Medical Education Conference for Trainees

Wessex Deanery 7th Annual Medical Education Conference for Trainees 8th November 2012 ‘Aspiring to Excellence’

Podium Presentations

Title: Involving medical students in monitoring patient experience Title: Education in Chronic Childhood Ilness: A Single Centre Study at the John Radcliffe Hospital, Oxford of Patient Led Initiatives

Author(s): K Collins, H Salisbury, T Kelley, S Shale, M Scarfe Author(s): Haiko Jahn, Julia Antich Duran, Mario Tristan, Orlando Urroz

Background: The GMC and NHS recognise the value in learning from patients. Background: Chronic childhood illness and high quality education has been The experiences they share with us provide the NHS and its care practitioners, closely linked to better outcomes long term. The World Health Organisation both present and future, with regular opportunities to improve outcomes and (WHO) support an initiative since 2004 where it was concluded that patient performance. safety and education given by the patients themselves is paramount. Method: A single centre prospective study in Costa Rica. Six illnesses chosen, Aims: 1. Improve student awareness of patients’ experiences; including, cerebral palsy, leukaemia, cystic fibrosis, diabetes mellitus, epilepsy 2. Involve students in service improvement; and spina bifida. Four patients from each group were nominated as patient 3. Provide the hospital with benchmark data on patient experience. educators. Qualitative feedback was taken and analysed in comparison to experiences of Methods: Medical students distributed questionnaires to all acute medical illness education from health care professionals. patients, discussed patients’ answers with them, and assessed their AMTS. Students were given the opportunity to be involved in data collation, analysis and Results: The facilitation of this project found from qualitative data that there feedback to the department. was a greater autonomy and understanding from the patients diagnosed with these conditions in the groups educated by fellow patients diagnosed with the Results: Three key areas for improvement were identified and specific actions same condition. defined to address them. Students listed many insights into life as a patient. Conclusions: To enable high quality patient education with compliance to WHO Conclusion / Key Message: Involving students in understanding patient guidance, a high degree of importance on education between patients experience can help to achieve excellence for students and hospitals. themselves should be looked upon at an early stage of illness diagnosis.

1 Title: A pilot peer-assessed vitual OSCE as exam preparation for Title: Development of a multi-media peer-to-peer medical final year medical students education tool – MQ Magazine

Author: Charis Manganis Author(s): van Boxel GI, Zenkner A, Watts E, Daley-Morris F, van Duren BH

Abstract: Staging ‘mock’ Objective Structured Clinical Examinations (OSCEs) Abstract: Medical students and Junior Doctors often have difficulty in publishing requires assessors and actors/patients. Consequently, practice for students articles in peer-reviewed journals – a recognised pre-requisite for career under exam-like conditions is scarce. development.

The aim of this pilot was to develop an effective, practicable model for medical The aim was to develop an educational magazine facilitating opportunities for student OSCE preparation. publishing peer-to-peer educational articles.

Twelve final-year medical students were invited to participate. In the first half, Contributors gain experience in writing articles and responding to editorial half students were candidates and half acted as simultaneous assessors/ feedback to create a published article in our journal, senior clinician input patients; groups then swapped. Twelve stations were set up, as per the exam. assuring quality. ‘Candidates’ rotated between stations. ‘Assessors’ used scripts of commonly- encountered cases whilst a candidate performed an examination. Images of We have published 5 issues to date, currently reaching 16 medical schools examination findings were provided. nationwide through 3500 copies. Furthermore, the on-line journal (www.medquarterly.com) has been accessed in over 40 countries worldwide Feedback was collected after publication of final examination results. All students resulting in article submission from around the globe. passed. All reported improved confidence. None reported that acting as assessor/patient was not useful. MQ Magazine allows opportunities for medical students and junior doctors to gain exposure and experience in medical publishing. Moreover, it is proving a A peer-assessed OSCE using virtual cases is a useful tool in OSCE preparation. useful and popular educational tool in terms of its content.

This model does not require assessors, actors or patients and can be MQ Magazine provides a medium for students and junior clinicians to learn how straightforwardly expanded and offered to large student numbers. to prepare, submit and publish a journal article.

2 Poster presentations

Title: Design, implementation and evaluation of a structured Title: Curriculum planning- The importance of feedback clinical teaching programme for final year medical students delivered by junior doctors Author(s): Shikha Arora & Asma Khalil

Authors: Albayati MA, Abay J, Hayes MC Background: Trainee feedback is a vital part of tailoring learning needs and assessing gaps in the teaching curriculum to ensure satisfaction in training. Aims: We aimed to develop a structured teaching programme for medical Aims: The aim is to achieve trainee satisfaction with the monthly teaching and students and evaluate the effectiveness of teaching by junior doctors on the ensure their learning needs are met. student learning experience. Methods: A questionnaire titled ‘How can we improve our monthly teaching’ was Methods: A rolling 6-week teaching programme for final-year medical students sent to 75 trainees. 20 responses were collected. Trainees were asked if their rotating in surgery at University Hospital Southampton was developed. The educational needs were being met, what topics they need covering, design of programme was designed under the supervision of the Undergraduate-Lead for each day, and separate days for ST1-2 and ST3-7. Surgery and Final-Year-Coordinator, and delivered by FY2-trainees. 90% of trainees felt their learning objectives were met. A range of topics to suit junior and senior trainees were suggested. A mixture of teaching styles was felt Results: Three student cohorts(39-students) were enrolled over a 24-week most appropriate. 70% felt that ST1-2 training could be separated from ST3-7; period. A total of 222(94.8%) end-of-session feedback questionnaires were however juniors felt that the joint training days were beneficial too. analysed. 81.1% rated session content as ‘very high’. 78.4% stated that junior doctors delivered teaching comparable to consultant-led teaching and 96.8% Conclusion: Trainee feedback to ensure satisfaction that learning objectives are reported the programme had a positive influence on their learning. Overall, met and being taught appropriately is instrumental to ensure training needs are 83.3% felt better equipped to prepare for Mini-CEX assessments. met. We continue to collect monthly feedback and suggestions for changes annually to ensure clinical excellence. Conclusions: Structured teaching delivered by junior doctors has the potential to enhance the student learning experience and improve performance at assessment. Additionally, near-peer teaching may be comparable to conventional consultant-led teaching in this setting and should be encouraged.

3 Title: Inter-disciplinary teaching: An effective way to improve Title: Wessex Anatomy Training for Surgeons and the MRCS: urology patient care on a general surgical ward. Lessons from two years.

Authors: Helen Cui, Angela Birnie, Heidi Tempest. Urology Department, Author(s): JF Donaldson, M GIbson, C Bamford, J Knight, A Talwar Churchill Hospital, Oxford Background: A working knowledge of anatomy is crucial for surgical practice and Abstract: Urology nurses gain many specialist skills necessary to manage patients MRCS examinations. London was the only UK Deanery offering prossection- admitted with acute urological conditions. In our trust however, patients with based teaching in 2009. urological problems may be admitted to the Surgical Emergency Unit (SEU) where care is provided by nurses trained in general surgery but not urology. Aims: To facilitate clinically focused anatomy teaching to Wessex Trainees.

In an attempt to enhance urological care for the benefit of our patients, we Methods: Senior surgeons delivered 16 half-day free sessions between Aug’10- initiated a small group teaching programme run by urology trainees for nurses on May’12. Written feedback was obtained. SEU focusing on ward-based urology skills and essential knowledge. Results: Feedback was extremely good: 100% of candidates rated sessions Questionnaires from 49 nurses showed lack of familiarity in managing patients extremely or very useful. A defined syllabus for each session and a “mock exam” with haematuria and ureteric stones, areas which the teaching then focused session were suggested - both were extremely well received. On average 6.2 upon. The same questionnaire, completed by 29 nurses who have received trainees attended each session (range 3-12) which were usually facilitated by 2 teaching to date, show improvement in skill confidence and knowledge levels in tutors. Feedback showed candidates preferred small group sizes. Candidates all areas. It is essential for us to continue educating and receiving feedback from suggested measures to improve attendance. our nurses to ensure a high quality urology service. Conclusions: We have facilitated the delivery of excellent surgical anatomy teaching to Wessex trainees. Attendance was disappointing: we are implementing changes to improve numbers.

Key Messages  Increased surgical anatomical knowledge for trainees.  Improvements resulted from trainees’ feedback.

4 Title: Sport Based Insights into Commissioning Title: Medfest 2012: Using film as a way to explore medicine and Authors: Dr Richard Elliott mental health

Work done for: Education Fellowship Author(s): Laura Evans & Larissa Ryan

Background: Commissioning is set to bring major changes to general practice, Background: Medfest is a national medical film festival, organised by psychiatry and trainees need to understand the principles underpinning it. We sought trainees and medical school psychiatry societies. inspiration from the summer of sport to give trainees direct exposure to novel team-based task with relevance to commissioning. Methods: A questionnaire was offered to all attendees at all the Medfest events around the country. Methods: General practice trainees (ST1/2) were divided into six groups. Each was given a non-medical scenario based upon commissioning, and the groups Results: Southampton attendees were asked to rate the event on a scale of 1-5 competed against each other to attain an overall goal. The participants were with 1 being ‘not successful’ and 5 being ‘highly successful’. The average rating observed during the day, and structured feedback was gathered at the end of the was 4.2. Attendees were also asked if the event had changed their likelihood of session. The data were collated and analysed. wanting to do psychiatry as a career. 59% said they were ‘more likely’ or ‘much more likely’ to choose psychiatry as a career following the event. Results: Teamwork within the small groups was excellent, but rivalry between the all groups meant that the overall goal of the day was not achieved. Feedback Conclusions: Southampton Medfest 2012 was well regarded by attendees and was positive. appeared to have a positive result in terms of improving attitudes and recruitment to psychiatry.

Conclusions/ Key Messages: Trainees found this a useful introduction to Key messages: Using film is an interesting and exciting way to stimulate commissioning. Feedback indicated that they learned about leadership, team- discussion among medical students. working and the importance of recognising the overall goal. Medfest 2013 is coming in Spring next year. www.medfest.co.uk

5 Title: Identification of appropriate blood transfusion requests in Title: Perceptions of learning and teaching in postgraduate paediatric surgery: an analysis of service and financial neurology training implications. Author(s): Stephan Hinze & Sai Loo Author(s): J H Frost, H Dagash, C Choruschyj, J Durell, H Jahn, N Patwardhan Abstract: Introduction: As with many areas of surgery, paediatric surgery often requires There has only been a limited amount of research into learning and teaching in careful pre-operative planning in regards to the need for transfusion intra or postgraduate neurology education. post-operatively. This study aims to analyse the need for peri-operative transfusion planning in relation to paediatric surgical procedures. Questionnaires (40 registrars, 28 consultants) and interviews (4 registrars and 1 consultant) were analysed using quantitative, as well as qualitative measures. Method: Retrospective review was undertaken over a twelve month period between 1st January 2011 to the 31st December 2011. Data was collected from a There are significant differences between consultants and trainees. Early trainees single centre. 2159 GS requests and 4487 CM units of red cells from patients <16 prefer a higher degree of formal teaching, incorporating specific objectives with years old were analysed. provision of a specific clinical context. In general, outpatient clinic exposure should have a greater emphasis than inpatient care (60% to 40%). There should Results: Analysis of (n=6646) CM and GS requests was undertaken and after be an equal divide between a time and competence based curriculum approach. exclusion criteria (n=155) GS requests and a correlating (n=48) CM units were Formative assessment should be slightly favoured over summative assessment. processed. A statistically significant rate of 14.82% was found which includes all units that were transfused after CM request. There was a per patient overspend Clinical experience associated with context specific discussions and feedback of £104.04 on each request. seems to be the most important aspect of learning in postgraduate neurology education. Trainee input into curriculum design is likely of benefit in view of Conclusion: Pre-operative blood transfusion planning in paediatrics is so far not changing perceptions on learning and teaching between registrars and widely evidence based. Our studies results suggest that clinical need for pre- consultants. operative cross-matching is not always justified in all paediatric procedures. These results justify further studies in to this area to allow for improved and appropriate clinical and economic outcomes.

6 Title: Death of the Cadaver Title: Can junior doctors teach? A pilot near-peer teaching scheme for the MRCP PACES. Author(s): Zaibun Khan, Amjad Ali and Sherief Alsayed Author(s): LH Lee, A Saigal Introduction: Core knowledge of anatomy is an integral part of undergraduate (Royal College of Physicians Associate Tutors & CT2 Doctors, Portsmouth) medical curriculum and GMC’s Tomorrow’s Doctors. The objectives of this survey are to review anatomy teaching in UK and junior doctors’ (FY1 level) Background: Peer-assisted learning is increasingly important in medical confidence in their anatomical knowledge. education. Several reports support the efficacy of near-peer teaching amongst medical students and junior doctors. The MRCP PACES is a postgraduate clinical Method: 356 medical students from 20 medical schools answered a exam with poor passing rates. It is a pre-requisite for specialist medical training in questionnaire on their experience of anatomy education in the UK between 2005 the UK. and 2010. Methods: We developed a teaching scheme for doctors attempting PACES. Results: Cadaver dissection as a main teaching method has continued to Tutors were junior doctors who had recently passed their membership exams. decline.The main method of anatomy teaching was problem-based learning Teaching was delivered in consecutive evenings in Queen Alexandra Hospital (35%), lectures (28%) and cadaver dissection (27%). In contrast, dissection was over two weeks. This consisted of small group system-based bed-side teaching the most preferred method of leaning anatomy followed by tutorials and lectures supplemented by power-point tutorials. Feedback forms were collected. respectively. Furthermore, most students regarded their knowledge as inadequate at an FY1 level. Results: Our teaching programme was very well-received. In particular, candidates found near-peer teaching effective and were highly interested in Conclusion: There was a discrepancy between the teaching methods of anatomy attending further similar teaching sessions. and student’s preferences for learning. Teaching of anatomy should be vertically integrated across the doctor’s training pathway and should remain practically Conclusion: Our pilot teaching scheme suggests that near-peer teaching is orientated. effective and viable at the MRCP level and can be used as an adjunct to senior- led teaching.

7 Title of the Paper / Poster: Junior Doctors Essential Cards Title: Introduction of constructive alignment in assessment design in Malawi Authors: Isabella Lo Author(s): H. Djafari Marbini Work done for: Junior Doctors Essentials (JDE) is an innovative project aim created by doctors for doctors. The project is updated and audited annually. It Background: Anaesthetic clinical officers are widely used in low income settings won £1000 at a regional conference to disseminate regionally and then was to address the issue of lack of trained specialist doctors. Their curriculum presented at the International Safety Conference in Paris in 2012 which has addresses the needs of the local setting in Malawi but is at times taught without promoted massive continued interest. the alignment of assessment and learning outcomes.

Abstract: The transition from medical student to Foundation Year 1 (FY1) doctor Aims: The aims were to challenge traditional methods of teaching and introduce is widely recognised as a challenging and daunting time. Junior Doctors Essentials the concept of alignment to the course tutors. (JDE) is a project created by doctors for doctors, commenced in Nottingham University Hospital in 2009. JDEs are nine credit-card sized cards, containing Methods: A weekend course used a problem based learning approach to concise clinical and practical information, aims to highlight the known risk to introduce the concepts. The assessment methods were modified to address the patient safety and help FY1 to avoid common clinical The transition from medical intended learning outcomes. student to Foundation Year 1 (FY1) doctor is widely recognised as a challenging and daunting time. Junior Doctors Essentials (JDE) is a project created by doctors Results: The intervention was assessed using feedback from tutors, as well as by for doctors, commenced in Nottingham University Hospital in 2009. JDEs are nine direct feedback from local hospitals where the successful trainees were credit-card sized cards, containing concise clinical and practical information, aims employed on how well prepared the trainees were for the demands of their new to highlight the known risk to patient safety and help FY1 to avoid common roles. clinical errors. The details of the cards have adapted to the needs of the Juniors in response to the annual audit and re-evaluation. We surveyed the effectiveness Conclusions: Curriculum alignment is a useful tool in designing courses and of using these cards after two months of employment. In 2012, 100% of FY1s assessments in a low income setting. recommended them to future cohorts and greater than 80% felt it ease the transition from a medical student to doctor, and improved patient safety. The JDEs have proved to save time, alleviate stress, and enable FY1 doctors to dedicate more time to patient contact and clinical decision-making.

8 Title: Problem based clinical governance training in a low income Title: Maintenance fluid prescription in pre-operative trauma setting patients: do we know what we’re doing?

Author(s): H. Djafari Marbini, S. Hinze Author(s): Yulanda Myint, Rebecka Asp

Background: There is a lack of local governance systems in low income settings. Background: Fluid/electrolyte prescription errors cause significant morbidity in A regional two day course in Malawi introduced the concept to anaesthetic peri-operative patients and are attributable to inadequate knowledge/training. clinical officers. Considering the range of abilities and knowledge in the group, a problem based learning (PBL) approach was chosen for these adult learners. Aims: To find whether FY1 doctors know the daily requirements and content of commonly prescribed fluids; to address any learning needs. Aims: To introduce the concept of clinical governace, and address common causes of peri operative morbidity and mortality. Methods: 16 orthopaedic FY1s in 2 regional hospitals were given a standardised questionnaire on fluid management. Pre-operative fluid prescriptions for 43 Methods: A PBL approach, utilising central critical incident reports as the basis of randomly selected elderly trauma patients from both hospitals in 04/2012 were the learning exercises was used. Participant satisfaction and participation levels reviewed to investigate compliance with BAPENS recommendations. were measured. In addition the local use of clinical governance methods was assessed prospectively. Results: 53% of FY1’s knew the daily sodium requirement, 47% for potassium, 23.5% for chloride. 35% correctly stated the composition of ‘5% Dextrose’; 6% Results: Participation levels and learner satisfaction were high. The learned correct for ‘Normal Saline’ and 0% for Gelofusine and Hartmanns solutions. 14% governance methods were subsequently introduced locally over the following of patients didn’t receive an adequate fluid volume whilst starved. 61% received months. too much sodium; 0% received enough potassium.

Conclusion: PBL can be a successful tool in learning clinical governance methods Conclusions/Key messages: FY1 teaching focusing on fluid/electrolyte in the developing world. requirements and the practicalities of replacement was conducted. A BAPENS recommendations reference guide was designed, to accompany prescription charts.

1. Callum KG, Gray AJG, Hoile RW, Ingram GS, Martin IC, Sherry KM, et al. Extremes of Age: The 1999 Report of the National Confidential Enquiry into Perioperative Deaths. London: National Confidential Enquiry into Perioperative Deaths, 1999. 2. Powell-Tuck, J et al (2011), ‘British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (BAPENS)’, viewed 29 Apr 2012, www.bapen.org.uk/pdfs/bapen_pubs/giftasup.pdf

9 Title: Attitudes to Careers Planning and Specialty Training Title: Educational talks for patients in General Practice (GP) Applications in a group of Foundation Year Two Trainees across the Wessex Deanery Author(s): Dr Catriona Roberts

Author(s): Rahman, Rezaur; Sammut, Luke; Esan, Ayomide; Allen, Rebecca Louise Abstract: During consultations in GP, patients often have many questions, which can be difficult to address within the short time available. It was therefore Introduction: We conducted an online survey of FY2 trainees in the deanery to decided to start educational talks for patients to improve their knowledge of establish opinions on careers planning and the imminent specialty training common conditions, promote health advice and to provide a forum for them to applications. ask questions. The talks also aimed to improve their medication compliance, reduce missed appointments and consultation time, address government QOF Methodology: A survey was sent to all FY2 trainees at Southampton General targets and reduce admissions to Accident and Emergency. Hospital and Salisbury District Hospital. The overall response rate was 55% (44/70). Three short talks where given on topics such as blood pressure. Patients were given feedback forms. Overall 29 patients attended. A majority of patients were Results: 69% of trainees surveyed felt “rushed into making decisions” about elderly. Almost all who attended asked questions. The talks were well received, specialty training; 44% felt prepared to make such decisions at this stage. Very 100% of patients found them useful. This is a small scale preliminary assessment few trainees undertook taster weeks or met with careers advisors during FY1. of the benefit of such public health education. 28 patients said they would attend Only 52% were aware of local careers services. 74% felt a compulsory taster further talks, which therefore will be continued. week in FY1 year would help in exploring careers options.

Conclusions: More can be done to address the lack of preparedness amongst Foundation Programme trainees. Low awareness is causing poor uptake of careers support services which needs to be better advertised, and provision for taster weeks throughout FP needs to be improved.

10 Title: HIV Education (HIVE) Title: How to Present your Examination Findings – a Junior Doctor led Session Author(s): Smith C.R., Edwards R.E., Waterhouse E. M., Seal K., Klaber E., Patel Author(s): Dr Ben Wildblood, Dr Alison Lennox Background: HIV is 100% preventable and 100% incurable. The HIV epidemic creates both an imperative to act and an opportunity to learn. HIV Education Background: Learning to present clinical examination findings effectively is an (HIVE) delivers interactive workshops to school pupils and enables medical important part of medical training. Oxford University medical students reported students to develop fundamental teaching skills. significantly less confidence in this area, compared with performing clinical examination (p<0.01). Aim: To evaluate the impact of this near-peer teaching model on knowledge and attitudes of school pupils. Aims: To assess the effectiveness of a junior doctor led teaching session in improving students’ confidence in presenting examination findings. Method: 105 pupils aged 14-15 completed a Likert scale questionnaire before and after a HIVE workshop. Methods: Students were given advice and tips on presenting. They examined ward patients and presented their findings to a junior doctor, who offered Results: Following the workshop there was a 53% increase in pupils who strongly constructive feedback. Students rated their confidence in different parameters disagreed ‘HIV is 100% curable’ and a 30% increase in pupils who strongly before and after the session. disagreed ‘People with HIV should be separated from people without HIV’. Results: Students reported significantly increased confidence in presenting Conclusion: This pilot study evidences that HIVE increases knowledge and examination findings, and also in discussing differential diagnoses (p<0.01). changes attitudes. With formal evaluation there is potential for widespread application. HIVE is a unique teaching model combining a public health initiative Conclusions and Key Messages: with an apprenticeship for future medical educators. 1. Medical students are not confident in presenting examination findings, and desire more teaching in this area. 2. A simple session by a junior doctor is effective in improving their confidence, and should be included in clinical teaching schedules.

11 Title: Improving Attendance At FY2 Foundation Teaching

Author(s): Dr J Wright

Abstract: The Foundation Programme is a two year programme that aims to provide a safe transition from medical student to practicing doctor. It is a period of significant gains in knowledge with many opportunities for learning, including formal teaching programmes. F2s at Royal Surrey County Hospital were significantly struggling to meet required attendance. As an F2 in a medical education role I was in a unique position to investigate this.

This project investigated the barriers faced by foundation doctors attending teaching by collecting data through questionnaires and semistructured interviews. Barriers were universal and included on-calls, emergencies and difficult rotas. Most strikingly though was a need to change attitudes and encourage foundation doctors to prioritise teaching.

To create a more professional approach to teaching a weekly reminder email was initiated. To improve accessibility for those who could not attend, a list of relevant e-learning modules was collated.