzeliusgarden 1, 171 77 Stockholm, SWEDEN) implement an internet-based learning system for medical Background: Computer based patient case simulation students. We report on the integration of e-Learning in the systems have during the recent years been introduced in reformed curriculum. During the planning of the project medical education to allow students to “meet” more cases we analyzed the situation at our university. We focused on that are educationally optimized and adapted to the actual those topics, where we could see an additional value by learning situation. However, three major problems exist implementing e-learning-content. The development of with most computer based case simulation systems today: computer-based OSCEs and MEQs has been an important they are expensive to develop, experienced multimedia step. The next step is the integration of e-PBL-cases in the developers are needed for the development and teachers/ usual working groups. Three different types of cases are clinicians cannot develop and adjust cases to fit their own offered: extended, medium and compact cases. We will specific educational needs ask the students and the tutors about the acceptance and the judgements, correlated among other things to gender Summary of work: The WASP project (Web-Activated and computer-know-how. We report on those results as Simulation of Patients) tries to solve these three problems, well as on the results of the eOSCEs. and still allow very realistic and highly-interactive simulations of clinical cases, delivered and edited via the Web. WASP is based on experience from a number of 8O 6 A survey of internet using status in academic national and international visualization and simulation members of Oromiyeh University of Medical Sciences projects. Most important case simulation features are available, including: interactive history taking, complete B Rahimi*, A Rashidi and N Zarghami (Educational Development physical examination (inspection, auscultation, palpation, Center, Oormiyeh University of Medical Sciences, Djahad Street, percussion, vitals, neurological exams etc.), complete lab Oormiyeh, IRAN) section including chemical labs, X-ray, MRI, ultrasound, Aim: Colleges are challenged to provide students with CT, phys lab, pharmacology lab, pathology lab etc.), diverse teaching-learning experiences. Educators who diagnosis and differentials, therapy, interactive session introduce new teaching-learning experiences must feedback and integrated references and online database evaluate the outcomes of these experiences. The Internet sources. We will demonstrate cases in medicine/ offers consumers unparalleled opportunities to acquire odontology and officially make WASP available to teachers health information. Internet use by faculty members started in Europe. More info: http://patientcases.org in 1998 in Oromiyeh University of Medical Sciences.This study examines Oromiyeh University of Medical Sciences faculty members’ use of the internet in the teaching process.

– 4.120 – Section 4 8O 9 Faculty members’ computer and internet technology Part of a pilot training project for a new professional role skill (the Perioperative Specialist Practitioner or PSP) is described. PSPs are being developed in response to Hassan Gholami*, Mahmoud Dezhhkam and Nasser Valaee imminent changes in UK junior doctors’ working hours. (Mashhad University of Medical Sciences, Education Development Centre, Ghoreishi Blvd, Daneshgah St, Mashhad, IRAN) Twelve PSPs (with backgrounds in nursing and allied health professions) are taking a one year full-time training Background: Due to the importance of computers and the programme, consisting of ten intensive one-week modules internet, faculty members should know how to use the at Imperial (using simulator-based training), interspersed technology for better education. This study was designed with blocks of supervised clinical experience at each for determination of faculty members‘skills about participant’s home site. An integrated electronic portfolio computers and the internet at Mashhad University of builds up a cumulative picture of each PSP’s development, Medical Sciences (MUMS) in 2002. with a focus on acquiring and learning from experience. Summary of work: A descriptive study was carried out on The portfolio emphasises logging and reflection. Handheld 100 faculty selected by random sampling. A questionnaire computers allow immediate recording of data. Clinical was designed in two parts, one about personal activity is logged using customised software, while reflective characteristics of members and the other to assess the written assignments are entered using a foldable keyboard. faculty members’ technology skills. The second part of the Data will be regularly uploaded to a central server and questionnaire contained variables such as: use of should be integrated into a virtual learning environment. technology, specific computer skills, acquisition of Training commenced in April 2003. This presentation technical knowledge, basic internet knowledge, internet outlines the background to the project, explains our information skills, adapting to technological change, effect underpinning assumptions about learning and assessment, of technology and Ethics in technology. Questionnaire describes hardware and software development, presents scales were low, median and high. The content validity preliminary findings and discusses key issues relating to and test retest reliability were also tested. mobile learning in this context. Summary of results: Participants in the study were 28% female, 8% professors, 18% associate professors, 52% 8O 12 Teaching ALS in remote and rural areas: a case for assistant professors, 21% lecturers and 1% instructors. teleconferencing 40% of faculty members had low and the rest median skills of computer and internet use. 20% had high, 70% median J Mardon*, L Hislop, S Wilkie and M Boyd (80 Kircaldy Road, and 10% low skill level of acquisition of technology Pollockshields, Glasgow, UK) knowledge. Aim: To show feasibility of providing equality of resuscitation Conclusion: Faculty members’ skill level for using computer training to rural and remote areas of the West of Scotland and internet technology is low. Considering the importance using video conferencing. of using computers in education, a study is recommended Summary of work: Advanced Life Support (ALS) Courses to determine the main factor causing this situation. have been shown to be a successful way of training multidisciplinary health care professionals in the provision 8O 10 Blended learning in a Health Informatics Course of resuscitation skills. This study examines the usefulness of bringing ALS course and skills to the remote and rural Jens Dørup (Section for Health Informatics, Department of practitioner via telemedicine. Biostatistics, University of Aarhus, Vennelyst Boulevard 6, 8000 Aarhus C, DENMARK) Summary of results: We showed feasibility of providing lectures to far sites with 100% acceptability of Summary of work: The present project describes a web videoconferencing to the trainees during an ALS course. site for a course in Health Informatics in the 3rd year of We also showed good inter-instructor concordance in medical studies. Health Informatics, as a small topic, was assessment of resuscitation skills between near and far offered only 3-4 days in the curriculum. The portal, including sites. We were able to show acceptable demonstration of a number of interactive facilities, was used in parallel with practical skills such as defibrillation, basic life support and more conventional university teaching methods like lectures basic airway management via the teleconferencing link. and small group tutorials. It was built using open source, This was initially problematic because of lack of adequate free software tools: PHP, MySQL, Apache, and Linux. visualization but was able to be overcome with careful planning of positions of the camera. Summary of results/conclusions: 1 Web based and traditional teaching and learning Conclusions: Videoconferencing is an exciting, acceptable activities in a traditional under-graduate university setting, and feasible way of bringing resuscitation training to can work in synergy, and should not be considered as practitioners in less accessible areas. competing alternatives; 2 Among students from a field like medicine, not related to IT, there is a considerable diversity with respect to IT 8O 13 Implementation of a teaching programme in skills, which needs to be taken into consideration when accident and emergency medicine via organizing IT related courses; teleconferencing 3 We found it to be important for learning of IT skills that J Mardon* and L Hislop (80 Kircaldy Road, Pollockshields, newly acquired skills could be directly applied in the Glasgow, UK) context of other topics in the curriculum (in our case biostatistics and a project work in environmental Aim: To develop and evaluate an innovative teaching medicine); programme for junior doctors training in accident and emergency medicine using videoconferencing. 4 Students were generally positive in their evaluation of the course and the portal. Small group tutorials scored Summary of work: Centralising teaching of junior doctors highest in the evaluations. has many advantages; including standardisation of information taught and support of smaller units, allowing equality of teaching across all hospital sites. However this 8O 11 Using handheld computers for mobile experiential can require increased resources because of the time learning required travelling to sessions and the lack of flexibility should emergencies arise. This study describes the R Kneebone*, H Fry, C Sorensen, G Wiredu and J Younger (Imperial implementation and evaluation of a centralised College School of Science, Technology and Medicine, Department programme for junior doctors training in accident and of Surgical Oncology and Technology, Faculty of Medicine, 10th emergency medicine using videoconferencing Floor, QEQM Wing, St Mary’s Hospital, Praed Street, London W2 1NY, UK) – 4.121 – Section 4

Summary of results: One year of videoconferencing programmes were evaluated and shown to be acceptable teaching programme was shown to save 12,600 miles in and effective. travelling and 500 hours of travelling time, compared with a conventional face-to-face teaching programme. We also Conclusions: Videoconferencing can provide all the linked a further three hospitals that previously had no advantages of a centralised teaching programme for junior teaching programme for their junior doctors, and set up doctors training in accident and emergency medicine national sessions for specialist registrars. All teaching whilst eradicating all of the disadvantages.

Session 8P: Computer Assisted Learning

8P 1 Computer-Assisted Learning in undergraduate 8P 3 Students’ response to CBT modules in surgical Psychiatry (CAL-PSYCH): evaluation of a pilot education programme A Göhring*, A Mehrabi, J Zumbach, E Gazyakan, S Holler, N De Allys Guerandel*, Patrick Felle and Kevin Malone (St Vincent Cono, M Kadmon, J Schmidt, F Kallinowski and M W Büchler (CBT University Hospital, Department of Psychiatry, Elm Park, Dublin – Laboratory, Chirurgische Univ, Klinik Heidelberg, INF 110, 69120 4, IRELAND) Heidelberg, GERMANY) Aim: To introduce and evaluate a computer assisted Summary of work: Computer Based Training (CBT) learning programme in undergraduate psychiatry (CAL- modules for medical education were tested to determine PSYCH). the value of these additional tools in surgical education. Medical students (47 men and 30 women) were asked to Summary of work: An interactive e-learning environment write free essays describing their experience with these was created within the University College Dublin portal to mediums. They were also required to suggest assist students in acquiring the necessary skills in improvements in whatever area they considered important. undergraduate psychiatry.The pilot phase consisted of providing their lectures on-line on the interactive site. Data Summary of results: The multimedia presentation was were gathered from the last group of students in 2001 (pre- rated very high. 99% mentioned it to be effective. 92% stated CAL-PSYCH) and the first group of students using CAL- they would use CBT modules as a studying tool and 83% PSYCH in 2002. We included assessment of percentage found them to be a valuable addition to standard lectures of students accessing the site, attendance rates at face-to- because of their video clips, animations and pictures. The face lectures and tutorials, and also a feedback questionaire students also stressed that the information presented from students who accessed the site. needed to be structured in different levels of difficulty to assure that students could fully profit from the knowledge Summary of results: All responders had used CAL-PSYCH. presented. The major points of criticism concerned Students gave higher ratings for quality and interactivity of themselves with the quality of the presentation. The lectures compared with the pre- CAL-PSYCH curriculum. multimedia components needed to be of high quality to Students also expressed enthusiasm about CAL-PSYCH avoid distraction of the student from an educational tool and encouraged us to develop the CAL-PSYCH programme that was otherwise described as a relaxing and interesting further. new way of studying. They signalled that they needed to be Conclusions: Computer-assisted learning environments able to select a level of difficulty in order not to be such as CAL-PSYCH provide the opportunity to bring overwhelmed by all facts presented. In conclusion the modern e-learning techniques to medical education, and response to CBT modules in surgical education was very may provide a new model for life-long learning in medicine. positive. The multimedia effect was something that was considered valuable by the majority of the students. They also signalled their intention to further experiment with the 8P 2 Evaluation of an interactive multimedia training medium, which will be an important step in making it a module in surgery standard part of medical education. A Mehrabi*, A Göhring, D Leisenberg, J Zumbach, E Gazyakan, S Holler, N De Cono, M Kadmon, J Schmidt, F Kallinowski and M W 8P 4 The Virtual Practicum – a model for comprehensive Büchler (CBT- Laboratory, Chirurgische Univ, Klinik Heidelberg, INF 110 , 69120 Heidelberg, GERMANY) technology based education Joe Henderson* and Christof Daetwyler (Interactive Media Lab, Summary of work: A Computer Based Training (CBT) Dartmouth College, Colburn Hill, One Medical Center Drive, module for students was developed using Macromedia Hanover NH 03756, USA) Director. It was implemented and evaluated with the help of a group of 121 medical students in our surgical course. In this presentation we will discuss the application of The results were evaluated using sub-points such as technology to promote more comprehensive clinical design, motivational aspects and effectiveness for education in the biopsychosocial aspects of primary care. knowledge acquisition. The students were randomized in ‘Comprehensive’ refers to the inclusion, in addition to two groups. They studies specific topics with either the scientific and technical knowledge, of knowledge that is teaching module (CBT: n=71) or in a regular class (n=50). less easily characterized, quantified, and taught: empathy, The following week, a test consisting of multiple choice intuition, the demonstration of artistry. Clinical education questions were conducted. After an additional bedside will be increasingly facilitated by the proliferation of teaching session for both groups, all students were given computers capable of displaying combinations of text, oral exams by a professor in which clinical thinking as well graphics, video, and sound; broadband networks capable as the ability for surgical decision-making were assessed. of delivering these multiple media to the home or office; and new methods for using these technologies for Summary of results: The multiple choice test showed education and training. However, current models for statistically significant differences in favour of the CBT technology-based learning are limiting, lagging behind the program (p<0.001) (CBT: Median=5 points of 10 vs. rapid technological evolution driving our entry into the Course: Median=3.2 points). The CBT-group also showed Information Age. Some recent educational model (Schön’s a 25% better result as compared to the control group reflection-in-action and reflective practicums, Boisot’s E- concerning the factors evaluated by the professor. space, Kolb’s learning cycle and Vygotsky’s scaffolding) Conclusions: The study indicated that CBT-modules provide for a more comprehensive and complete view of showed a significant increase in the acquisition of surgical health professional education. This presentation describes knowledge and an improvement in clinical thinking.

– 4.122 – Section 4 these models in depth and proposes a new model for 8P 7 Interactive CPN: evaluation phase: a didactic technology-based clinical training, the “Virtual Practicum,” computer program based on them. The Virtual Practicum is illustrated with interactive CD-ROM programs, dealing with “Primary Care Evelyn Palominos and Beatriz Saavedra* (School of Nursing, of Patients with HIV/AIDS”, “Genetics in Clinical Practice” Faculty of Medicine, Independencia 1027, CHILE) and “Smoking Cessation in Pregnant Women”. Background: Recent years have seen the increased use of computers in education, particularly in the health sciences. Training methods have been created to give up-to-date, 8P 5 Virtual interviews and simulation-based learning complete and didactic information. Olivier Courteille*, Uno Fors, Rolf Bergin and Kirsti Lonka Aim: To create a computer program, thus contributing to (Karolinska Institutet/LIME, Berzeliusgarden 1, 171 77 Stockholm, the training of second year Nursing students. To this end, a SWEDEN) course on Care Processes in Nursing (CPN) was The process of developing effective interactive simulations administered, in which the students themselves had to engaging students in active learning is highly related on follow the correct steps to develop appropriate learning cognitive styles and students’ learning. Computer Mediated through the computer. Communication leverages natural aspects of human social Summary of work: The content was based on class material communication and affects particularly the learner’s and complementary references to a PowerPoint (ppt) emotional state. But can this conversational interfaces Microsoft Office 2000 program, which through the use of stimulate and develop empathy specially in the case of hyperattachments, permitted interaction with determined clinical problem solving where the patient encounter is thematic sections of the program. simulated? The degree of simulation realism is reflected in the level of student involvement and motivation. The level Summary of results: A computational program called “ of interaction is a significant factor, but we also need to Interactive CPN” was created based on an Authorware take into account physiological factors like perception. system, for 2nd year students following Nursing at different Autonomous actors can create engaging and motivational Chilean Universities. The evaluation of this program was learning experiences by reacting to the student’s performed in a small sample, having had good acceptance environment and taking decisions based on perception and expectations among evaluators.This is consistent with systems, memory and reasoning. They could dramatically the importance which nowadays has relied on enhance collaborative experiment and simulation-based computational methods for the teaching-learning learning. The cutting edge research into the components approach in disseminating information, its main purpose of Human Computer Technologies will certainly allow us being the integration and understanding of the educational to assess the emotional impact of new multimedia and contents. multimodal educational systems in terms of both memory retention and learning outcomes. However, we need to have in mind individual preconditions and variety of learning 8P 8 Dynamic Patient Simulations® for residents in styles. Are we facing and exploring a new computer-based dermatology paradigm and not just a mechanization of the existing S Eggermont*, W Bergman and P M Bloemendaal (Leiden University paper-based paradigm? Medical Center, Heelkunde Onderwijs K6-R, Postbus 9600, 2300 RC Leiden, NETHERLANDS) 8P 6 E-learning in medicine: www.meducase.de At the Leiden University Medical Center dermatology is no Peter Langkafel, Stefan Höhne and Ralf R Schumann (Charité, Dept longer taught in plenary, large group sessions. Residents at the dermatology department are now expected to have of Obstetrics, Faculty of Medicine, Humboldt-University of Berlin, gained most of their basic knowledge from guided self- Augustenburger Platz 1, 10117 Berlin, GERMANY) study. For this purpose Internet assignments are already in Background: Meducase is an e-learning project of the use, teaching students the basics of dermatology. Charité Medical School of the Humboldt University Berlin, Residents gain most of their clinical experience from Germany, sponsored by a large grant of the German supervised real patient contact and during small group Secretary for Research and Education (“BMBF”). The sessions with experts. Because the expert’s time is rare project combines problem-oriented learning strategies and and costly, additional computer based training will be web technology in order to improve education of medical developed this year in the form of eight Dynamic Patient students. Simulationsâ to expand the clinical experience. During a simulation students are solely responsible for the diagnosis Summary of work: The implementation of clinical cases, and treatment of a dermatological patient. Students can multimedia-enhanced content, as well as simulation- perform history taking, physical examination and additional modules within the Meducase interface provides for a case- research to diagnose each case. The case does not based multimedia didactic approach in both, plenary automatically end after the prescription of therapy, but lectures and small team seminars focusing on practical students can make follow-up appointments to check skills, as well as in self-learning environments. The whether the therapy is sufficiently working. Each simulation Meducase concept is based on digitalized clinical cases concludes with a personalized review of the effectiveness and induces a high level of motivation in the students to and efficiency of the student’s performance. Students can acquire information in order to treat the virtual patient get acquainted with the course of illnesses that stretch correctly. To this end the student also has to use the over years and with common illnesses they should know computer to acquire information from related fields and about, but might not encounter on the outpatient clinic. theoretical backgrounds, which will lead to a crossing of discipline boundaries. Meducase includes both the presentation of cases as well as a systematic presentation 8P 9 Flexible multi-level knowledge integration in of content and enables the user to switch back and forth without preformed limitations. Didactically, Meducase computer-based medical teaching cases makes optimal use of interactivity, allows for individual R Singer*, I Martsfeld, J Heid, S Köpf, S Huwendiek, B Tönshoff and learning pace and thus guarantees for a maximum of F J Leven (Hygiene Institut, Labor “Computergestutzte” Lehr/ efficiency in learning the complex content of the world of Lernsysteme in der Medizin, Im Neuenheimer Feld 324, 69115 medicine. Employing New Media here allows for a Heidelberg, GERMANY) realization of most recent didactic strategies involving problem-oriented learning visualization by context-near Knowledge integration in computer-based medical environments. teaching cases is one key aspect in case-based training systems. By linking virtual cases to systematic knowledge sources, the semantic gap between systematic and case- oriented learning is getting smaller. Students working on

– 4.123 – Section 4

virtual cases have to perform all the actions a physician were raised on average by 20 percent. Ab initio students has to do in the real world: take medical history, do cope with initial IT requirements of word-processed examinations (clinical, technical, lab), pose diagnoses and assignments, and IT training during the semester. order treatment. Systematic knowledge sources can be accessed on demand by learners in order to get at least Conclusion/take-home messages: Relevant IT skills are enough background information to work through the case. crucial for Health Sciences students. Skills are taught to The proposed knowledge integration model consists of address gaps in knowledge. In this study, gaps are not three knowledge levels: Short expert commentaries that assumed, but rather identified and addressed early. This contain hints or interpretations of specific case-situations affords all students, especially those who have had no (first level knowledge), relevant external literature and previous computer experience, the opportunity to best articles that can be referenced (second level knowledge) utilise IT in their studies on their path to becoming Health and keyword-based database searches in order to access Professionals. further information (third level knowledge). Additionally the following aspects are considered: knowledge source type (textbook, dictionary, database, journals), technical 8P 12 Prize for implementing the new technologies in the implementation (static documents, database), license type teaching of the health sciences at the Rovira I Virgili (self created, public domain, commercial), publication University – from lectures to active learning medium (Internet, CD-ROM). The model has been A Castro, R Descarrega R, M R Fenoll-Brunet*, M Giralt, R Miralles implemented in the case-based training system CAMPUS R, M R Nogués, V Piera, T Sempere, R Solà and F Vidal (Universitat (http://www.medicase.de). 38 computer-based teaching Rovira I Virgili, Facultat de Medicina I Ciencies de la Salut, Carrer cases have been tightly integrated with systematic knowledge in a joint project with the Springer-Verlag Sant Llorenc 21, E. 43201 Reus (Tarragona), SPAIN) Heidelberg. The Faculty of Medicine and Health Sciences has been awarded the prize for Experiences in Improvement of the 2nd Plan for University Quality for its active teaching- 8P 10 3D pelvic floor: a tool for understanding learning methodologies, as part of the project by the topographical anatomy Ministry for Education, Culture and Sport to evaluate the quality of university teaching. This project describes various David Örtoft*, Hanna Reuterborg, Björn Meister and Staffan experiences in educational methodology in our Faculty, Cullheim (Institution for Learning Informatics, Management and where there has been a change from passive university Ethics, Medicinsk Visualisering, Karolinska Instituet, lectures to active teaching that uses both, new teaching Berzeliusgården 1,171 77 Stockholm, SWEDEN) methods and technologies. The aim is clear: to help Obtaining a spatial understanding of the muscular students to be autonomous and thus develop their ability to composition of the pelvic floor and its relation to vessels reflect, to encourage their critical capacity so that they can and nerves belong to one of the hardest challenges for a take responsible decisions, to promote attitudes such as student of anatomy. The focus of the project “3D PELVIC inquiry, communication and teamwork, and to improve their FLOOR” is to facilitate the basic three-dimensional competence in basic clinical techniques. The new understanding of a clinically important, but spatially teaching methods use digital images, clinical cases, complex area in topographic anatomy. The user initially problem solving and practical clinical sessions with meets a 3D-model of the bony pelvis that can be rotated standardized, simulated patients. The new methods have freely around any axis. Step by step, crucial ligaments and been trialled simultaneously in different knowledge areas: muscles can be added and removed by the user. Included Anatomy, Pharmacology, Medicine, Traumatology, are also the routes of the pudendal and sciatic nerves. Psychiatry and Histology. The Faculty would like to present The project is a cooperation between two fourth-year this project at the Conference of the Association for Medical medical students and two professors. 3D PELVIC FLOOR Education in Europe and contrast experiences with was immediately incorporated into lectures for medical colleagues who are also working in European medical students and was well received. In fact, 100% of the 105 education. students who reported having seen it, replied that it had facilitated their understanding of the topographical anatomy in the area. To further improve the implementation and 8P 13 Symposiaware for improving information development of the project, feedback from a cross- dissemination in visceral surgery professional reference group of teachers and students has M R Ahmadi*, A Mehrabi, K Gawad, A Göhring, J Schmidt, F been collected. 3D PELVIC FLOOR is demonstrated in Kallinowski and M W Büchler (CBT Laboratory, Chirurgische this session. Universitätsklinik Heidelberg, INF 110, 69120 Heidelberg, GERMANY) 8P 11 The computer literacy profile of incoming 1st year Background: The use of computers and growing health sciences students at the University of Cape importance of the internet have supported the spread of Town, and the effect of pre-course IT intervention surgical knowledge by electronic media. Now congresses are available on CDs. Does this new way of presentation Gudrun Oberprieler*, Ken Masters and Trevor Witt (University of have real value in surgical education? Cape Town, Academic Development Programme (ADP), Centre for Higher Education Development, Private Bag, ZA-7701 Summary of work: Physicians in surgery and internal Rondebosch, Cape Town, SOUTH AFRICA) medicine working in 2 university hospitals evaluated 2 symposia (implemented on CDs as a slideshow with Aim: To report on methods of the identification of the original audio) with surgical and gastroenterological computer literacy profile and effectiveness of basic contents using standardized questionnaires. Questions computer skills training interventions of incoming 1st year concerned personal background, education status and students in the context of an integrated IT/IL module in the experience with PC, e-mail, internet or CD-ROM. new Health Sciences curriculum at the University of Cape Questions on the latter were concerned with content, Town. relevance for clinical work and the improvement of Summary of work: Students complete pre-registration education using grades (1 = best, 6 = worst). questionnaires, and take an on-line skills assessment Summary of results: 37 colleagues could be evaluated about during Orientation. Students with very low basic IT skills the applications. 27 were working in a surgical and 10 in a receive intensive training. The effectiveness of this medical department. Prior PC knowledge was rated with intervention is evaluated through a practical assignment, 3. 60% used PCs in the hospital and at home, the remaining and a repeat of the on-line skills assessment. 40% either in the hospital or at home. All participants used Summary of results: The evaluation has shown that skills the internet. 57% had experience with symposiaware levels of students in the Orientation intervention programme before. The rating of the symposiaware itself was positive

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(1.8). Relevance and possible use of a slide-show for They also agreed that the assessment tools used in the conveying knowledge were rated with 2. 81% stated they program and the feedback provided were meaningful and would buy the module, 89% said they would spend up to helpful to their learning. No differences were found when 50 Euros. Quality, content and user friendliness were rated responses were compared on the basis of academic with 1.7. background, gender, citizenship, or first language of participants. Students agreed that the PBL cases kept them Conclusions/take home messages: Physicians frequently engaged, were useful to their learning and matched with use PC and the internet. This leads to a high acceptance the overall philosophy of the program. No differences were of electronic learning modules in medical education. A found on the basis of citizenship or first language. uniform structure of contents as well as an independent, Compared to graduate-entry students, school leavers web-based presentation is appreciated. To enhance showed a more positive attitude towards the PBL cases illustration, a picture- and video-oriented visualization and agreed that the cases kept them engaged (p = 0.033). should be chosen. Overall “symposiaware” is rated Female students compared to males, agreed that the PBL positively. It should cost no more than 50 Euros and could cases matched with the philosophy of the program (p = represent a valuable source of information for physicians. 0.012) and were useful to their learning (p = 0.048). Students’ scores in a post-test were significantly improved when compared with their scores in a pre-test (p =0.001). 8P 14 Stimulating interest in the tutorial – what is it worth? Conclusions: Undergraduate medical students found the P G Devitt*, E Palmer and N De Young (University of Adelaide, CAL program a useful formative assessment tool allowing Department of Surgery, Royal Adelaide Hospital, North Terrace, them to enhance their learning. Adelaide, South Australia 5000, AUSTRALIA) Background: Increased audience participation and interaction is thought to improve knowledge and 8P 16 PBL with a case-based e-learning program: understanding. Classes of mixed backgrounds and tutor experiences and developments indifference can make such participation difficult. Various Kai Sostmann* and Kai Schnabel (Medical Faculty of the Humboldt strategies have been used to improved tutor-student interaction. We report our experience with an electronic University, Reformstudiengang Medizin, Charité, Schumannstr voting system (EVS). 20/21, Berlin 10117, GERMANY) Summary of work: Fourth year surgical students participated Background: Multimedia applications or the so called “New in two tutorials on acute abdominal pain (AAP) and media” are introduced to Problem-Based-Learning as tools gastrointestinal haemorrhage (GIT). Students were to render clinical features of the traditional paper cases randomly allocated to have one or other tutorial more realistic. supplemented with EVS. Group A = AAP alone and GIT Research question: How can multimedia-enhanced PBL- plus EVS. Group B = GIT alone and AAP plus EVS. The cases be implemented into a PBL-curriculum? How is their students were pre and post-tested and asked to complete use perceived by the students? a questionnaire on the value of EVS. Summary of work: We measured the usability of the Summary of results: Eighty six students participated in the CAMPUS-Player within our regular PBL-sessions during study. Subjectively, the students reported increased the Pediatrics block (3rd year). enjoyment, participation and understanding with the EVS. Both groups of students improved their knowledge and Summary of results: Nearly ¾ of the students felt disturbed understanding of the two subjects, but there was no by the use of the computer. A majority sees the main difference between the EVS and non-EVS groups in terms advantage of the software in offering audio-visual aspects of what was learned and how well it was understood. of a case in contrast to the static papercases (videotapes, heartsounds). The strength of the CAMPUS-player lies in Conclusion: It is concluded that while electronic voting supporting students between the group sessions. Only when systems may appear to increase audience participation these easy to access media elements contribute to the and stimulate interest, there is no evidence that in the long student’s understanding of the patient’s clinical problems, term, such (costly) systems are of any aid to the the software is accepted as helpful. Other elements of a understanding of the content of a tutorial. clinical case do not create a surplus in the PBL-group setting, but should be offered for the preparation of the learning goals between the two PBL-sessions. As a 8P 15 Using a Computer-aided Learning program in an consequence the development of the PBL-adapted player- integrated Problem-based Learning medical course: version was initiated. role in formative assessment Samy A Azer (FEU, Faculty of Medicine, Dentistry and Health 8P 17 Residents as teachers: development of a new Sciences, Medical Building, Level 7, University of Melbourne, Parkville, Victoria 3013, AUSTRALIA) course using e-learning and face-to-face teaching Jesus Ibarra-Jiménez, Ismael Piedra-Noriega & Mariá de los Aim: (1) to assess students’ views on a CAL program Ángeles Jiménez-Martinez (address?) integrating basic and clinical sciences relating to the liver, bilirubin and bile salt metabolism. (2) To assess the Background: Residents have a two-fold responsibility: usefulness of including PBL cases that encompass the caring for patients, and teaching (patients, students, above mentioned cognitive skills in the CAL program and personnel, and public). However, they don’t usually receive their effects on students’ learning. formal training. Summary of work: 106 undergraduate first year medical Aim: To achieve seven teaching outcomes for first year students (79 school leavers and 27 graduate entrants) residents from several medical specialties, using E- participated in this study. Students were tested on the liver, learning, and face to face strategies. bilirubin and bile salt metabolism before and after using Summary of work: Course developed through literature the CAL program. After completing the CAL program, each search, expert consultation, residents and faculty need student filled out a 5-point scale questionnaire evaluating analysis, instructional design, and use of a technological the features of the program and usefulness to their learning. platform using BlackboardTM at ITESM in Mexico. Summary of results: Of the 270 students enrolled in the first Summary of results: Seventeen residents underwent E- year, 68 females and 38 males participated in this study. learning, and face to face activities, in order to achieve Participants agreed that the aims of the package were clear outcomes: 1) making short and long presentations, 2) from the start, the contents were logically organized, the bedside teaching, 3) teaching clinical judgment skills, 4) key concepts were easy to identify and the package was giving effective feedback on patient work-ups and follow- interactive and encouraged them to reflect on their learning.

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up notes, 5) teaching clinical procedures, 6) teaching Conclusion: Developing a course for residents as teachers during a journal club, and 7) modelling professional gives an opportunity to build on their future teaching role. behavior. We designed short lectures, independent study, Outcomes should be clearly specified, in order to design group activities, self- and peer-assessment using videos, good face to face activities, and make the best use of E- and expert consultation. E-learning served best for material learning. delivery, asynchronic work, and distance discussion.

Session 8Q: Learning Management Systems and Computer Based Assessment

8Q 1 Criteria list of a case-based computer-supported Summary of work: We compared a paper case in free text examination system in medicine answer format with a computerised version as an OSCE station at the end of an interdisciplinary PBL course in the C Goetz*, D Neumann and J Neuser (German Institute for Medical 4th year at the University of Munich. In addition to tutorials, and Pharmaceutical Examination, IMPP, Grosse Langgasse 8, D- lectures, skill training, and bedside teaching, 10 e-learning 55116 Mainz, GERMANY) cases were offered to the students for voluntary independent A list of criteria was developed to evaluate e-learning study. 42 students (5 tutorial groups) were randomly platforms for case based learning in medicine with regard selected to work on an e-learning case as one of the OSCE to their suitability as examination tools. The platforms stations at the end of the course; all other students used should be suited for the implementation of written the paper version of the case. examinations as demanded by the German regulations Summary of results: 56% of all students completed all 10 for the study of medicine (Approbation-sordnung für Aerzte). cases (126 out of 223) in preparation for the OSCE while Important aspects of these examinations are that all only 12% students completed none of the cases (27 examinees have to answer the same questions and that students). The students who completed all cases the sum of correctly answered questions is taken as the performed significantly better in the respective OSCE score. Relevant standards for software ergonomics, station. In addition, the marking of the e-OSCE results by psychometric aspects, and literature concerning computer the tutors saved time due to pre-processed student answers based testing were taken into consideration. The criterion and legibility advantages over the paper version. list has four parts: (1) objectivity; (2) ergonomics; (3) examination questions; (4) security. The criteria will be Conclusion: Computer-based cases can efficiently be used presented and mooted. for assessment in the context of an OSCE.

8Q 2 Students’ reflections on a web-based evaluation 8Q 4 Assessment with the case-based e-learning system system CASUS: acceptance and pilot validation Frank Sjöblom* and Vitikka Annu (University of Helsinki, Research V Kopp and M R Fischer* (University of Munich, Klinikum der and Development Unit for Medical Education, Faculty of Medicine, Universitat München, Medizinische Klinik Innenstadt, PO Box 63, Helsinki 00014, FINLAND) Ziemssenstr. 1, 80336 Munich, GERMANY) Since 1994, the Faculty has systematically collected Background: German medical faculties are confronted with feedback from students, especially since a hybrid-PBL new assessment needs: 34 obligatory marked exams are curricula was introduced in 1998. In 2001 a web-based required by the new legislation on medical education evaluation system was introduced. The web-based (“Ärztliche Approbationsordnung”). Our presentation evaluation system has been in full scale use since fall term demonstrates experiences with a case-based 2002. The web-based evaluation system was previously computerized assessment approach in internal medicine presented in Lisbon 2002 (Sjöblom & al, 2002). This paper at the University of Munich. describes further evaluation of the system, based on Summary of work: We characterized the test quality criteria student reflection. The purpose of this study is to evaluate of two different answer formats (MCQ and free text entry) in students’ reflections on the web-based evaluation system. two test cases with 24 items in 43 4th year students. This usability evaluation is essential at the present stage for the progress of system. Four topics have been Summary of results: The students’ performance (52 to 74% addressed in the study; usability of the evaluation system, correct answers) indicated an appropriate level of difficulty. its quality effects on education, student learning, and The MCQ (r=.84 and .64) and the free text answer format whether the students experienced that they could influence (r=.44 and .60) were correlated with federal MCQ results their own education. The evaluation questionnaire was as external reference. Internal consistency was .60 and implemented in the same web-environment as the regular .43, respectively. Parallel test reliability was .56 for both course feedback forms. The questionnaire consisted of formats. The level of student acceptance was high for local structured and open-ended questions. Approximately 500 electronic assessment whereas it was substantially lower students will have the possibility to evaluate the system. for federal exams. The evaluation will be given at the end of spring term 2003. Conclusion: This pilot study showed the feasibility and The data collection is in progress and results will be acceptance of electronic case-based assessment. Due to reported during the AMEE conference in 2003. the low number of students and test items, further studies are needed for a better validation of the instrument. An external reference for free text answers is needed. 8Q 3 Using e-learning cases for learning and assessment in an OSCE B Körner*, M R Fischer, M Holzer and S Schewe (Med Klinikum 8Q 5 Open source software technologies in medical Innenstadt der LMU, Ziemssenstr 1, 80336 Munich, GERMANY) education Background: Case-based learning systems can be used Stefan Höhne*, Peter Langkafel and Ralf R Schumann (Project for the assessment of problem solving abilities in the Meducase, Charité, Institut für Mikrobiologie & Hygiene, cognitive domain. Dorotheenstr. 96, 10117 Berlin, GERMANY)

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Aim: Long-term use should be a main feature of e-learning solving and knowledge management. Central to the applications. In the past the predominant number of curriculum is the Interactive Learning Modular Unit (ILMU). projects failed to achieve this goal. A main factor for this ILMU is case-based, driven by the e-med pathway concept may be the use of proprietary commercial software and the RLO (reusable learning object) Bank. The key products. In this presentation we will show how electronic features in the VMU model are the various applications learning works by employing a set of open source software (eg the iCSU, iLecture, the Image Bank and the online components and developments. assessment) and the chat function called the VMU Suite. These applications are fundamental to the creation of the Summary of work: Within the project Meducase we “VMU global campus”. The VMU platform with its developed several open source software products for e- application interphases will be the delivery system of the learning: an extensive medical authoring tool, a media IMU medical sciences curriculum extending the IMU database and administrative server tools representing basic campus globally. functions of a learn-management-system (LMS). The acquisition of the professional Content-Management- System (CMS) “Webman” and transferring it into open source by Meducase laid the groundwork for these 8Q 8 Virtual curriculum map and navigation in the elements. International Medical University ILMU Learning System Summary of results: Our experience with Meducase Anwar Kamal*, Gregory J S Tan and Kamal Salih (International confirms that open source software leads to both reduction Medical University, Sesama Centre, Plaza Komanwel, Bukit Jalil, of licensing costs and increased adaptability regarding 57000 Kuala Lumpur, MALAYSIA) development, maintenance, update, and collaborative use. Background: The growth in e-learning today is exponential. On the other hand open source software development It is now inevitable that future cohorts of students will be requires high initial development efforts, and an extended educated in a context where a large amount of time will be time to practical application. spent on on-line learning. The real challenge for e-learning Conclusions/take home message: Open source software is not in the use of technology to deliver the materials but in is a main factor securing sustained use of electronic using the technology to built on what we know about learning applications in academic medical education. It managing learners and how learners manage themselves. is affordable, flexible and allows for collaborative The latter often results in students getting “lost” in the sea application. of data and information. Summary of work: In developing the Interactive Learning Modular Unit (ILMU) for the Virtual Medical University 8Q 6 Discussion Board in Blackboard software platform Project, two approaches were used to allow the students as an additional support at tutorial session in PBL to navigate through the learning modules while keeping Demetrio Arcos*, Enrique F J Martínez, Graciela Medina, Ricardo track of their direction. The navigation indicator in the form Treviño and Jorge Valdez (Monterrey Tech School of Medicine, of a flow chart is designed to enable the students to identify Morones Prieto 3000 Pte. Col. Los Doctores, Monterrey N L their location as they move through the e-med pathways in Mexico 64710, MEXICO) the suite of ILMU modules. The ILMU system itself and its associated RLO bank constitute a graphic representation The differences in the expertise of the tutors in a tutorial of the IMU curriculum map. These navigation tools are session creates in the students a sense of confusion and features vital to the success of the ILMU learning module anxiety during the session, because of the personal that is being developed. teaching style and the different grades in the level of expertise (in the knowledge base and in the strategy). To diminish this anxiety on the students we used a blackboard 8Q9 The Interactive Learning Modular Unit: challenges to software platform. This software offers an adequate students’ learning learning environment to tutors and students; it includes a header frame with images and buttons customized by us Gregory J S Tan*, Anwar Kamal and Kamal Salih (International (only students and tutors of the specific course have access Medical University, Sesama Centre, Plaza Komanwel, Bukit Jalil, by web site). One of these buttons is called Discussion 57000 Kuala Lumpur, MALAYSIA) Board where the tutor opens a forum file for the student in Background: A key success factor in online learning is active order to write or put in a file report, or comment. At the interactive learning. This provides a challenge to the forum any of the tutors can answer any comment. This developers of online learning programs, congruent with encourages all students and tutors to be conscious about the paradigm shift from didactic teaching to constructivism. the objectives that have been discussed, the doubts that have emerged, and the conclusions obtained in any of the Summary of work: In the development of the online problem cases. This platform has supported tutorial interactive learning modular unit (ILMU) at the International sessions and has helped the students and the staff to Medical University (IMU) under its Virtual Medical University identify any problem that could be presented in the teaching Project, several approaches are taken to ensure a high and learning processes. level of interactivity and challenges. ILMU is driven by clinical problems and this presents the opportunity for problem-solving and knowledge management. The use 8Q 7 The Virtual Medical University (VMU) Project: of RLOs as “building blocks” for ILMU facilitates knowledge development of an e-learning platform at the management and linkages between different ILMU cases and learning applications. Animations and video streaming International Medical University, Malaysia are strategically located and learning issues are generated Kamal Salih*, Gregory J S Tan and Anwar Kamal (International through threaded questions as students progress through Medical University, Sesama Centre, Plaza Komanwel, Bukit Jalil, the e-med pathways. Continuing challenges to medical 57000 Kuala Lumpur, MALAYSIA) issues, data interpretation and opportunity for self- evaluation are provided. The key is in making ILMU “alive” Background: The concept of a virtual medical school has and this is critical to the success of ILMU, a problem based been a challenge to many educators and is now fast module for the Virtual Medical University of the IMU. approaching reality. In developing the Virtual Medical University (VMU) Project at the International Medical University in Malaysia, the curriculum philosophy and the pedagogy of medical education remain the driving force 8Q 10 Should Virtual Learning Environments be proactive for e-learning to complement IMU’s current medical communities? programme. Michael Begg (University of Edinburgh, College of Medicine and Summary of work: The approach to the VMU curriculum is Veterinary Medicine, Learning Technology Section, Hugh Robson in building an interactive learning environment for problem- Link Building, 15 George Square, Edinburgh EH8 9XD, UK)

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Using the University of Edinburgh’s undergraduate medical around open-source solutions, namely Plone, Zope, curriculum Virtual Learning Environment (VLE) for MBChB Python, MySQL, Apache, and Linux. This has allowed the students (EEMeC) as a working model, this short rapid development of high quality materials at low cost. communication compares the user/environment These are object-orientated in their approach, allowing relationship of EEMeC with LambdaMOO - a popular Multi- easy customisation and tailoring of documents and pages. User Object Oriented Domain (MOO). VLEs suggest a All editing can be done through-the-web, eliminating model for a community of practice in that they offer a unified problems of postage and duplicate versions. There is a environment in which learners, educators and other related hierarchy of access control, and strict workflow control. individuals can share virtual space, resources and Full Dublin Core metadata is supported. Currently, in information with each other. Although the VLE is suggestive addition to many searchable links, there are two study of community, it shows few of the elements of proactive guides which are being transferred to the site, both citizenship commonly associated with successful virtual previously available as printed documents. “Learning communities. Multiple Object-Oriented User Domains Paediatrics” was originally published in 1996 by the Centre (MOOs) are text based networked community applications for Medical Education in Dundee to assist new Paediatric that support communities of common interest, provoke a trainees during their orientation. “Service-based learning highly proactive citizenship, and generate a high quality of materials for Paediatrics” was originally published in 1996 immersion in participants despite being, for the most part, by the Open University. Both are currently being updated limited to textual representation. Drawing on research as part of the project, and specimen pages will be findings into immersion and its correlation to the quality of demonstrated. Future development will incorporate user “agency” afforded by a mediated environment, this feedback, customisation, and formative self-testing. The communication casts a light upon the emergent issue of address is http://www.paediatric-education.net whether encouraging proactive citizenship within a VLE may provoke a deeper quality of learning experience, or whether this aspect of successful online communities 8Q 13 Integration of IT in the study of medicine at the leads to a weakening of pedagogical primacy. University of Oslo Silje M Rosseland (The Faculty of Medicine, The University of Oslo, 8Q 11 Comprehensive electronic portfolio Det Medisinske Fakultet, Studieseksjonen/EDB-Avdelingen, PB.1018 Blindern, 0315 OSLO, NORWAY) I Treadwell (University of Pretoria, Skills Laboratory, Faculty of Health Sciences, PO Box 667, Pretoria 0001, SOUTH AFRICA) The Faculty of Medicine at UiO, owing to its diverse location, has opted for extensive use of IT, educationally Aim: To present a user requirement specification (URS) as well as administratively. Briefly, these are some of the for the development of an electronic portfolio for the Faculty areas in which IT is used: of Health Sciences. • Administratively – through email and web-based Summary of work: Since it would be costly to develop and information, electronic timetable etc. effect changes later on, all the stakeholders’ expectations • Educationally through Problem-based learning and of the portfolio were determined by means of practical skills acquisition (virtual class rooms, web and questionnaires. multimedia-based teaching). Summary of results: A user requirement specification (URS) • The faculty runs IT courses for 1st semester students to was compiled from the data indicating the following: upgrade their computer skills. 1 Who would be responsible for entering specific data: • Good computer facilities are available to all students. • Lecturer: Instructions/guidelines, outcomes, rubrics, • A new personal studies portal is currently being feedback, marks/symbols, practical assessments, established. logbooks; • Administrators: Personal data of student, academic There is within the faculty an executive responsible for records, progress test results; Student-IT. • Student: Evidence of learning (e.g. case studies and reflections), personal achievements, testimonials, peer group feedback. 8Q 14 The ACETS Project: putting ‘usable’ into the reusable learning object 2 Who would be privileged to specific information: • Lecturer: Students’ evidence of learning, status of R Ellaway*, D Dewhurst and D Leeder (The University of Edinburgh, assignments, assessments done during block/rotation, MVM Learning Technology Section, The Medical School, Hugh profiles of “Golden Threads” of the curriculum (e.g. Robson Link Building, George Square, Edinburgh, EH8 9XD, UK) professional attitudes, interpersonal skills), progress Aim: The abstraction of educational resources into discrete test results, logbooks; objects and their reuse in new settings offers great potential • Student: Learning outcomes, instructions, rubrics, benefit to both educators and educational institutions. The feedback, marks/symbols, profiles on “Golden concept of managing digital learning objects and delivering Threads”. them online has been a focus of educational interest for some time, but there is still a large gap between the A graphical illustration of the URS will be presented. potential of a learning object economy and the benefits it Take-home message: Management of learning by means may offer to teachers and learners. of an electronic portfolio needs meticulous planning. Summary of work: The ACETS project, funded under the Note: If you wish to collaborate please contact me at UK’s JISC X4L programme, is looking at bridging that gap [email protected] by creating case studies, best practice guidelines and workable solutions and applications of learning object reuse across a number of healthcare related areas. 8Q 12 A content-management framework application for Summary of results: The core outputs of ACETS are based postgraduate paediatric education around the ‘ACETS exemplar’, a context specific exposition C Melville*, R Melville and D Collins (City General, Academic Dept of one or more objects in use in real teaching and learning of Paediatrics, Stoke-on-Trent ST4 6QG, UK) situations. The exemplar consists of an informal reflective component describing how the object was selected, We have developed a content management framework for incorporated and evaluated in context and a formal Paediatric Education. The site presents information in a component describing the object in its context of use. searchable richly cross-referenced environment, allowing the rapid retrieval of relevant information. The site is based Conclusion: This paper focuses on the development and application of ACETS exemplars in medical education.

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8R 1 An on-line, interactive workshop for small-groups – 8R 3 General physician opinions of continuing medical key success factors education (CME) programs in Ahwaz, Iran Francine Borduas*, Christine Lamoureux and Michel Rouleau Abdolhossain Shakurnia* and Mohammad Smaeel Motlagh (Laval University, 2350 Boulevard Bastien, Suite 2, Québec G2B (Ahwaz University of Medical Sciences, Educational Development 1B5, CANADA) Center (EDC), Ahwaz, IRAN) Background: Online training is growing and medical Background: The continuing education law in Iran, aiming pedagogy is largely solicited. What makes a good on-line to provide a better health service, was established in 1990. CME program? The purpose of this poster is to share our After a decade, it is essential to examine the quality of experience in designing an accredited on-line CME already accomplished programs. Such an aim was program. investigated through this research to distinguish the strengths and weaknesses and eventually, to achieve Summary of work: CME experts and specialists developed quality improvement of CME programs. the contents of an interactive workshop and a specialized communications agency provided the logistical and Summary of work: This research was a descriptive study to technological support. Using the Internet, a CD-ROM or a evaluate Ahwaz GPs’ opinions of CME. The sample manual, the participants were able to participate in the population consisted of 15% of all Ahwaz GPs (N= 304), workshop with their colleagues in conference calls from randomly selected among all GPs participating in CME their homes or offices. The program reached 345 family programs. A questionnaire of 63 closed questions was used physicians all across Canada over a short 6-week period. to collect data. The validity and reliability of the questionnaire were investigated, 83%; were returned and Summary of results: The participants stated that the format the data were analysed by SPSS and chi–square test. made it possible to share clinical experience and integrate content efficiently. More than 90% agreed that the activity Summary of results: Statistical analyses showed that was relevant to their practice and would have an impact 71.08% appreciated the neccessity and benefits of CME on their practice and 96% of them said they would and that it was effective in changing their attitudes, participate again. knowledge and performance in professional matters. 73.4% pointed out that administrating and management of Conclusions: The use of new information and CME is relatively satisfactory. On the other hand, 61% communications technologies is making distance training believed that the content and 54.2%, the instructional accessible and is fostering best practice sharing between methods were of medium quality. To some extent, the CME family physicians and specialists. Expertise sharing and programs were considered to be irrelevant to the GPs’ solid logistical and technological support are key success professional needs. A significant difference was derived by factors for implementing this educational strategy. GPs’ age/ graduating year and their opinions about CME programmes, but there was no significant difference 8R 2 Using electronic resources to support CPD between male and female GPs’ opinions. Findings showed that CME programmes have achieved their relevant status. Andrew Sackville and David Brigden* (Mersey Deanery, University In particular, the majority of GPs considered the of Liverpool, Hamilton House, 24 Pall Mall, Liverpool L3 6AL, UK) programmes useful and necessary for professional The aim of this presentation is to review the different forms perfomance. This was more emphasized by recently of electronic resources which are used on two online graduated GPs, suggesting that the quality of the CME programmes which focus on developing and supporting programms should be maintained by employing more clinical practitioners in their teaching roles. These are the qualified instructors with effective teaching methodology MA in Clinical Education and the Postgraduate Certificate and also the content of the CME programmes should be in Teaching and Learning in Clinical Practice. Both applicable enough to be utilized in medical events. programmes are delivered by Edge Hill College and the Mersey Deanery for Postgraduate Medical and Dental Education. The presentation will outline: 8R 4 Gender and CME: female specialists’ perceptions of • The range of electronic resources available: these CME practices include e-books; e-journals; search engines and Jane Tipping* and Jill Donahue (10987 Warden Avenue, Markham, websites; Ontario L6C 1M9, CANADA) • The provision of access to these resources, using a VLE; Background: The numbers of women entering medical schools and the specialties is steadily increasing in • The process of incorporating these into both online Canada. CME has tended to be designed on the premise programmes; that there are no gender differences in learning. Previous • The role of the information specialist in working research with family physicians has revealed significant alongside the academic tutors; differences in the ways in which women approach and • Induction and support for students provided at the start experience CME. and throughout the programmes; Summary of work: This recently completed research asks • The patterns of use by students; the same questions of female specialists in order to • The evaluation of the electronic resources by students determine whether similar perceptions exist amongst and staff. specialists. The research asks the following questions: 1 What are the similarities and differences in the ways in The presentation concludes by stressing the need for which female family physicians and specialists perceive information specialists to be involved in all aspects of CME? planning the CPD programme, and ensuring that electronic resources are planned as an integral part of the 2 Do female specialists have specific learning programme, rather than as an add-on. preferences that need to be addressed by CME providers? 3 If so, how can they be addressed?

– 4.129 – Section 4

Conclusions/take home messages: The growing management improve organizational learning and population of female physicians can no longer be ignored. performance. This suggests that COP could provide The challenges many women appear to experience in solutions to barriers to learning encountered in traditional pursuing CME need to be addressed by the profession in CME. However, only research will determine if COP in care order to facilitate greater learning opportunities. delivery units will have a similar effect as it does in industry, namely to facilitate collaborative learning and practice improvement. 8R 5 An evaluation of the use of a workbook: ‘A framework for professional development in primary care (the Wessex way)’ in planning CPD 8R 7 Self evaluation in continuing medical education (CME): a rheumatological perspective Anthony Curtis*, Robin While, John Pitts, Rosemary Ramsay, Margareth Attwood and Vicky Wood (Primary and Community Christine Beyeler*, Reinhard Westkämper and André Aeschlimann Care, Wiltshire Shared Services NHS Consortium, Southgate (University of Bern, Department of Rheumatology, Inselspital, CH- House, Pans Lane, Devizes, Wilts SN10 5EQ, UK) 3010 Bern, SWITZERLAND) Background: The Chief Medical Officer’s report, ‘A Review Aims: To test the feasibility and to analyse the reliability of of Continuing Professional Development (CPD) in General multiple choice question tests (MCQTs) during CME Practice’ (1998) advocated the introduction of Practice meetings; to assess the appreciation of Swiss Professional Development Plans (PPDPs) and Personal rheumatologists to participate in self evaluations with Development Plans (PDPs) for all doctors working in feedback. primary care eventually to replace PGEA. Summary of work: Anonymous MCQTs identical with the Aim: The aim of this study was to examine the acceptance written part of the certifying examinations have been and value of ‘Professional Development: A Guide for conducted during national scientific meetings. A General Practice’ in Primary Care. questionnaire about attitudes was answered by 94.9% of participants of a general meeting. Summary of work: A qualitative approach was adopted using a maximum variation sampling strategy. Twelve practices Summary of results: Our experience confirms the feasibility across Bath and Wiltshire were purposefully selected and and high acceptance of MCQTs in the CME setting. 20 primary and community health-care practitioners, Reliability was good (mean Cronbach-alpha 0.83 over the including GPs, practice managers, health visitors and lead last 8 years [range 0.79-0.85]). 60.9% of the participants of education nurses took part in semi-structured interviews. A the survey found it useful, economic and efficient to assess focus group of seven health care professionals was also rheumatological knowledge by MCQTs and to offer the conducted to validate and extend the interview findings. option of self evaluation in comparison to peers. 71.3% found it valuable and motivating to receive feedback and Summary of results: Positive value was attributed to the 47.2% would appreciate an additional personalised workbook for planning CPD, although protected time for feedback. 70.8% expressed the request to continue effective delivery and implementation was considered to MCQTs every two years. be a necessary requirement for success. In addition, the role of facilitation was valued. Further support needs were Conclusions: MCQTs for learning needs assessment are also identified in terms of greater accessibility (e.g. CD- feasible, reliable and have a great acceptance among Rom and internet access) and inter-practice collaboration participants. Analyses of the results enable individuals and to promote best practice. the scientific societies to plan programs of professional development in a goal oriented way. Conclusions: This study confirmed positive support for the workbook as a tool for the effective planning and delivery of CPD. 8R 8 Comparing two snapshots over time: UK Medical Royal College CPD Policy Development 8R 6 The COP Pilot Project: a project to study information Francesca Johnson*, Stephen Brigley, Tom Hayes, Howard Young, exchange among specialists and other members of Stephen Hunter and Gladys Tinker (University of Wales College of selected clinical communities of practice Medicine, School of Postgraduate Medical & Dental Education, Heath Park, Cardiff CF14 4XN, UK) R Laprise*, M Hotvedt, J Parboosingh, R L Thivierge, J Toews, R Lemay, C Campbell, L Samson and T Gondoscz (Aventis Pharma, Aim: This papers aims to review the progress in the UK Department of Professional Education, 2150 St Elzear Boulevard Medical Royal College and Faculty Continuing West, Laval, Québec H7L 4A8, CANADA) Professional Development (CPD) policy development, implementation and evaluation. Medical Royal Colleges Aim: To describe how specialists naturally exchange in order to maintain high standards of professional practice knowledge and use technology to meet their learning amongst qualified medical practitioners, have made major needs, and to assess whether specific interventions can investment in CPD policy development. move these groups towards functioning as communities of learners. Summary of work: In 2001 a survey of 16 Royal Colleges and Faculties revealed a complex picture of a range of Summary of work: Specialists, residents and associated CPD policies with commonalities and differences. The HCP from 4 hospital units in Alberta, Québec and survey informed the production of a CPD guide designed Pennsylvania attended 2 workshops on the research to support those advising career grade staff on their protocol, the COP and the use of personal learning projects, continuing professional development. Key features of each and were trained on the tools provided to share information Royal College/Faculty Policy were identified from policy and knowledge among group members. Site managers documents and web sites. were assigned to organize collective learning sessions such as rounds and journal clubs. Numerous qualitative This paper will report the results of a repeat survey carried and quantitative methods are used to measure changes in out in 2003, and compare these results with those of 2001. the group’s dynamics and individual learning habits during Areas which have and have not changed will be identified. the 12-month study period. A consideration of current similarities, differences and anomalies will be discussed in relation to fundamental Summary of results: The characteristics of the groups and conceptions of continuing professional development and changes in learning habits during the first 6 months of the professional learning. study will be presented. Conclusion: This paper argues that making time to debate Conclusions/take-home messages: Organizations are these issues is critical to the evolution of a coherent CPD convinced that fostering COPs and supporting knowledge policy environment, which will be meaningful and motivating for medical practitioners.

– 4.130 – Section 4 8R 9 National Clinical Guidelines: educational programme Aim: This paper will explain how an evidence-based of rheumatoid arthritis in Finland 2001-2002 learning program, initially developed for practising physicians, became a learning tool across the medical Mari Anttolainen*, Ritva Peltomaa, Liisa-Maria Voipio-Pulkki and curriculum. Juha Pekka Turunen (The Finnish Medical Society Duodecim, PO Box, 00101 Helsinki, FINLAND) Summary of work: “Healthy ABC’s” (Assessment from Birth to Childhood), is a comprehensive learning program on Aim: The aim of the study was to plan and evaluate a the child’s periodic medical examination developed at systematic educational programme for a national Université de Montréal’s CPD Office. It includes 3 main guideline, and to investigate the knowledge, skills and components: a reference guide, practical and evidence- attitudes of physicians to the national guidelines. based, addressing most recent recommendations; tools Summary of work: The educational programme was for the patient’s medical record facilitating assessment; designed to cover the Cochrane-based clinical guidelines. and a 3 hour PBL small-group workshop enabling The programme outline was designed centrally but physicians to develop a thoughtful and individualized modified according to local needs. The educational approach to PPC.Summary of results: This program has process consisted of a series of lectures and patient cases. been implemented in CME across Canada over the last The skills, knowledge and attitudes of the participating year (2002) with a high level of satisfaction. Residents and physicians were measured before the initial educational also undergraduate medical students attending this event and six months thereafter using a structural program found it highly relevant and timely. All data will be questionnaire and an interactive polling system. Data were discussed along with the educational processes involved analysed using t-test and one-way analysis of variance. at each level of learning in medicine. Cronbach’s alpha was used to test the reliability of the Conclusions: Implementation of this program confirms that instrument. the same learning tools and PBL processes can be used Summary of results: The overall attitudes towards clinical in the continuum of medical learning from under-graduate guidelines were positive. A significant improvement in the to post-graduate (residency) to CME, especially when they result of the single attitude statement “National guidelines are relevant, practical and evidence-based. could help interaction with patients and relatives” was observed (p<0.05). Knowledge and skills elements were the same or showed improvement. The pre-planned 8R 12 Using individual practice profiles as a guide in patient cases were well received. The participants stated medical training for physicians involved in the that they learned most about the drug treatment. Toward Excellence in Asthma Management (TEAM) Conclusions: The pilot project has provided the basis for Program other educational activities, as new national guidelines Michel Turgeon, Louis-Philippe Boulet, Robert Thivierge*, Eileen will be published in Finland. Dorval and Pierre Raiche (Clinique Medicale Ste-Foy, 802 Chanoine Scott, Ste-Foy, Quebec, G1V 3N4, CANADA) 8R 10 Continuing Medical Education introduction in Serbia Background: Asthma is a health problem frequently Sinisa Gradinac*, Nebojsa Lalic and Djordje Radak (Belgrade encountered by primary-care physicians. Despite the existence of the Canadian Consensus on asthma of the University Medical School, Dedinde Cardiovascular Institute, M. Canadian Thoracic Society (1999), shortcomings continue Tepica 1, 11077 Belgrade, SERBIA AND MONTENEGRO) to exist between the care delivered to asthmatics and Continuing Medical Education (CME), and Continuing expert recommendations (care gaps). The Toward Professional Development (CPD) are well defined Excellence in Asthma Management Program (TEAM) is mechanisms of quality control in developed medical an ongoing project in the province of Québec (Canada), systems. We are striving to introduce the same concepts an objective of which is to offset these care gaps. in our medical community. The new course that Serbian Summary of work: One component of this program was society is taking after years of neglect is the return to the the formation of a cohort of physicians and patients ideas of a united Europe. This process requires time. The recruited in six Québec regions. Participating physicians medical system itself is undergoing thorough analysis and (n = 77) recruited asthmatic patients (n = 290), with whom reconstruction in order to achieve European standards. they pledged to meet on three occasions within a twelve- Harmonization with other medical schools in Europe month period, specifically to monitor their asthma. The comprises the introduction of CME as the means of quality resulting data related to treatment and follow-up of these control. The Ministry of Health and Belgrade Medical patients were recorded on standardized assessment School have recently formed the Center for CME. During sheets and centrally compiled. The principal care gaps this process, we encountered certain problems like the observed are related to prescribed respiratory tests, resistance to change. However, our delay in this process referrals to Asthma Education Centers (AEC) and written we see as the opportunity not to make the same mistakes action plans. Data analysis made it possible to trace a as seen in some other countries. We are currently practice profile of individual cohort physicians, as well as synchronizing with the European Credit Transfer System both regional and provincial profiles. As a second step, the in order to provide our physicians a free flow through the physicians were invited to participate in a training activity European network of CME. We would like to report our during which they were presented with their individual current status in CME introduction, its local popularization, practice profile, as well as the regional and provincial and our international cooperation in this field. profiles. They were then asked to reflect on their practices, identify care gaps and modify their practices in an effort to offset these shortcomings. Identifying potential barriers to 8R 11 Teaching Preventive Pediatric Care (PPC): an offset care gaps and strategies for removing them innovative approach to integrate evidence-based concluded this educational activity. Lastly, participating medicine across the medical curriculum physicians were asked to pledge their commitment to Martin Labelle*, Robert L Thivierge, Gilles Brunet, Dominique change. During the activity, the physicians manifested an Cousineau and Danièle Lemieux (University of Montréal, CME interest in this type of event and points raised by the Office, Faculty of Medicine, P O Box 6128, Centre-Ville Station, physicians are presented in this poster. Montréal, H3C 3J7 CANADA)

– 4.131 – Section 4 Session 8S: Management and Selection

8S 1 Setting research priorities in a medical university: Background: The standard of ISO 2000 as a standard term building up a partnership for “quality management defines the quality as affording the collection of properties to offer a “good” product or Saeed Asefzadeh (Qazvin University of Medical Science & Health “service”. Today, international organizations in different Services, Qazvin, IRAN) fields should be validated and licensed by reliable official Aim: To share our experience of building partnership for referees, but is ISO in education “meaningful”? The health research priority- setting. answer is definitely “positive”, but why have clinical or educational organizations have not received ISO so far. Summary of work: Qazvin University like 40 other medical This research investigates this question. universities in Iran is accountable for the health of the people and covers a population of 1,050,000 (62% urban- Summary of work: In this qualitative research 40 randomly 38% rural). In 2002, we formulated the strategy to redirect selected people in charge of administrative divisions have the research resources towards community health been interviewed. The data were collected with the development through partnership. A committee of multiple following results. stake-holders; policy-makers, health managers, GOs, Summary of results: 20% had no knowledge in this respect NGOs, students, researchers, medical specialists, therefore, 80% participated in the interview and pinpointed people’s representives, etc. was organized to coordinate the problems as: 100% believed in lack of finance, 100% the process of coalitions. To assess the health needs of lack of sufficient room, 100% lack of professional staff, the people all existing data were screened and utilized, 26 86% lack of knowledge on respect of ISO in administrative focus group discussions were organized and a sample of people, 86% lack of concern by the people with authority, 2,000 households were surveyed. The project was backed 65% lack of options to take necessary decisions, 50% lack by the stakeholders. of cooperation of people with lower ranks in the Summary of results: the findings of the survey and FDGs organization, 50% lack of adequate experience. were interpreted to define and prioritize the health related Conclusion: Performing of ISO apparently demands a problems facing the community. Interventional research collaborative effort that should be considered before projects are being conducted to develop the health and approaching any practical task in this respect. welfare of the target population by the coalitions of the stake-holders. Conclusion: Building up partnership for community oriented 8S 4 Longitudinal research in medical education: health research is the effective way to mobilize resources possibilities and challenges and develop health and welfare. Ann W Frye*, Christine A Stroup-Benham, Stephanie A Litwins and Steven A Lieberman (University of Texas Medical Branch, 8S 2 Introducing quality culture in the Tbilisi State Office of Educational Development, 301 University Blvd, Galveston Medical University TX 77555-0408, USA) R Khetsuriani, Z Avaliani*, G Simonia and Z Vadachkoria (Tbilisi Aim: This poster describes possibilities and challenges State Medical University, 33 Vazha-Pshavela Avenue, Tbilisi associated with a database documenting medical students’ 380077, GEORGIA) characteristics over time. Since 2002 Tbilisi State Medical University (TSMU) has Summary of work: In 1995 the University of Texas Medical participated in the Quality Culture Project, which has been Branch at Galveston began planning educational research conducted by European Universities Association (EUA) requiring more than readily-available academic data. We under the SOCRATES program. Georgia which is administered measures, including the NEO-FFI represented by the TSMU has been the only non European Personality Inventory, Mitchell Cognitive Behavior Survey, Union country which was selected for participation in this Medical School Learning Environment Survey, and Rotter project. The TSMU joined the Teaching and Learning Locus of Control survey, to students at four points during Network. In the Soviet period high schools were unawaren medical school. We integrated demographic and even about the term “quality culture”. Introduction and academic performance data from other sources into that development of quality culture is a prerequisite for achieving database. Approximately 1600 students are represented international standards of education. Creation of a quality to date. assurance unit in the TSMU is the first step in this direction. Summary of results: The poster will illustrate possibilities Further development of quality culture implies creation of afforded by a rich longitudinal database by presenting a normative framework on improvement of the quality of summaries of completed studies on curriculum effects and teaching and learning and elaborating effective criteria for current studies of academic success/failure and student the assessment and monitoring, and formation of a Task characteristics. We will also outline how we have met Force to develop a quality culture. Not all staff fully challenges inherent in maintaining the database. Among understands or has been made fully aware of the education those challenges are developing administration reforms undertaken by the Rector’s initiative. The optimal procedures supporting full student participation, designing model for the university has been considered to be strong meaningful student feedback, accommodating students central leadership combined with a creative and initiative not progressing with their class, keeping continuity during “periphery” – faculties and departments. Strategic administrative change, and optimizing researchers’ access management of the university including teaching and to data. learning spheres, should be bidirectional (“top - bottom” and “bottom - top”). Conclusion: Challenges associated with maintaining a database of repeated measures can be met with creativity, flexibility, and staunch administrative support. A longitudinal database allows interesting and valuable research 8S 3 Administrative staff opinions on the problems of questions to be addressed. meeting ISO in medical education P Afshari* and P Assadullahi (Ahvaz Medical Science University, Nursing and Midwifery School of Medical Science, University of Ahvaz, Ahvaz, IRAN)

– 4.132 – Section 4 8S 5 In METRO-land: developing a controlled vocabulary 8S 7 A system to support medical students’ experiential for medical education clinical learning R Ellaway*, A Haig and M Dozier (The University of Edinburgh, Tim Dornan*, Dan Powley, Judy Hadfield, Stephen Brown and MVM Learning Technology Section, The Medical School, Hugh Martin Brown (Hope Hospital, University of Manchester School Robson Link Building, George Square, Edinburgh, EH8 9XD, UK) of Medicine, Stott Lane, Salford, Manchester M6 8HD, UK) Aim: Increasingly, as electronically-mediated practices Aim: Help medical students gain first-hand experience of predominate, we need robust and appropriate information an appropriate range of clinical problems. management tools, in particular controlled vocabularies for describing ourselves and the world around consistently Summary of work: Despite an integrated, community- and objectively. Despite medical systems such as MeSH oriented curriculum design, students’ experiences are or general educational systems such as ERIC, there is no strongly influenced by the specialty interest of their hospital existing system for medical education, particularly outside firm, and therefore patchy. We developed a computer of a North American context. system to increase awareness of their current objectives, and help them attend relevant clinical activities hospital- Summary of work: the UK-based METRO group is wide. Two groups of eight students piloted the system, addressing this lack of a robust and consistent controlled which we evaluated through activity data, numerical quality vocabulary to describe medical education. This lack has ratings, and focus group discussions. a direct detrimental effect on teaching and resource management issues, such as in VLEs and reusable Summary of results: The 16 students ‘signed up’ 91 times, learning objects, and on finding reports of developments or once per learning week, to 30 different clinical activities, in medical education in databases like Medline. 51 (56%) of which were in firms other than their own. They voluntarily entered reflective descriptions of their learning Summary of results: the METRO group have created a on 95% of occasions, and evaluated it as relevant to a combined namespace of the MeSH and BEI taxonomies, median of 3 module objectives per signup. 80% of signup adding new terms only where gaps in the two existing events were rated 5-7 on a 7-point Likert scale for their systems are identified. A significant component is quality, and 45% allowed students actively to participate in formulating terms outside of a North American context. This clinical care. Students liked the system because it paper will describe the process of developing a UK-specific increased their autonomy as self-directed learners. vocabulary and making semantic links to terms standard elsewhere. Conclusion: An experiential learning management system can help students learn self-directedly from an appropriate Conclusions: the project should be of interest to anyone range of ‘real patients’. conducting research in medical education, and to other disciplines or language groups involved in similar work. 8S 8 Highlands Schools Medical Mentoring Scheme: Improving applicants’ chance of selection to medical 8S 6 Linking the undergraduate medical curriculum with school resource utilization and performance management Mandy Hunter and Malcolm Laing* (Undergraduate Teaching Judith Hadfield*, Tim Dornan, Tim Johnson and Daniel Powley (Hope Centre, 7th Floor, Raigmore Hospital, Inverness IV2 3UJ, UK) Hospital, Department of Undergraduate Education, University Aim: To describe Scottish and Highland trends in Teaching Building, Salford Royal Hospitals NHS Trust, Stott Lane, application and selection to medicine and the possible Salford M6 8HD, UK) influence of the Highland Schools Medical Mentoring Background: The Signup System (SUS) has been Scheme. developed as a comprehensive timetabling system for Summary of work: The UCAS database was searched for Undergraduate medical students allowing them to applicants and selected applicants to medicine from feedback on all aspects of their teaching. Highland and Scotland since 1998. The mentoring scheme Aim: To harness the information collected by the system to began in 1998 and has three components, including a inform the management agenda on educational resource local doctor who acts as mentor, a programme of hospital utilization across the organization and to feedback student work experience and an open day about medical careers. comments directly to the teachers. Summary of results: Highland has similar application rates Summary of work: Information on all teaching done by to medicine to the rest of Scotland (15.5/100,000 in Consultants, together with their student feedback, is Highland and 14.7/100,000 in Scotland). During the five channelled onto individual Consultant homepages within years since the mentoring scheme began, the percentage SUS in order to build up educational profiles. of selected applicants from Highland has risen from 56% in 1998 to 84% in 2002. Over the same period, the Scottish Summary of results: 13,070 teaching hours devoted to the selection rate has risen from 66% in 1998 to 74% in 2002. undergraduate medical curriculum distributed between 20 clinical directorates have been identified this academic Conclusions/take home messages: The influence of the year. Using these data it has been possible to present Highland Schools Medical Mentoring Scheme is a possible accurate information to Consultants on their individual explanation for the trend in successful applications to contribution to the undergraduate teaching programme medicine from Highland region. We recommend schools together with numerical and free text evaluation results. liaison projects like this to guide school pupils considering Benchmarks on aggregate numerical data have also been application to medicine. computed which allow comparisons between directorates. Conclusions: Linking delivery of the undergraduate medical 8S 9 Impact of writing a personal statement on residency curriculum with performance management and resource candidates utilization provides a comprehensive account of educational activity which can be of benefit during Angel M Centeno*, Cecilia Primogerio and Alejandra Blanco (School Consultant appraisal. Furthermore, it allows teachers to of Biomedical Sciences, Universidad Austral-Medicina, Av Juan take account of student feedback and improve the quality Peron 1500, B1629 AHJ Derqui, Pilar, Pov Buenos Aires, of the learning opportunities they provide. ARGENTINA) Background: A personal statement is seldom used for residency selection. Its use is usually directed towards understanding the candidate’s personal interest in a specific residency position. But there are no data on the impact that writing a personal statement has on the candidate.

– 4.133 – Section 4

Summary of work: We interviewed the top ranked 66 19 in northeastern, 8 in eastern, 9 in western and 16 in candidates to our residency program. southern). Three classes of 167 graduates are distributed to work in rural hospitals with the expectation of staying Summary of results: Ninety five percent of them had never longer there. written a personal statement, 91% considered it a useful tool for selection, although as a complement of the other Conclusions: This collaborative production, without selection requirements. Fifteen percent had difficulties establishing new medical hospitals, is more cost effective and felt uncomfortable writing it. Writing it helped the and ensures that MECs deliver nationally accredited candidates to set priorities, reaffirm their projects and to curricula and educational system, enabling the graduates define more clearly their personal and professional to be granted the degrees of MD, equivalent to any Thai objectives (74%). graduate. Most of the candidates stated it was useful to organize their thoughts previous to the personal interview. 8S 12 The medical admissions interview: comparison of Conclusions: The personal statement helps applicants individual unstructured interviews and semi- prepare for the selection process. Most of them are structured panel interview unfamiliar with it and some feel uncomfortable writing it. Most of the candidates value it as a complement of the C A Courneya*, K Wright, V Frinton and G Pachev (University of selection process and as tool that induces personal and British Columbia, Department of Physiology, 2146 Health professional growth. Sciences Mall, Vancouver, British Columbia V6T 1Z3, CANADA) Summary of work: UBC is revising its Medical Admissions Interview. We ran a pilot study which compared the current 8S 10 Gender difference in training for medical practice of “individual unstructured interviews” with one specialisation of Thai physicians “semi-structured panel interview”. Applicants were Chusak Uewichitrapochana (Buddhachinaraj Hospital Medical interviewed as per the current interview practice (two Centre, Department of Surgery, School of Medicine, Amphur individual interviews, with a scientist and a clinician), in Muang, Phisanulok 65000, THAILAND) addition, they were offered the chance to be interviewed by two panels using a semi-structured interview. Each panel Summary of work: The yearly number of females and males consisted of a clinician, a basic-scientist, and a community physician that were recruited for specialist training during representative. Thus, for each applicant, we had individual 1992-2002, which had been approved by the Medical interview scores (global and individual categories Council of Thailand, were analyzed. measured), and two panel interview scores (global and Summary of results: In total 2,942 female and 4,877 male individual categories measured). We compared each physicians were included in the study. Females made up measure’s correlation with admission status to evaluate 30% of specialist residency programs in 1992 and its predictive value. In addition, the extent to which the two increased to 45.5% in 2002, with the highest proportion in sets of measures vary together (correlation) was used as Pediatrics, Radiology, Anesthesiology, Ophthalmology, an index of how much the two measures were Psychiatry, Rehabilitation, Dermatology and Pathology: interchangeable. Since each applicant was interviewed about 66%, 70%, 64%, 54%, 54%, 64%, 66%, and 56% by two separate interviewers, as well as two separate respectively. The ratio of females to males increased from panels, we could assess inter-rater reliability. Finally, within 0.43 to 0.83 during the 11 year period. The trend is the panel interviews we used a Latin Square design to increasing significantly since the year 1997, which reflects counterbalance effects of interviewer’s profession and the increase in the female to male ratio of medical students question-order. The results are interpreted in terms of the since 1991. The specialisms that show the trend of an effectiveness of adopting the panel interview to replace increasing number of females are Ophthalmology, the individual interviews. Obstetric and Gynecology, Medicine, Pediatrics, Anesthesiology, Surgery, and Radiology. 8S 13 A preferential access program to a faculty of Conclusions/take home messages: The trend of female medicine for outstanding socially disadvantaged specialists is continuing increase due to increasing students: lessons learned in two years number of female to male ratio of medical student graduates. The trend towards social equity of females to Veronica Gaete*, Gloria Riquelme, Jorge Las Heras, Cristina males around the world has enabled females to do the job Zuñiga, Carolina López and Fabio Sáenz (Faculty of Medicine, of males. We will see more and more female specialists in University of Chile, Puerta de Hierro Oriente 10.109, Casa 34, Lo every medical specialty; even the number of female Barnechea, Santiago, CHILE) surgeons is increasing also. Background: Outstanding socially disadvantaged students have restricted access to the university in Chile. The Faculty of Medicine is running a comprehensive program, to offer 8S 11 The collaborative project to increase production of school students from a very poor and socially rural doctors: equity of student selection disadvantaged district a real opportunity to study a Suwat Lertsukprasert (Office of the Collaborative Project to professional career in the health science area. Preliminary Increase Production of Rural Doctors, Floor 9, Building 6, Office results presented earlier showed that participation in the of the Permanent Secretary, Ministry of Public Health, Tiwanon program was associated with the subject’s knowledge, life skills and national university selection test (PAA) score Road, Nonthaburi 11000, THAILAND) improvement, and that indirect benefits were observed (like Aim: To present a project solving physician shortage, other educational opportunities for non selected students, especially acute in rural areas. Summary of work: The Thai community educational expectations increase, etc.). Cabinet approved CPIRD in 1994, a joint project between Aim: The objective is to show results in the first two years of the Ministry of Public Health and the Ministry of University the program. Affairs. CPIRD recruits 300 students a year totalling 3,000 during 1995-2006, educates them and after graduating Summary of work: 30 students from 11 and 12 grade were sends them back to the hospitals of their provinces. preselected by academic performance, IQ, vocational Students undertake a university based first three years of profile, mental health and family support. They received their courses in basic and pre-clinical sciences and reinforcement in biology, chemistry, physics, language and clinical years based in one of 12 Regional Medical Centers. mathematics, life skills training, mentoring and vocational Students undertake the same end-of-course and counseling. There was a final selection based on school comprehensive examinations as their tertiary trained peers. grades, performance during the program and PAA score. Places were given to 8 of 20 eligible students. They went Summary of results: The 1,444 students are recruited from into Medicine (3), Phonoaudiology (2), Nursing (1), residents in the rural provinces (17 provinces in the north,

– 4.134 – Section 4

Kinesiology (1) and Occupational Therapy (1). They have permanence and/or success. 30% had low motivation to been offered free tuition, psychosocial support and food, study hard, 50% deficient study methods, 46.7% high risk transport and free teaching material during their careers. behaviors and 23.3% mental disorders. These factors were associated with a 23.3% exclusion or drop out rate, and Summary of results: After two years, most selected students the failure of medical students. High academic demands are performing well at the chosen careers, the program also influenced the latter. has generated positive development opportunities for the majority of participants, and indirect benefits continue Conclusion: A need to improve the preselection, the emerging. However, even though subjects were the academic and psychosocial support, and the career school´s best students, a significant number showed choices became evident. academic and psychosocial barriers for adaptation,

Session 8T: Outcomes, Professionalism and Research and Critical Thinking

8T 1 Good characteristics of doctors according to a Aims: To identify and develop effective models of perception and self-assessment of the 6th year multidisciplinary education and training in child protection. medical student practising in Khon Kaen Hospital, Summary of work: A literature search was undertaken in Thailand MEDLINE, CINAHL and Psychlit covering terms relevant to Surachai Saranrittichai*, Sirijitt Vasanawathana and Mungkon child protection and multidisciplinary education. Noimay (171/357 Soi Thantip, Prachasamosorn Road, Amphur Summary of results: 36 papers were studied. There was Muang, Khon Kaen Province 40000, THAILAND) consensus regarding training curricula with respect to role definition, identification of child maltreatment and Aim: Although doctors are among the top professionals, principles of effective intervention. However, training was people respect and expect humaneness and clinical considered to be incomplete in terms of content, focus competency. Claims and complaints against doctors are and quantity and was not integrated into training growing worldwide, also here in Thailand. We have set up programmes. Insufficient evaluation of training was a national standard qualification for doctors. But actually, undertaken and outcomes were limited to short term what do medical students know about good characteristics changes in knowledge and confidence with few attempts of doctors and their self-assessment of those to evaluate appropriate changes in behaviour. characteristics. What are they? What aspect should be improved? Conclusions/take home messages: Current initiatives in child protection education are unlikely to prepare Summary of work: A descriptive study, using rating multidisciplinary teams for the challenges of working in questionnaires scores 0-5, from 33 sixth year medical this area. An integrated outcomes-based model for change students who practise in Khon Kaen Hospital, in the is suggested. Northeast of Thailand, about their perception and self- assessment of good characteristics of doctors. Summary of results: The highest rated perception was 8T 3 Students’ perception of the medical profession at “responsibility” (mean = 4.52), followed by “ ethics” different stages of medical training (mean=4.48) then “clinical competency “ (mean=4.45). The lowest rated were “practical skill “ (mean=4.06) and M G H Nieuwhof*, M M Kuyvenhoven, M B M Soethout and Th J ten “creative thinking” (mean=4.06). In self-assessment the Cate (University Medical Center Utrecht, Onderwijsinstituut, highest rated was “ team working” (mean =4.47), followed School of Medical Sciences, Postbus 85060, 3508 TA Utrecht, by “ethics” (mean=4.42) then “responsibility” (mean=4.22), NETHERLANDS) while “life long learning” (mean=3.86), “clinical knowledge” Aim: To study whether the perception of the medical (mean=3.78) and “practical skill”(mean=3.78) were lower profession relates to study behavior and academic rated. The lowest rated was” leadership” (mean=3.64). achievement in medical students we did a survey among Conclusions: The final year medical students know the students at different stages about their perception of the good characteristic doctors. They are dependent on their medical profession. attitude and frequently practise it by the learning process, role model, and special activities to increase good Summary of work: Three groups of students were characteristic behaviour in doctors. interviewed: (a) at the start of medical training (n=16), (b) during clerkships (n=10) and (c) after graduation (n= 36). They were asked to describe as many characteristics as possible of the medical profession in general and of four 8T 2 Effective multidisciplinary education and training in specialities (general practitioners, internists, surgeons and child abuse and neglect youth health physicians). Data analysis was guided by M J Bannon* and Y H Carter* (London Deanery, Medical Education Grounded Theory Methology. Dept, Level 6V, Northwick Park Hospital, Watford Road, Harrow, Summary of results: First year students perceive the medical Middlesex HA1 3UJ, UK) profession in limited dimensions: activities of physicians, Background: Since 1945, there have been over 70 public their relationship to patients and their knowledge, skills inquires into cases of fatal child abuse in England. A recent and personality. They do not perceive much difference report concluded that while the child protection process between the four specialities, in contrast to students with was fundamentally sound, children at risk were denied clinical experience and graduate students. Undergraduate effective protection from harm as a result of ineffective students especially mention social aspects of the intervention and poor communication on the part of profession, while graduate hardly make any remarks on individuals and agencies. Education and training on the these aspects. management of child abuse and neglect is now considered to be essential for all professionals who care for children and their families.

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8T 4 Which medical skills are important? Clinical skills Aim: To describe self-reported attitudes and behaviors of questionnaire undergraduate medical students regarding professional integrity. J Schulze*, S Drolshagen and F Nürnberger (Dean’s Office, Fachbereich Medizin, JWG Universität Frankfurt, Theodor Stern Summary of work: A cross sectional study was conducted Kai 7, 60590 Frankfurt/Main, GERMANY) on 88 subjects (65 senior students and 23 interns) using a self-administered questionnaire consisting of 6 clinical and Aim: We will present data about the clinical skills perceived academic scenarios portraying a fictitious doctor engaged as necessary by medical faculty members of the Johann in unprofessional practice. Wolfgang Goethe-University Frankfurt. Summary of results: 81 (92.1%) participants believed Summary of work: Based on the Euroskills questionnaire professional misconduct is wrong, particularly failure to developed by a consortium of European medical faculties, consult and refer patients for specialists’ opinion, disrepect all members of the medical faculty were asked to rank to patients’ autonomy and preferences and research fraud. specific skills as “irrelevant”, “in theory”, “seen”, “done” and 73 (83%) respondents would not perform these activities. “master”; the questionnaire included both general and There were no significant differences in responses by discipline related skills. 38 questionnaires were evaluated. gender or year of study. Females and students, respectively, Summary of results: Most skills were rated as “theory” or were significantly more lenient than males (p=0.001) and “seen”. Rarely a topic was rated as irrelevant, whereas only interns (p=0.002) regarding penalties appropriate for a minority of the topics should be mastered by the students. unprofessional behavior. 64 (72.7%) respondents would The rating of general skills was quite homogenous, take action if colleagues failed to achieve professional whereas specialists rated skills from their discipline higher standards. that non specialists. Among the skills generally perceived Conclusions: Perceptions of professional and academic as “should be mastered” are e.g. taking a history, inspection misconduct are not different in UAE medical students and and palpation or testing reflexes, i.e. skills in general interns from those observed elsewhere. medical practice. No agreement was seen in topics like “evaluation of social or environmental influences in diseases” or “critical appraisal of own results”, usually in 8T 7 How does postgraduate medical training in general health care management or quality management. Conclusion: The results show the emphasis put on practice affect the trainers? theoretical knowledge even for practical skills among Niels Kjaer* and Charlotte Tulinius (Department of Research and academic teachers are at variance with students Postgraduate Medical Education, S. Jytland, Lindevej 18 V, expectations. Sottrup, 6400 Sonderborg, DENMARK) Aim: To highlight the effects of postgraduate medical training in general practice on the professionalism of the 8T 5 A compendium of tools to assess professionalism GP trainers, shown by a Danish study. Deirdre C Lynch, Patricia M Surdyk* and Arnold R Eiser (Accreditation Council for Graduate Medical Education, 515 No. Summary of work: We performed seven focus group interviews with GP trainers and trainees. The interviews State Street, Suite 2000, Chicago, IL 60610, USA) were semi-structured. The analysis was primarily data led Aim: To summarize results of a comprehensive review that and inspired by phenomenological methods. identified and categorized approaches to assessing Summary of results: Both the trainee doctors and the GPs professionalism reported in the literature over the past 20 experienced that the trainer role affected general practice years. positively. The trainees focused on: (1) Input of new Summary of work: To foster professionalism effectively and knowledge; (2) Facilitating knowledge development and to assess outcomes of those efforts, medical educators exchange among the older doctors; (3) Stimulating the must familiarize themselves with what assessment academic milieu. approaches can provide useful information. The authors The trainers focused on: (1) Mutual learning, better found 100 assessments that reflect those elements of professional self-awareness and auditing clinical professionalism around which agreement exists in the procedures; (2) More time available for the GP’s own work; literature. They organized the assessments into: 1) content (3) Positive influence on the working environment of the areas addressed by the approach, i.e., ethics, personal surgery in its entirety and the GP’s working enjoyment. characteristics, comprehensive professionalism, and diversity; and, 2) type of outcome examined, i.e., attitudes/ Conclusions: Our study shows that training courses in beliefs, knowledge, behaviors, and environment. Evidence general practice have a positive impact on the of the scope and variety of available assessments should professionalism of the trainers. The mutual learning stimulate efforts to improve existing assessments andto between knowledgeable young medical doctors and encourage further research. experienced GPs is a way to achieve evidence based medicine performed through experience based mind. Conclusions/take-home messages for participants: Useful and effective approaches to assessing professionalism vary according to the targeted group’s level of professional development - medical student, resident, or practising 8T 8 Ethics and professionalism: where do students physician. A comprehensive approach to assessing obtain their value systems? professionalism should be formative. It should focus on Helen Maxwell-Jones*, Ash Samanta and David Heney (Leicester the knowledge and behaviors of the individual as well as Medical School, Division of Medical Education, Medical Sciences those characteristics of the educational environment that Building, University of Leicester, Leicester LE1 9HN, UK) contribute to the professional development of students, residents, and faculty alike. Aim: We set out to ascertain which facets of medical education and broader life influences contributed to the approach and thinking of students when faced with an 8T 6 Self-reported attitudes and behaviours of ethical problem in a practical setting. undergraduate medical students regarding Summary of work: We administered a questionnaire to 160 professional integrity final year medical students at Leicester Medical School. The questionnaire contained 3 individual vignettes and D E E Rizk and M A Elzubeir* (United Arab Emirates University, asked students to rate potential influences on their Faculty of Medicine and Health Sciences, Department of Medical response. Further questions identified demographic data Education, PO Box 17666, Al-Ain, UNITED ARAB EMIRATES) and addressed which factors had most altered their perception of applied ethics.

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Summary of results: 136 students completed the Summary of results: Doctor-teachers evaluated the quality questionnaire. 85% were formally introduced to ethics prior of students’ professionalism in individual groups as follows to medical school. 67% felt that their perception of applied (scale -100 to 100): altruism, unselfishness, service -5; ethics had altered during their training. When asked what expert readiness, accountability, reliability -6; duty 6; had most altered their perception of ethics 43% said honesty, honour 41; respect for patients 13; respect for personal experience inside medicine, 11% said example colleagues, for teachers 43. Results at each clinic differ to set by seniors, 9% said patient contact and 7% said a considerable degree. Honesty, honour and respect for teaching. The results from the vignettes provided similar colleagues, for teachers were distinguished more positively patterns. Detailed results will be presented. than other groups. Different results at different clinics might possibly be the consequence of different internal teaching Conclusion: Formal teaching contributes only a small part rules. to the approach adopted by students to ethical problems. The environment in which student work and practise Conclusions: Learning professionalism through imitating remains the most important influence. This confirms a role model is in total agreement with results of similar previous findings and has implications for teaching. published studies. Individual groups of students’ professionalism were assessed and some areas were recommended, in which teaching of professionalism could 8T 9 Developing 360o feedback in UK postgraduate clinical be further improved. tutors’ professional development Kit Byatt* and A Long (Hereford Country Hospital, Union Walk, 8T 11 Student scientific activities at Jessenius Faculty of Hereford HR 2ER, UK) Medicine CU in Martin – present state and how to Aim: To show the process for developing a tool supporting improve it professional development of postgraduate clinical tutors Juraj Mokry*, Daniela Sevecova, Branislav Kolarovszki, Rudolf (PGCTs). Zach and Miroslav Sulaj (Jessenius Faculty of Medicine, Comenius Summary of work: Appraisal has been introduced for all University Martin, Department of Pharmacology, Sklabinska 26, consultants in the NHS to support clinical professional 037 53 Martin, SLOVAKIA) development. 360° feedback instruments are commonly Aim: The study was performed to assess the current state used in this process. Members of the National Association of students’ scientific activities (SSA) at Jessenius Faculty of Clinical Tutors are responsible for managing of Medicine Comenius University (JFMCU) and to outline postgraduate medical education (PGME) in UK trusts. As the possible ways of improving and spreading this part of part of its commitment to PGME, NACT decided to develop undergraduate education of future doctors. a formative 360° feedback instrument to support professional development in its members’ educational role, Summary of work: A 30-items questionnaire was completed complementing appraisal of their clinical role. anonymously by undergraduate medical students of all Experienced clinical tutors identified items of relevant study years. The best rate of return was observed in the 3rd behaviour and attitudes. A questionnaire was devised study year (94%), the worst in the 1st study year (35%). incorporating these. This was revised after consultation with a wide variety of individuals whose roles interacted Summary of results: More than 80% of students would be with clinical tutors. The information gained should provide interested in research, but only 5% of them are involved in an insight of how the individual is perceived by colleagues. SSA (the number increases with study year). Students’ This may allow the individual to identify areas worth research is limited by the lack of free time due to curricular developing or changing to improve his/her effectiveness in education (45%), missing cooperation contacts (40%), this complex and demanding managerial role. insufficient future professional motivation (38%), and shortage of information about research possibilities (25%). Summary of results: A prototype tool has been developed Scientific erudition and enough time for students were with apparently reasonable face validity. assigned to be the most important qualities of the tutor. Conclusion: Further work is in progress to validate this Conclusion: An alarming situation in SSA at JFMCU could instrument as a device to support PGCTs’ professional be improved by sufficient information about the research development. possibilities, increased future professional motivation (selection criteria by recruitments, postgradual fellowships), increased motivation of tutors to lead the 8T 10 Evaluation of students’ professionalism at Medical students, as well as by financial motivation of students. Faculty, Palacky University in Olomouc, Czech Republic – a pilot study 8T 12 Medical students’ performance on a Medline OSCE: Petr Jindra*, Radim Licenik, Lenka Doubravska, Vit Gloger, Jan does an intercalated degree help? Strojil, Renata Simkova, Iveta Zedkova and Cestmir Cihalik (Palacky University, Faculty of Medicine, Spolek Mediku – MEDU, M Dozier*, H Cameron and S Yewdall (University of Edinburgh, 775 15 Olomouc, CZECH REPUBLIC) Erskine Medical Library, George Square, Edinburgh EH8 9XE, UK) Aim: To describe our work which tests the hypotheses that Background: In 1995 in Philadelphia, the American Board students with an intercalated degree will perform better in of Internal Medicine defined professionalism as “aspiring information searching skills but that the difference will toward altruism, accountability, excellence, duty, service, diminish with the impact the exam has on student learning. honour, integrity and respect for others”. The given definition could be successfully applied to professionalism of Summary of work: Third year medical students sat an exam doctors, doctor-teachers as well as students. The aim of on Medline as part of an OSCE (objective structured clinical our study was to find out to what extent unprofessional examination). The exam was newly designed to test two behaviour of students in general might be a problem at the things: students’ ability to perform a focused literature medical faculty in Olomouc. search in response to a clinical management question, and their ability to choose appropriate types of article Summary of work: 50 questionnaires were distributed to records. We analysed the students’ performance and will doctor-teachers at selected clinics. Each questionnaire compare two successive cohorts. contained 24 statements concerning students’ behaviour assessed using Likert’s scale. Statements were divided Summary of results: On initial results, students doing an into six groups: altruism, unselfishness, service; expert intercalated degree at the University of Edinburgh scored readiness, accountability, reliability; duty; honesty, honour; higher than those without a BSc. We await outcomes from respect for patients; respect for colleagues, for teachers. this year’s OSCE to test this hypothesis further and look for The return rate was 83%. evidence that the precedent of this exam has had an impact on students’ learning.

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Conclusion: Even with information skills teaching for all 8T 14 Problems and impediments of implementing Best medical students in Years 1 and 3, those who take an Evidence Medical Education (BEME) strategy in intercalated degree performed better at the Medline exam Shaheed Beheshti University of Medical Sciences held in May 2002. Implications for information skills training, part of an evidence based medicine theme in the (SBUMS) curriculum, are discussed. Shahram Yazdani* (Shaheed Beheshti University of Medical Sciences and Health Services, Tabnak Street, Shaheed Chamran Avenue, Evin, 19395 Tehran, IRAN) 8T 13 A controlled comparison study of the efficacy of The Educational Development Center (EDC) of SBUMS, training medical students in literature searching which is the pioneer of EBM in Islamic Republic of Iran, skills has adopted a BEME strategy since 1999 to support Larry D Gruppen*, Gurpreet K Rana and Theresa S Arndt educational managers of SBUMS to make their decisions (Department of Medical Education, The University of Michigan according to current best evidence in medical education. Medical School, G1111 Towsley Center, Box 0201, Ann Arbor, MI In this article we discuss the main problems that we have 48109-0201, USA) confronted in the implementation of this strategy. Aim: This study assessed the benefits of training in These problems include: (1) Paucity of well designed evidence-based medicine (EBM) searching skills by outcome cause and effect research in medical education; means of a recently developed performance-based (2) Low internal validity due to methodological problems, outcome measure. mainly lack of familiarity of faculty members with quasi- experimental methods; (3) Low construct validity because Summary of work: A total of 45 senior students participated there is no consensus about terminology and operational in a month-long EBM elective in 2002 and 2003. This definitions of theoretical constructs commonly used as elective included an optional 90-minute training session dependent and independent variables in educational in EBM searching strategies at the beginning of the course. research; (4) Low external validity due to an intricate and Searching skills were assessed at the end of the course complex network of factors that affect educational through a structured, case-based problem which was outcomes and radical contextual differences between evaluated by two medical librarians using an instrument different educational settings that reduce generalizability designed at the University of Michigan and University of of research inferences; (5) Few systematic reviews, meta- Rochester. analyses, decision analyses, and cost-effective analyses Summary of results: The 14 students who participated in about educational interventions in the literature; (6) the search skills training had an average score of 65.7 Problems in the development of educational practice (s.d. 23.4) compared with 51.6 (16.9) for the 31 students guidelines (EPGs), integrating current best educational who did not participate (0 = worst, 100 = best). The 95% evidence with local and contextual specifications and confidence interval for this 14.1 point difference (1.7 to requirements; (7) Problems in bringing educational 26.5) indicates that, in spite of the low statistical power of evidence to the point of educational decision making; e.g. this small sample, the impact of the training was large and lack of databases of secondary and value-added research demonstrable. articles concerning medical education and lack of sensitive and specific standard search queries to find educational Conclusions: A brief educational intervention on EBM resources. At the end of article we have suggestions and literature search strategies results in a substantial increase recommendations to overcome these problems and in the quality of MEDLINE searches four weeks later. facilitate adoption of a BEME strategy in medical schools.

– 4.138 – Section 4 Session 9A: Computers in the Curriculum

9A 1 Does the computer add anything to a tutorial? Aim: To facilitate an integrated approach to learning P G Devitt*, E Palmer and N De Young (University of Adelaide, respiratory medicine. Department of Surgery, Royal Adelaide Hospital, Adelaide South Summary of work: A case-based, computer-assisted Australia 5000, AUSTRALIA) learning program was introduced in a blended manner in the primarily systems-based Edinburgh undergraduate Computers are commonly used to supplement, reinforce course. The program is a clinical scenario based on a or replace the tutorial. In terms of short-term retention of patient presented as a named individual (‘George’) with a information, this learning aid may be as effective as the distinct personality, social circumstances, and a relevant tutorial. We report our experience of interweaving clinical history of chronic obstructive pulmonary disease. computer-based material with a conventional tutorial, as Throughout the 5-year course, ‘George’ ages at the same assessed by independent observation of classroom speed as the students, his condition deteriorates and he dynamics, student reactions and long-term understanding develops appropriate complications. The first year of his of the content. Students were allocated to either a tutorial story, which integrates social sciences, physiology, alone or a tutorial + computer group. Both groups were biochemistry and pharmacology, was introduced to all 235 pre-tested and then post-tested two days and again four first year students in January 2003 during the eight week months after the tutorial. The tutorial group participated in respiratory science module. a discussion on gastro-oesophageal reflux and peptic ulcer disease. The topics were case-based. The second group Summary of results: We surveyed 40% of students chosen participated in a similar process, except that the case at random at the initial introductory session: 99% found the studies were delivered on a computer using a purpose- program easy to use and 92% felt it fitted well with formal built program which provided text, images, video, options teaching. The usage logs showed that 46% of students and feedback. Forty-two students completed the study. Use subsequently accessed the program. of the computer encouraged more uniform contribution Conclusions/take home messages: We will report the from students, who reported better understanding of the student response to the program, relate use to clinical problems. Both groups showed significant post- performance in the formal assessment, and discuss the test improvement, which was only sustained by the tutorial degree to which this integrated and blended approach has + computer group. It is concluded that the use of computer- been successful in enhancing student learning. based materials within tutorials may not only increase student participation, but may also improve long-term understanding of the subject. 9A 4 Wash-out of the innovation frenzy? A longitudinal evaluation of case-based e-learning in internal 9A 2 Systematic integration of information technology medicine with the CASUS systerm within a medical school curriculum M Adler*, A Simonsohn and M R Fischer (Klinikum der Univ Cam Enarson* and John Boehme (Wake Forest University School München, Med Klinik Innenstadt, Ziemssenstr 1, 80336 Munich, of Medicine, Medical Center Boulevard, Winston-Salem, North GERMANY) Carolina 27157, USA) Successful concepts for the integration of face-to-face Wake Forest University School of Medicine implemented teaching with e-learning components are rare. This the new Prescription for Excellence Curriculum in August presentation describes our experiences with the integration 1998. The School chose to use a phased implementation of lectures with case-based e-learning modules in internal starting with the class to graduate in 2002. Students are medicine at the University of Munich from 2000 to 2003. 6 provided with a laptop computer at matriculation and a to 8 cases per semester were subsequently available in personal digital assistant prior to commencement of the relation to the lecture topics. All students (n=660) worked clinical clerkships. The focus of the program has been on through the first case under the guidance of a tutor. An high-order skill development. Applications were created to additional case had to be solved to get course credit; other contain baseline course content in the students’ courses cases were available for voluntary use. Session log files for the pre-clinical years. In the students’ third year they are and questionnaires (paper and on-line) served as issued a PDA device to track their clinical experiences evaluation instruments. Student acceptance and motivation and to access mobile medical resources. Graduating was initially high but dropped by 15% from 2000 to 2003. students in 2002 (AAMC Graduation Questionnaire) rated The integration of e-learning with face-to-face lectures was their technology skills significantly higher than their peers initially appreciated by 70% of students versus only 45% in in the previous graduating classes and the national peer 2003. This decrease was possibly due to changed course group. This was particularly true for ratings of their ability requirements (no credits needed for e-learning). In contrast, to carry out searches of medical information databases, only 12% of students worked on cases voluntarily in 2000 critically review a published research report, and use a versus 31% in 2003. In conclusion the use of e-learning PDA for clinical purposes. The integration of technology cases seems strongly dependent on incentives like course into the medical school’s curriculum has increased credits. Nevertheless, the rate of voluntary use has students’ ability to access information, thus enhancing their increased over time, indicating that a minority of students educational experience and promoting the curricular goals benefit from this educational strategy. of self-directed, life-long learning and information management skills.

9A 3 Introducing George: initial evaluation of a new teaching method designed to enhance the integration of knowledge and understanding across a 5 year medical course Patricia M Warren*, Mike Porter, Rachel H Ellaway*, Phillip Evans, A John Simpson, Gordon B Drummond and Simon Maxwell (The University of Edinburgh, Medical Teaching Organisation, Medical School, Teviot Place, Edinburgh EH8, UK)

– 4.139 – Section 4 Session 9B: Assessing Communication Skills

9B 1 Medical students’ communication skills, from the 9B 3 Communicating information – knowledge and risk supervisor’s perspective – assessment in the final Connie Wiskin*, Phil Croft, Selene Burn and Dawn Dodwell year of undergraduate medical education in (University of Birmingham, Dept of Primary Care & General Göteborg, Sweden Practice, Learning Centre & Primary Care Sciences, Edgbaston, M Wahlqvist*, B Mattsson, G Dahlgren, B Hamark, M Hartvig- Birmingham B15 2TT, UK) Ericsson, B Henriques and U Hösterey-Ugander (Department of Aim: Students at Birmingham Medical School undertake Primary Health Care, The Sahlgrenska Academy at Göteborg role-played consultations as part of their final examinations University, P O Box 454, SE 405 30 Göteborg, SWEDEN) in General Practice. Clinical elements of the consultation Aim: Students´ development of an instrumental are scored by doctors, while communication skills are scored by negotiation between the doctor and the trained consultation strategy during a traditional medical simulated patient. In a previous 4-year study it was curriculum. discovered that students communicated less well in Summary of work: The aim was to analyse and evaluate scenarios requiring them to convey certain types of students’ communication skills in the last year of information to patients. This new study looks in detail at undergraduate medical education. Experienced how effectively students communicate different types of supervisors from the consultation skills course in the fifth information under exam conditions. term assessed nine term-ten students´communication skills, by scoring videotaped responses, using Kagan’s IPR Summary of work: The exam scoring scripts for role-played model and participating in a focus group interview. The stations are being analysed in detail to (a) define the communication task more precisely and (b) look for interview was analysed qualitatively. relationships between clinical and communication scores Summary of results: The focus group interview and the type of information that the question requires the acknowledged the students’ ability to listen in an open and student to convey. Analysis will be quantitative (SPSS). receptive manner but their concentration in collecting Summary of results: Preliminary results suggest that medical facts also emerged. The students also had students achieve better communication skills scores when difficulties in structuring the consultation, in being attentive to the patients’ life experiences and in responding to they communicate risk or discuss lifestyle than when they patients’ feelings. A core theme, instrumental strategy, are required to explain a test result or diagnosis. Significant emerged in a reflection of student-patient interactions. findings and the latest data will be presented at the meeting. Quantitative results validated focus group themes. Conclusion/take home messages: Students’ traditional Discussion: Do the criteria used for scoring tasks in clinical rotations and lack of longitudinal communications skills need customisation to suit the nature of the information being conveyed? relationships with patients might contribute to the deficiency of patient-centred skills. The formation of a traditional, doctor-centred professional role may hamper and jeopardize previous efforts to train medical students in 9B 4 Which communication skills are learnt in practice consultation skills. and which need to be taught? Knut Aspegren* and Peter Loenberg Madsen (Copenhagen School of Medicine, National Board of Health, PO Box 1881, DK-2300 9B 2 Identifying and improving preclinical students with Copenhagen S, DENMARK) unsatisfactory communication skills Aim: To identify which communication skills are learnt by Jon Dowell* and John Dent (University of Dundee, Tayside Centre practice and which need to be taught. for General Practice, Kirsty Semple Way, Dundee DD2 4AD, UK) Summary of work: 89 graduating students from Aim: To consider the value of assessing preclinical Copenhagen Medical School and 27 experienced doctors students’ communication skills. from Copenhagen University Hospital were tested on their Summary of work: The ‘Outcomes Based’ educational skills in interviewing and informing standardized patients. model implies testing particular competences and in 2002 The conversations were video-recorded and analyzed by we reported an initiative to formally screen pre-clinical independent observers using the Arizona Clinical Medical medical students’ consulting skills within an OSCE. Those Interviewing Scale for the interviews and a rating scale identified with major difficulties were obliged to attend and modified from Maguire et al. (1986) for the information. pass a two week intensive study module addressing basic Summary of results: The analysis showed a rather similar consultation skills before they could progress to clinical pattern among students and doctors. Both groups were training. This is now a regular component of the exam proficient in skills which characterize civil conversation, process at Dundee which we believe to be innovative. i.e. keeping eye contact and not unnecessarily interrupting Summary of results: This presentation will describe the the patient. Doctors were significantly better at eliciting approach we use, including the global ratings of borderline current problems, exploring timeline of history and performance, along with data on the numbers of student documenting data. Students were better at exploring identified, and subsequent progress. We shall present two patients’ feelings. Both groups lacked important basic years’ data, including an analysis of examiners’ reliability professional skills such as setting the agenda, structuring and improvement achieved through examiner training. the interview/information, using explorative questions and summarizing. Conclusion/take home messages: Screening preclinical student communication skills is feasible and accepted by Conclusions/take home messages: Important professional students but making the assessment reliable is difficult. communication skills are not acquired spontaneously while working as a doctor. Our study identifies skills which need to be taught and trained.

– 4.140 – Section 4 9B 5 Communication skills performance in an OSCE For each of the five physical examination and three history depends on clinical context and cannot be taking stations, the communication skills component sub- score correlated highly significantly with the non- assessed in isolation communication items on the checklists for that station A M S Chesser*, J Cleland, Z Miedzybrodzka and M R Laing (r=0.24-0.50 ,p<0.01), and also with the global score (University of Aberdeen, Undergraduate Teaching Centre, 7th awarded by the examiner for that station (r=0.40-0.75, Floor, Raigmore Hospital, Inverness IV2 3UJ, UK) p<0.01). Correlation between stations of the communication skills sub-scores, and between these sub- To investigate whether it is valid to assess communication scores and the communication skills station score, was skills in isolation, we designed an undergraduate OSCE in significantly weaker (r=-0.1-0.28), failing to reach statistical which a common communication skill component was significance in four of the eight stations. We conclude that embedded in the checklist for each of the history and the assessment of communication skills is highly context examination stations. One additional station assessed only specific. It is not valid to attempt to assess communication communication skills. The hypothesis was that skills using only one or two stations in an OSCE. communication skills components would correlate across stations. The nine station OSCE was sat by 161 students.

Session 9C: The Curriculum (2)

9C 1 Is self-efficacy in clinical skills of medical students a was to develop a common catalogue of learning tool to monitor curricular changes? objectives. Since further planning requires detailed knowledge of educational strategies, a faculty development J Juenger*, D Schellberg, C Nikendei, M Benkowitsch, S Schaefer, program will help staff to acquire knowledge and skills on R Faber, C Roth, B Auler and W Herzog (Dept of Internal Medicine, learning and assessment methods. Solutions to problems University of Heidelberg, Bergheimerstr. 58, 69115 Heidelberg, encountered in the curricular change process at Hamburg GERMANY) Medical School may provide helpful insights for other A problem in curricular change processes is to monitor medical schools in the same enterprise. effects of new interventions on the performance of students. At the University of Heidelberg a major curricular change was implemented two years ago. The traditional curriculum 9C 3 Evaluation of a new curriculum (HeiCuMed) – was replaced by a modular, problem-based curriculum. In comparison before and after implementation internal medicine a pilot study was conducted prior to the Martina Kadmon*, E Gazyakan, Susann Holler, Nina Latham and J change. The aim of the study was to prove the value of self- Schmidt (Surgery Clinic, University of Heidelberg, Im Neuenheimer assessment in students to support curricular change Feld 110, 69120 Heidelberg, GERMANY) processes. This study compared the traditional curriculum (TC) with the pilot curriculum (PC) and the following reform Background: At Heidelberg University a new modular hybrid curriculum (RC) in a pre-post design using skills-related curriculum was introduced in October 2001 replacing a self-assessment expectations (SE). Baseline and post- traditional lecture-centered curriculum. A systematic intervention data were obtained from 61 students in TC evaluation by students performed by the firm Science and 63 students in PC and two cohorts (n=53 and n=52) of Consult monitored the curricular change. It started two students in RC. Students in the PC and RC showed highly years prior to the implementation of HeiCuMed and significant improvements in their self-assessment continues now, so that comparative data are available. The concerning all SE-domains and most of these present work shows evaluation results of teaching in improvements were significantly higher than corresponding general surgery before and after the introduction of change-scores in the TC. Specific changes in the HeiCuMed. curriculum showed corresponding effects in SE of the Summary of results: Teaching in general surgery, consisting students. Therefore measurement of self-assessment of bedside teaching and didactic lectures in the traditional seems to be a valuable tool to support steering in curriculum curriculum, was evaluated worst among surgical and development. medical disciplines. In HeiCuMed the module general surgery reached the highest overall evaluation rates among the disciplines mentioned. 83% of the students rated the 9C 2 Problems encountered in changing a clinical subject positive, whereas 13% gave a neutral rating and curriculum – and their solutions only 4% rated negative. Bedside teaching and PBL were Sigrid Harendza*, Rolf Stahl, Gerard Majoor and Wim Gijselears evaluated positive by 79% and 76% of students respectively. (Universitätsklinikum Hamburg-Eppendorf, Zentrum für Innere The differences of evaluation before and after the change were highly significant (p<0.001). The competence and Medizin, Medizinische Klinik IV, Nephrologie und Osteologie, motivation of teachers were also rated significantly higher Pavillon N26, Martinistr. 52, D-20246 Hamburg, GERMANY) in HeiCuMed than in the traditional curriculum. Medical school graduates are confronted with great Conclusions/take home messages: Comparative demands on capabilities to deal with complex situations evaluation data on the traditional curriculum and in their future workplace. Simultaneously, the changing HeiCuMed showed significant improvement of student nature and fast expansion of medical knowledge requires ratings of both the programme and the teachers. medical schools to reflect upon what to teach. A new educational law serves as a catalyst for curriculum reform in Germany by demanding new approaches to medical 9C 4 Bottom-up innovation to improve medical education education and curriculum design. Hamburg Medical in surgery School has used this chance to consider radical curricular changes. A curriculum committee developed a curricular M K Widmer*, T Carrel and J Steiger (University of Berne, Dept. of strategy and structure with the main features of an Cardiovascular Surgery, University Hospital, Inselspital, 3010 academic year instead of semesters and rotating Berne, SWITZERLAND) themeblocks with integrated courses. Each themeblock Aim: European education standards (Bologna Convention), will be taught twice a year and the sequence of blocks and innovations in teaching methods and potential for electives can be chosen by the students. The main focus improving surgery education at Swiss university hospitals of each block is on integrated student-centered learning require a change of teaching programs. and the first challenge to the participating departments

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Summary of work: In the last 1½ years we introduced a Aim: This paper aims to evaluate a new undergraduate peer-guided curriculum for postgraduates in basic clinical Special Study Module in Drama and Medicine. The knowledge and skills in cardiovascular diseases, module gives students the opportunity to explore links supported by new teaching tools and interprofessional between drama and medicine in the context of the media, learning situations. Worksheets for self-assessment were dramatic literature, the film industry, health education, created to educate the participants in pre- and post- medical training (role play) and clinical resources preparation based on our institutional homepage. In (dramatherapy/psychodrama). addition a portfolio for undergraduate students was created to improve students’ reflection and to increase the Summary of work: The module is taught in a series of highly involvement of postgraduate peers as educational tutors. interactive small group workshops led by tutors with expertise in the field, including performers and therapists. Summary of results: The acceptance of these bottom-up Students are expected to invest time outside of the innovations by the participants was more than 95% and workshops in preparation, including study of literary text led to a more active presentation of topics. The long term (e.g. Shakespeare), appraisal of academic papers, effect of the program for daily practice has still to be devising of educational materials and critical review of evaluated. representations of medicine in television, film, the popular press and radio. Course assessment is by extended Conclusion: Following the establishment of these new research essay, presentation and workshop contribution. concepts the teaching and learning culture changed Evaluation is by questionnaire and focus group (pending). dramatically. The increased interest of young doctors for a By the time of the conference 2 cohorts of students will position at our institution and the positive feedback by a have been evaluated. Results will be presented for the first good ranking in the annual external evaluation by the Swiss time at AMEE. Medical Association stimulates further educational commitment. Conclusions/Take-home messages: Discussion will focus on the merits of broadening the context in which students think meaningfully about their profession, and the 9C 5 Drama and medicine – a Special Study Module implications of incorporating arts methodologies in a Connie Wiskin, Selene Burn* and John Skelton (University of scientific discipline. Birmingham, Dept of Primary Care & GP, Learning Centre & Primary Care Sciences, Edgbaston, Birmingham, UK)

Session 9D: Assessment and Delivery of Postgraduate Education

9D 1 Patient outcomes for colon resection according to 9D 2 Accuracy of medical staff assessment of operative training and certification performance J B Prystowsky and G Bordage* (Department of Medical Education A M Paisley* and S Paterson Brown (University Department of (M/C 591), College of Medicine, University of Illinois at Chicago, Surgery, Royal Infirmary of Edinburgh, 186 The Murrays, 808 South Wood, Chicago, IL 60612-7309, USA) Straiton, Edinburgh, EH17 8US, UK) The effect of surgical training and certification on three Aims: Competency assessment should not be given without patient outcomes (mortality, morbidity, and length of stay direct observation of performance. This study determines (LOS)) were examined for 15,427 patients who underwent whether medical staff provide assessment of operative a segmental colon resection in Northern Illinois from 1994- competence without direct observation of performance. 1997. Comparison groups included: university-based (UB) versus community-based (non-UB) residency program, Summary of work: Over 18 months all Senior House American Board of Surgery (ABS)-certification versus non- Officers on the South East Scotland Basic Surgical Training certified surgeons, colorectal surgery (CRS) subspecialty (BST) rotation were evaluated by consultants and registrars certification versus non-subspecialty certification (non- on their ability to perform specialty-specific operations CRS), and time in practice (<5, 5-20, >20 years) for using a previously validated assessment form. Frequency surgeons with ABS certification. Case mix variables were of medical staff assessment was compared with 1) trainee’s identified from discharge data (i.e., age, gender, colon recording of whether the specific assessor had directly pathology, co-morbid illnesses, urgency, surgeon and supervised them performing the procedure and 2) number hospital volume). Logistic regression was used to identify of supervised procedures performed by trainees derived significant variables for mortality and morbidity and linear from logbook data. regression was used to assess LOS. After risk adjustment, Summary of results: A high percentage of both groups type of residency training, years in practice, and CRS provided assessment of operative procedures which they certification did not significantly affect outcomes (p>.05). had not directly observed. Only 19/102 consultants and However, patients who were operated on by non-ABS- 20/95 registrars surveyed assessed only those procedures certified surgeons experienced significantly higher rates directly observed. 33 consultants and 18 registrars provided of mortality (7.1 vs 4.2, p<.05) and morbidity (30.7 vs 23.8, assessment without observation in over 50% of procedures p<.05) compared to patients operated on by ABS-certified evaluated. A median of 9% (range 0-54%) of assessors surgeons. ABS-certification is a critical surgeon-related provided assessment for procedures that trainees had factor in the outcomes of patients undergoing colon never even performed during the relevant attachment. resection. Outcomes data can link surgeon performance with their educational background and certification, and Conclusions: Medical assessors provided assessment of provide useful formative evaluation to surgical educators. trainee competence for operative procedures which they had not directly observed. Such discrepancy needs to be addressed if accurate assessment of competence is to be achieved.

– 4.142 – Section 4 9D 3 Evaluation of key skills: a new initative within Summary of results: Mean scores were higher for resident vocational training in West Midlands Dentistry than for peer physicians and 6 of these 13 scores were significantly higher (p < 0.05). None of the items completed Vickie Firmstone, Julie Bedward*, Alison Bullock, John Hall and by residents had KCC scores > 0.5. Furthermore, none of John Frame (CRMDE, School of Education, University of the residents’ items had KCC p-values < 0.05, whereas 9 Birmingham, Edgbaston, Birmingham B15 2TT, UK) of the peers’ items had KCC p-values < 0.05. The overall Aim: To report the impact on key participants of a revised internal consistency was higher for peers (alpha = 0.76) programme of Vocational Training (VT) in West Midlands than for residents (alpha = 0.71). dentistry. The Key Skills initiative involves Vocational Dental Conclusions/take home messages: Resident physicians Practitioners (VDPs) compiling an evidence-based portfolio uniformly rate faculty highly, suggesting the need for on six areas central to general dental practice. Portfolios increased attention to comments written on faculty and other coursework components can be used to gain evaluations. Importantly, peer evaluations yield higher exemptions in the MFGDP. interrater and internal reliabilities than resident evaluations, Summary of work: A case study approach was adopted. indicating that peer physicians are more reliable than Quantitative and qualitative techniques were combined to residents for assessing bedside teaching. explore the programme’s impact on key participants. Questionnaires were administered to all VDPs at three stages during training to gauge changes in levels of 9D 5 Strategic planning for developing Postgraduate confidence and experience in Key Skills. Medical and Dental Education in Wales Summary of results: Participants generally viewed Key Skills S A Smail* and H L Young (School of Postgraduate Medical and favourably. Links between Key Skills, clinical governance Dental Education, University of Wales College of Medicine, Heath and the MFGDP were seen to contribute to improved Park, Cardiff CF14 4XN, Wales, UK) quality within VT, and were valued. Statistically significant Aim: The development of a coherent framework for increases in VDPs’ levels of experience and confidence maintaining and enhancing graduate medical education were demonstrated across all areas of Key Skills. programmes throughout the country of Wales. Conclusions/take home messages: Key Skills should Summary of work: Early in 2002, the School of Postgraduate remain a constituent of West Midlands’ VT. Consideration Studies undertook extensive internal and external should be given to it becoming a compulsory element of consultation with key informants from both health service VT nationally and to Key Skills portfolios and other and academic backgrounds to review the current state of coursework components being used to assess minimum graduate medical education in Wales. The School also standards within VT. reviewed extant government policies and external documents. Following this review a formal strategic framework has been developed, setting out institutional 9D 4 A comparison of inpatient teaching evaluations by purpose, vision statements, core values and action required resident and peer physicians: who’s more reliable? in the School’s key business areas. The paper will describe, Thomas J Beckman*, Mark C Lee and Jayawant N Mandrekar (Mayo in outline, the content of the strategic framework. Clinic, 200 First Street SW, Rochester MN 55905, USA) Outcomes: The framework has been published and widely Aim: To compare the reliability of inpatient teaching distributed to decision-makers and politicians, and has then evaluations by resident and peer physicians on Mayo been used as a template for the development of business internal medicine hospital services. plans. It has been widely welcomed as providing transparency and a framework for accountability. Over the Summary of work: Three resident and 3 peer evaluators year since the business plan was produced, the overall observed 10 consecutively chosen attending physicians budget for graduate education allocated by government on the Mayo hospital services. Evaluations by resident and sources has grown significantly and at a rate that exceeds peer physicians were compared in terms of mean scores. previous expectations. Kendall’s coefficient of concordance (KCC) was used to summarize interrater reliabilities, and Cronbach coefficient Conclusions/take home messages: Transparent business alpha was used to determine internal consistencies of planning approaches can lead to improved relationships evaluations by residents and peers. with stakeholders, and may also generate an enhanced commitment from funding agencies.

Session 9E: Continuing Professional Development – Needs Assessment

9E 1 An effective learning needs assessment process for stand beside educational needs assessment in order to GPs meet the needs of the practice population. We therefore sent a questionnaire to 160 GPs in Northamptonshire. Derek Gallen and Glynis Buckle* (Oxford PGMDE, Albany House Medical Centre, 3 Queen Street, Wellingborough, Northampton- Summary of results: 91 replies were received, highlighting shire NN8 4RW, UK) the following: Aim: To encourage GPs to understand the most effective • 97% felt educational needs assessment was very important to their development; methods of learning needs assessment and thereby improving their self directed approach to future learning to • 87% saw clinical audit as a useful and usable tool; benefit themselves and their patients. • 90% suggested personal development plans both as a Summary of work: Much CPD undertaken by GPs has been useful structure to identify their educational needs and done in order to attract postgraduate education allowance as an aid to the appraisal process. rather than to address identified learning needs. Research Conclusions/take home messages: These results show a suggests that this does not improve the quality of patient dramatic increase in the perception of GPs in identifying care and skills that are acquired are rarely brought back to their learning needs. GPs need a structured method of the practice. This is still apparent, despite the Calman deciding educational needs in order to fulfil their own Report (1998) which stated that educational priorities must professional development and the appraisal process.

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9E 2 Training needs in sexual health: evidence from GP reviewers completed evaluation questionnaires and we trainers in the West Midlands, UK interviewed patients. Alison Bullock*, Wolf Markham, Phillipa Matthews and Stephen Summary of results: Of 167 physician volunteers, 142 Kelly (Centre for Research in Medical & Dental Education, School completed the study. Means for all 88 questionnaire items of Education, University of Birmingham, Edgbaston, Birmingham except three were above 4.0 on a 5-point scale. Patients B15 2TT, UK) rated physicians higher than other reviewers, physician self-assessments were generally lower, and scales Aim: To report on the perceived training needs of GP demonstrated strong internal consistency (Cronbach’s trainers in the West Midlands in the context of the new alpha >0.90). Patients were positive about their involvement national strategy for sexual health and HIV. and physicians valued their feedback. Summary of work: Data were gathered from training Conclusions/take home messages: MSF enables feedback documents, discussions with five representatives of key to physicians about communication and humanistic groups and, a survey of all GP trainers in the West Midlands aspects of their performance. Patient contributions are (79% response rate; n=295). important. Challenges are to facilitate use of feedback for Summary of results: There is a readiness to comply with professional development and to introduce learners to MSF the national strategy although high proportions (59%) did earlier in their education. not know the content of the strategy and 86% wanted training on its implications. Knowledge levels on sexual health issues were very high, although the need for partner 9E 4 BEME Collaboration Systematic Review: feedback notification for some sexually transmitted infections was and physician performance overestimated. Many wanted further training in sexual Jon Veloski, James Boex* and Daniel Wolfson (Jefferson Medical history taking (58%), STI testing (44%) and, HIV testing College, Centre for Research in Medical Education and Health Care, (39%). There is no clear match between current training 1025 Walnut Street, Ste 119, Philadelphia 19107, USA) programmes and qualifications and the services expected to be offered in GP surgeries. GP Registrars are not well Aim: To report preliminary results of a systematic review of prepared for sexual health care. There is also scope to the literature on conditions that influence the relationship develop the nurse role. between feedback and physician performance. Conclusions/take-home messages: The provision of sexual Summary of work: Using a protocol approved by the Best health in primary care, and more specifically, the Evidence Medical Education Collaboration, a Topic implementation of the national strategy, needs to be Review Group of 11 investigators searched the international accompanied by considerable training. literature since 1966. A total of 10 electronic databases including MEDLINE, HealthSTAR CHID and Science Citation Index were examined. The contents of key journals 9E 3 Using multisource feedback for physicians: report such as JAMA, CMAJ, Medical Care, Academic Medicine, of a pilot study Medical Education, Medical Teacher and the International Journal for Quality in Health Care were searched manually. Joan Sargeant*, Karen Mann, Suzanne Ferrier, Donald Langille, Data on design, sample, dependent and independent Philip Muirhead and Douglas Sinclair (Faculty of Medicine, variables were extracted and analyzed using systematic, Dalhousie University, Room C106, 5849 University Avenue, evidence-based tools. Halifax, Nova Scotia B3H 4H7, CANADA) Summary of results: The impact of feedback on physician Aim: We conducted a pilot study of a multisource (MSF, performance is moderated by specific conditions including 360-degree) feedback program for family physicians in the physicians’ active involvement in design and Nova Scotia. The research questions were: 1) How do implementation, the nature of performance assessed and physicians, their colleagues, coworkers and patients reported, the timing and extent of feedback, and other respond to the MSF instruments? 2) Is the program feasible concurrent interventions such as reminder systems. and acceptable? This paper reports upon question #1 and feasibility for patients. Conclusions/take home messages: Although there have been conflicting reports on the impact of formal assessment Summary of work: Physicians completed self-assessment and feedback on physician performance, the effects are questionnaires and 8 medical colleagues, 8 coworkers moderated by key variables. The designers of future and 25 patients completed questionnaires for each theoretical as well as practical studies on feedback in the participant. Participants received a report of personal clinical setting must consider these variables. scores compared with aggregate data. Participants and

Session 9F: Clinical Training: New Guidelines to a Common Approach: Leonardo da Vinci Project

9F 1 Clinical training: new guidelines to a common Summary of work: Tutors (n=20) who attended a 1.5 day approach: A Leonardo da Vinci multi centered project educational workshop and their trainees (n=34) were at the University of Lisbon, Faculty of Medicine involved in this process. The educational focus to support changing in the training process was the following 7 key M F Patrício*, J G Jordâo and P M Costa (Faculdade de Medicina de points: (1) to establish an educational agreement before Lisboa, University of Lisbon, Av Prof Egas Moniz, Piso 1, 1649- the training period; (2) to plan/schedule the training; (3) to 028 Lisboa Codex, PORTUGAL) give systematic feedback; (4) to use clinical cases as a Aim of presentation: To disseminate the results of a training learning tool; (5) to teach performing skills “step by step”; project implemented at the Faculty of Medicine of Lisbon (6) to assess students based on explicit criteria; (7) to within the Leonardo da Vinci Project. The aim of this implement a logbook reflecting the previous key points. experience was the improvement of clinical training within Summary of results: The following gains were the Pre-Registration Year. demonstrated by qualitative and quantitative evaluation: (1) a manifest enthusiasm of the involved tutors and students; (2) a better tutor/student relationship; (3) a gain

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in tutors’ self-confidence and competency; (4) an earlier Conclusions/take home messages: Training of tutors student involvement in the definition of their training permits innovation of teaching procedures within clinical objectives; (5) a more objective assessment; (6) a new practice. The spirit of the tutors’ pilot training increased logbook (more adequate learning objectives). tutors’ motivation and encourages the use of different teaching techniques. Conclusions/Take-home messages: (1) The few changes introduced in the educational process resulted in objective and measurable training benefits; (2) The training of tutors was crucial to change the training and assessment 9F 4 Clinical training: new guidelines to a common processes; (3) The logbook was essential to allow mutual approach: A Leonardo da Vinci multi centered project responsibility and process monitoring. at the University of Extremadura, Faculty of Medicine C Pizarro*, J M Morán and J A G Agúndez (Extremadura University - Faculty of Medicine, Avenida de Elvas s/n, E-06071 - Badajoz, 9F 2 Clinical training: new guidelines to a common SPAIN) approach: A Leonardo da Vinci multi centered project at the University of Wales College of Medicine, Cardiff, Aim of presentation: It is imperative to refashion healthcare UK education to achieve a common design adequate to meet the challenges of a European Higher Education Space. Howard Young*, Helen Houston, Helen Sweetland and Richard Mills With this aim, a multi-centred pilot project for clinical (School of Postgraduate Medical & Dental Education, University training was carried out in our University during the 2001- of Wales College of Medicine, Heath Park, Cardiff CF4 4XN, UK) 02 academic year. Aim of presentation: This pilot project has investigated the Summary of work: Ten 6th year medical students training needs of teachers and students for the participated in the multi-centred pilot clinical training standardisation of assessment in the mandatory programme. Twenty-six tutors corresponding to five training preregistration year at six universities in the EU. areas were responsible for teaching during 22 weeks with Summary of work: All 189 final year students undertook a a maximum ratio of one tutor for every two students. A total six week clinical consolidation module, shadowing the of 260 clinical objectives were programmed for every existing occupants of their future Pre-registration (PRHO) student. The objectives were separated into knowledge, post. In August 2002, the new PRHOs underwent local skills, and attitudinal objectives. The use of a log-book induction and received a logbook and reflective journal. At was recommended among other educational strategies. 3 and 6 months, educational supervisors and trainees Summary of results: The pilot clinical program was received evaluation questionnaires and a Record of In- achieved with positive results for all students. The Training Assessment (RITA). percentage of specific clinical objectives achieved was Summary of results: At 3 months, 68 trainees and their over 50%. Results also indicated that a careful reformulation supervisors responded and at 6 months 76. There was of objectives is imperative for the future development of the concordance between trainees and trainers in all areas. At program. 3 months, 98% and at 6 months 100% of PRHOs were Conclusions/take home messages: The pilot clinical deemed satisfactory or above in their RITA. Both groups training program results indicate that, after reformulation indicated there had been sufficient opportunity to develop of objectives, enough human and institutional resources knowledge, skills, attitudes and interpersonal skills, are available in the University Hospitals to establish an including the use of feedback. The logbook, reflective European common programme for clinical training. journal and educational contract had the lowest scores. Conclusions/take home messages: Further training in the use of logbooks, reflective journals and the role of 9F 5 Clinical training: new guidelines to a common educational contracts is required for trainees and trainers approach: A Leonardo da Vinci multi centered if standardisation is to be achieved. project at the Pecs University Faculty of Medicine Peter Szekeres* and Anna Bukovinsky* (Pecs Medical University, 9F 3 Clinical Training: new guidelines to a common Department of Trauma, 12th Szigeti Str, H-7623 Pecs, HUNGARY) approach: A Leonardo da Vinci multi-centred Aim of presentation: to present results of a pilot in Pécs project at the University of Granada, Spain University Medical School as part of a Leonardo da Vinci multi centred project. C Campoy*, J M Peinado, J Caòizares, C Chung and B Gil (Department of Paediatrics, School of Medicine, University of Summary of work: To improve the quality of sixth year clinical Granada, Granada 18012, SPAIN) training, a pilot project has been designed and performed. It started with Teachers’ Training on recent educational Aim of presentation: Dissemination of results from a pilot methods, skills training, OSCE, clinical cases, feedback tutors’ training (PTT) developed and assessed at the and the use of the logbook. This well-planned pilot of 3 School of Medicine, University of Granada. weeks’ duration was carried out in Internal Medicine and Summary of work: The PTT aimed to stimulate interest in OBG. These started with a short practice and an OSCE of the “tutor & student” relationship, to discuss the tutor’s clinical skills necessary for the training period and were needs, to introduce a new logbook of clinical skills, to followed by clinical training with close tutoring and develop methods for assessment, and feedback about feedback activities. Both Teachers’ Training and Students’ teaching procedures. An individual reflection about the Training periods were evaluated by questionnaires. PTT and students’ pilot programme was carried out. Some Summary of results: Teachers participating in the Teachers’ criteria were adopted and an assessment of the course Training evaluated it as useful for their future tutoring was performed. activities, and expressed that they would also participate Summary of results: High success and level of motivation in similar training in the future. As for the Students’ Training, of the tutors. 74% considered that objectives were achieved. regular feedback and the use of the logbook were found to 100% agreed about the content of the tutors’ and students’ be the most difficult task. However, both tutors and students training programme and 50% considered important an evaluated the pilots as successful. economic stimulus. 100% considered important the work Conclusions/take home messages: Professionalization of in dynamic groups and the need for educational support the teachers is an indispensable element of the material, and 50% thought that it had important advantages improvement of clinical training. However, both feedback for their own work; 65% considered that the educational and skills training should be introduced earlier in the strategy and the practical issues were correct. Advantages curriculum to bring better results. for our School of Medicine are already clear and the feeling was classified as very good from 100%.

– 4.145 – Section 4 Session 9G: Courses for Medical Teachers

9G 1 Results from the evaluation of a faculty 9G 3 Developing skills in educational appraisal: from development program for 414 Physicians as theory to practice Educators for a large German medical school Gellisse Bagnall*, William Reid and Chris Morran (NHS Education O Genzel-Boroviczény*, F Christ, T Aretz, E Armstrong and R Putz for Scotland - West Region, 3rd Floor, 2 Central Quay, 89 Hydepark (LMU, Neonatology, Maistr 11, D 80366 München, GERMANY) St, Glasgow G3 8BW, UK) Aim: Evaluation of a professional faculty development Aim: To present evaluation of an educational intervention program by participants. on appraisal training and its effect on subsequent practice of educational appraisal with doctors in training. Summary of work: The LMU Munich Medical School offers jointly with Harvard Medical International a 4.5 day faculty Summary of work: Since 2000, a workshop on educational teaching program since 1997. The course sessions were appraisal for trainees has been offered to all hospital ranked by the participants between 0 (excellent) 1 (very consultants in the West of Scotland. It emphasises active good), 2 (good), 3 (satisfactory), 4 (less satisfactory), 5 learning, is multi-specialty, and aims to: (1) clarify the (expectations not fulfilled). relationship between educational appraisal and assessment; and (2) increase understanding of how to Summary of results: The evaluation by the 414 participants conduct effective educational appraisal with trainees. of the nine courses showed a very high degree of Consideration is also given to dealing with poorly satisfaction with the course content. The best scores were performing trainees. Workshop evaluation was two-stage: achieved for interactive sessions with an obvious direct relevance for the participants’ own teaching: Participating • formative, to (1) establish whether stated educational in a tutorial as “student” (1.4± 1.3), observing a demo tutorial outcomes achieved; and (2) provide feedback about (1.3 ±1.3), giving and receiving feedback with video taping content and delivery. All participants (n=365) asked to a short lecture (0.5 ± 0.3). Except for a session on large complete anonymous form. group lecturing (0.8± 0.8) theoretical parts of the training • impact, to establish perceived impact of workshop on received slightly lower grades: Learning Theory (1.7±1.6), subsequent practice of educational appraisal. Internet use (1.8±1.3), Evaluation Theory (2.7±0.4), Case Questionnaire posted 6 months post workshop (n=202). Writing (1.6±1.3). Summary of results: Conclusion: Faculty development programs are very well • Formative evaluation (response – 90%). Most highly accepted by German Medical Faculty, particularly if they rated aspects: multi-disciplinary group discussion; include active participation and are relevant to their own specially produced videos of educational appraisal; how teaching. to deal with poor performance. • Impact evaluation (response – 53%). 63% had changed 9G 2 Studies on doctors and dentists taking university their practice. This included greater emphasis on: advance preparation; protected time; setting educational educational qualifications objectives; listening to trainee. David Wall* and Zoe Nuttall (West Midlands Deanery, PMDE, Institute of Research and Development Building, Birmingham Conclusion: Short course can contribute to improved Research Park, 97 Vincent Drive, Edgbaston, Birmingham B15 practice in educational appraisal for doctors in training. 2SQ, UK) Aim: To present research work on doctors’ and dentists’ 9G 4 Changing teachers’ learning skills – a pilot study beliefs on why they have undertaken university educational qualifications in medical education at certificate, diploma L Nasmith* and Y Steinert (University of Toronto, Department of and master’s degree level, and what they have gained. Family & Community Medicine, 256 McCaul Street, 2nd Floor, Toronto, Ontario M5T 1W5, CANADA) Summary of work: A questionnaire was derived from previous work in this area, a literature review and expert Aim: To evaluate the effectiveness of a workshop on opinions. It was piloted and shown to have good test: retest interactive learning. reliability and validity. The main questionnaire contained Summary of work: From a list of 70 registrants, 8 faculty free text questions, Likert style questions and free members were randomly assigned to a participant group comments box. It was sent to 121 doctors and dentists in (PG) and 8 to a non-participant group (NPG). The the West Midlands Deanery in England taking educational intervention consisted of a half-day workshop on interactive qualifications. There were 106 replies (88% response). lecturing. Six months after the session, individuals from Analyses included text analysis, Likert scale tests of both groups were videotaped giving a lecture. All 16 significance and factor analysis. individuals were also interviewed using a semi-structured Summary of results: Candidates thought that the questionnaire which explored: their thoughts about the qualifications had given them better understanding of lecture; their views about lecturing; and their thoughts about medical educational principles, improved knowledge and faculty development activities. skills, helped structure their teaching better and had given Summary of results: There were no differences in the type them greater insight. Factor analysis showed the main two of lecture given between both groups. In the lecture factors related to educational activities and medical preparation, the participants reported paying more attention education and the culture in which it is held. to incorporating interactive techniques while non- Conclusions/take home messages: Studying for a university participants focused more on the content. While delivering qualification in medical education appears to improve the lecture, the PG were more aware of the audience insight, knowledge and skill, give better understanding of response while the NPG were more concerned with medical education culture. It is also an enjoyable and covering the material. Most of the PG felt that they had stimulating experience! been interactive and their self-assessment correlated with the observer’s rating. Half of the NPG stated that they had been interactive although they rated themselves low as did the observer. On the observation grid, the PG used more examples, questions, techniques to engage the audience (e.g. buzz groups) and effective audio-visual and written materials than the NPG. The PG also scored higher on

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their presentation skills and on the degree of lecturer students and the perceived benefits they (medical interaction and student participation. residents) gain from this activity. It shows that the contribution by residents to the education of medical Conclusions: Through the use of self report and undergraduates has increased over the years resulting in observation, this pilot study demonstrated that participants the need for formal training courses in teaching and more in a half-day workshop on interactive learning changed supervision by faculty staff. In addition, there is a need for their attitudes about lecturing and increased their use of the knowledge of basic educational concepts that interactive techniques. constitute and facilitate teaching. From this review, an educational paradigm is described where the concepts of professional competency and teaching by medical 9G 5 The Physician-as-Teacher rule: hypothesis or fact? residents are re-examined. These concepts are described Jamiu Busari (Emma Children’s Hospital, Meibergdreef 9, 1105 AZ, in a different educational context called the physician-as- Amsterdam, NETHERLANDS) teacher rule, using the knowledge from theory in education and findings from educational research. A careful outline Aim: Description of a new paradigm in medical education: of this process is provided. the “Physician-as-Teacher rule”. Conclusion: The “Physician-as Teacher rule” claims that Summary of work: This paper describes a review of the “A skilled teacher has an increased chance of becoming a teaching activities conducted by medical residents from a good clinician, than a skilled clinician has of becoming a resident’s perspective. The review shows medical good teacher”. residents’ willingness to teach undergraduate clinical

Session 9H: Student Support

9H 1 Academic Support were living in dormitory accommodation and 40% were Norma Susswein Saks (UMDNJ-Robert Wood Johnson Medical living with their parents. Results on the stressors inventory showed that among the different stressors, difference in School, 675 Hoes Lane, UBHC D-341, Piscataway, NJ 08854- evaluation criteria in faculty and hospital, doubts about 5635, USA) choosing nursing as a career, unclear expectations of tutors Academic support has become an important component and faculty administration, fear of unemployment upon of medical education. Medical schools have an immediate graduation, long period of clinical education, hospital interest in fostering student academic success to assure personnel’s negative attitude, problems in marriage and timely progression through the academic program and to negative attitudes of authorities towards the student increase graduation rates. Academic support is also complaints, were more stressful than other factors. essential in educating medical students, as future Problems with children, spouse and dormitory roommates physicians, to become effective self-directed learners. The were least stressful. In general the most severe stressors aim of this presentation is to describe a successful were clinical stressors and least severe stressors were comprehensive academic support program that has grown personal stressors. For coping with stress factors, students and flourished over the past 20 years. Essential often used accepting responsibility and confrontive coping. components include providing specific content tutoring as Seeking social support and distancing were used at much well as instruction in effective and efficient study strategies lower rates. and test taking skills, early intervention and confidentiality. Participants will understand why academic support for medical students is often needed, how to encourage 9H 3 Influence of studying students’ health student participation and ways to measure the success of Onur Ozgur (International Federation of Medical Students’ a program. The challenges of hiring and training instructors Associations, Gringelsbach 61, 52080 Aachen, GERMANY) for positions in academic support will also be addressed. Aim: The aim is to present the results of this study, where students try to find out if there is a correlation between 9H 2 Stressors and coping strategies in nursing studying and students´ health, especially if there is a students, Shiraz – 2000 difference between the health and the various educational systems. The first results were presented in Berlin. In follow- Farkhondeh Sharif*, Reza Zighamiee, Hamid Ashkani and Alireza up studies last year faculties from The Netherlands were Ayatollahi (Shiraz University of Medical Sciences, PO Box 71935- included. 1331, Shiraz, IRAN) Summary of work: This study is organized by the IFMSA. Background: Entry to the industrial society has opened a The questionnaire contains the following areas: general new horizon to human life and has led to new achievements information, health information, lifestyle. aimed at securing a more comfortable life and better welfare. But the resulting changes in lifestyle caused stress In our analysis we focus on two aspects: educational system in humans so that the twentieth century has been named and educational level. the stress century. About 2,500 questionnaires from 7 schools (4 in Germany, Summary of work: With the aim of surveying the stressors 3 in The Netherlands) were collected. and coping strategies in baccalaureate nursing students, Summary of results: Students feel their health to be worse a descriptive-analytical study was designed in Shiraz than their peer population. Lifestyle changes much during nursing faculty and the 100 participants in this study were this time. The students sleep less, drink more coffee and chosen by multistage stratified systematic random alcohol and take less care of themselves. Some sampling from 300 students who had the necessary differences between PBL- and traditional curricula were qualifications to be included in this study. Participants found. answered a questionnaire consisting of three parts: demographics, stressors inventory and Lazarus coping Conclusions: Future health care workers feel that their checklist. health deteriorates during their studies and their lifestyle and habits get worse. Considering the future responsibility Summary of results: 33% of the students were males, 67% of the students, medical schools should offer courses to females; 97% were less than 23 years old. Also 93% of the cope with stress and the burden of the medical profession. samples were unmarried and only studying. Sixty percent

– 4.147 – Section 4 9H 4 Student support mechanisms – implementing Best 9H 5 Impact of a mentoring program in a Brazilian Medical Evidence Medical Education School: changes acknowledged by the students R Arnold* and J G Simpson (University of Aberdeen, Department Patricia Lacerda Bellodi* and Milton de Arruda Martins (CEDEM of Old Age Psychiatry, Clerkseat Building, Royal Cornhill Hospital, – Medical Education Development Center, School of Medicine, Aberdeen AB25 2ZD, UK) University of Sao Paulo (FMUSP), Rua Dona Luiza Julia, 12 apto. 62, Itaim Bibi, São Paulo, BRAZIL) Aim: We are reporting on our Regent scheme, which exists to support, mentor and advise undergraduate medical The “Programa Tutores FMUSP”, a Brazilian mentoring students by linking them with a member of staff. The program, has as its main objectives to contribute to a scheme has been in existence for many years, but has complete medical education and to promote greater never operated entirely satisfactorily. We therefore decided contact between students and teachers. The impact of to apply BEME principles – evaluate the scheme, study the the activity was evaluated after eighteen months of relevant literature, implement change and then re-evaluate. implementation by mini-forums in classrooms and through the application of a questionnaire (answered by 41% of Summary of work: Both students and staff expressed some the students). The students’ opinions are heterogeneous concern about the original scheme. Students in difficulties regarding their satisfaction with the program and the often failed to consult their Regent for help or advice. Some questionnaire has brought about the fact that many students Regents had so many students that it was difficult for them do not attend the meetings on a regular basis. However, to support them all. Despite concerns, the vast majority of almost 40% of the respondents acknowledged that there students and staff felt the scheme was important and should were changes due to the program (especially amongst continue. We decided to capitalise on this view of the those in the first year of the course), such as a better scheme by improving its effectiveness. We examined the knowledge of the course (23%); increase in the network of literature for evidence of best practice and changed the friendships (16%); motivational growth (16%); perception scheme accordingly, including limiting the number of of Medicine in a more positive manner (11%); improvement students to each Regent, making meetings mandatory and in the coping with stress (7%); and progress in academic set up by Regents and providing regular training sessions performance (1%). Such results indicate that the general for Regents. objectives of the activity have been communicated to a Summary of results: Reactions to the revised scheme were significant number of the students and efforts should be assessed using a postal questionnaire. Both students and continually made towards improving the students’ staff rated the changes positively and overall satisfaction participation. was improved Conclusion/take home message: We feel that our findings confirm the value of Best Evidence Medical Education in practice.

Session 9I: Patient Simulation

9I 1 A portable skills lab for scenario-based training 9I 2 Interpretation of three-dimensional structure from R Kneebone*, D Nestel, Lo B, R King, J Kidd, A Barnet, L Poore, R two-dimensional endovascular images: how Brown, L Edwards, G Z Yang and A Darzi (Imperial College School of experience and training affect perception Science, Technology and Medicine, Department of Surgical R S Sidhu*, S J Hamstra, D Tompa, R Jang, E D Grober, R K Reznick Oncology and Technology, Faculty of Medicine, 10th Floor, QEQM and K W Johnston (University of Toronto, Division of Vascular Wing, St Mary’s Hospital, Praed Street, London W2 1NY, UK) Surgery and the Centre for Research in Education, Toronto General Scenario-based procedural training combines inanimate Hospital, 1 Eaton South, Room 565, 200 Elizabeth Street, models and simulated patients within a structured, learner- Toronto, Ontario M5G 2C4, CANADA) centred environment (Kneebone et al, 2002). Initial skills Aim: To study the effect of experience and training on 3D lab-based development has highlighted a need to perception of 2D angiographic images of abdominal aortic transplant scenarios into a clinical environment to heighten aneurysms (AAA) using a novel computer-based method their realism. This paper describes a possible solution. of producing 3D depth maps based on subjects’ We present an innovative portable recording system, based interpretations of 2D images. on digital technology. Two miniature video cameras are attached to a discreet free-standing mount resembling a Summary of work: Eight experts (surgeons) and 18 novices drip stand. These record an MPEG-encoded and digitally (junior residents) were presented with a 2D AAA encrypted audiovisual output directly onto disc (DVD) within angiographic image. Using the software tool to capture a small computer located in an adjoining room. One their interpretation of surface attitude, a depth map was camera provides a wide view of the procedure, while the generated for each subject. The novices were then other has a pan-tilt-zoom facility for providing close up views randomized into control and treatment (brief AAA anatomy of procedural detail (controlled from the computer’s touch- educational session) groups. All subjects repeated the sensitive screen). Each scenario is watched in real time exercise on a second image. Comparisons between by observers who subsequently provide focused feedback. experts and novices were made using shape index (SI): a The digitally recorded performance is available for subject’s perception of overall object contour (calculated immediate review using any laptop computer. The entire using Spearman’s rank correlation). process is portable, self-contained and can take place Summary of results: The SI was different (p<0.001) between within a clinical setting. Detailed evaluation (observation the expert and both novice groups for the first image. and interviews) with 15 medical students provides strong Following the educational intervention, the control and preliminary support to the feasibility and perceived treatment groups had different SIs (p=0.001) with the educational value of this development. This inconspicuous, treatment group being more similar to the experts. portable yet securely-encrypted recording system offers the potential to explore the relationship between simulator- Conclusions/take home messages: By demonstrating that based training and clinical performance. surgeons and trainees differed significantly in 3D perception, we have established a method that captures the well-known but previously unstudied differences in perception related to experience. This is confirmed by the

– 4.148 – Section 4

improvement seen in the treatment group. These results investigating the students’ perception and opinion toward have potential implications for understanding the training using realistic CD-ROM programme. Three endovascular learning curve. months later the students received a follow up questionnaire. 9I 3 Teaching clinical reasoning with the Dynamic Summary of results: No significant difference of the total scoring in the practical test was found between the groups. Patient Simulator The students who had used the programme were positive S Eggermont*, P M Bloemendaal and J M van Baalen (Leiden about its structure and user-friendliness. The follow up University Medical Center, Heelkunde Onderwijs K6-R, Postbus questionnaire revealed no change in the perceptions and 9600, 2300 RC Leiden, NETHERLANDS) opinions toward computer-based learning but a limited use of the programme. In most medical curricula clinical reasoning is taught in small-group sessions directed by a medical specialist. This Conclusions: Novice medical students acquired a individual teaching approach is much appreciated by considerable and comparable ability in performing students, but also has some major drawbacks; the amount advanced cardiopulmonary resuscitation after training in of time a teacher has to invest, the variable educational both CD-ROM group and the small group discussion group. quality of the teachers and the opportunity for students to The majority of the students in this study had positive hide behind other people’s efforts and opinions, thus not attitudes toward computer-based learning. participating in the learning process. In January 2003 four Dutch medical schools started a cooperative, two-year project to develop computer based training material to 9I 5 On-site, hands-on simulation training program overcome these drawbacks. The Dynamic Patient using a mid-fidelity simulator for crisis resource Simulatorâ (DPS) will be used to create a relevant arsenal management and teamwork training of patient simulations with various clinical topics, with an embedded feature for teaching clinical reasoning. Kitoji Takuhiro*, Hisashi Matsumoto, Toru Mochizuki, Yuji Students can perform DPS cases independently as Kamikawa, Yuichiro Sakamoto, Yoshiaki Hara, Kunihiro Mashiko preparation for the small-group sessions. While performing and Yasuhiro Yamamoto (CCM Nippon Medical School, Chiba a DPS case, students can request assistance with and Hokuso Hospital, 1715 Kamagari Inba-Mura, Chiba Pref Zip 270- feedback on the clinical reasoning, adapted to the personal 1694, JAPAN) level of experience. Teachers can look into the students’ results, register common lack of knowledge and specific Aim: To show the effectiveness of an on-site, hands-on student’s problems, at which the following small group simulation training program using a mid-fidelity simulator session can be directed. Application of DPS is expected to (Laerdal SimMan(R)) for crisis resource management and improve clinical reasoning and make small group sessions teamwork training. of a more constant and higher quality. Summary of work: The number of simulation centers is growing, and some centers have equipment that can simulate realistic environments. Some routine working 9I 4 The impact of computer-based learning in training environments, however, cannot be easily simulated. We cardiopulmonary resuscitation used a compact and mobile mid-fidelity simulator to overcome these problems. We ran our simulator in the Helle Thy Østergaard*, Doris Østergaard, Anne Lipper, Alice CAT scan room of the Radiology Department to train staff Drenthe and Jan van Dalen (The Danish Institute for Medical members to be able to cope with anaphylactic reactions Simulation, Department of Anaesthesiology, Herlev University caused by iodinated contrast media, in the Emergency Hospital, Skandrups alle 46, DK 2730 Vaerlose, DENMARK) Room to help understand initial treatment strategies for Aim: The aim of this study was to investigate the possible unstable patients, and in the newly initiated “Dr. Helicopter” differences between two educational methods for the program to train doctors for helicopter rescue and treatment complex learning outcome of cardiopulmonary missions. resuscitation. Furthermore, the students’ perception and Summary of results: The use of a mid-fidelity simulator for opinion toward training using a realistic CD-ROM “on-site, hands-on simulation training” contributes to the programme was studied. development of crisis management skills and improved Summary of work: Fifty-eight seventh-semester medical patient safety in some medical fields. We used a scenario students were randomly assigned into 2 groups: 1) CD- checklist to evaluate performance scores. The scores of ROM training 2) Small group discussion. After the most of the students who participated in the simulations intervention all students were individually assessed in a improved. practical test using a resuscitation manikin linked to a Conclusion/take home message: “On-site simulation” is a computer. A questionnaire was given to both groups reasonable approach to reproducing real environments.

Session 9J: Rewarding Teaching

9J 1 Mayo Clinic Clinician Educator Award Program of the first three years of this program will be reviewed. Thomas R Viggiano* and Roger W Harms (Mayo Clinic, Mitchell This program has resulted in new courses, curricula, and the development of a variety of learning resources. Funded Student Center, B11, 200 First Street SW, Rochester, MN 55905, projects have been presented at educational meetings and USA) published in educational journals. This program has also As a result of diminished reimbursement for health services, facilitated the development of a mentoring program for clinical faculty in academic health centers are spending educational research. The impact of this program on the more time in patient care activities and less time in career development of clinician educators and the overall education and research activities. Mayo Clinic has impact of this program on Mayo Clinic’s educational implemented a program to grant time and resources to programs will be discussed. We are reporting the clinical faculty to support the development of educational experience of our program to provide a model, for other projects. Proponents of educational projects, judged to be academic health centers, to facilitate educational meritorious by an impartial peer review process, receive innovation and scholarship despite increasing constraints funding for time and other expenses for a maximum period on academic clinicians’ time and resources. of two years. The operational logistics, budget and results

– 4.149 – Section 4 9J 2 Financial incentives to improve teaching programme to develop future leaders. This paper will present the results of that consultation, identifying the key R P Nippert*, U Grawe, B Marschall and A Böckers (Institut fur competencies for an effective leader of healthcare Ausbildung und Studienangelegenheiten, der Medizinischen education, and the processes necessary to develop them. Fakultät (IfAS), Von-Esmarch-Strasse 54, 48149 Munster, It is clear that the generic competencies of effective GERMANY) leadership have to be supplemented by specific skills Teaching at medical schools in Germany has suffered related to working at the interface between educational considerably in academic reputation compared to research institutions and healthcare delivery systems. and patient care. To enhance teaching, improve its quality and reestablish it as an important part of academic life, a model of financial incentives was set up at the Medizinische 9J 4 An algorithm for distributing faculty funds on the Fakultät Westfälische Wilhelms-Universität, Münster. It basis of quality of teaching combines input and output measures. Input refers to H van den Bussche*, M Ehrhardt, H Kaduskiewicz (Institute of teaching load, styles and format, participation in oral General Practice, Universitätsklinikum Hamburg-Eppendorf, examinations, and training of final year students on the ward. Output is measured by comparing Münster students’ Martinistr. 52, 20246 Hamburg, GERMANY) results in the nationwide exams to the general mean of all In the past, allocation and distribution of funds in German German students. In addition, the results from students’ medical faculties was based on unclear criteria. Tradition evaluation of each course are taken into account. By this played a more important role than facts. If any, teaching model the amount and quality of teaching is defined by load was accounted for, but productivity did not play a role. institution (clinics and institutes). A ranking process Over approximately the last five years, many faculties have determines their relative position together with the financial introduced criteria of productivity in research. Very recently, compensation. The faculty has pledged 30% of the a discussion on how to reward quality of teaching has been manageable budget to be available for distribution. The raised. Hamburg medical faculty has developed a formula model was implemented last year. Incentives have been to reward teaching quality on the basis of student evaluation paid. As a result, the Institution has been extremely results, performance in examinations and tests and responsive and students’ evaluations seem to produce activities of the departments to improve their teaching increasing interest in teaching in faculty members. It programmes. Details of the algorithm will be presented remains to be seen whether it will produce spin off and and the problems of acceptance and compliance of the impact on the reputation system in academia as intended, faculty to such a scheme will be discussed. enhancing the prestige of teaching itself. 9J 5 Faculty recruitment and retention 9J 3 Developing tomorrow’s leaders of healthcare M R Sandhya Belwadi (M S Ramaiah Medical College & Teaching education in the UK Hospital, Msrit Post, Msr Nagar, Bangalore 560 054, INDIA Stewart Petersen* and Judy McKimm (Leicester Medical School, Aim: To conduct a survey among the teaching faculty and Department of Medical and Social Care Education, PO Box 138, students about selection of teachers in a medical school Leicester LE1 9HN, UK) attached to a teaching hospital. Dramatic changes in healthcare education around the Summary of work: A questionnaire was prepared and was world have been led by individuals who are expert in given to 50 senior faculty and students. educational matters, but often largely self-taught in leadership and management skills. New generations of Summary of results: Results from students and academia curriculum leaders need more structured preparation for reflect the cross section of opinions. their leadership roles. This take place in a few centres Conclusion/take home message: Selection of faculty and already, but the Higher Education Funding Council for retaining them is one of the biggest challenges. We need England has recently funded a leadership programme to do this job very carefully as the faculty and students are spanning all UK healthcare education providers. The initial the best human resources. Retention of 80% of staff is vital stage of this process is consultation with existing curriculum for the growth of any institution. leaders and other experts on the essential attributes of a

Session 9K: Is the Graduate Competent?

9K 1 Anxieties and fears facing general residency: are we Summary of results: Responses (from the 45% respondents) preparing students commencing clinical practice? identified some anxiogenic “islands” (death; meeting infections and AIDS; substance abuse; pain management; António Pais de Lacerda*, Paulo Seca and Maria José Metrass o o skills in critical care; increasing responsibilities; (Hospital de Santa Maria, R. Prof. Carlos Teixeira, N 1 - 5 C, 1600- interpersonal conflicts). 608 Lisboa, PORTUGAL) Conclusions/take home messages: Although it is Background: Anxieties and fears are common when impossible to feel comfortable in most areas of Medicine medical students start their hospital clinical work during when completing university, these gaps in preparedness the first two years of general residency. Do students feel should be considered in the design of new curricula for prepared to diagnose and treat conditions or to perform medical schools and focused clinical introductory courses, tasks and procedures they will confront soon in their in order to meet the needs of the next generations of residency period? residents. Summary of work: In order to understand eventually stressful situations, a semi-structured, 55-item questionnaire was sent to 56 1st/2nd year residents practising in a general 9K 2 Postgraduate education for hospital based hospital, listing possible anxiety-provoking experiences and midwives in the Netherlands potential concerns regarding expected clinical A Zuidinga*, W v d Meijs and F Scheele (Dept of Woman & Child competencies (diagnosis, management, data Care, St Lucas Andreas Hospital, Jan Tooropstraat 164, NL 1061 interpretation, technical skills, and attitudes). AE Amsterdam, NETHERLANDS)

– 4.150 – Section 4

Aim: To present a needs assessment for postgraduate Following the recommendation of the General Medical education for midwives working in moderate and high risk Council in ‘Tomorrow’s Doctors’ (1993), sessions of obstetric wards. communication skills, ethics and law are now required at most medical schools in Britain. In this paper we present Summary of work: The obstetric system in the Netherlands the results of a survey of Pre-Registration House Officers is based on firm boundaries between physiology and working in various teaching hospitals in London who had pathology. Midwives are trained for the low risk pregnancy all received training on obtaining consent as part of the group but 15% are also working in hospitals with moderate core undergraduate curriculum. We asked the junior and high risk patients. By telephonic questionnaires we doctors about their experiences, legal knowledge and contacted midwives in 16 different hospitals to make an views regarding the practice of eliciting consent. Fifty of 68 inventory of their job and whether they felt sufficiently (74%) Pre-Registration House Officers completed the prepared for their clinical work directly after their questionnaire. In particular, we examine the extent to which graduation. Finally the response was 100%! their undergraduate education in ethics and law applied Summary of results: Percentage of midwives who felt to medicine and communication skills training had insufficiently prepared with regard to moderate and high prepared them for clinical practice. In addition factors other care skills: to explain cardiotocography 50%, to insert than the training of medical students which are important infusion 68%, intra-uterine registration 87%, control the for the implementation of an ethically and legally new mother 18%, didactic skills 68%, diagnostic tests 50%, acceptable standard of informed consent will be discussed. working of medicines 81%, explain laboratory results 90%, make ultrasounds 75%, social skills 50%. Conclusions/take home messages: Clinical midwives feel 9K 5 A formal assessment of the practical skills of South insufficiently prepared to work in a hospital directly after African medical graduates on entry to their pre- their graduation. The Royal Dutch Organisation of registration year: evidence that key skills are lacking Midwives together with the Dutch Organisation of Rae Nash*, Vanessa Birch, Tuvia Zabow, Trevor Gibbs and Richard Gynaecologists made a new “clinical midwife profile” Hift (University of Cape Town, Department of Medicine, Faculty of which will be a starting point for the postgraduate education. Health Sciences, Anzio Road, Observatory 7925, SOUTH AFRICA) Aim of presentation: It is the perception of many senior 9K 3 Is the clinical study appropriate? Students’ views clinicians that South African medical graduates entering their preregistration year are insufficently skilled in common J Schulze*, S Drolshagen and P Schmucker (Deans Office, Theodor clinical tasks. We have tested this hypothesis in a group of Stern Kai 7, 60590 Frankfurt/Main, GERMANY) new interns (pre-registration house officers) reporting for The presentation will summarize results from a duty after graduation. questionnaire survey with students at the end of their clinical Summary of work: Seven core skills were assessed in a study. Students were asked prior to starting the practical standard OSCE. Tasks were assessed on two levels: basic year (Praktisches Jahr) about their preparedness in theory technical success, and attention to key quality issues such and practice. The questionnaire included both statements as maintenance of sterility. Subjects were thereafter asked about general perception of lectures, seminars, practicals to rate their own assessment of their performance. and clinical education, as well as their evaluation of specific clinical courses. Free comments were actively Summary of results: sought about good and bad personal experiences, as well • 58 interns drawn from all 8 South African medical as their suggestions for improvement. In general, students schools participated; lacked practical experience, especially patient contacts. • The programme was well-received; Also, they missed guidelines for action in common diseases. Correspondingly, most students rated high the • Performance in most skills was suboptimal; learning from books or clinical clerkships (Famulatur). • Technical success was commonly accompanied by Lectures usually were not well perceived, with an poor attention to aspects of quality; increasing acceptance for practicals and clinical • Students rated themselves as more competent than their seminars. Unanimously well evaluated were voluntary results warranted. courses, usually including small group teaching and practical experience. Despite the similarity in judging the Conclusions/take home messages: Newly qualified overall clinical curriculum, major differences were seen medical graduates lack facility and polish in the in the evaluation of specific clinical courses between the performance of key technical skills, and may not recognise two medical faculties. The survey indicated major their own lack of skill. We conclude that there should be a deficiencies in clinical practice and routine; we hope that stronger emphasis on the teaching of practical skills and the oncoming changes required by the Federal Licensing on their assessment during the undergraduate curriculum. Regulations (Approbationsordnung) will ameliorate these Skills of interns reporting for duty should be assessed and shortcomings. further training offered to them.

9K 4 Informed consent in clinical practice: experiences, knowledge and views of Pre-Registration House Officers Jan Schildmann*, Annie Cushing, Len Doyal and Jochen Vollmann (Institute of Medical History and Medical Ethics, Friedrich- Alexander University Erlangen-Nuremberg, Glueckstrasse 10, 91054 Erlangen, GERMANY)

– 4.151 – Section 4 Session 9L: Postgraduate Multiprofessional Education

9L 1 Evaluation of a faculty program in palliative care Conclusions/take home messages: education and practice • It is possible to develop and deliver new ways of working. Amy M Sullivan, Antoinette S Peters* and Susan D Block (Harvard • Scale down ambitions in the development of mid-level Medical School, Dana-Farber Cancer Institute, 44 Binney Street, practitioners. Room G420D, Boston MA 01984, USA) • Don’t underestimate the personal development agenda Aim: To present results of an evaluation of a faculty when moving people from their professional silos into development program in palliative care education and the unknown. clinical practice. Summary of work: The program featured a multidisciplinary 9L 3 Knowledge increase following an evidence-based faculty (physicians, nurse practitioners, educational multiprofessional education program aimed at psychologists) and participants from a range of disciplines service improvement and settings (generalist and specialist physicians, nurses, social workers, pharmacists, and ethicists in hospices, Kirsty Foster* and Janet Vaughan (RPA Women and Babies, RPA hospitals and schools of medicine/nursing). Training Newborn Centre, RPA Hospital, Missenden Road, Camperdown, focused on clinical skill development (e.g., communicating NSW 2050, AUSTRALIA) with patients and families about end-of-life issues, Aim: To demonstrate the benefits of employing an psychosocial and spiritual issues, pain and symptom educational strategy in the planning and establishment of management) and theory and practice in methods of a new service in a tertiary hospital setting. teaching and learning. Reflection on clinicians’ emotional responses to working with patients at the end of life was Summary of work: Two six station SCORPIO sessions were also encouraged. developed prior to the setting up of a dedicated Twins + Clinic for mothers with multiple pregnancy, at Royal Prince Summary of results: Surveys of three cohorts (n=111) Alfred Hospital, Sydney. The education was demonstrated statistically significant short- and long-term multiprofessional with tutors and participants being staff improvements on nearly all measured aspects of attitudes, from all relevant clinical areas. Information was derived preparation and practice, with large effect sizes ranging from a thorough literature search and combined with from 0.8-2.8. The majority (82%) said the experience was analyses from our own comprehensive database to ensure “transformative”, most reported greater enthusiasm and that the content was evidence-based and applicable to confidence in teaching and many implemented a wider our population. A pre and post-test of knowledge (max score variety of teaching methods. 20) was undertaken at each of the SCORPIO sessions. Conclusions/take home messages: A program that models Summary of results: In both SCORPIOs there was a highly and fosters multidisciplinary care and learning, reflective significant improvement in knowledge (SCORPIO 1: mean practice and attends to cognitive, affective and relational score increased 7.2 to 15.6; change +8.4; p<0.001. aspects of clinical care and teaching is effective in SCORPIO 2: mean score increased 6.7 to 16.6; change producing meaningful and lasting change in faculty’s ability +9.9; p<0.001). 95% of participants evaluated sessions as to provide and teach end-of-life care. “very good” or “excellent” on a five point Likert scale. Conclusions/take home messages: Interactive, small 9L 2 Into the unknown: the development of a new group, multiprofessional education is useful in preparation multidisciplinary health care professional of staff for introduction of a new service. Kath Start (Kingston University, Sir Frank Lampl Building, Faculty of Health and Social Care Sciences, Kingston Hill, 9L 4 Team communication in the operating theatre: Kingston upon Thames, Surrey KT8 7LB, UK) observations and interviews Aim: Creation of a postgraduate program leading to a new Debra Nestel*, Jane Kidd, Krishna Moorthy and Yaron Munz multidisciplinary role (the Health Care Practitioner) capable (Monash University, Centre for Medical and Health Sciences of delivering and supporting diagnosis, treatment and care Education, Faculty of Medicine, Nursing and Health Sciences, of patients, within seven integrated care pathways in acute Building 15, Clayton, Victoria, AUSTRALIA) medicine. The role addresses the twin challenges of doctor shortages and improved patient care. Aim: Although communication in health care is recognised as important, most educational interventions are aimed at Summary of work: improving doctor-patient communication. Commun- • The curriculum was based on care pathways and patient ications that promote effective teamwork are gaining groups defined by clinical services. Students came from importance for focused teaching and learning. Little a wide range of clinical/academic backgrounds. attention has been given to communication in operating • Profiling methods were used to tailor course content to theatres although it is increasingly acknowledged as a key meet academic or clinical deficits of individual students component of successful surgical teamwork and patient versus the course learning outcomes. safety. This presentation will explore the unique environment of the operating theatre and its implications • The curriculum combined problem-based learning for the ways in which individuals interact. centred on case scenarios, syndicate groups and web- based self-directed learning exercises. Summary of work: • Assessment includes a 50% clinical competence 1 Non-participant observational study in operating element, OSCE, reflective learning and student theatres. portfolios. 2 Focus group interviews with surgeons, trainee surgeons, Summary of results: The course started in October 2002, anaesthetists and nurses exploring experiences and with 19 students from nursing, physiotherapy and expectations of communication in the operating theatre. occupational therapy. The first qualified Heath Care Summary of results: Practitioners will go into practice in October 2003. • Verbal and non-verbal cues used in interpersonal communications compromised in the operating theatre.

– 4.152 – Section 4

• Basic social and interpersonal skills are frequently underpinning such activities. Four professional groups who absent. learn and work in operating theatres were interviewed. This • Factors outside the operating theatre influence paper describes and contrasts their perspectives on what communication within the theatre. constitutes an effective teaching and learning environment in that setting and sets their comments in the context of • All participants identified the need for improved education theory. communication. Summary of work: Focus group interviews with operating Conclusions/take home messages: There are several theatre personnel: surgeons, trainee surgeons, areas for development of communication within the anaesthetists and nurses. operating theatre. Individual and team-based approaches to teaching and learning about communication are likely Summary of results: Participants identified the following as to be beneficial. important: Consistency (e.g. teacher, content, use of instruments); A programme of learning; An opportunity to observe “experts” at work; A briefing session; Information at 9L 5 What makes the operating theatre an effective appropriate level for learner. Difficulties identified: Having two roles at once (clinician and trainer); Limited clinical teaching and learning environment? A multi- teacher training; Unhelpful feedback; Being learner professional perspective centred. Jane Kidd*, Debra Nestel, Krishna Moorthy and Yaron Munz Conclusions/take home messages: There was agreement (Imperial College London, 4th Floor, Paterson Centre, 20 South between professional groups on aspects considered to Wharf Road, London W2 1PD, UK) make teaching and learning in the operating theatre Aim: In hospital based postgraduate teaching and learning effective and these reflected principles of adult learning. there is little documentation of principles and theories

Session 9M: Special Subjects in the Curriculum

9M 1 Preparing preclinical medical students for brief ‘strand’. This includes Health Psychology; Healthcare smoking cessation interventions Ethics & Law; Public Health and Epidemiology; Communication; History of Medicine. Manchester Linda Z Nieman*, Lewis E Foxhall, Mary M Velasquez and Janet Y considers the B&SS relevant areas of study as shown in a Groff (UT Houston Health Science Center, Family Practice and move to greater horizontal integration with the biosciences Community Medicine, 6431 Fannin St, Suite JJL324, Houston, TX and clinical medicine but this perception is not always 77030, USA) shared by its students. We aimed a) to identify whether the Aim: To prepare preclinical medical students for their future perceived irrelevance of B&SS to medicine is peculiar to roles in facilitating smoking cessation. Manchester or more widespread among UK students, and b) to identify the factors that might help construct these Summary of work: Thirty seven preclinical medical students beliefs. Students across all five years of the course in enrolled in the Texas Statewide Preceptorship program Manchester and St. Andrews (Scotland) and Newcastle learned to apply the Transtheoretical Model and U.S. were surveyed on-line in relation to previous study of Department of Health and Human Services guidelines as behavioural or social sciences, peer influence, tutor frameworks for accomplishing smoking cessation. At the influence and the students’ own thoughts on the relevance preceptorship, students screened patients and of B&SS. The results of the study will be presented along documented their encounters on a Tobacco Assessment with some proposed targets for future intervention. Form that included a smoking history, and, for current smokers, their readiness to change, importance that they give to changing and their confidence that they could 9M 3 Medical students’ sexual history-taking behaviour change. With the agreement of the preceptor, they one year on from an educational intervention determined whether medication, counseling and patient education materials were appropriate. Annie Cushing* and Dason Evans (St. Bartholomews & The Royal London, Queen Mary’s School of Medicine and Dentistry, Clinical, Summary results: Of the 37 students, 18 returned 225 Communication and Learning Skills Unit, Room 235, Robin Brook Tobacco Assessment Forms (average per student: 12.5 ± Centre, West Smithfield, London EC1A 7BE, UK) 9.3). Compared to patients at the stage of pre- contemplation, patients at the stage of preparation more Teaching about sexual health is commonly confined to frequently received counseling (17% vs. 45%), medication obstetrics & gynaecology or sexual health clinics but may (27% vs. 51%), and education materials (36% vs. 57%). be an issue in many other clinical situations. We present Nearly 70% of time spent on counseling was under 5 attitudinal and self-reported behavioural outcomes of minutes. workshops for 4th year medical students designed to address a broad range of clinical contexts. There were Conclusions/take home messages: Preclinical students positive attitude changes and expressed intentions to ask can begin to develop a habit of screening and applying patients about sexual health where relevant. One year later brief smoking cessation skills. The challenge remains to students were asked how often and in what clinical settings encourage greater involvement in smoking cessation. they had asked patients such questions. 92% had done so, compared with 47% in the preceding 4th year, predominantly in O & G (82%) and sexual health clinics 9M 2 Medical students’ perceptions of the relevance of (75%), some in general practice (39%), in A & E (26%) and behavioural and social sciences towards their occasionally in other settings. There were no differences medical education between workshop attendees and a control group in either Christine Bundy, Lis Cordingley, Andrea Pilkington* and James frequency or location of asking sexual health questions. Urquhart (University of Manchester, Medical School, G711 Having an additional teaching session on sexual health, Stopford Building, Oxford Road, Manchester M13 9PT, UK) although no particular one per se, did increase the chances of a student taking a sexual history. There remain a small The University of Manchester is at the forefront of medical group of students who have never asked patients about education. A major component of the Manchester sexual health. The implications of these findings will be programme is the Behavioural & Social Sciences (B&SS) discussed.

– 4.153 – Section 4

9M 4 Teaching leadership and management to medical Background: The public has increasingly embraced students – perspectives from UK and Portugal alternative healthcare modalities, reflecting a need for more relationship-centered, holistic care plus recognition H M G Martins*, D E Detmer and E Rubery (University of of the human spirit in healing. To meet this need, Cambridge, Judge Insitute of Management, Trumpington Street, conventional physicians need to accommodate an Cambridge CB2 1AG, UK) understanding of CAM modalities, and be willing to talk Background: Healthcare faces increasing demands for with their patients about them. leadership and system change. This research explores Summary of work: We offered an 8-hour course with short perceptions on the relevance and content of leadership/ lectures interspersed with physical experiences involving management education within the medical school mind-body interventions (yoga, mindfulness meditation, curriculum. imagery), energy therapies (Reiki, T’ai-Chi) and body- Summary of work: Research was done simultaneously in based therapies (massage, breath-work, and the UK and Portugal. A survey of medical students and neuromuscular integrative action). Course objectives were young resident doctors was carried out using semi- to: describe the principles on which CAM is based; the structured questionnaires. The medical students’ overall scientific evidence for the efficacy and safety of CAM; and response rate was 70.6% (141/250 – 56.4% in UK and provide information about local CAM resources. 127/150 – 84.7% in Portugal). Thematic analysis was done We carried out a randomized control group study with a on opinions from the survey and on data from interviews self-report instrument that measured pre-post intervention with clinical directors, medical school professors and knowledge about and attitudes to CAM practice behaviors, hospital managers. and factors influencing willingness to suggest CAM to Summary of results: Preliminary results indicate that patients. Descriptive statistics (Mann-Whitney and Portuguese medical students attribute higher relevance to Wilcoxon Signed Ranks tests) measured group leadership/management education than their UK differences. Thirty-six physicians were randomized to counterparts (63% vs 42%). In both samples such control (N=16) and experimental (N=20) groups. education would be preferred during the clinical years, Summary of results: Both groups were statistically similar optional and one term/semester long. Main topic areas before the intervention on all items. Afterwards, the control that such education should cover include Managing group showed no change, but the experimental group people/team management; National Health Service; costs/ showed statistically significant improvement (p<.01) on prices and resource management. knowledge about and attitudes towards the targeted CAM Conclusions/take home messages: Leadership/ modalities (but not on non-traditional pharmacology, which management education is perceived as relevant; but its was not a targeted topic), and significant improvement inclusion in the medical curriculum needs to be tackled compared with the control. Factors influencing their carefully; students and other stakeholders are important willingness to recommend CAM were: research evidence, resources for the debate about relevance and curriculum personal experience, and assurance of safety. 45% planning, especially on new subjects. indicated they were likely/very likely to change their behaviors, while 50% were somewhat likely. Conclusions/take home messages: Physicians cannot 9M 5 Teaching complementary and alternative medicine advocate for CAM until they have personally experienced (CAM) to internists the benefits and been reassured of the scientific validity of M G Hewson*, J E Fox, H L Copeland and E Topol (The Cleveland the modalities. The workshop is relevant to all physicians. Clinic Foundation, NA-25, 9500 Euclid Avenue, Cleveland OH 44195, USA)

– 4.154 – Section 4 Session 10: Plenary 2 – Professionalism of Medical Education

10.1 Identifying and rewarding excellent teaching that the key to establishing evidence-based teaching and Sally Brown (Institute of Learning and Teaching in Higher learning is to understand which types of research and evidence are most appropriate for the type of questions Education, Genesis 3, Innovation Way, York YO10 5DQ, UK) being asked. Teaching is being foregrounded as never before and an increasing number of Higher Education Institutions are seeking to reward first class teaching. This plenary will 10.3 21st Century physicians’ social accountability and consider the questions: ‘What is teaching excellence?’ professional responsibility: the implications for How can we recognise it? What are the indicative qualities medical education and for the medical teacher and behaviours which enable excellent teaching to be identified? What reward mechanisms are appropriate?’ Eliot Sorel (School of Medicine and Health Sciences and School of The presentation will use the England/N Ireland National Public Health and Health Services, The George Washington Teaching Fellowship Scheme as an illustrative example. University, Dept of Psychiatry, 2121 K Street, N W, Suite 800, Washington DC 20037, USA) While the patient-doctor relationship remains the 10.2 Is evidence-based teaching and learning really cornerstone of modern medicine, physicians are expected possible? to consider it in the context of populations’ health, the Philip Davies (Strategy Unit, Cabinet Office, Rm 3.14, Admiralty dialectics of health and economics, and the widening gap Arch, The Mall, London SW1A 1WH, UK) of national and global health disparities. The 21st century challenges facing medical education and the medical Evidence-based teaching and learning is increasingly teacher are of increasing complexity in this new global being talked about as the way forward for improving medical context, and are redefining this and the next generation of and general educational practice. This involves integrating physicians’ responsibility and social accountability. The the experience, skill and judgement of teachers and speaker addresses the renewed 21st century medical learners with the best available evidence from systematic students’ and physicians’ commitment to life learning of research. However, what counts as ‘best available knowledge, skills, and attitudes augmented by several evidence’ and ‘systematic research’ is a contentious issue critical new areas: informatics, genomics, communication, which can hinder the development of evidence-based cultural competence, community-based participatory teaching and learning. This presentation will review the research, health policy and law, health economics and different types of evidence and research that are used in ethics, global health. medical (and more general) education and will suggest

Session 11: Plenary 3 –Teaching and Learning in the Healthcare Professions

11.1 Born to be good, train to be great 11.2 Putting the learning into e-learning Richard K Reznick (Dept of Surgery, University of Toronto, Suite Phil Race ([email protected]) 311, 100 College Street, Toronto, ON, Canada) In 50 years’ time they’ll look back at the present time as The talk will focus on the role of practice as a vital element when e-learning was taking its first faltering steps towards to training. The speaker will provide a rationale for why we being practicable. The problem in a nutshell is that there’s have to fundamentally re-think our basic preceptor-based precious little real e-learning around yet – there’s a great models of residency training. Using data from surgical deal of what is merely e-information. Now Einstein is education research, the speaker will discuss the role of reported to have said “knowledge is experience - everything simulation in training, examine ways of altering the learning else is just information” and how right he was. In this curves in becoming a competent practitioner, and discuss session, we’ll look at how we can help people to turn the applicability of concepts of training from other information into knowledge, and how best the new professions to the health care domain. technologies can assist in this quest. We’ll start with a little about how WE all learned things well (and badly) and look critically at what parts can, and cannot, be played by computer-monitors, keyboards and mice.

– 4.155 – Section 4

– 4.156 – AMEE Conference 2004 Access to Education in Healthcare

5–8 September 2004 Edinburgh International Conference Centre Edinburgh, Scotland, UK

Provisional Outline Programme

Saturday 4 September Pre-conference tours

Sunday 5 September Optional pre-conference workshops and group meetings Pre-conference tours Evening: Opening reception at ‘Dynamic Earth’

Monday 6 September Plenary 1: New models for curriculum delivery Short communications; Workshops Large group sessions; Posters Accompanying persons’ day tours Selection of evening entertainment in Edinburgh

Tuesday 7 September Plenary 2: Competency-based education and assessment Short communications; Workshops Large group sessions Accompanying persons’ day tours Scottish evening and Conference Dinner at Prestonfield House, Edinburgh

Wednesday 8 September Plenary 3: Interprofessional education Short communications; Workshops Large group sessions Accompanying persons’ day tours

Thursday 9 September Post-conference tours

If you would like to offer a pre-conference or conference workshop for consideration, please contact us as soon as possible. The provisional programme and call for papers will be available in October 2003 and registration will start in November.

AMEE Secretariat, Tay Park House, 484 Perth Road, Dundee DD2 1LR, Scotland, UK Tel: + 44 (0) 1382 631953; Fax: + 44 (0) 1382 645748 Email: [email protected] Website: www.amee.org More Information on AMEE AMEE is an international association for all interested in medical and health care professions education, with members in more than 70 countries. AMEE’s members include teachers, administrators, researchers, students, institutions and national bodies. As well as organising an annual conference, AMEE produces a series of practical education guides on topical issues in medical and healthcare professions education. Individual and student members of AMEE receive a copy of the Association’s journal, Medical Teacher, free with their membership subscription. Please contact us if you would like more information on the Conference or AMEE’s activities generally: AMEE Office, Centre for Medical Education, Tay Park House, 484 Perth Road, Dundee DD2 1LR, UK Tel: +44 (0)1382 631953 Fax: +44 (0)1382 645748 Email: [email protected] http://www.amee.org