Abstracts AMEE 2005

in collaboration with Vrije Universiteit and the VU university medical center, Amsterdam

Abstracts

30 August – 3 September 2005 RAI Congress Centre Amsterdam, The Netherlands

Association for Medical Education in Europe Tay Park House, 484 Perth Road, Dundee DD2 1LR, Scotland, UK Tel: +44 (0)1382 631953 Fax: +44 (0)1382 631987 Email: [email protected] http://www.amee.org 1 INDEX OF ABSTRACTS

Index of Abstracts

Wednesday 31 August (blue section)

Session 1 Plenary: What makes a good doctor? ...... 7

Session 2 2AUD Symposium: Attitudes and professionalism ...... 8 2A Symposium: Project GLOBE: A new initiative to provide quality CPD for Generalist Physicians .. 8 2B Short communications: Problem-based learning: the presenting problem .. .. 8 2C Short communications: Training for leadership ...... 10 2D Short communications: Student characteristics ...... 11 2E Short communications: Approaches to Multiprofessional education .. .. 13 2F Short communications: Methods of teaching and learning ...... 14 2H Workshop: How to improve oral examinations in medical practice .. .. 16 2L Short communications: Selection for graduate entry to medicine .. .. 16 2M Short communications: Clinical assessment ...... 17 2N Short communications: e-Learning: instructional design ...... 19 2O Short communications: Continuing Professional Development/Continuing Medical Education 1 .. 20 2R Workshop: Emergency and Trauma management: training providers and instructors .. 22 2S Workshop: Active learning on the Web: how to develop an effective instructional web site .. 22 2T Workshop: Multi source (360 degree) feedback for assessment, feedback and learning across the medical education continuum ...... 22 2U Workshop: Developing and using standardized video cases for computerized assessment of communication skills for pre-clinical medical students ...... 22 2 Onyx 1 Posters: e-Learning in medical education ...... 23 2 Onyx 2 Posters: Staff/Faculty development ...... 26 2 Topaz 1 Posters: Curriculum evaluation and change ...... 29 2 Topaz 2 Posters: Written assessment ...... 32 2 Ruby 1 Posters: Evaluation of medical schools and students ...... 34 2 Ruby 2 Posters: Curriculum evaluation ...... 36

Session 3 3AUD Symposium: e-Learning in medical education ...... 39 3A Short communications: Curriculum planning ...... 39 3B Short communications: Problem Based Learning: role of the tutor .. .. 40 3C Short communications: Multiprofessional education in the workplace .. .. 41 3D Short communications: Teaching and learning communication skills 1 .. .. 43 3E Short communications: Continuing Professional Development/Continuing Medical Education 2 .. 44 3F Workshop: East European/Central Asian Special Interest Group ...... 45 3H Workshop: Keeping an eye on quality: how the LCME trains and evaluates its survey teams .. 45 3L Short communications: Methods of selection ...... 46 3M Short communications: Portfolios in teaching and assessment 1 ...... 47 3N Short communications: Assessment of professionalism ...... 48 3O Short communications: Best Evidence Medical Education and other review methodologies .. 50 3R Workshop: Case material development, recruiting and training for standardization with Standardized Patients ...... 51 3S Workshop: Effective use of questioning during teaching ...... 51 3T Workshop: The Case Method ...... 51 3U Workshop: Questionnaire design and analysis for new researchers .. .. 51

– 1 – INDEX OF ABSTRACTS

3 Onyx 1 Posters: Use of simulators in medical education ...... 52 3 Onyx 2 Posters: Methods of teaching and learning ...... 54 3 Topaz 1 Posters: Student support ...... 57 3 Ruby 1 Posters: Education environment ...... 58 3 Ruby 2 Posters: Basic sciences ...... 60

Session 4 4AUD Symposium: Accreditation of institutions and programmes in medical education .. .. 62 4A Symposium: Complex Adaptive Systems ...... 63 4B Short communications: Problem Based Learning: implementing a course .. .. 63 4C Short communications: Teaching and learning communication skills 2 .. .. 64 4D Short communications: Multiprofessional education and teamwork .. .. 66 4E AMEE Fringe 1 ...... 67 4F Workshop: Feedback: Closing the teaching-learning loop in clinical skills .. .. 68 4H Workshop: Preparing and delivering better lectures ...... 68 4L Short communications: E-Learning: the virtual learning environment .. .. 68 4M Short communications: Portfolios in teaching and assessment 2 ...... 70 4N Short communications: Different approaches to evaluating a curriculum .. .. 71 4O Short communications: Postgraduate assessment ...... 72 4R Workshop: Learning to teaching: peer assisted learning ...... 74 4T Workshop: Implementing Competency Frameworks: lessons from the CanMEDS Project .. 74 4U Workshop: Supporting trainers in promoting professionalism ...... 74 4 Onyx 1 Posters: Clinical teaching and learning ...... 75 4 Onyx 2 Posters: Curriculum strategies ...... 77 4 Topaz 1 Posters: Postgraduate speciality training ...... 79 4 Ruby 1 Posters: The setting for clinical teaching and learning ...... 81 4 Ruby 2 Posters: Students; Gender issues in medical education ...... 83

Thursday 1 September (yellow section)

Session 5 Plenary: Medical education research and its translation into teaching and clinical practice .. 87

Session 6 6AUD Symposium: Bologna Process and medical education ...... 88 6A Symposium: Research in education ...... 89 6B Short communications: e-Assessment 1 ...... 89 6C Short communications: Teaching and learning about research ...... 90 6D Short communications: Student support ...... 91 6E Workshop: Designing and organizing reliable case-based tests with Short-Answer-Questions .. 92 6F Workshop: Personal and professional development – effective practices .. .. 93 6G Workshop: Effective communication in the health professions ...... 93 6H Workshop: Standardized assessment of reasoning in the context of uncertainty: the Script Concordance Test ...... 93 6L Short communications: Doctors practising in a different country ...... 94 6M Short communications: Written assessment ...... 95 6N Short communications: Standardized/simulated patients ...... 96 6O Short communications: Postgraduate 360o assessment ...... 98 6R Workshop: The International Virtual Medical School – IVIMEDS ...... 99 6S Workshop: Making education count in the promotion and tenure process .. .. 99 6T Workshop: A multidisciplinary initiative to create a resource for integrating women’s health into the curriculum ...... 99 6U Workshop: Clinical skills – where next? ...... 100

– 2 – INDEX OF ABSTRACTS

6 Onyx 1 Posters: Continuing Professional Development/Continuing Medical Education .. .. 100 6 Onyx 2 Posters: e-Learning and the virtual learning environment ...... 102 6 Topaz 1 Posters: Problem Based Learning 1 ...... 105 6 Ruby 1 Posters: Postgraduate training: the early years ...... 107 6 Ruby 2 Posters: Selection for medicine ...... 109

Session 7 7AUD Symposium: Evidence based teaching ...... 112 7A Short communications: e-Problem Based Learning ...... 112 7B Short communications: The Objective Structured Clinical Examination 1 .. .. 113 7C Short communications: Community based medical education ...... 115 7D Short communications: Evaluation of teachers ...... 116 7E Short communications: Evaluating the international medical student and doctor .. .. 117 7F Workshop: Ibero-American Group ...... 118 7G Workshop: Crisis resource management for healthcare professionals – a new six step approach .. 118 7H Workshop: Towards a core curriculum for Psychology in undergraduate medicine .. 119 7L Short communications: e-Learning: virtual patients ...... 119 7M Short communications: What is professionalism? ...... 120 7N Short communications: Understanding teaching and learning ...... 122 7O Short communications: General Practice/Family Medicine 1 ...... 123 7R Workshop: Tobacco treatment education ...... 124 7S Workshop: A framework for analyzing the quality of multiple-choice items .. .. 125 7T Workshop: Student involvement in quality improvement of medical education .. .. 125 7U Workshop: The role of needs assessments in designing teacher training programmes for medical residents ...... 125 7 Onyx 1 Posters: Curriculum planning ...... 125 7 Onyx 2 Posters: Self assessment and formative assessment ...... 128 7 Topaz 1 Posters: Outcome based education ...... 130 7 Ruby 1 Posters: Postgraduate assessment ...... 131 7 Ruby 2 Posters: Standardized patients and clinical teaching ...... 133

Session 8 8AUD Symposium: Assessment in the context of postgraduate training .. .. 136 8A Short communications: e-Learning and postgraduate education ...... 136 8B Short communications: The Objective Structured Clinical Examination 2 .. .. 137 8C Short communications: Staff/faculty development 1: Staff/faculty development in action .. 138 8D Short communications: The education environment ...... 140 8E AMEE Fringe 2 ...... 141 8F Short communications: Introductory/transitional courses in medicine .. .. 142 8H Workshop: Teaching professionalism: principles and practices ...... 143 8J Workshop: Lab coat pocket knowledge: the PDA as an aid to medical and teaching decision-making: a course for beginners ...... 144 8L Short communications: Teaching and learning clinical skills 1 ...... 144 8M Short communications: General Practice/Family Medicine 2 ...... 145 8N Short communications: Competency based postgraduate education .. .. 147 8O Short communications: Curriculum management and the stakeholders .. .. 148 8R Workshop: Let’s agree to disagree: quality assurance procedures in standardized patient assessments ...... 149 8S Workshop: Substituting for nature: a continuing education challenge .. .. 150 8T Workshop: Young Educators’ Group ...... 150 8U Workshop: Mastering the scholarly process ...... 150

– 3 – INDEX OF ABSTRACTS

8 Onyx 1 Posters: Problem Based Learning 2 ...... 150 8 Onyx 2 Posters: Postgraduate medical training ...... 152 8 Topaz 1 Posters: Assessment: clinical, 360o and portfolio...... 153 8 Ruby 1 Posters: Teacher evaluation ...... 156 8 Ruby 2 Posters: Teaching and learning theory; Peer-to-Peer learning ...... 158

Friday 2 September (green section)

Session 9 9AUD Symposium: Student involvement in medical education ...... 161 9A Short communications: International medical education; the Bologna Declaration .. 161 9B Short communications: Standard setting ...... 163 9C Short communications: Staff/faculty development 2: learning outcomes and rewards .. 164 9D Workshop: Mastering bedside cardiology using Harvey, the Cardiopulmonary Patient Simulator .. 166 9E Short communications: e-Learning in action ...... 167 9F Short communications: Teaching and learning about public health and health promotion .. 168 9H Short communications: e-Assessment 2 ...... 170 9L Short communications: Education and professionalism ...... 172 9M Short communications: Diversity and admission to medical school .. .. 173 9N Short communications: Postgraduate education 1 ...... 174 9O Short communications: Outcome based education 1 ...... 176 9R Workshop: A consumer’s guide to Generalisability Theory ...... 178 9S Workshop: Using Team Learning teaching methods to promote multiple professional competencies 178 9T Workshop: Portfolios: joy or burden? Lessons learned from experience in undergraduate medical training ...... 179 9U Workshop: Accept, Revise, Reject: reviewing educational research manuscripts .. .. 179

9 Onyx 1 Posters: Assessment of communication skills ...... 180 9 Onyx 2 Posters: Multiprofessional education ...... 181 9 Topaz 1 Posters: Evaluation of Problem Based Learning ...... 183 9 Ruby 1 Posters: Postgraduate education and Continuing Professional Development .. .. 186 9 Ruby 2 Posters: Teaching and learning communication skills ...... 187

Session 10 10AUD Symposium: Selection for medicine ...... 190 10A Short communications: Use of simulators ...... 190 10B Short communications: Problem Based Learning: results from different approaches to evaluation 192 10C Short communications: Staff/faculty development 3 ...... 193 10D Workshop: Best evidence simulation-based training using Harvey, the Cardiopulmonary Patient Simulator ...... 195 10E Short communications: Clinical teaching and learning ...... 195 10F Short communications: The student in difficulty ...... 197 10H Short communications: New challenges for the curriculum ...... 198 10L Short communications: Approaches to assessment ...... 200 10M Short communications: e-Learning clinical skills ...... 201 10N Short communications: Postgraduate education 2 ...... 202 10O Short communications: Outcome based education 2 ...... 204 10R Workshop: Playing the game – the role of games and simulations in medical education .. 206 10S Workshop: Integration of Ethics in the undergraduate medical curriculum .. .. 206 10T Workshop: Reflective Practice: how to use it to improve your clinical teaching .. .. 206 10U Workshop: Consent for patient recordings in healthcare education ...... 207

– 4 – INDEX OF ABSTRACTS

10 Onyx 1 Posters: International medical education; Language proficiency ...... 207 10 Onyx 2 Posters: The Objective Structured Clinical Examination ...... 210 10 Topaz 1 Posters: Professionalism and attitudes ...... 213 10 Ruby 1 Posters: Teaching and learning about research methods and Evidence Based Medicine .. 216 10 Ruby 2 Posters: Undergraduate training in primary care...... 219

Session 11 Plenary: New learning technologies ...... 222

Web posters (white section)

WBS The Basic Sciences ...... 223 WCA Clinical Assessment ...... 224 WCS Communication Skills ...... 226 WCEL Computers and e-Learning ...... 227 WCE Curriculum Evaluation ...... 228 WCP Curriculum Planning ...... 230 WPG Postgraduate Education and CPD/CME ...... 232 WP Professionalism ...... 234 WSD Staff/Faculty Development ...... 235 WSS Special Subjects in the Curriculum ...... 235 WS Students ...... 236 WTL Teaching and Learning ...... 237

– 5 – INDEX OF ABSTRACTS

– 6 – Session 1 WEDNESDAY 31 AUGUST Session 1

Plenary What makes a good doctor?

1.1 Attitudes and professionalism: The Miriam to culturally competent. It starts with understanding oneself Friedman Ben-David Lecture as a cultural being with insecurities and prejudices (cultural awareness). It demands some cultural knowledge on values David Stern (University of Michigan Medical School, Division and expectations of other members of our societies. It of General Medicine, 300 North Ingalls, Ann Arbor, MI 48109- leads to cultural skills, so that professional care providers 0429, USA) are capable of developing culturally sensitive interventions, What makes a good doctor? The characteristics of a good and it results in a cultural exchange, where continuing doctor are well-defined by the ideals of our profession communication leads to respect and further development and the expectations of our patients. But what makes a of cultural competence. good doctor? That is, what is the recipe for a good doctor? Certainly it takes training in the foundations of knowledge, clinical skills, and ethical understanding. However, these 1.3 Clinical Reasoning foundations are of little practical use until forged in the Geoff Norman (McMaster University Medical School, context of practice. Dealing with uncertainty, accepting Department of Clinical Epidemiology, 1280 Main Street West, responsibility, and reflecting on practice in an environment Hamilton, Ontario L8N 3Z5, Canada) conducive to professional formation can create the good This presentation is a review of 3 decades of research doctors we expect. into the nature of clinical reasoning. I highlight three distinct periods in our understanding of the process. In 1.2 Cultural Competence the first period, reasoning was viewed as a general skill, like problem-solving, which experts acquired in the course Ivan Wolffers (Vrije Universiteit, Amsterdam, Netherlands) of their training, and which could be elucidated by Interaction between people looking for care and providers observation and introspection as experts and novices of care is a meeting place of cultures. Providers of care worked their way though a clinical problem in a realistic need professional training for what is expected from them setting. In the end, little evidence of a general skill in this interaction. Internationally this has been labelled emerged, and it became evident that success was more as a process of ‘Interculturalisation’. This process involves directly related to knowledge in a particular domain. The two or more cultures, because providers of care as well as second period was characterized by attempts to identify care seekers of care belong to cultures. Cultures are the organization of knowledge used by experts. Various systems of interpretation that help people make sense of researchers have hypothesized that expert knowledge is what happens to them. Though in Western countries based on individual exemplar cases, semantic axes, professionals often think that others belong to a culture, propositional networks, conditional probabilities, and illness while they themselves work in a scientific way and belong scripts. Clearly not all can be right, and we are now entering to a culture of truth, reality is different. All human beings a third broad research program in which the central issue are cultural beings. Cultures are not homogenous and is how experts coordinate various kinds of knowledge to people belong to more cultures. In multicultural societies, solve particular problems. In concluding, I will draw a ‘good doctor’ is trained to move from culturally destructive implications for clinical teaching.

– 7 – Session 2 WEDNESDAY 31 AUGUST Session 2

Symposia 2AUD & 2A

2AUD Attitudes and professionalism opportunities in a cost-effective product oriented way. This will require formal cooperation among professional medical Trudie Roberts (University of Leeds, Medical Education Unit, organizations, national health systems, governments, Level 7, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK), Robert Galbraith (National Board of Medical Examiners, medical schools and practicing physicians. Project GLOBE Philadelphia, USA), David Stern (University of Michigan initiative is a new worldwide partnership aimed at Medical School, Ann Arbor, USA), Anne Garden (University improving the capability and competence of generalist of Liverpool, UK) and Moira Maley (University of Western doctors (with an emphasis on GPs and FPs) to deliver Australia) health and medical care of the highest possible quality What do we mean by professionalism and what are within their own countries and practice settings. A Steering professional attitudes? What are the implications for Committee of international leaders in medical education, selection? What is the role of the teacher? If we had a general practice, and family medicine as well as information basket containing professional attitudes/professional technology was convened in March 2005 and has attributes what qualities would be in it and what wouldn’t? developed an initial assessment of the needs and ways to How are attitudes taught and assessed? Can we only enhance the competence of GPs, FPs and health systems address behaviours which are visible rather then attitudes in a group of representative countries around the world. which are often hidden? Does it matter that an individual This session will report on the progress made during the may hold what we consider to be a non professional first months of the initiative and provide a forum for attitude if their behaviour is exemplary? Can attitudes be discussion by AMEE attendees about the future directions changed and if so how? If a student fails a knowledge or of the project. Brief presentations will focus on these four skills test then we provide remedial teaching – can this areas: 1) GP/FP educational and professional development apply to attitudes? The world of work and societies’ values needs from selected countries; 2) effective methods, tools are changing – can we offer a framework for attitudes and resources that will be applicable to deliver CME-CPD and professionalism which covers this? These are some of globally or regionally; 3) a report on currently available the issues that will be addressed in the session, together core-curricula and learning experiences for the education with others raised by participants. of generalist physicians, and 4) the development of a consensus declaration of the need for such an initiative to foster its widespread adoption. This is a multi-purposed 2A Project GLOBE: A new initiative to provide CPD initiative aimed at the front lines of medical practice, quality CPD for Generalist Physicians to be studied initially in a few countries but eventually to be made available worldwide. The goal is straightforward: Pablo A Pulido M Co-chair, Project GLOBE (PanAmerican to assure the highest possible quality of health care for Federation of Associations of Medical Schools, Venezuela), populations and for individual patients all over the world Dennis K. Wentz (WentzMiller & Associates, USA) Co-chair, Project GLOBE, Lewis A. Miller (WentzMiller & Associates, through equally high quality CME and CPD. During the USA) and Members of Project GLOBE Steering Committee open discussion, AMEE attendees will 1) share their thoughts about the need for developing such a world- Generalist physicians provide most of the first line care to wide effort to assist practicing generalist doctors in the world’s population. Yet, there is a need for better access remaining competent, 2) help identify areas for further by these physicians to quality continuing medical education cooperation and collaboration in developing CME and CPD and professional development opportunities in order to for this target audience, and 3) discuss the practical aspects help them maintain their competence to practice. New of providing assurance to society that medical practitioners systems of thinking are needed to maximize such are well-educated and competent.

Short Communications 2B PBL: the presenting problem

2B 1 Comparing a video case with a text case in a frequencies of clause categories were calculated and postgraduate problem-based learning format compared using chi-square tests. Greater improvements in clause frequency after the video case compared with 1 2 2 T Balslev* , W S de Grave , A M M Muijtjens and A J J A the equivalent text were seen in data exploration, theory 2 1 Scherpbier ( Arhus University Hospital, Skejby, DENMARK building and theory evaluation. and 2University of Maastricht, NETHERLANDS) The use of patient video recordings may be a valuable In domains with a strong visual component video cases supplement to postgraduate paediatric training, particularly may be a valuable addition to the training programme, pertaining to movement disorders. since they can show characteristic signs and symptoms of patient cases, are easy to obtain and highly authentic. This study was performed to investigate whether adding 2B 2 What determines the perceived quality of a a brief video case instead of an equivalent written text problem-solving case? improves cognitive and metacognitive processes (data exploration, theory building, theory evaluation and Johan Beullens*, Elke Struyf and Bo Van Damme (Centre of metareasoning) of residents in problem-based learning. Medical Education, Faculty of Medicine, K.U. Leuven, Eleven pediatric residents were assigned to one of two Minderbroederstraat 17, Leuven B-3000, BELGIUM) groups. Both groups analysed an identical vignette of a Background: Problems used in medical education vary in patient case. Immediately after this, one group watched a structure and complexity. We developed a questionnaire 2.5-minute video recording and the other group read a measuring both aspects in patient cases used as starting description of the same video recording. The groups then points in problem solving clinical seminars. We assessed re-analysed the case. Thinking processes were tapped by the reliability of the questionnaire and checked which items recording and analysing the verbal group interaction. The determine the perceived quality of a case.

– 8 – Session 2 WEDNESDAY 31 AUGUST Session 2

What was done: 159 final year medical students judged received lower points than those with “functional” learning 113 cases. 5043 forms were collected. The developed objectives (physiology, pathophysiology, pathology) questionnaire consists of 17 statements judged on a 6- regarding the first 3 categories. point-scale. Factor analysis and multiple regression analysis were performed. Reliability was assessed with Cronbach alpha. 2B 5 Patient encounters as the stimulus for student learning in problem based learning: Conclusions: Cronbach alpha of the total scale was 0.87. Factor analysis resulted in two reliable subscales: Structure a first evaluation of the Maastricht (10 items; alpha = 0.88) and Complexity (7 items; alpha experience = 0.79). Multiple regression analysis showed that the Agnes D Diemers*, Diana H J M Dolmans, Marijke S A van quality of a case depends positively on authenticity, Santen, Scheltus van Luijk, Ameike Janssen and Albert J J A relevance of pathology, coherence, challenge, structure Scherpbier (Universiteit van Maastricht, FdG, Skillslab, and instructive value and negatively on lack of information, Postbus 616, Maastricht 6200 MD, NETHERLANDS) incoherence and high level of complexity. Perceived quality Aim of Presentation: To overcome the gap between theory is more determined by Structure than by Complexity. and practice it is suggested to implement patient Take-home messages: Medical teachers should develop encounters as the ultimate stimulus for learning. But several well-structured, complete, coherent cases concerning not problems may arise when integrating patient encounters too complex, frequent pathologies. in PBL. We developed a model in which patients are used as a starting point for learning, consisting of four phases: preparation, patient encounter, self-study and reporting 2B 3 A letter from the sufferer in PBL tutorial phase. The aim of the study is to evaluate students’ Ariyuki Hori*, Naohiro Kuroda, Noriko Ainoda, Yukio Yasuda, perceptions of these four phases. Yoshiro Ohara and Koji Suzuki (Kanazawa Medical University, Summary of Work: Students filled out an evaluation Medical Education Center, 1-1 Daigaku, Uchinada-machi, questionnaire about the four phases. Kahoku-gun, Ishikawa-ken 920-0293, JAPAN) Summary of Results: Students are highly satisfied with The curriculum before clinical exposure is structured with the patient encounter phase, especially with the PBL tutorials, lectures and exercises in our University. Since instructiveness of the patient encounter. The reporting paper-based PBL cases are used in these tutorials, students phase is also highly rated, particularly the integration of are not able to feel patients’ and families’ emotional issues theory and practice. Students are less satisfied with the with reality. In such a situation, it is difficult to cover preparation phase and the generation of learning issues education of the affective domain. To address the affective after the patient encounter. domain before clinical exposure, we introduced a letter from the patient’s family as a sheet in a PBL tutorial. The Conclusions: This study demonstrates that real patient case was written based on a real patient who was suffering encounters can be implemented in PBL and in the from lung cancer with multiple brain metastases. He died perceptions of students lead towards a better integration three months after the first visit to our hospital. We asked of theory and practice. An explanation for this finding is his wife to write a letter about the story of his illness to that the patient is used as the driving force for student our medical students. The letter was used at PBL tutorial learning. Nevertheless this study demonstrates that some as the last page of the case. Most students realized they points need improvement to further optimize student have to consider not only about diseases but also patients learning. as human beings. They wrote letters to his wife about how they felt from the letter and what they could learn as medical students. The application of letters from sufferers 2B 6 Standardized patients and multimedia: such as patients or families in PBL tutorials could be one powerful PBL tools for medical education educational way for the affective domain. Sandor Vigh, Delia Anderson* and Julius L Levy (Tulane School of Medicine, Standardized Patient Program, Dean’s Office, SL 93, 1430 Tulane Avenue, New Orleans LA 701121, 2B 4 The evaluation of PBL scenarios by tutors USA) Ozden Palaoglu*, Meral Demiroren, Filiz Yalcin, Sabri The use of standardized patients and SmartBoard© Kemahli and I.Hakki Ayhan (Ankara University, Faculty of presentations in a problem-based learning setting facilitate Medicine, Departments of Medical Education and Pediatrics, a medical student’s understanding of the interrelation Karanfil Sokat 29/2, Kizilay, Ankara 06650, TURKEY) between human anatomy and disease processes. The The traditional discipline-based and lecture-based presentation of an actual clinical case of a patient with curriculum of Ankara University Faculty of Medicine has pancreatic cancer is used as the basis of a small group been changed to a problem-based hybrid curriculum PBL session during the freshman students’ study of starting from the academic year of 2002-2003. Faculty abdominal anatomy. The session consists of the use of members taking part in the organisation of modules are SPs and SmartBoards© for training students in the arts of also responsible for writing scenarios appropriate to the history taking, physical examination, test ordering, and predetermined learning objectives. However, some differential diagnosis. The SP simulates the patient; the inevitable inaccuracies were observed in the first year. All SmartBoard© displays tests, results, and tutorials. The scenarios were reviewed and some were re-written in the development at Tulane of an incorporated CT/MRI viewer second year of the new curriculum. As another result of and ZoomImage© technology permits easy navigation, this dynamic process the faculty members have gained panning and zooming of images in full screen size. A experience in tutoring. In order to evaluate the scenarios clinician-facilitator guides the exercise and keeps the and the PBL process, surveys were distributed to tutors at discussions on track. The integration of methodologies the end of every module and they were requested to reply enhances the students’ ability to use the framework of an to the questions on a 5-point Likert scale in 4 categories: actual clinical case to combine knowledge of anatomy and (1) appropriateness of the scenario, (2) achieving learning a complex clinical problem. This exercise teaches problem objectives, (3) PBL process and (4) the informativeness solving, encourages teamwork and self-directed learning, of tutor copies. Average scores for each category are and instructs interpretation of diagnostic imaging. This calculated and items with scores above 4 are considered entire process and the early interaction between students acceptable. Generally it has been found that scenarios with and patients add to the students’ enjoyment of gross more “structural” learning objectives (anatomy, histology) anatomy.

– 9 – Session 2 WEDNESDAY 31 AUGUST Session 2

Short Communications 2C Training for leadership

2C 1 Developing tomorrow’s leaders in health 2C 3 Professionalism in early medical education: and social care education evaluation of leadership in the gross Judy McKimm (University of Leicester, Department of Medical anatomy course & Social Care Education, Maurice Shock Medical Sciences Michael J Hromanik*, Stephen W Carmichael and Wojciech Building, PO Box 138, Leicester LE1 9HN, UK) Pawlina (Mayo Medical School, Department of Anatomy, Mayo This presentation aims to stimulate discussion about the Clinic, 200 First Street SW, Stabile Building 9-38C, Rochester purpose and future of leadership development for health MN 55905, USA) care educators. Three national leadership development To adapt to today’s changing healthcare environment, programmes specifically for aspiring leaders in health and modern physicians are required to possess new skills and social care education have been run in the UK. These are competencies not included in past medical school curricula. inter-disciplinary in focus, bringing individuals together to These include knowledge of team structure and the learn about key issues in leadership of health professionals’ principles of effective leadership. The structure of the gross education. Current innovations in leadership development anatomy course provides an early opportunity to introduce are utilised, aiming to complement in-house staff these concepts to first-year medical students. This study development programmes on leadership and management examined leadership and professionalism characteristics offered by many universities. Seventy participants attended and their impact on academic achievement among first- the programmes from a wide range of universities and year medical students completing gross anatomy. professional disciplines. Programmes include general Leadership responsibility of each four-member gross leadership topics, focussed towards health education, anatomy dissection team was assigned to each member tailored to the specific learning needs and contexts of the on a rotating basis. The leader was responsible for participants. A unique feature is the emphasis on the overseeing team-based learning activities and completion development of the individual as a health education leader, of laboratory objectives. Each leader was evaluated by providing opportunities for developing and practising skills the other team members via two survey instruments that acquired through clinical practice in a HE context. Although assessed leadership style and professional characteristics. many universities are developing leadership development The data were analyzed to determine the relationship programmes, these are mainly aimed at current leaders between these variables and the dissection team’s and are generic. Participants benefit from learning performance on examinations. Team performance alongside people from other organisations and professions demonstrated a positive association with the leader’s level and accessing acknowledged experts in leadership. This of respect (p=0.0177), integrity (p=0.0029), responsibility national programme, focusing specifically on the needs of (p=0.0002), and excellence (p=0.0223). The leadership health care educators, has brought about significant adaptability scale (p=0.0014) demonstrated a positive professional development in aspiring leaders and provided association with team performance on course examinations a model for other leadership development programmes. as well. This study indicates that leadership and professionalism characteristics positively influence team performance on gross anatomy examinations. 2C 2 Integration of leadership education with generalist physician training 2C 4 Development of a leadership skills workshop Perry A Pugno (American Academy of Family Physicians (AAFP), Division of Medical Education, 11400 Tomahawk in pediatric advanced resuscitation Creek Parkway, Leawood, Kansas 66211-2672, USA) Ronald Gottesman*, Elaine Gilfoyle and Saleem Razack (McGill University Health Centre, Montreal Children’s In U.S. postgraduate medical education, the importance Hospital, 2300 Tupper, C-808, Montreal, Quebec H9A 3H2, of training physicians in the knowledge, skills and attitudes CANADA) of leadership is only now being recognized. In recent years, some attention has been given to the competency of We conducted a prospective needs-assessment of pediatric professionalism among physicians-in-training, but for many, trainees that revealed discomfort with leadership, it is an ill-defined and vague concept to grasp… let alone communication and organizational skills during advanced evaluate. But leadership training is only this year becoming resuscitation. A resuscitation-based OSCE confirmed these a required component of generalist physician education. results. In anticipation of this change in postgraduate medical Objective: Implement and evaluate an educational education, a pilot program has been initiated that integrates intervention on leadership skills in resuscitation. the training of family physicians with a formal graduate Methods: 15 residents participated in a voluntary workshop degree program in health care leadership. Through a based on ‘Crisis Resource Management’ (Howard 1992). unique partnership among a professional association, a A plenary session preceded small group simulated Jesuit-sponsored graduate school of business resuscitation scenarios with role-playing. Objective management, and multiple local physician training evaluation was by checklist. Self-evaluated learning was programs has arisen a model curriculum that integrates by retrospective pre/post questionnaire (Skeff 1992). the competencies of leadership and medical professionalism into a seamless educational intervention. Results: Improvement in checklist scores was Early experience with this pilot program will be described, demonstrated from scenario 1 to 2 (63-87 p < 0.05). including how physician competencies are “matrixed” with Retrospective Pre-Post (5 point Likert scale): knowledge those of professional business leadership education and of tasks required of a leader (2.93-4.6*); appreciation of how program participants are evolving the curriculum impact of communication on delivery of care (3.80-4.80*); through their own creative efforts. Although not without ability to identify components of effective communication the challenges facing any new program, this pilot has (2.87-4.27*); understanding of fixation errors (2.67- clearly provided a unique educational opportunity for the 4.20*); overall performance as a team leader (2.33-3.47*); health care leaders of tomorrow. *p < 0.001. Conclusions: Improved objective scores between scenarios confirmed learning. We demonstrated self-reported improvement in tasks required of a leader, communication and the avoidance of fixation errors. Overall, the trainees reported improved comfort as team leaders.

– 10 – Session 2 WEDNESDAY 31 AUGUST Session 2

2C 5 A framework for academic leadership and 2C 6 Developing leadership skills in medicine management of a medical school Derek Gallen*, Glynis Buckle and Alex Bush (LNR Deanery, P P C Nel*, S Petersen, N J van Zyl, G J van Zyl and M M Nel Lakeside House, 4 Smith Way, Grove Park, Leicester LE19 1SS, (University of the Free State, School of Medicine, Faculty of UK) Health Sciences, Internal Box G48, P O Box 339, Bloemfontein, Aim: To develop effective management and leadership skills 9300 SOUTH AFRICA) essential to the future development of healthcare at an Managers need to reassess their role and create an early stage in the medical career pathway. environment within which education and training can be Summary: Our innovative post combines medicine, conducted successfully. The complexity of medical and management and leadership for Modernising Medical education institutions; the changes that have occurred and Careers Foundation Programme Year 2 doctors (previously are still occurring; as well as the expectations of higher SHO Year 1). This provides an opportunity for doctors to education and health institutions and bodies, demand that pursue an interest both in medicine and leadership. It gives urgent and informed action be taken in leadership and on them insight into and experience of the generic qualities the management front. The aim of the research was to and skills required for effective leadership. Acute general design a framework for leadership and management in medicine and general practice provide clinical experience medical schools on which the leadership and management for this post and are the setting for the management and of a school could be modelled if a school should wish to leadership programme. This lasts for twelve months, with do so. The premises for the academic leadership and doctors spending six months in each of the two specialities. management framework; the departure points for successful implementation; the different role-players who Results: This accredited leadership programme offered a influence leadership and management in medical schools; range of blended learning opportunities in four stages: as well as detailed formulations of the recommendations 1 Diagnosis of current performance against NHS on each aspect included in the framework, were given. Leadership Quality Framework The researcher proposed two ways of how the 2 Coaching from a personal development adviser recommendations made in the framework could be used, namely a sliding and a layering approach and/or by using 3 Core and optional learning e.g. job shadowing them together with a planning indicator. With this study a 4 Evaluation through delivery of a management project contribution is made to effective and efficient academic leadership and management in Medical Schools and can Conclusion: This programme will open up more career form part of a staff development strategy. options, whilst ensuring that effective leadership becomes an integral part of a doctor’s basic training, thereby developing effective leadership skills for future consultants and GPs.

Short Communications 2D Student characteristics

2D 1 Influence of studying on students’ health 2D 2 Self concept and psychopathology in O Onur*1 and R P Nippert2 (1International Federation of medical students at the Faculty of Medicine Medical Students Associations, Gringelsbach 61, Aachen of Porto: a longitudinal study 52080, GERMANY and 2Westfalische Wilhelms-Universitat, Medizinische Fakultat, Institute of Medical Education & I Lourinho, E Loureiro*, P Costa, M A Tavares and R Mota- Student Affairs, Munster, GERMANY) Cardoso (University of Porto, Office of Medical Education, Faculty of Medicine, Alameda Hernani Monteiro, Gabinete Aim: This student-based project focuses on a correlation de Educação, Porto 4200-319, PORTUGAL) between studying and students’ health, especially if Aim: To determine prevalence of anxiety, depression, different educational systems cause different stress, coping obsessive-compulsive traits and self-concept of medical strategies, life style and health. Preliminary results were students throughout the 6 years of the course. presented at past AMEE-conferences; this presentation will cover the final results. Summary: 146 freshman students (24,7% male; 75,3 % female), mean age was 18, 13 (s.d.=0.82), completed a Summary of work: This study is organized by IFMSA. The demographic questionnaire, the Hospital Anxiety questionnaire contains: General information, health Depression Scale (Zigmond & Snaith, 1983 adapt. information, information on studying and lifestyle. 1928 McIntyre, 1999, the Maudsley O-C Inventory (Experimental questionnaires from 5 schools (2 conventional schools and Version, Pocinho, 1993) and Clinical Self-Concept Inventory 1 PBL-school from Germany, 2 PBL schools from The (Vaz Serra, 1995), during phase 1 of our study (October Netherlands) were analyzed. 2002) and phase 2 (November 2004) where 99,3% Result: The conventional schools cause more study-related (n=145) students were attending 3rd year. stress than the PBL-schools. The workload and the pressure Results: Results of questionnaires are being correlated with are the main concerns. The stressed students report more demographic data (social-economic status, residence, diseases diagnosed during their studies. Asking the criteria of admission, reasons for selecting the medical students about their impression on their global health, course, grades obtained throughout the 3 years). This 86,8% of the PBL-students feel healthy, only 69,6% of procedure intends to evaluate to what extent the the non-PBL-students. experience of being a medical student influences the Conclusions: PBL-students feel mentally and physically dimensions present in the questionnaires used. healthier and report fewer problems with their health. A Conclusions: It’s largely accepted that Medical School is a student-centred and PBL-based study course seems to stressful social environment, leading to profound changes cause less stress, to prepare students better on stress in students as they progress in the course. Consequently and provide healthier and more sustainable coping it seems crucial to support students to cope, as well as mechanisms than in a conventional medical school. rethink some aspects of the on-going curriculum. (Supported FMUP, Fundação Calouste Gulbenkian)

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2D 3 Medical students’ epistemological beliefs: a 2D 5 Evaluation of daytime sleepiness in medical qualitative investigation students in Brazil Lynn Knight* and Karen Mattick (University of Plymouth, Patricia T Fiedler*, Patricia L Bellodi, Cinthya A Taniguchi, Peninsula Medical School, Room C315, Portland Square, Bruno Perotta, Geraldo Lorenzi-Filho and Milton A Martins Drake Circus, Plymouth PL4 8AA, UK) (Universidade de São Paulo, Faculdade de Medicina, Av. Dr Arnaldo 455 Sala 1216, São Paulo SP 01256-903, BRAZIL) Aim: To present preliminary findings from a longitudinal study investigating medical students’ epistemological Aim of investigation: To investigate the presence of beliefs (EBs) and approaches to learning (AL). excessive daytime sleepiness in medical students in Brazil and the differences of gender, year of medical course and Background: EBs concern the nature of knowledge and region of Brazil in daytime sleepiness. learning: beliefs about how individuals come to know, and how knowledge is constructed. These may change over Procedures: The Epworth Sleepiness Scale (ESS) was time (from simple to sophisticated) and span a number of applied to 787 medical students of the five regions of Brazil dimensions including: Certainty of Knowledge (from (430 males and 357 females). A quality of life questionnaire absolute truths, to tentative, evolving knowledge), was also applied (WHOQOL-BREF). Simplicity of Knowledge (from discrete knowable facts to Summary of results: Mean (± standard deviation) ESS knowledge as relative and contextual), Justification for values were 9.71 ± 4.63. Most medical students (56.6%) knowing (from residing in authority, to evaluation of had ESS scores > 9, values suggestive of increased daytime evidence) and Source of Knowledge (derived from authority sleepiness. Women had more ESS scores > 9 than men to actively constructed). (66.1% and 54.8%, respectively, p = 0.0016). There were Summary of work: We conducted semi-structured no significant differences in ESS scores among students interviews investigating medical students’ EBs and AL with from different years of the medical course. In addition, a purposive sample (n=15) at the end of their second- medical students from different regions of Brazil did not year (academic context) prior to their transition into the present significant differences in ESS values. clinical context (spring 2004). Follow-up interviews took Conclusions: A substantial number of medical students in place in 2005. Transcripts were analysed using the Brazil have sleep deprivation. Female medical students Framework approach. present more daytime sleepiness than male medical Summary of Results: Preliminary results suggest that some students. Daytime sleepiness may interfere with quality of students entering the clinical phase of study still have life and academic performance in medical students. relatively naive, unsophisticated EBs. Moreover, a complex relationship was found between the constructs of AL, tolerance of uncertainty and EBs. This included evidence 2D 6 The amount of mirthfulness and its relation of epistemological development and domain specificity with self-reliance in students of Lorestan (different EBs for different academic disciplines). University of Medical Sciences A Farhadi*, F Javaheri, Y B Gholami and P Farhadi (Lorestan University of Medical Sciences, End of Razi St, Khorram Abad, 2D 4 To become a Doctor: altruism, dream or Lorestan, IRAN) profit? Analysis of first year medical students’ motivations throughout 3 years Introduction: The aim of this research was to study the amount of mirthfulness of the students and its relation M F Patrício, A Pais-Lacerda and J Gomes-Pedro (University with self-reliance. of Lisbon, Faculdade de Medicina de Lisboa, Av Prof Egas Moniz, Piso 1, Lisboa 1649-028, PORTUGAL) Materials and methods: In this cross-sectional study 150 day students were selected using systematic random Introduction: It is widely accepted that individual sampling. To carry out the research two measurement motivations determine future professional attitudes. instruments of mirthfulness and self-reliance rate were Objectives: To identify: (1) why students have decided to used. become doctors; (2) if motivations are the same throughout Findings: 150 students including 82% female, 18% male, years and can be explained by gender. 93.8% single and 6.2% married were studied. Data Methods: 675 students (2002-03=221; 2003-04=203; analyses showed that 19.3% of the students had a low 2004-05=251) completed an anonymous questionnaire. amount of mirthfulness. The amount of mirthfulness of 62% of them was acceptable and 18.7% of them had a Results/conclusions: In the sample as a whole, we found good amount of mirthfulness. From the viewpoint of self- the following motivations: Vocation/dream (40%); “Helping reliance 29.33% of the students had a low self-reliance, other people” (26%); Scientific interest (13%); Profession 58% had a fair self-reliance and only 12.67% had a good without routine (16%); other (5%). Gender was a and high self-reliance. Data analyses showed that there is significant variable only in 2004-05, and only among a significant difference (P<0.001) between the amount of women could we find significant differences throughout self-reliance of the students. Data analysis showed that the years. These results can be explained by women’s the amount of mirthfulness is significantly higher in some higher percentages in “helping others” and “profession married students (P<0.05). Between the amount of with no routine”. mirthfulness and self-reliance there was a significant Take-home messages: Classical reasons for going to correlation (r=0.58) medicine – vocation, altruism, science – were found in Conclusion: There was a direct relation between this cohort of students. Financial issues and professional mirthfulness and self-reliance, and as it is mentioned in status, for example, were not mentioned as first options. different psychologic references, reduction of self-reliance is one of the symptoms of depression.

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Short Communications 2E Approaches to multiprofessional education

2E 1 Two years’ experience of a 2-year long 2E 3 The first 60 minutes, a multidisciplinary interprofessional course for graduate education for young doctors entrant medical and adult nursing students Per Brunkwall* and Gassan Darwiche (University Hospital Jon Fuller* and Mary Tod (St Bartholomew’s Hospital, Barts Malmo, Department of Anesthesia and Intensive Care, Carl and The London, Queen Mary School of Medicine and Gustavs Vag, Malmo 205 20, SWEDEN) Dentistry, Robin Brook Centre, Room 128, West Smithfield, Lack of courses in emergency medicine for doctors under London EC1A 7BE, UK) training is a problem in Sweden. Only 10 percent have Considerable attention and resources are now being put these courses early under their internship. The University into the development of interprofessional learning. There Hospital in Malmo has decided to offer a course for doctors are a wide number of different types of curricula for under training early in their education. The curriculum is interprofessional learning. Until recently most of these have based on a PBL-concept using a modified case methodology been short courses in postgraduate education. Recently a from Harvard in Boston. The course integrates doctors number of programmes have been developed for from different specialities with experienced nurses from undergraduate/pre-registration students. This paper the emergency ward. The five day course comprises: three describes one of them. theoretical days where cases from the emergency room are discussed with case methodology, and two days of Introduction: Barts and The London, Queen Mary, practical training, using an interactive patient simulator University of London and The St Bartholomew School of bridging between theory and clinical practice. The simulator Nursing and Midwifery, City University both have Graduate includes a mannequin that is controlled by a computer– Entrants’ Programmes in MBBS and Masters in Adult based (Macintosh) software which can give the trainee 88 Nursing respectively. Approximately 20% of the first year acute medical conditions. It can replicate many humanistic of these courses and a smaller proportion of the second functions including the cardiovascular and respiratory year are taught jointly as an ‘Interprofessional Course’. systems and have the ability to react to external stimuli. The courses have now been running for two years, with Our results from 100 participants over a two year-period 120 students having completed the first year. The courses are very encouraging, and over 85 percent of the have been evaluated throughout the years. participants were very satisfied with the course. The Results: The students and staff have evaluated the multidisciplinary discussion about different cases was much interprofessional aspect of the course positively. Joint appreciated. Our experience of this learning concept is problem based learning, the learning of practical skills and very good, since it promotes deep learning and an in- ethics and law teaching were particularly successful. depth collaboration between disciplines. Ongoing work is being undertaken in sessions on team building and leadership, whilst reciprocal shadowing in the practice setting is developing. Problems with practical 2E 4 ‘Multiprofessional collaboration’, a aspects of the course, such as timetabling and room formative evaluation of an educational pilot booking did not always go smoothly and caused H E Westerveld*, I I Zitter, H Wittink, G Croiset and Th J ten considerable annoyance to all concerned. The disparity in Cate (Universiteit Utrecht, Hogeschool van Utrecht, PO Box assessments, some of the communication skills teaching 85029, 3508 AA Utrecht, NETHERLANDS) and the intermittent nature of the programme were areas the students identified as also needing improvement. Aim of presentation: The aim is to present results of the formative evaluation of a pilot-setting, concerning multiprofessional, ICT-supported education for students 2E 2 Blended learning in clinical skills as an from different educational programmes: Physiotherapy, interdisciplinary education module Speech-therapy and Nursing of The Hogeschool van Utrecht and the medical programme SUMMA of the Ahmed Younis*, Terry Poulton and Annemarie Cancienne (St University Medical Center Utrecht. George’s Hospital Medical School, School of Physiotherapy, Cranmer Terrace, London SW17 0RE, UK) Summary of work: To evaluate, the following sources are used: Meeting-reports and products of educational Demand for educating health professionals for team development-team (November 2003 – February 2004); practice is increasing. In order to achieve effective, efficient Intermediary evaluations (2); Group-interviews (2) with education, more emphasis should be placed on educational developers and teachers/tutors; interdisciplinary teaching. We designed a interdisciplinary Questionnaires (32 participating students). clinical skills module. It was delivered by online and by traditional face-to-face techniques, for comparison. It Summary of results: The evaluative activities resulted in included materials prepared by, and designed to be used the following main outcome, which focuses on the by, different disciplines. Each skill unit was supported by development process. Developing a common frame of photographs to enhance understanding of examination reference, including a common language, by the procedures and diagnoses. Physiotherapy students and participating educational developers from different paramedics shared these materials in the first stage. The backgrounds, proved to be an intensive process, but is a special needs for each discipline were discussed during prerequisite for developing multiprofessional education. both delivery methods. The sessions were evaluated by This common frame of reference refers to both domain- the different groups of students and the results are specific elements (e.g. concept of ‘clinical reasoning’), and compared here. The results from different tests will be to educational aspects (e.g. educational vision and presented, with physiotherapy and paramedic students models). looking at the effectiveness of these sessions. The results Conclusions: The main conclusion is that development of for the paramedic students are encouraging and the multiprofessional education is a multiprofessional, anecdotal feedback from the physiotherapy students has collaborative activity in itself. The final education which is been very much in favour of this approach. Our hope is developed as a result, mirrors the benefits and difficulties that more schools will use the approach so that students of these multiprofessional, collaborative development from different disciplines will be exposed to shared efforts. materials which will enhance discussion and improve clinical and communication skills to the benefit of patients.

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2E 5 Solving medical problems – collaboration evaluating obtained results. Furthermore, interprofessional between new groups of undergraduate learning increased the understanding, importance and students relevance of having translational projects in molecular medicine. Annelie Brauner* and Ewa Ehrenborg* (Karolinska Institutet, Department of Medicine, King Gustaf V Research Institute, Karolinska University Hospital, Stockholm SE 171 76, 2E 6 Inter-professionalism as an educational SWEDEN) task Aim: To promote interprofessional relations between Gerald Neitzke (Hannover Medical School (MHH), Department clinically and experimentally oriented students by working of History, Ethics & Theory of Medicine, Carl-Neuberg-Str 1, with disease-related cases. Hannover D-30625, GERMANY) Background: Interprofessional learning is regarded as the Professionalism has clearly been described as a relevant base for future constructive and excellent health care. Thus, task in medical education. But a single medical profession it is important to offer interdisciplinary assignments in hardly ever acts on its own. Usually teamwork is applied molecular medicine already at the undergraduate level. on the wards in hospital. Therefore interactive capacities Summary: Medical students were given short case between medical professions become additionally presentations regarding patients with urinary tract infection necessary aspects of professionalism. These capacities and urine samples in order to perform rapid identification could be called interprofessional competency. A definition suitable for general practitioners. The biomedical students of interprofessional competency will be given. It focuses on the other hand were given the same patient samples on communication skills, the process of shared decision- but with the possibility to use all modern diagnostic tools making and the attitudes towards co-operation. If for species identification. The aim was to determine and interprofessionalism is one of the goals and objectives of discuss correctness and relevance of the obtained results medical education, shared learning opportunities among together with the development of new and reliable medical and nursing students are needed. An example for diagnostic tools. In addition, all students read and critically such a learning environment will be given: at Hannover analysed related scientific articles together from a Medical School an interprofessional ethics seminar has been diagnostic and clinical perspective in order to deepen their performed since 2001. Teaching methods and content of knowledge. This aim was reached, as evaluated by a the seminars foster students to develop interprofessional student led examination with an external examiner. skills. Interprofessionalism is the completion of professionalism in the context of co-operation on the ward. Conclusions: A deeper level of learning was achieved by discussing the scientific articles together and thereby re-

Short Communications 2F Methods of teaching and learning

2F 1 What qualities do good teachers possess? 2F 2 A new curriculum for subinterns in the Promoting excellence in teaching in department of surgery at Heidelberg problem-based learning courses University – problems of implementation, Samy A Azer (University of Melbourne, Faculty Education Unit successes and first adaptations (FEU), Faculty of Medicine, Dentistry and Health Sciences, Martina Kadmon*, Christine Engel, Monika Porsche and Parkville, Vic 3010, AUSTRALIA) Susann Holler (University of Heidelberg, Department of Role modeling is considered an integral component of Surgery, Chirurgische Universitatsklinik, Im Neuenheimer Feld medical and health professional education. We identify 110, Heidelberg 69120, GERMANY) people as role models when they possess qualities we At the AMEE conference 2004 we presented a poster on would like to have and when they are able to influence curriculum development for subinterns in our department. others to develop new skills and achieve their potential. Now we present data on the success and limitations of Role models inspire people to change their behaviour and curriculum implementation. The new curriculum was become high achievers and willing to succeed. Students implemented in December 2003. A major educational tool most likely acquire these good qualities when they introduced was a logbook. 57 students were included in continuously experience how their teacher handles difficult the intervention group between December 2003 and June and stressful situations, how they treat their patients, and 2004 and were subjected to pre-course and post-course how they handle ethical and moral issues as they manage OSCEs, self assessment and evaluation procedures. The each patient. Such positive experiences have long-term control group (subinterns between August and December effects on students and are most likely to reshape their 2003, n=30) were subjected to the same OSCEs and self attitude and enforce good qualities particularly when they assessment procedure. face challenging situations. What makes a good teacher? Results: The intervention group reached significantly higher Is it their personality, or their interpersonal skills? Is it result improvements in the post-course OSCE in items their competency in teaching and their ability to keep their relating to application of theory in clinical problem solving knowledge up-to-date or is it their capacity to attract people (p=0.013; control group n=11; intervention group n=12). and communicate effectively with them? Do Health Similar findings were observed concerning practical skills. Professional Schools use role models in an effective way The acceptance of the logbook is still improvable. to deliver their curricula? This presentation aims at addressing these questions: What are the qualities of a Conclusions: Students of the intervention group especially good teacher? How important is the use of role models in improved in “application of theory in clinical problem teaching and learning? What strategies do you use to solving” and “practical skills” Those are the major areas motivate your students? How to avoid de-motivating the new curriculum addresses. The logbooks showed that people? some tasks, e.g. positioning of gastric tubes, are difficult to accomplish in real patients. Therefore, we are presently adapting the curriculum introducing simulator training.

– 14 – Session 2 WEDNESDAY 31 AUGUST Session 2

2F 3 Team learning: tackling connective tissue 2F 5 Extra-curricular courses on clinical skills disease using students as instructors. Attendance D Soranno*, C McCoy and N Singer (Case Western Reserve and satisfaction? University, School of Medicine, Office of Curricular Affairs, M B Rasmussen, M Lind, M G Tolsgaard, A Gustafsson* and C 10900 Euclid Avenue, Room T-402, Cleveland, Ohio 44106- Ringsted (Copenhagen University Hospital Rigshospitalet, 4924, USA) Centre for Clinical Education, Amager Boulevard 101, 31, Aim of Presentation: We hypothesized that team learning Copenhagen 2300, DENMARK) incorporating preparatory readings and application At the Centre for Clinical Education a group of medical exercises would: 1) increase student engagement; and 2) students offer voluntary courses in clinical skills for their engender confidence and enthusiasm during current and peers. These extra-curricular courses are free of charge. future evaluation of patients with connective tissue disease Topics include IV-access, application of ventricular tube, (CTD). catheterization, suturation, neurological examination and Summary of Work: Preparatory readings were required. A resuscitation. The medical curriculum at Copenhagen content expert facilitated this session in which teams were University includes a number of short mandatory skills pre-assigned. Use of individual readiness assurance tests training courses. However, examination does not include (IRAT) ensured individual accountability for pre-reading. assessment of skills. The purpose of this study was to Group readiness assurance tests (GRAT) identical to IRATs investigate why students attend voluntary extra-curricular contributed to uniform team preparedness. IRATs and courses and how they perceived the quality of the courses GRATs were scored and counted towards the final course run by student instructors. A survey was distributed among grade. An application exercise containing a representative course participants and the response rate was 66/66 case was used for working through complex questions with (100%). Motivation for attendance were preparation for multiple answers. Teams were asked to make a specific clinical clerkship (70%), preparation for locum or internship choice from five options, and to report and defend their appointment (15%). desire to improve skills (8%), other choices. (7%). Ninety-five percent found the course fulfilled the goals, 98% that the level of difficulty of the skills taught Summary of Results: 1) >90% attendance; 2) active was suitable, and 100% indicated that the student student engagement as judged by observers; and 3) a instructors were competent as teachers. The results raise wide range of constructive written feedback including the the question whether clinical skills training in the formal need for better preparatory readings. The data suggest curriculum is sufficient. Using students as instructors might student investment and participation in the learning be a possible strategy to increase the amount of skills process. To determine the session’s effectiveness in training in the formal curriculum. improving knowledge, performance on final examination questions will be compared to historical controls. Conclusions/Take-Home Messages: Team learning can be 2F 6 Comparison of efficacy of implementing two successful using a single facilitator in engaging medical teaching methods, contract learning and students in the learning process. traditional, on clinical skill nursing students in psychiatric wards of hospitals of Tehran 2F 4 Peer learning – do students learn from one Jamileh Mohtashami* and Fatemeh Noughani (Tehran University of Medical Sciences, Faculty of Nursing and another? Midwifery, Faculty of Islamic Azad University of Varamin- L de Villiers and V C Burch (University of Cape Town, Institute Pishva, Nursing Research Centre, Tohid Square, Tehran of Ageing in Africa, L51, Old Main Building, Groote Schuur 141118, IRAN) Hospital, Observatory 7925, SOUTH AFRICA) Introduction: A learning contract is defined as a written Aim of presentation: Peer learning is an appropriate agreement between teacher and student, which makes teaching method for adult learners. Of concern, however, explicit what a learner will do to achieve specified learning is whether peer teaching achieves similar learning to outcomes. Learning contracts have been used as a teaching teaching by expert clinicians. and learning strategy for both undergraduate and graduate nursing students in many countries. Summary of work: During their medical clerkship third year medical students (n=150) reviewed literature relevant to Methods: This research is a quasi experimental study that one of five “Care of the Elderly” topics, interviewed and compares the effect of two different teaching methods, examined elderly patients and made 5-minute audiovisual contract learning and traditional on clinical skills for a group presentations to their peers using the patient encounters of nursing students who were in fourth year of study in a to illustrate the discussion. Fourth year medical students pre-registration bachelor of nursing degree programme in (n=170) acted as the control group. They clerked elderly Tehran. A learning contract was implemented as a learning patients in their clerkship and attended a series of lectures, tool in the student’s clinical placement in psychiatric with accompanying lecture notes, on the same topics. A nursing. Data were collected from questionnaires, 5-question test was administered to both student groups interviews and clinical evaluation papers with students. during the end-of-year examination. Results: The results showed that students agreed that Summary of results: Third year students achieved a there was an increase in the student’s autonomy and significantly higher mean test score than fourth year motivation in learning with the use of the learning contract. students (p=0.00000). Both knowledge recall (Q1: p=0.01, It also increased the sharing between students and clinical Q2: p=0.00000, Q4: p=0.00000) and understanding (Q5: instructors. p=0.00000) were better in the third year cohort. Conclusion: According to the findings of this study, contract Conclusion/take-home message: Patient-based structured learning is considered beneficial to student learning and peer learning activities provide good-quality learning has the potential to be used in clinical learning. encounters when compared to conventional lectures given by expert clinicians.

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Workshop 2H

2H How to improve oral examinations in Oral examinations are used in all medical faculties with medical practice the goal of assessing students’ clinical skills, attitudes and behaviours that are essential in providing high quality John Norcini (Director of the Foundation for Advancement of patient care. The ‘Mini-Clinical Evaluation Exercise’ (Mini- International Medical Education and Research (FAIMER), CEX) will be presented briefly in the workshop. We will Philadelphia, USA) and Reinhard Westkämper (IAWF, University of Bern, SWITZERLAND) discuss and show steps how this format can be used to improve the oral exams in your faculty, providing a more valid and reliable measure of performance.

Short Communications 2L Selection for graduate entry to medicine

2L 1 Selecting medical students into Australian prepared short talk. Each station is marked against specific Medical Schools: does it matter how? criteria by an assessor – thus the selection decision is made by 10 different people. The MMI is being trialled in R B Hays (James Cook University, School of Medicine, May 2005. The outcome of this new selection procedure Townsville, QLD 4811, AUSTRALIA) will be reported to the conference. Background: Australia now has 15 medical schools, with three or possibly more new schools planned. About half admit graduate students into four year PBL hybrid courses, 2L 3 Study motivation of secondary school and the rest admit school leavers into five or six year hybrid medical students course, with or without a PBL focus. Competition for places Pauliina Kronqvist, Jarkko Mäkinen, Satu Ranne, Olli Vainio is intense. All select students on a combination of academic and Pekka Kääpä* (University of Turku, Department of merit and personal qualities. All use some form of Pathology, Kiinamyllynkatu 10, Turku Fin-20520, FINLAND) structured interview process, one the selection “OSCE” Aim of presentation: We evaluated study motivation, method, to determine interpersonal skills. This paper commitment and development of clinical decision-making reviews the intent of these processes and explores the among medical students with different educational impacts on student cohort composition. backgrounds. Methods: The selection methods used in Australian medical Summary of work: The study included 176 first- and schools are briefly described, with particular reference to second-year medical students from the medical faculty of the experience at one new medical school – James Cook the University of Turku, Turku, Finland. A third of the University. students (31%) was admitted to medical education directly Results: Despite the difference in approaches, many from high school (secondary school entry), while the others medical schools appear to produce similar ranking of (69%) had already performed studies in other university applicants and to make offers to the same students. faculties or were graduate entry students with at least three years of practical training in heath care professions. Conclusion: There is very little evidence that selection In this study, the different student groups were compared methods make much difference to student cohorts, their on the basis of the IGSO (Inventory of General Study behaviour or later outcomes. More research is necessary Orientations) questionnaire and a patient narrative exercise to clarify whether the high cost of selection processes is with a clinical problem-case. worth the effort and cost. Summary of results: According to the IGSO analysis, all students showed systematic and practical orientation to 2L 2 The use of the multiple mini interview to their studies and their commitment to medical studies was select medical students high. By contrast, secondary school entry students Zulkarnain Hj. Hanafi, Mas Rinawati bte Abd Hamid, Nurolaini possessed significantly higher social orientation and tended Pg Hj MD Kifli, Charles Hoyle and Peter McCrorie* (St to report less deep orientation to their studies than students George’s Hospital Medical School, Department of Medical & with previous tertiary education. In patient narrative Healthcare Education, Cranmer Terrace, Tooting, London exercise, a holistic approach towards various medical, social SW17 ORE, UK) and psychological aspects in the problem-case students In partnership with medical schools in the UK, Australia was evident in the majority of medical students with tertiary and Canada, Universiti Brunei Darussalem is introducing education background, whereas secondary school entry a new 3-year biomedical science degree course for school students showed clearly stronger confidence in their own leavers which will allow graduates to progress to the clinical clinical examination and decision-making skills. courses at partner universities and obtain a medical degree Conclusions: First-and second-year medical students are from that institution. Following the model introduced by generally very committed and have a strong motivation to Eva at McMaster University, we decided to write our own learn medicine. However, during the early undergraduate version of the “Multiple Mini Interview” (MMI) to select education the secondary school entry students show medical students for Brunei. Applicants have to complete especially strong social orientation to their studies, when an “interview OSCE” consisting of ten 5-minute stations compared to students who entered the medical school at each of which they have to perform a task. Tasks include with a previous tertiary level education. Deep orientation a mixture of standardised interview questions (around and holistic problem-solving of the medical students motivation, experience and awareness of the medical entering directly from high school also tend to be weaker profession), dealing with ethical dilemmas, discussing than in students with previous tertiary education. In our psychosocial issues in response to picture stimuli, opinion, these findings should be taken into consideration communicating with a simulated patient, critique-ing a in organizing medical undergraduate courses, at least video of a doctor-patient interaction, presenting a pre- during the early phase of education. Observation and

– 16 – Session 2 WEDNESDAY 31 AUGUST Session 2

follow-up of study performance and motivation among the Summary: A series of critical incident interviews were different student groups throughout their medical conducted with a range of students, Deans and admissions education will be continued. tutors from 6 medical schools to define a working model of selection criteria (N=56). The results showed there were 8 key domains to be assessed including academic ability 2L 4 Cognitive learning style variations between & intellect, communication skills, initiative & resilience, school leaver and graduate entrants to effective learning style, organisation & problem-solving etc. medical school The results were used to develop an AC comprising 3 exercises (group, written, probed simulation) and several Paul Lazarus (University of Leicester, Department of Medical & Social Care Education, Maurice Shock Medical Sciences psychometric assessments. Exercises were piloted in six Building, PO Box 138, University Road, Leicester, LE1 9HN, schools (N=70) to evaluate content validity. UK) Conclusion: The results provide initial evidence for a model This presentation will highlight inherent differences in the of non-academic selection criteria for graduate entry into way in which graduate and school-leaver entrants to medical school, the first reported in the medical domain. medical school may go about their studies, and discuss Findings suggest that using ACs could improve the validity possible implications of these. Graduate entry is increasing. of selection compared with traditional interview techniques. Medical schools need to be aware of any differences which Future research directions are discussed. graduates may demonstrate in how they cope with their medical studies, compared to the ‘standard’ school-leaver intake, in order to inform teaching and possibly workforce 2L 6 Why do science graduates want to read planning after qualification. We know a little about medicine? approaches to learning in these groups, but there is little Teresa Pawlikowska*, Jag Sihota, Jane Kidd and Debbie work on inherent cognitive learning style differences. Biggerstaff (University of Warwick, Warwick Medical School, Leicester Medical School’s new graduate entry students Gibbet Hill Road, Coventry CV7 4AL, UK) were asked to complete the Kolb learning style inventory, Aim: Until recently scientists wanting to read medicine in as were a control group of school leaver entrants. The the UK have joined school-leavers on a 5-year course. results showed a significant difference (p<0.025) between Leicester-Warwick medical school was the first to offer the two groups, with the graduate group showing a graduate entry, with a minimum 2i degree. Graduate entry stronger preference toward convergent learning styles. programmes are thought to increase diversity of access, Considering the existing literature, these results may but they require significant additional commitment. We predict differences in performance in various examination were interested in what motivated postgraduates to formats, and may point to differences in choice of career undertake a second degree in medicine. after qualification. Such would be relevant for both curriculum and workforce planners. Method: All (n=64) students in the first cohort (2004) were invited to participate. 38 semi-structured interviews were conducted after final exams and were analysed 2L 5 Developing assessment centres to aid thematically. Motivation and experience of the application medical school selection process were explored. F Patterson*, K Petty-Saphon, M Kerrin, E Ferguson and V Results: Reasons for studying medicine divided into three Carr (City University London, 1 Bramcote Road, Beeston, groups. One group had not considered medicine previously Nottingham NG9 1AG, UK) and were empowered by their degree or contact with Aims: The aims are twofold: (i) to define a working model medical students. Others wanted to apply their science in of valid selection criteria to recruit students to graduate working with people. Most of the first cohort under the entry programmes at medical school and, (ii) using this new fast-track scheme had always wanted to become model, design and pilot an assessment centre process (AC) doctors, had failed to get a medical place leaving school, to elicit information relevant to these target domains. This and hence read a science degree first. exploratory study shows how the selection criteria were Conclusions: Graduate-entry schemes can be said to be developed using a multi-source approach. The research widening access to medical school, allowing a second was conducted with six UK medical schools. chance to those who mature later and achieve good science degrees.

Short Communications 2M Clinical assessment

2M 1 The short clinical assessment form evaluated Aim of study: The feasibility of the KKB form in making in the internal medicine clerkship clear whether assessed skills were directly observed or derived from indirect sources such as note review and M Louwerens*, F W Dekker and J H Bolk (University of Leiden, concomitant case discussion was studied, as was the Leiden University Medical Center, Albinusdreef 2, C5-56, perceptibility of longitudinal development of student Leiden 2300 RC, NETHERLANDS) performance. Background: The Short Clinical Assessment, in Dutch: Korte Results: 1276 KKB forms of 40 Internal Medicine clerks Klinische Beoordeling (KKB), derived from the American were evaluated. In only 5 % of KKBs it was clear whether mini-CEX, is used in the clerkships at Leiden University the assessed skills had been directly observed. Longitudinal Medical Center for assessment of clinical competence by development of student performance within the space of direct observation. On the KKB form medical interviewing the clerkship was not manifested in want of graduation and physical examination skills, clinical judgement, facility within the predominant ‘satisfactory’ domain. communication, organisation/efficiency, and professionalism can be scored. Instead of the original 9- Conclusions: These results give clear indications on how point mini-CEX scale, ‘unsatisfactory’, ‘satisfactory’ to improve the scale for use in the Dutch Internal Medicine ‘excellent’ scores are used in concordance with the final clerkship. assessment form used in the clerkships. The remark ‘not observed’ denotes the skills not being directly observed.

– 17 – Session 2 WEDNESDAY 31 AUGUST Session 2

2M 2 Assessment of clinical reasoning: is it 2M 4 Using video assessment to assess practical necessary to accept variability of answers skills: the case of PRHOs learning suturing within the panel of reference to detect skills clinical experience? Jeremy Martindale* and Linda Malek (University of Dundee, Robert Gagnon*1, Bernard Charlin1, Évelyne Sauvé1 and Cees Cuschieri Skills Centre, Ninewells Hospital and Medical van der Vleuten2 (1Education Medicale Continue, Université School, Level 5, Dundee DD1 9SY, UK) de Montreal, CP6128, Succursale Centre-Ville, Montreal H3C Aim: Videotape assessment potentially offers a reliable 2 3J7, CANADA and University of Maastricht, NETHERLANDS) assessment of competence in practical skills, and may be Background: The Script Concordance Test (SCT) assesses particularly useful for more complex skills, such as suturing. reasoning in the context of uncertainty. It uses an Videotape assessment was compared with “real time” aggregate scoring method that reflects the variability on assessment, to identify benefits and practical issues. answers demonstrated by members of a panel of reference. Summary of work: A group of 46 pre-registration house Methods: Items in the low, moderate and high variability officers (PRHOs) was observed and videotaped suturing categories were selected among a pool of items measuring in a skills laboratory. They were assessed “live” by checklist clinical reasoning. The final test, made of 103 items, was and later using the videotapes. The two assessments were administered to three contrasted groups in family medicine: compared, including ability to: observe the procedure 157 clerkship students, 30 residents and 30 experienced clearly; observe individual points of the procedure; award physicians. reliable global ratings. Four raters included experts and non-experts. They met in advance to agree guidelines for Results: A clear effect of variability was observed on the assessment and the videotapes were assessed by pairs of discriminative power of the test. Items with moderate raters. variability show high effect size for discrimination between extreme groups, while high variability items show less effect Summary of results: Videotape assessment was reliable size, and low variability items demonstrate no both inter and intra rater. Videotape assessment gave discrimination. advantages over “live” assessment, notably in ability to observe the procedure clearly and in awarding global Conclusion: Variability of responses in the panel of ratings. However the videotape assessment was time- reference is a key element of the discriminative power of consuming and could not capture some aspects of the the SCT. procedure, e.g. disposal of sharps. Take home message: As expected, and in accordance with Conclusion: In practical skills training, videotape the theory, items with moderate variability on answers assessment has significant benefits, which could be among panel members ensure maximal discrimination valuable in summative assessment of competence in between levels of expertise. practical skills. Potential benefits for formative feedback could also be beneficially explored. 2M 3 The validity of the Objective Structured Video Examination for assessing clinical 2M 5 Developing an objective continuous communication skills assessment tool for final year clerkship in Jon Dowell*, Cathy Jackson, Jean Ker and Robert Jarvis surgery at Aga Khan University (University of Dundee, Tayside Centre for General Practice, MacKenzie Building, Kirsty Semple Way, Dundee, DD2 4AD, Shazia Sadaf*, Hasnain Zafar, Naghma Naeem, Amanullah UK) Memon and Rukhsana W Zuberi (Aga Khan University, Stadium Road, PO Box 3500, Karachi 74800, PAKISTAN) Aim: To test the OSVE for assessing medical students’ perceptual skills for the information giving component of The study reports on the process of developing an objective the consultation. evaluation tool for continuous assessment of students during the Final Year Clerkship in Surgery at the Aga Khan Summary: In 2002 Dundee Medical School introduced new University (AKU). Students during the Clerkship in Surgery teaching on information giving in 4th year. Logistically it are assessed through continuous assessment (CA) and was only possible for approximately half of the students end of clerkship examination held at the end of the rotation. to attend. To assess this training and the potential of the The CA contributes 70% towards the total score while the OSVE exam we included an information giving task within remaining 30% score comes from the end of clerkship the summative year 4 OSCE and invited students to clinical examination. It was observed that the results of complete a 40 minute OSVE assessment at the start of these two components sometimes did not correlate, leading 5th year. This involved watching a 10 minute video of to dissatisfaction amongst students and faculty. To address information giving twice and providing free text comments this issue, focused group discussions were held with the on three relevant elements under each of three headings faculty and students, where the majority felt that the format (strengths, weaknesses and suggestions) and justifying of the tool being used was not objective enough. This led their opinion for each. Response was graded 0-2, giving a to a review of the “Students Continuous Evaluation Form” maximum of 18. Four markers independently assessed the by the Department of Surgery. A new continuous evaluation scripts. form was designed using Bandiera et al’s “Global Results: Trained students scored significantly higher in the Assessment Form” as a template. This form was piloted OSVE but not OSCE (n = 73). OSCE and OSVE scores did on two batches of the class of 2005. The revised format not correlate. There was high correlation between OSVE of the continuous assessment was termed as “holistic, examiners. objective and comprehensive evaluation” both by the faculty and the students. Considering the positive feedback Conclusion: The OSVE is time consuming but has potential received, a task force has been set up to review the for assessing specific components of the medical interview continuous assessment strategy and tools being used and merits further investigation. during all clerkships at the Medical College with the aim to design a uniform and standardized system of continuous assessment across all disciplines.

– 18 – Session 2 WEDNESDAY 31 AUGUST Session 2

Short Communications 2N e-Learning – instructional design

2N 1 A case study in creating and using reusable At the Medical University of Vienna, clinical skills are taught learning objects to 600 students per term in 60 parallel small-groups by up to 60 trainers. In order to ensure training quality, we G McConnell*, V H Dale and C Newlands (The University of require highly standardized and unambiguous learning Edinburgh, Royal (Dick) School of Veterinary Studies, material. In 2002 we revised our script for an introductory Summerhall, Edinburgh EH9 1QH, UK) skills course by including detailed procedural lists with Background: CLIVE (Computer-aided Learning in Veterinary illustrative images of all taught skills. With peers (students Education), a consortium of veterinary schools, has a with substantial clerkship experience) acting as instructors, collection of CAL materials produced over a period of 13 this script sets the fundamental standards to what is years. A mini project, funded by the Higher Education taught, trained and reliably assessed (since it also provides Academy Subject Centre for Medicine, Dentistry and the objectives for the OSCE-checklists). The script is made Veterinary Medicine in 2004, investigated repurposing available during the course in the form of a collaborative selected elements from these materials with the aim of hypertext (by means of a free web-service by providing web and VLE-ready resources in the veterinary www.quicktopic.com) that can be annotated. We context. Partners in the project were the Universities of encourage students and trainers to record problems, Edinburgh and Glasgow. deviating opinions or supplementary proposals regarding Summary: Resources were extracted from CAL packages the script on the spot. Their comments are evaluated and re-packaged as Reusable Learning Objects (RLOs) in annually by an expert panel and the learning material is a variety of ways, uploaded to a repository, catalogued accordingly refined. Evaluation results on the students’ and then downloaded and inserted into the VLEs in use in use of this online annotation tool as well as its efficacy in Edinburgh and Glasgow. The process was documented. raising the quality of the course material will be presented at the conference. In line with our positive experience we Conclusions: There are barriers to be overcome at each also plan to implement annotation functionality to teaching stage of RLO production and use: packaging, uploading and learning contents in our evolving eLearning and cataloguing a single object can take many hours; environment. vocabularies in veterinary medicine are not agreed; insertion into VLEs is not always straightforward, depending on the VLE. The authors concluded that the effort required 2N 4 Assessing the reusability of a concept-based (at the time of the study) would be likely to deter wide ‘Diagnostic Ultrasound – Acoustic adoption by novices and would only be worthwhile for Impedance’ learning object valuable/high quality resources. Andleeb Arshad* and Jamsheer Talati (Aga Khan University, Department for Educational Development, Faculty Health 2N 2 Recycled learning objects: the ACETS project Sciences, Stadium Road, Karachi 74800, PAKISTAN) Rachel Ellaway*, David Dewhurst, Dawn Leeder, Suzanne Aim of Presentation: Learning Object is defined as ‘any Hardy and Erin Mills (University of Edinburgh, MVM Learning digital resource that can be reused to support learning’ Technology Section, The Medical School, Hugh Robson Link (Wiley, 2000). This study briefly contemplates the Building, 15 George Square, Edinburgh EH8 9XD, UK) important issues in learning objects as raised in Much has been made of the promise of learning objects contemporary literature with a particular focus on the and reusable learning resources in the past few years. aspect of reusability. Subsequently, the development and Despite a number of large institutional, national and even educational worth of a learning object on Diagnostic international projects that have been set up predicated Ultrasound based on the concept of Acoustic Impedance on exchange and reuse of teaching materials many developed in the Medical School of Aga Khan University, teachers remain bemused by the subject. The ACETS Pakistan, is investigated in terms of its reusability. project has commissioned a number of detailed and Summary of work: Drawing from contemporary research grounded case studies of academics dealing with issues the study picks an instructional design from Bannan-Ritland of reuse in their teaching practices in order that the real (2000) which matches with the concept based ‘Diagnostic problems, opportunities and strengths of this approach Ultrasound – Acoustic Impedance’ learning object. can be identified and made available to all those interested Secondly, with Wiley’s (2000) taxonomy of learning objects, in reuse in their teaching. This paper will present the the study identifies a class where this learning object can findings of the ACETS Project, in particular focusing on be appropriately placed. Moreover, the process of positive messages for teachers who are confused by the construction of the learning object is described and prospect of using third party materials in their teaching. analysed. Symbolic Interactionism is used as a theoretical The main themes being that creativity and lateral thinking perspective for research and group discussion is used as counts for far more than technical infrastructure, and that a method. institutions will need to change their cultures if reuse is to happen on a wide basis. The paper will also present Take-home message: The study concludes on the argument messages for those involved in organising healthcare that instructional designs and pedagogical principles should education along lines of reuse and the application of be the guiding principles not only in the aggregation of learning object principles. learning objects for building a conducive learning environment but it should also be effective inside the learning object in shaping its structure as well as providing 2N 3 Towards standardization and better guidance in its process of construction. comprehensibility of course content: use of a web-based text annotation tool to 2N 5 Quality-managing outcome-based education enhance the collaborative formative review through the application of ICT of teaching and learning material P Boulton, M Brown*, S Clark, T Dornan, M Islam, G Murray, Michael Schmidts* and Thomas Link (Medical University of J Petch and D Powley (University of Manchester, School of Vienna, Core Unit for Medical Education, Währinger Gürtel Electrical and Electronic Engineering, Control Systems Centre, 18-20, AKH-Leitstelle 8L, Vienna A-1090, AUSTRIA) Sackville Street Building, Manchester M60 1QD, UK)

– 19 – Session 2 WEDNESDAY 31 AUGUST Session 2

Aims of presentation: Report an educational technology 2N 6 Students report and discuss real patient cases that can analyse and present evaluation data flexibly to in Virtual Learning Environment: a method to curriculum managers. Illustrate the application of data involve students in virtual learning management principles to the design of a virtual managed learning environment (VMLE). Kati Hakkarainen, Anti Syvänen and Teija Vainio (University of Tampere, Medical School, 33014 Tampere, FINLAND) Summary of work: We have built an educational technology to support learner-centred, outcome-based health We have developed hypermedia material on infectious professions education. At the core of the system is the diseases to support PBL. Virtual learning must be made principle of “reusable feedback”. Each item of learner accessible and meaningful for the students. This study feedback is stored as a transaction with metadata describes a way to attract students to virtual learning categorizing the associated learner, the event, the date resources. Third year medical students were given a task and the data type in a relational database star schema. to interview patients treated in an infectious diseases unit OLAP analysis and visualization technology allows the data and to report their case on a VLE with attached photos. to be queried flexibly and aggregated at later times to One teacher commented on all cases and summarized perform a variety of “what if”-type analysis. We have them. Volunteer students were interviewed and the developed a simple query facility that allows curriculum students also gave feedback in the block evaluation. The managers to quality-manage their curricula, at the same log-data on the VLE were analyzed. The students time as allowing learners to reflect on their experiences experienced writing and reading the cases rewarding. They and assessing the relevance of learning resources. appreciated that all could share the cases and the comments the teacher had presented. The summaries of Summary of results: Using the technology, we have the cases structured their learning. The cases and patient developed demonstrator software that allows curriculum photos appeared more authentic than those in textbooks. managers to browse the learning outcomes attained by The analysis of the log-data showed that the students educational events, learners, courses, and teachers. The systematically utilized the web cases. As a conclusion, we technology allows students to review the strengths and propose that the virtual learning should not only mean weaknesses of their learning portfolios and teachers to studying the materials designed by teachers. The students tailor their teaching to students’ individual learning profiles. showed genuine interest in publishing their own cases and Conclusions/take-home messages: The application of data using them as a study resource. This way of working gave warehousing technology to a VMLE that has the principle an extended dimension to real patient contacts. of feedback at its centre makes ‘real-time’ curriculum evaluation and educational quality assurance a reality.

Short Communications 2O Continuing professional development/continuing medical education 1

2O 1 CPD adherence: the first two years of Accreditation of continuing education (CE) can be a useful RCPCH CPD Audit method to substantiate that the activity meets or exceeds an established standard of quality. This presentation will A P J Thomson and RCPCH CPD Department (Royal College outline how an accreditation system was developed and of Paediatrics and Child Health, 2 The Avenue, Alsager, Stoke- implemented so that high quality CE within and outside of on-Trent ST7 2AN, UK) the Emirate of Abu Dhabi could earn a ‘seal of approval’. Background: The RCPCH CPD scheme was audited for 2002 An accreditation system should be based on criteria that and 2003. support a standard of quality. These need to include (as a Methods: Each year, 5% of scheme participants were minimum) criteria pertaining to participants’ needs, well- randomly selected. Returned records were checked for: defined learning outcomes, unbiased sponsorship and CPD activity log and match with credits claimed; completed methods of continuous improvement. Participants in CE Personal Development Plan (PDP); evidence of external events and activities should seek those programs which CPD. have earned accreditation and encourage sponsors of such to apply for accreditation. This presentation will provide Results: Results are for 2002 vs 2003. 171 (5.9%) vs 180 practical information on how we built our accreditation (6.1%) of scheme participants were recruited. 139 vs 146 system, the tools and assistance which we provide to records (4.8% vs 5.0% of participants, both 81% of applicants and the “lessons learned” as part of the requested) were audited. 18 vs 35 records (13% vs 24%) experience of raising standards and ensuring that CE which arrived more than 6 months after request. Failure to meet is of high quality earns accreditation, benefiting those who standards rose from 3 (2.2%) to 21 (14.4%) (p < 0.05). participate. Accreditation of CE – it does matter! For 2003 4 respondents declined, including one from 2002. Those claiming 25 external CPD points with insufficient evidence were 0 (0%) vs 1 (0.7% of returned records). 2O 3 Adjusting longer education courses with a Those claiming less than 25 credits rose from 3 (2.2% of good reputation returned records) to 16 (11.3%). 50% of respondents Helle Nielsen*, Annette Plesner Steenstrup* and Sidsel Wied* produced evidence of all claimed external activity. (The Danish Medical Association, Department of Medical Conclusion: CPD adherence is good but documentary Education, Domus Medica, Trondhjemsgade 9, Copenhagen evidence is inadequate. When adherence CPD should be DK 2100, DENMARK) improving, due to impending revalidation, audit failure rose The purpose of this abstract is to present an empirical from 2% of respondents in 2002 to 14% in 2003. and practical based theoretical discourse showing that, when adjusting postgraduate education courses with a good reputation, pre-analyses and uncovering participant 2O 2 Accreditation of continuing education – needs are useless without systematic follow-up and does it matter? evaluation. One of the reasons seems to be that the Susan Ward (General Authority for Health Services for the narrative attached to the education course sometimes is Emirate of Abu Dhabi, SKMC, PO Box 51900, Abu Dhabi, even stronger than the actual change of the education UNITED ARAB EMIRATES) course.

– 20 – Session 2 WEDNESDAY 31 AUGUST Session 2

Background: As The Danish Medical Association planned 2O 5 ‘Returners’ as learners: a needs assessment a revision of the education for leadership and management Jill Edwards* and Honor Merriman (Oxford PGMDE, The for physicians, we carried out a number of analyses and Triangle, Rossevelt Drive, Headington, Oxford OX3 7XP, UK) research as a part of a systematic analysis of participants’ needs and the needs of the health sector. In the light of 20% of doctors who have obtained certificates from the the research the education was revised and offered in a Joint Committee for Postgraduate Training in General new form and content. The change of the education was Practice (JCPTGP) don’t practice as principals. As a result implemented in order to offer efficient education based of the national government initiative to encourage these upon research and adjusted to a health care system doctors back into practice, the Oxford deanery commenced undergoing serious change, implying many different a ‘Returner Scheme’ in February 2003. Whatever the length assignments for its medical leaders. The revision of the of the break from practice the maximum retraining period education was based upon an analytic and systematic full time is set at six months; it is therefore essential that strategy. this short time is used for the maximum benefit of the learners. This study aimed to discover the learning needs Conclusion: The development, adjustment and revision of of this group of doctors. A mixture of methodologies was longer education courses with a good reputation demand used to ensure rigour: quantitative documentary review, a systematic pre-analysis followed by an equally systematic semi-structured interviews with ‘Returners’, focus groups post-analysis in the shape of assessment and evaluation. with trainers, content analysis of data. The need to update Only such an effort will assure the maintenance of the vast amounts of clinical knowledge was paramount. To superior purpose of the education course together with a address these gaps, the ‘Returner’ needed to be parallel development of the narrative of the education acknowledged as an adult learner and given time to course and the actual education. develop in a safe educational environment overseen by a trainer with excellent feedback skills. They needed a high 2O 4 Overcoming barriers for teaching and learning level of control over what and how they learned. For this at the interface of primary and secondary care group of learners the process of education was as important as the outcomes. M B Shershneva*, H B Slotnick and L L Bakken (University of Wisconsin-Madison Medical School, Office of Continuing Medical Education, Health Sciences Learning Center, 750 2O 6 Outcomes based CME/CPD: a case example Highland Avenue, Madison WI 53705, USA) Lawrence Sherman*, Linda Casebeer and Anna Carillo Prior research has demonstrated an educational value for (Postgraduate Institute for Medicine/Jobson Education Group, generalist-specialist communications. Improved 100 Avenue of the Americas, New York NY 10013, USA) understanding of challenges in such communications will Aim of presentation: Live symposia are often criticized as facilitate teaching and learning taking place between ineffective in influencing physician performance. There are physicians. several factors however that can enhance large and small Purpose: This study examines physicians’ perspectives on group learning to increase the chances for physician barriers for teaching-learning transactions at the interface performance improvement. Case-based learning and of primary and secondary care. interactive sessions can be highly effective in facilitating changes in physician practice patterns and improved Methods: We used secondary analysis of data collected in patient health outcomes. Enhancing performance in three prior interview studies of physicians’ learning in practice can be facilitated by using appropriate methods practice, consultation behavior, and learning in generalist- and by designing effective measurement strategies to specialist consultation. Participants included 20 primary assess the impact of these interventions. physicians and 15 specialists. Results: Physicians 1) described seven ways primary physicians and specialists Summary of work: Responses of attendees at a live learn from each other; 2) identified barriers for such international symposium to case-based questions were teaching and learning bearing on inadequate compared to responses to the same cases by matched communication skills, system issues, and physicians’ non-attendee controls. perceptions and beliefs; 3) noted predispositions toward Summary of results: Physician adherence to clinical practice certain barriers developed during medical training and guidelines: participants (67%) were significantly more likely cultivated within practice environments; and 4) proposed than non-participants (39%) to choose the treatment strategies to address barriers for their teaching and recommended by current clinical practice guidelines learning from each other including coping with challenges, (p=.001). Appropriate choice of therapy: participants were using their own and the system’s strengths, and bringing significantly more likely to choose appropriate emipiric about a change in their practice settings. therapy for febrile neutropenia (p=.04). Physician Conclusions: This study identified issues for discussion at confidence: non-participants were less likely to be confident various levels of physicians’ training and professional (33%) in managing febrile neutropenia in children than development. Roles for providers of continuing medical participants (52%), p=.04. education in enhancing teaching-learning transactions at Conclusions/take-home messages: The learner will the interface of primary and secondary care are also examine the linkage between program design and outcome discussed. measurement and the opportunities that measurement offers to examine the impact of CME on practice. Learn what data are available through measurement and how to use the data to improve CME programming.

– 21 – Session 2 WEDNESDAY 31 AUGUST Session 2

Workshops 2R-2U

2R Emergency and Trauma management: (4) Combine principles of active learning with principles training providers and instructors of effective Web page design to develop effective Web- based learning strategies; (5) Appraise educational 1 2 3 4 1 Mike Davis , Lia Fluit , Nigel Turner , Sue Wieteska ( Edge websites and justify suggestions for improvements. Hill/Lancaster University, Chorley, UK; 2Institute for Education and Teaching, UMC St Radboud Nijmegen, the Intended audience: Educators using Web-based instruction Netherlands; 3Dutch Foundation for the Emergency Medical to teach learners at any training level will find this workshop Management of Children (SHK) and Wilhelmina Children’s useful. Hospital, Utrecht, the Netherlands; 4Advanced Life Support Group (ALSG), Manchester, UK) Level of workshop: No prior knowledge required. Background to the topic: Life-support courses for qualified healthcare professionals are becoming commonplace and 2T Multi source (360-degree) feedback for are a recommended part of continuing professional develop assessment, feedback and learning across (CPD) in some countries. However the aims, teaching the medical education continuum methods and teacher training associated with these courses 1 2 3 are generally not well known amongst those involved in Jocelyn Lockyer , Joan Sargeant , Stephen Clyman , Julian 4 1 medical education, many of whom have extended their Archer . University of Calgary, Health Sciences Centre, Health Sciences Center, 3330 Hospital Drive NW, Calgary, AB, interests in recent years to include CPD. CANADA; 2Dalhousie University, Halifax NS, CANADA; Workshop content and structure: During the workshop we 3National Board of Medical Examiners, Philadelphia PA, USA; will provide an overview of all of the elements that make 4Sheffield Children’s NHS Trust, UK this form of course what it is, including instructor training Background: Multi source (360-degree) feedback (MSF) methods and networking. There will also be the opportunity is used to assess students, residents, and practicing to experience first-hand methods for skills teaching, physicians. It is used in the US, UK, and Canada by medical providing feedback and making decisions in assessments. schools, hospitals, HMOs, professional organizations and/ In addition, participants may contribute to discussions or licensing authorities. Competencies such as about skills retention, embedding practice into the communication skills, collegiality, professionalism, and workplace and related research. medical skills are assessed by questionnaires completed Intended outcomes: By the end of the session, participants by medical colleagues, co-workers, and patients. Self- will: (1) be aware of the variety of teaching modalities assessment may also be used. used in emergency and trauma management courses; (2) Workshop content and structure: After brief presentations, have had some practical experience of at least two of these participants will discuss the following questions: (1) What modalities; (3) have experience of participating in is the research base for MSF as an assessment and assessment of skills and scenarios. feedback tool? (2) Is MSF more appropriate for some levels Intended audience: Those interested/involved in CPD, of the continuum than others (e.g., practicing physicians multi-professional learning, skills or life-support training vs. medical students)? Why? (3) What challenges should and teacher training. be anticipated in implementing MSF and how do they vary by level of the continuum? (4) Are some competencies Level of workshop: Beginners through to advanced – all more appropriate for inclusion than others (e.g., levels will be able to participate. interpersonal skills vs. medical knowledge)? Why? Intended outcomes: Participants will: (1) Increase 2S Active Learning on the Web: How to develop awareness of the use of and research base for MSF an effective instructional Web site internationally. (2) Be able to identify some of the challenges in implementing MSF. (3) Be able to discuss its David A. Cook and Denise M. Dupras (Mayo Clinic College of Medicine, Rochester, Minnesota, USA) appropriateness for use at various levels of education and for assessing various competencies. Background to the topic: Web-based learning is used with increasing frequency in medical education, but many Intended audience: All levels of medical education and “educational” websites do not employ principles of effective assessment. learning. Participants in this workshop will learn to develop Level of workshop: Intermediate (some knowledge of effective educational websites by integrating principles of assessment desirable). active learning with the unique features of the Web. Workshop content and structure: The workshop does NOT 2U Developing and using standardized video require extensive computer experience and will NOT teach participants how to program Web pages or use educational cases for computerized assessment of “courseware” such as WebCT or Blackboard. It WILL communication skills for pre-clinical provide the medical educator with a framework for medical students developing educational websites using sound educational R L Hulsman and J D Donnison-Speijer (Academic Medical principles and effective Web page design. In an interactive Centre of Amsterdam, Dept of Medical Psychology, J4, PO Box discussion we will review principles of active learning and 22660, Amsterdam, NETHERLANDS) effective instructional design, and examine evidence-based Background to the topic: We developed a computerized principles of Web design using illustrative examples. objective structured video examination (OSVE) for Participants will design an educational website using assessment of medical communication skills. Students are principles learned and will critically appraise websites using presented standardized video cases on a computer, each defined criteria. followed by short-essay questions testing the student’s Intended outcomes: After completing this workshop, ability to recognize adequately and poorly performed participants will be able to: (1) Outline the steps involved communication skills, to understand the implications of in planning and developing a Web-based course; (2) these skills, and to offer alternative responses to enhance Describe principles of effective learning (“active” learning) the interaction. An OSVE aims to measure covert cognitive as they relate to Web-based education; (3) Distinguish scripts underlying overt communication behaviour. The idea effective Web page designs from less effective designs; that communication behaviour is directed by cognitive

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scripts is built on three premises. 1. Medical communication presented video and transcript, in subgroups the participant can be regarded as a complex task, in which participants will identify key communication problems, point out constantly make decisions about goals, information, effects, required skills, and develop questions. and solutions. 2. Skilful medical communication is goal- Intended outcomes: Participants will acquire know-how oriented, problem-solving behaviour. Competent in setting up a computerized OSVE. practitioners are able to use communication skills at the right time in the right way to reach goals and sub-goals in Intended audience: Anyone who is: medical school faculty their dialogues with patients. 3. Cognitive schemata or engaged in assessment of communication skills; interested scripts facilitate the construction of interpretations of in assessment; interested in computer based testing; situations and help to efficiently select a proper response. engaged in communication skills teaching and training. Workshop content and structure: This workshop will allow Level of workshop: no prior knowledge/experience participants to explore the use of standardized video cases required. for assessment of communication skills. Starting from a

Posters 2 Onyx 1 e-learning in medical education

2 Onyx 1.1 at the Faculty; (2) To determine their level of satisfaction Medical students’ attitudes to computer- with the system; (3) To compile a list of suggestions to assisted instruction improve the content, design and presentation. Nomar M Alviar (University of the City of Manila, General Summary of work: This work is a descriptive study. The Luna cor. Muralla Sts, Intramuros, Manila 1002, population comprised all (292) of the 4th and 5th year PHILIPPINES) medical students registered in academic year 2004. The data collection tool was a self–administered questionnaire. Background: The benefits of computer-assisted instruction The data were then analyzed using descriptive statistics. (CAI) are more assured if users have a positive acceptance of the instructional medium. Student attitudes, however, Summary of results: Nearly all (98%) of the subjects had have hardly been considered in CAI investigations in health used e-learning, and had a moderate level of satisfaction professions education. Knowing that positive reception to with the content for OB–GYN, Medicine, Pediatrics and CAI rests on something deeper than the novelty effect Orthopedics. Usage was between 1 and 4 times/person/ ensures a more effective diffusion of this innovation, month, with the highest frequency for Pediatrics. Most assuring stakeholders that user acceptance would be respondents found the content “satisfactory” followed by lasting, thus avoiding potential wastage of the fiscal design and presentation. Most (89%) felt modifications investment into CAI, especially if available resources are would improve the system and 74.1% would use it more limited. frequently if it were improved. Summary of work: This study aims to describe medical Conclusions: The majority of subjects experienced student attitudes to CAI and establish the relationship of moderate satisfaction with the e-learning and suggested these attitudes to external variables. Three hundred and improvements be made to the content, design and eighty two first- and second-year medical students from presentation. two schools in the Philippines completed a questionnaire exploring attitudes to computers, attitudes to CAI, demographic characteristics, and computer use. Tests of 2 Onyx 1.3 association were performed to determine the relationships Medical students’ negative and positive among these variables. engagement modes to Information Summary of results: Respondents expressed positive Technology (IT) attitudes to CAI in terms of perceived usefulness and ease Parvaneh Sharafi*, Klas Karlgren, Italo Masiello and Kirsti of use. These attitudes were significantly influenced by Lonka (Karolinska Institute, Department of LIME, Stockholm positive attitudes towards computers, early computer 17177, SWEDEN) exposure, and greater personal access to computers, Summary of work: This study aims to relate medical leading to a considerably greater self-reported intent students’ engagements in use of Information Technology among the respondents to make use of CAI. (IT) to their socio-demographic background, psychological characteristics and use of available web-based system in 2 Onyx 1.2 order to identify variations among students for further improvement and intervention. Medical students (n = 107; Medical students’ opinion on e-learning at the 71 female and 36 male; mean age: 25.60) filled in Faculty of Medicine, Khon Kaen University questions about different types of engagement modes, Watana Ditsathaporncharoen, Pisit Jodking, Dris flow experience, IT-competence, and their use of a web- Theerakulpisut, Cholatip Pongskul*, Amorn Premgamon and based learning system. Psychological variables such as Charnchai Panthongviriyakul (Khon Kaen University, stress, exhaustion, anxiety, lack of regulation and interest Department of Medicine, Faculty of Medicine, Khon Kaen were also examined. 40002, THAILAND) Summary of results: The results showed that students’ Background: the Faculty of Medicine at Khon Kaen stress, exhaustion and lack of regulation were significantly University implemented an E–learning system to related to their engagement modes. Anxiety, lack of interest supplement the conventional learning process. The pilot and low IT-competence positively showed a relationship projects consisted of subjects in Internal Medicine, with negative engagement modes. There were significant Orthopedics, Pediatrics, and Obstetrics and Gynecology. differences in terms of gender for enjoying, efficiency, IT- To date, no systematic evaluation of the investment has competence and flow experience, with female students been performed. having more negative experiences. The use of web-based Aim of presentation: (1) To find the average usage of the learning showed significant differences for flow experience, E-learning system by 4th and 5th year medical students IT-competence, efficiency, curiosity and also, frustration.

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Conclusions/take-home messages: It can be suggested 2 Onyx 1.6 that students’ higher anxiety and lack of interest related Blended e-learning of medical humanities in to their education, and low IT-competence as well as being nursing curriculum: a survey of informatics female are related to experiencing negative aspects of IT. knowledge of Florence Medical School Undergraduate Students 2 Onyx 1.4 Andrea A Conti*, Antonio Conti, Maria R Guelfi, Donatella WWW.MEDMICRO.INFO – a new forum for Lippi and Gian Franco Gensini (University of Florence, microbiology teachers Department of Critical Care Medicine and Surgery, Viale Morgagni 85, Firenze I-50134, ITALY) V Woznicová*, M Votava, O Zahradnicek, M Dvorackova, V Hola, P Ondrovcik and F Ruzicka (Masaryk University, Background: Available evidence indicates that a Blended Department of Microbiology, Pekarska 53, Brno 656 91, E-Learning (BEL) approach is characterized by high didactic CZECH REPUBLIC) quality and effectiveness; nevertheless, few data are Aim of presentation: We present our solution of the available for undergraduate nursing students. A survey following problem: How to increase an exchange of the was therefore carried out to test the basic informatics educational “know-how” and to reinforce communication knowledge of the undergraduate nursing students of two in microbiology in the Czech Republic. New challenges (e.g. branch sites of the Florence Medical School. EU educational space) require new approaches. Summary of work: Thirty-three nurses (26 females, 7 Summary of work: We applied the following approaches males; age range: 22-42 years) registered in the to extend communication in a community of teachers: (1) undergraduate course answered a validated questionnaire Electronical conference; i.e. a discussion group and a web aimed at investigating their basic knowledge of informatics site designed for microbiology educators; (2) Conventional and their interest in following a BEL approach focused on conference; the annual conference “Tomasek days of young the Medical Humanities. microbiologists” involved a section focused on didactics of Summary of results: The overall interest in the Blended E- microbiology. Learning approach proposed was high (significantly Summary of results: We developed a web site which serves superior to the 80% threshold foreseen in our null as an information source for medical students/teachers hypothesis, p<0.01). Our survey did not document any and a forum for educators. The site has both English and statistically significant difference in informatics knowledge Czech versions and it comprises medical microbiology atlas between males and females; instead, it recorded a with macro-and microphotographs, videos, webcams and significantly higher knowledge of informatics on the part instructions for practical courses. of younger students (<25 years) as compared to older ones (>25 years). Conclusions: We understand teaching as a lifelong learning process which should be specifically supported and should Conclusions/take-home messages: The data represent a comprise mutual interactions in a community of educators. positive indication for implementing remote electronic academic teaching in the Florence Medical School. Take-home message: www.medmicro.info

The project is supported by the Czech Ministry of Education 2 Onyx 1.7 grant 646/2005. Who’s using our teaching website? K L Franson* and E A Dubois (Leiden University Medical 2 Onyx 1.5 Center (LUMC), Center for Human Drug Research, E-trainer as a didactic approach to change Zernikedreef 10, Leiden 2333 CL, NETHERLANDS) the learning and teaching culture of a Background: In 2003 the TRC Pharmacology database was medical faculty made available on the web. This was done after it was Kai Sostmann*, Susanne Hamelberg, Kai Schnabel, Tina Fix determined that the benefits of general distribution and Gerhard Gaedicke (Charité - University Berlin, outweighed the risks of possible loss of proprietary Department of General Paediatrics, Klinik für Allgemeine information. Now, two years later, the question remains, Paediatric, Augustenburgerplatz 1, Berlin 13353, GERMANY) who’s using our stuff? How is the TRC accessed? It is not possible to Google “ACE inhibitors” and find us, instead Introduction: New technologies emerged during the last since the TRC is a database, it is only reached via direct years in different varieties and E-learning scenarios into inquiry: http://coo.lumc.nl/TRC. Upon arriving at the the medical faculties. After the technology-oriented phase database the visitor is requested to enter a student number of development of the new scenarios, the following step or an email address. The date, topics viewed, and time implies integration of these E-learning-tools into the spent are recorded and stored each week. curriculum. Summary of results: In the previous academic year, there Aims: The concept of the project ELWIS-MED (funded by were over 82,000 hits attributed to nearly 900 Leiden the Federal Ministry of Research and Education starting students doing their coursework. 114 were students from from May 2005 to 2008) includes the initiation of a process another medical school in the Netherlands who were of faculty change. The benefits of new learning encouraged to use the site. 213 were outside visitors and technologies will be embedded into a holistic didactic of these, most casually reviewed the material, but others concept which should lead to the development of a new visited each topic and we assumed this was to copy all the learning and teaching culture at the Charité. material. We had no reports of malicious use or tampering Methods: The project endows selected departments with with our database. E-trainers for a limited period of time. They serve as Conclusions/take-home messages: These data suggests catalysts for the self-learning process of the departments’ that the material has reached its intended group, with teaching staff. They transfer their E-Learning and didactic little outside interference. knowledge to the local medical teachers to develop fully- integrated interdisciplinary blended-learning scenarios on their own. The scenarios are generated for both educational tracks of the Charité: PBL and traditional medical education. ELWIS-MED integrates the principles of Gender Mainstreaming into the didactic scenarios.

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2 Onyx 1.8 2 Onyx 1.10 Can online interactive videos improve End-of-life care of distance education student awareness and familiarisation of program basic clinical skills? Anita Singh1*, Leila Lax2, Larry Librach1, Glenn Regehr, Tim Green*, Arnold Somasunderam, Chara Balasubramaniam Sandra Langlands, Marlene Scardamalia, Lawrence Spero, 1 and Terry Poulton (St George’s University of London, Meaghan Brierely, and Ju Ho Park ( Mount Sinai Hospital, Department of Medical and Healthcare Education, Educational Temmy Latner Centre for Palliative Care, 600 University 2 Technology Unit, London SW17 0RE, UK) Avenue, Toronto, Ontario M5G 1X5, CANADA; Biomedial Communications, Faculty of Medicine; The traditional ‘face to face’ nature of clinical skills teaching is often limited to a very short period of time, with a lack Aim: The aim of this program is to help family physicians of individual tuition. The onus is on the lecturer to plan provide better care for their dying patients and their out their already heavily-committed teaching time families. E-Learning provides the opportunity for isolated effectively. The aim of this project was to develop video practitioners to share knowledge and connect ideas across resources for clinical skills in such a way that they were communities while maintaining a busy practice. easily adaptable as lesson aids to a host of healthcare Summary: Five web-based modules explore the breadth disciplines. Due to the 3-D nature of clinical skills, video is of issues in palliative care, including pain and symptom an obvious medium to use to mirror the movement of a management, issues of death and dying and community- skill procedure. These videos were used as an initial ‘how- based care. This program is a 22-week, accredited, to-perform’ demonstration by the teacher. The students continuing professional development course, piloted in were able to access these resources, via the website, before 2004. A novel E-Learning model was developed integrating and after teaching sessions to either familiarise themselves multimedia cases for collaborative knowledge building and or use as a revision tool. We hope to present the results two interactive videoconferences. Principles of evidence- from a series of tests, with our students, looking at the based reasoning, self-directed learning, self-assessment, effectiveness of these videos in teaching. The results are reflective practice, and knowledge translation are used to encouraging and the anecdotal feedback has been very create a unique E-Learning format. much in favour of this approach. Our hope is that more Results: Evaluation was guided by a design research institutions will adopt a similar approach so that we can paradigm. A mixed methods case study approach was used all share materials by minimal re-purposing, rather than for formative evaluation. Quantitative results of knowledge re-inventing the wheel. pre- and post-tests were triangulated with online knowledge building activity measures and a self-reported 2 Onyx 1.9 satisfaction survey. Evolving web-based induction courses for Conclusion: This program provides a unique and robust international medical graduates environment for busy, isolated family physicians to enhance their knowledge and improve their practice in End-of-Life D P S Sandhu*, S Cavendish and D D Gallen (LNR Postgraduate Deanery, Lakeside House, 4 Smith Way, Grove Care. Park, Enderby, Leicester LE19 1SS, UK) Background: Since 1999, the LNR Deanery, with 2 Onyx 1.11 Department of Health sponsorship, has held 18 Induction Virtual education: a new form of learning in Courses for International Medical Graduates. These were public health 2½ day residential courses each accommodating 50 doctors. This allowed group-work and a broad-based Juan Cobos (University of Alcalá, Dpto Ciencias Sanitarias y curriculum. Though successful, the high cost was £20,000 Médico Sociales, Campus Universitario - Facultad de Medicina, Ctra. Madrid-Barcelona, Km. 33,600, Alcala de per course and the waiting list spiralled to 800 doctors Henares, Madrid E-28871, SPAIN) needing induction. Aim of presentation: The technological advance in Summary of work: To address this, one-day induction information, and the reference in the European courses with web-based pre-course activities were Constitution, encourages the promotion of virtual education established, accommodating 150 doctors. Handouts in the University. available on the web presented reflective questions to stimulate enquiry and understanding in preparation for Summary of work: 17 students from the Faculty of Medicine the one-day attendance. Topics of the previous course carried out a study of investigation in Public Health, over were adjusted to fit within the shorter time. Risk- 1 month, utilising exclusively the web as an instrument of management and NHS culture as covered by hospital work, communicating with the tutor by e-mail. induction were excluded. More attention was given to Objectives: (1) To evaluate the educational management identified priority areas of career development and and degree of satisfaction of the students; (2) To employment opportunities. investigate how to build scientific thinking. Summary of results: Evaluation of the 1-day induction Material and methods: 17 students were divided in 4 demonstrates trainees benefited from the pre-course groups. Each one examined a part of the investigation. material though, for some, the cost and accessibility of The work consisted of identifying Spanish and non-Spanish printing was problematic. work relating to Public Health: web pages of scientific Conclusions/take-home messages: The process has societies and legislation; databases, scientific journals, resulted in delivering the course to three times as many articles related to Public Health in the European trainees at half the cost without losing essential content. Constitution and virtual bookstores. Each group presented/ This approach allows 600 doctors to attend a course in a displayed their investigations in writing and an oral 12-month period with minimum wait. presentation. The evaluation consisted of a survey, valuation of investigation and form of oral presentation. Summary of results: 75% of students were using the web for learning and tutorials by e-mail. Half of them had difficulties in synthesis of the information and teamwork. The availability and degree of knowledge of data processing created an important difficulty. Conclusions: The web is a useful instrument for teaching. It is necessary to improve training of the researcher and teamwork.

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2 Onyx 1.12 2 Onyx 1.13 Interactive clinical patient scenarios on-line Learning how to apply and use an easy to David Byrne, Stephanie Cobb*, Joy Heard, Richard Else, Robin use e-learning platform in medical teaching Stott and John Rees (GKT School of Medicine, King’s College Miguel Ruiz* and Rafael Ospina* (El Bosque University - London, Department of Medical and Dental Education, 4th Bogotá, Transversal 9A Bis No 132-55, Bogotá, COLOMBIA) Floor, Henriette Raphael House, Guy’s Campus, London Bridge, London SE1 1UL, UK) Learning Objectives: 1 Show the medical education teaching community a simple e-learning platform; 2 Aims: To develop web-based interactive patient scenarios Introduce a course for medical education teachers to access to support 3rd year medical students. an easy to use e-learning platform; 3 Offer a tool that Background: Revision of the third year of the allows medical education teachers to permanently undergraduate programme at the Guy’s, King’s and St communicate and evaluate through the web with their Thomas’ School of Medicine for 2005/6 involves production trainees. of 36 clinical problem scenarios for three 12 week rotations. Work done: E-learning is part of the new educational Summary of work: We have developed interactive electronic revolution. Students can access information through the scenarios that guide the user through the stages of patient web with the teacher being able to follow the trainee presentation, examination to discharge and follow up alone virtually. The student and teacher meet in the virtual and in small groups. The problems are supplemented by classroom where there is no limit in time or space. E- further scenario developments and expected outcomes and learning platforms offer different tools that enable the backed up with face-to-face facilitator contact, automatic students and teachers to 1 exchange files; 2 follow links; links back to preclinical resources for revision and 3 participate in forums; 4 chat; 5 make announcements; appropriate peer reviewed web sites. Student tracking and 6 have an agenda; 7 submit assignments; 8 test the progress recording is incorporated into the system. The students through exercises that include high resolution web-interface has been designed to ensure educational images. Teachers have access to statistics for keeping track curriculum requirements are appropriately covered. of each trainee. We offer a course created at our University Student tasks are embedded throughout each scenario. that introduces medical teachers to an easy to use e- Conclusions: Using the expertise of our electronic learning learning platform and how to use it. This course offers the resources team with on-going clinical input from scenario introduction to a great tool in medical learning that closes developers and student feedback at all stages we have the gap between teacher and student. developed a system tailored to the requirements of our current curriculum, providing students with a viable and effective educational resource covering core material.

Posters 2 Onyx 2 Staff/faculty development

2 Onyx 2.1 2 Onyx 2.2 Development and implementation of a Bedside Teaching (BST) workshops for strategic faculty development tool to faculty members of 5 Iranian Universities of promote learner-centered approach in an Medical Sciences: Does it work? ambulatory care setting Azim Mirzazadeh (Tehran University of Medical Sciences, PO J Sommer*, M Nendaz, D Lefèbvre, A Barofio, C Layat, Ph Box 14185-481, Tehran, IRAN) Huber and D Clavet* (Policlinique Universitaire Genève, 24 Background: Bedside teaching is considered to be a Rue Micheli-du-Crest, Genève 14 12111, SWITZERLAND) valuable teaching tool in clinical medicine and many clinical This project takes place in an ambulatory care internal faculties are either unaware of good bedside teaching medicine clinic in Geneva, where the quality of clinical strategies or unable to apply them. teaching became an explicit preoccupation during recent Methods: We planned to conduct 7 full-day BST workshops years. The objective is to develop and implement a learning in five Iranian Universities of Medical Sciences. Until now, tool of learner-centered teaching skills in a patient-centered 3 workshops have been conducted for 58 faculties. The spirit of care. The development method includes iterative program included different methods such as lectures, group process of literature review, systematic observations of discussions and video-recording and feedback. They oncoming users in action, elaboration of the format and completed pre and post-workshop questionnaires. In the the wording of the tool and recurrent validation with local pre-workshop questionnaire, we asked them about their teachers and a medical education consultant. The actual perceived and desired level of competency in conducting format is a rubric that describes dimensions of quality of BST. In the post-workshop questionnaire they answered the approach that should be promoted according to local questions about two outcomes of the workshop: whether clinical teaching set up and defining features of the clinical they have an increased appreciation for bedside teaching, teacher’s work for each group of dimensions and for three and will increase the use of bedside teaching. They also levels of mastery. The implementation method involves rated their competency after attending the workshop. clinicians in using this tool to develop their teaching skills and providing feedback on the criteria against which their Results: Means (SD) for each of the two respective work will be judged. They will also use the rubric on a outcomes were: 4.5 (0.6), 4.3 (0.9), respectively. day-to-day basis to revise video taping of their own work, Participants’ responses showed noticeable differences with colleagues or with the faculty development leader of between their current and desired level of competency in the group. During this process, we realise the importance BST and the difference reached statistical significance (P to make explicit the educational values underlying < 0.001). Comparison of post-workshop competency with promoted intentions and actions. those of pre-workshop competency showed that participants improved their competency significantly (P < 0.001) in BST.

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Conclusions/Take-home messages: Clinical faculty Summary of results: A batch of 12 TAs has been trained members are interested in improving their bedside teaching through this new faculty development initiative. An analysis skills. Providing short courses in bedside teaching helps of the scores on pre and post workshop questionnaire as them in this way. well as students’ ratings of facilitation skills of TAs confirmed that the objectives of the course were met. 2 Onyx 2.3 Conclusion/Take home message: The success of this course Education staff and their expectations from has led to the decision by the Academic Council of the AKU to make this course mandatory for all new teaching the educational committee of the vice faculty to equip them with the knowledge, skills and chancellor of Shiraz University of Medical attitudes necessary for effective facilitation and student Sciences centered teaching. V Keshtkar*, M R Dehghani, M Dehbozorgian and Z Karimian (Shiraz University of Medical Sciences, Educational Development Center, Zand Blvd, Shiraz, IRAN) 2 Onyx 2.5 Faculty professionalism – a code of conduct The goal of the educational committee of the vice chancellor of education of Shiraz University of Medical Cathleen C Ruff*, Anita Glicken and Gerald B Merenstein Sciences is to improve the quality of education staff. This (University of Colorado Health Sciences Center, Child Health Associate/Physician Assistant Program, Mail Stop F543, PO committee wants to begin its activities formally. In this Box 6508, Aurora CO 80045-0508, USA) survey the expectations of staff have been studied. Aim: To describe the process of creating a faculty code of Methods: This cross sectional study was done by conduct related to professionalism. Within the University questionnaire from non academic staff. Its validity and of Colorado School of Medicine (UCSOM) the Child Health reliability was approved by a pilot study. These data Associate/Physician Assistant Program (CHA/PA) has gathered consists of age, job experience and their opinion developed a faculty code of conduct. Components of this about programming, educational courses and the code and the challenges in its implementation will be managerial roles in staff education. Data have been summarized. analyzed by statistical software SPSS. Summary of work: A thorough review of existing literature, Results: Eighty percent of staff believe that their including the standards of conduct for students and findings organizational unit should offer educational courses and and recommendations of an ad hoc Committee on 20% of them believe the committee should execute the Professionalism at the SOM was conducted. Based upon professional course. 70% of them agree that intervention this review, several broad categories were identified as of the vice chancellor of education is needed for improving pertinent to a code of conduct. the quality of the course. 52% of them said that the educational course must be optional. Summary of results: A code of conduct was developed. The categories identified as pertinent to a code of conduct Discussion: It seems that the educational committee should were: 1) Background and applicability; 2) Program values; take a more active role in training of educational personnel. 3) Conduct with students; 4) Communication and This can be done more effectively by the committee interactions with others; 5) Professionalism; 6) because it is more familiar and it is needed. The committee Unacceptable behavior and 7) Interpretation of standards. should consider the freedom and participation of its staff Faculty discussion revolved mainly around creating in decision-making and consultation about their educational comprehensive, but specific measurable behavior in order needs. to identify useful categories of responses that would warrant intervention. 2 Onyx 2.4 Conclusions: A code of conduct is a method of promoting The design, delivery and evaluation of a faculty professionalism and a reporting mechanism for short course in medical education for unacceptable behavior, which will help promote student teaching assistants at Aga Khan University professional behavior. Naghma Naeem*, Shazia Sadaf and Rukhsana W Zuberi (Defence Housing Authority, 5-B, 12th Central Street, Karachi 2 Onyx 2.6 75500, PAKISTAN) “Getting started…”: a practical guide for Aim of the study: The aim of this study is to share the clinical tutors experiences gained during the design, delivery and Margery H Davis and John A Dent (University of Dundee, evaluation of a short course in medical education for Centre for Medical Education, Tay Park House, 484 Perth Teaching Assistants (TAs) at Aga Khan University (AKU). Road, Dundee DD2 1LR, UK) Background/Rationale: Keeping in line with the global Background/Rationale: Although often busy with clinical trends in medical education, AKU introduced the renewed responsibilities and research commitments, most doctors MBBS curriculum in September 2002 which incorporated enjoy the time they spend with students in clinical teaching Problem Based Learning (PBL) as one of the main teaching situations. Unfortunately being less prepared than they strategies. During implementation of this curriculum a need would wish may create anxiety and uncertainty and was felt for inducting and training more faculty in facilitation contribute to student confusion and disillusionment. skills. To overcome this shortage, fresh AKU graduates with no prior teaching experience were recruited as What was done: In staff-development situations tutors tend 1 teaching assistants to facilitate the PBL sessions. A total to prefer help from printed material . A series of booklets of 36 TAs have been recruited under this scheme. was produced to help tutors with clinical teaching in six different locations: clinical skills centre; ambulatory care What was done: Although sporadic training sessions were teaching centre; hospital wards; primary care; day surgery conducted for TAs during the years 2002 and 2003, a unit; and integrated teaching area. They provided more formal and structured course was developed by the background information, some educational theory as well Faculty of the Department for Educational Development as practical tips. They used diagrams, icons, photographs (DED) at AKU in November 2004. The aim of this faculty and a standard format including “What to do before you development initiative was to introduce the TAs to the start”, “What to do when you get there” and “What to do educational philosophies underpinning medical education when the session is over”. Additional resources were and impart tutorial facilitation skills. This educational course indicated and personal reflection encouraged. Booklets is one of its kind for TAs in Pakistan. were circulated to all teaching staff in our group of teaching hospitals.

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Conclusion: This method of staff development is easy to ii) prepare for practice by learning in small groups and iii) produce and circulate and has been well received. explore ways in which their new teaching and learning skills could be used in hospital and community-based Take-home messages: Written material available for on- practice. the-spot use is valued by clinical tutors who may otherwise have little time to prepare for clinical teaching sessions. Conclusions/take-home message: A faculty development programme that incorporates the psychological principles Ker and Dent (2002) Medical Teacher 24, pp 437-446 of change (loss: acclimatisation: renewal) will support clinicians as they overcome reluctance to educational 2 Onyx 2.7 innovation, become more reflective about their own Initiation seminar in medical education: attitudes and behaviours and progress ultimately into Saint-Joseph University experience valued partners with the medical school. Elie Nemr*, Marwan Nasr and Simon Abou-Jaoude (Saint- Joseph University Medical School, Hopital Hotel-Dieu, Bvd 2 Onyx 2.9 Alfred Naccache, Achrafieh, Beirut, LEBANON) Helping postgraduate trainees become Aim of Presentation: Since 2003, the Medical Education better teachers: practice and reflection Committee of Saint-Joseph University Medical School, D J Davis*, L Ravn, C Ringsted, A H Henriksen, R Meldgaard formed by a group of 10 physicians who had a 3-month and J L Sørensen (Center for Clinical Education, Department full-time training in medical education in Canada, runs a 5404 (Teilumbygningen), Blegdamsvej 9, Copenhagen 2100, mandatory 2-day initiation seminar in medical education DENMARK) for every new faculty. The aim of our presentation is first Aim: Teaching is an important task for postgraduate to assess the acceptance of such training program by the trainees. Many postgraduate programs offer instruction in faculty and second to evaluate the perceived quality of teaching to their trainees, with which trainees are generally this seminar. satisfied. Our presentation describes a course that Summary of work: 44 new faculty attended the seminars. promoted reflection in teaching. 12 themes were developed to initiate them to the various Summary of work: We designed a 2-day course for senior teaching and assessment methods and to introduce our house officers that combined learning theory, an curriculum, which is student-centered and uses problem- individually designed clinical teaching activity, and a based learning as an important teaching method. At the reflective report. One day was spent in the classroom and end of the 2nd day, the participants were asked to fill in in small group activities. The other day was used for the evaluation form which included 4 parts: global planning and completing a teaching activity, and writing assessment, assessment of each presentation, overall the reflective report. The report was sent electronically to satisfaction and free comments. a designated preceptor for feedback on the planning and Summary of results: Questions 1-8 evaluated the overall described execution of the teaching activity. program. Participants had the following choices: Summary of results: There was wide variation in the Completely disagree, Disagree, Agree, Completely Agree. reports, with some showing deep understanding of the 94% of the responses were either Agree or Completely planning and execution of clinical teaching activities and Agree. Questions 9-20 evaluated the 12 parts of the others showing a much more superficial approach. Similarly seminar and each question included 2 parts: a-Relevance the depth of reflection varied, with most reaching the level to practice, b-Quality of Presentation. Participants had the of descriptive reflection but not higher, and some not following choices: Poor, Fair, Good, Excellent. 93% of the reflecting at all. Those lacking reflection improved with responses were either Good or Excellent. 100% responded feedback. Yes to the question 21: “Would you recommend this seminar to a colleague?” and 90.9% responded Yes to the Conclusions: The course format was feasible. Reflection question 22: “Would you like a more in-depth training in was generally not deep. Whether depth of reflection medical education?” correlates with teaching efficacy will be the subject of future studies. Conclusion: This experience clearly demonstrates that young faculty in our medical school are interested in getting a training in medical education. Second, faculty 2 Onyx 2.10 development can be successfully achieved by a local group Critical reflection as a method for of physicians expert in medical education instead of merely educational training of clinical teachers in a relying on worldwide well-known medical educators. hospital setting Anna Kiessling (Karolinska Institute, Danderyd Hospital, 2 Onyx 2.8 Centre for Clinical Education/ KKC, Stockholm SE-18288, Enabling educational innovation: it’s all in SWEDEN) the mind Background: The daily clinical work as a physician at a Peta Foxall* and David Leeder (Institute of Clinical Education, University Hospital often includes acting as a clinical teacher Peninsula Medical School, St Luke’s Campus, Heavitree Road, for medical students. However, the clinical educational Exeter EX1 2LU, UK) training of physicians needs to be further improved. To Background: The introduction of a new undergraduate our knowledge the critical reflection method has not yet medical curriculum into the clinical environment is been used in clinical educational training for physicians. dependent on a purposeful relationship between the The aim was to evaluate the feasibility of the critical medical school and healthcare providers. A key factor in reflection method, and to use the reflective thinking as a such a relationship is a faculty development programme clinical teacher. that is responsive to changes in clinicians’ concerns and Summary of work: 5-7 internal medicine attending learning needs as they adapt to the roles and physicians – working as clinical teachers for medical responsibilities required of contemporary clinical teachers. students – and one facilitator participated at each seminar. What was done: We delivered 23 training workshops to The participants in turns tell a story focused on experience 439 clinicians who had been recruited to teach the first from a teacher-student situation involving a critical dilemma Year 3 (2004/05) student cohort of the Peninsula Medical that evoked own emotions. The story-teller then formulates School, UK. The central theme of each workshop was the the critical problem. Then the group try to “turn the story” development of students’ clinical reasoning skills via and see the situation from other perspectives. Finally the constructive feedback and formative assessment. Clinicians facilitator and the group reflect on relevant theories (i.e. were actively encouraged to: i) reflect on prior experiences; education, conflict, cooperation and leadership).

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Summary of results: The participants rated this seminar convenience method has been done. The data related to as very valuable in their professional development, knowledge and attitudes were gathered using pre and post especially the opportunity to reflect together with workshop questionnaires. A checklist was used to evaluate colleagues regarding critical dilemmas. their practice before the workshop. Conclusion/take-home message: A critical reflection Results: The results showed that mean and standard seminar for physicians working as clinical teachers is deviation of pre workshop x=6.014, SD=3.7, for attitude powerful, feasible and appreciated. x=14.19, SD=1.2 & practice x=13.6, SD=2.2 and post workshop ones were x=13.4 SD=3.9, x=18.2, SD=2.1, &x=14.82, SD=2.68, respectively. There was a significant 2 Onyx 2.11 relationship between pre and post workshop knowledge Investigation of the impact of elementary and attitude (p<0.001). There was no such a relationship teaching methodology in practice domain. No significant relationship was observed between attitude, knowledge variations and practice. It E Nouhi*, A Haghdoost and S Farajzadeh (Kerman Medical Sciences University, Medical Education Development Center, cannot be judged that practice variations were affected Jomhoori Islami Blvd, Shafa Street, PO Box 761874 7653, by knowledge variation during the workshops. There was Kerman, IRAN) a correlation coefficient between age and post workshop knowledge (r=0.33 and p<0.03), and an increase in age Introduction: It is obvious that teachers’ familiarity with resulted in a decrease in the acquired knowledge after teaching methods along with medical revolutions is the end of the workshop. necessary to achieve the quality improvement in education, two of the effective factors to succeed in applying Conclusion: It seems the workshop can improve the educational content in practice domain, knowledge and participants’ knowledge and attitude, but besides attitudes of participants in educational programs. educational workshops some other factors are necessary for behavioral improvement in the practice domain. Method: In order to investigate the impact of the faculty a semi experimental study on 70 participants, selected by

Posters 2 Topaz 1 Curriculum evaluation and change

2 Topaz 1.1 Aim of Presentation: To show impact of graduate evaluation Student evaluation with a focus on on ongoing curriculum revision and improvement of a curriculum improvement using an additional medical school, Maharat Nakhon Ratchasima Hospital rating system (MNH). Summary of Work: Results of an evaluation of graduates’ Bert Huenges*, Thorsten Schager, Hille Lieverscheidt, Yvonne performance and competency using focus group interviews Aders and Herbert Rusche (Ruhr-Universitat Bochum, Medizinische Fakultät, Büro für Studienreform, Stiepeler Str and questionnaires in 2004 were categorized to favorable 129, Bochum 44801, GERMANY) and unfavorable outcomes and reported to the MNH curriculum committee and other faculty. Many activities Scales used in student evaluation, even when combined and projects have been launched or planned for launch in with students’ comments, often miss consequences for 2005 to correct weaknesses and to strengthen strengths curriculum improvement. Therefore, we extended our guided by the graduate evaluation. Examples of projects school marks rating system for the end of block evaluation are a new course in Clinical Epidemiology and Evidence- (1 = best to 6 = worst) with an additional 3 point scale, Based Medicine, a Systematic Approach to Clinical represented by different “smileys”. Students can give Symptoms course, Academic Volunteers Project, and Role curriculum planners instructions to “revise!”, “leave things Model Award etc. as they are” or “praise!” each item. If they want a distinct item to be revised or praised, they are asked to give reasons Conclusion: A graduate evaluation is an important task why. During three semesters 339 evaluation items, that provides valuable information needed for curriculum obtained from 42 students show an overall correlation revision and improvement. Results of the evaluation would between the two scores (r² = 0.69, p <0.001); but there be worthless if there was not any movement or impact. are also distinct interesting differences: “Leave things as they are” could coincide with school marks ranging from 1.4 to 3.2; even when poor respective good school marks 2 Topaz 1.3 are given, some students have reasons to “praise” Strategies for change in a classical medical respective “revise” distinct aspects. Our aim was not only school: a call for ideas to create a culture of respect, by giving students the Anabela Mota Pinto*, Maria Filomena Gaspar and José A P possibility to give concrete proposals what should be done, da Silva (Universidade de Coimbra, Faculdade de Medicina, but also to make students’ feedback more helpful for Departamento de Educação Médica, Rua Larga, Coimbra curricular improvement. Effects on the utility of students’ 3004-504, PORTUGAL) evaluation results on curricular improvement are to be This poster presents a preliminary strategy for change in discussed. a classical Portuguese medical school, as a call for support and input from the European Medical Education community. 2 Topaz 1.2 The Faculty of Medicine of Coimbra is an historical medical What happens after a graduate evaluation? school (one of the oldest in Europe), running a traditional discipline-based parallel course curriculum. Over 200 P Supasai, S Lermanuworarat, T Asawavichienjinda, Y teachers are involved, in Medicine and Medical Dentistry. Tongpenyai, P Ambua, S Ambua, P Thanomsingh* and T Heads of disciplines have enjoyed complete pedagogical Himman-ngan (Maharat Nakhon Ratchasima Hospital (MNH), autonomy, with very loose coordinating mechanisms. A Department of Pediatrics, Medical Education Center, 49 Department of Medical Education was only recently Changpeuk Road, Muang District, Nakhon Ratchasima Province 30000, THAILAND) established. Based on previous external evaluations, student enquiries and teacher surveys, the following main needs were identified: less theory, more practice in the

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curriculum; emphasis on clinical, methodological and social management. In order to realise the goals the fitting skills; teachers’ training in medical education principles instruments were developed and tested with a defined and practice; implementation of coherent coordination group of students and teachers (interviews, pre-testing mechanisms for curriculum assessment and development. and single-item probing of the questionnaire) to improve acceptance. Strategy: Professional dedicated staff; Organization of a core representative group of teachers who will receive more Conclusions: The instruments we found out to be suitable intensive training and act as “Educational Champions”; for curriculum evaluation in a change process are: 1. A Implementation of a dynamic webpage designed to foster module-questionnaire which allows comparison of modules partnership with teachers and students; Yearly “campaign” and single lectures within the modules. 2. Publishing of for progress in three main school-wide educational the results and commitment of the responsible teacher to priorities; Offer of Masters Course in Medical Education; make a statement to bad results and to publish suggestions Regular internal quality assessment and promotion for improvement. 3. Establishing of discussion points, procedures as applied to teaching and learning. organizing for exchange of information, troubleshooting and error-management. 2 Topaz 1.4 Students’ feedback improves their academic 2 Topaz 1.6 performance Final-year medical education: mapping out an improvement strategy by focus groups B Demirhan*, E Öôüp, H Müderrisoôlu, S Türkoôlu, M Demirbilek and Z Kayhan (Bapkent Universitesi Typ Facultesi, P Weyrich*, M Schrauth, B Kraus, C Nikendei, R Riessen and 1 cadde, 10. sokak, no 45, 06490 Bahcelievier, Ankara, S Zipfel (University of Tuebingen, Medizinische Klinik IV, TURKEY) Otfried-Mueller-Str 10, Tuebingen D-72076, GERMANY) The aim of this study was to see the results of the revisions Background: The final year of medical education in that we made in accordance with the feedback. From 1998 Germany comprises a 4-month period of practical work in to 2001, grade points of total 112 students were evaluated an internal medicine department. The objective of our for Phase I, II and III. These were compared with feedback project is to improve the quality and efficiency of this and curriculum development efforts. In 1998 and 1999 educational term. To map out a useful restructuring when we compare students’ academic performance in strategy, we first carried out focus groups to learn more Phase I, II and III respectively, in Phase III student grade about students’ wishes and experiences during the final- points were significantly lower than Phase I and II year period. (p<0.001). In spite of this there was no significant Methods: 41 students of two German university hospitals difference obtained in 2000-2001. Another point was, participated in four independent focus groups before and grade point averages of students admitted in 1998-1999 after the 4-month period in internal medicine. Meeting were significantly lower (p<0.05) than students admitted transcripts were subsequently content analysed. in 2000-2001 Results: Most students expected an effective integration Students admitted in: into the ward’s workflow and wished to have sole responsibility for a limited number of patients under 1998 1999 2000 2001 continuous supervision. They also favoured a defined Phase I 69,7±1,6 66,8±1,4 73,5±1,4 71,9±1,4 labour time that frequently allows concomitant literature Phase II 69,9±1,6 69,6±1,4 70,5±1,5 71,4±1,5 studies. After this educational period, the following main criticisms were reported: deficient ward integration, Phase III 65,4±1,4 64,7±1,0 69,7±1,0 70,4±1,5 inadequate supervision owing to lack of time of ward physicians, exhaustive routine activities instead of patient In 2000, revisions in response to feedback were made in care and insufficiently defined students’ assignments. Phase III (Duration of some committees was shortened, Conclusions: Our surveys let us deduce the following main contents were overviewed, and adaptation of national core tasks for the future: (1) improvement of ward integration curriculum and teacher education courses were begun). by introductory weeks, (2) definition of time slots for Conclusion: Revisions of the curriculum based on the supervision, (3) structured clinical skills training and (4) students’ feedback improved students’ academic reflection of typical students’ assignments. performance. 2 Topaz 1.7 2 Topaz 1.5 Student and teacher attitudes to curriculum Finding the fitting instruments for change evaluation in the process of a changing V Ypinazar, G Griffin* and S Margolis (United Arab Emirates curriculum University, Department of Family Medicine, FMHS, PO Box Monja Tullius* and Michael Sywall (University of Göttingen, 17666, Al Ain, UNITED ARAB EMIRATES) Referat Lehre, Robert-Koch-Str. 40, Göttingen 37075, Background: Medical schools worldwide are undergoing GERMANY) curriculum change to encompass the principles of adult Background: The clinical curriculum at the Medical Faculty learning. Little is known about student and teacher of the University of Göttingen has undergone a major attitudes to change pre and post-implementation of a new change within the last year. Medical education is no longer curriculum. supported by single disciplines, it now takes place in What was done: In this prospective cohort study, student interdisciplinary, subject-orientated modules. To establish and teacher attitudes were assessed both before and after and secure a high quality of the medical training, a system the introduction of curriculum change (implementing adult of Evaluation had to be implemented. learning principles) using a questionnaire developed from Summary of work: In a small project group 4 goals of the focus group discussions. evaluation were determined: 1. Optimisation of structure, Conclusion: Despite being aware of the likelihood of an organisation and (coordination of) content within and after increased workload and despite uncertainty as to the the change process. 2. Commitment of the students to meaning of ‘self directed learning’, students were excited take evaluation seriously. 3. Commitment of the responsible and expressed generally positive attitudes towards change, teachers to take evaluation results seriously and react in becoming more positive with time. Teachers perceived an appropriate way. 4. Establishing a system for quick themselves as better able to adapt to change but their exchange of information, troubleshooting and error- attitudes remained essentially unchanged over time.

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Take-home messages: Trust students to be positive about show lower stress levels than those of the traditional track. curriculum change that is intended to provide long-term Decreasing levels of stress as well as significant correlations benefit in spite of short-term cost (increased workload) with environmental and psychological factors can be found. and rapid implementation. Expect teachers to be sceptical Further results and the implication for curriculum planning about curriculum change, especially if the change is rapid and evaluation will be discussed. and it increases their workload. 2 Topaz 1.10 2 Topaz 1.8 Preventing problems instead of trouble Medical School of Shaheed Beheshti: shooting in the implementation of implementation of reform in Undergraduate curriculum reform Medical Education (UME) program Hanneke Mulder* and Edith ter Braak (UMC Utrecht, Masoud Mardani Dashti*, Hosein Godarzi, Noushabeh Pejhan, Universitair Medisch Centrum, Onderwijsinstituut, Statenum Houshang Khazan, Mohammad Java Ehsani, Mohsen 0.304, Postbus 85060, Utrecht 3508 AB, NETHERLANDS) Kheirmand and Katayoun Rostami (Shaheed Beheshti Background: Theories of change processes support our University of Medical Sciences and Health Services, Medical School, Dean’s Office, Parvaneh Street, Yeman Street, Evin, experience that the implementation phase of curriculum Chamran Express Way, Tehran 19395, IRAN) reform is notoriously difficult. Especially when major changes are intended, there is a considerable risk that Background: In 2000, educational experts at the only superficial and organizational changes will be attained. Educational Development Center of the University of Shaheed Beheshti, started the revision of more than 300 Work done: We used insights about change management undergraduate medical education (UME) curricula, and to systematize our experiences with the design, UME standards around the world and in a 3 year period, development and implementation of two medical curricula. and after revisions of the proposed preliminary curriculum, We shared our findings with others in charge of curriculum developed a final reformed curriculum for the University’s innovation and identified aspects of curriculum change that 2004 UME. The new curriculum has been implemented deserve more attention than they usually get. since 2004. Conclusions: Problems during implementation partly result Method: Executive steps taken place to implement the from overemphasizing the polarity between policymakers new curriculum during the last year can be summarized and those who are responsible for carrying out the plans, as follows: (a) New committees and councils were formed between creativity and implementation, between politics and started working, including, the Reform Strategic and practice. In order to be successful we need a more Council (with the responsibility of conducting the program), integrative perspective. Implementation should not be the Curriculum Committee, the Interdisciplinary considered to be just one stage of the process of Committees, teams for designing and writing reference innovation. In contrast, innovation must be taken into textbooks and study guides; (b) Many informative and account from the very beginning of the process as a whole. learning sessions were held for the faculty members, Take home messages: We will discuss guidelines and tips executive staff and students; (c) Continuous evaluations that have been proven useful. A thorough connection of the new curriculum were carried out. between design and implementation and a central role, Conclusion: By now most of the Faculty members have right from the start, for those responsible for the been eagerly involved in the new curriculum and the implementation of the innovation, are critical for success. students’ feedback on it has been remarkably satisfactory. The curriculum has also gained a considerable appreciation 2 Topaz 1.11 around the country. All these encourage the university to continue its move toward educational excellence. Can management skills help improve the educational climate? Peter Henriksson*, Eli Westerlund, David Mörtsell, Elisabeth 2 Topaz 1.9 Rooth and Martin Roll (Karolinska Institute, Danderyd Pressure, personality and performance: a University Hospital, Stockholm SE 18288, SWEDEN) comparison between reformed and Clinical diagnostics is the first clinical course of the medical traditional medical education education programme at Karolinska Institute and located Heidi Linnen (Charité University Medicine Berlin, in the fifth semester. Most of the teachers/tutors are part Reformstudiengang Medizin, Schumannstr 20/21, Berlin 10117, time teachers and physicians. I was – as newly appointed GERMANY) study director – disappointed with the student satisfaction Background: Numerous studies on students’ stress show ratings and the working climate of the tutors. The payment that increasing pressure is accompanied by decreasing and cost of teaching were completely mixed with that of performance and show the need for a “healthy” curriculum. the departments. Everyone told us that it was impossible In 1999 a reformed medical curriculum (RT) was launched to get a clear view of the resources. However, we applied at the Charité, Berlin aiming on an improvement of the skill of economics and succeeded to get a clear view undergraduate education. and an agreement on the size of the resources with the heads of the involved departments. This enabled us to Summary of work: In order to identify important factors reorganize the use of resources and to use modern of stress in personality as well as in the curriculum, a teaching techniques. It was early apparent that the whole longitudinal research project over a period of three years educational climate changed. The tutors were very satisfied has been conducted. The investigation focuses on a and so were the students. Teachers from following courses differentiated analysis of stress, personality, and the spontaneously noticed a positive change in the skills and curriculum following two central questions: (1) Are there attitudes of the students. The student satisfaction ratings differences in personality profiles and perceptions of the have continuously increased from 5.2 to 9.2 (of 10) during curriculum among students choosing one track over the 2.5 years. other? (2) Does major curriculum change modify students’ attitudes towards their curriculum, levels of confidence, Conclusion/take-home message: Economic skills might at self-esteem, and perceived stress? least in some instances be a prerequisite in the improvement of education. Summary of results: At the beginning, no significant differences in personality profiles can be detected but the Locus of Control (LOC). There are significant differences in the perception of the curriculum: Students of the RT

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Posters 2 Topaz 2 Written assessment

2 Topaz 2.1 Cohort Progress OSCE Correlation Sharing resources for UK undergraduate written assessments – Two years of UMAP 1997-1999 39.6 (5.2) 72.0 (5.8) r = 0.41; p<0.001 1998-2000 40.7 (5.9) 71.0 (4.4) r = 0.21; p<0.001 G J Byrne, A C Owen*, N D Bax, J R Barton, A Garden, T E Roberts and P A O’Neill (University of Manchester, Universities 1999-2001 41.0 (5.6) 72.3 (4.9) r = 0.43; p<0.001 Medical Assessment Partnership, ATR 4, Education and Research Centre, South Manchester University Hospitals, 2000-2002 42.0 (5.8) 73.4 (5.6) r = 0.24; p<0.001 Southmoor Road, Manchester M23 9LT, UK) 2001-2003 38.6 (4.7) 72.5 (4.0) r = 0.29; p<0.001 Introduction: UMAP is a collaborative initiative which began 2002-2004 52.8 (3.6) 69.7 (5.3) r = 0.12; p=0.03 in 2003 aiming to lift individual exam preparation burden by pooling question writing resources, and in doing so raising standards of available questions. Our formula of Conclusion: The presence of only a weak correlation question writing workshops and question review panels between clinical and knowledge based performance raises has been well established across the five founding partners questions of test validity. Further work is required to clarify and ten further medical schools are set to join. the reasons for this discrepancy and the relative importance Methods: Best practice in question writing, distilled from of knowledge to clinical competence in the undergraduate the works of Drs Susan M. Case and David B Swanson, curriculum. was incorporated into workshops which have proved a positive forum for generation of multiple choice and 2 Topaz 2.3 extended matching questions. Clinicians and academics join forces to write questions on competences agreed to Recirculating questions in medical be core for undergraduates. Specialist workshops examinations – factors for meaningful addressing underrepresented subjects are also run. All examinations questions are examined by site level review panels. Items J Schulz, A Syed-Ali*, S Drolshagen and F Nuernberger are subsequently tagged to the UMAP learning blueprint, (University of Frankfurt, Medical Faculty, Office of the Dean, which combines curricula and GMC learning outcomes. Theodor Stern-Kai 7, Frankfurt D-60590, GERMANY) Questions are then banked and offered to UMAP partners. Medical examinations are relevant for student assessment Results: Approximately 98% of items are reviewed needing and feedback to both students and faculty. Well designed minor amendments. Approximately 1% are unsuitable e.g. examinations are a valuable tool for guiding student too specialised. Less than 1% of questions are learning behaviour and topics covered during their study. unsalvageable. Over 2000 items have been written by 250 In German federal examinations the wording of all authors at 25 workshops. Partner medical schools can now questions has to be published resulting in questions that access more material in preparation for examinations than can only be used once – published questions will rather individual activities would allow. be learned by heart and the correct answer memorized The future: A similar rate of increase in the volume of without necessarily understanding the medicine behind it. questions coming into the bank is to be sustained over While restructuring its curriculum the medical faculty of coming years. As the bank grows, the two examinations the Johann Wolfgang-Goethe-University Frankfurt has UMAP sources for each medical school will increase. decided not to publish its examinations questions; students’ right to check the grading under supervision is untouched. Using this procedure, questions remain secret, students 2 Topaz 2.2 may view their own examination under supervision but Performance in written and clinical are not allowed to copy the text. We have tested students assessment: is there a correlation? during their clinical studies since 2003. In order to test the efficiency of keeping questions secret identical G K Mahadev*, M Mawdsley, P A O’Neill, A C Owen, P questions were posed both on different terms, i.e. winter McCardle and G J Byrne (University of Manchester, UMAP, or summer term, as well as during the same term on ATR 4, Education and Research Centre, South Manchester examinations on different days. In neither outline, i.e. using University Hospitals, Southmoor Road, Manchester M23 9LT, UK) identical questions six days apart as well as with 6 or 12 month delay was there evidence for rote learning. The Background: The core knowledge-based and clinical percentage of students correctly answering these questions assessments in the Manchester Undergraduate Medical was similar, especially considering the fact that examination Curriculum are progress tests and OSCEs respectively. We topics are propagated as a way to direct student learning. have investigated the relationship between student Using a similar procedure effectively keeps questions secret performance in PTs and OSCEs. while still maintaining the students’ ability to check their Methods: Performance for six clinical undergraduate individual results. student cohorts of the curriculum years 3 and 4 between 1997 and 2002 was analysed. Each student took four PTs 2 Topaz 2.4 followed by an OSCE. Each PT consisted of 250 True/False questions. Each OSCE had a 14 station assessment that Faculty attitudes toward designing of MCQ included clinical and history taking skills. For each student in Ahvaz Joundi-shapour University of cohort, mean and standard deviations were calculated and Medical Sciences scores compared (students t-test). Correlation between M Fakoor*, A Shakurnia, A Malayeri and P Asadollahi (Ahvaz the individual performance in PT and OSCE was measured Joundi-Shapour University of Medical Sciences, Research (Pearson). Affair Central Office, Golestan Ave, Ahvaz, IRAN) Results: In all cohorts, there is a weak correlation between Background: Multiple choice questions (MCQ) as a world PT and OSCE performances. However, for a large wide commonest method in testing is used in student proportion of the students, there appears to be no assessment proficiency in many universities including relationship (See table). There is great variation between Iran’s. The popularity of this method, MCQ test design cohorts. has come to be regarded as a major concern. This survey

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has aimed to investigate whether the teachers are Usually the assessment results are available within one confident enough about the accuracy and efficiency of their hour after students have finished their tests. Afterwards, MCQ tests according to the approved standards. the item analysis is made by using difficulty and discrimination indexes which allow us to identify and select Summary of work: This was a descriptive cross sectional those questions with problems - those very difficult or study. Data were gathered using a questionnaire containing easy and those that don’t discriminate students. After this 13 closed questions focusing on preparing and designing analysis some questions are eliminated from the test, MCQ questions. The questionnaire was distributed among reformulated and after, used in other tests. Comparing 50 faculty members 72% was returned. The collected data students’ marks before and after this process we realize were analyzed by SPSS software. that, in general, group dispersion is increased as we can Summary of results: 70% stated that they design their see by the resulting standard deviations. Using these questions correctly. 12.26% stated that they design their criteria, more equilibrated tests arise in term of difficulty questions correctly to some extent. Only 6.01% stated and they are also more discriminative between best and that they do not follow an accurate test design. worst students. We also improve quality of items and we Conclusion: Generally it is inferences that MCQ design can select those with better indexes for posterior tests. should be considered as a method of concern by university authorities. 2 Topaz 2.7 The Berlin Progress Test (PT) as an instrument 2 Topaz 2.5 of evaluation of medical teaching Evaluation of designed MCQs in Ahvaz K Brauns*, S Hanfler, J Voetter, S Fuhrmann, K Osterberg, A Jundi-Shapour University of Medical Mertens, B Mueller, D Wieland, S Koelbel and Z M Nouns Sciences (Universität Medizin Berlin, Charité, Schumannstr. 20/21, Berlin 10117, GERMANY) A H Shakurnia*, A Khosravi, A Shariati and A Zareei (Ahvaz Background: To evaluate the quality of a faculty’s teaching Joundi Shapour University of Medical Sciences, Educational Development Center (EDC), Educational Affairs, Golestan Ave, in Germany usually questionnaires are used. Students are Ahvaz, IRAN) asked to report their teaching situation. Obviously such evaluation does not represent the students´ true ability Background: Multiple choice questions (MCQ) are one of to answer medical questions which should be a main the student evaluation methods in higher education educational goal. Nor are examinations suitable to evaluate worldwide and basic principles exist for devising them. If the medical teaching, because they confound the effects not followed, the accuracy of education and the evaluation of teaching and learning to the test. Therefore a test process will be called into question. We decided to evaluate assessing the momentary knowledge without the effect the accuracy of MCQ tests designed by university teachers from learning to the test is needed. The PT as it is a in Ahvaz Jundi-Shapour University of Medical Sciences. formative exam could be such an instrument of evaluation. The aim was to improve MCQ design and teaching quality by introducing the results of survey to the teachers. Summary of work: In this study students´ PT results of single units were compared before and after they received Summary of work: In total, 2865 MCQ devised by the the corresponding teaching. university teachers during year 2004 were collected. Firstly a group of educational experts in the university came to Summary of results: The results showed that most of the an agreement on the basic principles of the standard MCQ cohorts had progress directly after the teaching. This could standards during several sessions held, and 16 questions support the sensitivity of the PT as an instrument of were then selected for analysis. The prevalence of true evaluation of Medical Teaching. In few cohorts no progress and false questions was determined and the analyzed could be found after receiving teaching in certain units, so results were reported in terms of percentage and it should be discussed whether this can be used as frequency. information about a lack of quality of teaching. Summary of results: From analyzed MCQs, 75.59% were correctly designed according to basic MCQ designing 2 Topaz 2.8 principles. There were between one to several problems Electronic review process in 24.47 MCQs. The most common problems were Wolfram Urich*, Bernhard Marschall, Birgit Killersreiter and application of negative verbs in the stem and “all of the Frank Ückert (Institut fuer Medizinische Informatik und above” and “none of the above” in responses. No statistical Biomatematik, Department of Medical Computer Science and significance was seen between designed MCQs and sex of Biomathematics Muenster, Domagkstrasse 9, Muenster 48129, the teachers. The details of results will be presented in GERMANY) full. Aim of Presentation: Information about project and call Conclusions/take-home messages: To improve MCQ for international collaboration. design, some feedback is needed from research of this Summary of Work: The department of Medical Computer survey to the teachers. This will provide an essential Science and Biomathematics generates a program for a background for eliminating the present problems computer-based review process for medical multiple-choice encountered with MCQ design. examination questions. The system is developed in tight cooperation with the deanery offices of the Medical Faculty 2 Topaz 2.6 of the Muenster University. Using docimological criteria to improve Summary of Results: A pool of high-quality questions will quality in multiple choice question tests be built up in collaboration with the medical faculties of the state of North Rhine-Westphalia, Germany. The internet I Neto, A Gouveia*, R Costa, M Campos and J Fermoso (University of Beira Interior, Faculty of Health Sciences, Rua based system allows the construction of individual Marques d’Avila e Bolama, Covilha 6200-001, PORTUGAL) examinations in only a few steps. The questions can go through a multilevel review process including an optional Knowledge evaluation at the Faculty of Health Sciences of inter-faculty review. Passing this external process the UBI is simultaneously formative and summative and questions and/or full examinations are made available for learning is assessed every 15 days. This assessment is all involved faculties. The ambition is to increase the made according to the objectives students have to attain cooperation of the faculties, the build-up of a statewide after the learning process. The assessment is made using question pool and the integration of individual learning MCQ tests with the Question Mark„¥ program which allows target catalogues to provide a learning target to each us to perform it on line using the Faculty computer network. examination question. After modifying a question the

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formerly versions are still accessible and the inheritance of incorrect decision may lead the student far away from structure is saved. the appropriate treatment path. Summary of work: A graph-model representing multipath- 2 Topaz 2.9 tests is adopted in our system. A serious problem in building A case-based examination system with multipath-tests is the amount of work for the model creation. The complexity of the model may be reduced by multiple answer paths merging different paths. We consider the possibility of Andrzej Kononowicz*, Marta Zabiñska-Popiela, Irena automatic import of clinical paths into examination models. Roterman-Konieczna and Józef Krzysiek (Collegium Medicum A web application for case-based examinations (multipath Jagiellonian, Department of Bioinformatics and Telemedicine, examination in midwifery) will be presented. Applied University Zakad Bioinformatyki i Telemedycyny, ul. Kopernika models can be stored in XML format with possibility of 7e, Krakow 31-501, POLAND) their exchange. An editor for examination models creation Background: Questions do not depend on the students’ will also be presented. answers of proceeding questions in traditional multiple Conclusions/take-home messages: We believe that case- choice tests. This approach is especially not appropriate based examinations with multiple paths will improve the in case-based examinations, where the student of medicine quality of assessments in medicine. Exchangeable should learn, how to deal with the real patients’ cases. examination models will help to simplify the creation of Modern computer-supported examination systems in these tests. medicine resemble a situation in which the student makes a decision on each step of the therapeutic path. A selection

Posters 2 Ruby 1 Evaluation of medical schools and students

2 Ruby 1.1 Summary of work: This study was to examine the Evaluation of medical schools based on the classification validity and predictive validity of the WFME Standards accreditation standards. A survey of the input and output indicators in the accreditation standards has been Danette W McKinley*, Kathleen A. Conaboy, John J Norcini, conducted and the data have been investigated through Zhamilya Nugmanova and Saltanat Yeguebaeva (ECFMG, 3624 cluster analysis and regression analysis. Market Street, 4th Floor, Philadelphia PA 19104, USA) Summary of results: First, Korean medical schools can be Aim of Presentation: Reform in medical education has been classified into seven types according to the amount of progressing through important international partnerships, invested resources and the educational outcome. The result and one example of this is curricular change in the Central showed that the accreditation standards have validity in Asian Republics (CAR). The purpose of this investigation the schools of lead type, average type, and unconcerned is to compare survey responses to the WFME medical type. Second, variables predicting a pass rate of the Korean education standards for this sample of international medical medical licensing examination were found out to be the schools. college’s quota of students, the number of journals per Summary of work: A survey was developed to collect student, and the Korean Scholastic Achievement Test information on schools internationally, and a translated (KSAT). Variables predicting the level of student satisfaction version was piloted with the Council of Rectors of the CAR. include the total lecture hours, educational facilities per Data from the survey was compared to a subset of the student, and the KSAT. WFME standards to determine the extent to which these Conclusions/take home messages: Applying uniform standards could be met. standards to all different types of schools is inconsistent Summary of results: Survey questions that collected with validity for enhancing the quality of medical education. information related to WFME standards were identified. Furthermore, new standards including predictive variables For example, the objective regarding statements of mission and outcome variables need to be developed. and objectives was met by 100% of the schools, with 85% reporting statements included objectives on the role of 2 Ruby 1.3 the medical school and graduates in health care in the community. Promotion of new teaching methodologies and selection of learning issues: the Conclusions: Efforts at collecting baseline data to track progress in medical education reform have begun and strategies for a successful outcome additional information (e.g., elective experiences offered, D Pavlovic*, M Visnjic and G Kocic (Faculty of Medicine Nis, educational and assessment methods used in preclinical Bulevar Dr Zorana Djindjica 81, Nis 18000, SERBIA & and clinical curricula) will be summarized and presented. MONTENEGRO) Background: In line with curriculum reform process 2 Ruby 1.2 according to the Bologna Declaration, the Faculty of Medicine Nis has to implement the new learning methods Validity of accreditation standards for and study organization. Students should be professionally medical schools in Korea trained in medicine even at undergraduate level and should Eunbae Yang* and Moosang Lee (Yonsei University, take initiative. Department of Medical Education, College of Medicine, 134 Summary of work: The Commission for Teaching Quality Shinchon-Dong, Seodaemun-Gu, Seoul, KOREA) Control offered the questionnaire to the students about Background: The Accreditation Board for Medical Education teaching organisation improvements. The questionnaire in Korea has been putting its effort into inspecting medical was anonymous. The marks were 1-5 where 1 denoted schools since 2000. It is apparent that the accreditation “complete disagreement” and 5 “complete agreement”. standards should have validity so as to improve the Summary of results: 3.40 (2.55-3.25) – faculty offers full educational quality. How can we confirm that accreditation preparation for professional work 3.82 (3.05-4.60) – faculty standards have the validity? offers adequate theoretical knowledge 2.99 (2.66-3.32) -

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faculty offers adequate practical knowledge 3.21 (2.91- Conclusions: After successful implementation, the QMS will 3.51) – well organised. Modern didactic approaches be a powerful instrument to provide an excellent (seminar papers, individual or group projects, preliminary environment for all individuals and institutions involved in exams – colloquia, continual assessment) are now the educational process allowing a continuous improvement introduced. In this part of curriculum reform students have at each level. to take much greater responsibility for their own education. A questionnaire was distributed to the students to assess their opinion concerning the elements of the curriculum 2 Ruby 1.6 reform. Out of 120 students in their second study year Quality assurance system: the relation to 36.23% were very satisfied with seminars, 94.02% very faculty management and actual potential of satisfied with partial colloquial exam and 62.31% satisfied medical faculty departments with continual assessment. G Kocic*, D Pavlovic and M Visnjic (Faculty of Medicine Nis, Institute of Biochemistry, Bulevar Dr Zorana Djindjica 81, Nis 2 Ruby 1.4 18000, SERBIA & MONTENEGRO) The action of the Association of Faculties of In accordance with the European standards, the Faculty Medicine in Chile (ASOFAMECH) to assure adopted the Act on Teaching Quality (part of its Statute), the quality of medical education in Chile based on the following principles: it is supportive and assists students and staff; ‘open’ and well documented; Octavio Enríquez Lorca (University of Concepción, Faculty satisfies the university quality assurance requirements and of Medicine, Casilla 160-C, Concepción, CHILE) any external quality assurance agency; it is based on the The aim of ASOFAMECH is to assure the quality of medical principle that each staff member is responsible for his own education. It promoted a development plan that in 1999, work (The Dean, The Head of the Department, the course put into motion the accreditation of careers, that soon staff); the system itself is under surveillance. The Audit should become mandatory. Since December 2003, the Team comprises 15 members of full-time academic staff National Medical Examination is applied and all graduates and 4 students. The main tasks are: control of actual from Medical Schools take it voluntarily. Since 1979, performance of teaching activities and examinations, ASOFAMECH created an accreditation system for different monitoring of students’ objections, anonymous training programs for specialists. In 2003 the incorporation questionnaires concerning the performed teaching of these programs to the Law of Quality Assurance of activities, monitoring of student accomplishments, Superior Education was requested. In 1984, ASOFAMECH monitoring of the proportion of students passing or failing participated in the creation of the National Corporation to exams, control of the departmental teaching and exam Assess and Certify Medical Specialties (CONACEM). documentation. Again, based on the Statute, the Board Recently, the Health Superintendence was created. This for Science and Education, after the suggestion of the organism will gather a national registry of specialists. Postgraduate Education Board, put forward the Regulations ASOFAMECH, Scientific Societies, The Chilean College of on Preparing & Performing of the Written Test, a mandatory Physicians and the Academy of Medicine proposed that a part of the examination. The confidentiality of the question title obtained from an accredited training program in a bank has to be maintained by all the teachers and University or a certificate emanating from CONACEM should associates, with Chief and Secretary of the course be requisites for the incorporation to this registry. These Department. are the actions taken by ASOFAMECH to assure the quality of medical education in Chile. 2 Ruby 1.7 The teaching and assessment of 2 Ruby 1.5 undergraduate psychiatry in the Medical Quality management of medical education Schools of the United Kingdom and Ireland at Dresden Medical Faculty Ruth Edwards*, Nisha Dogra and Khalid Karim (University Margret Tiebel*, Oliver Tiebel and Peter Dieter (Technical of Leicester, Greenwood Institute of Child Health, Westcotes University Dresden, Medical Faculty Carl Gustav Carus, House, Westcotes Drive, Leicester LE3 0QU, UK) Fetscherstr 74, Dresden 01307, GERMANY) Background: The General Medical Council of the United The Dresden Medical Faculty decided to implement a Kingdom is the governing body for undergraduate medical Quality Management System (QMS) for medical education education and sets the expected outcomes but also allows with the goal of certification of the DIPOL®-curriculum. individual medical schools to decide on the content and Aim: A QM-handbook will be designed, describing delivery. This means there may be a huge variability in processes involved in medical education at Dresden Faculty. what the schools teach. It is uncertain what These are processes touching faculty leadership, undergraduates receive in this training and whether it organisation and administration of the curriculum: enables them to develop the appropriate skills and attitudes to address mental health problems. Leadership processes: Mission statement; definition of main educational goals with concern to the health care What was done: The educational lead for psychiatry at system; faculty development program; resources; each medical school in the United Kingdom and Ireland promotion of faculty, reward system. completed a questionnaire that provided factual information on the teaching structure, contents and assessment Core processes: student affairs (coordination of timetables, methods in the current psychiatry curriculum. examinations, enrolment, consulting); coordination of learning modules and courses including definition of Conclusions: The response rate was 96%. Some aspects learning objectives, choice of teaching methods and of the teaching were consistent across the medical schools coordination of teaching personnel; evaluation; public with other areas showing great variability. The course relations. content was broadly similar with clinical academics and NHS consultants involved to the greatest degree. Teaching Supporting processes: Facilities; libraries; information methods could differ in some areas but the assessment, technology; psychological support for students. length of experience and course position varied greatly. Results: We would like to introduce the first step of Take home message: There are significant differences in implementation of a QMS. Almost all of the core processes the teaching of psychiatry to undergraduate students. It and responsibilities of the involved faculty and staff are is therefore difficult to know if the training fulfils the described in detail and refer to the law. The leadership requirements of the GMC and produces competent processes have been defined and partially characterized. practitioners.

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Posters 2 Ruby 2 Curriculum evaluation

2 Ruby 2.1 preferred a non-medical partner. Maintaining a happy family Group’s internal evaluation of Medical- life was the priority after graduation of 69% of males and Surgical Nursing Department of Semnan 60% of females. When compared to their currently employed school-mates 43% felt they had better prospects University of Medical Sciences in life. M Saberian*, M Asgari, N Raees Dana, E Atash Nafas, M Take home message: The idealistic attitudes and Nobahar, A Ghods and A Asadi (Semnan University of Medical Sciences, Educational Development Center (EDC), Bassij expectations are observed in the ajority of first year medical Blvd., Semnan, IRAN) students. Medical courses need to be oriented to sustain these qualities. Introduction: The goal of evaluation is judgment about education quality and to define points of weakness and strength, for achievement of educational goals and 2 Ruby 2.3 promotion of quality. Internal evaluation by members of Students’ perceptions of their final year the group is the best method. The purpose of this study peripheral hospital attachments: findings was internal evaluation of the medical-surgical nursing from a qualitative study in a UK medical group of Semnan University of Medical Sciences for quality development. school Materials and methods: A CIPP decision making facilitation Diana Kelly* and Richard Phillips (Guy’s, King’s & St Thomas’s School of Medicine, Division of Medical Education, Sherman model was used. The characteristics of every desirable Education Centre, 4th Floor, Thomas Guy House, Guy’s condition and their indicators were determined for input, Hospital, London SE1 9RT, UK) educational process and output index. The data collection instrument was a questionnaire and checklist. The Aim of presentation: What do students believe affects the questionnaire used rating on a 5 point Likert scale quality of their experience on outside placement? We report (excellent to very weak). For equipment evaluation a 3 a study utilising focus groups. The aims were (1) to obtain point scale was used (perfect, imperfect and non-existent). formative student feedback during placements; (2) to Society and sample of evaluation were Faculty members enable comparison of themes between hospitals and and support manpower and nursing students. The final identify common strengths and areas of concern. score was obtained as the average of all scores and Summary of work: Final year medical undergraduates at interpreted according to Gourman’s classification. Guy’s, King’s & St Thomas’ School of Medicine undertake Summary of results: The manpower group gave the lowest eight-week clinical placements in medicine and surgery in score (1.32), and education course gave the highest score sixteen district general hospitals in southern England. The (3.86). Students gave high scores (4.23) to their own placements’ aims are for students to assess and manage teachers for teaching theory, but teachers received a low patients, enhance clinical and communication skills, score (3.01) in clinical teaching. The output of the develop professional attitudes and be effective team educational system is graduation and achievement of new members. A series of focus groups, involving over 130 knowledge. The score of graduated skills was 1, and faculty students, took place at hospitals mid-placement. Shortly members’ creation of new knowledge was 2.84. after each group a confidential report was prepared and sent to the hospital concerned. Further follow-up is planned Conclusion: The score of medical-surgical nursing group for a year later. in all evaluated fields is 2.86; thus on the basis of Gourmani’s classification is in the highly satisfied ranking. Summary of results: Analysis of the focus groups will be To make preparation of a logbook, specific journals and completed for presentation at conference. Preliminary data educational films, provision of PBL and group discussion show that a number of issues [for example, feeling part of workshops are suggested. the clinical team] are common. Conclusions/take home messages: Focus groups can be 2 Ruby 2.2 held, analysed and reported to inform change within a placement. Students value voicing their views; this study Expectations and perceptions of first year continues to measure the impact of their feedback. medical students M N Chandratilake, A Kasthuriratne* and A R Wickremasinghe (University of Kelaniya, Faculty of Medicine, PO Box 6, 2 Ruby 2.4 Thalagolla Road, Ragama, SRI LANKA) Routine evaluation of the disciplines in the Background: Medical students’ expectations of the medical undergraduate medical course of the Faculty course and the attitude towards their future profession of Medicine of the University of Porto (FMUP): influence their educational performance. Information on a concise tool for teaching management them will be useful for re-orientation of medical courses M A F Tavares*, L Guimarães, A Bastos, E Loureiro and M C to fulfil demands on the profession. Silva (University of Porto, Office of Medical Education, Summary of work: A descriptive cross sectional study, using Faculty of Medical Education, Alameda Hernani Monteiro, Porto 4200-319, PORTUGAL) a pre-tested self administered questionnaire was conducted for the first year students of the Faculty of Medicine, Aim: Development and assessment of a brief questionnaire University of Kelaniya, Sri Lanka. for measuring teaching performance in disciplines of the medical course of FMUP. Summary of results: The commonest reason for choosing medicine was to serve the country. Financial benefits were Summary of work: An initial 30-items questionnaire was the least common reason. Most students felt coping ability designed to evaluate planning, resources, teacher/students in dealing with the academic work load and separation interaction and students’ self-evaluation within each from home is ineffective. 64% expected to join the discipline. Students (n=956) attending the first 5-years government health sector after graduation. 6% expected medical degree filled in the questionnaire at the end of to become university academics. 51% of females wished 2002-03 academic year. Based on mean standardised to marry a medical graduate while 52% of the males scores, 39 disciplines were ranked for teaching evaluation.

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A short version (Q10) of this questionnaire was extracted, 15 educational groups (9 basic sciences groups and 6 through cluster analysis of item-correlations with the global clinical groups). (SPSS, 9 and 10) software was used for scale and reliability analysis. Scores of the Q10 obtained analysis of the data and (HG- 3 and 9) Harvard Graphic in the following academic year (928 students) were used was used for drawing the diagrams. to monitor changes. Summary of results: The findings of the research showed Summary of results: A regression analysis was used for that the average of the function of educational measuring agreement between mean Q10 scores. The management in basic sciences groups and clinical groups results evidenced extreme deviations from the overall are respectively 76.4% and 86.6 % while the overall regression fit for 6 disciplines. By excluding them neither average of the function of clinical groups and basic sciences the slope was significantly different from 1 (t=2.0, df=31, groups is 80.5%. p>0.05) nor the constant from zero. Positive deviations Conclusions: The function of educational management is corresponded to planned interventions to improve teaching directly in line with the evaluation process. Making use of efficiency. evaluation in each step of educational activities is a Conclusions: The Q10 showed both high consistency, for necessary measure. disciplines where no changes were expected, and high sensitivity to management changes. 2 Ruby 2.7 (FMUP, Fundação Calouste Gulbenkian) Using qualitative data from a Program Directors’ Evaluation Form as an outcome 2 Ruby 2.5 measurement for medical school Students’ opinions on introduction to S J Durning*, J Hanson, L Pangaro and Jackson (Uniformed clinical course in Buddhachinaraj Hospital, Services University Health Services, 19800 Fawn Vista Way, School of Medicine Montgomery Village MD 20886, USA) P Rojnsanga*, S Pannarunothai and Y Jariya (Buddhachinaraj Aim: To determine the utility of qualitative comments Hospital, School of Medicine, 90 Srithamtripidok Road, written by program directors in response to a survey Phitsanulok 65000, THAILAND) concerning post-graduate year 1 (PGY-1) graduates of our medical school. Hypothesized that comments would serve Background: Introduction to Clinic course is the lesson as an additional outcome measurement, adding information that aimed to introduce the medical students to the learning not captured by numeric data. process in the clinic which was different from preclinical years. The proper management of the course may yield a Summary of work: Program Director Evaluation Form good result in understanding how to learn in clinical years. surveys were mailed at the end of each academic year The objective of this study was to explore the student’s from 1993-2002. Two investigators independently reviewed opinion on the educational program provided. and coded all comments. Summary of work: A cross-sectional study with Summary of results: 1218 surveys were included (77% questionnaire survey to all students who experience the response rate). Comments were coded as positive, negative course. or neutral and were categorized into themes. General themes were classified as analytic or synthetic. Analytic Summary of results: 116 students responded tothe theme was divided into knowledge, skills, and attitude questionnaire, 52 were male and 84 were female. 66.4% categories. Skills category was further divided into preferred the interactive lesson between students and teaching, clinical, research and leadership. Synthetic lecturer. Only 5.2% of these students preferred active categories were overall performance comments and RIME learning and student-centered strategy. Most of the (Reporter,Interpreter,Manager/Educator) comments. Inter- students preferred skill learning in small group and 60.3% rater reliability was high, with kappa >.8. Comments recommended that the course should be separated from yielded additional data in each domain that added to another course. collected quantitative data; this was particularly evident Conclusion/take home message: These students’ opinions with negative comments. Compared with 4% of students reflected their background of learning and should be who received numerical rating less than satisfactory, 7% considered in the administration of a learning strategy. received comments classified as negative. Negative comments not detected by numeric data usually involved professionalism and/or clinical skills. 2 Ruby 2.6 Evaluation of educational management in Conclusions: Qualitative comments from the Program Tehran University of Medical Sciences Director Evaluation Form survey can serve as a useful outcome measurement for programmatic evaluation. Fereshteh Farzianpour*, Mohammad Ali Sedighi Gilani, Ali Akbar Zeinalou and Mohammad Reza Eshraghian (Tehran University of Medical Sciences, Faculty of Health, Shahrak- 2 Ruby 2.8 e-Apadana, U2, Faz 4, Block 36, Voroodi 3, Tabagheh 1 Personal maturation of medical students Sharghi, Tehran 13918, IRAN) through medical socialization Background: Evaluation of educational management has R R du Preez (Weskoppies Hospital, PO Box 1392, Groenkloof, a special place among our educational activities. It is used Pretoria, SOUTH AFRICA) to provide feedback on educational activities in order to ensure efficiency and quality of such activities, to inform Background: A reformed curriculum was introduced for decision makers and directors of educational systems. The first-year medical students at the University of Pretoria in information obtained through evaluation may be used for 1997. One of its aims was to foster the development of judgement of educational affairs in order to make decisions soft skills in a more overt and focussed manner. A study for promotion and upgrading of educational affairs and its was undertaken to compare students’ views on the way expected outcomes. they acquired and developed soft skills before and after the curriculum reform. Summary of work: The aim of this piece of research work is evaluation of the function of educational management Summary of work: Qualitative methods were used to collect that covers educational planning development, organizing data on the way final year medical students described educational activities, carrying out educational activities their development of soft skills and the influence of medical (orientation and leading) and, finally, control and evaluation school on their own personal growth. A purposive- of an educational process. The employed method is theoretical sample of 42 students from the traditional descriptive and analytical by making use of enquiries from curriculum and 49 from the reformed curriculum was

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recruited. Data were obtained by means of focus groups, Personal and professional development (PPD) is individual-in-depth interviews and autobiographical increasingly relevant to medical, veterinary and other sketches. professionals. Modern adult education theory supports the Summary of results: Students experienced the same involvement of students in curriculum design particularly for the types of outcomes associated with PPD i.e. attitudes personal struggles and obstacles in their own personal and behaviour. Using the Nominal Group Technique the maturation, no matter if during the old or new curriculum views of medical students were sought in 2002/03 Conclusions: A good hard look at our selection criteria concerning their experiences of PPD in the undergraduate and processes for medical students is needed, together programme (AMEE, Bern, 2003). Further work in 2005 with an unwavering and strong support system for the using a similar network of students identified specific issues students and a streamlined feedback or complaint platform. where students considered they could contribute to PPD curriculum design. Students welcomed opportunities to be involved e.g. as course representatives, co-researchers, 2 Ruby 2.9 through evaluations and suggesting innovations. Key PPD Internal evaluation of baccalaureate issues included more personalised feedback relating to program in midwifery on the scope of progress, wider choices for student selected components students in Shaheed Beheshti Faculty of of the curriculum, and better use of the opportunities for Nursing and Midwifery inter-professional learning. Cautious interpretations are necessary because of validity and reliability issues. There Farzaneh Pazandeh (Shahid-Beheshti Medical Sciences are consistent themes from the two periods of this research University, No1 soroush. St, Hormozan Ave, Shahrak-e-gharb, and across different phases of the curriculum - students Tehran, IRAN) are willing to contribute to systematic audits of the PPD Introduction: Evaluation and validation is a review process curriculum, if only the institution asked for their against standards in functions and capabilities of an contributions, and there should be an increased institutional organization. Evaluation is directed toward quality control, commitment to PPD. assurance, and promotion. This study was conducted to internally evaluate the educational program of midwifery students. 2 Ruby 2.11 Summary of work: 89 midwifery students participated. Data Influence of life support training in the were collected by a questionnaire in which the optimal undergraduate curriculum on self-efficacy in condition was asked in terms of 7 criteria obtained from resuscitation national and international standards. Jos Draaisma*, Guido Roest, Rob van Kesteren and Arnold Summary of results: Midwifery students had an appropriate Vulto (UMC St Radboud, Weezenhof 29-54, Nijmegen 6536 composition in terms of age, grade of high school diploma, HN, NETHERLANDS) and rank in entrance examination of universities. Most of Aim of presentation: The importance of training medical them had no or low interest when they had started their students in life support is widely recognised and accepted. academic education with no interview. However, at the This study was performed to assess life support training time of this study, 50% of them expressed their eagerness in the undergraduate curriculum in the Netherlands. Part about their major. The average score of their previous of the study was to determine the self-efficacy of students term was primarily (63%) between 15 and 16 (scale 0- in different years of their study in respect of resuscitation 20). Educational failure was not observed in these students, and different associated psychomotor skills associated with but 50% of them thought about abstaining from studying. airway, breathing, circulation and disability. More than 90% of them agreed upon the competence of Summary of work: The year representatives of the different their instructors in theoretical courses and 63% of them medical faculties were interviewed using a questionnaire upon clinical instructors. 93% of students expressed that which contained open-ended questions regarding life they had no role in devising or evaluating their educational support training organisation, content, skills development planning. and self-efficacy. They were asked to rate their self-efficacy Discussion and Conclusion: Selecting talented students in respect of cardiopulmonary resuscitation skills and from high schools nationwide to study midwifery is different psychomotor skills using a 100 mm visual important. It seems that admitted persons should be analogue scale. interviewed at the beginning about their interests and Summary of results: Students were uniformly convinced concerns. However, one of the main reasons in this regard of the importance of life support training. There was a may be unemployment of graduates and unsuitability of constant desire for more training in life support. working condition which brings about disinterest in the students. However, the existing life support training programs did not lead to an explicit increase in self-efficacy during their medical study. Students appear to have less self-confidence 2 Ruby 2.10 about resuscitation of children, and the psychomotor skills The personal and professional development needed in children. curriculum and student involvement Conclusion: We cautiously conclude that life support I J Robbe (Cardiff University, Centre for Applied Public Health training in the medical curriculum in the Netherlands seems Medicine, School of Medicine, Temple of Peace & Health, to have no definite affective effect on medical students Cathays Park, Cardiff CF10 3NW, UK) during their training.

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Symposium 3AUD

3AUD e-learning in medical education the field. The discussion will be of relevant to anyone with a broad interest in e-learning in medical education. To David A Davies (University of Birmingham, Medical School, assist in the preparation for this symposium delegates are Edgbaston, Birmingham, B15 2TT, UK), Martin Fischer (University of Munich, Germany), Peter Greene (MedBiquitous, invited to submit questions on topical e-learning themes Baltimore, USA) and Sebastian Uijtdehaage (David Geffen to the conference organisers in advance of the conference. School of Medicine, Los Angeles, USA) Delegates will be invited to introduce their question from the floor during the symposium. This symposium will provide the opportunity to discuss current themes in e-learning with a panel of experts in

Short Communications 3A Curriculum planning

3A 1 Changing the curriculum – reform of the old for professional duty. “This brings together all of our duties while developing the new – a benefit to and roles as a doctor into one circle”. students Take home message: There is nothing as powerful or A Carmichael*, G MacCarrick and P Stanton (University of inspiring for professional practice as the real thing. Tasmania, Faculty of Health Science, Private Bag 71, Hobart, Tasmania 7001, AUSTRALIA) 3A 3 Transforming the first preclinical year from In keeping with worldwide trends, Australian medical a lecture-based, discipline-oriented to an schools have moved from traditional to case- or problem- integrated hybrid curriculum – Do students’ based curricula, with approximately half [including the Tasmanian School of Medicine (TSoM)], reforming their perceptions and outcome match? existing undergraduate courses. In these reforms, least C Schirlo*, W Gerke, E Berger, E W Russi, P Groscurth, W change has occurred in the latter clinical years and students Vetter and F Wirth (University of Zürich, Studiendekanat der in the final cohorts of the “old” courses often felt neglected Medizinischen Fakultät, Office of Educational and Student when new courses were introduced. Reform in the TSoM Affairs, Zürichbergstrasse 14, Zürich CH 8091, has focussed initially on the final two years of the “old” SWITZERLAND) six-year course and the development of these as the final Aim of presentation: At the faculty of medicine in Zürich two years of the new five-year program. Undertaken in the first preclinical year was remodeled to integrate learning three clinical schools, the new program integrates hospital content and foster self-directed learning. To evaluate the and community placements and clinical discipline effects of the new curriculum the last cohort of the old components throughout the two years, culminating in a preclinical year was compared to the first new cohort. period of clinical attachment preparatory to internship. Summary of work: A 21 item student questionnaire was Common elements include weekly clinical cases and administered in both groups. In addition these data were assessment tasks to ensure quality and consistency across compared to the corresponding examination results. the three schools. This developmental process has benefited students and also the School in its use of Summary of results: The new curriculum had positive resources. Students in the final cohorts of the “old” course effects on students’ perception of relevance for medicine benefit from the reform changes while those in the new of the content in chemistry and physics (p<.001), the progress into an already established program. degree of support by teachers (p<.01) and the appropriate composition of lectures and small group formats (p<.001). However, while the examination results in chemistry 3A 2 Learning from the real thing: life cycle significantly improved (mean 60.76, SD 16.96 vs. 56.13, curriculum at University of Durham SD 16.97) there was a significant decrease in physics John Hamilton (University of Durham, Queens Campus, (mean 53.80 SD 13.82 vs. 68.23, SD 10.81). In contrast University Boulevard, Thornaby, Stockton-on-Tees TS17 6BH, there was a significant increase in the examination results UK) in clinical anatomy of the locomotor system while students in both cohorts rated the relevance as high. In spite of the Background: Phase 1 Curriculum at Durham is students’ perception of an improved teacher support there complementary to that at our partner, Newcastle. In the was no measurable increase in extracurricular support Life Cycle component Durham has placed real patients at frequency. the centre of case-based learning. This presentation will describe the organisation, support and student opinion of Conclusions: Perception of relevance of learning content this experience. In the first Unit from conception to birth, does not necessarily lead to an improvement in assessment the teachers are patients with Down Syndrome, Spina performance. The students’ perception of an improved Bifida, and normal pregnancy, together with family and support may be mainly attributed to the increase in small health professional teams. Each patient extends learning group formats. from biological science to the experience of life, health service organisation, medical decision making, preventive care, ethics and risks of decision making and the 3A 4 Multimodality collaborative approach to foundations of future health. Integration with the study of teaching respiratory histology a pregnant mother, Medicine in Community, and Personal Anca M Stefan, Cristian Stefan* and Armando Fraire and Professional Development will be described. Student (University of Massachusetts Medical School, Department of approval is extremely high both for the learning of science, Cell Biology, 55 Lake Avenue North S7-139, Worcester MA for insight into the experience of health and illness, and 01655-0002, USA)

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As part of the ongoing efforts for horizontal and vertical 3A 5 HannibaL: a totally modular curriculum integration in medical education, a multimodality approach without Bachelor/Master structure was designed and implemented in teaching the Respiratory System section of the Histology course offered to our first- Volkhard Fischer* and Hermann Haller (Hannover Medical School, Presidents Office, OE 9103, Carl-Neuberg-Str.1, year medical students. Each faculty member who taught Hannover D-30623, GERMANY) in this section participates in more than one course or program in the medical school curriculum, which facilitates Starting in fall 2003 Hannover Medical School changed the continuity between courses without redundancy. The the traditional curriculum for the medical students to a histological concepts presented in lectures and lab were totally modular one. The goals can be summarized as correlated with and reinforced by use of macroscopic follows: 1) A curriculum which offers significantly more pathological specimens, recorded normal and pathological practical experiences to all 270 students per year; 2) A respiratory sounds, developmental anatomy, principles of curriculum which combines practical training with a medical interview and physical diagnosis, clinical vignettes, intensive program in molecular medicine; 3) A curriculum radiological material, and videoclips portraying which enables the students to recognize that there are physiological as well as common pathological conditions different, important perspectives on every disease like such as asthma, COPD, and pneumonia. Special emphasis prevention, curative medicine, rehabilitation and health was placed on: (a) looking at the architecture of the economics; 4) a curriculum which offers our students the respiratory system from a functional perspective; (b) opportunity to find their own focus in research and practice. problem-solving skills; and (c) the direct practical relevance Because we still organize our modules around the underlying any theoretical concept. In addition to more traditional subjects the curriculum conversion wasn’t a traditional testing methodology, the students had the radical shift compared with other popular models of medical opportunity of self-evaluating their knowledge during a education. But the received feedback from students, staff special session with polling facilities. This integrative and and politics was much better than expected and the interactive approach was well received by students and experienced stumbling blocks were smaller than feared. contributed to superior results obtained by them for that The greatest obstacle seems to be a lack of imagination particular block examination. and openness on the way to Bologna.

Short Communications 3B Problem based learning: role of the tutor

3B 1 Evaluating the role of tutors in PBL sessions Summary of results: Many tutors have interpreted the role of the tutor in PBL as a completely passive one with all the Sevgi Turan*, Melih Elcin, Orhan Odabasi, Kirsten Ward and responsibilities being on the part of the students. The Iskender Sayek (Hacettepe University, Faculty of Medicine, Tip Egitimi ve Bilisimi AD, Shihhiye, Ankara 06100, TURKEY) workshop has been redesigned to put equal stress on the role of the tutor with respect to four aspects of PBL: Problem based learning (PBL) sessions have been learning, process, group dynamics and feedback. Since conducted at Hacettepe since 2000 and the role of the most tutors have already participated in workshops this tutors is still the main difficulty of this educational approach. helps only new ones coming in. Strategies are being worked The aim of this descriptive study is to evaluate both the out for competence development for tutors at the level of students’ and the tutors’ perceptions of the role of tutors the courses in the curriculum. in PBL sessions. A questionnaire was distributed to year 2 and 3 students. It had 22 statements and used a 5 point Take-home message: It is important to define the specific Likert scale. The scale measured four dimensions: role of the tutor with respect to the particular design of metacognition, conduct, communication, and evaluation the curriculum. and feedback. Students gave tutors the lowest rating on the evaluation and feedback dimension (3.68 in year 2 3B 3 Faculty and students’ perceptions about and 3.55 in year 3). The dimensions conduct, and communication received the highest ratings (3.94 and 3.95 teaching styles of tutors in problem-based in year 2 and 3.99 and 3.93 in year 3). Among tutors, the tutorials dimension of evaluation and feedback was also rated lowest Salah Kassab*, Marwan Abu-Hijleh, Qasim Al-Shboul and (3.85 in year 2 and 3.43 in year 3). The highest ratings Hossam Hamdy (Arabian Gulf University, College of Medicine were for conduct in year 2 (4.16) and for communication and Medical Sciences, PO Box 22979, Manama, BAHRAIN) in year 3 (4.20). Students and tutors agreed in the area of Aims: The aim of this study is to examine the self-rated worst performance for tutors; but the areas of better compared with student-rated teaching styles of PBL tutors. performances for tutors varied according to year and point In addition, we examined the relationship between of view. teaching styles of tutors and actual performance in tutorials. 3B 2 The tutor: a dumb duck or…? Methods: The study included 48 tutors from basic and Gudrun Edgren* and Jakob Donnér (Lund University, Medical clinical sciences and 276 medical students in the pre- Faculty, Centre for Medical Education, PO Box 117, Lund SE clerkship phase (year 2, 3, & 4). Tutors and students were 221 00, SWEDEN) given a questionnaire with a 5-point Likert-type scale consisting of 21 items that comprise four domains of Aim: The medical programme at Lund University uses teaching styles (facilitative, collaborative, suggestive & problem-based learning during the preclinical part of the assertive). In addition, quantitative and qualitative data curriculum. At regular intervals students complain that regarding students’ evaluation of tutor performance were many groups do not function well. Actions like a faculty analyzed. workshop for tutor training and rules for PBL-work have been established, but complaints keep coming. This study Results: Tutors perceived themselves in the facilitative end was undertaken in order to identify the cause of the of the spectrum of styles. Self-rated scores of tutors in the problems and to take actions aiming at improvements. facilitative domain (4.39 ± 0.09) were negatively correlated with those in the assertive domain (3.06 ± 0.07, r = - Summary of work: Focus group interviews with students; 0.006). However, students perceived tutors as a blend of personal interviews with tutors; questionnaires to classes. styles with less “facilitative” and more “assertive” scores

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(P<0.01) than tutors self-rating. In addition, students Take home message: The presented non-medical case is rating of the performance of tutors were based not only a useful tool to illustrate the method of PBL and the role on their teaching styles, but also on other attributes such of PBL-tutors, especially in a setting, in which trainees as establishing rapport with students, having content have a heterogenous background of medical experience. expertise and providing academic help for students. Conclusion: There is a gap between students and tutors 3B 5 A faculty development for hospital perceptions about teaching styles of tutors. In addition, specialists: PBL and post-graduation other attributes are important determinants of an effective tutor. Stewart Mennin1, Regina Petroni-Mennin*2, Valeria Lima3, Roberto Padilha3 (1Instituto de Ensino e Pesquisa, Hospital SirioLiabes, Sao Paulo, BRAZIL; 2Federal University of Sao 3B 4 Using a non-medical case in training PBL– Paulo, BRAZIL; 3Faculdade de Medicina de Marilia, BRAZIL) tutors in Heidelberg, Germany Thirty hospital specialists in thrombosis, intensive care and H M Bosse*, S Huwendiek*, M Kirschfink, S Skelin and C pain management requested faculty development in order Nikendei (Kinderklinik, INF 153, Heidelberg 69115, to teach post-graduate specialization. A series of GERMANY) participatory interactive workshops was developed and implemented over a four month period. Methods included Background: PBL is an integral part of the medical small-group discovery learning, case writing and editing, curriculum in Heidelberg (HEICUMED). Because of the small-group tutorial experiences and direct observation heterogeneous background of medical experience (from and feedback from peers and experienced facilitators. junior house-officers to consultants) a non-medical case Hospital residents served as students for the direct hands- is used for the training of PBL-tutors. In the non-medical on-experiences. The initial focus was on “How People paper case, a young couple faces the breakdown of their Learn”, followed by how cases fit with discovery learning. car on their holidays. Expected learning goals include Cases were written using a progressive disclosure format. psychosocial aspects and “differential diagnoses” for the Individual case author meetings followed by on-line editing breakdown of the car, both explanatory and procedural proved to be a successful approach. Thirty teachers were approaches are expected. trained as PBL facilitators for three post-graduate courses, Rationale: To evaluate the acceptance and feasibility of one of which is multidisciplinary. Facilitator training required the non-medical case and the gain of competences among three days and consisted of working in groups, practicing the PBL-tutors in the training. with actual students using cases written by the trainees What was done: Items were evaluated as self-assessment and direct observation and timely feedback. Follow-up skills pre and post intervention; data were analyzed fitting a training continues with direct observation and informal mixed linear model for repeated observations. meetings during each course. This approach to training has proved to be successful and was well received among Conclusions: All participants considered the non-medical specialists who are now using PBL in their courses. case as a useful and enjoyable tool to illustrate the steps of PBL. Over the course there was a gain in self-assessed competence in understanding the steps of PBL (p<.0001) and the role of a PBL tutor (p<.0001).

Short Communications 3C Multiprofessional education in the workplace

3C 1 Interprofessional education at work: Take-home messages: IPE should be part of professional learning together whilst working together development at all levels and there are a number of ways in which IPE can be implemented in the workplace. Claire Dickinson*, Jane Metcalf, Pauline Pearson and Marion Grieves (University of Newcastle upon Tyne, School of Medical Education Development, The Medical School, Framlington 3C 2 Interprofessional learning in the work Place, Newcastle upon Tyne NE2 4HH, UK) place: are there specific teaching/ Background: Evidence suggests that interprofessional facilitation skills? Results of a Delphi Survey education (IPE) in the workplace, as opposed to the from the PIPE Project classroom, does more to effect change and improve services (Barr, 2002). The North Tees and Hartlepool NHS Julia Bray*, Elizabeth Howkins*, Gill Young, Bee Wee, Katy Trust, in the North East of England is funding two work- Knewell Jones and Maggie Lord (University of Reading, School based IPE initiatives. of Health and Social Care, Bulmershe Court, Earley, Reading RG6 1HY, UK) Work done: The Expert Facilitator in Interprofessional Aims: The purpose of this paper is to share findings of the Training (EFIT) programme consists of five training days study that collaborative learning is maximised through and involves participants from 9 professions. The EFIT expert facilitation and how these results are being used to participants are trained to initiate and facilitate IPE within enhance facilitation of Inter Professional Learning (IPL) the clinical setting. The Ward-based Interprofessional across the consortium of Higher Educations Institutions Education (WIPE) is a weekly multi-disciplinary educational and Thames Valley Strategic Health Authority. meeting. Both initiatives look at professionals’ working relationships and examine how these may be improved. A Summary of work: This research was carried out to mixed method evaluation of both projects (using establish if current preparation of facilitators for work-based interviews, observation and standardised questionnaires) IPL is sufficient and explore whether there are additional is underway. skills and methods required to promote effective IPL. Using a Delphi Survey, an expert panel of facilitators were Conclusion: IPE can take many forms and should be flexible selected throughout the UK in health and social care. to include a broad range of professionals. Early findings suggest that these training initiatives have resulted in Summary of results: The evidence that emerged confirms changes that improve working practice and client care. that collaborative learning is maximised through enhanced facilitation skills identified by the panel. The enhanced skills

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require a number of priorities on the part of the facilitator Method: Students from different programs practice and greater awareness of certain issues for the learners teamwork, meet patients and plan care under supervision. to meet the IPL learning outcomes. They learn about each other’s competence and how to combine them. Through discussions and seminars, Conclusion: Exploration of the data has produced the highlight new questions out of ethical point of view, beginnings of a model of IPL facilitation and the PIPE team compliance, living condition and drugs. are currently producing guidelines for facilitators which will be published. Workshops are being held to promote Results: The students highlight the teamwork, to learn the findings and evidence for effective IPL in the work about each other’s competence, together meet a patient place. at home and the discussions afterwards. Also, the professionals highlight the opportunity to meet the patient together with other professionals, to hear and discuss the 3C 3 Not only doctors – learning from other students’ point of view. This project involves public health colleagues centres and the professionals in the south area of K Simpson*, G B Drummond, G Lloyd-Jones, A D Cumming Stockholm and students from four programs at KI, and H Cameron (University of Edinburgh, Medical Teaching undergraduate level, i.e. Medicine-, Nursing-, Occupational Organisation, College of Medicine and Veterinary Medicine, Therapy- and Physical Therapy programs. Teviot Place, Edinburgh EH8 9AG, UK) Evaluation: This project is evaluated both from students Aim of Presentation: The General Medical Council states and supervisors/the professionals’ point of view. The that medical graduates must understand the working questionnaire is valid and used at Linköping University. framework in which medicine is practised as well as value the roles and expertise of other professionals. The presentation will describe an interprofessional learning 3C 5 Evaluating interprofessional education in project that helped to address these salient aspects within the real NHS a Student Select Component at University of Edinburgh S Jackson*, C Stevenson, J Campbell, J Metcalf, J Medical School. Lewandowski, A Lamb, J Carling, A Chadwick, B Wallis, S Summary of Work: 3rd year medical students shadowed a Barsoum, S Jones and J Wardle (University of Teesside, School professional/practitioner to observe and discuss individual of Health and Social Care, Parkside West, Middlesbrough TS1 3BA, UK) and team activities on a minimum of 3 four-hour sessions, over 14week period. Participants were: 251 medical Aim: A joint initiative involving 2 acute NHS Trusts and students; 114 public sector health and social care the University of Teesside has introduced Interprofessional professionals; 50 associated professionals (police, prison, Education (IPE) for Medical, Nursing and Allied Health Care ambulance, etc); 45 commercial, voluntary and private Students. This is in response to directives from the sector individuals/organisations. Formative assessment Department of Health and growing evidence indicating that was written reports and presentations. Quantitative and team-work and collaboration between professional groups qualitative evaluation data were gathered from students improves patient care. and practitioners: Readiness for Interprofessional Learning Methods: A Whole Systems Methodological approach was Survey (RIPLS); Questionnaire using Likert scale and free used to investigate all aspects of IPE: appreciation of text; Electronic discussion board; Staff-student meetings. students’ attitudes, Clinical Lecturers’ (CL) teaching Conclusions: The project generated considerable interest approaches and the learning/facilitation environment. and controversy, by epitomizing a conflict between the Multiple methods were used to collect data (interviews, ‘social’ and ‘science’ aspects of medical teaching. This was non participant observations and RIPLS Questionnaire evident in the high response rate (72%) and students’ (Readiness for Inter-Professional Learning, Parsell and Bligh spontaneous engagement with evaluation and course (1999)). development. 74% reported favourable experiences. Full Results: CLs developed different IPE learning environments analysis of results will be presented. (ward based, lab based, simulated manikin). To date 152 students have been part of the evaluation process (Nurses 3C 4 Better health through interprofessional n=59, Medical Students n=80 and AHP Students n=13). Students reported enjoying IPE sessions and RIPLS data collaborative education – learning together showed significant positive difference in attitudes towards in public health care inter-professional working. Interestingly this difference was Margaretha Forsberg Lam* and Magdalena Hedberg not solely dependent on the environment within which (Karolinska Institutet, Dept of Soedersjukhuset, Sjukhusbacken IPE took place, suggesting that it may be the psychosocial 10, Stockholm 11883, SWEDEN) and teaching interactions used by the CLs that bring about Background: Participation in collaborative interprofessional this change. A Grounded Theory analysis is underway to training has successfully been a part of medical and health look closely at the student/CL relationship within the IPE care education at Karolinska Institutet since 1998. environment. Purpose: Provide opportunities for undergraduate Conclusion: IPE is effective, non threatening and enjoyable interprofessional collaborative learning through clinical according to students. The interactions between students/ training and collaborative patient-centred practice in public CL along with effectual facilitation of learning opportunities health care settings. may be important components in changing students’ attitudes to IPE.

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Short Communications 3D Teaching and learning communication skills 1

3D 1 Combining the teaching of communication 3D 3 A comparison of clinical communication and physical examination skills in an skills between two groups of final year interdisciplinary students course: students medical students with different levels of obtain patients’ perspectives communication skills training at H Goehler*, J Kretschmann, A Dieterich and U Schwantes Stellenbosch University, South Africa (Charité, Universitaetsmedizin Berlin, Institut für M R de Villiers*, M van Heusden and M Wright (Stellenbosch Allgemeinmedizin CCM, Berlin 10117, GERMANY) University, Faculty of Health Sciences, PO Box 19063, Background: What does it feel like when a physician is Tygerberg 7505, SOUTH AFRICA) examining your chest? How to ask about drug abuse in a Background: Effective communication is the hallmark of a patient’s interview? 3rd year medical students (n = 350 good doctor-patient relationship. Patients’ problems are each term) acquire basic medical skills as history taking more accurately identified and they are more satisfied with and body examination in a combined course at the Medical the care received. Training in this highly complex skill is School of Charité Berlin. Communication skills are trained still developing in South African medical undergraduate in small groups with simulated patients while physical programmes, especially against the backdrop of a examination is practised by the students on one another. multilingual and multicultural society. Significantly more The goal is to provide students with necessary insight into training time is invested in clinical communications skills patients’ perspectives besides teaching basic medical in a new curriculum that was instituted in 1998. The aim knowledge. of the study was firstly to compare the clinical Methods & Results: Surveys are used to find out about communication skills of two groups of final year medical students’ opinion at the end of the course. Among other students who had different levels of communication skills questions, students are asked how they value the training, and secondly to make recommendations on combination of communication skills with physical effective changes in this training. examination in one course and if they consider they Methodology: Standardised doctor-patient interviews obtained a better insight into patients’ perspectives due performed during the final year examination were to exploration training on one another. Overall acceptance videotaped for both 2003 and 2004 final year students. of the course is high. Over 70% of the students declare to These were assessed by 2 independent blinded evaluators have learned a lot for their future career. using an abbreviated version of the Calgary-Cambridge Conclusion: Combining physical examination and communication guide for skills not done (0) and done (1). communication skills achieves high levels of acceptance The data were statistically analysed using STATISTICA 7. by students. Participants appear to gain insight into Results: 161 interviews were analysed. Both groups patients’ perspectives. performed very well (mean=1) in listening to the opening question, encouraging the patients to tell their story, and demonstrating appropriate non-verbal behaviour. Ending 3D 2 Students’ attitudes toward communication the session by summarising and clarifying the plan was learning – a cross-sectional study from the however poorly performed (mean=0.4). The 2004 group four medical schools in Norway was statistically significantly better in using signposting to Hilde Grimstad*, Tor Anvik, Tone Nordøy and Per Vaglum facilitate progression between sessions and information (Norwegian University of Science & Technology, Faculty of giving (p-value = 0.02). Medicine, ISM, MTFS, Trondheim N-7489, NORWAY) Conclusion: Despite the fact that the new curriculum group The aim of the presentation is to present one part of the (2004) did better in core communication skills, the general work of a Norwegian national research group (EKKO) that lack of difference between the two cohorts needs attention. is evaluating the teaching in clinical communication at all Merely adding more time to communication skills training four medical schools in Norway. does not seem to be the answer. Incorporating more experiential training, training of the trainers and addressing Summary of work: The national research group has language and cultural issues may improve outcomes in reported teaching methods, timing and settings for future clinical communication skills training. communication teaching at all four medical schools in Norway. Besides, all medical students in Norway received a set of questionnaires about their background, self 3D 4 Games for teaching communication skills: reported communication skills, attitudes towards learning Survivor! communication skills, perceived medical schools stress and clinical communication knowledge. To measure students’ Cindy L Adams (University of Guelph, Department of attitudes, the Communication Skills Attitude Scale (CSAS) Population Medicine, Ontario Veterinary College, Guelph, was used. Ontario N1G 2W1, CANADA) The 4 year undergraduate communication curriculum at Summary of results: Methods in teaching communication the Ontario Veterinary College (OVC) includes in-class skills, time spent on teaching, timing and setting for interactive workshops, a simulated client and patient teaching communication skills differed between the program and a community medicine rotation in final year. different schools. The students at two of the four medical A well established model from human medicine called the schools showed the well-known decline in attitude-scores Calgary-Cambridge Observation Guide 1 and 2 (CCOG) is towards communication from start to end of medical school, an essential component of the curriculum including the while students from the other two schools had the same format, feedback, teaching, learning and assessment. In level of attitude-score at start and end of medical school. year 1 of the program 2 class hours are devoted to skills Conclusions/take home messages: It is possible to have a based learning using a game format called Survivor. In high attitude-score towards communication at the end of their pre-assigned teams of 6, students rotate through 4 medical school. stations. Each station requires them to focus on a specific skill including open-ended questions, reflective listening, empathy. The fourth station involves sorting verbal responses into categories. Groups are given 15 minutes

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to complete the tasks at each station and their responses students. The system has overcome many barriers in are recorded on a work sheet. Completed work sheets are utilizing SPEs and has provided efficient and effective used by the instructor to assess student comprehension. learning. They are also total scored and the team with the highest score receives a prize. This game format for skills based teaching has been also been used for preceptor training 3D 6 Focus on feedback: 2 effective tools and with primary care teams in practice settings. This designed for SPs, faculty and students to activity is transferable to other professional programs. enhance the delivery of feedback on communication skills 3D 5 An innovative training assessment center Laura Jayne Nelles* and Catherine Smith (University of for teaching communication skills Toronto, Standardized Patient Program, 1 Eaton South Room 565, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Orhan Odabasi*, Melih Elcin, Kirsten Ward, Murat Sincan, CANADA) Iskender Sayek, Murat Akova and Nural Kiper (Hacettepe Universitesi, Tip Fakultesi Egitimi ve Bilismi AD, Sihhiye, In this presentation participants will become familiar with Ankara 06100, TURKEY) a tool for training communication and feedback skills developed at the University of Toronto (UofT). At U of T Recording standardized patient encounters (SPEs) on we work on communication issues with learners of varying videotape provides a convenient tool for subsequent abilities in myriad settings. Often these learners feel more coaching. The aim of this project was to design a center comfortable focusing on medical content rather than and a methodology for communication skills training and communication. In order to teach communication skills to evaluate early outcomes. At the Training and Assessment we have developed specific tools that allow us to address Center, communication skills training is offered for students the multiple communication aspects of patient centred and residents. Each of the 9 rooms is equipped with a interviewing. One of these tools has many applications digital camera, and a motion detector triggers the SPE and can be used extensively in a workshop setting or as recording. Videos are archived in a database associated an individual training tool. It involves trigger tapes of with relevant metadata. The students get feedback in simulated student-patient interviews designed to be used subsequent tutorials when the interviews are accessed with an observation/assessment guide. This tool can be via the intranet. In 2005, we used 13 SPs for a total of used by: 1 individual SPs or groups of SPs practicing/ 1848 SPEs with a maximum duration of 8 minutes; the learning feedback skills; 2 individuals or groups of medical recorded material used 167 GB, or 6.4% of the total learners developing communication and self-assessment capacity. At the end of first year, a short questionnaire skills; 3 faculty development for coaching/feedback was distributed to students to evaluate the system. In training. Through watching a trigger tape and using the rating “impact of the system on the learning process”, the guide, participants will have hands-on experience using median rating for first and third year students was 4.00 this effective instructional aide and will learn how to adapt (beneficial); it was 5.00 (very beneficial) for second year it for a variety of learning environments.

Short Communications 3E Continuing professional development/continuing medical education 2

3E 1 Effects of a peer review group program for 3E 2 Self evaluation of CPD effectiveness in improving the treatment for chronic resuscitation training patients: a randomised controlled trial Mike Davis* and Sue Wieteska (Edge Hill, Department of P Denig*, W N Kasje, P A de Graeff and F M Haaijer-Ruskamp Social and Psychological Sciences, St Helen’s Road, Ormskirk, (University Medical Centre Groningen, Department of Clinical UK) Pharmacology, A Deusinglaan 1, Groningen 9713 AV, The aim of this paper is to explore the post course NETHERLANDS) experiences of candidates who undertake training in a Aim: To show results of an educational program for peer variety of advanced life support courses conducted under review groups of GPs, aimed at implementing treatment the auspices of the Advanced Life Support Group. An email guidelines. was generated automatically at course + 6 months and respondents were directed to an online questionnaire based Summary of work: 16 peer review groups were randomized on a seven point Likert style scale plus two open items for to receive a program on chronic heart failure treatment free comment. In general, candidates had high (CHF) or hypertension treatment in diabetes patients (RR- expectations of the potential relevance of the course and DM). During one group session, GPs discussed potential end of course evaluations were even more favourable. barriers and treatment changes for some of their patients While evaluations at course + 6 months were less in the light of the guidelines. Changes were assessed in enthusiastic, there was still considerable recognition of prescribing of ACE-I for a number of randomly selected the values of the course, 75% of respondents considering patients in both arms. their experience to have been relevant or better. 79% of Summary of results: 69 GPs participated in the CHF candidates reported that they had put skills into practice. program and 29 GPs in the RR-DM program. No significant Results give us some confidence that the courses are effects were found. ACE-I was added at follow-up in only having the desired impact. However, we have identified a 40 of the 508 CHF patients (8% intervention, 7% control), clear case for further research, including gathering data and in 34 of the 451 RR-DM patients (8% intervention from observations and some means other than self-report. and 7% control). Only 53% of the CHF patients and 60% of the DM patients had a GP-contact in the year after the intervention. 3E 3 Family physicians’ learning in practice: linking theory and practice Conclusion: The approach based on one peer review group session was not sufficient for changing the treatment of Joan Sargeant*, Karen Mann, Douglas Sinclair, Cees van der chronic patients. More active support is needed for review Vleuten, Job Metsemakers, Philip Muirhead and Suzanne and recall of individual patients whose treatment appears Ferrier (Dalhousie University, Faculty of Medicine, Room to be suboptimal. C106, 5849 University Avenue, Halifax, Nova Scotia B3H 4H7, CANADA)

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Aim of presentation: At AMEE 2004 we reported a study professional development branch of the RxCEL Competence of family physicians who received high scores in a formal Program, the self-assessment will enable pharmacists to multi-source feedback (MSF) formative assessment develop learning plans for the future. A pilot program was program. These physicians were self-directed, self-aware developed to evaluate the implementation strategy for the learners who learned intentionally from practice, especially self-assessment, as well as integration with the existing from patients and colleagues. This presentation explores learning portfolio. The evaluation consists of two phases: these findings in light of current understanding of learning survey of the impact of the self-assessment tool and further in practice and discusses implications for medical exploration of the impact of self-assessment through focus education. group interview. The evaluation of the pilot program is Summary of work: We reviewed general and medical underway. Preliminary results indicate that self-assessment implementation is successful within a CPD program. education research studies, discussion papers and Information about pharmacists’ experience and the impact conceptual approaches addressing learning in practice and of self-assessment will be presented. maintaining competence. Specific review topics included informal learning and learning through experience, physician learning in practice, and explicit and implicit 3E 5 Development of an Assessment Programme: knowledge related to the different domains of professional Assessing Stakeholder Perception competence (e.g., medical expertise, interpersonal relations, patient and self management). This paper will Douglas J Murphy*, Kevin W Eva, David Bruce (NHS present key results of this review and relate them to study Education Scotland, 34 Randolph Road, Broomhill, Glasgow findings. G11 7LG, UK) Summary of results: Practice is a central stimulus for Aim of presentation: Increasing sophistication in learning. However, both the knowledge gained informally development of evaluation instruments has led to criticism through practice and the learning processes used appear that reality is being sacrificed for psychometric purity, with to be influenced by perceptions of what is explicitly valued measurement concentrating on what can be measured and recognized in medical education and practice. rather than what matters. To ensure content validity any new system must fully cover all relevant domains of activity. Conclusions/Take-home messages: Much of physician In addition, satisfaction with the process on the part of all continued learning can occur informally through their stakeholders is likely to be determined by the extent to practice and interaction with colleagues. Making implicit which confidence is maintained that the goal of coverage professional content and learning processes more explicit has been met without excessive redundancy. The purpose may contribute to this learning. of this study was to determine the perceived role various evaluation instruments play in assessing the competencies 3E 4 Implementation and evaluation of a self- expected of practising physicians. assessment program for pharmacists in Summary of work: Three groups of stakeholders (experts, Alberta, Canada trainers, and trainees) completed a blueprinting exercise in which they were asked to rate the extent to which each Theresa Schindel*, Roberta Stasyk and Stanley Varnhagen of 8 evaluation tools were believed to assess each of 8 (University of Alberta, Room 3127 Dent/Pharmacy Centre, competencies using a 7-point rating scale. The 8 Edmonton, Alberta T6G 2N8, CANADA) competencies were derived from the Good Medical Practice The implementation and evaluation of a pharmacist self- guidelines. assessment pilot program will be presented. The Summary of results: High levels of agreement within and competence program of The Alberta College of between groups were established, thus ensuring that the Pharmacists, Canada, has evolved and expanded over the resulting blueprint provides a consensus on which physician last 30 years to consist of two branches: continuing evaluation systems can be modelled. professional development and competence assessment. The continuing professional development branch began Conclusion: Although insufficient for the development of with mandatory continuing education in 1976 and moved an assessment programme it is useful and important to to a professional learning portfolio in 2001. In 2005, self- involve stakeholders to establish alignment of purpose. It assessment will be incorporated into the learning portfolio. is anticipated that the resultant blueprint will facilitate The self-assessment is based on a detailed competency satisfaction with the assessment process. profile for Alberta pharmacists. As part of the continuing

Workshops 3F & 3H

3F East Europe/Central Asian Special Interest 3H Keeping an Eye on Quality: how the LCME Group trains and evaluates its survey teams Group facilitated by Kathleen Conaboy (American Carol Aschenbrener1, 2Barbara Barzansky, 3Cam Enarson and International Health Alliance, 6351 Meadow Crest Circle, Reno 4Robert Talley. 1 Association of American Medical Colleges, NV 89509, USA) and Jadwiga Mirecka (Medical College of 2450 N St. NW, Washington DC, USA; 2AMA; 3Creighton Jagiellonian University, Krakow, Poland) on behalf of AMEE University School of Medicine; 4University of South Dakota Executive School of Medicine Within the context of significant international interest in Background to the topic: The Liaison Committee on Medical quality improvement in medical education, this workshop Education (LCME) accredits MD education programs in the provides the opportunity for discussion of reforming US and Canada, the latter in cooperation with the medical education in post-Soviet countries. Regional, Committee on Accreditation of Canadian Medical Schools. international, political and institutional issues will be The quality of the accreditation system depends on the identified. Participants will address: defining common rigor and consistency of the process of surveying programs issues and addressing common problems; sharing best and holding them accountable to the accreditation practices; economizing organizational resources; and standards. Surveyors for the 20-30 medical school visits maximizing outcomes through joint planning and per year are drawn from a pool of about 240 volunteer, implementation.

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uncompensated peers who are active in medical education Intended outcomes: Participants will: (1) Identify key and administration. criteria for selection of accreditation survey teams; (2) Share best practices for initial and ongoing training and Workshop content and structure: This interactive workshop support of survey team members; (3) Enhance their will share best practices in the selection, training and understanding of mechanisms for quality assurance and ongoing support of voluntary professionals who conduct quality improvement of the accreditation survey process. accreditation surveys. Topics will include an overview of the LCME accreditation process and role of the survey Intended audience: Individuals interested in the selection, teams; selection of surveyors and incentives for training and ongoing support of accreditation survey teams participation; preparation and training for the roles and for established or developing medical school accreditation responsibilities of team chairs, secretaries and members; systems. materials to support the evaluation process; ongoing Level of workshop: Intermediate: some knowledge of the quality assurance and quality improvement activities to purposes of accreditation is desirable although a brief ensure the integrity of the survey process; and key ethical introduction to the LCME’s accreditation process will be issues. Attendees will have an opportunity to participate included. in a brief training exercise.

Short Communications 3L Methods of selection

3L 1 Identifying predictors for successful study variables were: (1) study intermissions and drop out rates in a revised medical curriculum (2) the results of the preclinical final examination at the end of the fourth semester and (3) the total number of Ben van Heerden*, Chris Aldrich, Wynand van der Merwe and study credit points achieved during the medical program. Barney de Villiers (University of Stellenbosch, PO Box 19063, Tygerberg 7505, SOUTH AFRICA) Locally admitted students had passed their preclinical final examination more often, had achieved more credit units Aim: Due to changes in assessment in South African in average, had fewer study intermissions and a lower secondary schools as from 2008, current academic criteria drop out rate in comparison with centrally admitted will no longer be applicable for the selection of medical students. Preliminary follow-up data show that the students. The purpose of this study is to identify alternative interviewed students were more committed and motivated predictors for success and possible obstacles to successful than those who were taken in on the basis of their previous study. academic achievement. The results clearly indicate that Methods: The study population includes all students the local admission procedures were well worth the effort admitted to the MB,ChB programme at our Faculty since and economical investments. 1999. Artificial Neural Networks (ANN) are forms of artificial intelligence ideally suited to determine from a large number of variables (“inputs”) the most powerful predictors for 3L 3 SIP 1 – the selective exam at the end of the certain outcomes (“outputs”). With future ANN “learning” first year on new data this prediction can improve. Numerous input H G Kraft (Medical University of Innsbruck, Institute for variables are used for the ANN to determine the most Medical Biology & Human Genetics, Schoepfstr. 41, Innsbruck powerful predictors of academic performance during the A-6020, AUSTRIA) first two years of the programme, including: gender; age; ethnicity; language; academic performance at secondary In 2002 a new curriculum was introduced at the Medical and/or tertiary education level; results of the National University of Innsbruck. A major change in this curriculum Placement Test; quantitative results of student feedback, was the introduction of a new exam system consisting of etc. As output variables (measurement of “success”) for summative and formative exams. The first of these new the ANN the marks obtained in course modules during the exams (SIP 1 – summative integrierte Prüfung) is the first two study years are used. selective barrier that regulates the admission to the limited positions of the second year. In Austria access to medical Results: The results and possible implications (also at schools is by law without restrictions. Hence we have to national level) will be discussed. deal with far more students than we can handle. Every year > 600 students start to study medicine in Innsbruck but only 275 are allowed to continue to the second year. 3L 2 What is the use of interviews and In order to achieve a high validity, reliability and objectivity psychological tests in selecting students to the format of a MC test was chosen consisting of 160 a medical program? items. The questions relate to the following disciplines: Kirsti Lonka*1, Hans Hindbeck1 and Patrik Scheinin2 anatomy, histology, physics, human genetics, cell biology, (1Karolinska Institutet, Department of Learning, Informatics, physiology, chemistry, biochemistry, biostatistics, and Management & Ethics (LIME), Berzelius vag 3, Stockholm SE general medicine. The implementation of this exam was 171 77, SWEDEN and 2University of Helsinki, FINLAND) facilitated by the use of LogiExam, a software bundle that handles the storage of the questions, the generation of Selecting students to medical programs is a world-wide personalized test and answer sheets ready for scanning. problem. How to get the best students into the demanding So far this test has been performed 8 times (including profession? Is there added value in using expensive repetitions) and the results will be presented. selection procedures or could selection be based on grades alone? The first local admission to the regular medical program at Karolinska Institutet took place in 1992. It 3L 4 Selection testing for entry to medicine was based on interviews and psychological tests. The present evaluation was carried out in 2004. Locally Cecily Aldous* and Philip Brown (ACER, 19 Prospect Hill admitted students were compared with those whose Road, Camberwell, Victoria 3124, AUSTRALIA) admission was based on grades and academic Many medical schools have introduced a test into their achievement. It included all medical students that entered selection processes to measure applicants’ general aptitude the program from 1997 to 2001: A total of 983 students and relevant non-academic attributes. This has been driven of whom 577 had been locally admitted. The dependent by curricula emphasising new styles of learning, and by

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awareness of the inadequacy of selecting on academic 3L 5 Admission criteria to medicine – are there results and interviews alone. Testing also assists in relevant factors besides academic grades? managing fairly and transparently an increasingly large pool of applicants. Over ten years ACER has worked closely C Buksch-Beudt, J Schulze*, F Ochsendorf and F Nuernberger with medical schools to define their needs and provide (J W Goethe-Universitaet Frankfurt, Dekanat Fachbereich Medizin, Theodor Stern Kai 7, Frankfurt/Main 60590, them with purpose-designed test instruments: New GERMANY) Australian graduate-entry (accelerated) courses, open to graduates of any discipline, created a need for applicants Recent changes in German regulations for medical school to demonstrate a requisite knowledge of basic science in admission allow universities to select up to 60% of their addition to communication, problem solving and reasoning applicants according to their own criteria. Besides academic skills, and so in 1995 GAMSAT was developed. Medical achievements usually graded by high school notes schools recruiting from among school-leavers had different additional factors may be considered to selecte those best assessment needs, and UMAT was designed to complement suited for medical studies and the profession. Efforts have high-school results and assess logical reasoning, problem been made to identify those factors; however, very few solving and the ability to empathise. Nearly all applicants factors have been shown to be good predictors. In order to medical schools in Australia and New Zealand must take to identify factors we have designed a prospective study one of these tests. In UK the GAMSAT-UK and MSAT tests to evaluate applicant activities outside school in five main are currently used by seven medical schools. The MMSAT areas - special medical expertise, academic achievement, has been developed for use in Malaysia. This paper will other extracurricular achievements, social engagement and explore the different testing models and provide data on sports. During the first phase these parameters have been their performance. compiled to gain insight in the spectrum of activities medical students perform. These activities will be compared both to their academic achievement in university courses as well as their grades in federal examinations. We will present the study outline and preliminary results from university course performance.

Short Communications 3M Portfolios in teaching and assessment 1

3M 1 Introducing student learning portfolios: the 2004) to develop the skills of reflective practice. challenges and rewards The review and analysis of patient scenarios is one focus K B Smuts* and C Ginsburg (University of the Witwatersrand, for integration in the new curriculum. Students work in PO Box 875, Morningside, 2057 SOUTH AFRICA) small groups with a facilitator to define the core knowledge, skills and attitudes prompted by each patient. Aim of presentation: This presentation documents the Subsequently, mind mapping software (MindGenius introduction of learning portfolios as an adjunct to www.mindgenius.com) is used to consolidate a class traditional assessment methods in an integrated, problem- overview and define key objectives. Using a specific tool based medical curriculum. Portfolios address aspects of in their ePortfolio to record the process, students determine the personal and professional development theme such their own learning objectives and create an action plan as ethics, reflection on learning in hospital and community that maps out the routes, methods and resources they sites and written communication skills. Ten entries are will use to consolidate their learning. They then follow up submitted over two years. these processes using the Learning Diaries in their Summary of work: There are many interesting and ePortfolios to reflect on each patient and identify the challenging aspects to portfolio assessment: introducing strengths and weaknesses of their approach. Inside their the idea of portfolios to students and getting “buy-in”; ePortfolio, students set target dates for learning, record developing and testing the marking rubric; deciding who the achievement of their objectives, upload evidence of will mark and how to monitor consistency; deciding on competency and build a profile of case studies. Evaluation whether topics should be assigned or free choice; results from the first year of use will be discussed. introducing a full portfolio review and interview at the end Cotterill SJ, McDonald AM, Drummond PD, Hammond GR. of two years; the summative use of portfolio marks in the Proc. ePortfolios 2004 http://www.eportfolios.ac.uk/ final examination FDTL4/docs Summary of results: The results of the first two years of the portfolio project evaluation will be presented. The exercise is proving worthwhile and students generally do 3M 3 Experience with Personal Digital Assistants well and are proud of their efforts. (PDAs) in postgraduate education Conclusions/take-home messages: Portfolios are satisfying Carsten Hering Nielsen*, Sven Felsby, Claus Moger and Peder but highly work intensive, requiring clear guidelines and Charles (Aarhus University Hospital, Department of processes that are justifiable educationally and sustainable Endocrinology & Metabolism, Aarhus Amtssygehus, Tage- Hansens Gade 2, Aarhus DK-8000, DENMARK) over time, when the excitement of a new initiative begins to wane. Background: In connection with the reform of the postgraduate medical education in Denmark, the use of PDAs was introduced as part of a three-year project on 3M 2 Using an ePortfolio to encourage goal improving postgraduate learning in three clinical setting and reflective practice in new departments (Endocrinology, Orthopaedic Surgery and medical students Anaesthesiology) at Aarhus University Hospital. 246 doctors participated. Jim Aiton*, Julie Struthers, Simon Cotterill and Susie Whiten (University of St Andrews, Bute School of Medicine, St Andrews, The aim was to determine whether encouraging intensive Fife, UK) use of IT would improve educational culture. 160 entrant students in the new medical curriculum at St Actions: All doctors were supplied with a PDA, for which Andrews are using a web-based ePortfolio (Cotterill et al., the e-portfolio ‘STYLUS’ was developed. STYLUS contains

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VAS-evaluation tools for assessing personal and Background/rationale: during graduate studies in departmental educational aspects in addition to the specific pharmacy, students are generally taught to develop specific learning goals for the different postgraduate topics – i.e. scientific knowledge. Nevertheless, a career in the Pre-Registration House Officers and introductory positions pharmaceutical industries or in the academic field needs in Orthopaedic Surgery and Anaesthesiology. Every six the acquisition of other, otherwise crucial, competencies months the doctors completed a questionnaire survey. defined as cross-disciplinary competencies. The supervision and the evaluation for the development of cross-disciplinary Conclusions: The use of portfolios can improve everyday skills are both presently lacking. Therefore, a reflective communication between tutor and learner and assist in portfolio has been developed. planning and accomplishing educational programmes. The term ‘Competence Hunt’ was developed to support What was done: The portfolio was designed in a data base individual learning strategies. Several obstacles may affect electronic file. The first part defines the student profile and prevent the use of e-portfolios. Digital signature is and the career objectives, the second part comments mandatory if documentation standards are to be met. reflections explaining how the student developed the competencies throughout different activities (such as a Take-home-messages: Introducing enhanced IT use in journal club) and finally, a summary of all the reflections medical education is exciting but requires thorough made for each skill. Therefore, students can use reflections strategic considerations and commitment to be successful. to improve the skills less acquired. It is currently piloted tested with 10 graduate students. 3M 4 A mastery learning model of competency Conclusions: Preliminary data demonstrate wide assessment using electronic portfolios acceptance of the tool by graduate students. The tool Lindsey Henson* and Elaine Dannefer (Case Western Reserve appears as an efficient way to document progression in University, Department of Anaesthesiology, Cleveland Clinic the diverse cross-disciplinary skills that will be needed in Lerner College of Medicine, 9500 Euclid Avenue NA-24, their future jobs. Cleveland OH 44195, USA) Take-home messages: The portfolio will serve as a tool to Background: Performance of our students is assessed using document, reflect and improve cross-disciplinary a mastery-learning model in which achievement of competencies, needed to become a highly qualified competency standards is criterion-referenced, not time- scientific expert for job employment. referenced. Our electronic portfolio process supports this model. 3M 6 Foundation Programme Learning Portfolio: Methods: The evidence database in our students’ portfolios fulfilling its potential? includes self-assessments, assessments from faculty (group facilitators for PBL and other sessions, clinical and research Ida Ryland*, Jeremy Brown, Mary O’Brien, Graham Lamont, preceptors), peers, and other professionals and required Rob Gillies, Ben Shaw, David Graham and Tom Chapman course materials (e.g. PowerPoint presentations, concept (Mersey Deanery/Edge Hill College of Higher Education, 1st maps, research proposals, patient logs and journals). All Floor Hamilton House, 24 Pall Mall, Liverpool L3 6AL, UK) online assessment forms are linked to the medical school’s In August 2004 the Mersey Deanery established 242 nine competencies and use behavioral descriptors of Foundation Programme Year 2 (F2) posts in a Deanery- expected level of achievement, rather than numerical rating wide Modernising Medical Careers pilot. Each trainee scales. Assessors provide narrative comments on areas received a Foundation Programme Learning Portfolio to needing improvement and areas of strength for each detail the range of experience, education, assessments competency on the form. Several times each year, students completed and, with support from their Educational review evidence for each competency across courses, Supervisor, review their clinical practice on a regular basis learning experiences within courses, types of assessments, identifying goals and competencies to be achieved during and assessors and write reflective essays to document their training year. This study aims to investigate the their progress toward mastery of the competencies. The trainees’ views of the use of the Portfolio in their first F2 essays and associated learning plans become part of the post. Following ethical approval, a questionnaire containing students’ portfolios after review by their advisers. both open and closed questions was distributed to 147 (61%) trainees who had given written consent to Conclusion: A purposeful design of assessment forms, participate in the study. Completed questionnaires were portfolio structure, and process of evidence review can received from 65% (95/147). The main findings of this facilitate implementation of a mastery-learning, study indicate that 77% (73/95) of F2 trainees found the competency-based model of medical student assessment. Portfolio to be ‘helpful’ or ‘very helpful’, enabling them to systematically complete the educational requirements of 3M 5 Towards a reflective tool to demonstrate their post. Conversely, 23% (22/95) found the Portfolio to the development of cross-disciplinary be of ‘little’ or ‘of no help’. Free-text responses from the competencies for graduate students. A trainees expressed the need for trainers to receive education and training on Portfolio use. In summary, to project from the Faculty of Pharmacy of the fully realise the educational potential of the Portfolio, University of Montreal instruction on its use is essential for trainees and trainers. D Girardot and P Moreau (University of Montreal, Faculty of Pharmacy, Montreal, CANADA)

Short Communications 3N Assessment of professionalism

3N 1 Assessment of medical professionalism: a Aim: To present integrated evidence on effectiveness of systematic review interventions to assess professionalism in medicine. V Jha*, Z Setna, H Bekker, S R G Duffy and T E Roberts Objectives: Describe range of measures used to evaluate (University of Leeds, Department of Obstetrics and professionalism, describe types of interventions to evaluate Gynaecology, Level 9, Gledhow Wing, Beckett Street, Leeds professionalism, integrate evidence from studies evaluating LS9 7TF, UK)

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the effectiveness of assessment methods for Results: One item had to be excluded from the data professionalism. analysis. On average the students answered 58% of the questions correctly (range 22%-84%). Mean item difficulty Design: Cross-sectional survey of primary empirical was 0,58. The internal consistency for the entire 32 items research examining medical professionalism employing a was á=0,622, 34 items would be needed to reach á=0,7. systematic review method. 84% of the students agreed that the content of the test Methods: Review focussed on all primary empirical studies was relevant for their future professional life. Female investigating professionalism in medicine. students performed significantly better than male students. Results: A total of 134 articles were included. Preliminary Conclusions: The first trial run of the test showed high examination of the articles suggests that there is little acceptance among the students and satisfactory consensus on how to assess professionalism or professional psychometrics. Further research is needed to clarify the attitudes in medicine. Further, attitudes to professionalism correlations between written and performance based tests are seldom the primary focus of articles and often skills and the predictive value for future job performance. and knowledge are assessed rather than attitudes. Analysis of the data will be presented at the meeting in a succinct and easily assimilable form, which will be of use to others 3N 4 Psychometric evaluation of moral in this interesting and difficult field. competence scale in nursing practice among nursing students 3N 2 P-MEX: A tool to evaluate professional Pantip Jormsri* and Acharaporn Sripusanapan (Chiang Mai behaviour University, Faculty of Nursing, 100 Intavaroros Road, Muang District, Chiang Mai 50200, THAILAND) R Cruess*, Jodi Harold-McIlroy, S Cruess, Y Steinert and S The study was to evaluate the psychometric properties of Ginsberg (McGill University, Center for Medical Education, Lady Meredith House, Room 201, 1110 Pine Avenue West, the Moral Competence Scale (MCS). The MCS was Montreal, Quebec H3A 1A3, CANADA) developed for measuring moral competence in nursing practice based upon Thai culture. The MCS includes three Aim: To report on the development of the Professionalism scenarios each with a set of questions on a five-point scale. Mini-Evaluation Exercise (P-MEX), an adaptation of the All scenarios present ethical issues in nursing practice. MiniCEX evaluation methodology to the professionalism Content Validity Index (CVI) was .88. The MCS with 65 domain. items was administered to 163 nursing students. To identify Methods: 24 behaviors reflecting professional construct validity, Principal component analysis resulted characteristics were identified through the literature, expert in 43 items, which were clustered into eight components opinion, and group consensus. A 4 point rating scale was for all three scenarios. The components were to represent used: Unacceptable, Below Expectations, Met Expectations, moral competence since their internal consistency and Exceeded Expectations. Informed consent was reliabilities ranged from .72 to .86 and each component obtained and 211 forms were completed on 74 third and consisted of at least four items. The alpha coefficients of fourth year students by 47 evaluators (34 faculty, 13 three scenarios ranged from .86 to .92, and that of the residents). total MCS was .94. According to its psychometric properties, the MCS has been accepted as a valid and reliable scale Results: The mean number of forms per student was 2.85 and considered appropriate and clear for measuring the (range 1-9). Four items had more than 40% marked N/A, concept of moral competence in nursing practice among indicating low utility in this context. Four other items had Thai nursing students. at least 3% of the ratings in the Below Expectations category, indicating greater sensitivity to minor breaches of professionalism. Exploratory Factor Analysis revealed 4 3N 5 The importance of being earnest factors, well aligned with published dimensions of professionalism, explaining 85% of total variance. Scale M Moeller*, A Frewer, S Stoeckel, B Lohff and G Neitzke (Hanover Medical School, Parkstr. 21, 46359 Heiden, Reliability (alpha) was 0.98. Semi-structured interviews GERMANY) indicated the form was easy to use, promoted feedback, made faculty think about their own behavior, but had too Medical Ethics is gaining greater attention in the education many items. of future doctors and has generated significant discussion about related teaching objectives and outcomes. Critical Conclusions: This method is feasible, reliable and for this discussion is the evaluation of current teaching demonstrates good construct validity. Further validation methods to generate constructive reflection. At Hanover work on a revised form is currently underway. Medical School, a study was conducted to investigate the outcomes of medical ethics classes. A questionnaire was 3N 3 Psychometric properties of a multiple- designed to measure students’ development in the handling choice-test of medical students’ of moral dilemmas before and after attending ethics classes, as well as their changing attitude towards medical professional behaviour ethics. This was done through assessing affective and Sebastian Schubert*, Claudia Kiessling, Heiderose Ortwein, practical components related to specific teaching aims. Antje Remus, Ulrich Schwantes and Oliver Wilhelm (Charité The results of this study will be presented and discussed University Medicine Berlin, Universitätsmedizin Berlin, regarding the current status of medical ethics classes. The Arbeitsgruppe Reformstudiengang, Trainingszantrum für teaching class “History, Theory and Ethics of medicine” Arztliche Fertigkeiten, Schumannstr. 20/21, Berlin 10117, became a compulsory part of the German medical schools GERMANY) curriculum in October 2003. A recent survey investigated Background/Rationale: Medical students’ professional the state of its implementation. Its results will be discussed behaviour is, if at all, tested by performance based tests. in view of the above mentioned. In order to create a healthy These are usually quite expensive. As an alternative we and effective learning atmosphere, it is important to remain developed a written situational judgement test and realistic regarding the possibilities of educating, self- conducted a study to test its psychometrics. reflecting on the present and honest in attitude in the interactive teaching setting. What was done: 17 situations with 33 single-best-answer multiple choice questions were developed based on expert consensus. The test was completed by 97 5th year medical students.

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Short Communications 3O Best Evidence Medical Education and other review methodologies

3O 1 A systematic review of different models of 3O 3 Lack of strong evidence for systematic learning and teaching communication skills review on the validity, reliability and M Mc Dermott*, B Young, J Carroll, F Lobban, R Nancarrow, applicability of the OSCE for pregraduate S Peters and K Young (The University of Liverpool, Division assessment of Clinical Psychology, Whelan Building, Liverpool L69 3GB, UK) M F Patrício, T M Hayes, M Julião, F Fareleira and A V Carneiro (University of Lisbon, Faculdade de Medicina de Introduction/Aim: This systematic review aims to examine Lisboa, Av Prof Egas Moniz, Piso 1, Lisboa 1649-028, the effectiveness of different models of communication PORTUGAL) skills learning and teaching, and to address questions Background/rationale: OSCE is being largely used for concerning the process, role and value of communication pregraduate assessment, despite lack of evidence on its skills programmes. Consequently, the review entails validity (V), reliability (R) and applicability (A). identifying, appraising and integrating a large and diverse body of evidence. Objective: To undertake a systematic review on the published evidence of OSCE as an assessment tool for Methodology: The search strategy will be topic-based and medical students. guided by techniques recommended by the NHS Centre for Reviews and Dissemination (CRD) and by specialist Methods: Pilot study on 50 papers. medical education literature searching guidelines. The Results/Conclusions: OSCE aims, subjects, stations review will include both quantitative and qualitative studies. (number/type), duration, venues, exams, type/purpose, Results/Conclusions: Work on the review is ongoing. The and course year were described. Only one study reported process of conducting a systematic review in the field of simultaneously on the 3 issues (V, R, A). Of the remaining, medical education will be discussed. This will focus on the only 32.5% gave data on reliability, 22.5% on validity and issues involved in dealing with a large and diverse body of 7.5% on applicability. We found widely differing criteria evidence, balancing review comprehensiveness with used to describe validity/relability/practicability, paper practical considerations and the process of conducting a focus, as well as missing data regarding teachers (45%), review which is informed by both quantitative and examiners (23%) and simulated/patients (30%), making qualitative evidence. Our experiences of conducting a it impossible to determine the strength of evidence (high/ systematic review will provide useful guidance for medical medium/low). schools, policy makers, regulatory bodies, researchers and Take-home messages: In terms of OSCE evidence for others with an interest in communication skills education. pregraduate assessment, most of the data is incomplete and difficult to analyze. 3O 2 BEME Systematic Review on predictive values of assessment measurements 3O 4 A BEME Systematic review of the literature obtained in medical schools and future on the effectiveness of self-assessment in performance in medical practice clinical education Hossam Hamdy*, Kameshwar Prasad, M. Brownell Anderson, Brian McKinstry, Jan Illing*, Gellise Bagnall, Iain Cothart, Albert Scherpbier, Reed Williams, Rein Zwierstra, and Helen Alex Haig, Helen Allbutt, Heather Peacock, Alison Evans, Cuddihy (*Leading Investigating Institution: Arabian Gulf Rachel Adams and Susan Hrisos (*University of Newcastle University, College of Medicine & Medical Sciences, PO Box upon Tyne, Postgraduate Institute for Medicine & Dentistry, 22979, Manama, BAHRAIN) 10-12 Framlington Place, Newcastle upon Tyne, UK) This BEME Systematic Review is an attempt to answer an Introduction: In clinical education self-assessment is being important question in medical education, which is “To what increasingly used as a formative tool. It is frequently used extent do measurements obtained in medical schools in undergraduate and postgraduate clinical education as predict performance ‘outcomes’ in future practice after a means of evaluating learning interventions. However, graduation”. The review describes the conceptual the ability to self assess is seldom tested and self- framework of the relation between learning outcomes and assessment skills are rarely taught. practice outcomes. The methodology of systematic reviews Review question: What is the evidence that explicit in education, inclusion and exclusion criteria, search methods used in self-assessment strategy and sources, selection methods, assessment and methodological quality of included studies, data extraction, (a) identify learning needs; (b) promote change in learner analysis and synthesis and estimating the combined effect activity? (c) promote change in clinical practice? size in educational research will be outlined. Approach: (1) Identify the scope of the research on the Findings: The titles of 20,000 citations were visually effectiveness of self-assessment methods; (2) Review the scanned. Out of these, 560 abstracts were reviewed, 175 evidence of the impact of self-assessment methods on full papers were further reviewed by two reviewers. Finally identification of learning needs, learning activity, clinical 38 papers fulfilled the inclusion criteria (Kappa 0.8). The practice; (3) Identify the perceived value of self-assessment pooled results of the included studies provided mild to to learners; (4) Make recommendations for further research moderate correlation between medical school performance and practice. variables and performance during the internship, residency Progress: The group has met on seven occasions; agreed and beyond. It was found that clinical grades can predict the research question; definition of self assessment, the residency performance better than basic science grades. inclusion and exclusion criteria. We have drafted and tested Performance on similar instruments of measurements are coding sheets and a web based coding sheet has been better correlated. Evidence of predictor and performance constructed. Abstracts have been extracted and reviewed in practice after residency training are rare and weak. New and a list of papers to be considered for inclusion in the measurements of performance in practice might be review has been produced. Full paper review is about to considered for further studies: patient outcomes and begin and by September we expect to have selected all process of care. the papers for inclusion in the review and to have started the analysis.

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Workshops 3R, 3S, 3T, 3U

3R Case material development, recruiting and 3T The Case Method training for standardisation with SPs Martin Stjernquist and Elizabeth Crang-Svalenius (Medical Graceanne Adamo, Clinical Skills Developer, National Board Faculty, University of Lund, Lund, Sweden) of Medical Examiners, 3750 Market Street, Philadelphia, USA Background to the topic: The Case method is a student and Wendy L. Gammon, Director, University of Massachusetts activating method that hones problem solving skills and Medical School Standardized Patient Program, Boston, USA therefore is useful in clinical education within the health Background: With use of SPs in OSCEs becoming professions, although it originated from Harvard Business widespread, interest in the quality of standardisation School. The method requires less teaching resources than increases. This workshop will address methods of case Problem Based Learning (PBL) does. The Case method is material development, SP recruiting and training that will used at the Faculty of Medicine, University of Lund in both support standardisation necessary to use outcomes with undergraduate and graduate programmes. confidence in scored contexts. Workshop content and structure: We conduct a case, from Structure: Discussion of recruiting and training basics for both a medical and nursing perspective, involving the multiple SPs portraying same case. Using a partially workshop participants as students. Pedagogical and developed case in a template, participants will further technical aspects will be discussed as well as the use of develop materials for a standardised patient station as a the Case method as a teaching tool, with regard to different group. Breakout groups will refine a high stakes checklist. settings and educational levels. Recommendations about Participants will receive a copy of the fully developed how to write a case in a way that is suitable for this method materials. will also be addressed. Who should attend: Faculty, administrators and staff Intended outcomes: The participants will achieve a basic responsible for creating assessment exercises (OSCEs, SP understanding of the Case method so that they can start exams) with standardised patients. to incorporate the method in their own teaching. The Level of workshop: The workshop will be useful for those participants should also have knowledge of how a case is of have never created a SP case as well as experienced constructed. case writers. Intended audience: Educators within the health professions. 3S Effective use of questioning during teaching Level of workshop: No prior knowledge needed. Zubair Amin (Faculty of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Main Building 1, Level 3U Questionnaire design and analysis for new 4, SINGAPORE) researchers Background to the topic: Good questioning is an excellent David Wall, Alison Bullock, Mike Clapham and Zoe Nuttall aid to teaching and learning that is seldom used to the (West Midlands Deanery and University of Birmingham, fullest extent. Good questioning brings excitement in the Institute of Research and Development Building, Birmingham classroom and is a key instructional strategy for student- Research Park, 97 Vincent Drive, Edgbaston, Birmingham, UK) centred learning. Background to the topic: A workshop to give new Workshop content and structure: Fundamental concepts educational researchers a start on the principles of (e.g. definition, purpose, benefits); Various types of designing and analysing simple questionnaires. This questions and their usages; Educational benefits of good workshop will focus on the quantitative aspects of the questioning during teaching and learning interactions; analysis of questionnaire data, when we get onto the Dealing with wrong responses from the student; analyses of data. Questioning techniques. In this interactive workshop a Workshop content and structure: There will be a mixture brief-plenary leads to discussion and hands-on activity. of keynote talks, individual work, group work and Participants review each other’s works and contribute to demonstrations of the analyses. A workbook will be the group learning. Job–aid cards and other reading provided for each candidate. materials will be provided. Intended outcomes: At the end of the workshop candidates Intended outcomes: Recognize the basic types of will understand the principles of designing a simple questions; Discuss benefits of good questions; Cite questionnaire, and relating the design to ways in which examples of questions with higher cognitive value; the data resulting from the questionnaire may be sensibly Demonstrate how to deal effectively with students’ wrong and easily analysed. response; Effectively use question and answer cycle. Intended audience: New researchers in medical and dental Intended audience: Medical and para-medical teachers education, such as those about to embark on their first involved in classroom and clinical teaching. questionnaire based project. Level of workshop: No prior knowledge/experience Level of workshop: Beginners only please (no prior required. knowledge/experience required).

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Posters 3 Onyx 1 Use of simulators in medical education

3 Onyx 1.1 Conclusions/take-home messages: According to the Using high-fidelity simulation to support the findings of this study, there is no difference between the NHSU junior scholarship initiative to effects of two educational methods of CPR. Therefore in regard to shortage of CPR doll in nursing schools and introduce core skills in healthcare careers to hospitals, CPR teaching though film can compensate with 14-19 year olds doll. T Smith*, A Nunn, M Dancey, I Curran and C Sadler (Barts and The London Medical Simulation Centre, 9 Prescot Street, Lower Ground Floor, Aldgate, London E1 8PR, UK) 3 Onyx 1.3 A 6 step approach to simulator based Aims: Develop a practical skills workshop introducing 14- 19 year olds to the importance of core competencies in training of non-technical skills career development, using interactive learning experiences M Haensel*, M P Mueller, S Weber, F Hardt, A Fichtner, R within a simulated patient environment, and in doing so Saifoulline and T Koch (University Hospital Dresden, demonstrate the potential career options within the NHS. Department of Anaesthesiology, Interdisciplinary Medical Simulation Centre, Fetscherstr 74, Dresden, GERMANY) Methods: Facilitated small group workshops were designed to allow participants individual opportunities to explore Introduction: Simulator based courses have been set up clinical tasks in a patient and participant safe environment. for pilots and health care professionals to train the effective Emphasis was placed on generic communication skills, management of crisis. In aviation but not in the field of empathic listening and effective teamworking. Skill stations medicine crew resource management (crm) seminars are included aseptic surgical scrubbing, cannulation, well established. These seminars consist of psychological venepuncture, intravenous drug preparation, intravenous exercises on non-technical skills such as “situation fluid administration and basic X-ray interpretation. The day awareness”, “team working”, “decision making”, and “task ended with a manikin-based scenario utilising skills learnt management”. Because of the missing realistic setting the during the day. participants may not transfer these skills into their working environment. Results: Feedback from the course was extremely positive. Students found the day interesting and enjoyable, and Summary of work: We developed a crm seminar for found the course reinforced the importance of core skills physicians containing both psychological exercises and with regard to future career development. Initial feedback simulator training. This new curriculum follows a 6 step showed 45% of students would consider a career in approach. At first the instructors demonstrate good crm healthcare after the course. behaviour in an example scenario to form a cognitive model about the aim of the course. After a theoretical introduction Conclusion: Simulation seems an effective educational tool the participants practise their knowledge in psychological for introducing 14-19 year olds to the need for basic core exercises. The fourth step consists of psychological skills to access further career options and the importance exercises in a short simulator scenario in order to transfer of long term career planning. The objective of raising the knowledge into a medical context. A realistic crisis awareness of potential healthcare careers was also scenario using a high fidelity patient simulator and the achieved. debriefing with focus on the non-technical skills are the last modules. 3 Onyx 1.2 Conclusion: We introduce a new simulator based curriculum A comparative study of the effect of two to teach CRM competencies. This is realized in a transfer- teaching methods of CPR (doll and film), on oriented six step approach. knowledge and performance of first year students 3 Onyx 1.4 Zahra Monjamed (Tehran University of Medical Sciences, Emergency Crew Resource Management Faculty of Nursing and Midwifery, Nosrat Sharghi, Tohid (ECRM) – a new simulator course to teach Square, Tehran 1951879618, IRAN) non-technical skills Background: CPR education is an important item in the M P Mueller*, S Weber, M Haensel, F Hardt, A Fichtner, R nursing education program. Achieving the effective method Saifoulline, B Bergmann and T Koch (University Hospital Carl in CPR teaching is the aim of any teacher. Gustav Carus, Department of Anaesthesiology & Intensive Care Summary of work: This quasi-experimental investigation Medicine, Fetscherstr. 74, Dresden 01307, GERMANY) was conducted to compare the effect of two teaching Introduction: Crew Resource Management (crm) seminars methods of CPR on knowledge and performance of first consist of psychological exercises on the non-technical skills year nursing students. The samples were 30 students in “situation awareness”, “teamworking”, “decision making” each group (doll and film) that were selected through and “task management”. These seminars are well simple random sampling. One group was trained through established in aviation but not in medicine. During the lecture and doll and the other one by lecture and film. last few years several simulator based course concepts to After 7 days, the data were collected through questionnaire teach non-technical skills have been published. They and check list. contain simulator training but no psychological exercises. Summary of results: The results showed that the majority Summary of work: We set up a one day course for (56.6%) of students in lecture/doll method and 63.4% in emergency physicians consisting of four 90 minutes blocks, lecture/film method had obtained a level of knowledge in one for each crm-competency. A lecture and psychological regard to CPR and there was no significant relationship exercises are followed by a “Mini-Sim” exercise in a between the two methods, (X2=0.27 df=1 p=0.59). Also simulator scenario focusing on the respective crm- the results showed the majority (56.7%) of students in competency. Subsequently the participants treat a both groups had obtained satisfactory performance and simulated patient and are debriefed by a psychologist and there was no significant relationship between the two a physician. groups (X=20 DF=1 p=1).

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Summary of results: 18 participants took part in two training and simulation scenarios were evaluated as highly courses, 17 of them completed the evaluation positive and ALL interns addressed the need for continuing questionnaire. 15 attendees rated the workshop as suitable training. to link theory and practice. 14 participants rated the Conclusions/take-home messages: Considering the psychological exercises as useful and the content of increasing number of younger doctors graduating, the practical relevance for their job. 17 participants valued reduced working hours and the increasing focus on hospital the course as “very good” or “good”. productivity, it is about time to implement the use of clinical Conclusion: A combination of psychological exercises and skills laboratories and simulation centres in emergency simulator training seems useful to teach non-technical medicine training. skills. 3 Onyx 1.7 3 Onyx 1.5 The effect of simulation-based training in Hands on – establishment of a novel neonatal resuscitation approach for student training in Frankfurt Berit Woetmann Pedersen*, Morten Lebech, Anne Lippert and W A Flaig*, J Frank, S Rose and I Marzi (Universitätsklinik Doris Østergård (University of Copenhagen, Department of Friedrichsheim, Department of Trauma-, Hand and Gynecology and Obstetrics, Danish Institute for Medical Reconstructive Surgery, Marienburgstr 2, Frankfurt D-60528, Simulation, KAS Herlev, Herlev Ringvej, Herlev DK 2730, GERMANY) DENMARK) Background: Linking knowledge and procedural skills is a Aim: To study the effect of a simulation-based course in key component for successful training of medical students neonatal resuscitation (NR) designed for midwives and in surgery. Until recently, in Germany medical student obstetricians. training in surgery was not well balanced, favouring theory Methods: The participants received literature concerning and neglecting learning of important procedures. the theoretical background: (1) Presentation of the Aims: The aim was to establish a surgery class; (i) the algorithm; (2) Skills-training in relation to NR; (3) Full- opportunity for students to learn and improve surgical skills, scale simulations of resuscitation scenarios followed by (ii) to be introduced in the planning and sequence of debriefing of resuscitation skills and knowledge; (4) operations and at the same time (iii) enhance motivation Evaluation of the effect of the training programme by and give a feeling of confidence. participants’ self-assessment of confidence before and after training. Confidence was described as a VAS-score 1-5, Summary of work: The development of new classes with where “1” meant not confident, and “5” meant confident. more than 100 students leads to a model suitable for teaching procedural skills in surgery. In a realistic simulation Material: Midwives: 50, obstetricians: 24. on cryoconserved bodies, surgical procedures were Results: Self-assessment score in relation to the following outlined and taught systematically. These simulated questions before and after training regarding midwives operations ranged from basic suturing to the planning and and obstetricians respectively were: Assessing the need performance of complex operations. Supervisors were of NR: median 4,0-4,4 (midwives)/median 4,0-4,5 included from different specialties like: General-, Cardiac- (obstetricians). Ventilation: 3,0-4,5 versus 3,0-4,5. Chest , Neuro- and Vascular surgery, as well as Orthopedics, compressions: 3,0-4,6 versus 2,8-4,7. Use of algorithm: Traumatology and Urology. 2,8-4,3 versus 3,0-4,6. Practical use of NR: 3,4-4,4 versus Conclusion: The evaluation of the program suggests that 3,0-4,6 teaching procedural skills and knowledge in surgery Conclusion: The changes in self-assessment before and provides a substantially improved student training and after training indicates that a systematic, intensive education in surgery. simulation based course in NR is effective.

3 Onyx 1.6 3 Onyx 1.8 Postgraduate training in emergency Inquiry on simulation at the Faculty of medicine; the need for both clinical skills Medicine, University of Montréal training and simulation J V Patenaude*, A Sansregret, R Lalande*, M Boivin, C Bourdy, S Gundrosen*, S Einvik, M Husby, T G Tanemsmo, I Williams L Demers, P Drolet, S Dubé, J Julien, B Ska, R Thivierge and and P Aadahl (Norwegian University of Science and S Normand (University of Montréal, 32 Somerville, Montréal, Technology, Department of Circulation and Medical Imaging, Quebec H3L 1A2, CANADA) Faculty of Medicine, Trondheim University Hospital, Trondheim N-7006, NORWAY) Background: In 2004, University of Montreal ‘’vice principal for undergraduate studies and continuing education’’ Background: Self-assessment of clinical skills among established a task force with vice deans of dentistry, graduates entering internship has revealed a considerable nursing, medicine, pharmacy faculties. The goals were to variation within and between different universities. Apart institute a university unique vision to mandate simulation from Emergency clinical skills, overall scoring improved as a principal pedagogic method to give full scope to a during one year of internship. It is obvious that it is “university skills lab” human resources and infrastructures, necessary to have a strategy to improve practical devote to the acquisition and maintenance of health emergency medical skills. competencies, interdisciplinary new practices and technical Summary of work: Every 6th month 18 new graduates expertises. enter internship at our hospital. They are offered an Summary of work: In this reflection process, a teacher introductory course in organisation and medical record group from the medicine faculty elaborated definitions of writing and a one-day course in advanced heart/lung skills lab facilities, simulation methods and standardised resuscitation (AHLR) including one part focusing on the same 8 competencies as teaching goals for the 4 emergency procedures. Part two consists of different faculties. A large mecanographical inquiry consisting of emergency scenarios including debriefing sessions 52 questions for each of the 8 competencies was conducted presented in the simulation centre. A questionnaire for to evaluate the relevance, the actual and probable use in self-assessment and an on-site evaluation help us to 5 years and the impacts on programs and faculties of each evaluate and improve the course. of 13 categories of pedagogic tools describe in skill lab. Summary of results: In accordance with other studies, The 63 pre and post graduate teaching committees the knowledge and skills necessary for performing AHLR responsible for 2000 medicine students participated in this differed between graduates. In addition, the clinical skills survey.

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48 medicine faculty completed the questionnaires and the simulator for CVC. The effectiveness of a simulator was results will be presented. They represent a knowledgeable evaluated by assessing the competence of the residents and unique sum of information addressing simulation in performing CVC on patients at an emergency room. methods and future interdisciplinary practices as a main Summary of work: Ten residents were randomly assigned tool and goal. to two groups: a simulator group (n=5) (the residents receiving 90 minutes course with a simulator) and non- 3 Onyx 1.9 simulator group (n=5) (those without a simulator). LapSimGyn: Construct validity and Competence was evaluated by observing residents performing CVC on patients. The faculty rated the performance curves performance of residents using a 5-point scale. The check Christian Rifbjerg Larsen, Jette Led Sørensen*, Teodo list was also used to evaluate 3 additional items consisting Grantcharov, Christian Ottosen, Torur Dalsgaard, Torben V of the number of attempts to insert the needle, time taken Schroeder and Bent Ottesen (Rigshospitalet, Afd. 4031 Gyn to complete the procedure and number of complications. Klinik, Blegdamsvej 3, Købehaven Ø 2100, DENMARK) Summary of results: Simulator group had better mean Background: Safe realistic training and unbiased scores than non-simulator group in all items; performance quantitative assessment of technical skills is required in score (3 versus 2), number of attempts (4 versus 2), time laparoscopi. With Virtual Reality simulators it may be taken to complete (9.5 min. versus 22.5 min.), possible to train both basic and advanced surgical skills complications (0 versus 0.4). and procedures, and to evaluate the trainee. Conclusion: Our study showed clear benefits of CVC Aim: To investigate the construct validity of LapSim®Gyn simulator for residents to train in CVC. VR simulator, and to determine the learning curves of doctors with different laparoscopic experience. Material and methods/what was done: 30 gynaecological 3 Onyx 1.11 residents, consultants and senior consultants were included Simulation and training in clinical skills in a in three groups: novices with little laparoscopic experience Faculty of Medicine (<10 procedures), group with intermediate experience Hernando Matiz*, Claudia Cifuentes, Adriana Torres and (>20 and <60 procedures) and a group of experts (>100 Miguel Ruiz (Universidad el Bosque, Transversal 9 A Bis #132- procedures). All performed 10 sets of simulations each 55, Bogotá, COLOMBIA) holding three basic skill programs, and one ectopic pregnancy program. Time and economy of movement were The laboratory is an educational technology which, based measured and analysed. on psychological educational principals, allows the development of systematic training of abilities in clinical Conclusion: Preliminary data suggest that LapSim®Gyn skills, exploring different methods and tools. During the might be able to discriminate between gynecologists with past century, teaching was based on students observing different levels of expertise, hence meeting the construct their teacher or instructor. Towards the end of the 1960s, validity. Learning curves differ between groups, showing new points of view were introduced, such as Ausubel’s that experts quickly reach a plateau on their learning curve, theory, who demonstrated that in order for education to followed by the intermediate group and the novices. More be more effective, it should have the learning process in detailed data will be presented. mind giving the student an opportunity to select his own Take-home messages: 1.LapSim®Gyn VR-simulator might method. To start, teaching must be changed from “Teacher show construct validity. 2. A learning curve can be obtained Centered”, to “Student Centered”, introducing the student in LapSim®Gyn. to the methodology of problem solving, giving an opportunity for integration of different elements, creating his own questions thus projecting his knowledge and the 3 Onyx 1.10 objectives of learning. The simulation and skill laboratory Effectiveness of a newly developed covers an area of about 600 square meters divided in 5 mannequin-based training simulator for sections, in the following rooms: Cardiopulmonary central venous catheterization Resucitation, Anamnesis and Simulated Physical Examination, Simulation And Clinical Skills, Gyneco- Masahiro Tanabe*, Masami Tagawa and Shigeto Oda (Chiba Obstetrics, Triage, Audiovisual: Teaching with computer University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, aids and E-learning. Advanced Skills: Noelle, Sim/man, JAPAN) Sim/baby, Harvey, Sam, Nursing Anne and Cardionics. We Background: The methods to teach technical skills to also have the standardized patients facility. residents have remained underdeveloped. We have We recommend that simulation must be a technology for developed a new mannequin-based training simulator for improving learning in medical health sciences. central venous catheterization (CVC). This study was designed to evaluate the effectiveness of a newly developed

Posters 3 Onyx 2 Methods of teaching and learning

3 Onyx 2.1 Methods: A teacher conducted a learning lesson by game Learning ophthalmology by game playing playing for 5th year medical students, class 2004. Before playing the game, teachers lectured in basic eye knowledge A Nitiapinyasakul, N Nitiapinyasakul and P Ambua* (Maharat and gave out study guides. Students were paired to work Nakhon Ratchasima Hospital (MNH), Medical Education together. A clinical picture slide was shown to one student Centre, 49 Changpeuk Road,Muang District, Nakhon Ratchasima Province 30000, THAILAND) then he/she had to explain signs of the picture to his/her pair (buddy) and other students, after that the buddy gave Aims: To evaluate students’ satisfaction and to compare diagnosis of the slide. Then they switched roles for a next summative evaluation of clinical competence in diagnosis slide. Sixty four slides were shown to students with correct of common eye diseases between classes 2001-2003 and clinical signs and answers by a teacher. Students’ class 2004. satisfaction was evaluated using questionnaires with a 5-

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point Likert scale. Summative evaluations of clinical Conclusion: The carefully designed study guide is highly competence between classes 2001-2003 and 2004 appreciated by students and “study guide template” that students were also compared. includes a well designed layout is a useful aid for medical teachers who have had no experience in producing a study Results: Students were satisfied with learning by game guide. The template allows medical teachers to invest their playing. Summative evaluation of clinical competence in time in the production of the content rather than in the diagnosis of eye diseases increased significantly in class layout and format of the guide. 2004 when compared to classes 2001-2003. Conclusion: The game can encourage students’ self directed learning in ophthalmology because it is learning 3 Onyx 2.4 with fun. Tutorials: are they worth the effort? Henri A Verhaaren (University of Ghent, Biomedical Library, 3 Onyx 2.2 Campus University Hospital, De Pintelaan 185 (0P8), Gent Bird watching techniques improve medical B-9000, BELGIUM) student pattern recognition in histology and Tutorials are an integral part of most medical curricula. histopathology However, they are often heavily criticized by students and staff. Their added value is questioned. Benjamin Sayers*, Roee Lazebnik and William Bligh-Glover* (Case Western Reserve University, School of Medicine, Office Over the last year a commission evaluated the tutoring of Society Deans, 10900 Euclid Avenue, Cleveland, Ohio process in our institution. All tutorials were screened and 44106, USA) propositions for improvement made. The ideal characteristics of both tutorials and tutors were formulated Aim of presentation: 23% of Case first year medical to make this educational format really contribute to the students failed histopathology in the 2003-2004 school development of a good continuing learning attitude. To year. We hypothesize techniques adapted from bird optimize tutorials a wide variety of factors should be watching will improve the performance of second year assessed: their relation to the other educational formats, medical students on their histopathology exams and the content, timing and organizational aspects. Essential is an United States Medical Licensing Examination. integrating and interdisciplinary approach. Students should Summary of work: We made flashcards that describe the receive teaching tasks. Profile and education of the tutors key morphological patterns of normal and diseased tissues are equally important. The ideal tutor has knowledge of using techniques exemplified by Roger Tory Peterson in the global curriculum. He should have clinical experience, his field guides. Peterson analyzed the important features and be allowed full creativity with his students. Digital for rapid recognition and made reference materials that tutoring, an ideal format to acquire prerequisite knowledge, emphasized these features. Concentrating on GI pathology, should be monitored by the “human” tutor. Tutorials are we have taken normal colon, tubular adenoma, only beneficial if they are the result of a continuous transformed tubular adenoma, and adenocarcinoma. We education and evaluation process. This educational format took images of these entities and made flashcards, with a requires highly skilled teachers and a meticulous screening colour image on one side and the obverse with key patterns of its functional and organizational aspects. The human highlighted and descriptive text. and the digital tutor should merge into one educational Summary of results: Second year medical students were process. tutored by Dr. Bligh-Glover and then were given the flashcards. The control group received no flashcards. The 3 Onyx 2.5 performance on the GI committee subject exams will be Can the format of a study guide impact on evaluated. student performance? Key lessons learned: The scope of the problem is much greater than we anticipated. The amount of disease entities V Bond*, P Owen, R Fewtrel and L Wilkie (University of Liverpool, Clinical Skills Resource Centre, The Infirmary, 2nd that need to be covered is immense. Histology alone is Floor, E Block, 79 Pembroke Place, Liverpool L69 3GF, UK) much more manageable. Background: Basic Life Support (BLS) is taught by demonstration followed by supervised practice, with the 3 Onyx 2.3 clinical scenario of a clear airway. Teaching is supported Development and evaluation of study guide by a study guide that conforms to the European template for integrated modules: a study in Resuscitation Council guidelines. the Medical School at King Abdul Aziz Work done: Performances of two cohorts of 250 students University, Saudi Arabia in BLS within OSCEs were compared following changes to the study guide format for the second cohort. Each group Awdah Al-Hazimi* and Margery Davis (King Abdul Aziz University, Physiology Department, College of Medicine, PO had been taught in the same way and assessed using the Box 80205, Jeddah 21589, SAUDI ARABIA) same standardised mark sheet. The only difference was in the structure of the study guide: the content remained Aim: This study describes an effective and efficient the same. Overall student performance and the individual approach to the production of study guides. elements were analysed. Summary of work and result: The undergraduate medical Conclusion: Overall performance was significantly improved curriculum in the King Abdul Aziz Univeristy in Jeddah, in the second cohort who received the new format study Saudi Arabia, was reformed in 2002. It is integrated, guide with a decrease in the standard deviation and organised in courses and modules, and has an increasing significant improvement seen in some key items of the proportion of problem-based and self-directed learning. BLS. Further evidence suggests a continual improvement The new curriculum has presented the faculty and students in BLS performance supporting the theory that with specific challenges. Accustomed to a traditional restructuring the study guide layout has enabled students teacher-centred approach, students needed much more to apply the correct sequence pertaining to a given clinical support and encouragement in taking advantages of scenario. independent learning. A well designed study guide may be the most important student learning tool in the new Take-home message: The structure of support material integrated curriculum. The approach is based on the for students can have a significant impact on their retention development and the use of a study guide template. The of skills and performance at examination. guide is evaluated by second year medical students at King Abdul Aziz University.

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3 Onyx 2.6 Background: Nurses are main members of critical care Using mind maps as a tool to enhance group units and quality of care effect on patient health promotion. work One way of empowerment of knowledge and skill is through education. The aim of this Quasi-experimental study is to Julie Struthers*, Predrag Bjelogrlic, Maureen Crosby, Ruth determine the effect of nurses’ education with the group Cruickshank, Susie Whiten and Jim Aiton (University of St discussion method on the quality of nursing care in patients Andrews, Bute School of Medicine, St Andrews, Fife, UK) with Myocardial infarction. 160 entrant students in our new medical curriculum are Summary of work: All nurses and 45 patients were selected using mind mapping software to identify the learning based on convenience sampling in CCU in a teaching objectives that relate to patient scenarios. The review and hospital in Tehran city. The instrument for gathering data analysis of patient scenarios is one focus for integration in was a checklist and questionnaire. The nurses’ education the new curriculum. Students work in small groups to define with method group discussion was applied within eight learning objectives arising from the scenarios. In the initial sessions: thinking and doing in nursing, decision making stages of the development of group skills, it was felt skills, critical thinking, problem solving and team work important to offer the class an insight into the whole range approach in nursing care. After one month, it was evaluated of objectives developed by other groups. To do this, the and the quality of nursing care compared. class meets to consolidate the outcomes and key objectives arising from their earlier group discussions. Mind mapping Summary of results: The findings showed 20% of nurses software provides a means of linking learning objectives before group discussion had good operation quality, from all of the groups into a single document. This student- whereas after the sessions, 80% had good operation led activity leads to the development of a mind map for quality (paired t-test, p <0.001). Patient satisfaction each patient. Subsequently, individual maps are combined indicated 35.6% of patients before education were to link the knowledge, skills and attitudes that are common unsatisfied and only 2.2% were satisfied, whereas 31.1% to all the scenarios. of patients were satisfied after the intervention (paired t- test, p <0.001). Mean score of the operation was 4.6 that The mind maps are accessed and edited by individual increased to 38 after intervention. students who may use them to provide a framework for creating an action plan within their ePortfolio and Conclusions/take-home messages: This study showed the consolidation of their learning within our new curriculum. importance of using an innovative education method in Evaluation of results from the first year will be discussed. Medical- Surgical and critical care units.

3 Onyx 2.7 3 Onyx 2.9 Small group teaching in an Epidemiology Using questioning technique during classes: course: an experience from Iran perception vs. reality Azita Goshtasebi*, Ali Kamkar and Bahram Taremi (Yasouj HaeJin Jeong, Sangyeoup Lee*, Sungsoo Kim, YunJin Kim, Medical University, Faculty of Medicine, University Campus, HaeKyu Kim, SeongWan Baik, ByungYong Rhim, ByungKyu Yasouj, IRAN) Park, Chulhun L Chang and IhnSook Jeong (Pusan National University Hospital, Family Medicine, 1-10 Ami-dong Seo-gu, Background: It was the first time that small group teaching Busan 602-739, SOUTH KOREA) (SGT) was used in a medical curriculum in Iran. The aim of this study was to compare students’ attitudes and Aim of presentation: Questioning is a universal teaching knowledge scores between SGT and lecture based teaching strategy. The aim of this study is to analyze observational of Epidemiology. data on teachers’ questioning techniques during a class at a college of medicine and to compare it with data on What was done: 22 first year medical students were the teachers’ perceptions about their questioning enrolled in a course which used a hybrid curriculum techniques. (lecture-based and small group discussion) for teaching basic Epidemiology in spring term of 2004. Data about Methods: Data on the questioning techniques of 42 faculty attitudes and knowledge scores of two methods were members who were teaching the second year students collected at the end of the course. Scores regarding were collected with a 28 items-questionnaire. The attitudes of these two teaching methods were analyzed questionnaire consisted of 28 items covering the topics of using a two-sided Wilcoxon test. the awareness and characteristics of questioning skills. A student volunteer was assigned to the classes for observing Summary of results: Our students were satisfied and the teachers’ questioning techniques. The teachers did preferred SGT in terms of evaluation method for the course, not know what was going on. participatory learning and team work, effectiveness and developing self learning skills (P<0.001). Students scored Results: The majority of the teachers utilized some sort of higher in topics of SGT (P<0.001), but believed that they questioning technique and preferred open questions. The needed longer discussion of the topics. Satisfaction levels findings in this study regarding the wait-time before answer didn’t differ between two teaching methods for course were similar to the results from the existing studies which organization. suggested that the wait-time was less than one second. About 50% of the teachers perceived that their usual wait- Conclusions/take-home messages: Implementation of SGT time is between 6 to 10 seconds, however the results for teaching Epidemiology showed satisfactory results, but showed otherwise. The average wait-time was found to needs some changes such as better question design and be only 0.6 second. course organization for good performance. We suggest other medical schools should integrate this teaching Conclusions/take-home messages: There were significant strategy in medical education curricula with appropriate discrepancies regarding the wait-time between the professional and organizational development. teachers’ perceptions and reality. Therefore, we suggest that teachers should give students sufficient time to answer. As others have suggested, one effective technique might 3 Onyx 2.8 be counting to yourself to force you to wait an appropriate Nursing education: group discussion time. method and quality of nursing care Mahdi Safari*1, Mahvash Salsali2, Fazlollah Ghofranipour3 (1Tabriz University of Medical Sciences, Department of Nursing, School of Nursing, Maragheh, IRAN; 2Tehran University of Medical Sciences, IRAN; 3Tarbiat Modarres University, IRAN)

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3 Onyx 2.10 Results: The session went well and a lot of discussion was Integrating legal, ethical and practice generated both in the groups and between groups. The aspects in a Team-Based Learning session students felt it was of particular benefit to have faculty from different courses present at the same time. Both Glynn Till, Hettie Till, Allan Freedman and Stuart Kinsinger qualitative and quantitative student evaluations of the (Canadian Memorial Chiropractic College, 6100 Leslie Street, session gave positive results with the students enjoying Toronto, Ontario M2H 3JI, CANADA) the group interaction to solve “real life” problems as well Purpose: To use Team-Based Learning to assist preclinical as the immediate feedback from the faculty. They indicated students to better realise that certain actions or decisions that they preferred learning some course material on their that they might take in practice could have serious ethical own in preparation for an applied session and that more or legal implications. emphasis should be placed on actual cases and scenarios in the teaching of ethics. A hundred percent agreed that a Methods: The faculty member responsible for teaching solid foundation in some aspects of law is important for Jurisprudence to our 3rd Year students developed the successful clinical practice. scenario which was a composite taken from his actual client files and embellished by the other team members to include Conclusion: The positive outcome of this session has led ethical and practice issues and questions. Although the to a number of other faculty members expressing interest session was used to apply previously learnt material, the in including TBL in their courses. students were also given extra pre-reading. The session was offered by the whole team to a class of 156 students.

Posters 3 Topaz 1 Student support

3 Topaz 1.1 surveyed to determine whether their advisors: 1 are The role of pastoral care in a medical school consistently available, 2 discuss students’ ability and potential, 3 explain essential information about college E A Jump* and D C M Taylor (University of Liverpool, School regulations and resources, 4 coordinate the earning of Medical Education, Cedar House, Ashton Street, Liverpool experience through course and career planning and L69 3GE, UK) academic progress, 5 frequently assess and review the Summary of work: For over 10 years we have been students’ files and records, 6 assist students in problem attempting to determine what medical students require solving and decision making skills. from the formal personal support systems in the medical Summary of results: Students expressed that there was school. The study has spanned the transition from a little effort from the advisor or faculty to get to know them traditional to a PBL-based course. We have used the same adequately. Overall students’ satisfaction grade of the questionnaire on three occasions, 1995, 1999 and 2003. advising process was 56%. The questionnaire was derived from a Q-sort technique based on items derived from focus group discussions. Conclusions/take-home messages: Systematic and periodic evaluation of advising programs is essential to their Summary of results: The key attributes of a personal tutor effectiveness. Students should be surveyed on a regular are similar to those required of a medical practitioner and basis to determine the quality of the academic advising have not changed over the past 10 years. Personal tutors process. should be prepared to keep information confidential, should be good listeners, should be easily accessible and should inspire confidence. However, when comparing the results 3 Topaz 1.3 obtained from students in the new versus the traditional Do students need additional pastoral curriculum, the newer curriculum students were more likely to want guidance on time management and careers support during clinical placements? guidance. Sue R Whittle* and Deborah G Murdoch-Eaton (University of Leeds, School of Medicine, Room 7.19, Level 7, Worsley Conclusions/take-home messages: The results we obtained Building, Clarendon Way, Leeds LS2 9NL, UK) suggest to us that the personal tutor is in a key position to influence the professional development of a prospective Background: A recent survey of student opinion at Leeds doctor. This is likely to become increasingly important as Medical School, using the established and validated DREEM student numbers rise. questionnaire1 revealed that many students felt that there was insufficient support available to help them cope with stress. This issue was further investigated using focus 3 Topaz 1.2 groups and interviews. These showed that while, for some Student evaluation of academic advising students, the problem was lack of awareness of the support quality mechanisms already in place, a significant number reported stress associated with incidents witnessed during clinical Azra Shamsdin* and Sohrab Najafipour (Fasa University of placements. Students in higher years requested the Medical Sciences, Microbiology Department, Ebne Sina Square, PO 7461686688, Fasa, IRAN) services of a dedicated counsellor. Background: Academic advising is a developmental Summary of work: In order to investigate this further, and process, which assists students in the clarification of their to provide evidence to support such an appointment, a life and career goals and in the development of education questionnaire has been developed which is currently being plans for realization of these goals. The improvement of piloted with all students on clinical placements (years 2- academic advising can promote student satisfaction with 5). The questionnaire aims to elicit examples of stressful the college experience and encourage them to try hard experiences, how students believe that they are affected enough to fulfil their educational goals. This survey reflects by these in the short and long term, and if, or where they an assessment conducted at Fasa Medical School to currently seek support. determine student satisfaction with the academic advising Summary of results: Preliminary results suggest that process. student response to experiences during placements is often Summary of work: A questionnaire method was used for strongly influenced by issues in their personal life, e.g. 85 students, as voluntary and anonymous. Students were family illness. The nature and frequency of reported

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incidents, and the implications for provision of additional Guidelines Use, Theory and Practice of Evidence-Based pastoral support will be discussed. Medicine, Theory and Practice of Antibiotics. (2) Educational Research: Educational Evaluation Analysis, 1Roff S, McAleer S, Harden RM, Al-Qahtani M, Ahmed AU, Nurse-Physician Communication, Evaluation of Students´ Deza H, Groenen G & Primparyon P. Development and Professionalism. (3) Educational Programmes: Training validation of the Dundee Ready Education Environment Programme to Support Medical Students´ Scientific Measure (DREEM). Med Teacher 1997; 19(4): 295-299 Research – offered since 1999, Breaking Bad News Course – the course spread to district hospitals. (4) Communication 3 Topaz 1.4 Skills Group: An interdisciplinary working group for Support for the second year medical communication skills in medicine comprising physicians, students with neuroanatomy difficulties students, nurses, clinical psychologists, foreign language consultant. (5) Guidelines to Enhance Undergraduate P Boonruangsri*, N Kunatippapong, W Mothong and A Medical Education: Teaching Skills, Psychology of Attitudes, Srikoolwong (Khon Kaen University, Department of Anatomy, Instructions for Completing a Practice Standard Review – Faculty of Medicine, Khon Kaen, THAILAND) developed by the American International Health Alliance. Neuroanatomy was a difficult subject for some preclinical (6) Discussion Forums. students. From the previous reviews, we found that 2-3% of students failed the subject. The course evaluation found that some students needed a support system. The program 3 Topaz 1.6 aimed to prevent examination failure of the students in Students’ viewpoint on professors’ academic year 2004. performance, method of selection, description Summary of work: The 16 volunteers from 131 students of duties and the extent of responsibilities were identified and divided into 4 groups. The remedial S Hajiaghajani*, R Ghorbani, M Malek, M Jenabi and M program tutors diagnosed the students for educational Saberian (Semnan University of Medical Sciences, Educational problems, learning style, examination preparation and Development Center (EDC), Bassij Blvd., Semnan, IRAN) private information. The tutors and students co-operated Background: Universities have a crucial responsibility in in a management plan. The tutors supported the students training the students and to achieve this goal, provision of for study method, topic consultation and tutorial. consultation and guidance is indispensable. In this way, Summary of results: The program outcome evaluation students will be assisted to overcome difficulties, improve found that the students passed the neuroanatomy self- awareness and independent decision-making. examination in 93.75% (15 in 16 cases). Their letter grades Methods: In this cross-sectional study 275 students (205 were B=31.25% (5 cases), C+ = 50 % (8 cases), C=12.5% female, 70 male), studying for an MD or a BS, or a college (2 cases) and D+=6.25% (1 case). degree participated, for whom guiding professors were Conclusions/take-home messages: It is concluded that this assigned from different departments. The students program is advantageous for academic failure prevention completed a 45-item questionnaire including queries on and should be the model strategy for the department or demographic, performance of guiding professors, how they academic affair. are selected by the students, and description of their responsibilities and the expectations of the students from them. To ensure the validity and reliability of the 3 Topaz 1.5 questionnaires, content validity test and re-test methods From medical students involved in were used and the students were then asked to pass their developing educational programmes to comments using “X” marks in front of each question. doctors. Reflecting 6 years of experience in Results were analyzed using SPSS software and Chi-square medical education at the level of 5%. Radim Licenik*, Cestmir Cihalik, Lenka Doubravska, Daniela Results: Our study showed that 64% of the students had Jelenova, Petr Jindra, Pavel Kurfürst, Jarmila Potomkova, referred to guiding professors individually of whom 59.1% Renata Simkova, Filip Wagner and Iveta Zedkova (Palacky were seeking educational consultation; 86.9% were University Faculty of Medicine, Hnevotinska 3, Olomouc 775 “eager” or “relatively eager” to refer to guiding professors 15, CZECH REPUBLIC) individually. Of all participating, 57.5% expected their Palacky University Medical Students´ Association (PUMSA) guiding professors to be in the same educational field, established the Section for Scientific Research in 1998 and and 53.5% of them preferred guiding professors to be the Section for Medical Education in 2001. Both sections selected for freshmen by the students of the final year of are concerned with undergraduate medical education. the same educational field. Help of the guiding professor Through various activities they primarily aim to contribute in educational, familial and social economic problems was to medical education improvements. Former medical preferred by 63.3% of students. students, nowadays doctors, utilize their clinical Conclusion: Our study indicated that guiding professors experiences as physicians in the district and teaching have been able to solve students’ problems to a great hospitals. They still co-operate with PUMSA and bring new extent. ideas: (1) Theory and Practice: Theory and Practice of

Posters 3 Ruby 1 Education environment

3 Ruby 1.1 Aim: The aim was to evaluate the strengths and Educational environment in the Medical weaknesses of the curriculum and educational School of King Saud University environment. Eiad Al-Faris*, Ashry Gad, Tomadher Al-Dakheel, Norah Al- Summary of work: The Arabic translation of the DREEM Rowais and Mohamed Al-Rukban (King Saud University, 50 items scale was distributed to all the medical students Department of Family & Community Medicine, School of of the school. Medicine, PO Box 2925, Riyadh 11461, SAUDI ARABIA) Summary of results: The results showed that only 40% of the students were encouraged to participate in class and

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82% believe that there is no good support system for climate score as a predictor of end of term academic students who get stressed. Only 19% felt that the teaching achievement will be examined at the student level using a is simulating and 37% did not agree that the learning multiple regression model. Student input/background environment is comfortable. 60% did not agree that what variables such as previous academic achievement and was learned in the previous period has been a good demographic variables (gender, age, nationality, admission preparation for this year work. Only 37% thought that status) will be controlled for. Results will be available in long term learning is emphasized over short term learning. July 2005. Lessons learned from this study and recommendations to rectify the weak areas will be presented. 3 Ruby 1.4 Evaluation of the learning environment of 3 Ruby 1.2 paediatric residents in academic and non- Dundee Ready Education Environment academic teaching hospitals Measure (DREEM) inventory in defining the Martine Raphaël*, Klarke Boor, Franciska Koens, Scheltus difficulties of the undergraduate curriculum van Luijk, Fedde Scheele and Ronnie van Diemen-Steenvoorde at the Medical Faculty Skopje and the (VU University Medical Center, Department of Medical impact of Tempus Project* Education, Onderwijsinstituut, MF/Room D 237, PO Box 7057, Amsterdam 1007 MB, NETHERLANDS) Z Gucev*, A Alonso, J H Seitz, J Saveski and J L Barat (Medical Faculty Skopje, 50 Divizija BB, Skopje 1000, MACEDONIA) Aim of presentation: To evaluate the learning environment of paediatric residents in academic and non-academic Summary of work: The advantages and disadvantages of teaching hospitals, we developed a questionnaire. the undergraduate curriculum at the Medical faculty Skopje and the impact of the Tempus project* was assessed using Summary of work: A 16-item questionnaire was developed the DREEM. 128 students from the fifth year (5 years’ that measured elements of residents’ learning environment. experience in studies, and 2 years’ experience with Items regarded feedback, patients, education, level of Tempus) were tested by DREEM. Responses ranged from responsibility and other topics and were evaluated on a 5- strongly agree (4), agree (3), uncertain (2), disagree (1) point Likert scale. and strongly disagree (0). Means and standard deviation Conclusions: Preliminary results showed that paediatric scores were calculated as well as percentage of responses residents (N=104, response rate was 89%) rated the indicating agree-disagree and uncertain. learning environment on a 1-10 scale for academic teaching Summary of results: Many areas of concern were identified. hospitals compared to non-academic hospitals 6.66 and The encouragement to participate in class is low (1.23+/ 7.45 respectively (p<0.001). The results also suggested - 1.03), the support for students who get stressed (0.73+/ an effect of year in training with the residents in the -0.73) is insufficient. The teaching is sufficiently stimulating penultimate year scoring less high on some items. (2.233+/-1.13), and practical work is deemed to have a More than 30% of the respondents experienced too much good professional level (1.66+/-1.42). Furthermore, the workload and a similar percentage of residents agreed college has to be better timetabled (0.73+/-1.09). It seems that they fulfilled duties that made them feel insecure. that cheating is a problem (3.13+/-0.99). Using another formulation, the influence of connections in cheating is Take-home message: Paediatric residents give higher high (0.95+/-1.33). In addition, theoretical learning is ratings to non-academic teaching hospitals as opposed to accentuated (2.98+/-1.24), and the overall teaching academic teaching hospitals. In the last but one year of experience is not far from disappointing (2.2+/-1.37). paediatric residency training we noticed a decrease in residents’ appreciation of the learning environment. Conclusions: The curriculum has to be changed (3.41+/- 1.02). On the other hand, the Tempus experience is useful (2.74+/-1.28) in presenting that some of the difficulties 3 Ruby 1.5 encountered are common with other Medical faculties. At Pre-Registration House Officers’ perception the same time the possible solution to those problems are of the educational environment within NHS well presented in this Tempus project. As always changing Tayside curriculum and old habits is a challenging task. Lawson Barclay (15 Ledmore Terrace, Gowriepark, Dundee *JEP 16011-2001: Bordeaux, Bilbao, Hamburg, Skopje DD2 4UF, UK) Background: This study was originally undertaken as an 3 Ruby 1.3 assignment on Educational Environment for the Diploma Educational climate as an independent in Medical Education Course, which the author was predictor of academic achievement in undertaking. medical education Work Done: The Postgraduate Hospital Educational Environment Measure (PHEEM) was distributed to all Lotte O’Neill (University of Southern Denmark, Institute of Sports Science and Clinical Biomechanics, Campusvej 55, PRHOs within NHS Tayside during August 2004. Odense M 5230, DENMARK) Conclusions: Overall it was found that the PRHOs were Aim: To investigate the role of students’ perception of generally satisfied with their educational environment. The educational climate as an independent predictor of main areas of concern were the number of hours the junior academic achievement in medical education. A number of doctors were working, and lack of appropriate feedback studies within secondary science education have supported from seniors. It was also noted that for almost every item, climate as a predictor of academic achievement. There is the mean score for those working in surgery was less than currently a lack of studies in medical education to support the mean score of those in medicine. the existence of this construct. Medical students often make Take home messages: Overall the Pre Registration House up a highly selected group representing the academic top Officers who participated in the study were satisfied with of the applicant pool. It is unknown whether situational their educational environment. influences such as environment are as important determinants of behaviour as personal characteristics in Those responsible for teaching junior medical staff need such a group of students. to be aware of the importance of providing appropriate feedback. Many of the respondents were working more Method: The validated Danish translation of the Dundee than their contracted hours. The perceptions of the Ready Education Environment Measure (DREEM) inventory educational climate by those working in surgery were was distributed via e-survey to 1026 undergraduate significantly less positive than the perceived educational medical and chiropractic students in March 2005. The environment of those working in medicine.

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Posters 3 Ruby 2 Basic sciences

3 Ruby 2.1 3 Ruby 2.3 The haze of basic sciences in a PBL Implementation of active learning elements curriculum – like it or hate it in the dissection course in Medical Andreas Braunsberg*, Peter Kube and Joerg Pelz (Charité, University – Pleven, Bulgaria Reformstudiengang Medizin TAF und, Prodekant für Studium N Kovachev*, R Davidova, P Moushatova, St Yochkova, St und Lehre, Charité Campus Mitte, Schumannstr 20-21, Berlin Trifonov and N Narlieva (Medical University of Pleven, 10117, GERMANY) Department of Anatomy, Histology and Cytology, 1 kl Ohridsky Basic science concepts are implicitly present and may be Str, Pleven 5800, BULGARIA) notably hidden and structured in a seemingly organ based Background: In 2004 research about the Anatomy PBL curriculum. The rationale to teach content through curriculum and ways of upgrading adequate anatomy patient cases is to provide students with a context in which knowledge in clinical studies was performed. The results they will encounter the concepts in their clinical practice. show that 70% of second year students prefer passive Learning concepts from various disciplines or domains in studying. The aim of this study is to estimate the initial a seemingly random sequence may contribute to PBL results of introduction of active learning components in students’ relatively poorer performance on the basic dissection course. science portion of licensing exams. We analysed the Summary of work: A programme of active learning was (hidden) basic science rationale of the 3rd semester in the reformed curriculum in Berlin (Charité) taking into implemented in half of the course, the other half served as a control group. Active learning groups were divided in consideration that “nothing in Biology makes sense except small subgroups (2-3 students) and each was given “clinical in the light of evolution” [Dobzhansky]. This semester tasks” – some practical clinical questions in a specific comprises three blocks: blood (2 weeks), inflammation (7 region. Students had to study, to dissect this region and weeks) and sexuality, reproductive organs and hormones. to present it to the rest of the group. The knowledge One of the most widely accepted theories to explain the evolution of sex is that it evolved as an adaptation to assist acquired has been assessed by interim and final tests. Students’ and teachers’ attitudes were studied. sexual individuals in resisting parasites (Red Queen hypothesis). Evidence for this explanation is provided by Summary of results: Students in the experimental group the rate of molecular evolution of genes for kinases and show higher results in anatomy tests in comparison to the immunoglobulins in the immune system, thus revealing control group. Active learning students show higher interest the connection of the three seemingly arbitrarily taught in dissections, like a close student-teacher relationship. blocks. Making explicit the implicit basic science concepts Teachers admire the increased interest in self reading and may help students to understand the underlying concepts. learning. Knowledge assessment will continue in the final anatomy exam. 2 Ruby 2.2 Conclusion: Results are encouraging and we are planning Living anatomy – combining anatomy to implement the active learning in the whole course. teaching with clinical examination S Berghoff*, J Schulze*, F Seibert-Alves, U Kersken-Nuelens 3 Ruby 2.4 and F Nuernberger (Johann Wolfgang Goethe University, Genetics teaching in medical schools 2003 Senckenbergische Anatomy, Theodor Stern Kai 7, Frankfurt/ Main 60590, GERMANY) Helen Jones, Hilary Burton and Heather Owen (Open University Centre for Education in Medicine, The Open Anatomy is one of the main preclinical topics; however, University, Crowther 208, Walton Hall, Milton Keynes MK7 students yearn for clinical relevance. In order to improve 6AA, UK) the anatomical courses and increase clinical connections Aim of presentation: To describe the current state of the anatomy course was restructured four years ago during genetics teaching in medical schools and the assistance, a revision of the medical curriculum in Frankfurt/Main. support and resources needed for genetics education. Beginning with muscle and bone system in the first semester, internal organs are taught during the second Summary of work: A postal questionnaire was sent to 24 semester, head and nervous system during the third medical schools in the UK as part of a wider project to semester. Since 2004, all three parts are combined with develop a strategy for education in genetics throughout self-examination sessions termed “Anatomie am Lebenden” the health professions. (living anatomy). These sessions are intended to project Summary of results: Results showed: Great variability anatomical knowledge to the living body, they are tutored between schools in the number of learning objectives for by students and supervised by clinicians. Besides projection genetics addressed in the undergraduate curriculum; A it is also intended to better prepare students for their wide range of genetics SSMs available, offered in different courses in clinical examinations. During the fourth semester years and by a variety of departments; Genetics teaching preceding the first federal examinations anatomical delivered through a variety of curriculum models and knowledge is integrated in seminars to provide connections teaching methods; Resources generally made in-house and between seemingly unrelated topics as well as in depth not shared. Use of internet and other electronic resources examination preparations. Initial experience indicates a was rare. The main barriers to change were lack of time good acceptance of anatomical self examination elements to develop resources, an already-overloaded curriculum, both by participants and student tutors. Further experience staffing levels, lack of resources to champion changes and will indicate how the preparation for anatomically relevant developments in genetics, and genetics not being seen as clinical situations can be further optimized. a priority by colleagues. Conclusions/take-home messages: This survey showed how learning objectives in genetics could be embedded into an undergraduate curriculum, the educational resources that had been developed, further resources that were required, and the potential for future sharing.

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3 Ruby 2.5 Summary of work: An action-research approach was used Neuroscience and Neuroscience-related in three years (01/02, 02/03, 03/04) followed by evaluation content and instruction in undergraduate of teaching/learning outcomes, through questionnaires delivered to students. Questions addressed level of medicine and Psychology programs in organization of the discipline, role of teaching staff, Turkey: a survey on curricula and lectures, practical sessions, educational media, scheme of perceptions anatomical teaching and educational model. Gonul O Peker*1, 2, 3, 4, Eser Sozmen2,5, Vedat Evren2,3, Oguz Summary of results: Eighty percent of the students Gozen2,3 and Ferhan G Sagin2,5 (Ege University, 1Center for returned the questionnaire in 01/02, 56% in 02/03 and 2 3 Brain Research, Faculty of Medicine, Dept. of Physiology, 68% in 03/04. After exclusion of questionnaires with 4Dept. of Medical Education, 5Dept. of Biochemistry, 35100 excessive missing information, 465 were included, 150 in Izmir, TURKEY) 01/02, 131 in 02/03, and 184 in 03/04. Evolution of Challenges and Questions: (1) Relatively new, opinions in the domains described was analysed and multidisciplinary, (should be thoroughly) integrated, significant improvements were found. The strengths and exponentially growing field: Essential in medicine, weaknesses of the course were analyzed by content biomedicine, behavioural science programs; (2) Novel analyses. object of desire in research and emerging priority for practitioners (growing population of elderly and Conclusions: The evaluation of the discipline was highly favourable for most parameters and demonstrated a neurodegeneratively affected in the community); (3) “Brain positive evolution of the course, emphasizing the clinical and behaviour”: Difficult to teach and learn; (4) Literature survey: “Neurological assessment: Most challenging/ approach to the anatomical knowledge as an innovation stressful in physician’s training and practice”; (5) Growing introduced in the discipline-based organization of the concern: National, international standardisations and curriculum. accreditations. Supported by FMUP and Fundação Calouste Gulbenkian. Approach and Procedures: (1) Two different questionnaires with 30-60 items, subitems; (2) Sampling/population: 3 Ruby 2.7 Medicine and psychology students, neuroscience/ Students’ experience of learning anatomy in neuroscience-related course or block/programme directors, educators at 30 universities in Turkey; (3) Various statistical a problem-based curriculum: a qualitative evaluations for demographics, curricular features, study perceptions. L Wentworth*, S Smithson and T Dornan (Manchester Royal Results and Impressions: (1) Medical curricula: Course Infirmary, Room 39, Dr Residence, Oxford Road, Manchester M13 9WL, UK) content and duration variations: 0 hours-20 weeks in early phases; variations decrease in clinical courses, clerkships; Aim of presentation: To discuss learning anatomy in a (2) Medicine and psychology: Ownership of instruction problem based learning curriculum from a student and instructional strategies: Significant variations; (3) perspective. Psychology programs: Rather “soft-science-based” in Summary of work: The medical undergraduate curriculum general; only 5 schools in the largest cities, universities: at Manchester uses problem based learning throughout Reasonable content of hard, biological, molecular, cellular all five years. Teaching about basic sciences, including science. anatomy, is systems-based and the combined responsibility Conclusions and Projections: (1) Urgent requirement: of basic scientists and clinicians. With uncertainty existing Unanimous redefinitions, core contents, inclusion of about the adequacy of students’ knowledge of anatomy, standard neuroscience courses to the undergraduate this study explores students’ experiences of learning programmes, in general; (2) Recommendable matters: anatomy in a problem based curriculum. Qualitative data Internationally acceptable standards for instructional were collected from focus groups comprised of students methodologies, diverse contents to serve specific purposes from all five years of the course. in different schools and programmes. Summary of results: Anatomy was rarely included in PBL case discussions. The students valued dissection as a 3 Ruby 2.6 learning resource particularly where their demonstrator Making the difference in medical education: had a good understanding of the overall course structure. Assessment was a driver for learning but was examined the challenge of clinical anatomy in a infrequently and in little depth. The students felt that their traditional medical curriculum anatomy knowledge was adequate for the Manchester M França*, M S Silva and M A F Tavares (University of Porto, course but that they should know more. Faculty of Medicine, Institute of Anatomy, Alameda Hernani Conclusion: Whilst students perceived that learning Monteiro, Porto 4200-319, PORTUGAL) anatomy was incompatible with problem based learning, Aim: To evaluate the renewed module-based discipline of they did suggest that teachers who were knowledgeable Clinical Anatomy, where the conceptual background is about this method of learning coupled with more thorough followed by surface, sectional and radiologic anatomy and anatomy assessment could improve their anatomy case discussion. knowledge.

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Symposium 4AUD Accreditation of institutions and programmes in medical education

4AUD 1 Accreditation of medical schools in North 1973, the Iranian Council for Graduate Medical America: Assuring quality Education was established as the competent authority to supervise GME in the country. Under the Council are Carol A Aschenbrener (Association of American Medical the Accreditation Commission and what will be Colleges, 2450 N St. NW, Washington, DC 20037, USA) ultimately Specialty Review Committees. To date 15 The LCME was founded in 1942 to unify the separate committees have been established and the standards accreditation processes of the Association of American have been developed in nine specialties. Residency Medical Colleges, representing the academic programmes have started to implement the standards community, and the American Medical Association, by conducting self study. The Specialty Review representing the physician practice community. The Committees will review the residency programmes LCME is a “virtual” organization, recognized by the US (including a site visit) which will lead to determination Department of Education as the sole credible accrediting of their accreditation status. A summary of the system entity for programs leading to the MD degree. In will be presented specially according to the recently addition to accrediting such programs in the US, the developed guidelines of WFME-WHO for accreditation LCME accredits medical education programs in Canada, systems. in cooperation with the Committee on Accreditation of Canadian Medical Schools. The presentation will outline key elements for quality assurance and quality 4AUD 4 What seems specific for accreditation of improvement in medical education, through medical schools? accreditation. Jadwiga Mirecka (Medical College of Jagiellonian University, Str. Kopernika 19E/1, Krakow, POLAND) 4AUD 2 Accreditation and recognition of medical The accreditation of medical schools includes several schools in Europe – the Swiss approach elements which seem specific for medicine: a need to take into account the Global Standards for Medical Rolf Heusser (Director OAQ, Center for Accreditation and Education; the more complex functions of the school, Quality Assurance of the Swiss Universities) including teaching, research and medical service, with The Bologna process and the internationalisation of the all of them to be considered; availability of data labour market increase the need for mutual recognition reflecting educational outcomes from license of medical degrees and titles in Europe and call for the examinations and/or selection process for specialist establishment of trustworthy accreditation systems. In training; the size of the staff (faculty) involved which Switzerland, accreditation of basic medical education by far exceeds that related to other disciplines (if only and of postgraduate medical education is organized due to necessary representation of all clinical and carried out by the National Center for Accreditation specialties); the volume of the documentary presented and Quality Assurance in Higher Education (OAQ, Organ by schools in self-evaluation questionnaire; extra duties für Akkreditierung und Qualitätssicherung). The OAQ of academic teachers related to medical service, and has a legal fundament for its actions. It is working thus different criteria for staff (teachers) evaluation; a independently and is recognized by the Swiss stress on practical skills training and assessment; government. In pre- and postgraduate medical educational facilities including not only lecture and education the Swiss accreditation is based on the WFME seminar halls, laboratories but also hospital wards and global standards for quality improvement and is in line outpatient clinics; specified requirements concerning with the draft WHO-WFME guidelines for accreditation curriculum length and content. In general medical of medical education. In order to adopt these accreditation tends to focus more on the output data international guidelines to the Swiss national context, (competences of graduates, their performance on high- a close collaboration was established between the OAQ, stake exams) than on input data (school management, the Swiss government, the Medical faculties of the Swiss administrative procedures). universities and the Swiss medical professional association (FMH). The new accreditation procedure has been well accepted by the Swiss medical community 4AUD 5 Accrediting medical programs: A and all stakeholder groups involved. The fact that these comparison of paper-based and visit– accreditations have been carried out by an independent based procedures agency and the fact that the decisions have been based Richard Hays (School of Medicine, James Cook University, on internationally acceptable quality standards may Townsville, QLD 4811, AUSTRALIA) increase the credibility of the Swiss medical health system and should facilitate the international Background: Processes for accreditation of medical recognition of the Swiss medical qualifications. programs may be based on either examination of documentation provided by the educational institutions, or visits by surveyors to seek evidence from 4AUD 3 Establishment of a national accreditation stakeholders of how well the documentation reflects system – the Iran experiences the reality. This paper reports the experiences of an international surveyor in both kinds of processes, using Azim Mirzazadeh (Tehran University of Medical Sciences, consensus-based global standards developed by the PO Box 14185-481, Tehran, IRAN) World Federation of Medical Education (WFME). In response to concerns about the quality of medical education, policy makers in Islamic Republic of Iran Methods: Two medical schools in the Asia-Pacific region have focused on quality improvement and paid more and three European postgraduate specialty programs attention to accreditation as a tool in recent years. sought international perspectives in their accreditation. Several programmes have been organized to establish All provided self-evaluations against their respective accreditation systems for different levels of education standards. In the visit-based process, a team of in medicine and dentistry. The first and best established surveyors visited to interview staff, students, accreditation system in Iran is the evaluation and professional organisations, regulatory bodies and accreditation system for Graduate Medical Education funders. In all cases the surveyors produced a detailed (GME). By a special act of the national parliament in report on performance and recommendations for

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improvement. Accreditation decisions were made by Aim: The present world-wide occupation with quality relevant jurisdictional authorities. assurance and especially accreditation or similar Results: The visits facilitated surveyor evaluations and measures as documented by national initiatives and allowed discussion about differences in perception with international contributions (e.g. by UNESCO, OECD and within the Bologna process) has prompted WHO and local stakeholders, a potentially valuable stimulant of WFME to act to facilitate accreditation in medical continuing quality improvement. However, distant examination of documentation, websites and email education by providing a set of guidelines for questions did provide a sound understanding of the accreditation of basic medical education. design and delivery of the training programs. The visit- Summary of work: As one of the first activities within based process can be significantly more expensive and the framework of the WHO/WFME strategic partnership more intrusive, compared with self-paced document to improve medical education a joint international task examination. force on accreditation was established. After a task force Conclusion: A visit-based process is more meeting in October 2004 and following consultations the WHO-WFME guidelines for accreditation of basic comprehensive, but a paper-based process can work if medical education is now available. sufficient documentation is provided from a range of stakeholders and communication channels are Results: The guidelines are recommendations or non- established. binding guidelines and are global, but flexible guidelines. The guidelines cover: Fundamental requirements of an accreditation system, the legal 4AUD 6 The WHO-WFME guidelines for framework, organisational structure, standards and accreditation systems criteria, the process of accreditation, main elements in Leif Christensen (World Federation for Medical Education, the process of accreditation, decisions on accreditation, University of Copenhagen, Blegdamsvej 3B, Copenhagen public announcement of decisions and the benefits of 2200N, DENMARK) accreditation.

Symposium 4A Complex adaptive systems

4A Complex Adaptive Systems illustrated and discussed in three different contexts. Tim Holt will apply complexity to the control of blood glucose Stewart Mennin (Mennin Consultoria em Saude Ltda, Avenida levels in diabetes. Joachim Sturmberg will discuss health Jacutinga 579 Apto 41, Moema, CEP 04515-030, Sao Paulo, Brasil), Joachim Sturmberg (Australia) and Tim Holt as a complex adaptive system and teaching holistic (University of Warwick, UK) medicine in an undergraduate program. Jim Price will describe interprofessional education as a complex system Medical education and health care systems are continuously and relate it to the uncertainty of educational outcomes, evolving. This symposium, moderated by Stewart Mennin, and as a guide to educational strategies. will briefly review core ideas in complexity which will be

Short Communications 4B Problem based learning: implementing a course

4B 1 Two years program of clinical skills and general appreciation). integration in a problem-based learning Conclusion: Clinical skills integration in a PBL program is a curriculum promising strategy to meet the high standards required Bernard Martineau*, Guy Waddell, Sylvie Bourque and René by doctors. Our program seems to help foster: 1) Hivon (University of Sherbrooke, Faculty of Medicine, 3001, procedural knowledge by demonstration, practice and 12 e avenue nord, Sherbrooke, Québec J1H 5N4, CANADA) immediate feedback, 2) integration between declarative (PBL) and procedural knowledge as well as encouraging Following literature review and program evaluation of our the 3) elaboration of conditional knowledge. curriculum, we noted that procedural knowledge was taught in parallel to declarative knowledge in a way that students were having difficulty integrating these 4B 2 The transition to PBL: making sure the PBL components into clinical practice. We address this problem model is explicit for students by integrating clinical skills teaching in our PBL curriculum. Ray Peterson*, Carole Gannon, Ted Cleary and Anne Tonkin Methods: The new program was launched in September (University of Adelaide, Faculty of Health Sciences, Medical 2003 for 150 first year medical students. The program Education Unit, Adelaide SA 5005, AUSTRALIA) has five different components: 1) training for 25 mentors Undergraduate medical students entering from secondary and 18 tutors by PBL modules, 2) disciplinary history taking education often do not understand the learning and physical examination taught by PBL tutors, 3) expectations in a self-directed PBL program. In particular, transdisciplinary clinical reasoning and patient appreciating what does PBL really mean in the curriculum, communication course taught by the same mentor over and how students should think about their learning to two years, 4) regular encounters with patients and 5) achieve the desired outcomes of the program. To aid the evaluation by new OSCE. transition to PBL, considerable attention has been given Results: We note a high level of satisfaction from every to articulating the PBL process, and modelling activities in participant. Similar results were obtained on the five both small group tutorials, and in large group sessions as dimensions evaluated (planning, tutor/mentor students complete PBL cases. Data from student and PBL performance, evaluation and feedback, specific activities tutor questionnaires, and a student written reflective

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journal for a PBL case provided evidence on students’ programme. These programmes are structured around abilities to apply the PBL model, develop their reasoning problem-based learning (PBL) (Barrows, 1994). and knowledge base, evaluate their individual learning Summary of work: A pilot study was undertaken evaluating: approach and learning within groups. The transition to 1. Student expectations of career progression; 2. Actual PBL did improve student understanding and ability to use effects on career progression following programme the process, and to develop a knowledge base, although completion. Graduates were sent a questionnaire, developing mechanistic explanations was difficult. Using comprising quantitative questions and free text responses a reflective journal for one PBL case, although not keenly (response rate 75%, n=15). A second group of graduates supported by students, did help them understand the from the previous year was subsequently approached and learning demands. Making the PBL approach and learning 30% (n=13) responded. The groups were analysed explicit can help beginning students understand the separately and collectively. program expectations. Having students keep a reflective journal on a case did increase their awareness of these Summary of results: Expectations: 46% chose the degree goals. programme specifically for career advancement. Actual effects: 46% reported “…career progression as a direct result of study”, with a further 46% reporting that “study 4B 3 Quality of learning objectives – a PBL group has probably had positive influence on career”. attribute? Conclusion: This suggests that distance learning nursing Joerg Pelz*, Reinald Adlung, Ute Tautenhahn and Elisabeth degrees, using a PBL model, are able to directly affect Hoffmann (Charité, Medical Faculty of the Humboldt career progression. Following this pilot, all graduates will University Berlin, Prodekanat Studium und Lehre, Charité be evaluated immediately after graduation and Campus Mitte, Schumannstr. 20/21, Berlin 10117, GERMANY) longitudinally. With permission, employers will also be Learning objectives created by students during the first evaluated on their attitudes towards DLC students’ PBL guide the learning activities. The group agrees on a progression as an employee. core set of learning objectives, often in the form of Barrows HS, (1994). Practice-based learning. Problem- questions, which form the basis of students’ self-study. based learning applied to medical education. Springfield, These learning objectives should be specific and achievable Illinois. Southern Illinois University School of Medicine. within the time available between two group meetings. We estimated the quality of learning objectives for this process taking into consideration the student experience 4B 5 Holding on to Teddy: a corrective with PBL. Three raters independently judged the learning recapitulation of the emotional value of PBL issues of about 30 PBL groups of 5 different semesters as a ‘transitional object’ according to formal and content criteria. In the reformed curriculum in Berlin papercases are based on complex real Brian Bailey (Napier University, School of Community Health, patient casuistic from the 1st to the 10th semester. 13 Crewe Road South, Edinburgh EH2 4LD, UK) Students receive a handout with a trigger situation for Aim: To apply emotion theories to PBL as a counterbalance group discussion. They are free to decide which aspects to dominant, cognitive perspectives in order to strengthen of the case at hand (basic sciences, clinical, its theoretical basis and bolster the resolve of investors in epidemiological,...) they want to deal with. Differences this radical innovative approach. detected between the groups were not directly related with the semester i.e. the experience with the PBL process. Unresolved debates by opinion leaders about PBL’s (cost) The between group differences were relatively constant effectiveness and an apparent declining interest in during the course of a semester. The quality of learning ‘spotlighting’ the approach at AMEE conferences may give objectives created by a PBL group is more dependent on some cause for concern about its future. At the same time, group variables than on the educational level. at grass roots its spread world-wide seems likely to continue. PBL leaders will not, perhaps, have forgotten what those early heady years of innovation felt like, but 4B 4 Evaluating practice and career outcomes for seem to have no explanation (i.e. in published form) for nurses completing distance learning degree that crucial developmental period in their (and PBL’s) life. programmes Albanese has identified a need to search for theories that will help to explain the global success of PBL. To this end, Linda Malek*, Pauline Horton and Elizabeth Rogerson and by way of correctively recapitulating the emotional (University of Dundee, Distance Learning Centre (Nursing and value of PBL, the author will apply Winnicott’s child- Palliative Care), Tay Park House, 484 Perth Road, Dundee development theory of ‘transitional objects’ (of which the DD2 1LR, UK) Teddy Bear is one of the best known examples): PBL being Background: A key measure of success of distance learning an adult equivalent and no less important for that. nursing degree programmes offered by the Distance Take Home Message: Hold on to Teddy, new toys often Learning Centre (DLC), University of Dundee is the effect break easily. on practice and career beyond the timespan of the degree

Short Communications 4C Teaching and learning communication skills 2

4C 1 Using simulated patients to improve SPs, scenario development and running bilingual SP communication across language barriers sessions. Sarah Escott* and Miriam Hawkins* (Bradford City PCT, Our work: Bradford, like many European cities is Joseph Brennan House, Sunbridge Road, Bradford BD1 2SY, increasingly ‘multicultural’. Over 50% of the inner city UK) population describe their ethnicity as ‘Asian or British Asian’ with a further 5% using other ‘non-white’ categories and Aim: We present innovative work, demonstrating bilingual 1% report being born in other EU countries. For many, simulated patient (SP) scenarios used to improve language barriers are obstacles to effective health care. communication in bilingual healthcare encounters. We Despite increasing availability of interpreters many health highlight key lessons for recruitment and training bilingual

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workers lack skills needed for their successful use. Building Summary of results: The preliminary findings from the on experience using SPs to teach communication and video observation will be presented (demonstration) and consultation skills, Bradford City Teaching PCT and ‘West discussed in the paper. Yorkshire Simulated Patients’ have developed bilingual SP Conclusions: The originality of this experiment has provided scenarios allowing practice of communication via us interesting data about the correlation between stress interpreters. Scenarios, piloted with under- and post- and the power of video-based simulated patients to affect graduates, included the use of face-to-face and telephone and move students (empathy). services, and European, South Asian and British Sign languages. Key messages: Tomorrow’s Doctors emphasised the 4C 4 Do medical students’ attitudes towards importance of effective communication across cultural and patients predict their learning of language barriers. New SP scenarios offer a way to ensure communication skills during preclinical this but require additional planning and training for both training?: a longitudinal study SPs and facilitators. Sarah Peters* and Fiona Lobban (University of Liverpool, Division of Psychiatry, Liverpool, UK) 4C 2 Multicultural society: a transcultural Increasingly central to communication training is the communication training in a medical adoption of a ‘patient-centred’ approach to consultations. curriculum Patient-centredness involves valuing patients’ understanding of their illness and the social/psychological Reyis Kurt* and Cornelius T Postma (Radbous University context of disease and differs from the traditional doctor- Medical Center Nijmegen, Department of Medicine 541, Postbox 9101, Nijmegen 6500 HB, NETHERLANDS) centred consultation, which involves a more authoritarian attitude towards the doctor-patient relationship. Patient- Introduction: Doctors in many countries see patients from centred orientation of qualified doctors is associated with different origins. Because they are mainly trained in greater communication skills and patient satisfaction. communication with patients from their own cultural and Research indicates that by graduation students have ethnic background, they have insufficient communication become more paternalistic/doctor-orientated. To counter tools to optimise the relationship with foreign patients. this trend, an 11-session programme was developed during Aim: To train the students to recognise factors leading to students’ 1st-year. This study investigates if changes in miscommunication, to learn to deal with language barriers, attitude towards patients following training are associated to understand the influence of migration on social context with changes in communication behaviour. 300 1st-year and to develop an adequate personal communication medics were videotaped interviewing a simulated patient method concerning especially non-western immigrant before and after the programme. Participants also patients in western countries. completed a measure of doctor-patient orientation. An independent researcher, blind to the within-subject design, Method: In small teaching groups interns discuss their rated communication skills. Progress of student attitude experiences with transcultural patient care aided by and behaviour following the intervention is described and accompanying texts. After that, a student takes the history the predicted relationship between the variables tested. of a migrant simulated patient. The other students observe Although not possible to establish causality in this complex from behind a one-way screen and the session is recorded. association, increased understanding of the relationship Thereafter the communication of this patient and doctor supports current developments in the move from skill- are discussed. based towards attitudinal-based communication Evaluation: The results of the evaluation showed on a four- programmes. Suggestions for such developments are point scale with 4 the highest mark a 3.0 for usefulness presented. and a 3.0 for the supervision of these training sessions. Conclusion: Transcultural communication training with 4C 5 Teaching techniques of communication simulated patients is a useful tool in the clinical training in skills in pediatric practice for junior medical multicultural patient care settings. students Priyasuda Hetrakul*, Amornsri Chunharas and Boonmee 4C 3 Are conversational agents the way to go for Sathapatayavongs (Mahidol University, Faculty of Medicine, assessing communication skills? Ramathibodi Hospital, Division of Medical Education, 270 Rama VI Road, Bangkok 10400, THAILAND) O Courteille*, K Karlgren and P Sharafi (Karolinska Institutet, LIME, Berzeliusgarden 1, Stockholm 171 77, SWEDEN) Aim of presentation: To demonstrate teaching techniques using non-patient learning cycle to achieve competent Aim of presentation: In May 2004, all of the Term 8 Med doctor-patient communication. Students (120) from Stockholm participated simultaneously (4 hospitals) in an OSCE examination. Four stations (out Summary of work: The 90-minute classroom session has of sixteen) consisted of two computer-based Interactive been carefully developed for each group of 20 fourth-year- Simulated Patients and two Standardized Patients. The medical students. Two pediatric staff (PH, AC) start by common goal for the participants at these four stations asking students using photographs of children, followed was to interview a patient and then make a diagnosis. by specifically observing video clips of real short office Half of the students were video-filmed when interacting visits with infants to early teens. Then students were given with the simulated and standardized patients. Additional scenarios to encounter with parents and a 4-month-old, a data (log files) was collected during the computer 1-year-old, and a 4-year-old child for role-play. The class interaction. discussed each role-play with a basic communication checklist and watched examples of video clips of good Summary of work: By means of a special coding scheme, pediatric office visits. At the end of the session, students the video-analyses from the sessions concerned enabled have the opportunity to discuss their communication us to: compare the flow experiences and the realism of problems with pediatric patients before the summary this life-like situation between the simulated patient and lecture of essential communication techniques. the Standardized patient; observe the impact of the simulated patient on the student’s confidence and ability Conclusions: Students have rated the session as very useful to solve clinical problems; collect authentic emotions on and practical. We recommend using a combination of students for building a database. experiential strategies to teach communication skills.

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Short Communications 4D Multiprofessional education and teamwork

4D 1 Improving multiprofessional teamwork in Conclusions/take home messages: Interprofessional operating theatres through collaborative teamwork is impaired through stereotyping of the role of inquiry the ‘other’. Use of video vignettes illustrating team issues may provide an effective means for educating Alan Bleakley*, Linda Walsh, Adrian Hobbs, James Boyden interprofessional empathy. and Jon Allard (University of Exeter and Plymouth, Peninsula Medical School, Institute of Clinical Education (Room F50), Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall 4D 3 No time to waste: multidisciplinary TR1 3HD, UK) simulation training for managing obstetric Aim of presentation: To report on progress of the Cornwall emergencies Theatre Team Resource Management project, established in 2002 to improve patient safety through effective Ron Brendel, Marion Heres* and Fedde Scheele* (St.LucasAndreasziekenhuis (SLAZ), Jan Tooropstraat 164, multiprofessional teamwork in operating theatres (OTs). Amsterdam 1062 BW, NETHERLANDS) Summary of work: A complex educational intervention was Aim of presentation: To demonstrate a training program introduced to 300 OT staff through collaborative inquiry that is developed to improve the team performance during methodology. The intervention includes team self-review obstetric emergencies. (TSR) - regular briefing and debriefing, with videotaping options; close-call (near-miss) incident narrative reporting; Summary of work: Gynaecologists and nursing and iterative human factors education. The focus is non- management of the department Obstetrics & Gynaecology technical practices (teamwork, communication and would like to optimize the team cooperation during obstetric situational awareness). Data is fed back to staff through emergencies. A curriculum was developed for examining newsletter and governance meetings to stimulate cycles and treatment of the patient according to MOET® of reflection and action. We were able to stagger the (Managing Obstetric Emergencies and Trauma). While the introduction of the project across two comparable theatre MOET® is developed for doctors, our approach is an complexes with a one-year lag, offering an opportunity to integrated simulation training for all participating measure the effect of the intervention upon team climate professionals. The training takes place in an actual labour through a validated Safety Attitude Questionnaire (SAQ). room. A patient (actress) acts the appropriate signs and symptoms. Examination and treatment takes place real Summary of results: SAQ data show a significant positive time. A structured evaluation of the skills as well as the shift in teamwork climate as a result of the intervention. team cooperation was done. TSR logs, close-call reports, observation and interview data indicate improvements in teamwork promising Results: We started with different simulated cases. Each establishment of a self-sustaining and reflexive safety simulation ends with an extended evaluation of the culture. performance while the Pendleton feedback rules are applied. The implementation was uncomplicated because Conclusions/ take-home messages: Multiprofessional the whole team endorsed the importance of these teamwork for non-technical practices can be improved multidisciplinary trainings. through structured educational intervention and sustained through collaborative inquiry methodology. The model is Conclusions: Multidisciplinary simulation training is feasible transferable to other clinical team contexts. for the improvement of team performance during obstetric emergencies. We strongly recommend this multidisciplinary training to all obstetric teams. 4D 2 Improving multiprofessional teamworking: can video vignettes facilitate interprofessional empathy? 4D 4 Does team building training improve interprofessional education? A prospective Adrian Hobbs*, Linda Walsh, James Boyden, Alan Bleakley study and Jon Allard (Royal Cornwall Hospital, Department of Anaesthetics, Truro, Cornwall TR1 3LJ, UK) U Hylin*, A Longueville, S Kalén and S Ponzer (Karolinska Institutet, Institutionen Södersjukhuset, Sjukhusbacken 10, Aim of presentation: To report on the educational value of Stockholm 118 83, SWEDEN) video vignettes in facilitating empathy for the role of the ‘other’ in operating theatre (OT) teams. The aim of this study was to investigate if a one-day team building course, preceding the course at a interprofessional Summary of work: Within a wider project looking at training ward would make the student teams collaborate relationships between teamwork and patient safety, we better and thereby to a larger extent reach the goals for noted that effective teamworking is frustrated by a variety the course. At this training ward medical-, nursing-, of rhetorical strategies used to position self and other occupational therapy- and physiotherapy students through reinforcement of professional boundary. This participate in a two-week interprofessional course. In some results in, for example, sequestration of information and groups the students’ learning and team work had been sabotage of feedback processes. While job-swap less good. 16 two-week courses were carried out. In each experience could educate empathy, this is unrealistic for course 3 teams were working and learning together. During OT teams. An alternative is the use of video vignettes. 2 semesters 24 out of the 48 teams received the team Different professional groups script and act the vignettes, building training and the other 24 teams served as controls. which highlight typical teamwork issues. The vignettes are A questionnaire with both rating questions of e.g. fulfilment then played to all OT teams who are asked to speak from of course goals, and open questions was given to the differing role perspectives to gain empathy for the ‘other’. students after the course. Another questionnaire was given Summary of results: Video vignettes have been produced to the supervisors. and are being piloted. An evaluation of their short-term The students’ ratings did not differ significantly between impact will be reported at this presentation. Data will be the groups. However, both groups rated all items quite triangulated from the Readiness for Interprofessional high, i.e. 7-8 on a 9-point scale. The open questions Learning Scale (RIPLS), self-reports, in-depth interviews showed that the students that had received team training and uptake of briefing and debriefing. seem to have more time for clinical work. The supervisors found the training very useful for the students.

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4D 5 Multidisciplinary medical education: and facilitate teacher teams, factors such as leadership, influences of team processes and communication and faculty development have to be taken organizational facilitation on educational into account. The current study addresses implementation quality and curriculum change issues by assessing the nature of multidisciplinary team processes and its effects on reaching R E Stalmeijer*, W H Gijselaers, H A P Wolfhagen, S Harendza objectives of multidisciplinary education. Our research was and A J J A Scherpbier (Maastricht University, P O Box 616, conducted within two large medical schools that were in 6200 MD Maastricht, NETHERLANDS) the middle of a curriculum change process. Combination of theory, practice and multidisciplinary clinical Teamwork was assessed through a rating scale measuring education is considered the most desirable approach in key processes within teams and perception of the order to prepare students for medical practice. However, organizational facilitation of their work. The quality of whenever medical schools try to implement education was determined by judgements of students and multidisciplinary education, both research and practice medical education experts. Currently, data collection is in show that representatives from the different medical fields progress and results will be available at the conference. experience difficulties while working together. This may Our data-analysis aims to shed light on the fundamental eventually result in poor educational quality, or non- question how team success can be explained based on cooperative behaviour. To institutionalize curriculum change the team processes and the organizational facilitation.

4E AMEE Fringe 1

4E 1 Embedding students at sea – effective database that is used by several games. This way the learning with people with special limitations difficulty of questions is automatically registered and can be used to eliminate arguable questions. This registration Moira Maley (University of Western Australia, Education also facilitates adjustment to different user levels and is Centre, Faculty of Medicine and Dentistry (M515), 35 Stirling used by “Million Dollar Doctor”, another game, to rank Highway, Nedlands, WESTERN AUSTRALIA) questions from novice to medical specialist. Undergraduate medical students normally have minimal exposure to people with physical or intellectual limitations and therefore may graduate unaware of their own personal 4E 3 Tomorrow’s patients – Brave New Medicine skills in working with these people. Their preformed Peter Kube, Joerg Pelz and Georg Weikert (Reformstudiengang attitudes in this unexplored area have a large influence on Medizin – Charité Berlin, Schumannstr 20-21, D-10117 Berlin, their professional skills and the impact they may have on GERMANY) patients later in their careers. How do you create a safe Background: While ‘Tomorrow’s Doctors’ are already under opportunity to assess specific attitudinal perspectives and construction, ‘Tomorrow’s Patients’ are preeminently seen reflect on the need for a shift? A curriculum option was in regard to nowadays patients. Hence medical humanities constructed where students and people with special courses centre around challenges as ‘ageing populations’, limitations went to sea on a square rig sailing ship for five ‘chronic diseases’, and ‘multi-morbidity’. Transhumanism, days learning to sail alongside one another. This Posthumanism, and Extropianism (TPE) – movements experiential learning highlighted key aspects of attitude bearing reference to medicine – striving to prevent formation and facilitated reflection on their professional diseases, extend the range of human body and mind, practice. Fifty-five students have had this opportunity and defeat death. While some of TPE’s goals seem attractive, the outcomes indicate that it is a very effective learning others are too weird to be acceptable. However, even environment. A recurring quote from students every year moderate success of TPE will change desires and needs is “.. I have learned more about these people from several of Tomorrow’s Patients and hence of Today’s Students. days at sea with them than I would have learned in years in the hospital setting”. Also they are quite adamant that Summary of work: A course on TPE led medical humanities “...This has been the best learning experience of my whole students to question medicine’s cognizance, aims, and course... all students should get this opportunity”. limits: Do we enjoy pain, disability and dying? Certainly not. So what is wrong with getting rid of them? Certainly a lot! But still we strive for it. If everything were permitted, 4E 2 Enjoyable formative assessment: games in then healing would shift to modelling, and care to design. medical education What if engineers or designers were in charge instead of S Eggermont*, P M Bloemendaal and A J M de Man (Leiden doctors? Strange? Sure, but threatened by TPE. University Medical Center, Dept of Surgery K6-R, P O Box Conclusions: Weird ideas motivated students to 9600, 2300 RC Leiden, NETHERLANDS) contemplate about Tomorrow’s Patients and hence central At Leiden University Medical Center multiple-choice aspects of medicine: disease, healing, death and questions are used for summative and formative Tomorrow’s Doctors’ musts and mustn’ts. assessment. Recently the idea is taken up to produce Take home messages: How about you: is suffering ‘old- games for medical education, based on the same type of fashioned’, keeping one’s sex ‘boring’, and dying ‘out’? questions, offering students an attractive way to prepare for their exams. In the new game “CamelRace”, students can make their camel run a race. The velocity of answering 4E 4 Heart to Heart: using the Standardized medical questions determines the camel speed, thus Family to teach goals of care and introducing time pressure. Wrong answers make the camel communication skills in end of life care take a rest. Competition makes games more exciting, but online collaboration in games has proven to be difficult for Anita Singh, Dori Seccarechia, Kerry Knickle and Diana Tabak small-scale applications. High-score lists that appear only (CRE-SPP, 200 Elizabeth St, 1 Eaton South, room 565, Toronto, at the end of a game cannot bring about this excitement. ON M5G 2C4, CANADA) We now confront players directly with other students’ result Introduction: Physicians and allied health care providers by logging former session data and using this data to involved in palliative care are faced with a myriad of control opponent camels the student runs against. All challenges from patients and their families. Issues of pain questions and students’ answers are logged in a central management, establishing goals of care, and requests for

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euthanasia are common. Resolving conflict, outside the in, reflect on and explore highly sensitive and multifaceted office, with family members struggling with imminent loss emotional palliative situations. of a loved one can often upset the professional equilibrium. Objectives: Participants will: (1) Gain a greater The Standardized Family is an innovative dynamic teaching understanding of the advantages of experiential learning; tool that recreates the depth and complexity of real life (2) Develop communication skills with families facing end situations, and provides an opportunity for the learner to of life issues. develop their communication skills and explore their own communication style and attitudes in a safe environment. Conclusions: Sophisticated communication skills are crucial for the palliative care team. Standardized Families are a Description: The session will begin with a brief overview dynamic educational resource that assists the learner in of educational program objectives, followed by a brief the development, evaluation and retention of these skills. simulation. Participants will have an opportunity to engage

Workshops 4F & 4H

4F Feedback: Closing the teaching-learning process; (2) Identification of effective strategies for giving loop in clinical skills feedback in relation to acquisition of skills. Debra Nestel, Roger Kneebone, Heather Fry (Imperial College Intended audience: Anyone who gives and/or receives London, Division of Neuroscience, Charing Cross Hospital, feedback and is interested in challenging accepted St Dunstans Road, London W6 8RP, UK) practices. Background to the topic: Feedback is perceived to be an Level of workshop: Intermediate – some knowledge/ essential element of the teaching and learning process in experience desirable the acquisition of skills. Our experience suggests that current models of feedback and guidelines for debriefing are often inadequate. These models usually encourage 4H Preparing and delivering better lectures the learner to reflect on a recent demonstration of skills Reuben M Gerling (Nihon University School of Medicine, 423 and identify those that worked well prior to identifying Matatomi, Chonan, Chosei, Chiba, JAPAN) skills requiring development. There are advantages to this Background to the topic: Lectures are an important chance model: Learners consider what they are doing well; for the teacher to deliver information to medium and large Learners receive feedback that is balanced between groups of students. The ability to do so effectively depends strengths and weaknesses; Facilitators and observers are on the proper understanding of the ways lectures work encouraged to look for and articulate effective practice; It and on the correct preparation of the material as well as provides a framework for the development of facilitation the delivery itself. skills by achieving a balance of learners’ strengths and weaknesses. However, there are also disadvantages to this Workshop content and structure: The workshop will deal model: Learners’ needs are not necessarily dealt with as with the types of material suitable for lectures, the the learner receives feedback in a tutor imposed framework preparation and the delivery of the material and the that deals with effective before ineffective, strengths before assessment of outcomes. Some of the work will be done weaknesses or working well before doing differently. We with worksheets that will give the audience a chance to challenge this approach to giving feedback and/or practice the ideas explained in the workshop. The workshop debriefing in the context of adult learning principles and will also deal with self-evaluation through feedback to learning theory. enable the participants to discover problems that may exist with their lectures and improve their future performance. Workshop content and structure: After an introduction to the educational theory underpinning feedback, participants Intended outcomes: Participants may be in a better position will have the opportunity to share experiences of giving to evaluate the material they need to teach. They will be feedback and/or debriefing in the context of medical and able to understand how lectures work and therefore plan health care professional education. Discussion activities lectures that will be more effective and will be of greater will focus on the participants’ experiences in relation to benefit to the students. models for giving feedback. Intended audience: Persons who at the moment are Intended outcomes: Discussion and reflection of own involved in lecturing or who believe that they may have to practice in relation to giving feedback do so in future. Possible outcomes: (1) Increased understanding of the Level of workshop: No prior experience is needed for this theory underpinning feedback in the teaching-learning workshop.

Short Communications 4L e-learning: the virtual learning environment

4L 1 A structured review activity to promote impact of cognitive style. Learner construction of a table learning in a web-based course: a highlighting key relationships among study material has randomized, controlled trial been proposed to promote critical thinking and improve learning, and allows Web-based implementation. We David A Cook (Mayo Clinic College of Medicine, Division of hypothesized that such a structured review activity (SRA) General Internal Medicine, Mayo Clinic – Baldwin 4A, 200 would improve test scores, that learners with wholist First St SW, Rochester MN 55905, USA) cognitive style would have higher test scores than analytic Aims: Few studies have compared different instructional learners when using the SRA, and that wholists would methods in Web-based learning (WBL) or evaluated the prefer the SRA more than analytics.

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Work: Medical students and internal medicine and family submissions and random quiz exams with real time full medicine residents completed the Cognitive Style Analysis results. Students can access the platform by a common and then completed a WBL course in complementary and web browser to experience a new way to enjoy studying alternative medicine. Participants completed the SRA for and keep in touch with teachers without geographical one randomly assigned module. Results: 71 participants limits. The system traces every student’s actions in order consented. The difference in test scores between use to create an historical student curriculum. TestNet is an (78.7%) or nonuse (77.5%) of the SRA was small and integrated and complete learning experience offering nonsignificant (p=.463). Cognitive styles were not significant advantages for undergraduate/postgraduate associated with test scores. Participants with intermediate medical students and teachers. wholist-analytic style preferred the SRA more than analytics (p=.006). Medical students preferred the SRA while residents did not (p=.002). 4L 4 Building assessment into a VLE-based programme for clinical educators Conclusions: The SRA did not influence test scores as expected. Cognitive style influenced preference, but not Andrew Sackville and David Brigden (Mersey Deanery for test scores. Postgraduate Medical and Dental Education, Edge Hill College of Higher Education, 7 Rutland Crescent, Ormskirk L39 1LP, UK) 4L 2 Critical appraisal of the effects of a virtual The authors have been instrumental in developing a learning environment in a PBL Postgraduate Certificate and an MA in Clinical Education undergraduate medical curriculum over the last five years. These programmes have primarily used a virtual learning environment for delivery, although Bas A de Leng*, Diana H J M Dolmans, Arno M M Muijtjens and Cees P M van der Vleuten (University of Maastricht, optional contact days also form part of the package of Department of Educational Development and Research, PO blended learning. Some of the challenges facing the authors Box 616, Maastricht 6200 MD, NETHERLANDS) in the design and delivery of the programmes have revolved around assessment. Background: In September 2003, Maastricht Medical School joined the other faculties of Maastricht University The challenges included: a) The need to build in in using BlackboardTM Virtual Learning Environment (VLE). assessment which was “real” for the participants; b) The The VLE is integrated in the existing PBL curriculum. It need for assessment which was “manageable” for part- supports as an intranet application both face-to-face and time participants; c) Using assessment forms which computer mediated tutorial group discussions, students’ encouraged the use of the VLE and electronic resources; self-study activities following these discussions and course d) Ensuring that Masters-level knowledge and higher-order design by teachers. academic skills were demonstrated. The presentation will focus on some of the solutions adopted by the authors, Work done: In December 2004, 1.5 years after VLE was including using online tasks formatively on a weekly basis implemented, we evaluated its use. We surveyed year 1 to build into a cumulative summative assessment portfolio; and year 2 students about the perceived educational the role of negotiation in determining the detailed benefits from VLE with regard to the 3 different phases of assessment tasks; incorporating peer observation and the PBL process: preliminary discussion of a problem, self- collaborative learning into assessment schemes; etc. The study and reporting the results of self study. The focus authors demonstrate that it is possible to organise an was on the effects of the VLE on both group interactions assessment package which adopts innovative solutions to and the consultation of information resources. assessment challenges, but which still ensures that Conclusion: In the perception of students the VLE Masters-level standards are met. stimulated face-to-face interaction in the tutorial group, but didn’t stimulate asynchronous communication at a distance during self-study. 4L 5 AAMC MedEdPORTAL – providing online resources to advance learning in medical Take-home message: In order to exploit the potential of asynchronous computer mediated communication to bring education the discussion started in the preliminary meeting to a Robby Reynolds (Association of American Medical Colleges deeper level during self-study, one has to apply this (AAMC), 2450 N Street, N.W., Washington DC 20037-1127, technology critically and deliberately. USA) In an effort to improve the health of patients and 4L 3 TESTNET: a bridge between teachers and populations through dissemination of peer-reviewed educational materials the Association of American Medical students Colleges (AAMC) has launched MedEdPORTAL – Providing Elisa Talini*, Andrea Bertini and Davide Caramella (University Online Resources To Advance Learning in Medical of Pisa, Department of Diagnostic and Interventional Education. MedEdPORTAL (www.aamc.org/mededportal) Radiology in Pisa, via Roma 67, Pisa, ITALY) is a web-based tool that promotes collaboration across The demand of distance learning and interactions between disciplines and institutions by facilitating the exchange of teachers and students provided by the World Wide Web peer reviewed educational materials, knowledge, and suggested the creation of TestNet at the University of Pisa, solutions. Through MedEdPORTAL faculty and medical Faculty of Medicine. TestNet, a web based platform realized schools may both publish and share instructional and with Open Source J2EE technology and MySQL database assessment materials. MedEdPORTAL is actively soliciting server, is intended as an interactive system to share and instructional materials, assessment tools, faculty deliver medical learning concepts. TestNet gives teachers development resources, and virtual patient cases. This the opportunity to create, customize and manage on-line short communication or poster will provide an overview of courses providing e-learning resources, multimedia the MedEdPORTAL system, including examples of various documents, quiz (multiple choices, drag & drop, fill the types of materials and the submission and peer review gaps), live lectures and live students support (individual process. Participants will be encouraged to consider their on-line meeting with teachers). A section is reserved to own educational resources and identify potential items manage in-house exams, providing students’ on-line exam which may be suitable for submission to MedEdPORTAL.

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Short Communications 4M Portfolios in teaching and assessment 2

4M 1 Conditions for successful use of portfolios 4M 3 Portfolio interviews – a useful assessment for reflection strategy E Driessen*, K Overeem, J van Tartwijk and C van der Vleuten V C Burch* and J L Seggie (University of Cape Town, (Maastricht University, Faculty of Medicine, Department of Department of Medicine, J Floor, Old Main Building, Groote Educational Development & Research, PO Box 616, Maastricht Schuur Hospital, Observatory 7925, SOUTH AFRICA) 6200 MD, NETHERLANDS) Aim of presentation: The resource-intensive nature of Aim: In this presentation we address the question: “what portfolio assessment limits widespread use. Examination are the conditions for successful reflective use of portfolios times exceeding 90 minutes per candidate are reported. in undergraduate medical education?” We describe a less time-consuming method of portfolio Summary of work: We designed a portfolio that was aimed assessment. at stimulating reflection in early undergraduate medical Summary of work: Fourth year medical students (n=181) education, using experiences described in the medical recorded 25 patient encounters during a medical clerkship. education literature and elsewhere. Conditions for reflective The portfolio of encounters was examined by single- portfolio use were identified through interviews with 13 examiner interview. Four randomly selected cases were teachers (mentors), experienced in mentoring students discussed using structured questions; responses were who were developing their portfolios. The interviews were scored using a global rating scale. Pearson’s correlation analysed according to the principles of grounded theory. co-efficient, Cronbach’s alpha co-efficient and the standard Results: The conditions for successful reflective use of error of measurement (SEM) of the assessment tool were portfolios that emerged from the interviews fell into four determined. categories: coaching, portfolio structure and guidelines, Summary of results: The mean (+/- SD, 95% CI) score relevant experiences and materials, and summative achieved was 67.5% (+/- 10.5, 66-69.1). The correlation assessment. According to the mentors, working with a co-efficients for the interview, when compared to written portfolio designed to meet these conditions will stimulate and clinical examinations, were respectively 0.42 and 0.37. students’ reflective ability. Cronbach’s alpha co-efficient was 0.88 and the SEM was Conclusion: This study shows that portfolios are a 3.6. potentially valuable method to assess and develop students’ Conclusion /take-home message: Single-examiner portfolio reflective skills in undergraduate medical training, provided interviews, using standardised questions scored with a certain conditions for effective portfolios are recognised global rating scale, are reliable, broaden the spectrum of and met. Portfolios have a strong potential for enhancing assessment and require less examination time per learning and assessment but they are very vulnerable and candidate. This represents a useful addition to the existing may easily lead to disappointment. Before implementing array of patient-centred assessment tools. portfolios in education, one should first consider whether the necessary conditions can be fulfilled. 4M 4 Evaluation of the use of a group portfolio in community work in the second year of 4M 2 Portfolio assessment: the influence of medicine, University of Valparaiso different elements on final results Peter McColl*, Pamela Eguiguren, Ernestina Esparza, Silvia Hanke Dekker*, Johanna Schönrock-Adema, Jelle Geertsma Ulloa and Jorge Gregoire (Universidad de Valparaiso Chile, and Janke Cohen-Schotanus (University Medical Centre Calle Pedro Montt 217 Depto 3, Recreo, Viña del Mar, CHILE) Groningen, Faculty of Medical Sciences, Research and Development in Medical Education, A. Deusinglaan 1, Aim of presentation: Obtain the opinion of the students in Groningen 9713 AV, NETHERLANDS) relation to the use of a Group Portfolio as an evaluation tool and significant learning. Background: The portfolio of our medical school consists of the following elements: personal profiling, assignments Summary of Work: Ten groups of 6 students carried out a and professional behaviour. All elements are assessed. The community work evaluated by a group portfolio. At the score on personal profiling is a global score, on the end of the course, an anonymous questionnaire was assignments it is an overall score based on three applied, with questions and closed answers from 1 to 5 measurements and on professional behaviour the score is Likert Scale, and questions with open answers. the average of several measurements. These three scores Results: Likert scale 5-4 points: Porfolio contributed to my are merged into the final result. The question is: which significant learning: 55,2%; Porfolio as a tool of evaluation element influences the final results most? of my learning: 50,0%; Portfolio contributes to think on What was done?: For this study 402 portfolios of first year academic work. 57,0%; Portfolio contributes to team work: students are analyzed. The final results were assessed 69,0%. 100% informed that the aim of the course was and the influence of the elements is determined by means fulfilled. Open answers: The group portfolio allowed them of a stepwise linear regression analysis. to review their experience, their thoughts and to make decisions. They perceive that the teachers value more Conclusions: The final portfolio results were: unsatisfactory quantity than quality in their compiled work. A positive for 8%, satisfactory for 64% and good for 28%. The evaluation of the stimuli for team work. Contributes to analysis showed that personal profiling explained 44% of improve coordination, distribution of tasks, the variance, the assignments explained 21% and complementation, leadership, overcome conflicts and professional behaviour explained 7%. It was disappointing different views. that professional behaviour has so little influence on the final results. A possible explanation is that the procedure Conclusions/take-home messages: Look out for the of averaging gives imbalances in the final results. emphasis which is valued in documented material v/s work performed in site. Contribute to team work. The experience Take-home message: In determining final results it is better obtained in the community undoubtedly was a good source to use original global scores instead of scores which are of significant learning. For this reason we recommend to the results of averaging procedures. continue with its use, but to introduce important changes in their form and use.

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4M 5 Evaluation of medical students’ reflective students re-rated themselves against their original criteria. learning: use of Ideal Self Inventory They could then amend their descriptors, and rate themselves against their new criteria. Isobel Braidman* and Ioan Davies (University of Manchester Medical School, Division of Laboratory and Regenerative Preliminary Results: Of 51 randomly selected students, Medicine, Stopford Building, Oxford Road, Manchester M13 61% amended their descriptors after the first year. We 9PT, UK) defined 8 major categories of student descriptors, of which We have recently introduced Professional and Personal “organisational activities” was the largest. A small Development Portfolios (portfolios) to first year students, proportion already used metalearning/reflective descriptors in which they combine evidence for developing skills with (3.2% of all descriptors), as early as their first session, reflective learning practices. Reflection on learning and which doubled by the last session, contrasting with non- individual development, however, is unfamiliar to most first medical students, who did not generate these criteria at 2 year students. an equivalent stage . Aims: Establish how medical students describe their Conclusions: These early observations indicate the richness learning and development. Ascertain whether this changes of information provided by this study, which encourage us over their first year of portfolio activity. to use the Ideal Self Inventory in evaluating development of metalearning, reflection and student self perceptions. Summary of work: We employed the “Ideal Self Inventory”1 1 used to analyse Personal Development of non-medical Norton LS, et al 1995 Counselling Psychology Quarterly students2. All first year students (N=380) provided 5 8(4):305-310. descriptors of a “very good medical student” in their first 2Walters D, Norton LS 2004 ILTHE Annual Learning and portfolio session, against which they rated themselves on Teaching Conference, University of Hertfordshire, pp 53. a 6 point scale. In their last portfolio session of the year,

Short Communications 4N Different approaches to evaluating a curriculum

4N 1 A systematic process for applying reflective change. One wants to know if students distribute their practice principles to course improvement time proportionally over the different blocks of the curriculum and spend it in the appropriate learning context. S. Beth Bierer*, Elaine F Dannefer and Alan L Hull (Cleveland Clinic Foundation, 9500 Euclid Avenue, NA 25, Cleveland, What has been done: In the academic year 1999-2000, Ohio 444195, USA) together with the introduction of a new medical curriculum Background: Our course directors adopted a systematic Ghent University developed a method for detailed study process to monitor and improve a new medical school time measurement. With this method the time spent on program by simultaneously applying the principles of different courses is measured, and also the type of learning program evaluation and the principles of reflective practice activity and the extent to which innovative and up-to-date during and after each course. learning tools are used. What Was Done: A four-step process was implemented to Ten groups of students, proportionally representing each (1) collect pertinent information from stakeholders (student educational group and gender, recorded 4 weeks of the ratings of courses and teaching effectiveness, student academic year on a structured form of 48 blocks of half an performance assessments, student focus groups, weekly hour. faculty meetings), (2) analyze and interpret this information Results: Participation varied between 65 and 90%. No in a timely manner (written reports and faculty discussions), difference was found between the results of the same (3) make judgments about course effectiveness (course blocks registered by two cohorts of students of consecutive director report and action plan), and (4) improve teaching academic years, and only moderate differences were found and learning practices (report course improvements to by comparing results of different random samples of stakeholders, inform planning for faculty development individual students. initiatives). Conclusion/take home messages: With this method valid, Conclusions: Faculty and students have embraced the reliable and detailed information could be gathered, of course evaluation process as evidenced by their active extreme importance for all involved in the new curriculum participation in information-gathering and the course design. directors’ insightful improvement plans submitted to the curriculum council for approval. 4N 3 A graduate visiting project and focus group Take Home Message: A systematic, reflective practice interviews: what did we learn from trips? approach to course evaluation provides opportunities to encourage both faculty and students to reflect on course P Supasai*, Y Tongpenyai, P Ambua, S Ambua, P Thanomsingh delivery and outcomes, thereby resulting in timely and and T Himman-ngan (Maharat Nakhon Ratchasima Hospital well-informed strategies to improve undergraduate medical (MNH), The Medical Education Center, School of Medicine, curricula. 49 Changpeuk Road, Muang District, Nakhon Ratchasima Province 30000, THAILAND) Objective: To gather inputs for medical curriculum revision 4N 2 Development and validation of a prospective, from an evaluation of graduates’ performance and random sample method for measuring study- competency. time and learning context: data of 8,326 24- Design: Qualitative study based on focus group interviews. hour registrations from 347 medical students during four academic years Method: A half day visit for each hospital was done. Three groups of participants were interviewed separately, J Van der Veken* and A Derese (Ghent University, Faculty of physicians, nurses and other health personnel, and Medicine and Health Sciences, Centre for Education graduates. Participants were asked their opinions on Development, University Hospital, 3 K3 De Pintelaan, Gent graduates’ performance and competency, the MNH medical B-9000, BELGIUM) curriculum, and suggestions for improvement. Purpose of the study: Monitoring study time and learning context is especially meaningful after a thorough curriculum

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Results: There were 18 hospitals in 3 provinces, 54 (18 x findings and sources – literature, accreditation reports, 3) interview sessions, 58 physicians, 86 nurses and other benchmarking exercises, internship performances. health personnel, and 36 graduates participated in the Complementing these data, two surveys of alumni and focus group interviews. In general, all participants were students identified significant concerns that these groups satisfied with the MNH graduates’ performance particularly had or were experiencing with their medical education. in professional habits and procedural skills. They suggested The first survey focused on the adequacy and that the most required characteristics of rural doctors are appropriateness of content and pedagogy in basic and responsibility and adjustment to colleagues and clinical sciences and the second on adequacy of their clinical communities. Medical knowledge becomes less of a priority skills development. These data included both quantitative but also important. and narrative feedback. Concerns that were consistently identified across years in the medical programme and by Conclusion: Graduate visiting consumed much effort; both students and alumni cross validated many of the however it resulted in fruitful information that helps the conclusions drawn from other investigations and sources. MNH in medical curriculum improvement. Feasibility is As importantly, this feedback from students and alumni questionable if the number of graduates and hospitals were found to be a surprisingly effective tool in marketing increases. the need for curriculum revisions to teachers and for mobilizing their participation in planning curriculum 4N 4 Factors influencing academic achievement of revisions and adopting new pedagogical methods. The medical students in the basic medical sciences resulting sense of increased ownership has led to a more successful implementation of the revised curriculum and Khalid Bin AbdulRahman (King Saud University, College of improved pedagogical methods. The importance of Medicine, Medical Education Center, PO Box 2925, Riyadh soliciting and using student and alumni input in this process 11461, SAUDI ARABIA) of change was itself an important finding within the region. Objectives: To explore the medical students’ views about the important factors that may influence their academic achievement in basic sciences education. 4N 6 Progress testing as a curriculum- independent instrument for curriculum Methods: A survey questionnaire was developed based on the analysis of a focus group session with six third year evaluation students. The five point Likert scale was used to measure J Van der Veken, A Derese*, L Schuwirth and J de Maeseneer the responses of students about the top twelve factors (Ghent University, Faculty of Medicine and Health Sciences, that negatively and positively interfere with their academic Centre for Education Development, UZ 3 K3 De Pintelaan 185, achievement. Gent B-9000, BELGIUM) Results: Out of 606 distributed questionnaires, 409 Aim of presentation: Demonstrate the value of Progress (67.5%) were returned. The top three important factors Testing as an instrument to compare the old and new that negatively interfere with their academic achievement medical curricula of Ghent University. were: the huge amount of lectures (89.5%), the Summary of work: Over the past 6 years, all students of disintegration between basic science courses (85.1%) and the first 6 study years participated in the December edition the absence of study guides for all courses (84.8%). of the Maastricht Progress Test. This coincided with the Moreover, the top three factors that positively enhance introduction of a new, modular and integrated curriculum their academic achievement were, the horizontal in 1999. Of the three chapters of the Progress Test we integration between basic sciences courses (93.2%), the only present the results on “basic (biomedical) sciences” presence of study guides for each course (90%) and and “clinical sciences”. The scores of Maastricht students improvement of lecturing skills of basic science teachers are used as reference points. (89.2%). Summary of results: Participation was about 90% in each Conclusion: It was obvious from the current study that year. For basic biomedical sciences the students of the old our basic sciences curriculum has to be changed from curriculum scored significantly lower in their 2nd and 3rd conventional to innovative approaches. year; from the 4th year they score significantly higher than those of Maastricht. For clinical sciences all years of the old curriculum score significantly lower. The students of 4N 5 Using student and alumni input in the new curriculum scored better on both chapters: for curriculum planning basic biomedical sciences they score from year 3 on higher Clarke B Hazlett (The Chinese University of Hong Kong, than Maastricht; for clinical sciences the scores are only Faculty of Medicine, Office of Educational Services, 9A, Block lower in the third year. B, Prince of Wales Hospital, Shatin, New Territories, HONG KONG) Conclusions/take-home messages: Progress testing is a valuable tool for curriculum comparisons within, and As a precursor to planning major curriculum revisions, a probably also between, medical faculties. medical school in Asia was informed by several relevant

Short Communications 4O Postgraduate assessment

4O 1 A behavioural rating system for surgeons’ technical skills. We have previously described the analytic non-technical skills techniques used to determine the critical non-technical skills required to complement technical competence and S Paterson Brown, N Maran*, S Yule and R Flin (Scottish maintain safe performance in the operating theatre. Clinical Simulation Centre, Stirling Royal Infirmary, Livilands Gate, Stirling FK8 2AU, UK) Work done: The NOTSS (Non-Technical Skills for Surgeons) skills taxonomy comprises 14 non-technical skill elements Background: Recent studies suggest that adverse events in surgery are more often caused by breakdowns in non- reflecting interpersonal and cognitive skills. Four technical skills, such as communication and teamworking, independent panels of consultant surgeons provided than failings in technical proficiency. Despite this evidence, example good and poor behaviours for each element of the major focus of surgical training and assessment is on the NOTSS skills taxonomy. A further multidisciplinary group

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reviewed the resulting behaviours and selected 3-6 for performance, anaesthetists consistently overrated their each element. Behaviours are described as active verbs performance compared to those performing at higher levels and must be observable or able to be inferred through (p=.0001). Results will be related to the existing communication.Conclusions: The prototype behavioural literature.Conclusions: Simulation can reliably test marker system comprises 122 indicative behaviours anaesthetists’ ability to manage emergencies but multiple selected from those generated. A 4-point rating scale was cases are required. The disparity between self-assessed selected. The reliability of the system is currently being and judges’ scores has implications for optimising learning tested using standardized videos. If reliable, the system from simulated clinical experience. may be used to rate and provide feedback on surgical non-technical performance in the operating theatre. 4O 4 How to evaluate physician-in-training professional growth. The RIME framework 4O 2 Mini-PAT (Peer Assessment Tool): can a approach for professional development multisource feedback tool be a reliable and during residents’ rotations in critical care feasible component of a national medicine assessment programme? A Pais de Lacerda*, Zélia C Silva and Carlos França (Hospital J Archer*, J Beard, J Norcini, L Southgate and H Davies de Santa Maria, Intensive Medicine Department, R. Prof. (University of Sheffield, Medical Education Research Building, Carlos Teixeira, No1 – 50C, Lisboa 1600-608, PORTUGAL) Floor D, Stephenson Wing, Sheffield Children’s Hospital, Western Bank, Sheffield S10 5ND, UK) Aims: Assessing residents’ performance when under supervision, during clinical rotations, has been regarded Aim of Presentation: To explore whether mini-PAT derived as “subjective” and difficult. Our purpose was to use the 1 from SPRAT is reliable and feasible for use in early RIME (Reporter-Interpreter-Manager-Educator) evaluation postgraduate training. synthetic framework to assess physician-in-training Summary of Work: mini-PAT was piloted initially in one professional development during a critical care rotation, Deanery to evaluate the clinical performance of Foundation in order to stimulate learning and to improve professional trainees. It is a questionnaire mapped to GMP2 and the competence evaluation. 3 draft MMC curriculum . To evaluate reliability, 95% CI for Methods: A “Professionalism-Evaluation-Form” (PEF) was mean ratings were calculated based on Generalisability developed integrating the professional competencies theory. Feasibility was explored by examining the time taken (ACGME) required to meet the defined developmental to complete and the response rate. levels of critical care knowledge and performance goals, Summary of results: Fifty-eight trainees were assessed to under the RIME framework, towards a more inform their training. 62% of their proposed raters “comprehensive global assessment” of residents. All house completed a mini-PAT form. Doctors’ overall mean scores staff evaluators, who had directly observed his/her ranged from 3.68 to 5.41 (mean 4.55, SD 0.36). 67% of everyday performance, evaluated each resident. doctors required only 4 raters to achieve a reliable score. Results: When used at mid-rotation period, this descriptive The mean time taken to complete the questionnaire by a assessment approach proved to be of great value to the rater was 7 minutes. residents, identifying areas for improvement, driving Conclusions: Using 95% CI the majority of doctors will learning, and reinforcing competence standards need only 4 raters to assess them reliably. mini-PAT appears expectations. Both physician-in-training and house staff/ a reliable and feasible way of assessing large numbers of faculty considered the PEF a useful evaluation tool for doctors to support training programme quality assurance describing and fostering residents’ professional growth. procedures. Take-home message: Assessment of residents continues 1Archer J C, Norcini J J, Davies H A. Peer review of to be a challenge to faculty/house staff in the realm of paediatricians in training using SPRAT. BMJ 2005;In press. professionalism. This task can be improved with a mid- 2Good Medical Practice. London: General Medical Council, rotation qualitative evaluation integrating expected 2001. competencies within the RIME scheme of professional development, providing the residents with a timely and 3http://www.mmc.nhs.uk/curriculum.asp?m=3. meaningful feedback.

4O 3 Psychometric characteristics of simulation- 4O 5 Acceptability and impact of postgraduate based assessment in anaesthesia progress testing: trainees and tutors views J Weller*, B Robinson, B Jolly, L Watterson, M Joseph, S Bajenov, A Haughton and P Larsen (University of Auckland, M G K Dijksterhuis*, L W T Schuwirth, J G Nijhuis, G G M Faculty Education Unit, Faculty of Medical & Health Sciences, Essed, D D M Braat and F Scheele (Ikazia Hospital, Private Bag 92019, Auckland, NEW ZEALAND) Nieuwehaven 93, Rotterdam 3011 VN, NETHERLANDS) Aim: Simulation may be useful for competence assessment. Aim of Presentation: Progress Testing is especially praised The purpose of this study was to determine the for the possibilities it offers for feedback to student, tutor psychometric properties of simulation-based assessment and training-program. We studied acceptability and in the context of emergency management in anaesthesia. educational impact of Postgraduate Progress Testing. Summary of work: Following ethical approval, and a Summary of Work: Both trainees and tutors received a systematic literature review, 21 anaesthetists undertook 3 questionnaire about educational impact and acceptability standardized simulated anaesthetic emergencies. The 63 of yearly Progress Testing. videotaped scenarios were rated independently by 4 Summary of Results: The response rate was 99% for judges. Using generalisability theory, we determined the trainees and 80% for tutors. They both agreed to the influence of subject, case and judge on the variance in statement that yearly Progress Testing should be continued judges’ scores, and the number of cases and judges needed and obligatory. They also agreed that adequate assessment for a reliable result. Self-assessed scores were compared during medical specialist training is crucial. Both trainees to the mean judges’ score. and tutors agreed that the results of Progress Testing could Results: An acceptable generalisability coefficient was be useful during the in-training evaluation, but only few obtained using 4 judges and 10-15 cases. More was gained indicated actually doing so. Neither tutors nor trainees by increasing the number of cases than the number of changed their training-program or study-behavior because judges, in terms of test reliability. We found a modest but of the results of the Progress Test. significant correlation between self-assessed and externally rated scores (rho=.321, p=0.01). At the lower levels of

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Conclusions: We conclude that the Postgraduate Progress we have chosen besides a practical skill assessment a Testing in our study group is well accepted. However, the computer-based key-feature exam for the first time. Via impact on education represented by impact on in-training key-feature approach we tried to assess clinical decision evaluation, study-behavior and training-program is making and procedural clinical knowledge. This method miserable. We think there is a lot to gain from both teaching and the application as an assessment tool was developed the tutors how to use the results during the in-training in Canada and described in 1985 by Page and Bordage for evaluation and emphasizing self-analysis in trainees. the first time. Method: Using the catalogue of important learning 4O 6 Computer-based key-feature exam – objectives the students had to solve 10 major key-feature emergency care medicine problems with altogether 30 dependent questions. These important learning themes were picked by a faculty Th. Boeker*, C Grube, K Brass and H Bardenheuer (University committee and transformed into clinical cases. In contrast of Heidelberg, Schillerstrasse 16, Heidelberg D-69115, to the semesters before this exam was approved computer- GERMANY) based. Introduction: After implementation of new training Results: The experiences and the impressions of the regulations in the new “Arztliche Approbationsordnung” students of this new assessment by using a questionnaire in Germany in 2002 emergency care medicine became an is described and chances of computer-based assessment independent department with separate grades. Therefore were exemplified and discussed.

Workshops 4R, 4T & 4U

4R Learning to teach: Peer Assisted Learning in Background: What are effective methods to implement the medical curriculum large-scale curriculum change? There are theories and there are realities of such processes. Both are important Michael Ross1, Phillip Evans1, Katie Gowing1, Kirsty Ross1, 2 2 1 considerations in the many jurisdictions around the world Paul de Roos and Salmaan Sana (University of Edinburgh , that have moved to develop, adapt, and implement UK and Vrije Universiteit2, Amsterdam, Netherlands) competency frameworks for medical education. Putting Background to the topic: The General Medical Council in into practice this new approach poses a series of challenges the UK now require undergraduates to have experience of for medical leaders and educators. The Royal College of teaching, however techniques for achieving this are not Physicians and Surgeons of Canada has been implementing widely reported. This workshop will explore Peer Assisted its framework of needs-based competencies, called the Learning (PAL) which has been used in some medical CanMEDS Project, for more than a decade. Now in Phase schools as a means by which students can gain knowledge 4, it is releasing a new version this fall. and experience in this field. Workshop content & structure: In this session, participants Workshop content and structure: We will start by discussing will enhance their ability to implement competency some proposed learning outcomes for medical curricula frameworks. Using a combination of interactive discussion relating to teaching and build a framework for addressing and activities, we will present the theoretical basis of these. Participants will then be invited to consider in small implementing curriculum change, the strategies used for groups how different aspects of learning to teach could CanMEDS, and lessons learned from the realization of the be developed in their medical courses and will present CanMEDS Roles framework across 62 specialties on a their findings to the group. Finally students will discuss national scale. We will also provide participants a sneak from personal experience two of the PAL approaches which preview of the new “CanMEDS 2005” framework. have been used successfully at Edinburgh medical school Intended outcomes: By the end of this session, participants (the Student Peer Learning-Incident Technique “SPLIT” will be able to: and Peer Tutoring Programme), and we will discuss some other examples from the literature. 1. Describe CanMEDS and other competency frameworks Intended outcomes: Participants will appreciate more of 2. Describe 3 theoretical approaches to implementing the issues around helping medical students learn to teach. curriculum change Participants will have had an opportunity to discuss some 3. Describe the process and strategies of implementation of the issues and share some of the experiences of students of the CanMEDS Roles in Canada who have participated in peer assisted learning and 4. Apply the information provided to a curriculum change teaching. Participants will develop a framework for they are considering in their own context. addressing some of these issues in their own curricula. We will construct a summary of the workshop findings Intended audience: All medical educators, with a special and conclusions, and will circulate this to participants by emphasis for those who are, or who will be, implementing e-mail shortly after the conference. competency-based frameworks in their medical education Intended audience: All those who are considering systems. developing or participating in peer assisted learning, as Level of workshop: All levels, from beginner to advanced. well as staff with responsibilities for curricular development and student support. 4U Supporting trainers in promoting Level of workshop: All levels. professionalism Andrew Long, Kit Byatt, Gordon Jackson, Andrew Jeffrey and 4T Implementing Competency Frameworks in Liz Spencer. National Association of Clinical Tutors, 56 Queen medical education: theory and lessons from Anne Street, London W1G 8LA, UK the CanMEDS Project Background to the topic: There are growing concerns in Jason R Frank and Nadia Z Mikhael (Royal College of the UK, reflected internationally, about an apparent decline 1 Physicians and Surgeons of Canada) in professional standards within the medical profession . One of the aims of Modernising Medical Careers, the current

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reforms to Postgraduate Medical Education within the UK, that are responsible for managing medical education to is to “ensure that professional attitudes and behaviours ensure that medical professionalism is valued and taught are embedded in clinical practice”2. This places a within our institutions. It may be possible to develop a responsibility on those that are providers of medical matrix of Knowledge, Skills and Attitudes against teaching education, either as trainers or as educational managers methods (eg Directors of Postgraduate Medical Education) to ensure Intended audience: Although this workshop is primarily that professional values are actively promoted through aimed at Directors of Postgraduate Medical Education it teaching and role modelling. will interest all those that have a responsibility for teaching Workshop content and structure: Through presentation healthcare students about professional values in medicine. and small group work with experienced facilitators this Level of workshop: Intermediate. It is recommended that workshop will aim to define the knowledge, skills and participants should have some background knowledge of attitudes necessary for teachers to promote the concepts the issues being discussed. of professionalism in medicine. The session will endeavour to identify the challenges relating to issues of medical 1. Bligh J. Professionalism. Med Educ 2005; 39:4 professionalism in undergraduate and postgraduate 2. Department of Health (2005) Curriculum for the training within the UK and compare current issues to those foundation years in postgraduate education and training. prevalent in other parts of the world. Department of Health, London Intended outcomes: The intentions are to share knowledge, identify best practice and thereby equip those

Posters 4 Onyx 1 Clinical teaching and learning

4 Onyx 1.1 Methods: The purpose of this descriptive-analytical study, Course concept for small group teaching in was to determine the three levels of clinical skills including: clinical urological methods for first clinical Must learn (ML), Useful to learn (UL) and Nice to learn (NL) skills in last year nursing students (N=40); to year students determine the level of mastery in each skill; and the method U Zimmermann* and K-J Klebingat (University Greifswald, of learning. Subjects were selected by purposive sampling. Department of Urology, Fleischmannstrasse 42-44, Greifswald Data were collected by a two-part questionnaire, including 17487, GERMANY) demographic data, diagnostic procedures, site, methods Objective: Lower urinary tract symptoms are relatively of learning and, finally the level of mastery in each uniform but point to various diseases. Communication procedure. The data were statistically analyzed using SPSS about these symptoms is difficult because the patient gives software. no clear statements. Furthermore, to differentiate between Results: The results revealed that the highest level of illnesses it is essential to make additional investigations mastery was related to «Must Learn» skills (Mean: 85). that could be uncomfortable. The goal of a course was to This revealed that most of the nursing students had learned teach communication skills and investigation methods to basic nursing skills. However, our data showed the higher differentiate diseases in a correct manner. interest of nursing students to perform «high level Method: Three half-day courses for 52 students were procedures» which required the «Nice to learn» skills. performed. In each course were 4 students. Every day Conclusion: Regarding the obtained data, it is concluded started with an introduction seminar followed by practical that there is a need to encourage the instructors to pay work. The practice contains history taking, digital rectal more attention to teach the «Nice to learn» skills in order examination on a model, urinanalysis with dip-sticks and to meet students’ requirements for performing the high ultrasound. The didactic concept, the content and practical level procedures which could result in higher motivation. relevance as well as the personnel practical use were evaluated with a questionnaire. 4 Onyx 1.3 Results: About 95% of participants ranked the didactic concept at the high or highest level. The content and Knowledge, and practice of and attitude to practical relevance was rated at the highest level by 95%. informed patient consent among doctors and All participants ranked the personnel practical use at the medical students in Chantaburi Province high or highest level. K Sawasdichai*, S Kaewtrakarnwong, P Teerakitpisal, R Conclusion: The practice-oriented small group teaching Kitjarak, W Prasongthum, J Pattanapanit and O Mahothorn for lower urinary tract symptoms is a feasible method and (Prapokklao Hospital, Medical Education Center, Leubnoen sensitises students for communication of these symptoms Road, Tumbon, Tachalab, Muang District, Chantaburi 22000, THAILAND) and to perform additional investigation in an adequate manner if needed. Background: Informed patient consent is an essential issue for doctors practising in the proper way. This study was conducted with the hope that it could help design a training 4 Onyx 1.2 program in the future. Assessing the clinical skills of nursing Summary of work: This was a descriptive study using 164 students questionnaires distributed to sixth-year medical students Sakineh Shahsavari Esfahani* and Leila Mosallanegad (20), interns (17), general practitioners (24) and specialists (Jahrom School of Medical Sciences, Motahari Street, Fars, (103). Jahrom 74148, IRAN) Summary of results: 142 of 164 questionnaires were Background: Licensed nurses are required to have a completed by 85 males and 57 females. Of the 142 working knowledge of standards. In this study we assessed responders, 71.4% had average knowledge about this three levels of clinical skills among nursing students in issue. There were no significant statistical differences in Jahrom School of medical sciences. the knowledge between sexes and studied groups. The topics which were answered incorrectly by most responders

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were the exact age that a patient could give his or her score showed a positive attitude in 1st-3rd semester but own consent (77.5% of the responders) and the patient’s not in the 4th. right in selection of choices of treatment for their own Conclusions: Students improve their attitude regarding illness (61.3% of the responders). Information from the emotional aspects of disease and death but not for primary questionnaires also showed that doctors had not paid care, mental disorders, research and other medical aspects. enough attention to the informed patient consent during Attitude regarding mental disorders had the worst score. their hospital practice and most responders were all in agreement that they should pay more attention to this important issue. 4 Onyx 1.6 Conclusion: Some doctors including medical students had Influence of gender on medical students’ incorrect understanding about the exact age that a patient practical skills could give his or her own informed consent and also M Karami, A Shakurnia, P Asadollahi* and M Haghirizadeh wrongly understood that a competent adult patient could (Ahvaz Joundi-shapour University of Medical Sciences, EDC be treated against his or her will. These misunderstandings Educational Affair, Golestan Ave, Ahvaz, IRAN) should be emphasized in the future training program. Background: Until a few decades ago, the educational opportunities for women were restricted. In recent years 4 Onyx 1.4 in Iran, admission rate of women entering universities not Development of clinical decision making in only has been increased, but also their chance of admission veterinary medicine is more than men. The mean of the total average of scores obtained by female students in the educational course has Stephan Ramaekers*, Peter van Beukelen, Hanno van Keulen, been higher than males, but it has been said that men are Wim Kremer and Albert Pilot (University of Utrecht, IVLOS/ more successful practitioner than women. This UU, P O Box 80127, Utrecht 3508 TC, NETHERLANDS) investigation has been done to compare the theoretical Background: To prepare students for real clinical problems, and practical scores between male and female medical the faculty of Veterinary Medicine (University of Utrecht) students. introduced case-based seminars (clinical demonstrations, Summary of work: This research is a cross-sectional study. practicals and case-based discussions) in their curriculum. The theoretical and practical scores obtained by 3 periodic A set of instruments is needed to assess students at various groups (344 individuals) of men and women were collected levels and monitor their development of competence in and then analyzed by SPSS software and chi square test. clinical reasoning and decision making. One of the key elements is how novices (4th year), advanced students Summary of results: Statistical analyses of data do not and experienced veterinary clinicians coordinate the various indicate any significance between theoretical and practical kinds of knowledge in solving clinical problems. scores obtained by men and women. In other words, the ability of men and women in learning theoretical knowledge What was done: On the basis of the research literature and gaining practical skills is approximately similar, although concerning clinical reasoning in human medicine and the mean of the total average scores obtained by female observations of 4th-year students a first draft of an students has been higher than males. observation instrument was made. To validate the instrument and tune it to the domain-specific circumstances Conclusions: There seem to be no difference between the of veterinary medicine, the instrument is tested on levels of theoretical practical skills of students according experienced clinicians (performance analysis using to gender, but in general, female students have higher ‘Observer’ software). total average scores and better educational improvement in comparison to male students. Conclusions: The processes of gathering and interpreting information, and drawing conclusions how to proceed require interactions between declarative and procedural 4 Onyx 1.7 knowledge. The strategy used to solve a particular clinical What attributes correlate with medical problem largely depends on the extent of uncertainty and students’ ease of transition into the clinical pressure on time. Reducing the degree of authenticity environment? (paper-based case versus real patient) directly affects the strategy and the kinds of knowledge used. J Shacklady*, I Davies and T Dornan (79 Standfield Drive, Worsley, Manchester M28 1WB, UK) Aims: Report some correlates of students’ ease of transition 4 Onyx 1.5 from pre-clinical to clinical studies. Changing attitude at clerkship rotation Method: Eleven weeks after entering the clinical Isabela M Benseñor*, Eliane R Tomic, Patrícia L Bellodi, environment, 209 students were asked to Likert-rate and Milton A Martins and Maria de Fátima A Collares (University comment in free text on how well their experiences both of São Paulo, Faculty of Medicine, Rua Paris 381, São Paulo inside and outside medical school had prepared them for CEP 01257 040, BRAZIL) clinical learning. Their textual responses, independently Background: We evaluated changes in the attitude of rated by two researchers as positive, negative, or neutral, students during clerkship rotation using a Likert scale were treated as a dependent variable with gender, age, developed at USP-RP, applied twice a year. place of preclinical study and prior academic achievement Methods: The scale evaluated the attitude of the students as independents. regarding emotional aspects of disease (factor-1); death Results: 78% students gave valid responses. 25 completed (factor-2); primary care (factor-3); mental disorders phase 1 in other universities. Students with positive (factor-4); research (factor-5); and other medical aspects transitions were significantly more likely (p<0.05) to be (factor-6). Score < 3.0 suggest negative attitude; between aged over 21 on entry to the course and have completed 3.0-3.9 conflicting attitude; > 3.9, positive attitude. Mean phase 1 locally. Students from a non-PBL preclinical course score was calculated for each factor in 1st-4th semesters were significantly more reliant on experiences inside at clerkship rotation. medical school. Results: For factors 1-4 and 5, mean score reflected a Conclusion: This larger study confirms our previous conflicting attitude in almost all measures; for factor-1 observation that mature students have better transitions, there was a positive increase in mean values from 1st-3rd and suggests that didactic preclinical training increases semester (P=0.03) decreasing at 4th; for factor-2 there students’ dependence on the course. The lack of was a progressive increase from 1st-4th semester association between performance in assessments and ease (P=0.01); factor-4 had the worst score; for factor-6 mean of transition shows progression through medical studies can be measured in many different ways.

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4 Onyx 1.8 Method: In a pilot study, 65 hospital workers were polled Mind set as a critical factor for by means of two sets of six key questions each with regard implementation of teaching principles to learning methods, environment, mentoring and assessment. A B Bijnen, P Kievit*, A E R Arnold, M L C Stikkel and H M Maathuis (Free University Medical Centre, Institute of Medical Results: There was a large measure of concordance Education, and Foreest Institute, Medical Centre Alkmaar, between medical doctors and other personnel. Opinions Studler van Surcklaan 15, Bergen 1861 MA, NETHERLANDS) differed mostly with regard to the responsibilities assigned to trainees. There was a different outlook of trainees and Background: Because of capacity and patient mix, non- specialists towards the usefulness of activities that trainees university hospitals have a dominant role in postgraduate should undertake in organising their own curriculum. teaching in the Netherlands. As health delivery is here the prime task, structuring a clinical curriculum, will mainly Conclusion and take home message: This suggests that rely on the motivation and goodwill of the organisation, responsibilities of trainees should be carefully defined and medical staff and other employees. Implementation of that further efforts to induce change should primarily be frequently time consuming new teaching principles is directed toward a mental congruence of trainees and tutors therefore heavily dependent on the congruity of mind of rather than the other stake holders involved. This the various stake holders involved. hypothesis should be tested in a larger scale investigation.

Posters 4 Onyx 2 Curriculum strategies

4 Onyx 2.1 a dynamic process to address integration of its multiple Interdisciplinary curriculum planning for themes Behavioral Health, Communication Skills, Diversity, subjects starting with ‘psych…’ Ethics, Geriatrics, Integrative Medicine, Pain Management, Palliative Care, Public Health curricula across a four year Katharina R Spatz*, Maria Feldmann and Sebastian Schubert program. (Charité, Universität Medizin Berlin, AG Reformstudiengang Medizin, Schumannstr 20/21, Berlin 10117, GERMANY) Summary of work: At the UNMHSC SOM, a “Cross-Cutting Themes” Task Force was appointed to collaboratively Background/rationale: Subjects dealing with psycho-social identify the status of current cross-cutting issues in the aspects of medicine occupy a special position in the medical curriculum; develop a comprehensive curriculum for each curriculum. Pathophysiological basics, diagnosis, follow- issue and an implementation plan that reduces redundancy. up and therapy differ considerably from somatic clinical A theme content expert developed a comprehensive fields. Many students have difficulties approaching these subject curriculum based on national recommendations disciplines. supported by published references. These curricular What was done?: To introduce students to these fields documents were then integrated into the school of the Reformed Medical Curriculum (RMC) at the Charité in medicine’s desired “Six Core Competencies”. Through Berlin developed a 4-week block named “Psyche & consensus, the Cross-Cutting curriculum was reviewed by Experience” in the fifth semester. The block is taught by the Task Force for gaps and redundancy. A detailed six different disciplines. Using patient paper cases, implementation plan began in August 2004. Impact of this seminars, tutorials in communication skills and real-patient process involves evaluation tools already embedded in the contact in clinics, psychological basics and disorders are ongoing evaluation structure. demonstrated interdisciplinarily. To measure the Conclusions/take-home messages: A sustainable, dynamic satisfaction with this block of students we used students’ process to integrate evolving cross cutting themes into an evaluation results and number of participants in voluntary already established curriculum is feasible. interdisciplinary seminars. To complement the evaluation two students (KS, MF) also performed a teachers’ survey by questionnaire. 4 Onyx 2.3 Conclusions: Students appreciated this block. Participation Enhancing student-centered learning in the voluntary seminars was high. The teacher’s through curriculum change questionnaire revealed above all their satisfaction with the M N Chandratilake*, N R de Silva and N Samarawickrema students, the interdisciplinarity and the organisation. (University of Kelaniya, Faculty of Medicine, PO Box 6, Detailed results will be presented on the poster. Talagolle Road, Ragama, SRI LANKA) Background: In 2004, the curriculum at the Faculty of 4 Onyx 2.2 Medicine, University of Kelaniya, Sri Lanka, was changed ‘Fitting it all in’: Innovative process to from traditional, discipline-based, to integrated, organ- integrate behavioral health, communication systems-based. Making the curriculum more student- centred was an important reason for change. skills, diversity, ethics, geriatrics, integrative medicine, pain, palliative care, Work done: We examined the extent of change achieved, public health across School of Medicine and students’ attitudes towards this change. To assess change in student-centred activities, we compared the curriculum proportion of curricular time set aside for self-directed Judith Kitzes*, Renate Savich, Summers Kalishman and Craig learning (SDL) by students in the first term, between the Timm (University of New Mexico, Health Sciences Center, last batch of students on the old curriculum, and the first School of Medicine, Palliative Care Section, MSC 11 6020, 1 batch of students on the new curriculum. To assess University of New Mexico, Albuquerque 87131-0001, USA) students’ attitudes towards change, we held a focus group Background: Some required components of the medical discussion with 12 students on the new curriculum, and school curriculum apply across all years of medical school. distributed a self-administered questionnaire to the whole Single theme integration is reported widely in the literature. batch. However, the University Of New Mexico Health Sciences Center School Of Medicine (NMHSC SOM) has developed

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Conclusions: Only 2.4% of curricular time was set aside requirements of the State educational standards and the for SDL in the old curriculum, whereas in the new, it was special needs of the country. The new strategy of the 10.8%. However, most students (78%) still felt that time integration purposes and tasks of the study arose. The for SDL was inadequate. Almost all students (85%) used curriculum covered the teaching in the “vertical” (courses) the time as intended by staff, for studying subject matter. and in “horizontal” (subjects) directions. This system helped to avoid wasting time because of duplication of Take Home Message: During the process of curriculum some subjects at the profiled and affiliated departments. change, it is important to ensure that re-scheduled learning activities reflect the original reasons for change. Conclusion: The KSMA has a module system of education experience. There is need for further development of other modules, technical and learning resource materials at 4 Onyx 2.4 KSMA. A survey of students’ opinions about integrated medical learning 4 Onyx 2.6 M H Meshkibaf*, M Hosseinzadeh, A Ebrahimi and M A Integrating prevention in the medical Sahmoddini (Fasa University of Medical Sciences, Ebne Sina Square, Fasa 74615-168, IRAN) curriculum – the role of the 3rd medical year at FCS-UBI, Covilha, Portugal Background: Traditional medical education, which is mainly teacher based, was divided into two different phases J M Calheiros*, M Castelo Branco, I Neto, J Queiroz and J including basic science and clinical practice. It seems that Fermoso (Universidade da Beira Interior, FCS-UBI, Faculdade integrated medical education which combines basic science Ciencias Saude, Covilha 6201-001, PORTUGAL) with the clinical course is a more effective method for The learning process of Preventive Medicine assumes that medical learning. students have full knowledge of previous modules - “Epidemiology/Community Health” and “Primary Health Materials and Methods: We selected 100 medical students Care”. The main objective of this module is to promote at the final stage of their course who have already integration throughout the curriculum. Prevention should experienced both phases of the traditional medical course. be considered as an essential component of the activities A questionnaire was administered to find out their in the clinical setting reducing artificial boundaries between viewpoints and suggestions about medical learning which prevention, cure and care. Students should acquire was mostly focused on the traditional and integrated fundamental knowledge and corresponding attitudes in medical education methods with a view possibly to change the following areas: (a) Identify/characterize the different and improvemedical education. community prevention activities developed in the Results: Out of 102 students 91% considered that the community; (b) Describe the main preventive activities medical course should start with at least one month of considered by the Portuguese National Plan for the observation in health centers (hospitals, polyclinics, following clinical categories and situations: 1. Cancer; 2. laboratories) and 86% considered that a few days of clinical Cardiovascular disease; 3. Infectious disease; 4. Metabolic, observation should be included, starting from the first endocrine and nutrition diseases; (c) Identify/characterize month of their course. 76% would like to observe the the main preventive activities, developed in society as well functioning of clinical laboratories, interpretation of results as in medical practice for integrated risk factor control, etc. behaviour associated – Tobacco Use; Nutrition; Physical Discussion & Conclusion: In general, 98% of students Activity; Sexual Behaviour; (d) Identify/characterize the believe that the basic science and physiopath (first phase) role of the social environment in the dynamic of the various should be more clinical. Hospital and polyclinical types of epidemics; (e) Identify/characterize the different observations should start from the early stage of the available strategies for the control of the various types of medical course. At the end of their course they have a epidemics; (f) Understand the role of history taking in the new way of thinking. Ultimately, “In medical education we clinical setting, regarding individual and group prevention should aim to understand the subjects rather than just to and curative care (including sentinel events). obtain a good mark; please be more clinical and practical with us.” 4 Onyx 2.7 The comparison between teacher centered 4 Onyx 2.5 and student centered educational methods About the integrated (module) system of of learning education at the Kyrgyz State Medical M Anwar, S Khademi*, M H Meshkibarf, J Feridoni and A Academy (KSMA) Ebrahimi (Fasa University of Medical Sciences, Ebne Sina Sq, Fasa, Fars, IRAN) D A Adambekov* and R D Alymkulov (Kyrgyz State Medical Academy, 92 Ahunbaev Str, Bishkek 720020, KYRGYZ Background: Various approaches to learning are suggested REPUBLIC) and practised. The traditional methods of medical Background: The purpose of this work was curriculum education are teacher based which are usually carried out planning improvement at KSMA by means of introduction as lecturing by teachers. In this method the students’ of a module system. Reformation of the health system in involvement in the process of education is not remarkable, Kyrgyzstan predicted the reformation of higher medical but the new approach supports student involvement. education. Materials and methods: The subjects of this study include Summary of work: The module system implied the 36 second year medical students, who have been asked fragmentation of sections on subjects whilst simultaneously to complete a professional questionnaire, at the end of maintaining integrity, completeness and self-sufficiency. the term after completing the general psychology lectures The morphological and theoretical disciplines were divided 50% of which were carried out by students and 50% by into general and partial sections included in the module teachers. At the end, the students’ opinion regarding both and partially transferred to the third year of study. Long- ways of lecturing was analyzed by SPSS. term clinic training in Therapy, Pediatrics, Surgery, Results: The results obtained in this study show no Obstetrics and Gynecology were introduced in the fourth significant difference between the two methods of teaching year and narrow disciplines were continued in the fifth after comparing and analyzing the marks given by students. year. The sixth year of study is completely devoted to long- However, in some particular points the marks were term clinical training at multi-profiled polyclinics, Family moderately higher with students gaining confidence, Medicine Centers and Family Group Practitioners. The mutual understanding, innovation, encouragement to use module system was introduced with respect to the more textbooks, etc., if students take part in the process

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of teaching. Also the mark given by students for some Work Done: Program Design: Student groups (10-15) other points such as learning capability, improvement of participate in five preceptor directed sessions. Session 1: learning etc., were the same for both ways of lecturing. Groups review the case of an obese couple. Session 2: Discussion and conclusion: Most of the students thought Groups divide into teams (2-3) and choose case-related they had actively participated in this program, and were topics to research. Session 3: Teams present reports to interested, but due to certain engagements such as group. Session 4: The class shares learning points. A attending classes, exams, research activity, etc, they did physician demonstrates an interview, examination, and not have sufficient time to prepare their lectures. However, treatment plan formulation with an obese patient. Session this program was more encouraging, interesting and 5: Students tested using case-based items and satisfying for the students. standardized patient stations. The program is being piloted with ten students. Evaluations will be presented. Initial results show students are excited to explore medical and 4 Onyx 2.8 social issues related to obesity. Teaching the essential, supporting wider Conclusions: Medical students need experience in obesity knowledge: core and elective courses assessment and treatment. Students enjoyed learning Bogdan Djuricic*, Vesna Bosnjak-Petrovic, Vladimir about obesity and related issues through this interactive Bumbasirevic, Tanja Jovanovic, Nebojsa Lalic, Dragan Micic program. and Predrag Pesko (University of Belgrade, School of Take-home messages: Obesity management can be taught Medicine, Dr Subotica 8, Belgrade 11000, SERBIA & MONTENEGRO) to medical students. Allowing students to pursue self- directed learning on topics of interest and the opportunity Arguably, (quantitative) development in medical sciences to interact with obese patients provided the most effective exceeds medical students’ capacity to achieve all- learning. encompassing durable knowledge and sufficient practical skills within the timeframe of medical education. Organ- based and problem-based learning schemes are attempts 4 Onyx 2.10 to overcome the problem, yet there is inherent risk in Active learning about public health in choosing a paradigm to be biased towards the “most undergraduate medical curricula: a SARS common”, and to “uniform” the knowledge. In an attempt tabletop exercise to provide students with structured transfer of knowledge and skills, while allowing them to investigate in some depth John F Mahoney* and Steven L Kanter (University of core subjects or tangential medical subjects, we have Pittsburgh School of Medicine, Office of Medical Education, allocated considerable time, 30% of the total, for elective M-211 Scaife Hall, 3350 Terrace Street, Pittsburgh PA 15261, USA) courses that are not restricted to the particular study year, but rather vertically reachable. As for fully paramedical Background: Recent events (terrorism, tsunami, emerging and supportive subjects, facultative courses are available, infections) have reemphasized the importance of public that are not formally evaluated. Electronic teaching classes, health (PH) topics. Medical students have limited exposure virtual learning environments, and computer-assisted to PH and may not appreciate the relevance and importance learning seem well suited for this type of course. In clinical of PH concepts to their professional development and fields the concept may pose a challenge in turning elective/ practice. facultative teaching into short training courses in practical Methods: First year medical students participated in this clinical skills for a small group of students. The large two-hour tabletop exercise during the first week of school number of courses offered may also bring “too much of (two classes, n=297), at the end of a PH module. Each the same”, and clustering of courses may help students to student was assigned a role, given minimal background make optimal choices. information, and participated in discussions from the perspective of their role. Roles included health department, 4 Onyx 2.9 physician, mayor, reporter, etc. Faculty facilitated groups Treating obesity, treating the of nine students as they worked through the response to this infectious outbreak. The scenario led students to neighbourhood: a program for medical consider influenza strains and SARS as possible causes. students to assess medical and Summary of results: Evaluation included critical incident- socioeconomic issues of obese patients style questions. 87% identified particularly positive features Eileen Seeholzer, Brian Chow and Margaret Gross* (10900 of the exercise that promoted learning or stimulated Euclid Avenue, BRB 113, Cleveland OH 44106, USA) thinking. Students highly valued the hands-on nature of Aim of presentation: Obesity is a leading cause of the session, and remarked on the importance of the topic. preventable death in the United States. Medical students Conclusions: This exercise helped students gain an learn little about obesity. Students who are taught to appreciation of the interdisciplinary nature of PH practice examine obese patients and make exercise/dietary plans as it introduced content on emerging infectious threats. develop needed skills. This active learning approach is a useful alternative to PBL or role playing.

Posters 4 Topaz 1 Postgraduate speciality training

4 Topaz 1.1 Aim: To show that despite the lack of Histopathologists in Factors affecting the potential for the UK, histopathology has a future and there are expansion for training places in possibilities for expanding training places. Histopathology Departments Summary: The shortage of Histopathologists in the UK has led to the implementation of the histopathology schools Katrina Chambers*, Janet Grant, Mairead Maxted and to increase the number of SHOs trained annually. Heather Owen (Open University Centre for Education in Medicine, Crowther 208, Walton Hall, Milton Keynes MK7 Results: Schools have the capacity for more trainees in 6AA, UK) terms of clinical material and SpR support. There is more

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potential for increasing training places in schools compared Conclusion: Shift pattern of work is changing training and to non-schools, schools could add an extra 12 SHOs (on teaching in all specialities. This method offers a useful average) dependent on certain resources being available. template for delivery of postgraduate education that can Non-schools could also increase their capacity to include be used for all other specialities. 8 SHOs (dependent on resources). Conclusions: The schools system has been successful and 4 Topaz 1.4 the introduction of further schools will expand training PBL in postgraduate training in places. The increase in the number of histopathology training schools means that approximately 100 SHOs per Anesthesiology year can be trained. S Adam*, K Kuizenga, on behalf of the Dutch ‘Task Force’ on PBL in Anesthesiology (University Hospital Rotterdam, Department of Anaesthesiology, Erasmus University Rotterdam, 4 Topaz 1.2 Dr. Molewaterplein 40, Rotterdam 3015 GD, NETHERLANDS) Reflective log in the analysis of critical Background: Problem-based learning (PBL) has been incidents in Anaesthetic training applied in undergraduate medical education for a long time Kirtida Mukherjee (Medway Maritime Hospital, Department but is rarely used in postgraduate training (PGT). Our aim of Anaesthetics, Windmill Road, Gillingham, Kent ME7 5NY, is to establish PBL as a teaching method in PGT in UK) Anesthesiology in the Netherlands. Aim: Analysis of Critical incidents is an integral part of Summary of work: A ‘Task force’ (TF) was established anaesthetic training at postgraduate level. They are usually within the Dutch Society of Anesthesiologists consisting carried out in departmental monthly meetings. However of teaching staff anesthesiologists of all 9 Anesthesia reflective analysis of critical incidents for trainee support training institutions in the Netherlands. Members of the and evaluation is seldom used. TF have written and discussed several PBL cases. The subjects of the cases cover the learning objectives identified Method: Reflective practice in the analysis of critical by the National Board. From April 2004 on, all Dutch 2nd- incidents in Obstetric practice in a District General hospital year residents in Anesthesiology have participated in this is described. The trainees were at either Senior House PBL program in small tutorial groups. Officer or Specialist registrar level. None had previous experience of Reflective practice in the past and explanation Summary of results: The residents appreciate the PBL of the process was absolutely essential. A Consultant method which they find inspiring. They need more time Anaesthetist with experience in reflective practice chose for learning and feel that knowledge can be retained more the critical incidents. 12 such cases with 6 trainees over a profoundly. The formation of a national ‘Task force’ has period of over a year were selected. Individual trainees synchronized theoretical training programs and has involved in the patient management were asked to describe stimulated exchange of educational ideas and methods. their reflective analysis of the incidents together with The TF will provide PBL cases for sequential years of the suggested changes. anesthesia curriculum. Results: Trainees found the process very stimulating, Conclusions: PBL is a teaching method in PGT in educationally challenging and were more keen to accept Anesthesiology highly appreciated by residents and changes when reflective practice was instituted. teachers. Conclusions: Obstetric Anaesthesia is a practical procedure based speciality. Reflection on one’s performance is rarely 4 Topaz 1.5 carried out in clinical settings because of the time Competencies in neonatal life support in constraints. This study demonstrates the very useful role first year pediatric specialist registrars of reflective analysis in anaesthetic modular training. B Weeteling*, R M van Elburg and R J Gemke (VU University Medical Center, Department of Pediatrics, PO Box 7057, 4 Topaz 1.3 Amsterdam 1007 MB, NETHERLANDS) Modifying delivery of postgraduate training Aim of presentation: Acquisition of resuscitation skills is to accommodate changing educational highly relevant for specialist registrars (SpRs). However, requirements due to shift pattern of work the level of training and experience have not been systematically evaluated in pediatric SpRs starting with L J Challenor*, V Jha and S J Kaufmann (St James University Hospital, Department of Obstetrics and Gynaecology, Level on-call responsibilities. The aim of this study was to assess 09, Gledhow Wing, Beckett Street, Leeds LS9 7TF, UK) the qualifications of neonatal life support (NLS) in first year pediatric SpRs. Aim: Problems of delivering education within a regional postgraduate training programme in Obstetrics and Summary of work: All first year pediatric SpRs in the Gynaecology (O&G) due to adoption of a shift pattern of Netherlands who were attending a mandatory national work for trainees are addressed. course on acute disturbances of vital functions, filled out a questionnaire on how frequently they had performed Summary: Traditional delivery of teaching at the Yorkshire NLS elements: airway and breathing (9), circulation (9), Modular Training Programme has been in the form of CNS (2) and integrated elements (4). For each element 4 training days each Friday. Following introduction of shift qualification levels were assessed: (1) study of theory (2) pattern of work, there has been a decrease in attendance practice in skill stations (3) supervised practice in patients by trainees due to inability to attend as they are either and (4) non-supervised practice in patients. finishing or starting weeks of nights or are off following weeks of nights. In addition, annual leave and other shift Summary of results: Qualification levels of all NLS elements work (evenings etc) further contribute to lack of of first year pediatric SpRs in the Netherlands will be attendance. The innovative use of ‘education weeks’ presented. The level of training and experience of all consisting of short courses instead of each Friday has been elements varied widely, both generally and at the moment introduced to overcome this problem. Advantages include: of starting on-call service. Skill stations were used relatively increased attendance by trainees, controlled release of infrequent, despite the possibility to practice without staff allowing better planning of services, trainees not potential adverse effects. repeatedly missing the same clinical sessions and Conclusion: A more systematic assessment of NLS decreased chance of cancellation of study days as teaching qualification levels in pediatric SpRs helps to assess and is delivered in blocks as opposed to ad hoc days. establish baseline requirements for NLS courses for SpRs and to identify elements that require attention or further training in individuals.

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4 Topaz 1.6 Conclusions: Both residents and teachers have a Key issues in surgical training in contribution to make to the learning environment. Key gynaecology: an exploration issues for trainees are: a calm and patient teacher, who gives them self-confidence and is not too quick to take Clasien van der Houwen*, Klarke Boor, Gerard Essed, Peter over the operation. Key issues for gynaecologists are that Boendermaker, Albert Scherpbier and Fedde Scheele residents demonstrate an active attitude towards learning (Tjongerschans Hospital, Department of Obstetrics and and enable them to stay in control of the operation. Gynaecology, Heerenveen, Mr P.J. Troelstraweg 33, Teaching and learning in theatre can be improved by more Leeuwarden 8916 AB, NETHERLANDS) structure: before the operation residents’ personal learning Background: The operating theatre is the main setting of goals should be discussed, during the operation residents gynaecology residents’ surgical training. should verbalise each step and afterwards, operation and What was done: We conducted 7 focus group interviews teaching should be evaluated in a structured fashion. (4 with residents and 3 with gynaecologists) to identify Take-home messages: Gynaecologists should be aware of key issues concerning teaching and learning in theatre. the impact their attitude has on residents. Residents should All groups were asked to describe the ideal learner and adopt an active attitude towards learning and demonstrate the ideal teacher. The transcripts of the discussions were this by preparation and by asking questions. Teaching and analysed. learning should be structured in a way that is clear to both teachers and residents.

Posters 4 Ruby 1 The setting for clinical teaching and learning

4 Ruby 1.1 on evidence and will cope with the time limitations of the Student and teacher perceptions of an outpatient setting. They practise a focused standardized undergraduate voluntary Pediatric Private- medical history and physical examination. During one semester the students spend three consecutive Wednesday Praxis-Prevention Project (PPPPP) at mornings with a GP and three mornings with physicians Heidelberg University from the university specialty clinics – a total of 144 hours H M Bosse, F Fehr, S Skelin* and S Huwendiek (Kinderklinik, of patient contact per student. Attachment to one GP’s INF 153, Heidelberg 69115, GERMANY) office for the entire course introduces longitudinal follow- up. Each semester, the students must hand in two Background: In Germany most pediatricians work in private standardized case reports, which they will discuss in the practice whereas medical education is currently carried tutorials. The course is accompanied by lectures concerning out predominantly in tertiary care centers of Germany’s social medicine, health care economy and other new universities. To ameliorate for this mismatch of educational compulsory subjects required by law. opportunities and communities requirements our program was launched. During their pediatric rotation of four weeks Summary of results: During summer 2005, a total of 800 Heidelberg students can opt to participate in four afternoon students are enrolled. All participating GPs (approximately sessions in private practices parallel to their regular 200), who are part of LMU’s faculty, are being prepared in pediatric clerkship. In groups of up to two they are either one-day or three-day courses. introduced to aspects of preventional Pediatrics. Meeting Conclusion: Our course mirrors the shift towards families with mostly healthy infants students have ambulatory medicine and prepares our students for the opportunities to learn about the national system of well wide range of outpatient care from family practice to child check-ups with hands-on experience in history taking subspecialty clinics. and physical examination and to practise soft skills while interacting with the families. 4 Ruby 1.3 What was done: By means of qualitative methods, data of the students and teacher perceptions of this project were Evaluation of the community-based primary assessed and are presented. care medical education program for the fifth Conclusions: Both students and teachers highly appreciated grade students. A report on its early phase this project. Students gained knowledge, skills and data attitudes in preventive Pediatrics and teachers appreciated Kenichi Mitsunami*, Junji Nishiyama, Tsutomu Tanaka, the interaction with the students. The project was Hidetoshi Matsubara and Tadao Bamba (Shiga University of acknowledged to be highly effective. Medical Science, Department of General Medicine, Tsukinowa- cho, Seta, Otsu, Shiga 520-2192, JAPAN) Take-home message: The project we present was acknowledged to be a highly effective method of teaching Background: Primary care physicians in the communities preventional Pediatrics. of Japan are very heterogeneous. Some of them are generalists and can be called general practitioners or family physicians. Most of the others are specialists, e.g. 4 Ruby 1.2 gastroenterologists, ophthalmologists, and so on, but they A novel ambulatory medicine course are still freely accessible to patients and in this sense they integrating specialty clinic and family practice can be also called primary care physicians. Community- based primary care medical education is not common as M Muehlstaedt*, O Genzel-Boroviczény and M Fischer yet in Japan and we have just started that kind of program (Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Dermatologie und Allergologie, Frauenlobstr 9- in cooperation with Shiga Medical Association, Japan. 11, München 80337, GERMANY) Summary of work: Twenty-two 5th grade medical students Aim of presentation: We present the new course of of our university underwent clinical clerkship at private ambulatory medicine that LMU Munich (Germany) has offices in Shiga Prefecture for 4 straight days. Each student developed for its new medical curriculum MeCuMLMU. evaluated the clerkship and each physician evaluated the student immediately after the clerkship. We categorized Summary of work: The students will learn to use resources the physicians and investigated the relation between the economically, will base their treatment recommendations categories and the evaluation.

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Summary of results: Family physicians rated students lower final progress test (the last two are written tests). The than those who are not (p<0.04). Students rated the scheme has been used in three Residencies and has proven clerkship higher that included visiting care (p<0.04). to be successful in assessing students on the different variables. This work will present the assessment scheme Conclusions: Our community-based primary care medical in detail and the results of its application to the first three education program may provide students with the idea of residencies – Internal Medicine, Child and Maternal Health importance of patient-centered medical care. and Mental Health. Take-home messages: Participation in visiting care arouses students’ interest in primary care. 4 Ruby 1.6 Comparison of development of clinical skills 4 Ruby 1.4 in two groups of students Health-related quality of life of the last year medical students: comparison between G Blee*, S Morales, M Dominguez and E Espinosa (Universidad Nacional Autónoma de México, Calle Union 77, community-based and university hospitals Depto 304-A Col. Escandón Del. Miguel Hidalgo, México DF K Sriruksa*, W Chandrakachorn and D Konsriyattra (Khon CP 11800, MEXICO) Kaen Hospital, Pediatric Division, Srijan Road, Tambol Objective: To determine if the development of clinical skills Naimuang, Amphur Muang, Khon Kaen Province 40000, of medical students was the same in units of first level of THAILAND) medical care as those in hospitals. Quality of life is usually inverse to workload. For medical Methodology: A study of two groups of 60 students in students, the quality of life is not always worse especially each one was designed. A group was formed with those in community-based hospital. that had undertaken the course of Propedeutics and Objective: To compare the health-related quality of life of Physiopathology, with a duration of 20 weeks, in Units of the last year medical students in community-based and Family Medicine and the other group which was assigned university hospitals. to the Hospitals. The selection was carried out by simple Method: 135 students were evaluated by “the standardised aleatory sampling. At the end of the course, they were questionnaires (SF-36)” which consist of 8 dimensions-35 assessed through the elaboration of a clinical history of a items (bodily pain (BP), general health perceptions (GH), real patient. The instrument used was a check-list of clinical general mental health (MH), physical functioning (PF), role history. It explores three aspects: doctor-patient limitations due to emotional/physical problems (RE/RP), relationship, the clinical skills for the history taking and social functioning (SF), and vitality (VT)) and 1 item of the physical examination. reported health transition. Results: The results of the student t test comparison of Results: The community-based students had more the two averages of independent groups, a t of 4.831 overnight on call hours (44.8hr/week), less sleeping hours went at a level to ƒÑ = 0.01. The perfomance of the (5.1hr/day). Both groups were unsatisfied with their students that had undertaken the units of Family Medicine sleeping hours, working and leisure days. Fifty-four percent was better than those assigned to the hospitals. of community-based students reported their health worse Conclusions: The tutorial teaching is more effective in units than one year ago. However, the health-related quality of of Family Medicine than in Hospitals. life was not statistically different from the university-based students in all dimensions. 4 Ruby 1.7 Conclusion: The community-based students gain more experiences in clinical than the university-based students Evaluation of a pilot clinical skills lab using but they have to endure more workload and less sleeping OSCE in the Internal Medicine Clerkship of a hours. However, their health-related qualities of life were Greek Medical School not different. E Smyrnakis*, N Dombros, A Benos, A Faitatzidou, S Metallidis, A Fovos, G Mingiori, A Triantafyllou, E Minasidou, V Manoli, P Pantelidou, K Toufas, K Karida, X Xiarxou and E 4 Ruby 1.5 Giannoulis (Aristotle University of Thessaloniki, Medical Assessing student learning and professional School, Priamou 10, Thessaloniki 54453, GREECE) development in clinical residencies: a Background: In order to overcome the deficiencies in proposal clinical skills training, a pilot clinical skills lab (CSL) was J Pinto-Machado, O Candeias, M Cerqueira-Gomes, D Cunha, designed, implemented and evaluated in a Department of J Cotter, A Rua, N Sousa, A Freitas* and M J Costa Internal Medicine of the Thessaloniki Medical School. (Universidade do Minho, Medical Education Unit, School of What was done: The designed 3-month CSL consisted of Health Sciences, Gualtar Campus, CPII, Piso 3, Braga 4710- seminars, regular training and self directed practising. The 057, PORTUGAL) CSL was evaluated by a 15-station OSCE, that was designed Background: The clinical phase of the University of Minho’s and implemented for the first time in the School. School of Health Sciences Degree in Medicine was launched From the 55 students attending the compulsory three- in 2003-04. From this moment onwards, students’ learning month clerkship, 42 attended (study-group) and 13 did takes place mostly in the two affiliated Hospitals - therefore not attend (control-group) the CSL program. out of school boundaries - under the supervision of numerous tutors. Clinical skills and professional The overall mean OSCE score for the study group was competence have gained more momentum in students’ 66.36% (SD: 9.17) and for the control group 51.45% (SD development. This represents an increase in complexity 4.37) respectively (p<0.001). The cutting score based on compared to previous curricular years. The unique global rating of borderline performance was 54%. The organizational characteristics of the residencies demands success rates were 92.8% (39/42) for the study-group the introduction of a novel and adequate examination and and 23% (3/13) for the control-group, (p<0.01). assessment scheme. Conclusions: The pilot CSL program improved the clinical Summary of work: A new assessment scheme was devised training significantly. The implementation of a CSL that in agreement with the school’s principle that students will cover learning needs of all medical students and the should be endowed with knowledge, skills and attitudes. adoption of the OSCE as the main method for clinical skills It is based on five variables that contribute to the final assessment will upgrade the level of undergraduate medical marks: 1. professional behaviour; 2. skills; 3. patient education. examination and discussion; 4. module examinations; 5.

– 82 – Session 4 WEDNESDAY 31 AUGUST Session 4

4 Ruby 1.8 Outcomes achieved and lessons learnt: Sharing of Assessment of teaching practical skills in resources; Multi-professional usage of resources – ALERT, clinical skill lab of Jahrom Medical School Manual Handling, ECG, biomedical equipment, central lines, catheterisation, transfusion teaching, physiotherapy Mitra Amini (Jahrom Medical School, Boxing and Printing teaching Amini, Nasr Street, PO Box 71458-46549, Shiraz, IRAN) Training of non-clinical educational staff; Guiding Background: The clinical skill lab in Jahrom Medical School enthusiasm! Publicity – brochure and “Open Day”; is part of the educational developing centre. This centre Feedback. provides an opportunity for improving clinical skills of medical students in a simulated learning setting. The main Conclusion: The main purpose of a Skills Laboratory is goal of this study was to determine the effectiveness of effective learning. Students from different professions come clinical skills training on clinical competencies of medical together in the Skills Laboratory and can learn from each students through a self assessment approach. other, identifying how their individual skills and knowledge contribute to the team. Multi-professional learning is seen Summary of work: A questionnaire about necessary to arise from this environment but remains secondary to procedural skills was prepared and after piloting was the main purpose. answered by medical students before and after training in clinical skill lab. The data gathered were analysed by SPSS software. 4 Ruby 1.10 Summary of results: The results showed a significant The teaching professor in a non-academic difference for intubation skills and cardiopulmonary setting: a new institution resuscitation after training in the clinical skill center A B Bijnen*, A E R Arnold, F Scheele, A M J J Verweij, H J M (p<0.05). The difference was also statistically significant van Rossum and J A A M van Diemen-Steenvoorde (Free in the field of gynaecological examination (p<0.05). There University Medical Centre, Institute of Medical Education, was no statistically significant difference between male Studler van Surcklaan 15, Bergen 1861 MA, NETHERLANDS) and female students. All of the students mentioned that Background: Preclinical teaching is mainly a university this kind of clinical teaching decreases their stress and domain, but two-third of clinical training in the Netherlands malpractice. takes place in non-university hospitals. This figure will rise Conclusions/take-home messages: The results of this study because of the recent 40% increase of medical students. showed that practising in clinical skill lab considerably Quality control in these institutions is therefore of prime increases self efficacy of medical students for doing the importance to ensure future quality of health care. necessary procedural skills and helps them to reduce their Problem analysis: Four categories of problems impede stress. teaching quality improvement, associated with: professionalism (transparency of financing, contracts and 4 Ruby 1.9 training); definition and knowledge of curricular goals; Developing a multi-professional clinical development and implementation of evidence based learning; and practical problems on the working floor skills laboratory in North Devon (service delivery versus education, different view points). Julian Cox* and Mervyn Dent (North Devon District Hospital, Problem solution: The Free University Amsterdam Medical Education Centre, Raleigh Park, Barnstaple, Devon EX31 4JB, UK) nominated three teaching professors in two non-university hospitals. This resulted within one year in the Aim: To describe the creation of a skills laboratory from implementation of several teaching principles (outcome- the planning stage to successful implementation and with based education, skills laboratory activities, structured this, the achievement of a multi-professional learning learning modules for interns, portfolio assessment) and environment. hospital-wide enthusiasm with both medical and Work done: The finance bid – General Education; The plan paramedical personnel to participate in various teaching and build – Medical Education; Additional finance – programs. Undergraduate Tutor; Purchase of equipment – Conclusion and take home message: Although part of the Postgraduate Clinical Tutor, Undergraduate Tutor, Nurse solution is in hands of the authorities and professional Education Manager, Consultants, Junior Doctors, Specialist associations, nomination of teaching professors in non- Nurses, Nursing Undergraduates, Physiotherapists, university hospitals helps to create the necessary Dieticians, General Practitioners; The Teaching team – all professional structure and acceptance of the need for professionals above; The Students – all professionals quality improvement in clinical teaching. above; Analysis of needs – time, location, equipment.

Posters 4 Ruby 2 Students; Gender issues in medical education

4 Ruby 2.1 learning environment of the intern year – an important Does the intern year nuture ethical and bridge between student and registered medical practitioner. professional development? Perceptions of Summary of work: Perceptions of interns at Beaumont interns Hospital, Dublin about their intern year were obtained. A mixed methods approach, focus groups and a F Meagher (Royal College of Surgeons in Ireland, Department questionnaire, was used. The framework for analysis was of Medicine, Beaumont Hospital, Dublin 9, IRELAND) grounded theory. Background: The internal hospital culture is a dominant influence on the professionalisation of students and Summary of results: The questionnaire response rate was doctors-in-training. The attitudes and behaviour of 66% (n=44).Thirty-four percent n=15) had observed unethical behaviour during a typical week or month. One physician role-models are recognised as an important factor third of interns felt that their ethical sensitivity became in the nurturing of professionalism in trainees. There has been increasing concern regarding the quality of the less sharp as their intern year progressed. Ninety-seven

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percent (n=41) of interns considered their senior measurement only as a means of quality control during colleagues to be good role-models. Bullying was implementation of curriculum changes and not as an aid experienced by 14% of interns in a typical week. in time management. Conclusions: These preliminary data suggest that the intern year could be structured to be more supportive towards 4 Ruby 2.4 the professional and ethical development of interns What determines the choice of including obstetrics in a future medical career? The 4 Ruby 2.2 views of undergraduate students of Québec Relationship of personality variables and (Canada) stressful life events to the onset of physical Marie-Josée Bédard*, Sylvie Berthiaume, Marie-Dominique illness among medical students Beaulieu, Alain Demers, Ann Rothman, Céline Leclerc, Ronald Lebeau (Université de Montréal, Faculté de Médecine, Pavillon Nahid Khajehmougahi (Ahwaz Jundishapour University of Principal U-231-2, 2900 Boul. Edouard Montpetit, Montréal, Medical Sciences, Department of Psychiatry, Golestan Québec, CANADA) Hospital, PO Box 173, Ahwaz, IRAN) Summary of work: A study was undertaken to identify Aim: The purpose of the study was the relationship of factors that influence medical students in their decision to personality coping types (PCT) and stressors to the onset practice obstetrics in their future medical practice, and at of physical illness. what point in their undergraduate curriculum they do it. A Summary of work: In this cross sectional study, subjects survey of medical students in the province of Québec were 137 medical students of Jundishapour University of (Canada) was undertaken. A questionnaire was completed Medical Sciences who were selected randomly. The at two points in their training: the beginning (time 1) and instruments were the Life Events Survey (LES) and Millon the end of clerkship (time 2). Behavioral Health Inventory (MBHI). Summary of results: Summary of results: A moderate relationship was found Time 1 (nb : 485) Time 2 (nb : 353) between life events and illness, though the strength of the relationship was a function of the life change and illness Prenatal care measure utilized. At most, when negative weighted events Yes 190 (39.4%) 118 (33.4%) was used as the life events measure and total health No 156 (32.3%) 200 (56.7%) problems experienced was used as the illness measure, a Undecided 137 (28.3%) 35 (9.9%) positive correlation was found between life change and Deliveries illness (P<.001). PCT were found to differ significantly on Yes 162 (33.5%) 77 (21.8%) illness measures. ‘Anxious-Moody’ individuals emerged as No 179 (36.9%) 224 (63.4%) a high illness group, ‘Dependent-Sociable’ individuals and Undecided 142 (29.4%) 52 (14.7%) ‘Aggressive-Negativistic’ individuals emerged as moderate illness groups, and ‘Passive-Conforming’ individuals and ‘Confident-Narcissistic’ individuals emerged as low illness At time 2, 8% of the students had changed their opinion groups. in favour of practicing obstetrics vs 20% that had changed Conclusion: These results suggest that PCT is a key factor their opinion in a negative manner (quality of life, loss of in assessing the relationship between stress and onset of interest, rotation uninteresting and disappointing, negative physical illness. Therefore changes of PCT can decrease atmosphere). The undecided have a tendency to change physical illness. their minds in a negative manner (personality conflicts with professors, stressful medical situations, bad outcome during a delivery, negative atmosphere. 4 Ruby 2.3 Effects of study time measurement on study Conclusions/take-home messages: Clerkship rotation does not seem to help in the recruitment of candidates and commitment of undergraduate students in also fails to sway undecided students towards an obstetrical Medicine practice. The subjective perceptions as “obstetrical practice M Maelstaf*, I Vandenreyt and M Vandersteen (Universiteit is gratifying or is too demanding” are the best predictors Hasselt, Campus Diepenbeek, Agoralaan - Gebouw D, of that professional choice. The rotation seems to have Diepenbeek B - 3590, BELGIUM) little impact on those perceptions. Background: Registration of study time provides quantitative data about study commitment. Registered 4 Ruby 2.5 study time is compared to the official time budget and the Attitudes towards psychiatry: what do study commitment of peers. Does registration of study time monitor time management? medical students perceive? Summary of work: Between October 2003 and January Boonprom Chetratanont and Anupong Suthamnirand* (Chonburi Medical Education Center, Chonburi Hospital, 2005 a newly developed web based tool was tested by Bansuan, Muang, Chonburi 20000, THAILAND) 1st year students in Medicine. All students (50) participated. Half of them formed the experimental group, Background: There are three basic questions underlying the others the control group. The registration was the attitude of medical students towards the practice of continuously evaluated during this period. psychiatry: is psychiatry an art of a science, or is it neither? Is the psychiatrist a “real” doctor? Are psychiatric patients Summary of results: (a) The measurement tool was user always difficult to treat, and sometimes dangerous? Our friendly; (b) there was a correlation between study time aim was to identify the range of response to these and study results, but no significant difference between fundamental issues for students undergoing medical study results of both groups; (c) the motivation of the training. participants decreased alarmingly during the project. Reasons: (1) no useful feedback, real study time aligns Summary of work: We devised a questionnaire with 18 budgetted time. Tutorials, assignments and short teaching questions on a five-point scale. There were three periods provide sufficient aid in study management. (2) categories: the attitude to psychiatry as an academic no immediate changes in a stable curriculum, with well discipline; the problems posed by psychiatric patients; and known but unsolvable bottlenecks. the status of the psychiatrist as a professional. The 5th year medical students were enrolled in this survey before Take home message: Although the application is ready for and after their psychiatric clerkship course, and the two use, the Faculty of Medicine has decided to use time sets of results were compared.

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Summary of results: The only measure of improvement Purpose: To analyse the current status of women in could be identified in the attitude to psychiatry as an academic medicine, and to identify institutional barriers academic discipline, but attitudes were unchanged that may influence women’s academic advancement in regarding the fear of difficult patients, and the aim to be a medicine. psychiatrist. Methods: A detailed search related to gender and Conclusions/take-home messages: The attitude towards professoriate of many literary sources, such as ‘Medline’; the field of psychiatry among physicians in Thailand is still the Educational Resources Information Centre (‘ERIC’); a problematic area. They lack skill in their approach to the the Association of American Medical Colleges, the Ontario psychiatric patient. Medical students have little or no Institute for Studies in Education Database and others was interest in that branch of training, and consequently there conducted. is a shortage of psychiatrists. This is a serious problem Results: The first part of this paper presents the current and we should best address it by integrating a more highly status of women in academic medicine that will focus on developed training program in psychiatry. enrolment in medical school, selected specialties, and the rate of academic promotion and disparities in salaries 4 Ruby 2.6 between women and men. The second section addresses Women in academic medicine – issues and the obstacles that hamper advancement of women in academic medicine, and focuses on lack of mentorship, factors influencing women’s advancement rigidity in career structures, sex discrimination, and in medicine and academia: barriers and domestic responsibilities. The third section proposes the future perspectives solutions from women pursuing careers in academic Ewa Szumacher (Sunnybrook & Women’s College Health medicine. Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N Conclusion: Many suggestions and solutions that have been 3M5, CANADA) gathered from a variety of disciplines and may be Background: The term ‘glass ceiling’ is often used to implemented generally by women in medicine will be describe the circumstances of women in business and presented at the meeting. academia. Despite gains made by women over the past decades, the glass ceiling is still a component of a majority of women’s medical careers.

– 85 – Session 4 WEDNESDAY 31 AUGUST Session 4

– 86 – Session 5 THURSDAY 1 SEPTEMBER Session 5

Plenary Medical education research and its translation into teaching and clinical practice

5.1 The urgent need for more research into evidence, they often rely on experience or intuition when medical education teaching students and residents. To what extent have we moved towards an ethos and practice of best evidence Henk Schmidt (Erasmus University Rotterdam, Netherlands) medical education? What barriers have we encountered? Medical education is a high-stakes endeavour, not only How can we make further progress? Case examples will because its quality – or lack thereof – has a profound illustrate challenges and opportunities in using evidence influence the quality of health care delivery, but also to inform educational practice and decision-making. because training doctors is expensive. These factors justify a scientific approach to improving medical training. Some examples will be presented of how original research in 5.3 From knowledge to implementation this area has changed educational practices for the better Professor Martina Cornel, Vrije Universiteit, Amsterdam, and has influenced the quality of health care. Netherlands Scientific knowledge changes rapidly. Doctors trained in 5.2 From Best Evidence to Practice: the use of 2005 need to work in a context of changing scientific research findings in medical education evidence, and need to adapt to this during the decades that they will actively work in health care. In order to Yvonne Steinert (Faculty of Medicine, McGill University, 3655 realize implementation of new preventive strategies in Promenade Sir William Osler, Montreal, Quebec, H3G 1Y6, health care, continuous education is needed, not only to Canada) improve knowledge of trainers and trainees, but also to Best evidence medical education has been defined as “the work out how legal, ethical and societal issues can be implementation, by teachers in their practices, of methods addressed. What is the role of public health authorities, and approaches to education based on the best evidence how can risks be communicated effectively, how can available”. Although medical teachers and educators predictive medicine lead to empowerment? increasingly base their medical decisions on research

– 87 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Symposium 6AUD Bologna process and medical education

6AUD 1 The WFME-AMEE statement on the countries, schools and students would be willing to do. Bologna process Moreover the traditional division of curricula into basic and clinical components would be petrified with a Leif Christensen (World Federation for Medical Education, resignation from their integration in system or PBL University of Copenhagen, Faculty of Health Sciences, based curricula. Ethical issue of patients’ exposure to Blegdamsvej 3B, Copenhagen, DENMARK) students who do not intend to be medical doctors will Aim: To summarize the position of the organisations in have to be taken into account. medical education towards crucial aspects of the Establishment of ECTS: because a mandatory Bologna process for the attention of the Bergen component of medical curricula is much higher than in Ministerial Conference in May 2005. other disciplines, recognition of studies taken in other Summary of work: Pursuant to the discussions at the schools must be based on their content rather than on AMEE meeting in Edinburgh September 2004 a working student workload. The system as such does not seem group to prepare a policy statement was established to influence the entire organization of medical curricula. jointly by WFME and AMEE, also including Student mobility although in principle accepted, creates representatives of AMSE and WHO-Euro. The statement problems due to more rigid curricula, and a need cover was adopted February 2005 and submitted to the all required areas. Existing differences in curriculum secretariat of the Bologna Follow-up Group in March models (subject vs system based, or PBL based) as 2005. well as necessity to communicate with patients in their Results: The organisations endorse the purpose of the native language make exchange of medical students Bologna Declaration and support full involvement of somewhat difficult. medical education in the Bologna Process. The Quality assurance is crucial to guarantee graduates organisations emphasize that the specificity of medical being “safe doctors” yet quality control and accreditation curricula and the current situation of European medical need to be specifically oriented, and not simply follow schools must be considered when implementing the the rules elaborated generally for higher education Bologna objectives in medical education. The statement contains comments on most of the objectives or action European dimension may have some relevance for lines. Implementation is regarded as advantageous for medical schools in respect to defining the European most medical schools. However, one objective, the core curriculum (Tuning project). But it has to be adoption of a system essentially based on two main remembered that in contemporary world medical cycles in medical education is by several countries and education must strive towards global rather than many medical schools regarded as problematic and European only dimension. potentially harmful to the quality of medical education. 6AUD 4 The Bologna Process – investigating 6AUD 2 How can medical education in Europe advantages and disadvantages – relation benefit from the Bologna Process? to the “Tuning Project” Tim Jones (International Centre, University of Bristol, Allan Cumming (Director of Undergraduate Learning and University Union, Queen’s Road, Bristol BS8 1LN, UK) Teaching, College of Medicine and Veterinary Medicine, This presentation will discuss the benefits to medical University of Edinburgh, Medical Teaching Organisation, Teviot Place, Edinburgh, UK) education of the Bologna Process under the following headings: (1) Student mobility; (2) Transferability and The European Commission is keen to foster a process accumulation of credits; (3) The Diploma Supplement of harmonisation of learning outcomes/competences and transparency of qualifications; (4) MEDINE, the for Higher Education in Europe. This work is known as Thematic Network in Medical Education. the Tuning Project, and is closely linked to the Bologna Process, ECTS and the Diploma Supplement. It has been supported by the Socrates programme. To date, 9 6AUD 3 Why medical schools have problems with disciplines have defined learning outcomes. Several the Bologna Declaration more disciplines have entered the next phase, and the Jadwiga Mirecka (Jagiellonian University Medical School, Medicine Tuning Project is part of the work of the new Department of Medical Education, Str. Kopernika 19E/1, MEDINE Thematic Network. Tuning is not about unified, Krakow, POLAND) prescriptive or definitive European curricula, but is about describing points of convergence and common While universities and other high education institutions understanding, and protection of diversity. The Tuning in many signatory countries of the Bologna Declaration process is based on learning outcomes, expressed as are halfway in implementation of its directives, most what a graduate is able to do. These include generic medical schools stay apart. It is not a general concept and discipline-specific outcomes, and correspond to the of the European Higher Education Area which causes final qualifications of a learning programme. They are resistance, but some of the particular goals. defined for first and second cycles, where appropriate. Implementation of studies based on two cycles does The methodology includes questionnaires to academics, not comply with the Council Directive 93/16/EEC graduates, and employers, with rating scales for defining the scheme of medical studies (6 years/ 5.500 importance, scope for new items, and detailed statistical hours). Simple division of studies into 2 halves would analysis, leading to a consensus statement. In the result in the first cycle graduate being neither competent context of the current changes affecting Higher for a labour market nor further studies in biological Education in Europe, and the free mobility of the medical sciences. A total reconstruction of medical curricula workforce within Europe, working towards a greater would be required with a more general training in early degree of harmonisation of graduate competences in years, accompanied by an extension of professional medicine seems appropriate. training to further 4-5 years. And that is not what

– 88 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Symposium 6A Research in education

6A Research in Education current research and possible avenues for future directions. Should research in medical education be more theory Cees van der Vleuten and Diana Dolmans (University of driven? Who should be involved in carrying out research? Maastricht, NETHERLANDS), Henk Schmidt (University of Rotterdam, NETHERLANDS), Geoff Norman (McMaster What types of designs are desirable or undesirable? Are University, CANADA), Yvonne Steinert (McGill University, large scale evaluations useful or not? These are but a few CANADA), John Bligh (Peninsula Medical School, UK) and of the issues that will be addressed in this symposium. A Lambert Schuwirth (Maastricht University, NETHERLANDS) forum of excellent research experts will engage in a discussion in which the audience will be directly involved. Following up on the plenaries on research in medical education this symposium discusses the status of our

Short Communications 6B E-assessment 1

6B 1 What is the student experience of taking assessments, while the non-attendee pass rate was 12/ online assessments? 26. Formative assessment shall have diagnostic value as well as a high student acceptance level. Both goals were Stephen Harvey* and Terry Poulton (St George’s Hospital attained. It is also to be emphasised that FACS proved a Medical School, Medical Education - GEP Office, Cranmer strong motivator for students to spend more time in patient Terrace, Tooting, London SW17 0RE, UK) contact as the pivotal means to acquire clinical competence. As the use of technology rapidly increases throughout all aspects of Medical Education, so the question must be asked, “What are the students’ views regarding online 6B 3 Technical and legal security problems of assessment, and how does it impact upon them?” The web-based assessment systems and aim of this study is to determine what factors most possible solutions influence student perceptions of how online examinations (both formative and summative) are received by them. As J Heid*, M Bauch, M Haag, F J Leven and K Brass (University of Heidelberg, Max-Planck-Str 39, Heilbronn 74078, most virtual learning environments have the capability to GERMANY) produce online quizzes/assessments with ease, do we pay sufficient thought to the end user, and their experience? Aim of presentation: Web based assessment players are Our students regularly provide online feedback to the used widely in the education of students. The advantage weekly PBL cases and recently have started to take of web based assessment systems lies in the easiness of formative assessments online. We have extensively using the same technics for the assessment and computer surveyed the students to capture their views on how we based training/presentation. But using a browser means implement online assessment and have also gathered using a pure client/server architecture, which is extremely information on what they feel when faced with it. The vulnerable against network problems. The browser itself conclusion that we wish to present is the feedback that is exposed against defraud attempts. The presentation we have received on our implementation of online will show the risks and suggested solutions for computer assessment. As companies provide reams of information based assessment. on the technical side of the equation, we will be taking Summary of work: After analysing the problems of stock of the student experience and highlighting the key computer-based assessment a new approach was points that must be met to ensure both institution and conceived which uses an extended version of a client/ students benefit. server architecture so that a temporary loss of the network connection will not interrupt the assessment. Furthermore, 6B 2 The diagnostic value of formative specific technics are used to increase failure avoiding, security and usability. assessment case studies Conclusions: Using simple web-based systems for Shekhar M Kumta* and James Ware (Chinese University of assessments is dangerous regarding technical and legal Hong Kong, Department of Orthopaedics and Traumatology, risks. An advanced architecture should be used to increase Prince of Wales Hospital, Shatin, HONG KONG) security. CAL has become a widespread utility both liked and disliked by students. When supportive of comprehensive and well planned curricular delivery it is much appreciated but when 6B 4 Using a web-based, standardized patient it replaces face-to-face study opportunities it risks module to assess clinical reasoning becoming the object of student criticism. FACS, using J G Wiese* and D Anderson (Tulane School of Medicine, multimedia rich presentations, help students develop Department of Medicine, 1430 Tulane Avenue, New Orleans graduation level pattern recognition skills and also supports LA 70112, USA) feedback. However, both feedback and diagnostic value are essential for effective formative assessment. A Standardized patients (SPs), useful in assessing clinical retrospective study was made of 412 students accessing performance, are limited in assessing clinical reasoning. 42 FACS during their surgical and orthopaedic clerkships. Bayesian theory suggests using a differential diagnosis to 86% of those students used the cases and almost 90% direct information gathering is an essential component of found the exercises useful while 267 completed 20 or more effective clinical reasoning. We designed a web-based and 82 completed 10-19 cases. 78 students were found program (WebSP-CRAYON) to assess students’ ability to at risk with interpretation of emergency radiology and extra use differential diagnosis in directing a patient encounter tutorial sessions were offered. 52/78 students attended and laboratory resource utilization. and achieved a passing rate of 46/52 in their clerkship

– 89 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Students interacted with an SP. After completing the Aim: To describe the management of GP appraisal in Wales. assessment, students accessed WebSP and entered their GP appraisal in Wales is managed by the Section of differential diagnosis, ordered laboratory and radiographic Postgraduate Education for General Practice. studies; to which results were provided. The SPs completed The appraisal website: GP appraisal in Wales operates checklists on history and examination maneuvers through a state of the art web-based appraisal system. performed. The CRAYON assigned quality scores for GPs must register with the system in order to select an questions asked, maneuvers performed, and test ordered appraiser and have access to their virtual appraisal folder. based upon its relevance to the students’ differential diagnosis. A total resource cost for laboratory studies Support for GPs/CPD: Extensive guidance materials are ordered and time spent with the SP was calculated. 301 available on the website. Appraisal workshops were offered students were assessed. Senior physicians established the to all GPs across Wales during Autumn 2004. gold-standard for the quality scores. The mean student Quality assurance: To improve and develop the appraisal score was 59% (SD 9%) of the gold-standard score. The system we have set up a robust internal quality assurance mean resource utilization was $259; the gold-standard programme. We see it as imperative that we run equally was $181. This web-based program, used in conjunction robust systems of external quality assurance. Tenders for with standardized patients, can provide valuable insight an external quality assurance programme will be evaluated into students’ clinical reasoning ability, and provide and awarded on 13 January 2005. feedback on total resource use. Future plans: (1) Review of documentation. (2) The learning intentions database will be refined and the link 6B 5 Developments in GP appraisal in Wales with CPD will be further developed in line with the CPD Katie Evans* (Wales College of Medicine, School of strategy. (3) The external quality assurance exercise will Postgraduate Medical and Dental Education, Heath Park, be undertaken during Spring 2005. (4) A CD ROM will be Cardiff CF14 4XN, UK) commissioned during early Spring 2005 to provide additional support and guidance to GPs and appraisers (available at conference).

Short Communications 6C Teaching and learning about research

6C 1 Medical students’ perceived improvement of 6C 2 A method for medical students to acquire medical research training skills and their research experience results on a written exam after two N D S Bax* and P Stark (University of Sheffield, Academic different courses Unit of Medical Education, 1st Floor, Coleridge House, Northern General Hospital, Herries Road, Sheffield, UK) Franciska Koens*, Daphne Bloemkolk, Mandy van den Brink, Maarten Boers and Ronnie van Diemen-Steenvoorde (VU Introduction: Tomorrows Doctors (GMC 1993 & 2002) University Medical Center, Department of Medical Education, recommends that medical students should gain an Onderwijsinstituut, MF/Room D 237, PO Box 7057,Amsterdam understanding of the scientific method, including related 1007 MB, NETHERLANDS) technical and ethical principles. However new NHS research Aim of presentation: In September 2005, a competence- governance regulations makes it difficult for students to based, assessment-driven and context-situated medical acquire such knowledge by conducting their own research. curriculum will be implemented at the VU University Medical Thus, a new “Research Attachment” (RA) was introduced Center. In the new medical research training (MRT) course, in 2004/2005 attaching 250 Year 2 students, as part of teams of students collect data on lifestyle and health and their Student Selected Component programme, to existing acquire epidemiological concepts by generating their own research teams. database, answering their own research questions and Methods: 92 research options with existing ethics approval presenting the results in a concluding symposium. In where appropriate, were offered by researchers in the contrast, the current program is mostly lecture based. We Faculty of Medicine. Most students engaged with one of compared students’ perceptions of MRT-skills improvement their pre-choices of projects. RAs lasted six weeks; students and exam marks of the current and new program in a became part of the research team and submitted a 2500 pilot study. word report on their work, structured as a research paper. Summary of work: In January 2005, we (quasi randomly) Their graduate, inter-personal skills and professional selected 22 second-year medical students to participate behaviours were also assessed. in the pilot study of MRT. We compared this group with Outcomes: Preliminary analysis indicates that the RA is a the students following the current program in terms of valid and feasible way of enabling students to develop an performance on a multiple-choice exam and students’ understanding of research methods and to fulfil the GMC’s perception of MRT-skills improvement on a 7-point Likert recommendations. A detailed analysis of students’ and scale. supervisors’ evaluations will be presented. Conclusions: Preliminary results showed no significant difference on students’ exam results but some significant differences in favour of the new course on the perceived 6C 3 Teaching Evidence Based Medicine (EBM) to improvement of MRT-skills. This perceived difference in medical students and physicians improvement of MRT-skills is not reflected by the written K Mueller, S Biller, J Forster*, A Pohl, E Haake and Y Falck- exam. Future research topics are whether the skills actually Ytter (University Hospital Freiburg, Elsässer Strasse 2m, 79106 have improved and how to measure those skills. Freiburg, GERMANY) Take-home message: Competence based curricula should Background: EBM has had an enormous impact on how to assess competence as well as knowledge. incorporate current best evidence to medical care and it is widely used as an instructional tool in many medical schools (See also Web poster WSS 3) world wide. In contrast, German Medical Schools disseminate knowledge in an apprenticeship-like relationship that has fostered the handing-down of

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medically related content in a trust dependent manner. and rotating the host site among the participants has This has shaped the learner to become overly dependent increased participation and substantially reduced costs. on expert opinion as the only source of medical evidence. Conclusions: An annual academic competition among city- Aim: Assess the effectiveness of a standardized teaching wide GME programs has encouraged young investigators approach in EBM to overcome this shortcoming of the to become involved in the academic process. Awarding German medical system and to identify barriers of EBM monetary prizes to top finishers and recognition of use. participation of all entrants fosters a sense of pride in the participants and sponsoring institutions. Summary of work: In a prospective cohort study, final year students had either undergone a pre-defined structured Take home Message: An annual academic day competition intervention in EBM (together with physicians or final year can be an effective tool to foster academic development students only) or served as a control group. Outcomes in young investigators. are the effectiveness of the teaching intervention measured by changes in knowledge (pre-validated, standardized written test), skills (self disclosure) and long-term change 6C 5 Effect of participating in evidence-based in competence (standardized face-to-face encounter). implementation research on dentists’ beliefs Summary of results: 28 students and physicians completed Wendy McCombes (NHS Education for Scotland, East and the intervention. Probands of both intervention groups North East, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK) demonstrated significant improvement in knowledge in EBM. As part of the planned educational activities 84 Scottish Vocational Dental Practitioners (VDPs) participated in a Randomised Control Trial (RCT) comparing an evidence 6C 4 Academic excellence competition provides a based oral hygiene package to routine care. The study forum for young investigators aims were to further an understanding of what might Joseph Drazkowski*, Joseph Sirven and Leanne Andreasen influence dentists’ participation in primary care research (Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix AZ 85022, and investigate the effectiveness of evidence-based oral USA) hygiene advice and instruction upon patient oral hygiene and self-reported behaviour. While at the preparatory stage Background: Research training is an important addition to some trainers of the VDPs were not wholeheartedly medical education. Phoenix Arizona is the sixth largest supportive of their VDPs’ involvement, on completion of city in the USA. Community based training programs lack the study 79% of trainers responded to a post study formal research involvement. There are 92 local graduate questionnaire the results of which indicate: 69.7% of medical education training (GME) programs with 1,100 trainers believed RCTs can be carried out in general dental residents and fellows. A competitive academic excellence practice; 63.2% felt that RCTs should be carried out in day was started by Mayo Clinic Arizona and Maricopa practice; 59% thought trainers should have the opportunity Medical Center with goals of fostering research and to participate in a research study and 61% were willing to exposing the learner to research methodology. participate in a research study. In conclusion Scottish Work Done: This competition recently expanded from its Dental Vocational Trainers are generally supportive of original sponsors all training programs city-wide. With two practice based research and agree that VDPs and trainers sponsoring institutions there were 60 submissions. There should have the opportunity to take part in research study are currently 6 institutions involved with more than 200 and be involved in the choice of study topic and study submissions. A consortium of all teaching institutions meets protocol. to plan the annual event. Involving multiple institutions

Short Communications 6D Student support

6D 1 The ‘Home Group’: a new approach to the home group tutor. A minority of students did not value student support the home group system, and we examine reasons for this looking at the free-text responses. David Hartman*, Richard Hays, Gary Hamlin, Shane Bullock, Alan Sive and Jan Veitch (James Cook University, School of Conclusions: The “Home Group” is an alternative model Medicine, Douglas, Townsville, QLD 4811, AUSTRALIA) of student support based on skills development in a Aim of presentation: We describe the “Home Group” system supportive environment, and is enjoyed and valued by a at James Cook University. This structured program has an majority of students. explicit supportive and pastoral function, but is orientated towards developing strengths (reflective capacity, 6D 2 The Hospital Dean; an alternative to the communication skills, teamwork, and learning skills) rather personal tutor than identifying pathology. We present our evaluation of this approach. Caroline R M Boggis* and P A O’Neill (University of Manchester, School of Medicine (G14), Stopford Building, Summary of work: We surveyed all students in two Oxford Road, Manchester, M13 9PT, UK) consecutive semesters over three academic years. Students completed a questionnaire with Likert scales and gave free- Aim: To describe an alternative to personal tutors text comments. supporting students during their clinical learning. Summary of results: A majority of students indicated that: Rationale: Changing healthcare environments, academic they enjoyed home group meetings; the program helped and daily living pressures necessitate robust student them with their approach to learning and studying; helped support mechanisms. At Manchester Medical School year them understand the process of medical training; and was 3 students progress to clinical placements in teaching good for their confidence and self-esteem. Respondents hospitals continuing with problem based learning (PBL). identified the value of friendships and support networks The Hospital Dean (HD) provides the main support with developed within Home Groups, the importance of support students informed verbally and in writing of services and feedback from peers, and the mentoring function of available with strong emphasis on seeking help early. The

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clinical and PBL tutors who provide additional support are Patient care is influenced by the well-being of their health encouraged to link with the HD. Weekly sessions are professionals/doctors. Mentoring and appraisal are allocated for student appointments, HD or student initiated, important mechanisms for the development of all providing students opportunities to discuss academic and/ functioning health professionals. In the UK the General or personal matters aiming to problem solve, organise Medical Council now insists that students must receive remedial learning and where appropriate initiate regular, structured, and constructive appraisal. A survey disciplinary procedures. was undertaken to investigate the current approach of UK Medical Schools to pastoral support systems and appraisal Process: For 568 consultations, during 49 months (1998- issues. Topics included whether and how pastoral care is 2002), 361 students were seen, 380 HD initiated and 188 delivered, what training is offered to those who provide it student initiated. The distribution across year groups was and the theoretical bases for models of pastoral care. year 3 39%, year 4 47%, year 5 11% and resits (all years) Information was also sought on examples of integration 3%. Most issues were resolved in one or two meetings of student support within the curriculum and whether and with a few students having severe problems necessitating how personal and professional development is assessed multiple consultations. Generally discussions related to or monitored. Models of appraisal appropriate for medical attendance, poor academic performance, health (anxiety, students are presented and linked with concepts of depression, sports injury) and family pressures. teaching and developing professionalism together with Conclusion: The HD addresses student issues repeatedly strategies for embedding this personal and professional thereby provides experienced student support and a focus learning within the curriculum. Models of mentoring, co- and continuity of care for students on geographically mentoring and peer support currently in use within the scattered clinical placements. wider context of healthcare education will also be presented. Based on the conclusions from this theoretical and practical approach we will describe how one graduate 6D 3 Medical student perceptions on a entry medical school intends to enhance its own pastoral supportive, group-based mentoring program support system. introduced in a Brazilian Medical School M F A Colares, M Castro*, C M Peres, J F C Figueiredo, A D 6D 5 Does student support improve C Passos, M L V Rodrigues, R B Oliveira and L E A Troncon (University of São Paulo, Departamento de Clinica Medica, performance? Prediction of performance in Faculty of Medicine of Ribeirao Preto, Av Bandeirantes, 3900, the final examination from performance Ribeirao Preto SP 14049-900, BRAZIL) early in the medical course Entering medical school may be associated with a number A L Tonkin* and J N Hudson (University of Adelaide, Medical of difficulties, which may hinder student performance and Education Unit, Adelaide SA 5005, AUSTRALIA) personal development. At the Ribeirao Preto Faculty of Medicine (University of São Paulo, Brazil), an elective Background/rationale: Students who struggle academically mentoring program aiming at supporting first year students in the early years of medical school occupy large amounts of staff time and effort in attempts to support them through was introduced recently. Mentors were recruited from the course. Such support is often assumed to be valuable, faculty and medical staff, and trained under the supervision without clear evidence that it benefits either the student of committee composed by senior faculty members plus a psychologist and an educationalist. After one year of or the school. regular, bi-monthly group meetings, student perception What was done: We looked at two successive cohorts in a on this experience was assessed using a structured 6 year undergraduate medical curriculum, comparing their questionnaire. Responses from regular attendees (N=20) exam performance at the end of year 3 to that in the final were compared to those from peers who either did not examination, to determine whether or not students with enroll for the program or attended the meetings only poor performance at the year 3 level were able to improve occasionally (N=54). Students from both groups shared later in the course with extensive support. Year 3 positive opinions about the program and highlighted the examination performance was highly correlated with final mentor’s supportive role, which was viewed as facilitating examination performance (r=0.57, p<0.001), and was also adaptation to a new environment. Failure to enrol for the highly predictive of continuation in the course vs. program and/or low student attendance was explained as subsequent failure and/or withdrawal (p<0.01). being caused by concomitant engagement in other extra- Conclusions: Poor performance in early years of the medical curricular activities. Student perception on the program course is highly predictive of on-going difficulties, despite was regarded as encouraging and has prompted additional student support. discussions focused on measures that could enhance student interest and participation, and thus facilitate the Take-home messages: Students with poor performance in permanent implementation of this mentoring program. year 3 of an undergraduate medical course have a low probability of uncomplicated progress through the rest of the course and may be better served by career counselling 6D 4 Pastoral support systems for medical students or time out than by intensive support. Gill M Grimshaw* and Jane M Kidd (University of Warwick, Warwick Medical School, Medical Teaching Centre, Coventry, CV4 7AL, UK)

Workshops 6E, 6F, 6G & 6H

6E Designing and organizing reliable case-based in many cases. However, with well designed short answer tests with Short-Answer-Questions (SAQs) questions it is definitely possible to construct reliable tests. SAQ progress tests at the University of Amsterdam and Dr Jany Rademakers and Prof Dr Olle ten Cate (UMC Utrecht, Utrecht University over a number of years consistently School of Medical Sciences, Utrecht, Netherlands) result in reliabilities higher than 0.80 (Cronbach’s alpha) Background to the topic: Open-ended test questions have with less items than similar true-false progress tests. the connotation of being unreliable, which is probably true Rigorous procedures for item construction, marking and

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quality control are necessary to attain these high Who should attend? All those involved in PPD as part of reliabilities. their own work or in facilitating the learning of others. Previous experience of PPD learning and teaching is Workshop content and structure: The workshop focuses desirable as the workshop aims to share experiences. The on benefits of open questions, the construction of case- main reason for attending is a genuine interest in the based items, procedures for marking and quality control. outcomes. Programme: (a) Introduction on experiences with SAQ progress tests in the Netherlands; (b) Item construction (checklist of do’s and don’ts) Exercise: Group discussion 6G Effective communication in the health of open questions and/or case-based items which are made professions beforehand by the workshop participants (2 questions per Hannah S Kedar (Psychologist, The Hebrew University of participant); (c) Marking procedures (model answers, Jerusalem, Centre for Medical Education, PO Box 12272, distribution of questions;(d) Quality control procedures; Jerusalem 91120, Israel) (e) Test construction (item selection, test validity). Exercise: Construct the most reliable test from a selection of Background: A major change in the health professions in questions (in pairs); Demonstration: Computing the recent years has involved a shift in the relationship between reliability of open questions patients and health professionals from a paternalistic orientation toward a patient-centered approach. This shift Intended outcomes: Participants have a better insight into requires health professionals to acquire, or improve, their the advantages and disadvantages of SAQ tests; communication skills as an essential component of their Participants are aware of the do’s and don’ts regarding professional competence. the construction of SAQs; Participants have learned about procedures of test construction, question marking and Objectives: At the end of the workshop participants will quality control and how to implement them. (1) become acquainted with principles of effective communication; (2) be able to apply these principles to Intended audience: Teachers, assessment professionals. their actual interactions with patients, patients’ families, Level of workshop: intermediate (some knowledge/ and/or team members (through role-plays that will be experience desirable) exercised in the workshop). Who should attend: Health care professionals who serve either as practitioners or as educators may benefit from 6F Personal and professional development – this workshop. The messages of the workshop are relevant effective practices for physicians as well as for nurses, dentists, veterinary Iain Robbé (School of Medicine, Cardiff University, Temple of practitioners, etc. Peace & Health, Cathays Park, Cardiff CF10 3NW, UK), and Expected outcomes (take-home messages): Expected Debra Nestel (Imperial College, London, UK) outcomes involve an acquaintance with principles of Background: Personal and professional development (PPD) effective communication, a model for teaching is increasingly relevant to medical, veterinary and other communication skills, and an enhanced ability to apply professionals because of the growth in expectations from this model in practice as well as in education in the health patients, families/carers, employers, and the wider society. professions. Handouts will be provided. The outcomes associated with PPD often involve attitudes and behaviour e.g. self-directed learning, effective communication, reflective practice and coping with 6H Standardized assessment of reasoning in uncertainties and other stressors. Thus there is growing the context of uncertainty: the Script interest in teaching and learning strategies relevant to PPD Concordance Test (SCT) learning, and in the assessment of competencies. This workshop will explore participants’ experiences of teaching B Charlin, R Gagnon and B Carrière (University of Montreal, Faculté de Médecine – direction, C.P. 6128, succursale centre- and learning about PPD and discuss how the teaching of ville, Montréal, Québec H3C 3J7, CANADA) PPD can be facilitated for adult learners. Participants may use this knowledge to enhance their own and others’ PPD. Background: The essence of expertise in the professions lies in the capacity to solve ill-defined problems i.e., Content: The workshop will build on the key issues that reasoning in contexts of uncertainty. Assessment of ill- were identified in the PPD workshops at the AMEE meetings defined problems is difficult to achieve in a standardized in Bern and Edinburgh led by the presenters. Participants manner. will explore their experiences of learning and teaching PPD – working in small groups and in the plenary group: Workshop content and structure: Presentation of SCT Introductions, background, setting the scene (15 minutes); principles; discussion based on the example of SCT items; PPD teaching and learning – case studies (20 minutes); discussion of research results on validity and reliability of Critical reflections – individuals, small groups – re. the test. The material will include examples taken from an experiences (15 minutes); Common themes and prioritised assessment of reasoning skills in emergency paediatrics. issues (20 minutes); Themes, strengths and weaknesses The format will be interactive, with emphasis on free revealed in the workshop; implications for more effective discussion and exchange of ideas. practices (20 minutes); Summary, reflection and evaluation Intended outcomes: Participants will discover a test that (5 minutes). allows to reliably discriminate examinees across different Objectives: (1) To share experiences of teaching and levels of experience, in domains that were up to now learning about PPD; (2) To discuss how teaching of PPD difficult to assess. has been facilitated for adult learners (undergraduates and Intended audience: Undergraduate, postgraduate, and postgraduates), in order to identify themes, advantages continuing education in the health professions; the tool and disadvantages. has been used mainly in medicine but it can be applied in Outcomes: (1) To identify ways to promote the learning all health professions. of PPD; (2) To share experiences of facilitating learning in Level of workshop: Intermediate and advanced (some PPD; so that participants can enhance their own and others’ knowledge/experience required). PPD.

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Short Communications 6L Doctors practising in a different country

6L 1 The West Midlands regional clinical little is known about the specific undergraduate educational attachment scheme for international doctors experiences of IMGs. All US allopathic medical schools are required to undergo a stringent accreditation process and Mohamed Arafa*, Denise Harris and Phillip Tuttle (West extensive data about the schools are available. The purpose Midlands Deanery, PMDE, Institute of Research & of this study is to gather information about the educational Development, Birmingham Research Park, 97 Vincent Drive, Birmingham B15 2XE, UK) content and experiences, venues, and assessment methods used in these schools. Preliminary data from several of The United Kingdom National Health Service continues to the schools indicates that most submit to some form of rely on overseas doctors in the delivery of its healthcare accreditation process but there are differences in system. They currently form 35% of the medical workforce. admissions processes, curricular structure and Overseas doctors face many challenges on arriving in the organization, and clinical experiences. With a projected UK. Understanding a new health system and adapting to shortage of doctors in the US, these schools may play an a western culture remain prerequisites for these doctors even bigger part in the healthcare system. Having more to have a successful career in the UK. This can be achieved detailed knowledge of the educational experiences they through preemployment clinical attachments and induction provide helps inform policy-makers and those responsible courses. Many overseas doctors find it extremely difficult for graduate medical education. to secure a clinical attachment placement because of limited placements and the lack of national policy on recruitment to these schemes. In this paper, we discuss 6L 4 The case for internationalizing graduate our experience with the West Midlands regionally medical education administered clinical attachment scheme. J S Nagra* and Fredric D Burg (Melaka-Manipal Medical The scheme is based on a centrally coordinated electronic College, 463-1 Jalan Batu Hampar, Bukit Baru, Melaka 75150, database, which is maintained by a project facilitator. MALAYSIA) Regional guidelines for clinical attachments have been The development of internationalizing medical education implemented. Sixty educational supervisors in twelve by rotating students through multiple campuses; across hospitals in the West Midlands are participating in the countries, giving them the best learning opportunities and Scheme. Each trainee is issued with educational contract, exposing them to multiple cultures needs to be developed. has a nominated educational supervisor and goes through The advantages will be in promoting the art of medicine a system of appraisal and assessment. Preliminary while overcoming cultural barriers, developing an evaluation of the scheme suggests that regional clinical understand of different cultures, establishing new bonds attachment schemes are an efficient system for meeting of friendship, exposing students to wider morbidity profiles the educational needs of overseas doctors. and preparing them for the challenges that arise with the emergence of new clinical entities. The multicultural 6L 2 International links as a means to deal with exposure will enhance confidence to practice in different global settings in an ethical, cost conscious manner. workforce shortages and cultural Collaboration between faculties will provide unique competencies approaches to clinical issues; allow simulation methods, F Burg (State of Alabama, Suite 347, Shelby King Hall, e-learning and virtual reality sessions to reinforce bedside University of Alabama Huntsville, Huntsville Al, Alabama teaching for graduate medical education. Such ventures 35899, USA) broaden the scope for staff development, adaptive In Alabama a Commission has been formed to develop curriculum, community based learning and research. state wide solutions to the Health Care Crisis. There are Learning Portfolios and OSCE will play a major role in significant shortfalls in the numbers of health care workers assessment. International standards and accreditation in Alabama and the US. One approach is to recruit criteria, based on outcomes allowing for cross cultural international students to the United States. Simultaneously dimensions and broader acceptability, will need to be there are many US students who would like an educational evolved. Most importantly in the context of globalization, experience in another country. Developing significant the widely divergent needs of communities and approaches academic links between two institutions that facilitate the to meeting those needs of regions can be addressed. flow of students between nations should be beneficial to Faculty and administration together can study the cost of all. However there are many roadblocks. These include medical education and efficiencies may be identified cost, aculturation, and acceptance into a second country’s depending upon the regional partnerships. educational programs. Two institutions, one in the US and a second in India have spent the last year developing such 6L 5 Coming home: successful entry into a program called the “International Scholars Program”. postgraduate medical education of This paper will discuss our successes and failures. Canadians studying abroad M I Bowmer* and Sandra Banner (Memorial University of 6L 3 The educational experiences of U.S. citizens Newfoundland, St John’s, Newfoundland, CANADA) who graduate from International Medical Canada’s medical schools turn away 4-5 acceptable Schools: preliminary results candidates for every one they enrol. Some seek their John Norcini*, M Brownell Anderson, Danette McKinley and medical education outside Canada. Since Canada relies Deliya Ryan (FAIMER, 3624 Market Street, 4th Floor, on international medical graduates (IMG) for over 20% of Philadelphia PA 19104, USA) its physician workforce, repatriating internationally Graduates of international medical schools (IMGs) play an educated Canadians into postgraduate education can help important role in the provision of health care in the United meet our continuing requirement. The number of Canadian States. Approximately 25% of practicing physicians students studying abroad is unknown. Over 100 Canadians completed their undergraduate medical education abroad are studying medicine in Australia and over 275 in Ireland. and IMGs currently fill roughly one quarter of the positions Data from the Canadian Residency Matching Service in graduate medical education. Compared to their provides insight into where Canadians are studying and counterparts from U.S. medical schools (USMGs), relatively their success in obtaining postgraduate education in

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Canada. 40% of the Canadians in the 2005 match were and that the schools are being influenced more and more studying in Ireland and 40% were studying in Caribbean by the global economy and global manpower issues. What medical schools. Using data from 2004, 80% of Canadian are the underlying issues for medical educators? students from international medical schools successfully Discussion: The talk/discussion centers on global issues matched to Canadian postgraduate programs. In the same of Workforce/Manpower, Educational Objectives and year only 13.2% of all international medical graduates Curriculum, Testing/Assessment/Evaluation and Licensure, matched in Canada. Accountability/ Discipline/Appeals, and Measures of Canadians who are new IMG are more likely to match to Success and Failure. Canadian residency programs than those IMG who are Conclusions: There is a need for medical schools around more than three years post graduation. Possible reasons the world to be aware of how they currently fit into the include: the new graduate is more competitive because global educational system and to be proactive in their future they are closer to their medical studies, or there is a plans to ensure that they maintain a balance of meeting presumption that Canadians schooled in Canada prior to their local needs as well as being able to be a partner in their medical education, will easily integrate into the the global community. Canadian medical system. Take Home Message: Universities used to be the gatekeepers of knowledge: this is no longer true and 6L 6 The impact of the globalization of medical medical schools are finding the need to address the new education on medical educators realities of having to integrate into a larger global community. It is not a question of “if” it needs to be done, David E Blackmore*, Peter McCrorie, Lambert Schuwirth and Lesley Southgate (The Medical Council of Canada, 2283 St but rather “how” best to do it. The purpose of this paper Laurent Blvd, Ottawa, Ontario K1G 3H7, CANADA) is not necessarily to provide all the answers, but to outline some of the issues/challenges that need to be met. Background: Medical schools around the world are finding that there is a need to be connected to global networks

Short Communications 6M Written assessment

6M 1 Incidence of flaws in unedited achievement affect students’ scores are very important. The present tests study was conducted to determine the effects of changing answers in Multiple Choice Examinations on students’ 1 2 2 1 Ara Tekian* , Stella Majors and Fa’ek Jamali ( University scores. of Illinois at Chicago, Department of Medical Education (m/c 591), 808 South Wood Street, Room 986, Chicago IL 60612, Method: The study was conducted in Mashhad University. USA, and 2American University of Beirut, LEBANON) Data were collected from the answer sheets of 32 midwifery Aim: Multiple-choice questions (MCQs) are one of the most students, in the final examination. In all, the answers of popularly used measurement instruments, yet many students to 3840 questions were assessed. institutions do not edit such tests prior to administration. Results: In general this study showed that students gained Most of the time tests are compilations of MCQs submitted from changing answers. The number of answers changed by various faculty with no experience in item-writing. This by each student ranged from 1 to 12: Answers changed study investigates the incidence of flawed items in two from correct to false were 32 items. Answers changed tests. from false to correct were 96 items. Answers changed Work done: Three judges established 18 types of flaws (8 from false to false were 32 items. single-flaws and 10 multiple-flaws) derived from the 31 Discussion: Most students change answers, even if they principles for MCQ construction (Haladyna et al, 2002). have been warned against this practice. Students are more The judges independently classified the number of flaws likely to change their answers on multiple-choice exams for two different basic-science tests that were single-best from wrong to right than from right to wrong. The results answer type with 5-options. of this study should be considered in light of some Results: Test-A (45 MCQs) had 11 single-flaws, 18 multiple- limitations. As educators we have the responsibility for flaws and 16 no-flaws. Test-B (41 MCQs) had 13 single- informing our students about the latest research in the flaws, 18 multiple-flaws, and 10 no-flaws. The two tests field of knowledge acquisition and recall. combined had 26 no-flaw items out of 86 (30 %). 70% of the MCQs were flawed. The most common types of single- 6M 3 Tell your students to rethink and change flaws were “unfocused stems,” “heterogeneous options,” and “all-of-the-above.” The most common multiple-flaws their answers to Multiple Choice (MC) were “unfocused-and-negative.” questions – at least once! Conclusion/Take-home messages: High incidence of flaws M R Fischer*, D Bauer and V Kopp (University of Munich, in unedited tests does not provide a good measure of Klinikum der Universitat München, Medizinische Klinikum Innenstadt, Ziemssenstr. 1, Munich 80336, GERMANY) students’ achievement in high-stakes examinations. MCQs should be reviewed and edited prior to administration. Aim: Students often believe that the first answer to an Faculty development might improve the quality of item- MC-question coming to mind is the best. We examined writing. whether the instruction to students to rethink and change their answers when in doubt leads to an improved test score. 6M 2 Effects of changing answers in multiple choice examinations on students’ scores Summary of work: We have previously shown that changing answers to MC-questions leads to an improved Hossein Karimi Moonaghi (Mashhad University of Medical overall test score in the German National Boards Exam. Sciences and Health Services, No 19, 10th Banafshe Street, When students are instructed about these findings, their Abobargh, Mashhad, IRAN) overall test results should be better than without Background and purpose: Because MCQ has many instruction. We randomly assigned 41 3rd-year students applications, determining the effects of factors that may to the instruction and 38 to the non-instruction group.

– 95 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Each group answered 78 MC-questions from general and Pearson correlation results show moderate to good positive occupational medicine after a 15-week semester. linear relationships between Year 3 and Year 5 scores for each cohort (r = 0.36 to 0.54, 0.33 to 0.52, 0.47 to 0.64, Summary of results: The instructed students changed more P < 0.001). These results reveal a non-causative answers (6.2 vs. 4.2%; p<.05) and improved their score relationship. The authors now propose to examine the more (plus 2 vs. 1%, p<.05) than the non-instructed interaction of other factors, e.g. gender. group. We confirmed that changing an answer once is statistically beneficial; further changes did not improve the test score in both groups. 6M 5 Detection of probable cheating in tests Conclusion: Students should be informed on the beneficial Pedro Herskovic* and Eduardo Cosoi (University of Chile effects of changing initially given answers to MC-questions Medical School, Clasificador No 7, Correo 7, Santiago once when in doubt. Rethinking of answers should be 8389100, CHILE) encouraged. Introduction: Some authors have reported that up to 58.2% of medical students admit cheating in tests. We 6M 4 Performance in undergraduate progress have anecdotal complaints of students who do not cheat. tests as a predictor of medical school Our purpose was to evaluate if cheating in tests was occurring locally. performance Methods: A statistical method developed modifying one C Noor*, A Owen, G K Mahadev, P A O’Neill and G J Byrne described by Ercole (Medical Education 2002;36:166-172), (University of Manchester, Universities Medical Assessment Partnership, ATR 4, Education and Research Centre, South was used in three multiple-choice tests that were part of Manchester University Hospitals, Southmoor Road, the assessment of thirty-two students in a course. A Manchester M23 9LT, UK) “Weighed Similitude Score” (WSS) was obtained. The location of students in the room was registered, and a Whilst measurements of reliability are commonplace in the blueprint of where they sat was made. Pairs of students assessment literature, commentary on validity, particularly who obtained a WSS of 2.5 standard deviations above predictive validity, is relatively rare. The University of average were considered as possible cases of cheating Manchester wished to investigate the predictive validity of and their sitting places were analyzed. The adjacent pairs the Manchester Progress Test (MPT), an examination with high WSS, were considered as probable cases of administered simultaneously to all students on a total of cheating. five occasions over their clinical years. The MPT has a mean reliability of 0.84, however, its predictive validity is Results: Between 35,5% and 60,0% of students were unknown. Data was collated to assess whether scores considered possible cases. Eighty-seven percent of obtained by Year 3 students on the MPT had any predictive students with high WSS were seated adjacent. Between effect on Year 5 scores. Three cohorts were examined 24,8% and 46,7% of students were considered probable (1998, 1999, 2000) (n=943). Any student not sitting five cases. consecutive examinations was removed (n=107). The Conclusions: Even though this method requires validation, 2 remaining data was grouped (n=836) and analysed. r the results suggest that cheating happened. We must regression values reveal that for each cohort much of the develop strategies to prevent, detect and manage cheating. variation in Year 5 scores could not be explained by the Year 3 scores (r2 = 0.20, 0.19, 0.32, P<0.001). However,

Short Communications 6N Standardized/simulated patients

6N 1 Effects of being a simulated patient – 6N 2 Combining standardized patients with implications for quality assurance simulation technology at a Canadian J Kretschmann*, A Froehmel, H Goehler, A Dieterich, W Burger National Specialty Examination and U Schwantes (Medical School of Charité Berlin, Institut R Hatala, B O Kassen*, M Bacchus, G Cole and S B Issenberg Fuer Allgemeinmedizin Charité, Schumannstr. 20/21, Berlin (University of British Columbia, St Paul’s Hospital, Suite 5907, 10117, GERMANY) Burrard Building, 1081 Burrard Street, Vancouver BC V6Z 1Y6, Aim of presentation: In a pilot study we aim to detect how CANADA) people experience working as a Simulated Patient (SP) at Aim of Presentation: Standardized patients (SPs), often our faculty. lacking physical abnormalities, are frequently employed Summary of work: Since 2000 SPs have been an integral in high-stakes assessments of clinical competence. part of teaching at Charité Medical School of Berlin, Incorporating simulation technology with SP assessments assisting in communication skills trainings and exams offers the advantage of standardizing patient abnormalities, (OSCE). Strain on SPs varies depending on the task (e.g. provided that the assessment process demonstrates psychiatric role; physical examination). Previous studies acceptable validity evidence. have shown that simulating has various positive and Summary of Work: We developed, implemented, and negative effects on SPs. Therefore questionnaires were validated OSCE-type stations that combined simulation developed and administered at the end of teaching and technology with SPs for the 2004 Royal College of exam units to gather information on the current state of Physicians and Surgeons of Canada’s Comprehensive participating SPs at the end of a working day and on the Objective Examination in Internal Medicine. effects of being an SP in general. Digital audio-video simulations of cardiology and neurology Summary of results: Results will be presented regarding physical abnormalities were included in 11 SP OSCE-format the subjective perception of being an SP. stations. Two examiners evaluated each candidate’s Conclusions: Specific actions are being suggested to performance. Reliability and validity data of the stations support SPs in their professionalism and minimize stress was assessed. Examiners were tested on a sub-set of the as a measure for quality assurance. audio-video simulations.

– 96 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Summary of Results: Inter-rater reliability for the audio- and communication skills. Former curriculum students video simulations ranged from 0.83-0.85. Construct validity trained these skills during internship in the 6th year after was addressed by assessing candidates’ and examiners’ a single training on manikins. diagnostic accuracy for a sub-set of simulations (mean Aim: To assess the effect of learning intimate examinations score 0.79 +/- 0.26 and 0.84 +/- 0.24, respectively). Post- with IEAs by comparing students from former and renewed examination surveys confirmed face validity. curriculum. Conclusions: Incorporating simulation technology with an Method: 3 groups were compared: former curriculum SP assessment represents a feasible and valid approach students (FC/IEA-/internship+) after internship, renewed to the assessment of clinical competence in a high-stakes curriculum students (NC/IEA+/internship+) after setting. internship, and fifth year NC students immediately after the IEA training (NC/IEA+/internship-). Four assessment 6N 3 Standardized patients and long psychiatry instruments were used: an OSCE using detailed checklists examination simulations and global rating scales, a score list on students’ attitudes filled in by the IEAs, a student questionnaire on self- Nancy McNaughton*, Brian Hodges and Susan Abbey esteem, and a questionnaire containing 72 items on the (University of Toronto, University Health Network, Donald performing of gynecological and urological skills during Wilson Centre for Research in Education, 200 Elizabeth Street, internships. Statistical analysis: SPSS (12). 1ES-565, Toronto, Ontario M5G 2C4, CANADA) Results: Both groups of NC students scored globally better Purpose: There is growing controversy regarding the in the OSCE (significance for male examination). Sub scores feasibility of standardized patients (SPs) for speciality for « completeness » and « systematic approach » were certification. In psychiatry, long case interviews are significantly higher in both NC groups for male and female necessary to assess comprehensive skills. This requires examinations. encounters of approximately one hour, raising questions regarding the impact of sustained simulation on both role NC/IEA+/internship+ have better self-esteem and self- authenticity and actor well being. This case study explored confidence concerning gynecological and urological clinical how actors prepare for the enactment of long psychiatric and communication skills. Best results were scored after roles, as well as how these roles impact them both within IEA training AND internships. IEAs are influenced by the « and beyond the enactment itself. experienced » students after internships: FC/IEA-/ internship+ and NC/IEA+/internship+ have both good Methodology: SPs enacted roles undercover during a scores, better than the NC/IEA+/internship- students. daylong mock psychiatry exam. Data were collected following the exam day using a focus group, reflective Conclusion: Learning intimate examinations with IEAs has journals, and telephone interviews. Using a grounded a positive effect on the performance of medical students theory approach, data were analyzed by two researchers that is even strengthened and reinforced during their in a constant comparative process discussing emerging internship. themes. Summary of results: SPs reported satisfaction portraying 6N 5 Standardized patient self-training using a sustained psychiatric roles. Prominent themes included: web-based training module experiences in a role in an interview, between interviews, and outside role-play. Actors discussed: the importance Tony Errichetti* and John R Boulet (Philadelphia College of of ‘fit’ in both their acquisition and enactment of an Osteopathic Medicine, 4170 City Avenue, Suite 108, authentic role, the phenomenon of character identification Philadelphia PA 19131, USA) while portraying a role; and their difficulty shedding the Aim: Investigation comparing traditional standardized role following performance. patient (SP) training methods to a web-based SP self- training module. Conclusions: While SPs enjoy portraying longer roles, implications of performance over time needs further Summary of work: Results of an investigation comparing examination, both to ascertain short and long-term effects traditional SP training methods to a web-based SP self on actors to determine its effects on the reliability and training module will be reported. This web-based module validity of long stations in examination settings. allows SPs to self-navigate through training materials containing text, graphics and video clips. The module tests SP mastery of case portrayal and assessment material and 6N 4 The effect of learning intimate examinations readiness to take a qualifying performance trial with a SP with simulated patients on the performance trainer. of medical students during their internships Summary of results: 10 SPs will be trained in traditional K Hendrickx*, B Y De Winter, W A A Tjalma, G Peeraer, D methods (i.e. paper case, role play with SP trainer, etc.) Avonts and J J Wyndaele (University of Antwerp, Department and 10 SPs will be trained using a web-based self training of General Practice, Skills Lab, Campus Drie Eiken, module. This pilot investigation will be conducted in the Universiteitsplein 1, Wilrijk 2610, BELGIUM) spring of 2005 in preparation for a fourth year medical Background: The medical curriculum in Antwerp was student OSCE. Analysis of variance will test the null reformed in 1998. For fifth-year undergraduates, a project hypothesis that there is no difference in portrayal fidelity with simulated patients (Intimate Examination Associates, or checklist accuracy between SP groups. IEA) was implemented in 2002. Students learn uro-genital, Conclusions: Web-based self-training methods may prove rectal, gynecological and breast examination in healthy, effective in training SPs in portrayal and documentation trained volunteers (setting: 2 students, 1 IEA and 1 medical and lowering SP trainers costs. Such methods, if shown to doctor). Students receive immediate feedback after each be effective, may also change the role and function of the session with focus on personal attitude, technical skills SP trainer/educator in significant ways.

– 97 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Short Communications 6O Postgraduate 360o assessment

6O 1 360 degrees assessment of interns in 6O 3 Multi source feedback: 360 degree internal medicine assessment of professional skills of clinical A Malchow-Møller*, K K Pedersen, O B Rasmussen, A Rohold directors and K Aspegren (South Danish University, Office of Medical David Wall*, Hugh Rayner and Robert Palmer (West Midland Education, Winslowparken 17, Odense C DK-5000, Deanery, PMDE, Institute of Research and Development DENMARK) Building, Birmingham Research Park, 97 Vincent Drive, Aim of presentation: To explore the possibilities of 360 Edgbaston, Birmingham B15 2SQ, UK) degrees assessment of interns in the Danish setting. This study was undertaken to establish a validated Summary of work: Danish postgraduate training requires questionnaire for 360 degree assessment of clinical assessment of specific learning objectives. Internship in directors (CDs) in a large teaching hospital. There is a job Internal Medicine has 65 learning objectives to be description and person specification containing 14 assessed. We considered 22 of these suitable for competencies or abilities expected of a good CD which assessment by the method. Medical departments of three were used in a questionnaire for senior clinical staff who hospitals contributed 10 interns to the study. Each resident worked with a CD, rating each statement on a 1 to 5 Likert was assessed by at least 10 persons of which one was a scale depending on how much he/she judged each quality secretary, four were nurses and five senior doctors. as being important in the CDs job. The questionnaire and responses were delivered electronically. Respondents Summary of results: The assessors spent 5-15 minutes to stated their gender, present post and number of years fill in the forms. Of the 22 chosen objectives, 15 could employed. There were 107 completed questionnaires (55% reliably be assessed by doctors, 12 by nurses and 2 by return); 90 stated their post, 89 their gender and 88 the secretaries. The assessment identified unsatisfactory time worked locally. Cronbach’s alpha was 0.89, indicating achievements in 5 of the interns. Number of unsatisfactory a high level of reliability, with no rogue questions. Three objectives varied from 8 to 2. They were mostly within the independent factors, unaffected by post, gender or years areas of communication skills, collaboration, leadership employed, were found; they have been distilled under the and professionalism. Psychometric properties were headings of Operational Management, Interpersonal Skills satisfactory. and Creative/Strategic Thinking. Using these factors we Conclusions/take-home messages: Chosen internship have developed a validated questionnaire for CDs to pass learning objectives can reliably and with reasonable use to 10 directorate colleagues with 5 grades from of time be assessed by 360 degrees evaluation. ‘unacceptable’ to ‘excellent’. Comments will be encouraged. This will form an important part of CD appraisal. 6O 2 One Deanery’s approach to the introduction of a new appraisal and assessment process 6O 4 Team assessment of behaviour: the assessors and their ratings – doves and F Anderson* and E A Hesketh (NHS Education for Scotland, Postgraduate Medical Office, Ninewells Hospital and Medical hawks? School, Level 7, Dundee, DD1 9SY, UK) Alison Bullock*, Andy Hassell, Andrew Whitehouse, David Wall Background: The East Postgraduate Deanery introduced and Lawrence Wood (University of Birmingham, School of Education, CRMDE, Edgbaston, Birmingham B15 2TT, UK) a modified PHAST (Pre-registration House Officer Appraisal and Assessment System), consisting of a 360o screening Aim of Presentation: From April 2005 UK doctors in training questionnaire and an on-the-job assessment of practical have to undergo 360º assessment of their professional skills. This was necessary, as previous assessment behaviours. Drawing on data from a West Midlands pilot processes had failed to provide sufficient evidence to inform study of team assessment of behaviour (TAB), we report registration decisions. Unlike the previous assessment tool, who the assessors were and how different professional this new system required input from Consultants, Specialist groups rated the junior doctors. Registrars, Senior House Officers and Senior Nurses. Summary of Work: On a single-sided form, 1378 evaluators Work Done: A series of uni-professional, departmental, assessed 171 senior house officers (SHOs) in four domains: ward and open meetings, throughout the Deanery, professional relationship with patients, communication, provided a platform for the dissemination of information team working and accessibility. about the new PHAST system. Despite our best efforts Summary of Results: Most commonly nurses (35%), junior not all staff were able to attend, therefore ward packs doctors (14%), consultants (13%), registrars (13%) and were produced. Information was also relayed to medical administrators/management (10%) made the staff through a poster campaign, a messaging system on assessments. their payslips and a leaflet mail-shot. Trainees were informed about the PHAST system and given their appraisal Although most assessments indicated ‘no concerns’ across and assessment documentation at their formal hospital all four domains, 6% showed ‘some or major concern’ in induction. at least one domain. The distribution of ‘concerns’ across the professional groups varied. Junior doctors and Conclusion: All 93 trainees completed PHAST during their administrators/managers were less critical (less than 1% PRHO year. The successful introduction of this new PHAST of each group identified concerns) compared to consultants system, compared with the difficulties experienced in the (10%) and ‘others’ (12%, mainly operating department initial pilot, can be attributed to the effort made to inform practitioners) (p=0.001). staff about the system and address any concerns raised. Take-home Messages: Guidance on the selection of Take Home Message: The key to introducing a new assessors in any 360º process should take into account appraisal and assessment system is preparation. that rating behaviour varies by staff group.

– 98 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6O 5 The development and psychometric Results: 186 of the 197 recruited physicians participated. assessment of multi score instruments to The mean number of respondents per physician was 17.7 assess practicing anesthesiologists for patients, 7.8 for co-workers, and 7.8 for medical colleagues. All instruments had a high internal consistency Jocelyn Lockyer*, Claudio Violato and Herta Fidler reliability (Cronbach’s alpha >.95). The generalizability co- (University of Calgary, Health Sciences Centre, Continuing efficients (Ep2) were .65 for patients, .56 for co-workers Medical Education, 3330 Hospital Drive NW, Calgary, Alberta and .69 for peers. Compared with data from other specialty T2N 4N1, CANADA) groups for whom instruments had been developed Aim: To develop a set of multi source feedback (360- previously, there was a lower patient response rate. Further, degree) instruments to assess and provide feedback to fewer items on these surveys resulted in a lower anesthesiologists about practice related behaviors. generalizability co-efficient. Work Done: Surveys were developed so that 30 patients Conclusions and Take Home Messages: It is feasible to (11 items), 8 co-workers (19 items), 8 medical colleagues develop multi source feedback instruments for (29 items) and the physician (29 items) could assess anesthesiologists. Attention needs to be paid to the length communication skills, professionalism, collegiality, of the instruments and the appropriateness of including continuing professional development and collaboration patient surveys for this group. using 5 point scales. Physicians were responsible for recruiting patients and identifying co-workers and colleagues who could answer the questions.

Workshops 6R, 6S, 6T & 6U

6R The International Virtual Medical School – successful promotion. A brief interactive plenary will IVIMEDS present criteria for educational scholarship. The participants will be divided into smaller groups to develop David A Davies and Ronald M Harden (IVIMEDS, Tay Park a template for documenting their educational activities and House, 484 Perth Road, Dundee DD2 1LR, UK) the evidence of effectiveness. These will then be shared This workshop will present an opportunity to learn more with the larger group. Finally if time permits, they will about IVIMEDS, The International Virtual Medical School, work in dyads to develop an individual or organizational a worldwide partnership of medical schools and institutions plan for career development within their own context. Key working together to develop the full potential of e-learning lessons learned from this exercise will be shared in the across the continuum of medical education. The aim of large group. IVIMEDS is to provide an effective means of sharing digital Intended outcomes: At the completion of this workshop, learning resources among partner institutions. During the participants will be able to: (1) describe a variety of workshop there will be an opportunity to see first hand promotion guidelines used in their institutions and identify the IVIMEDS approach to e-learning including a full commonalities between them; (2) describe criteria for demonstration of the IVIMEDS e-learning platform. For scholarship particularly in education; (3) identify enablers those new to IVIMEDS this workshop will present the and barriers to successful promotion through sharing their opportunity of seeing how an international collaboration own experiences; (4) document their educational of medical schools can effectively work together. For those scholarship activities and evidence of effectiveness; (5) who have previously encountered IVIMEDS this session develop a plan (individual or institutional) for career will provide an essential update to the advances in e- development within their own context. learning collaboration. For more information in advance of the workshop including the opportunity of sampling a tour Intended audience: All medical educators. of the IVIMEDS platform, please visit www.ivimeds.org Level of workshop: Appropriate for all levels from beginners upwards. 6S Making education count in the promotion and tenure process 6T A Multidisciplinary Initiative to Create a Linda Nieman (University of Texas Health Science Center at Resource for Integrating Women’s Health Houston Medical School, 6431 Fannin St, Suite JJL324, into the Medical School Curriculum: An Houston, TX 77030, USA) and Louise Nasmith (University of Overview and Practicum Toronto, Department of Family and Community Medicine, Toronto, CANADA) William Metheny (Brown University School of Medicine, Women and Infants Hospital, 101 Dudley Street, Providence Background to the topic: Over the past few years, RI 02905, USA) universities are recognizing the contribution of education and teaching in the promotion and tenure process. Background to Topic: The Association of Professors of However, faculty members continue to struggle with issues Gynecology and Obstetrics (APGO) Women’s Health related to the documentation and description of their Education Office (WHEO) hosted a series of retreats for activities and the evaluation of their performance. This medical educators from multiple disciplines in the basic workshop will assist teachers and educators in the areas and clinical sciences to develop an educational tool for described by the objectives in order to assist them in the integrating sex and gender differences in health and elaboration of a teaching dossier and of a career disease into the medical school curriculum. Retreat groups development plan within their own context. first developed competencies then specific objectives. They identified expected competence levels for each learning Workshop content and structure: Participants will introduce objective based on Miller’s pyramid, and identified themselves and state their expectations for the workshop. appropriate evaluation methods for measuring competence Some of the participants will share the promotion and of the specific learning objective. The groups linked each tenure guidelines currently being used in their institutions. objective to the ACGME core competencies, and identified Through group discussion, commonalities between them reference materials. The working groups produced eight will be identified as well as the barriers and enablers for sets of competencies with a total of 340 learning objectives.

– 99 – Session 6 THURSDAY 1 SEPTEMBER Session 6

The final document is available as a hard copy, as a PDF 6U Clinical skills – where next? at www.apgo.org/wheocomp and in a searchable format Paul Bradley (Peninsula Medical School, Research Way, Tamar at this website. The Women’s Health Online Curriculum Science Park, Derriford Way, Plymouth PL6 8BU, UK) Builder lets users build a curriculum from learning objectives they select, similar to adding items to an online Background: Paul Bradley is the Professor and Director of shopping cart. At any point, a user can display, review, Clinical Skills at Peninsula Medical School (PMS). The PMS edit, save, retrieve, print and post their custom-built has an extensive program of clinical skills running MyCurriculum. throughout the undergraduate program. He has been closely involved in the development of clinical skills teaching Workshop Content and Structure: Following an overview and learning since the early 1990s and has an interest in of the development of the curriculum tool, attendees will the acquisition and retention and transfer of clinical skills participate in small groups to identify a hypothetical or in undergraduate education. He also has an interest in actual curricular situation at an institution where there the place of high fidelity simulation in the undergraduate are gaps in teaching women’s health. Small groups will curriculum and how this can best be used to prepare select a topic and use the APGO Competencies to search students for their roles as junior doctors. for learning objectives related to that issue that can be implemented into the curriculum. Participants will recognize Objectives: This workshop will seek to examine two main the utility of the document for assessing and establishing areas of interest. Firstly, given the increasing role of clinical competency in women’s health. skills learning in the undergraduate curriculum, how is this likely to develop in the future? What skills should we expect Intended Outcomes: Acquaint participants with the our students to acquire and how? Secondly, given the development of the document and the on-line version titled significant investment in developing clinical skills learning Women’s Health Care Competencies for Medical Students: where is the evidence to support this approach? The Taking Steps to Include Sex and Gender Differences in paucity of evidence is disturbing. What approaches to the Curriculum. Participants will practice using the tool to research shall we adopt to deal with this issue? build curriculum in women’s health for their home institutions. Target audience: Educators with an interest in clinical skills teaching, learning and research. Intended Audience: Targeted for medical educators involved in curriculum development and faculty committed Level of workshop: Advanced (participants should have to improving women’s health care. considerable experience in clinical skills teaching and learning in order to make the most of this workshop). Level of Workshop: Beginners/Intermediate.

Posters 6 Onyx 1 Continuing professional development/ continuing medical education

6 Onyx 1.1 6 Onyx 1.2 Role of an international University in An interactive playing cards workshop on continuing medical education for health asthma – an innovative educational method care providers F Borduas*, M Rouleau, L P Boulet, M Marrin, J Bouchard E S Johnson*, G H Hendrix, C Rao and A E Pensick (Kingstown and J Blais (Laval University, Clinique Medicale de Neufchatel, Medical College, PO Box 885, Ratho Mill, St Vincent and The 2425 Boulevard Bastien, Suite 101, Québec G2B 1B3, Grenadines, WEST INDIES) CANADA) St. George’s University was founded in 1976 on the Background: Asthma control and care are frequently sub- Caribbean Island of Grenada. Today it consists of Colleges optimal and new methods to improve knowledge transfer of Medicine, Veterinary Medicine, Public Health and Arts are needed. This presentation will describe an interactive and Sciences and its campus extends also to St. Vincent. educational method, integrating Play and Scientific The medical school has carried out many activities to components, and will present results of the initial evaluation improve health care and CME for providers as well as faculty from participating physicians. of SGU. Since 1996 28 programs have been presented on Summary of work: An interactive Playing Card workshop the two campuses with 1400 registrants from St. Vincent, combines the play activity component of playing cards with Grenada and other Caribbean Islands, US, Canada and the scientific content of current asthma guidelines. The UK. These include physicians, nurses and other health care physicians have to manage real-life cases using the tools providers. The Programs are certified for CME and co- that are provided to them and discuss with their peers sponsored by the Seton Hall Graduate School of Medicine, and asthma specialists about the optimal management of USA, as well as the AMA International section. ACLS, ATLS the cases proposed. and PTLS programs offer certification to attendees. Faculty are from the US, UK, Canada, Caribbean Islands and SGU. Summary of results: An initial assessment of participating Financing comes from SGU, corporate, and contributions. physicians shows that the method is considered innovative Attendees complete an evaluation form; these indicate the and stimulates reflection and exchanges. The game allowed Programs are appreciated and useful, particularly since communication of relevant content, experiment with a travelling to attend meetings and courses is very limited. different learning format and stimulated interactivity in a We conclude that medical educational institutions have climate of friendly competition. an obligation to perform CME in their home environments. Conclusions/take-home messages: This new interactive This format works well. educational intervention, integrating Play and Scientific components is considered by participating physicians as innovative, enjoyable and a valuable method to communicate and integrate Asthma Guidelines Recommendations to current practice.

– 100 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6 Onyx 1.3 6 Onyx 1.5 Medical journalism: broadband to bedside Dentists’ opinions about CME efficacy Joseph Sirven*, Ed Sylvester, Joseph Drazkowksi and Leanne programs in Ahvaz, Iran Andreasen (Mayo Clinic and Arizona State University, Mayo Seyed Reza Saeidian*, Abdolhossein Shakurnia and Maryam Clinic Hospital/Neurology 5W, 5777 E.Mayo Blvd, Phoenix, Ashrafi-zadeh (Ahvaz Joundi-shapoor University of Medical Arizona 85054, USA) Sciences, EDC Educational Affair, Golestan Ave, Ahvaz, IRAN) Background: Medical Publishing is essential for academic Background: Continuing Medical Education (CME), promotion, obtaining research grants and promoting health designed in order to increase knowledge and professional education. However, medical curricula and continuing skills, was formally accepted as a necessity from 1974. In medical education (CME) rarely address this topic. Iran, the parliament enacted CME about ten years ago Work Done: Two parallel but interrelated curricula were urging all physicians and dentists to pass defined courses created and piloted; one for medical professionals at Mayo of CME. In this study we searched for dentists’ opinions Clinic and the other for students at the journalism school about need, content and efficacy of CME programs in at Arizona State University (ASU). The physician curriculum Khozestan Province. consisted of a 3-session CME accredited series covering Summary of work: In this descriptive study, dentists were all aspects of medical publishing. Medical faculty with a asked for their points of view on CME programs in proven record of successful publishing along with Khozestan Province. A validated and reliable questionnaire journalism professionals were utilized in a workshop to with 54 closed questions was used for data gathering. discuss effective methods that lead to publication success. Data were analyzed by SPSS software. Faculty from Mayo Clinic and ASU jointly initiated a project on accuracy in health reporting. Summary of results: The average age of the study population was 39.36±6.45 years. 31% of participants Conclusions: 96 physician participants attended the CME were female and 71% of them male. 79.3% of participants workshop on medical journalism. A post course survey claimed CME programs were useful as they were not only demonstrated the effectiveness of the course with effective on preserving their knowledge, but also effective unanimous consensus that this type of course filled a gap on increasing their professional skills. 50.2% of study group for professional development. Moreover, 10% of attendees was dissatisfied with program contents. They complained successfully became first time authors within the year of of CME shortage in dealing with regional health problems. completing the course. 58% of participants pointed that CME programs are not Take-home messages: Our unique pilot led to an enhanced sufficiently designed to satisfy their needs. They physician understanding of medical publishing that led to recommended needs assessment to be carried out before an increase in publications, and accurate media coverage planning a CME program. Significant differences was and ultimately better health outcomes. observed between males’ and females’ opinions about CME performance (p=0.029), and between the young and older groups’ points of view about CME performance (p=0.032). 6 Onyx 1.4 Promotion of management education to Conclusions: Although dentists in Khozestan Province institution-based physicians as part of reflected a positive attitude to increase the output of CME programs, they requested revisions on contents and continuing professional development objectives of the programmes. Christina Ang*, Ling-Huey Chua and Peter Mack (Singapore General Hospital, Postgraduate Medical Institute, Block 6, Level 1, Outram Road, Singapore 169608, SINGAPORE) 6 Onyx 1.6 Background: A need for management skills identified by Are planning and partnership between senior physician-administrators from the primary industry and CME body realistic? healthcare sector led to a partnership with SGH G Bond, R Dutil, C Guimond, P Raîche* and L Roy (1440 Ste. Postgraduate Medical Institute to co-offer a 35-hour course Catherine Street West, Suite 1000, Montréal, Québec H3G 1R8, on basic management in 2002. CANADA) Work Done: The course, entitled “Coming to Grips with Purpose: Demonstrate with concrete example that CME Management” on basic management course was developed body (FMOQ) and 17 CHE reps from different to provide an insight into core functional skills in areas of pharmaceutical companies can work together and share organisational theory, human resource, finance and validated programs availability to answer doctors’ needs strategy. The curriculum was designed with the context of on regional basis. Furthermore, synchronize together their the healthcare industry in mind. Feedback and course activities through the FMOQ Network (19 associations evaluation was done after each module to improve the covering Québec Province territory) to plan the 2003-2004/ course design. 2004-2005 CME activities calendar. Results: The course was overwhelmingly subscribed, Methods: Explanation of the 4 steps we went through to attracting physicians, nurse managers and administrative build our project; (1) Planning strategy; (2) Needs executives. The positive feedback and the long waiting assessment through the network by the FMOQ - CME list of participants were evidence of the programme’s Committee/Focus Group with industry; (3) Data analysis/ success. It resulted in the course being conducted three action plan; (4) Impact: After 5 months; After 1 year; times between 2002 and 2004 and gave rise to a follow- Number of programs chosen, physicians reached and up training programme on Leadership skills in 2005. number of associations involved. Conclusions and take-home message: Management and Results: 2 day meeting where industry and Regional CME Leadership skills have long been neglected in the education Directors have shared information, content and planning. of medical professionals. The need to acquire such skills The concept to be explained during the presentation on becomes increasingly acute as clinicians progressed in the site. seniority of their roles within the hospital. Increasingly we have to rethink and debate whether Management knowledge should also form part of our undergraduate medical curriculum.

– 101 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6 Onyx 1.7 Introduction: To consider the exact determination of faculty Evaluation of CME/CPD: provider, learner members’ educational needs through need assessment and organisational perspectives leads to medical education quality improvement and can be the base of planning, implementation and evaluation Taina Mäntyranta*, Timo Tolska, Juha Pekka Turunen and of educational system’s activities. The goal of this study is Hannu Halila (Centre for Pharmacotherapy Development, P.P. to determine and compare the attitudes of the Box 55, Helsinki FIN-00310, FINLAND) administrators of educational departments and faculty Aim of presentation: Evaluation of CME/CPD focuses often members on need assessment. in assessment of teaching, sometimes in learning. Change Method: In this study, attitudes of 41 administrators and in practice is seldom evaluated. We have developed a 43 faculty members were assessed. The data were comprehensive model for evaluation covering perspectives gathered by questionnaire. of provider (teaching), individual learner (learning) and organisation (change in practice). Results: The preferable characteristics of proper educational need assessment model for faculty members Summary of work and results: include: pay attention to expressed needs; goals and standards should be the sources of need determination; Focus in evaluation; examples of methods Beta and Zeta types are the proper ones; need assessment Teaching should be done at educational group level; developmental Need: Assessment of learning needs;pre-test needs are preferable to others; need assessment should Aim: Formulation of learning aims;analysis of be done in the whole organization in certain periods of programmes time by using a questionnaire. There was significant Structures: Organisation, logistics, competence of teachers; difference between two groups only in the field of need analysis of plans and programmes concept (p=0.004). Processes: Content and learning methods; analysis of Conclusion: There is necessity for need assessment before programme, participant feedback planning and implementation of every educational program Outcomes: Participation satisfaction: participant feedback for faculty members in order to improve professional knowledge and skill. Using the proper model can increase Learning efficacy and effectiveness of this process. Need: Self-evaluation of learning needs; portfolio Aim: Aims set by learner; portfolio Structures: Internal structures (motivation); portfolio 6 Onyx 1.9 Processes: Learning styles and strategies; portfolio, learning Dr Will Mayo’s Reading List diary H Linday and J S Newman* (1412 Weatherfield Ridge Court Outcomes: What is learned; traditional tests, OSCE SW, Rochester, Minnesota 55902, USA) Change The aim of this presentation is to give insight into the Need: Assessment of needs for change; registries, patient post-graduate educational forces which helped shape the record systems career of William Mayo. Dr Mayo graduated medical school Aim: Formulation of aims for change; analysis of plans in 1883. In late 19th century Minnesota, there were few Structures: What helps and hinders change; questionnaires avenues for continuing medical education. The primary Processes: What has been done for change; questionnaires methods were travel, and reading journals and textbooks. Outcomes: What changes have happened; registries, patient In the basement of a building on the Mayo Clinic campus, record systems Dr Mayo’s private journal was rediscovered. In this journal he transcribed the essence of every article which he read. From 1884 to 1892, Dr. Mayo recorded over 330 journal 6 Onyx 1.8 articles, which he found important or significant in some way. He wrote in 1935, “Reading papers is not for the Administrators’ and faculty members’ purpose of showing how much we know and what we are attitudes about educational need assessment doing, but is an opportunity to learn”. Dr Mayo wrote 879 at Mashad University of Medical Sciences publications. His first effort, Description of Hysteria, in A Emadzadeh*, M Behreini Toosi, H Karimi, M Yavari and S 1883, was never accepted for publication. In 1885 he first Ebrahimzadeh (Mashad University of Medical Sciences, published in Transactions of the Minnesota State Medical Educational Development Center (EDC), Central Building, Society. In conclusion, the discovery of Dr Mayo’s journal Daneshgah St, Mashad, IRAN) and the information enclosed gives a unique perspective and insight into the development of academic interest in an important figure in Medical Education.

Posters 6 Onyx 2 e-learning and the virtual learning environment

6 Onyx 2.1 phases during the academic year 2002/2003. The fact User support as a critical success factor in that the regular educational activities were running during the implementation of a virtual learning the implementation process was a sincere risk factor. Performing a very strict user support program successfully environment eliminated this risk. Peter G M de Jong (Leiden University Medical Center (LUMC), What was done: A centrally located Blackboard support Onderwijscentrum div 2, Kamer C5-54, PO Box 9600, Leiden 2300 RC, NETHERLANDS) team consisting of 4 students and one faculty member supported approximately 100 teachers and over 1600 Background: Nowadays virtual learning environments are students. The service of the team covered all commonly used in modern medical curricula. In Leiden communication to faculty, the creation of new courses, Medical School a homemade first generation virtual learning account management, the instruction of students and an environment has been replaced by the Blackboard learning individual in-office instruction for teachers on the use of system. Functional implementation was performed in 3

– 102 – Session 6 THURSDAY 1 SEPTEMBER Session 6

the system. Students as well as teachers were supported Summary of results: Since the launch of the EARS system phase by phase on 3-monthly basis. at the beginning of January 2003 over 700 elective abstracts have been entered displaying elective information Conclusions: The well-organized personalized user support from 69 different countries ranging from Australia to has been the major success factor in the smooth Zambia. implementation of a complete new learning environment. Take-home messages: It is better to do something extra or even something that is not your task in order to support 6 Onyx 2.4 users through a critical phase in change management. Reusable learning objects in undergraduate medical education 6 Onyx 2.2 Joy Heard*, Jeremy Ward, John Rees and David Byrne (GKT Web-based system for teaching quality School of Medicine, King’s College London, Department of Medical and Dental Education, 4th Floor, Henriette Raphael standards and ethics in healthcare: House, Guy’s Campus, London Bridge, London SE1 1UL, UK) development and evaluation issues Aims: To design a repository for medical and health related Kingsley Osonnaya* and Comfort Osonnaya (Queen Mary, learning objects interoperable between other systems University of London, Epidemiology and Education Unit, Centre for Adult & Paediatric Gastroenterology, Institute of Background: At Guy’s, King’s and St Thomas’ we have Cell and Molecular Science, Bart’s and The London, School integrated science and clinical practice in medical student of Medicine and Dentistry, Turner Street, London E1 2AD, UK) education: introducing clinical experience into early years of the course in addition to basic science. In later years Background: The aim of this paper is to describe the when students are in small groups on many sites it has development and evaluation of a new web-based computer been difficult to ensure coverage of core material and the system at Queen Mary, University of London, which can continued presence of basic science elements alongside be used by clinicians and students to access health clinical experience. information to enhance their knowledge and understanding of quality standards, legal and ethical issues in healthcare. Summary of work: We have developed an innovative system to deliver web-accessible reusable learning Summary of work: A menu driven web-based system was resources and the indexing and database systems designed and implemented using distributed object necessary to allow contextual delivery through our virtual technology. Some of the modules offered by the system learning environment. The database query and indexing include Quality issues and clinical governance guidelines, systems are structurally in line with other projects and ethical issues guidelines, consent to medical treatment standards in order that interoperability is possible between guidelines, complaint and litigation guidelines, and data stores in future. Close liaison with academic content evidence-based practice module and patient information specialists and staff training in using metadata to describe packages. The developed system was tested and learning objects is critical to the success of the project. thoroughly evaluated by its users. Conclusion: We have produced the technical infrastructure Summary of results: Overall, the findings showed that the to provide simple access to electronic learning resources developed system met its objectives to a large extent. For that can be “reused” by students throughout a medical example, a functionality exposure score was generated programme and between courses to allow appropriate by users rating whether the system promotes medical reinforcement of learning. education, research and patient care. The system average for functionality was 4.4 (1=Not at all, 3=Very good extent and 5=Great extent). The results have also demonstrated 6 Onyx 2.5 that the system promotes effective teaching and learning A generic visual model for supporting in quality standards and ethics in healthcare, and has a positive impact on the participants’ skills and attitudes at outcome-based placement learning with ICT our institution. H Dexter, J Petch, J Hadfield*, M Brown, S Clark and T Dornan (University of Manchester, Hope Hospital, University of Manchester School of Medicine, Stott Lane, Salford, 6 Onyx 2.3 Manchester M6 8HD, UK) On-line elective abstract record system Aim of presentation: Report a visual model that specifies Joy Heard and David Byrne* (GKT School of Medicine, King’s roles and processes to be supported in virtual managed College London, Department of Medical and Dental Education, learning environments (VMLEs) for placement learning. 4th Floor, Henriette Raphael House, Guy’s Campus, London Summary of work: Through developing a VMLE to support Bridge, London SE1 1UL, UK) clinical medical students, we have obtained ‘proof of Aims: To develop an on-line database driven elective concept’ that ICT can outcome-base students’ placement abstract repository where final year medical students must learning. We now report the use of visual modelling submit their elective abstracts. techniques to extend the concept to other outcome-based Summary of work: The Elective Abstract Record System health professions curricula. We obtained usage narratives (EARS) forms part of the year 4 resources on the Guy’s for the application of ICT to eight learner-centred curricula, King’s and St Thomas’ Virtual Learning Environment (the ranging from an access to medicine course to the GKT Virtual Campus). This web-based system allows professional rehabilitation of refugee doctors. From a medical students to submit and view elective abstracts synthesis of the narratives we identified roles and the from previous students to provide independent and activities associated with them, and developed a generic informed information to help in the process of deciding model describing learning, teaching and management where to go on elective, based on previous student processes. We then used the visual analysis model to experiences. Students have the option to search EARS by develop demonstrators of two sample processes, validated continent, country, town, discipline, year of elective, rating them in a postgraduate medical and a clinical psychology (1-5) or by entering a free text search option. The curriculum, and used them to scope the VMLE’s application information provided covers general activities carried out to two curricula for professionals allied to medicine. during their elective, other opportunities and amenities in Summary of results: Twelve distinct roles were modelled the area and describes the best and worst things about with approximately seventy functions enabling the required their elective. Full secure and authenticated on-line editing support. The model facilitated implementation of two of existing abstracts and submission of new ones is processes that involved interactions between roles in both possible. learning and learning administration contexts.

– 103 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6 Onyx 2.6 6 Onyx 2.8 Meeting the pedagogical demands of a Paediatric nutrition: how to make a Problem-Based Learning course in a Virtual problem-based CD for nationwide Learning Environment application L Cordingley*, L Yong, I Davies, M Regan and A Ginty J Hans Hoekstra*, Gerard Damen and the VOK Steering Group (University of Manchester, Medical School, The Faculty of (Hieronymus Bosch Hospital, Department of Pediatrics, PO Medicine, Dentistry, Nursing and Pharmacy, Room 2.522, Box 90153, Hertogenbosch 5200 ME, NETHERLANDS) Stopford Building, Oxford Road, Manchester M13 9PT, UK) Background: Significant deficits in the application of clinical Background and aims: Problem Based Learning has nutrition for healthy and sick children are widely reported. student-directed learning principles as key tenets. The In the Netherlands this problem was addressed by a group Manchester University Undergraduate Medical programme of paediatric gastro-enterologists with special interest in is a PBL course based upon a fully integrated curriculum. education. Without prior experience the group looked for It is horizontally integrated in that PBL cases and intended possibilities to make an educational problem based CD for learning outcomes are interdisciplinary; and it is vertically medical students and residents. It was clear that such a integrated in that ‘strands’ or themes run through each programme could only be realized with the financial support year of the programme. The course is structured so that from an industrial company. We describe pro’s and con’s students meet topics at least twice. Our task therefore is in the choice for technical support, the procedures for to develop a VLE that: (1) supports learning on a complex, sound ethical cooperation with an interested company, the fully integrated programme whilst not undermining the formation of a steering group, selection of authors for 30 educational ethos of student-directed learning; (2) allows problem based cases, the role for each co-author, the on curriculum revision whilst maintaining continuity of line input of all educational material, the technical support experience for each cohort of students. by a project manager and a media manager, registration Summary of work: This paper will outline our progress in of rights, the interactions, and feedback with reviewers tailoring a bespoke VLE that complements face-to-face and editorial board. The project was successfully delivery of the programme, and our rationale for not accomplished in a 2-year period. All rights were transferred adopting a generic VLE. Important outputs of the project to the Paediatric Association of the Netherlands. The CD include the establishment of cohort specific electronic is now freely available for all medical students, residents, versions of the curriculum. A further positive outcome of and other professionals working in the field of preventive this endeavour is that discussions about the educational and curative paediatrics. principles of the programme are revisited and reinvigorated. Conclusions: A wide scale and expensive educational Conclusions: The complex nature of an integrated PBL project is feasible under conditions of properly selected programme highlights the requirement for close professionals and supporting companies. collaboration between medical educationalists and developers. 6 Onyx 2.9 Innovative multimodal on-line CME: 6 Onyx 2.7 enhancing participation and feedback Study Coach and Learning Environment D Paquette*, M Luneau, L Carty, D Kazitani, R J Gagnon and (SCALE): developing a nationwide medical R L Thivierge (University of Montreal, 721 Hartland Avenue, computer-based training database Montreal H2V 2X5, CANADA) Mathijs Doets*, Peter M Bloemendaal, Frank G Diepmaat, Background: There are plenty of on-line CME programs Martien J Quaak and Pieter F de Vries Robbé (Erasmus MC, available, but the vast majority of these activities present OIG - Institute of Education, Room Ff2.31, PO Box 1738, traditional lectures to passive participants. In CME, it is Rotterdam 3000 DR, NETHERLANDS) well established that multiple and tailored interventions Background: Since January 2005, four Dutch medical are more effective to help physicians change behaviour. schools are cooperating in the SCALE project, which aims Summary of work: We have opted to develop on-line to develop an open online portal (based on the Leiden activities integrating multimodal educational approaches. University Lesson Registration System LRS.Net) for Before a workshop, participants (191) were sent clinical structured access to web-based medical Computer Based cases, profile questionnaire and pre-test. Real time online Training (CBT) programs. All programs will be indexed by workshop with simultaneous phone access to expert, was a wide range of characteristics, regarding content, but followed by immediate post-test. Then voluntary also administrative and technical features. Furthermore, participants (71) received tailored feedback modules every the SCALE system will monitor the history of students in two weeks for two months, a group with expert access relation to CBT learning goals and offer them automatic (33), and another group without (38). and individual study advice. Teachers can track the Summary of results: In comparison with a standard students’ progress over time. workshop, 76.4% to 86.8 % were as or more satisfied Summary of work: In the first step of the project, about the interaction level between participants and representatives from all eight medical schools in the experts. Behaviour intention to change was 83%. Netherlands were consulted in an inventory of information Knowledge acquisitions between pre and post-test was needs. Subsequently, a multi-dimensional classification significant with p <.0001. The tailored feedback modules system for all Dutch medical CBT programs was developed, participants had lower performance (p <.0001). We noted based on international standards. Regarding medical a tendency of sustained participation in the “expert access content, several classifications like MESH, ICPC2 and the group”. USMLE descriptions were compared. Finally, the MESH Conclusion/take-home messages: Our online multimodal classification was chosen because of its broadness and workshop is efficient in regards to knowledge acquisition, completeness. Next, the functional design of the study and tailored feedback modules enhance that process and coach will be defined and a prototype will be built. A fully helped physicians to detect more learning needs. functional system is planned to be available mid-2006. The SURF foundation supports the SCALE project.

– 104 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Posters 6 Topaz 1 Problem based learning 1

6 Topaz 1.1 6 Topaz 1.3 Why do students rate poorly their tutors on Medical students’ perception of problem- feedback? A prospective study based learning tutorials at the Nelson R Anne Baroffio*, Mathieu Nendaz and Nu Viet Vu (University Mandela School of Medicine (NRMSM) of Geneva, Faculty of Medicine, Unit for Development and S Singaram (Nelson R Mandela School of Medicine, School of Research in Medical Education, 1e rue Michel Servet, Geneva Undergraduate Medical Education, University of KwaZulu- 4 1211, SWITZERLAND) Natal, Private Bag 7, Congella, Durban 4013, SOUTH Aim: In our problem-based learning curriculum, students AFRICA) rate 65% of their tutors insufficient in providing feedback. Background/rationale: In January 2001, a PBL, learner Tutors however never raise this competency as a training centered integrated curriculum was implemented at the need. We tested 3 hypotheses: 1) students do not NRMSM. The new curriculum was met with great scepticism understand what “feedback” means, 2) tutors do not by many in the faculty who held the view that “if it’s not provide sufficient feedback, 3) tutors provide feedback, broken why fix it.” Further, implementation and teething but students expect another type of feedback. problems, lack of infrastructure and resources and the Methods: 1) The rating scale’s item on feedback was made additional funding needed to set up, seemed to have more explicit and we assessed whether students’ ratings strengthened these scepticisms. Against this backdrop, this changed; 2) Tutors received a mini-course on feedback, study aimed to evaluate the effectiveness of the “heart” and its effectiveness was evaluated by tutors’ evaluation of the PBL curriculum, the small group tutorials with the of the mini-course, self-assessments of their feedback hope that this might shed some positive light on the new strategies, and students’ ratings; 3) Students described curriculum. the type of feedback received or expected from the tutors. What was done?: A survey was conducted of the medical Results: 1) After item change, only 16% of the tutors were students with both open and closed ended questions still rated insufficient by students on feedback; 2) Tutors regarding the impact of the small group tutorials on their judged the mini-course helpful to understand the goal of learning, attitudes and behaviour. Additional information feedback and to develop new strategies. About half of was also obtained from focus groups and semi-structured them estimated providing a better feedback. Students’ interviews. ratings confirmed this finding; 3) Tutors provided feedback Conclusions: Analysis of the results indicate that the on cognitive process (80%), and group functioning (20%). majority of students have reflected positively on the impact However, students required more feedback on content of the small group tutorials to their learning as well as issues. their overall development i.e. personally and professionally. Conclusion: Students may rate poorly their tutors on Take home messages: Small group tutorials have a stronger feedback, since 1) the word “feedback” is not explicit impact on student learning and make studying medicine a enough, 2) tutors need more training on how to provide more enjoyable experience due to the positive social feedback, and 3) students expect more feedback on elements it offers. content. 6 Topaz 1.4 6 Topaz 1.2 Experiences from a two-year ICT and Tutor-student interaction at metacognitive problem-based learning seminar for nine level in PBL-tutorial postgraduate residents in psychiatry Tri Hanggono Achmad and Dwi Agustian (Universitas John Olav Roaldset*, Olav Linaker, John Christian Fløvig, Padjadjaran, School of Medicine, Medical Education Research Eystein Stordal, Kjersti Brandtzaeg and Torstein Vik and Development Unit (MERDU), Jl. Pasirkaliki No 190, (Norwegian University of Science and Technology, Faculty of Bandung 40161, INDONESIA) Medicine, Langelandsveien 42, Aalesund 6010, NORWAY) Interaction with the student at the metacognitive level is The project’s aim was to improve the quality of the basic function of the tutor in order to facilitate student postgraduate education by teaching research theory and independence and foster students’ critical thinking and some other themes insufficiently covered in the regular self-directed continued learning. For this purpose, tutors education. We also wanted to evaluate whether the course as well as students should understand properly the could be presented adequately using problem based structure of the tutorial process and metacognitive thinking. learning and ICT. Finally, we wanted to stimulate This could be achieved by continually monitoring and recruitment and cooperation in the region. The main theme evaluating the tutorial process. Our study shows that the for the seminar was basic methodological aspects of longer the students take part in the tutorial process, the research. The participants had to design and accomplish better their understanding in metacognitive thinking, which their own research project (the “problem”). Additional is shown by their increase ability in running a proper tutorial themes were: giving presentations, informing and process, such as developing the learning issues and educating patients and families, foreign psychiatry and correlating information necessary for clarification of mental retardation. Following a two-day meeting in concepts relevant to the case. On the tutor’s side, data December 2003, the agenda was: four monthly video- from students’ evaluation forms on tutor activity showed based sessions of three hours, a one-day meeting (June), that only 55.3 % of tutors can facilitate an effective tutorial three monthly video-based sessions, a two-day meeting group process, and only 58.2 % of them are excellent in (November). This agenda was repeated the following year. facilitating the group’s ability to think critically. This All participants had access to e-mail, internet and to the phenomena show that it is easier to develop interaction in intranet of the University of Trondheim (NTNU), including metacognitive level in students’ minds than in the tuto’s, literature services. There will be an external and internal which in part could be due to the influence of the traditional evaluation of the project. So far the participants are working teaching method that has been embedded in a traditional on six research projects. Experiences with the seminar so teacher’s mind. far will be further discussed.

– 105 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6 Topaz 1.5 6 Topaz 1.7 Learning about sexual diversity in a Problem-based learning problem-based medical undergraduate Alyson Quinn* and Harish Gupta (University of Warwick, course: is a distinct educational focus Centre for Primary Health Care Studies, Warwick Medical needed? School, Coventry CV4 7AL, UK) Sarah Smithson* and Val Wass (The University of Manchester, Why did we do this? 1. Student perspective and support Division of Primary Care, Rusholme Health Centre, Walmer their development; 2. Didactic teaching is reduced and Street, Rusholme, Manchester M14 5NP, UK) self-directed is increased; 3. Counter ‘Fear of Failure’; 4. The tutors are helping to Manage the Fear. Aim of presentation: To discuss diversity education using sexual diversity as an example, and informed by this study How was this done? 1. This was achieved from individual which assesses the need for a distinct educational focus feedback; 2. Staff Student Liaison Committee (SSLC); 3. in a problem based medical course. Evaluation forms; 4. Feedback of and from assignments. Summary of work: It is widely accepted that medical Using assignment marking and feedback: 1. Definition what undergraduate education should address issues related do we mean by problem based learning with mature to human diversity. This study uses sexual diversity as an professional learners in General Dental Practice; 2. example and examines whether relevant education occurs Formative assessments – feedback by tutors on marking within a medical course which uses problem based learning this formative assessment; 3. Assignments are set with (PBL). The study explores diversity education from two ‘tapering’ guidance; 4. Take home messages are given at perspectives; the curriculum on paper, reviewing published the days together at the University. curricular content, and the curriculum in action, Take-home messages: 1. How to motivate mature interviewing students and teachers. professional learners; 2. Be a ‘Life Coach’ and support at Results: Relevant learning objectives are identified within all stages; 3. How to arrange and support Time skills, knowledge and attitudinal domains. Six PBL cases Management Advice (TMA); 4. Preparing the ‘Coach’ to include fundamental index clinical situations such as coach. sexually transmitted diseases. Neither students nor Conclusions: The results indicate the need for greater teachers report any education devoted to sexual diversity. exposure of medical students in this setting to the new They give examples of opportunistic teaching and learning academic specialty of family medicine in order to increase occurring within core attachments to hospital and their knowledge of this field and perhaps influence their community, student selected clinical attachments to choice of a primary care career. specialties such as infectious diseases, and PBL case discussions. Students recognize the educational importance of peer discussions occurring outside the medical course. 6 Topaz 1.8 Conclusion: Learning about sexual diversity occurs within Teachers’ conceptual development in a PBL this problem based medical course and a distinct training program educational focus is not needed. Yolanda Marin-Campos*, Bertha Maria Nájera-Tijerina and Alberto Vázquez-Tapia (National Autonomous University of Mexico, Porto Alegre 259 A-402, Col. San Andrés Tetepilco, 6 Topaz 1.6 Delegacion Iztapalapa, México DF 09440, MEXICO) Does tutor evaluation in a problem-based learning curriculum assess different aspects Training teachers to participate in a Problem-Based Learning (PBL) project implies a change in their traditional of learning from written examination? conception of teaching. This traditional conception is Ji Young Kim, Hee Jung Son, Kyung Pyo Hong* reflected at the beginning, and very often, along the (Sungkyunkwan University School of Medicine, Office of training program. Subjects possess previous ideas related Medical Education, 50 Iiwon-dong, Kangnam-ku, Seoul 135- with what they will learn. These ideas can be correct or 710, SOUTH KOREA) erroneous, and will facilitate or make difficult the learning Background/rationale: Sungkyunkwan University School of process. From the constructivist perspective of learning, Medicine in Korea has implemented a problem-based an initial assessment should be carried out to identify the learning (PBL) curriculum since 1999. Tutor evaluation is subjects’ previous ideas and monitoring the conceptual aimed to assess students’ performance during a PBL changes along the course. Research on subjects’ session while written examination is focused on knowledge conceptions and conceptual change has been carried out as a result of PBL. This study is to examine whether tutor over the past decades in order to adequately address the evaluation assesses different aspects of learning from complex process of learning. written examination. Objective: To determine how subjects’ conceptions of PBL What was done: The participants in this study were 89 vary, and how a specific subject’s conception differs from first and second-year students, who took a set of 2 tests general students’ conceptions. during the first month of 2004 PBL units. The set included; Procedure: Eleven teachers, who were not familiar with (1) Self-Directed Learning Readiness Scale (SDLRS) and PBL, participated in a 132-hour course, which deals with (2) Learning Orientation Scale (LOS) which consists of two the theoretical and methodological basis of PBL. Declarative parts: schoolwork orientation and academic orientation. knowledge was analyzed through open-response test What was found: It was found that tutor evaluation scores administration. Data were collected at the beginning, were significantly correlated with SDLRS, schoolwork during and after the instruction to investigate teachers’ orientation and academic orientation scores in LOS, while conceptual development. written examination scores were significantly correlated Results: Variations in conceptual development were with only schoolwork orientation in LOS. detected. Subjects’ responses allowed identification of Conclusions: This finding suggests that tutor evaluation conceptual changes and misconceptions. in a PBL curriculum assesses students’ self-directed learning readiness and academic orientation, which written examination does not. Take-home messages: Tutor evaluation is a useful method to assess the medical students’ traits as learners such as self-directedness and academic desires.

– 106 – Session 6 THURSDAY 1 SEPTEMBER Session 6

Posters 6 Ruby 1 Postgraduate training: the early years

6 Ruby 1.1 6 Ruby 1.3 Postgraduate training for new doctors in the What do UK medical students want in their UK – a better educational experience from Foundation Programmes? August 2005? Andrew Whitehouse* and David Wall (West Midlands Deanery, Gellisse Bagnall*, Anne Hesketh, Jan Illing, John Spencer and Postgraduate Medical & Dental Education, Birmingham Tim van Zwanenberg (NHS Education for Scotland, NES - West Research Park, 97 Vincent Drive, Birmingham B15 2SQ, UK) Region, 3rd Floor, 2 Central Quay, 89 Hydepark Street, Background: In August 2005 UK medical graduates enter Glasgow G3 8BW, UK) 2 year Postgraduate Foundation Programmes, specified Background: The aim of this presentation is to stimulate by “Modernising Medical Careers”. Some say their views discussion around measurement of the educational have not been considered in programme design. experience for new doctors, and the development of a Summary of work: We conducted a survey of final 3 year tool which has the potential to play a major role in the students in Medical schools at Universities of Birmingham, quality assurance of the new Foundation programme in Warwick and Keele for their views on year 2 content, timing the UK of year 2 allocation and the place of General Practice. Summary of work: During 2004-5, the General Medical Opinions were analysed by gender, medical school and Council commissioned NHS Education for Scotland and the year of graduation. Northern Deanery at Newcastle to conduct a scoping exercise. The aim of this study was to establish a research Summary of results: 241 students responded. Numerous protocol to measure the educational impact of the ‘The comments were received. Gender did not influence views. New Doctor’ (1997) – a guidance document for training Warwick, graduate entry, students preferred year 2 choice doctors in their first postgraduate year. Data collection during year 1. 2005 graduates preferred full 2 year combined stakeholder interviews and an overview of specification at year 1 appointment. 2006 graduates relevant literature on junior doctor education. Both preferred a range of specialities in year 2, those in 2004- methods indicated that rather than a retrospective 5 preferred a speciality flavoured year. Principle component measurement, it would be more fruitful to design a factor analysis revealed 3 clusters. Speciality flavoured year prospective study. This would focus on developing a robust 2 enthusiasts also wanted a wide choice, and to choose tool to measure the educational experience of medical year 2 during year 1. Those preferring to know the full 2 graduates entering the first year of the new Foundation year layout at appointment to the programme also wanted programme, and would thus include some evaluation of primary care experience. Those wanting no speciality the impact of the 2005 update of The New Doctor. This flavoured year 2 were a separate group. paper will provide an overview of the evidence from the Conclusions: We identified a wide range of opinion, and scoping exercise which resulted in the above that graduate entry students have distinctive preferences. recommendation, and discuss how to take it forward.

6 Ruby 1.4 6 Ruby 1.2 Development of a University degree course From PRHO to F2: perspectives from Junior for training in generic non-clinical skills Doctors Peter Spurgeon* and Robert Palmer (West Midlands Deanery, Julie Bedward, Ian Davison, Robert Palmer, Peter Spurgeon International Institute for Clinical Leadership, Birmingham and Hywel Thomas* (University of Birmingham, Centre for Research Park, 97 Vincent Drive, Birmingham B15 2SQ, UK) Research in Medical and Dental Education, School of Education, Edgbaston, Birmingham B15 2TT, UK) A central theme of Modernising Medical Careers (MMC) for junior doctor is the importance of non-clinical Background/Rationale: This paper draws on an evaluation competency training in the curriculum of the 2 year of the educational and service impacts of the introduction Foundation programmes, enabling doctors to be better of pilot F2 posts in the West Midlands Deanery in England. prepared their roles in the NHS of the future. At present What was done? The first part of the evaluation was a we are piloting the delivery of modules that will be baseline survey undertaken in August and September 2004. incorporated into an Award that will be recognised by A questionnaire was sent to all doctors taking up their Birmingham University, and contribute points towards first post after their pre-registration house officer (PRHO) higher degrees initially a Certificate and subsequently a post, enabling a comparative analysis of F2 post holders Masters degree. The generic competencies being taught, with ‘conventional’ SHOs and those on GP VT schemes. A as defined in the Foundation (MMC) curriculum, include total of 940 questionnaires were distributed to 13 hospitals effective communication, managing effectively across and 444 were returned, a response rate of 47.2 per cent. sector boundaries, time management, self-directed learning, NHS organisation and teamwork. This Conclusions: The survey shows junior doctors as positive presentation will cover the experiences of development, about their PRHO experience and the post they are about delivery and evaluation of the pilot, the challenge of to begin but with limited enthusiasm for four-month obtaining the University recognition and the setting up of rotations. The main differences between the three groups the formal programme. In addition the benefits of inclusion relate to the views and experiences of those on a GP VT of a management placement for Foundation trainees will scheme. be discussed. Take-home messages: The analysis highlights key benefits of the PRHO year in terms of its challenge and the nature and quality of the experience. It raises questions about the integration of on and off-the-job training.

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6 Ruby 1.5 6 Ruby 1.7 Delivering the core curriculum in the Enhancing continual professional Modernising Medical Careers Foundation development for junior hospital doctors: a Programme post graduate award in professional skills Glynis Buckle* and Gail Rose (Leicester, Northamptonshire & J Kidd*, M Allen, M Walzman, P O’Hare and E Peile Rutland Deanery, Lakeside House, 4 Smith Way, Grove Park, (University of Warwick, Warwick Medical School, Medical Enderby, Leicester LE19 1SS, UK) Teaching Centre, Gibbet Hill Road, Coventry CV4 7AL, UK) Aim: To consider the advantages of interactive class room Background: In the UK, until recently, continual based learning within the Foundation Programme professional development for junior doctors has been the curriculum. remit of the National Health Service. The development of the Foundation Year 2 (FY2) grade of doctor as part of the Summary: In delivering the curriculum we aimed to Department of Health’s strategy for modernising medical combine work-based learning, problem-based learning, e- careers (MMC) is an opportunity for medical schools to learning and interactive workshop class room based work collaboratively with the NHS to enhance the learning. Our programme provided 21 days class room educational experience of these junior doctors. learning for 35 doctors throughout the Foundation Year 2 (previously SHO Year 1). The topics covered were Methods: Working with clinicians in the West Midlands teamwork, time management, communication skills, Deanery responsible for the education of the new grade consultation skills, evidence based medicine, career junior doctor Warwick Medical School designed and guidance, introductions to - medicine, mental health, implemented a Post Graduate Award (PGA) in Professional paediatrics, surgery, obstetrics and gynaecology. Skills. The PGA concentrates on two topics from the competencies described by MMC: audit and effective Results: The interactive workshop format made good use communication. The educational sessions were delivered of small group work which provided an opportunity for as part of their protected learning time. Sixty of the 68 doctors to practise interpersonal skills in a secure doctors registered for the award. Attendance at the environment. Bringing together the same people sessions varied. Each session was evaluated and each topic throughout the year provided peer group support and was summatively assessed. developed a relationship with the postgraduate deanery teaching team. The quality of the sessions was easier to Conclusions: This pioneering award was met with a high monitor as all doctors received the same teaching and the level of interest from these junior doctors. These doctors outcomes were evaluated in the same way are keen to continue their educational experience with a view to attaining an award accredited by a higher education Conclusions: Releasing doctors to attend educational institution. The development and sustainability of the events has an impact on service delivery and we therefore award will be discussed. need to consider whether the advantages of interactive class room taught sessions outweigh the pressures on service delivery. 6 Ruby 1.8 Advanced life support education for junior 6 Ruby 1.6 medical officers Implementation and evaluation of the UK Rachel E Day, Andrew M Ellis, Sue Melville and Rodger Foundation Programme for junior doctors: a Laurent* (Northern Clinical Skills Centre (USYD), University pilot study in Northumbria Healthcare NHS of Sydney, Royal North Shore Hospital, Level 5, West Wing Vindin House, St Leonard’s, New South Wales 2065, Trust AUSTRALIA) C Stensen*, L D Larsen, S Corbett, I Neilly and M Welfare Background: Junior Medical Officers (JMO) are frequently (North Tyneside General Hospital, Northumbria Healthcare NHS Trust, T106 Research and Development Office, Rake Lane, the first medical respondents to cardiopulmonary Tyne & Wear NE29 8NH, UK) emergencies. A lack of formal training in Advanced Life Support (ALS) skills results in JMO anxiety and clinical Aim: To evaluate the implementation of a pilot of the UK team concern. Foundation Programme for trainee doctors and the impact of organisational change on the training experience. Objective: To initiate and assess an ALS training program for post-graduate year one (PGY1) JMOs. Background: The Foundation Programme includes three hours of structured classroom training for junior doctors Method/work done: A formal ALS training programme was every other week. To provide access to curriculum and introduced into the PGY1 orientation program in 2004. accommodate changes in working hours, patient care has This comprised of didactic, clinical and small group practical been divided into emergency and out of hours care, and sessions. Assessment was performed 4-6 weeks later. specialty care. Theoretical assessment consisted of a multiple choice question paper and practical competencies were assessed Methods: A qualitative study of Foundation Board minutes, using clinical case-scenarios. Remediation included small- reflective diaries maintained by staff, and interviews and group clinical skills teaching and ward-based tutorials. This focus groups with junior doctors to follow the process from was followed by re-assessment. inception to implementation. Results: In 2004, of 34 candidates, only 17 achieved Results: Changes were made to the programme due to competency. After remediation, only 2 remained non- problems of availability of clinical and educational competent. In 2005, of 35 candidates, 31 achieved supervisors. Staff diaries recorded swift development of competency. After remediation, all were competent at ALS. team solutions to problems that arose, but a wish for more consultation prior to implementation, and time to meet Conclusion/Take-home messages: PGY1 JMOs have afterwards. Trainees found it useful to have protected subsequently reported ALS training as valuable, including learning time, but had difficulty leaving wards to attend improved confidence in managing emergencies. training. They wanted training content to be more clinical. Emergency response team members have also observed Emergency care rotations reduced trainees’ continuity of improved JMO performance at cardiopulmonary care, experience of clerking and feedback on performance. emergencies. A formal ALS training program is an essential Conclusions: More staff consultation before and after component of JMO education and results in an improved implementation was needed, and junior doctors’ training ability to manage emergency situations. needs require further investigation.

– 108 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6 Ruby 1.9 the specialty field was assessed. Results were analyzed Survey of factors that affected 1st year by using SPSS program. residents for selection of their specialties in Result: The response rate was 69.4% (68 of 98). Only Shiraz University of Medical Sciences in 2004 32.4% of respondents identified the most important aspect influencing their choice of specialty was interest in that Rita Rezaee*, Ali Reza Mesbahi and Maryam Abdollahi (EDC field and least important aspect was facility during Center, Iman Shomali Street, Janb-e bank Sepah, Kooche No 4, #210, Shiraz 71868, IRAN) education. (29.4%). 56.7% of respondents had high level of satisfaction with their specialty. Purpose: The aim of this study was to survey 1st year residents of Shiraz University of medical sciences in 2004 Discussion and conclusion: Residents use many criteria in to determine factors that influenced their selection of a selecting a field of specialty such as interest, facility during specialty field. education, better scope, more income, family priority, chance of matriculation and field prestige. Knowledge of Method: A questionnaire was distributed to 98 first year these influential factors should help training programs offer residents of Shiraz University of medical sciences in 2004. appropriate career guidance. Many of them were The influence of more income, interest, facility during unsatisfied due to insufficient teaching and working long education, family priority, better scope, chance of hours and experiencing periods of little sleep. matriculation, field prestige and level of satisfaction with

Posters 6 Ruby 2 Selection for medicine

6 Ruby 2.1 other student factors, we studied whether there is a More women in medicine – is there a relationship between any of those variables and academic problem? A literature review of the performance in the first year discipline Gross Anatomy. changing gender composition, structures Summary of work: We analysed the group of students and occupational cultures in medicine admitted to our Medical Faculty in 2004-2005 and studied the relation between sex, age, admission marks, Sue Kilminster*, Julia Downes, Brendan Gough, Deborah educational background, motivation for medical studies Murdoch-Eaton and Trudie Roberts (University of Leeds, or personal interests and the scores obtained in Gross Medical Education Unit, Worsley Building, Level 7, School of Medicine, Clarendon Way, Leeds LS2 9NL, UK) Anatomy. Aims: The purpose of this presentation is to highlight some Summary of work: The students had had high admission of the evidence, issues and explanations about the effects scores. However, this fact was not related to the results of the increasing numbers of women in the medical obtained in the subject studied. Factors like sex, profession. Internationally, there are increasing numbers motivations for choosing medical studies and educational of women entering medicine. Although each country has background showed differences in their relationships with different health care systems and social contexts, all still the admission scores and with the scores obtained in the show horizontal (women concentrated in certain areas of discipline. Interestingly, the students who were not sure work) and vertical (women under represented at higher why they had chosen medical studies and those who had levels of the professions) segregation. chosen them only because they like them, obtained better scores in our discipline than those who had chosen them Summary of work: We conducted a literature review which for humanitarian, economic or scientific interests. Besides, identified evidence that delineates some of the effects of activities like playing sports showed to be a beneficial factor. gender on the culture, practice and organisation of medicine: 6 Ruby 2.3 Summary of results: (1) There are increasing numbers of women in medicine and completing explanations about Medical and dental students in Portugal: the effects on the practice and organisation of medicine. personality traits (2) There is some evidence about the effects of gender on Maria Filomena Gaspar*, Anabela Mota Pinto, Eunice the culture, practice and organisation of medicine. (3) Carrilho and José António P da Silva (University of Coimbra, There are problems with some of the research Faculty of Medicine, Departamento de Educação Médica, Rua methodologies used and we identify areas for further Larga, Coimbra 3040-504, PORTUGAL) research. (4) There is a need for further research to explore Background: Both medical training and professional the impact and implications of these changes in the gender performance require a broad range of analytic, clinical, composition of medicine. This would have immediate personal, managerial and social skills (Gonella et al., 1993, relevance both for workforce planning and understanding Diamond et al., 1995). Entry selection mechanisms and the changing nature of health professions’ education and high academic demands may, among other factors, have health care delivery. relevant impact on the personality profile of medical students and its development during medical training. 6 Ruby 2.2 Pertaining knowledge may be pivotal in advising relevant school strategies. This longitudinal study aims at Admission system, personal characteristics understanding: (1) specificities of personality profiles of and academic performance medical students; (2) the contribution of personality factors B Mompeó (University of Las Palmas de Gran Canaria, to academic attainment; (3) the impact of medical school Departamento de Morfolgia, Centre de Ciencias de la Salud on the development of personality traits; (4) the ULPGC, Dr. Pasteur s/n, Las Palmas de Gran Canaria 35016, contribution of personality traits and academic achievement SPAIN) in professional performance. Background: Public Spanish universities employ a common Summary of work: The five-factor model (FFM) of admission scoring system for students based on high school personality was adopted. First year students from five grades and the PAU (Access university essay). Aiming to different Faculties in our University were enrolled and asked know the predictive values of this admission method and to fill-in the personality inventory NEO-PI-R (Costa &

– 109 – Session 6 THURSDAY 1 SEPTEMBER Session 6

McCrae, 1992). Summary of results: Results for medical resources, but students suggest using this kind of test for students were very promising showing mean scores on all medical schools. At this time it is too early to conclude Conscientiousness, Openness, Agreeableness and that our selection method is successful but this follow-up Extraversion higher than for the Portuguese age-matched study shows that we can solve the previous problem of validation sample, and lower in Neuroticism. We present recruits dropping out of medical school. the results of the first moment of this longitudinal study. Results are discussed in terms of cultural beliefs and implications for selection and training processes. 6 Ruby 2.6 How can we choose students from rural areas? 6 Ruby 2.4 Learning skill assessment for student Boonyarat Warachit*, Pairoj Boonluksiri, Saoda Yudthasompop and Prapa Ratanachai (Hatyai Hospital, Hatyai selection at Medical Education Center, Medical Education Centre, 182 Ratakarn Road, Hatyai, Hatyai Hospital, Thailand Songkla 90110, THAILAND) Saoda Yudthasompop*, Boonyarat Warachit and Pairoj Background: Due to the problem of shortage of doctors in Boonluksiri (Hatyai Hospital, Hatyai Medical Education rural areas, local recruitment faced the problem of student Centre, 182 Rattakarn Road, Hatyai, Songkla, THAILAND) drop out due to inability to learn. Objective: To determine the learning skill competency of Objective: To set the selection method that enables candidates such as listening skill, searching skill, social students from rural areas to study medicine and determine science, mathematics, and science. the predictor of the selected students. Methodology: There were 121 students enrolled. The Methodology: From 2001-2004, high school students from assessment tools for learning skill competency were divided rural areas had to join four main methods of selection into 5 specific areas such as listening skill with watching including learning skills working in wards, interview with VCR and constructed response question (CRQ), social patients and interview by committees. Each method was science with reading article and CRQ, mathematics with used to test student competency. CRQ, and science with reading article or data interpretation with CRQ. Results: 115 high school students were enrolled and 73 students were selected. Total scores of those who passed Results: The scores of learning skill were analyzed as were statistically significantly higher than those who did follows: listening score mean 49.99+10.02, searching not pass. Using Pearson correlation the correlation in four score mean 50.00+10.00, social science mean methods is statistically significant. The selected students 49.99+10.02, mathematic mean 49.99+9.99, and science had higher ability in three selection methods except mean 49.99+9.99. The correlation coefficient matrix of 5 working in wards. When comparing among four methods, specific areas had positive correlation (range 0.17 to 0.53 interview by committees had higher odds ratio than with statistical significance), however the correlation interview with patients, learning skills and working in wards coefficients of science to the others had negative (odds ratio = 1.20, 1.15, 1.09 and 1.05 respectively). correlation (range -0.04 to -0.33 with statistical significance). The prediction of learning skill competence Conclusion: Student competency had been used to select was associated with 5 specific areas. The highest beta students from rural area who had lower entrance coefficients were searching skill and social science as 0.59 examination score than normal passing level. The predictor and 0.37 respectively. The lowest beta coefficient was in selected students is predominant in interview by science (beta = 0.23). committees while working in wards showed no correlation for selection. Conclusions: The learning skill competency of candidates was prominent in searching skill and social science. There were positive correlations among 4 specific areas except 6 Ruby 2.7 correlations of science with others were negative. Interim review of widening access students’ achievement in the BM programme at 6 Ruby 2.5 Southampton Medical School A new student selection method, successful Carolyn Blundell (Southampton University Medical School, or not? Medical Education Unit, Biomedical Sciences Building, Bassett Crescent East, Southampton SO16 7PX, UK) Araya Khaimook* and Boonyarat Warachit (Hatyai Hospital, Hatyai Medical Education Centre, 182 Ratakarn Road, Hatyai, Background: A six-year, BM6, Widening Access programme, Songkla 90110, THAILAND) with a Year 0 has been running at Southampton Medical School for three years. It was developed to facilitate entry Hatyai Hospital, as part of a collaborative project to increase into the Medical School of applicants who come from production of rural doctors, recruits 20 students each year backgrounds, which for various reasons have prevented from local areas, for training in medicine. The problem is them from fulfilling their potential. All selected applicants that some of our students cannot pass the examination must meet socio-economic criteria. BM6 students who during training. Usually 1 or 2 students drop out every successfully pass Year 0 progress to Year 1 of the BM year. To correct this problem in 2001 we implemented a programme, joining the direct entry students (whose entry new student selection method. Our assumption is that grades are considerably higher than those for BM6). certain factors other than those shown by a conventional written examination affect their academic achievement Summary of work: An interim review was undertaken, as during training. Therefore a new selection method, was part of a longitudinal study of BM6 students’ academic designed consisting of some activities at Hatyai Hospital performance and progression, to establish if such students such as working as a team, testing of learning skills, could achieve successfully in the early years of their BM working in the wards, and interviewing patients in order programme. Available data on academic performance and to test their interpersonal skills, problem solving skills, entry scores (& Year 0 performance) of BM6 Cohorts 1 leadership, potential for self development, professional and 2 were compared against the whole BM cohort. attitudes, personality and learning skills. This study Conclusions: Early indications are that the objective of a describes the development and implementation of the new widening access to medicine programme within the medical student selection method and preliminary results validating school, to alter the student entry profile, can be met the effectiveness of the process. A detailed description of without compromising standards of student achievement the process is presented. Preliminary investigations indicate and experience. that the new process takes more faculty time and

– 110 – Session 6 THURSDAY 1 SEPTEMBER Session 6

6 Ruby 2.8 6 Ruby 2.9 REHASH: successful transfer of medical and Academic performance of Phase I Students healthcare learning resources from Higher at Bapkent University, Faculty of Medicine: Education (HE) to Further Education (FE) in six-year experience the UK E Ooup*, S Turkoolu, M Demirbilek, F Pahin, B Demirhan, L Chara Balasubramaniam*, Terry Poulton, Arnold Pepkircioolu, H Muderrisoolu and Z Kayhan (Baþkent Somasunderam and Stephen Harvery (St George’s University Universitesi Typ Facultesi, 1 cad 10 sokak no 45, 06490 of London, Department of Medical and Healthcare Education, Bahcelievier, Ankara, TURKEY) Educational Technology Unit, London SW17 0RE, UK) Background: Baþkent University Faculty of Medicine started A recent UK governmental drive for widening participation its undergraduate education program in 1998. The first to Higher Education (HE) has provided non-traditional students enrolled in 1998 graduated at the end of 2003- learners with an opportunity to enter medicine and 2004 academic term. healthcare through a variety of new routes. However, an Summary of work: In this study, we compared the emerging problem is that HE is still better adapted to its academic performance of the Phase I students enrolled at traditional ‘school-leaver’ market. Baþkent University between 1998 and 2003 in terms of The project objective was to enhance online student their grades, grade point averages throughout their support for adult learners in Further Education (FE), who education. We also analyzed the influence of their high often express both a high level of motivation and a high school grade point averages, nationwide University Student level of anxiety during the transition from FE to HE. The Selection Examination grades, the rank of our school in Repurposing Existing Healthcare Assets to Share (REHASH) their preference list on their academic performance. project aims to provide teachers and students with Summary of results: It was found that University Student attractive learning materials to bridge the gap between Selection Examination grades and their high school grade FE and HE. REHASH provided an opportunity to work point averages were relevant factors in the student success, closely with teachers and students from Croydon College whereas the rank of our medical faculty in their preference (FE), ‘repurposing’ HE materials for parts of their ‘Access list was not. to Healthcare’ course. Additionally, whilst repurposing the materials, the FE teacher was able to construct a lesson Conclusion/take-home message: The success of the plan around the available resources. Student feedback was students in their earlier stages of education strongly very positive. Following a short pilot study, Croydon affected their performances during medical education. This adopted this model for its entire ‘Access to Healthcare’ fact should be taken into account for the evaluation of the course. Continuation of repurposing resources between academic success of the individual medical students. FE and HE sectors will hopefully promote a feeling of familiarity, and enhance student support for adult learners.

– 111 – Session 7 THURSDAY 1 SEPTEMBER Session 7

Symposium 7AUD Evidence based teaching

7AUD Evidence based teaching experience gained by those involved in systematic review work for BEME, and in other groups such as EPPI and Marilyn Hammick (BEME Consultant), Barry Issenberg (Centre Campbell will form a platform for the discussion. for Research in Medical Education, University of Miami, USA), Alex Haig (NHS Education for Scotland, UK), Hossam Hamdy Participants are asked to identify specific issues for (Arabian Gulf University, Bahrain) and Mark Newman discussion at the symposium and to send these in advance. (Evidence for Policy and Practice Information and Topics could include: the need for evidence based teaching; Coordinating Centre (EPPI-Centre), University of London, UK) the practicalities of basing decisions about teaching on evidence; what constitutes evidence; sources of evidence; This year the Best Evidence Medical Education (BEME) conducting a systematic reviews. We hope that participants symposium presents an opportunity for a broad look at will offer topics for future systematic reviews. evidence informed practice and policy in education. The

Short Communications 7A e-problem based learning

7A 1 Learning basic sciences mechanisms using facilitated through interaction with others. Practice was PBL scenarios on the web stated to change as a result of course participation, and materials useful to general practice were created. Topic Bjorn Bergdahl*, Anna Fyrenius, Stergios Kechagias, Anne- problem-solving was improved but there appeared to be Christine Persson and Elvar Theodorsson (University of a systematic bias in the course. Curiously, doctors said Linköping, Faculty of Health Sciences, Department of Medicine and Care, Linköping SE - 581 85, SWEDEN) that interacting with other doctors was confidence boosting or reassuring. Overwhelmingly, course participants held Aim of the presentation: To share experiences of PBL using participation in the PBL exercises to be valuable to their web-based scenarios to reinforce learning in basic science. needs and practices. We conclude that in terms of student Summary of work: After having applied PBL since 1986, a reflection at least, evidence exists for online PBL to be revised medical curriculum started in 2004. One aim was considered a valid and useful learning tool for online to strengthen understanding of basic science mechanisms. postgraduate dermatology courses, and indeed provides New web-based scenarios were constructed for phase I additional benefits not encountered in conventional of the curriculum using the “EDIT” web platform. learning. Summary of results: 45 web-based multimedia scenarios were constructed. Schematic pictures, short animations 7A 3 Virtual tutorials during clinical clerkship and videos were used to illustrate basic mechanisms in A Fyrenius*, A C Persson, T Leiden and B Bergdahl (Linköping realistic contexts. In order to evoke questions and inquiry, University, Unit for Educational Development & Research, The the triggers only present a limited amount of information. EDIT-project, Faculty of Health Sciences, University Hospital, The scenarios start from physiological conditions (sports Linköping SE 581 83, SWEDEN) competitions, pregnancy, health tests), clinical problems (fracture, pain, hyperthyreosis) and community situations Aim: The medical programme at Linköping University has (immigration, poverty). For feedback, a case summary can been using problem-based learning since 1986. To achieve be opened when the tutorial group has concluded a case. high quality in clinical clerkships, students are placed in The new scenarios have received positive evaluations by hospitals all over the region for 4-week clerkships. The students and tutors alike. The cases have directed the main objective of this project was to provide opportunities students to deal with basic science problems in a realistic for tutorials during the clinical clerkships, to keep the context and seem to have increased the students’ study tutorial groups united throughout the semester and to efforts. stimulate integration between theory and practice. Conclusions/take-home messages: PBL scenarios on the Methods: A learning management system (LMS) was web can vitalize learning of basic science content in the structured for 12 tutorial groups, five students in each. early semesters of medical studies. The groups met virtually once a week to analyse a case presented by one of the students. A chat forum was used for brainstorming and generation of learning goals, while 7A 2 Online postgraduate problem-based learning: an asynchronic discussion forum was used for follow-up content analysis of reflection points contributions. Focus groups and a questionnaire were used for evaluations. M L Gonzalez and A J Salmoni* (Cardiff University College of Medicine, Department of Dermatology, PO Box 24, Heath Results: The first evaluation of the process indicated that Park, Cardiff CF14 4XN, UK) technical problems were rare. The chat forum worked well for brainstorming and for generating questions and learning Due to reasons of geographical remoteness and flexibility, goals. The discussion forum was, however, considered to medical education is rapidly moving to an online medium. be difficult to handle in a dynamic and useful way. For a postgraduate course in dermatology, we developed a tool for online problem-based learning (PBL) exercises Conclusion: PBL tutorials are feasible using an LMS. The which requested reflection from all students. We performed PBL process is affected, and modifications are needed for a content analysis of these comments to understand optimal function. whether online PBL was a worthwhile exercise for postgraduate dermatology teaching. Comments about three topics by 182 international students were analysed. Most commonly mentioned were improvements in topic knowledge and that learning was

– 112 – Session 7 THURSDAY 1 SEPTEMBER Session 7

7A 4 Successful implementation of the computer 7A 5 Collaboratively constructed diagrams to in Problem-based Learning (PSL) facilitate small group, problem-based learning L Charron*, J P Messier, R Lalande and A Ferron (University Marc Brisbourne*, Stephen Aaron and David Begg (University of Montréal, Faculty of Medicine, Médecine-Direction, 2900 of Alberta, Faculty of Medicine and Dentistry, Division of Edouard Montpetit, C.P. 6128 succ. Centre-Ville, Montréal, Anatomy, 5-05D Medical Sciences Building, Edmonton, Alberta Québec H3C 3J7, CANADA) T6G 2H7, CANADA) Currently, our students are learning by PSL through most We are designing a website to support the collaborative of their academic years. To successfully introduce daily construction of diagrams to analyze simulated patient use of the multimedia, we were compelled to adopt a cases. The diagrams assist students’ planning, organizing strategy that proceeded according to the following steps: and evaluating information in order to develop differential first, a permanent core of designers, including course diagnoses. Students require instructional support to content and computer experts, worked at developing develop expert clinical reasoning skills; however, activities tutorials from original documents, texts and video tapes explicitly facilitating the development of such skills are available within the university community. These were often overlooked in problem-based learning tutorials. exploited for the enhancement and complementation of Diagrams function as a visual representation of a patient each PSL step, namely, the construction, presentation and case that helps students to outline and assess information, resolution of cases, and, finally, evaluation of the quality develop a differential diagnosis and rationalize the data of learning. Second, students were encouraged to build within the context of the differential diagnosis. Constructed and organize their own databanks according to their diagrams can then serve as a focal point for sharing and deficiencies, interests, potential research projects, discussing the group’s reasoning process where tutors and exceptional clinical cases encountered, etc. These materials other group members can provide feedback. could be validated and encouraged when presented at A pilot study with second-year medical students at the the students’ symposium held in the course of the second University of Alberta was conducted using a paper diagram academic year. Third, to ensure that these learning habits, construction toolkit to evaluate their performance and developed as pre-graduates, influence those of the preferences in the creation of patient diagrams. The results practising physician, use of laptops and the Personal Digital of the pilot study indicate that diagrams fulfil these Assistant in learning and knowledge updating was expected outcomes and that students are motivated by promoted. To guarantee full success of this approach, these the activity. User participation in the initial design and steps needed total acceptance by students and teachers development made recommendations to help improve the as well as strong Faculty backing, especially in view of the concept of the web site and are being incorporated into a financial burden such developments may impose on the working prototype. institution.

Short Communications 7B The OSCE 1

7B 1 The birth and world-wide adoption of the 7B 2 Incorporation of a written simulated patient OSCE: an advanced socio-historical study medical record into a clinical skills OSCE Brian Hodges (University of Toronto, Faculty of Medicine, G Whelan*, J Boulet, T Rebbecchi and D McKinley Donald R. Wilson Centre for Research in Education, Toronto (Educational Commission for Foreign Medical Graduates General Hospital, 1ES-565, 200 Elizabeth Street, Toronto, (ECFMG), Clinical Skills Assessment Program, 3624 Market Ontario M5G 2C4, CANADA) Street, 3rd Floor, Philadelphia PA 19104-2685, USA) Background: Since its birth in 1975, the OSCE has been SP-based OSCEs assess the clinical skills of history-taking, adopted in an astounding number of locations around the physical examination, and communication with patients. world. Previous research explored the set of 900 published The checklist-based scoring often used with this format, articles on OSCEs and sketched a preliminary socio- however, neglects a critical component of patient historical analysis the OSCEs world-wide uptake. This study encounters, namely, the recording of pertinent positive extends the literature review with key informant interviews. and negative medical history and physical examination findings, differential diagnoses, and diagnostic workup Method: Twenty interviews were conducted with individuals plans. Through inclusion of a Patient Note (PN), this deficit identified in the literature as key figures in the history of was addressed in the Clinical Skills Assessment (CSA) the OSCE. Interviews, conducted in Dundee, Toronto, administered by the Educational Commission for Foreign Hamilton, Philadelphia, Ottawa, New York and Montreal, Medical Graduates (ECFMG) from 1998 through 2004. Over were audio-recorded, transcribed and coded for emergent the course of CSA, 463,687 PNs were assigned holistic themes. scores by trained physicians. These scores had only a Results: Interviews confirmed and extended themes modest correlation with checklist scores suggesting that identified in the literature review. In addition to ‘traditional’ these PNs assess a unique dimension of clinical skills. arguments for OSCEs (superior psychometric properties, Although checklists can capture history and physical shift from knowledge to performance, etc) there are other findings, only by inclusion in the PN does the examinee important forces in the adoption of OSCEs. These include: demonstrate recognition of their significance. The need to professionalization of standardized patients, the rise of develop differential diagnoses and workup plans mandates psychometricians and metaphors of accountability and an organized approach that supports synthesis and analysis production and the use of OSCEs to define professional of information rather than simply gathering information in roles and ‘turf’. a rote or “shotgun” manner. Finally, entering medical Implications: OSCEs can be viewed as innovative methods information is an essential part of medical practice and of testing, but also as important tools in the construction the PN added fidelity to the examination while also allowing of both the medical profession and emerging medical assessment of higher order written communication skills. education professions. Understanding these functions of OSCEs extends our ability to use them constructively for institutional as well as educational purposes.

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7B 3 Variation on a theme: the role of 7B 5 Do medical undergraduate assessments multiprofessionalism to assess trainees in an predict clinical performance as a Pre- Objective Structured Clinical Examination Registration House Officer? (OSCE) in Neonatal-Perinatal Medicine W A Watson*, J Bennett, K Walker, G Needham, M Laing and Brian Simmons*, Ann Jefferies, Deborah Clark, Jodi McIlroy, H McKenzie (University of Aberdeen, Medical Education Unit, Diana Tabak and Program Directors of the Neonatal-Perinatal College of Medicine, Medical School, Polwarth Buildings, Medicine Programs of Canada (2002-03) (Sunnybrook & Foresterhill, Aberdeen AB25 2ZN, UK) Women’s College of Health Sciences Centre, Department of Aim of presentation: Does performance in undergraduate Newborn & Developmental Paediatrics, SWCHSC-Women’s assessment predict the level of clinical performance in Pre- College Campus, 76 Grenville Street, Room 476, Toronto, registration house officers (PRHOs)? Ontario M5S 2B6, CANADA) Background: Standardized patients (SPs) are used in the Summary of Work: Members of the 2003 University of OSCE to portray patients/parents. We developed an OSCE Aberdeen graduating class who became PRHOs in the North for trainees in Neonatal-Perinatal Medicine in which health of Scotland Deanery were studied (n=134). Scores from professionals portrayed standardized health providers undergraduate assessments were analysed, in particular (SHPs). the Final Year OSCE score. PRHO performance was assessed by PHAST (PRHO appraisal and assessment Aim: To compare reliability of SHP and SP stations. system) a questionnaire that covers 4 domains of practice Summary of Methods: Two OSCEs, conducted in 2002- (good clinical care, maintaining good medical practice, 03, included 14 SP and 8 SHP stations (respiratory effective relationships with patients and effective working therapists, nurse practitioners, nurse educators, physicians with colleagues) and is completed by 4 raters (consultant, and a medical student). Examiners completed station SpR, SHO and nurse). Univariate and multivariate analyses checklists, global ratings (CanMEDS roles - medical expert, were used to seek correlations between undergraduate communicator, collaborator, manager, professional, scholar, scores and PHAST results. health advocate). SPs and SHPs completed communication Summary of Results: With univariate analysis, the median global ratings. Reliability was determined by alpha total PHAST score correlated significantly with the final coefficients, which were projected to 10-stations, using OSCE (p<0.001) and with the years 3 and 4 OSCE total the Spearman-Brown prophecy formula. SPs, SHPs, (p<0.03). Multivariate analysis confirmed a significant examiners and candidates provided feedback. association between the outcome at final OSCE and Results: 54 trainees participated. Projected alpha individual components of the PHAST score as well as the coefficients were greater than 0.70. There were no total score (p<0.001). significant differences in reliability between SP and SHP Conclusions: There is a significant correlation between stations (p > 0.05). Reliability was consistently higher for performance in the final year OSCE and clinical the CanMEDS and communication global ratings, than performance as a PRHO. Further analysis of correlations checklists. between PHAST and undergraduate assessment is being carried out and will increase our understanding of the links Stations Checklist CanMEDS Communication between undergraduate and postgraduate performance. 2002 SHPs 0.71 0.87 0.79 Doctors requiring additional support could be identified SPs 0.85 0.92 0.93 from the beginning of PRHO year from OSCE scores and a tailored education package put in place. 2003 SHPs 0.74 0.85 0.84 SPs 0.75 0.87 0.90 7B 6 Self evaluation correlated poorly with Feedback confirmed SHP roles were considered realistic residency admission grades on OSCE-based and appropriate. test Conclusions: SHPs may be used in OSCE stations, which Julio César de Oliveria*, Thelma Suely Okay, Maria Patrocinio require knowledge and expertise. SHPs could be used in Tenório Nunes, Itamar de Sousa Santos, Leonardo Borges de high stakes exams. A formal training program should be Carros e Silva, Cristina Helena Fonseca-Guedes and Joaquim considered. Edson Vieira (University of São Paulo Medical School, Av. Dr Arnaldo 455, Room 1216, São Paulo CEP 01246-903, BRAZIL) 7B 4 Introduction of practical OSCE at Royal Background: Observed Structured Clinical Examination (OSCE) was adopted to provide selection for Residency Veterinary College programs to a public Hospital in Brazil, 2004. It included 2 S Head (Royal Veterinary College, ASD, Hawkshead Lane, stages for Internal Medicine, Surgery, Pediatrics, Hawkshead, North Mymms, Hatfield AL9 7TA, UK) Gynecology-Obstetrics and Social Medicine each. We The Royal Veterinary College introduced OSCE for assessing compared OSCE grades with self-evaluation scores. the practical competence of its final year students in March Methods: Data from 314 physicians were obtained. From 2005. Following experience of medical schools, the OSCE assessment students were invited to answer a self- students experienced formative OSCE prior to the evaluation form of skills levels (0 – don’t know to 5 – summative. The initial series of OSCE for one quarter of experienced) for station aims. the year (39 students) were laboratory and basic clinical Results: Self evaluation scores correlated poorly with OSCE skills based. A Clinical Skills Centre (CSC) was developed grades, unrelated to best station (4.20 with r2=0.061) or in parallel with the introduction of OSCE, attendance being the lowest one (1.49 with r2=0.009), Pearson test. The on a drop in basis. Attendance developed at the CSC as overall score attained a mean of 3.20 while the mean OSCE the OSCE series progressed and this was reflected in more was 56.90, still correlating poorly (r2=0.053). capable students in some competences. The latter series of formative OSCE were more large animal (LA) based Discussion: The OSCE provides a nearer real clinical and were scheduled in barns on site, necessitating a robust situation. As candidates may better understand the aims sound communication system. The timing, with sound and for every station it would be expected to see a fair vision, was PowerPoint program driven and will be correlation for self-evaluation scores and grades. The self- demonstrated. The use of live animals presents difficulties evaluation form allowed the examinee to consider oneself concerning animal welfare and a mix of models and live from not knowing to mastering but candidates have not animals – frequently changed – were used. Exchange of achieved such correlation. our experience and suggestions of how to expand the Conclusion: Young physicians could not self-evaluate OSCE scenarios will be appreciated. grades during Residency admission test.

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Short Communications 7C Community based medical education

7C 1 Perceptions of Pre-Registration House ambulatory medicine, regardless of some demographic Officers (PRHO) and their Supervisors to the differences in the population. introduction of community-based Problem- Based Learning (PBL) education 7C 3 The use of pilot educational projects as Simon Watmough*, David Taylor, Anne Garden and John important steps in the curriculum Howard (University of Liverpool, School of Medical Education, innovation process: the experience of a 2nd Floor, Cedar House, Liverpool L69 3GE, UK) Greek medical school In 1996 Liverpool reformed its medical curriculum from A Benos*1, E Panagopoulou1, E Smyrnakis1, N Kavaka1, E traditional to integrated PBL. Community attachments were Giannakopoulos1, M Gavana1, T Zdoukos1, T Aslanoglou1, A significantly increased and now account for approximately Garyfallos2 and N Dombros2 (1Laboratory of Hygiene & Social 30% of undergraduate clinical placements. We formed Medicine, Aristotle University of Thessaloniki, , P O Box 1689, focus groups with graduates to ask their views on their Thessaloniki 54006, GREECE) undergraduate GP placements. They felt there was too Background/rationale: The Thessaloniki Medical School has much community teaching in the course and they were a traditionally overloaded with factual knowledge being “forced” to become GPs. However they felt the curriculum limited in a tertiary hospital based setting and placements were useful preparation for hospital work dominated by a didactic educational approach. In order to noting that PRHOs usually deal with minor ailments on establish a consensus for the needed innovation of the the ward. General Practice was a good place to practise curriculum, educationally innovative pilot projects were communication and they enjoyed the one-one interactions developed. with patients. What was done: A pilot community oriented educational GP PRHO rotations began in Mersey in 2000. When this project, the ‘Daisy Project’, promoting the integration of work was carried out GPs had supervised 3 cohorts of clinical, research and communication skills training, was Liverpool graduates. We sent questionnaires and held implemented on a voluntary basis. Medical students could interviews with these GPs. They were positive about the select activities of the project, including a communication PRHOs who were seen as having good communication group, a nurse-assistant role providing clinical skills and referral skills, understood disease process, took a good training, a health promoting intervention program, a history and examination and were good problem-solvers. primary health care placement and a research group. The They welcomed the introduction of the new curriculum positive evaluation of the project by both students and and in particular the increase in community teaching, teachers involved in the process have led to the although none of the GPs were particularly “evangelical” incorporation into the formal curriculum of the following about community placements believing GP surgeries modules: a Clinical Skills Lab as part of clinical training, require further funding to supervise students and PRHOs. and courses on Primary Health Care, Communication Skills and Research Methodology as Selected Special Study 7C 2 The spectrum of clinical encounters at the Modules. primary level of care into a family health Conclusions: The use of pilot projects is providing, on top model of the expected methodological improvements, the opportunity to diffuse the evidence for the needed changes E Amaral*, A Zeferino, W Nadruz, L O Sarian and C Inhaia and to amplify the support and consensus to innovative (CAISM/UNICAMP, Divisão de Obstetrícia, Rua Alexander Fleming 101, Campinas SP, São Paulo SP CEP 13083-970, activities. BRAZIL) Aim: To compare the spectrum of clinical encounters 7C 4 A mini medical curriculum arising from experienced by medical students at the primary level of Tsunami care. Indika Karunathilake*, Lanka Alagiyawanna, Nilanka Summary of work: During the 4th year of a six-year Wickramarathne, Kremlin Wickramasinghe and Dujeepa curriculum at UNICAMP/Brazil, 112 students performed Samarasekera (University of Colombo, Faculty of Medicine, clinical encounters, supervised by faculties and trained MEDARC, Kynsey Road, Colombo 8, SRI LANKA) tutors at six primary health units, recording the cases in a Aim of presentation: To illustrate the role of curriculum logbook. development in providing disaster relief. Summary of results: Among 920 adults, 878 women’s Background/Rationale: The December 26th Tsunami led health, and 889 children’s consultations, the top primary to massive human suffering and created health problems diagnoses were: for adults - hypertension (17.5%), which need to be promptly addressed. Deploying adequate musculoskeletal/connective (11.7%), diabetes mellitus numbers of trained healthcare personal to fulfill this (7.7%), respiratory (7.0%), digestive (7%), infectious requirement within a short period of time was a tremendous diseases (6.8%), psychiatric disorders (5.9%), and challenge. An alternative option was to train medical dermatological conditions (5.1%); for children - students to provide disaster relief in an organised manner. developmental follow up (42%), respiratory (13.8%), and Therefore, the Faculty of Medicine, Colombo, Sri Lanka, dermatological diseases (11.9%), anemia (6.6%), and decided to develop a short-course on disaster management infectious diseases; for women, vaginal discharge, to train the medical students. abnormalities of menses and climacteric symptoms (53.3%), antenatal care (19.3%) and cervical cancer Summary of work: The first step was to conduct a needs screening (13.7%). Students cared for the commonest assessment by a multiprofessional group to identify the ambulatory conditions, as expected, with some differences training needs. The identified areas were management of among health units on the spectrum of primary diagnosis acute injuries, infections, maternal and child care, reflecting age and economic status of the population. psychological support, medico-legal aspects and management of a relief camp. The content for a one-week Conclusions/take-home lessons: Clinical experience in course was decided accordingly. Small-group discussions primary health units into a family health model allows and task-based learning were the teaching/learning medical students to experience essential cases in methods. A manual on disaster management was

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developed as reference material. Assessment was by direct Take home message: Medical curricula should be adjusted observation. The trained medical students were according to the changing health needs of the community. successfully deployed in disaster relief.

Short Communications 7D Evaluation of teachers

7D 1 Measuring the hearts and minds of clinical even more effective than having one. The majority of the teachers: construct validity of a multi- feedback provided was positive and valuable. dimensional scale Conclusion: To be and to have a critical friend is worth the Thomas J Beckman* and Jayawant N Mandrekar (Mayo Clinic, extra workload. Therefore, the Critical Friend concept Division of General Internal Medicine, 200 First Street SW, should be made part of regular teaching practice. Rochester MN 55905, USA) Aim: To determine the validity of faculty assessments 7D 3 Residents’ feedback on consultants’ teaching comprised of interpersonal and cognitive domains, utilizing J W Briet*, E Flikweert and M T Miedema (Geertruiden evaluations by residents on an inpatient service. Hospital, PO Box 5001, Deventer 7400 GC, NETHERLANDS) Method: One thousand evaluations were completed on 60 Aim: Teaching qualities can be improved by teach-the- internal medicine faculty. Theory supported a two- teacher courses and by direct feedback in daily life dimensional, 14-item scale. Principal Components Analysis encounters. Learning happens in different settings: demonstrated the scale’s dimensionality. Internal practical skills in direct learner-teacher contact; more consistency and inter-observer reliabilities were calculated, general competencies by observation of role models and and relationships between domains and instructor by experience; knowledge by study. We wanted to explore characteristics were examined. the teaching quality of our consultants in speciality-specific Results: Principal Components Analysis revealed three and general competencies. domains: interpersonal, clinical-teaching and efficiency. Summary of work: A questionnaire of 28 items was Internal consistencies of all domains are high (alpha > designed based on the 7 CanMEDS roles and the Cleveland 0.90). Inter-observer agreement is good (range: 0.64 to Clinics’ Clinical Teaching Effectiveness Instrument. The 0.83). A trend in the interpersonal domain is higher scores results were discussed between representatives of the for lower-ranking faculty. Significant findings are higher residents and each of the consultants individually. All scores for assistant professors in the interpersonal domain residents were asked to give their opinion in which setting (p = 0.008), and higher scores for male than female faculty the 7 CanMEDS roles were best learned. The in the interpersonal (p = 0.041) and clinical-teaching (p = representatives had to reflect on the process of giving 0.008) domains. feedback on their own teachers: if general feedback rules Conclusions: Clinical teaching evaluations reduce to were followed, and whether they expected a positive interpersonal, clinical-teaching, and efficiency domains. influence on teaching quality and professional behaviour. Evidence for construct validity includes predicted domains, Questionnaires were completed by about forty residents high internal and inter-observer reliabilities, and differential in eight departments. The results will be presented. item functioning among faculty subgroups. Utilizing a Conclusion: We hope to demonstrate that this exercise in homogenous sample of resident evaluators minimized feedback will be a worthwhile learning experience for both variance. Interestingly, lower-ranking faculty scored higher consultants and residents, and that it results in a greater in the interpersonal domain, suggesting that lower-ranking awareness of the learning of general competencies. faculty may focus more attention on teaching activities than full professors. 7D 4 Relation between personal character, 7D 2 To be and to have a critical friend in medical teaching methods and knowledge teaching capabilities of academic staff Abdolali Ebrahimi*, M H Meshkibaf, M Agholi and R Lars Owe Dahlgren, Björn E Eriksson, Hans Gyllenhammar, Nikandish (Fasa University of Medical Sciences, Department Maarit Korkeila, Annika Sääf-Rothoff, Annika Wernerson and of Pathology, Ebne Sina Square, PO Box 746168688, Fasa, Astrid Seeberger* (Karolinska Institutet, Karolinska University IRAN) Hospital, Huddinge, Stockholm,141 86, SWEDEN) Background: Generally the evaluation of academic staff is Background: In order to stimulate reflection and continuous carried out by the end of each term. One of the important professional development, a model of critical friends points in educational evaluation is to analyze the evaluating each other was introduced in medical education. relationship between various factors involved in the process Methods: Three pairs of critical friends were formed, of education. In this study the student will evaluate their consisting of experienced medical teachers (n=6). Each teachers in 3 different aspects, personal character, teaching teacher was assigned to give one lecture and one seminar methods and knowledge capabilities. in his/her specific research or clinical field. The critical Materials and Methods: The data of academic staff friend evaluated the performance in class, acting as an evaluated by students were collected from the education observer using a preformed protocol. The evaluation was developing centre ( EDC). The relation between the various communicated to the teacher during a 45-minute session factors were analyzed using SPSS statistical program. within 48 h after the teaching session. Each of the six teachers was criticised and gave criticism within the pair Results: The study showed that there was a significant configurance. The outcome of the process was evaluated relation between the academic staff personal character by an experimenter, not participating in the process who and their knowledge capabilities in 71.37% of the staff performed a semi-structured interview with each of the (P<0.05), also there was a significant relation between six teachers. academic staff personal character and their teaching methods in 61.65% of the subjects, finally the significant Results: Each teacher had a different way of reflecting on relation between teaching methods and knowledge teaching after the project than before and made changes capability was 48.9% (P<0.05). in his/her way of teaching. To be a critical friend may be

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Discussion: The results obtained in this study revealed What was done: We have now analysed 98 anonymised that the highest relation were between the knowledge feedback forms from 8 clinical tutors. A Cronbach’s alpha capability and the other two parameters (personal of 0.945 suggested reliability of the tool. Factor analysis character and teaching method) whereas, the relation shows that the 29 items cluster into 6 distinct groups. between teaching methods and personal character were Feedback from participants revealed that for the moderate. With this result it can be concluded that the information gained using this tool to be most useful, knowledge capability can influence teaching method feedback needed to be given by someone trained in this positively and therefore these two parameters are essential process. for each other. However, the effect of personal character Conclusions: This tool would appear to be reliable. of academic staff and its influence on the other two Reducing the number of items from 29 to 6 should make parameters is low but should not be denied and forgotten. it easier to administer and would be expected to improve the return rate in real life use. Care should be given to 7D 5 Improvement of a multisource feedback tool planning how feedback is given after using this tool. We for PGME faculty leaders should trial the revised version and confirm these preliminary findings. Kit Byatt*, David Wall and Andrew Long (Hereford County Hospital/NACT, Department of Geriatric Medicine, Union Take home messages: PGCT360 is a reliable and valid Walk, Hereford HR1 2ER, UK) multisource feedback tool. It can be made simpler to administer. Feedback needs to be given sensitively and Background: The National Association of Clinical Tutors is constructively by someone trained in the process. developing a multi-source feedback tool (PGCT360) to help clinical tutors’ self-development in their postgraduate medical education role. We previously showed that this tool has both face and content validity.

Short Communications 7E Evaluating the international medical student and doctor

7E 1 Assessment of medical competence of The University of Melbourne attracts a third of all foreign medical graduates in Europe: the international medical students enrolled in Australian new Dutch approach universities. In an age of global medical education, this paper analyses the academic outcomes achieved by these Olle Th J ten Cate*, Cornelius T Postma, Albert J J A students compared to Australia-born students (all origins) Scherpbier, Elke Peters and Ted A W Splinter (UMC Utrecht and first generation migrant and refugee students (who University, School of Medical Sciences, University Medical constitute an additional third of all medical faculty Centre Utrecht, PO Box 85060, Utrecht 3508 AB, enrolments). Based on analysis of academic records for NETHERLANDS) 1200 students across five years of medical training, this Aim: The Netherlands has accommodated hundreds of paper provides powerful insights on the degree to which foreign medical graduates over the last decade. However, differences in language, education and cultural background current procedures for acknowledgement and impact on academic outcomes for select country of origin supplementary training do not suffice, because (a) groups. procedures take too long, (b) the assessment of competence is inadequate and (3) the treatment of candidates is unequal at different university medical 7E 3 Medical education and one world medicine centers. A new national procedure was deemed necessary. N G Patil* and S K Lam (The University of Hong Kong, Faculty Work done: A task force designed a procedure to assess of Medicine, 2/Floor, Academic & Administration Building, the medical competence of foreign graduates, necessary Sassoon Road, Pok Fu Lam, HONG KONG) for adequate functioning in Dutch health care. Collaboration Use of medicines other than or in addition to allopathic with ECFMG (USA) helped to shape this design. In February (western) medicine is prevalent in most parts of the world. 2005 the plan was presented. Certificate and degree courses in traditional medicine are Results: From 2006 on foreign medical graduates will be also offered in various countries. The Medical School required to pass basic exams (Dutch and English language, (est.1887) of Faculty of Medicine, The University of Hong ICT skills, communication) before applying for the Kong has its MBBS course teachers involved in teaching of assessment of medical competence. This includes (a) basic basic sciences and clinical skills to Bachelor of Chinese science knowledge, (b) clinical knowledge - UMSLE-step2- Medicine (BCM) students from faculty affiliated School of CK, (c) clinical skills (meeting standards of at least USMLE- Chinese Medicine (est. 2000). Interestingly, nearly 25% step2-CS), (d) an interview based on a completed portfolio of the BCM syllabus has certain elements of western and (e) observation of patient management skills and medical education. Faculty recognizes the converse professional behaviour during a 12 week clinical rotation. possibility to formally bring in teaching of Complementary The assessment results in a decision to acknowledge the and Alternative Medicine in medical education to progress diploma, or to require supplementary medical training of towards “One world medicine” - be it a western, Chinese 1, 2, 3 or 6 years. or of any other nature. Currently, medical students are offered special study modules (SSM) in Traditional Chinese Conclusions: The new assessment procedure may serve Medicine. Funding has been obtained to establish a as an example for other European countries. purpose-built research and education facility to support clinical research, and facilitate the development of 7E 2 Factors determining academic outcomes for standards and models of interface between western and Chinese medicines. A combined degree programme in international medical students in Australia MBBS/BCM with a core syllabus remains a distant Lesleyanne Hawthorne*, Sue Elliott and Graeme Hawthorne possibility. The authors will highlight the concept, practical (University of Melbourne, Faculty International Unit, implications, and feasibility of teaching of ‘one world Medicine, Dentistry and Health Sciences, 5/207 Bouverie medicine’ in medical education. Street, Parkville, Victoria 3010, AUSTRALIA)

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7E 4 Recruiting and retaining international 7E 5 Developments in professional psychology medical graduates in Nova Scotia, Canada training in UK and Europe D Bruce Holmes*, Robert F Maudsley, Alexa Fotheringham, E A Campbell*, Chair Membership and Professional Training Linda Mosher, Kevin Bourke, Gwen MacPherson and Cameron Board British Psychological Society (University of Glasgow, Little (Dalhousie University, Faculty of Medicine, Learning Department of Psychological Medicine, Division of Community Resource Centre, 5599 Fenwick Street, Lower Level, Halifax, Based Sciences, Gartnavel Royal Hospital, Glasgow G12 0XH, Nova Scotia B3H 1R2, CANADA) UK) Aim of Presentation: The presentation will describe the The British Psychological Society is the learned society as work of the College of Physicians and Surgeons of Nova well as being the professional body for applied Scotia, the professional body for licensing physicians in psychologists. The Society maintains a register of Chartered Nova Scotia, to increase the capacity to assess and Psychologists in the fields of clinical, counselling, integrate international medical graduates (IMGs) into educational, occupational, health and forensic psychology. clinical practice. The Society accredits undergraduate awards in UK Universities as well as more than one hundred postgraduate Summary of Work: The Clinician Assessment for Practice programmes. In addition, the Society administers six Program (CAPP) is designed to initially assess the clinical postgraduate examination boards which provide routes to competence of IMGs wishing to enter family practice and qualify as a Chartered Psychologist. The aim of this paper then on an on-going basis to mentor, supervise, evaluate, is to describe the recent review by the Society of all the support, and integrate the IMGs into their new practice competency based curricula for the six branches of community. A distinguishing feature of the program is its postgraduate applied psychology. This review has been comprehensive and ongoing nature during the first year prompted by QAA developments, the move towards of practice. An educational plan, based initially on the Statutory Regulation of Applied Psychology and the advent structured assessment and past clinical experience, is an of a European Diploma in Psychology. The European integral part of the program to address perceived and Diploma will be the benchmark for professional practitioner identified professional needs of the IMG, and may be psychology throughout Europe. Some of the tensions that modified by the IMG in collaboration with the mentor as have arisen between a curriculum driven training model the year progresses. and an apprenticeship model of training have been Summary of Results: The CAPP will be implemented for highlighted by these developments and will be discussed the first time in June 2005. The presentation will include a in the paper. The issue of specialist titles and areas of description of the process and the results from stakeholder practice have also been challenged by competency based feedback. The second iteration of the program is scheduled curricula and the implications for regulation of the for December 2005. profession will be considered. Conclusions/Take Home Messages: The CAPP model can be used for the assessment and integration into clinical practice of other health professionals.

Workshops 7F, 7G & 7H

7F Ibero-America: Current Challenges in countries; b) Effective methods, tools and resources that Medical Education: An overview from AMEE will be applicable to deliver CME-CPD globally or regionally; and PAFAMS and c) identifying available data to further develop a core- curricula based on competencies. The second action is Margarita Barón Maldonado Universidad de Alcalá, Madrid, the @HEALTH project to create a community of EU and Spain), Alejandro Cravioto (Universidad Nacional Autónoma Ibero-American faculty, researchers, medical schools, and de Mexico) and Pablo A Pulido M (Pan American Federation other relevant institutions operating in the field of e-health of Associations of Medical Schools, Caracas, Venezuela) to stimulate cooperation, technology transfer and joint Improving quality and professionalism of the products or Research Projects through innovative applications of IT outcomes of Medical Education in the Americas is a major supporting feasible and efficient health policies geared to challenge. There is a need of rethinking Medical Education improve quality, safety and efficiency in healthcare systems to meet urgent and emerging social and health and evidence based medical education. requirements of the population. Institutional evaluation and accreditation programs, based on nationally developed standards with the WFME orientations have been well 7G Crisis resource management for healthcare accepted, now optimized and complemented with those professionals – a new six step approach of the Institute for International Medical Education, IIME, Michael Mueller, Mike Haensel, Soeren Weber focused on outcomes. The process is evolving to look into (Interdisciplinary Simulation Center ISIMED, Dept. of the quality of the outcomes of the Medical Schools, as Anaesthesiology, University of Technology, Dresden, Germany) seen by measurements at the end of the medical studies and the initiation of medical practice, based on the global Background: Most adverse events in the field of medicine minimum essential requirements, GMER of the IIME. The are human factor related. To address this topic, many Panamerican Federation of Associations of Medical Schools, simulation centres offer crisis resource management PAFAMS, an academic, non governmental organization, courses. These courses contain simulator scenarios and founded in 1962 for the advancement of medical education structured debriefing and focus on the non-technical skills and biomedical sciences in the Americas, is fostering the (situation awareness, decision making, task management exchange of ideas and experiences among members, and teamwork. Most simulation centres do not involve associations and affiliated medical schools in the Americas. psychologists in the training; furthermore there is a lack PAFAMS is focusing on two additional actions, one in post of teaching psychological knowledge and practice on the graduate education through its Project Globe: A New non-technical skills. Psychological training as a stand-alone Initiative to Provide Quality CME- CPD for Generalist course such as crew-resource-management (crm) in the Physicians. A pilot work is advancing with three main tasks: field of aviation is usually well evaluated but the participants a) GP/FP Educational Development Needs from selected do not transfer the acquired knowledge into their working environment.

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Workshop content and structure: We demonstrate the block processes: (a) contributes directly to understanding of on situation awareness as part of our new simulator based health and illness, and to the practice of medicine; (b) curriculum to teach the non-technical skills. This consists equips doctors with the psychological tools to be lifelong of the following six steps: (1) Demonstration of good crm learners and educators; (c) contributes to robust practice in a short scenario; (2) Theoretical background psychological health for practitioners working in demanding of situation awareness; (3) Psychological exercises; (4) and rapidly changing work environments. The rationale MiniSim: Psychological exercise in a patient simulator for an agreed curriculum is stronger than that supporting setting; (5) Realistic simulator scenario; (6) Structured the existing disparity across medical programmes, some (video) debriefing. of which have little or no psychology component. There are two main reasons for working towards a core Intended outcomes: Demonstrate the objective: improving curriculum: (a) for quality assurance and (b) to provide a crm behaviour, (step 1); increase the participants´ baseline for curriculum development and research. We have knowledge on situation awareness (step 2); sensitize the a duty to comply with best practice for quality assurance participants for situation awareness related errors (step and evidence based curricula, by not doing so we are 3); transfer of knowledge into working environment (step vulnerable to the idiosyncratic whims of the host medical 4); exercise good situation awareness in realistic scenario school who may neither want nor understand the (step 5); feedback from a psychologist (step 6). programme that we should provide. This makes us Intended audience: Teachers interested in teaching of the complicit with a ‘service model’ of teaching that undermines non-technical skills; teachers who work with simulators; the centrality of psychological knowledge to medicine. healthcare professionals interested in strategies to increase Agreement on a core curriculum and best teaching and patient safety. learning methods will strengthen our position as a group Level of workshop: intermediate (some knowledge/ and can facilitate further research. experience desirable) Workshop content and structure: Short presentations will precede small group work to determine and debate core content material. Small groups will be facilitated by expert 7H Towards a core curriculum for Psychology in facilitators, all of whom have considerable experience in Undergraduate Medicine curriculum design and teaching psychology to medical Christine Bundy and Lis Cordingley (University of Manchester students. Medical School, UK); Sarah Peters (University of Liverpool Intended outcomes: A consensual draft core curriculum Medical School, UK); and Judy Rock (University of Keele for psychology teaching and learning. Medical School, UK) Background to the topic: There is no agreed core Intended audience: Anyone responsible for, interested in curriculum for psychology in medicine, indeed there is little or having expertise in design and/or delivery of psychology/ consensus as to what should be taught, how it should be behavioural sciences to medical undergraduate students. learned or how it should be assessed. This workshop Level of workshop: Intermediate (some knowledge/ argues that psychology is a crucial part of any medical experience desirable). curriculum because knowledge of key psychological

Short Communications 7L e-learning: virtual patients

7L 1 A new incentive for guideline Further studies are necessary to compare the learning implementation: evidence- and case-based impact and effectiveness of case oriented versus text-based learning on the internet teaching methods. Horst Christian Vollmar*, Cornelia-Christine Schürer-Maly, Lothar Heymanns, Nik Koneczny, Justina Engelbrecht, Wilfried 7L 2 Integration of ‘virtual patients’ in Kunstmann, Susanne Löscher, Günther Ollenschläger, Monika undergraduate medical education: students’ A. Rieger and Martin Butzlaff (Medical Knowledge Network perceptions of different learning scenarios of Witten/Herdecke University, Alfred-Herrhausen Str 50, Witten 58448, GERMANY) S Huwendiek*, S Koepf, B Hoecker, J Heid, M Bauch, H M Bosse, M Haag, F J Leven, G F Hoffmann and B Toenshoff Based on the medical online platform www.leitlinien- (University Children’s Hospital Heidelberg, Department of wissen.de the Agency for Quality in Medicine and the General Pediatrics, Im Neuenheimer Feld 153, Heidelberg D- German Medical Association joined educational forces with 69120, GERMANY) Witten/Herdecke University. To strengthen the transfer of the National Disease Management Guidelines (NDMGs) into Background: Realistic multimedia teaching cases (“virtual clinical practice, virtual interactive cases are offered for patients”) have been used for undergraduate medical CME. Based on NDMGs, interactive virtual patient histories education in Pediatrics at Heidelberg University since 1999. are constructed and complemented with appropriate These virtual patients are presented by the CAMPUS system media, e.g. ECGs etc. Different learning modules allow (www.medicase.de). CAMPUS distinguishes itself from various interactions between users and their virtual other systems by offering all the diagnostic and therapeutic patients. Each module ends with a detailed feed-back on options of a modern children’s hospital in any single case the user’s decisions. All case histories are supplemented (“simulative concept”). This approach allows users to with 10 questions. In the case of 70% correct answers, interact with their patients in a more dynamic and realistic CME-points can be obtained. fashion. The virtual case histories were well appreciated. Physicians What was done: 43 pediatric teaching cases were acknowledged the way of learning which resembles, albeit developed on the basis of real patient data and were virtual, their daily routine. Out of their experience with integrated as obligatory and voluntary elements in the the first cases, the users delivered many useful pieces of pediatric clerkship at Heidelberg University. Cases were advice, which are very valuable for further improving the offered to students for small-group study and self-study. patient histories. According to individual preferences, From 2001 to 2005 the students’ perceptions of different physicians can study medical topics by either reading the curricular integration scenarios were assessed using NDMGs or by diagnosing and treating a virtual patient. qualitative and quantitative methods. This data will be presented.

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Conclusions: Undergraduate medical students found Summary of work: Cases were developed according to interacting with virtual patients to be a valuable learning problem-based learning. Following reviews by experts tool for both individual and collaborative learning. They associated to the University of Witten/Herdecke, two cases also felt that the blended learning curricular integration were tested in a pilot study by 13 physicians evaluating scenario was highly effective. ten topics. Results were displayed on a five point Likert- scale. Take-home messages: Use of virtual patients is a valuable learning tool, for both individual and collaborative learning Summary of results: Strengths: The online cases were in undergraduate medical education. well accepted by the participants. More than 85 percent rated this kind of learning/knowledge-transfer excellent or good. 90 percent would choose this method again. 7L 3 Student responses to a pilot web-based Weaknesses: The participants would have appreciated interactive system for medical students – more media, more proximity to clinical practice and more lessons for design and application options for interaction. Realisation: Based on many useful comments of test users all online cases were adapted and Hemal Thakore*, Tim McMahon and Peter Dervan (University College Dublin, Department of Pathology, Earlsfort Terrace, improved. Dublin 2, IRELAND) Conclusions: Case-based online-learning is suitable and Background: A model learning environment was created has potential for transferring medical knowledge. Linking that could be used by teachers to develop an e-based, online-cases to corresponding guidelines facilitates multi-layered, problem-solving scenario involving the complementary learning. How far online cases may serve investigation and analysis of a medical problem presented as efficient additional learning instruments is an important by a patient. question for further research. What was done: A virtual consultation programme was created within this template and it was piloted with a group 7L 5 The use of virtual patient simulation to of 200 2nd year Irish medical students. Student responses increase the availability of clinical teaching were gathered through a variety of qualitative and cases in Latin America quantitative methods and the data used to critically assess the perceived value to students of the e-tutorial. Mihaela Botezatu*1, Hernando Matiz1, Miguel Ruiz1, Nabil Zary2, Uno Fors2 (1Universidad El Bosque, TV 9 A Bis No 132- Conclusions: Medical students found the product to be a 55, Bogota, COLOMBIA; 2Karolinska Institutet, Stockholm, valuable educational tool due to its innovative interactive SWEDEN) approach. Assessment features and on-line availability were The Colombian School of Medicine, at the University el also highly rated, as was the future potential of the product. Bosque, Bogota, is faced with many of the problems any Take-home messages: The benefits of developing the faculty has when setting up clinical rotations for its tutorial are: Encouragement of independent and active students: lack of appropriate teaching cases for a particular learning; Assessment features that allow instantaneous instructional moment, absence of relevant pathology during feedback; A note-book that enables both reflection and short clinical rotations or unavailability of desired clinical process assessment; Promotion of greater use of University practice altogether. Considering new ways to broaden our Virtual Learning Environment; Availability to students on students´ clinical skills, in March 2005, in cooperation with demand: any time, any place, anywhere; Ideal for Karolinska Institutet, Sweden, we implemented in the development as a tool for continuous professional curricula the Web-SP software (Web Simulation of development. Patients), developed by the Department of Learning, Informatics, Management and Ethics, which allows the creation of virtual clinical cases. We started with tropical 7L 4 Online case-based learning diseases, using actual clinical records from the Military C C Schuerer-Maly*, H C Vollmar, N Koneczny, D Kempkens, Hospital in Bogota. Colombia is the first Spanish speaking M Koch, S Loescher and M Butzlaff (Universitaet Witten- country to use Web-SP and its introduction at our University Herdecke, Alfred-Herrhausen-Str.50, Witten D-58448, was successful, with high acceptance both by teachers GERMANY) and students (as expressed by surveys in this first Aim: Medical doctors face a flood of publications. The implementation phase). We believe the virtual simulation medical knowledge network evidence.de offers evidence- of patients to be a curricular design option not only because based online publications helping physicians to choose. of overall scarcity of real patients, but also because of Additionally to guidelines, evidence.de offers online case- motivation and engagement shown by creators and users, based learning as new knowledge transfer instrument for according to both KI´s extensive experience and our own. guideline implementation into clinical practice.

Short Communications 7M What is professionalism?

7M 1 How significant is Emotional Intelligence in correlations were found between some aspects of the the professional nature of undergraduate course, and negative correlations for others. Female medical students? students scored significantly higher than males for EI and Empathy, with a corresponding positive correlation for some Elizabeth Austin, Phillip Evans*, Katie O’Hanlon and Belinda components of the course. Positive Attitude and Magnus (University of Edinburgh, College of Medicine and Conscientiousness had a significant association with Veterinary Medicine, The Medical Teaching Organisation, Academic Achievement. Significant differences in Emotional Teviot Place, Edinburgh EH8 9AG, UK) Intelligence were found between students in Year 1 and Outcomes relating to the personal and professional aspects Year 5 suggesting that students become more detached of undergraduate medical education are a ‘core’ issue in from their emotions as they proceed through the course. the Edinburgh MBChB programme. Emotional Intelligence, These findings have important implications for curriculum Empathy and Personality traits for students in Year 1, 2 planning. and 5 were measured using standard tests. Positive

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7M 2 From vocation to profession – medical an integrated outcome-focussed “professionalism” students’ reflections on being a doctor programme throughout the course at the University of Sheffield, we sought to determine the medical students’ Eva E Johansson* and Katarina Hamberg (University of Umeå, understanding of the term professionalism. Institution of Public Health & Clinical Medicine, Family Medicine, Umeå 90187, SWEDEN) Summary of work: All students (n=1200), were asked for 5-6 words describing “professionalism” as part of an on- Being a physician is a stimulating challenge, today also line questionnaire. The data were mapped to the 14 described as stressful and exhausting. How do medical elements of Duties of a Doctor2 and the frequency of each students figure their future? In a qualitative analysis of word was noted. 104 2nd year medical students’ essays on professional motivation and career goals, we found that students Summary of results: 465 students responded (39%). Most expected doctors to be highly respected, hardworking students cited ‘honesty’, ‘respect’ and a ‘polite and authorities. They pondered how they would model their considerate manner’. They were least aware of ‘working own life – and were socialized – to fit in. They considered with colleagues’, ‘decision-making’ and ‘ethics’. Some the commitment of ‘doing good’ and ‘helping others’, but words, ‘abstract’,’ distant’, ‘important’ suggested a more hesitated upon a ‘vocation’ demanding too much personal formal, hierarchical impression of professionalism. There sacrifice. Belonging to a new generation they figured was some inconsistency e.g. communication, which is themselves different; “not as greedy” – not for work and emphasised in the programme but was ranked only glory, nor for money. Quality of life was depicted as moderately by the students. purposeful work and a rich, creative private life. The Conclusions: Students have a good understanding of many potential for change, in their views, relayed on women’s aspects of professionalism, however, there are areas of enlarging part of the workforce. discordance between the outcomes defined by the medical Men forecasted a new professional identity with highly school and the students’ understanding, suggesting interesting work but also time for leisure, hobbies, and modifications to the programme, particularly around family. Women more feared having to choose between teamworking and ethics. work or family commitment, and abstain from surgical 1. American Board of Internal Medicine (ABIM) / American specialities. They all hoped that a shortage of doctors would College of Physicians-American Society of Internal Medicine enable part-time duties. The engendered expectations of (ACP-ASIM) Medical Professionalism Project. (2003). http:/ next generation doctors ought to challenge medical /www.abimfoundation.org/professional.html, (accessed educators, planners, policymakers and administrators. 12.2.05). 2. General Medical Council (2001) Good Medical Practice. 7M 3 Identifying professional behaviour and London: General Medical Council values in medical doctors 3. Royal College of Physicians Canada CanMeds. Project Susan Miles* and Sam J Leinster (University of East Anglia, http://rcpsc.medical.org/canmeds/index.php (accessed School of Medicine, Health Policy & Practice, New Medical 15.3.05) Building, Norwich NR4 7TJ, UK) Aim: Medical schools are increasingly including training in various aspects of medical professionalism into their 7M 5 Ethics for teachers curricula. However, disparity in the literature as to what Talat Ahmed*, Tasleem Rasool, Habib Ahmed Qureshi, Salma constitutes professionalism, and the related professional Shah, Ahmed Yaqeen-ud-Din, Ali Yawar Alam and Sher Dil behaviours and values will impact on training and Khan (Shifa College of Medicine, Sector H-8/4, Islamabad, assessment of medical professionalism. The aim of this Pakistan) study was to identify the types of professional behaviour Summary of work: A comparative cross sectional survey that people believe medical doctors should exhibit, and was done to determine the perception of common qualities the underlying values driving these behaviours. of an ethical teacher among three groups (teachers, private Summary of work: The laddering technique, a one-to-one and public medical students), compare students’ perception interview method, was used to identify professional with teachers’ perception and compare perception of public behaviour and values. Three groups were interviewed: first medical college with that of private medical college by year undergraduate medical students on the UEA MB/BS formulating a proforma consisting of 31 carefully chosen course (n = 31), qualified and practising, Norwich-based statements encountered often in the teaching institutes, medical doctors (n = 30), and members of the local general in order to assess the response of the teachers and the public with a recent medical experience (n = 33). students as ‘ethical’ or ‘unethical’. Students and teachers of Shifa College of Medicine (private), and students of Summary of results: The results indicated differences in Rawalpindi Medical College (public) participated in this preferred professional behaviour between the three groups, study. About 319 subjects were picked by non probability particularly between the doctors and the general public. purposive technique. Sample size was calculated using Epi- In this presentation the behaviours identified and between- info 6.0. group differences will be discussed. Summary of results: There was a disagreement among Conclusions: These data will be used to assess attitudes teachers and students over ‘snubbing students on not to professional behaviour in medical students both at UEA answering a question in class’ (54%, 16% as ethical and at other medical schools. respectively. p 0.000), or on ‘coming late into a class’ (66%, 41%. p 0.02), ‘expelling students out of class for misbehaving’ (34%, 60%. p 0.01). Majority agreed as 7M 4 What we understand about professionalism: unethical, with no significant difference among groups, medical students’ views over ‘provoking a student to file a complaint against another Patsy Stark*, Chris Roberts and Catherine Gray (The teacher’ (88%), ‘making students believe that another University of Sheffield, Academic Unit of Medical Education, teacher is not a good teacher or evaluator’ (92%) and 1st Floor, Coleridge House, Northern General Hospital, ‘breaching the confidentiality of institute or department’ Herries Road, Sheffield S5 7AU, UK) (86%). About ‘taking the time of teaching for preaching Aim of the presentation: There is an international drive to ethics/religion/irrelevant stories/jokes’, there was a develop professionalism in medical students1,2,3. The significant difference (p 0.01) in opinion between the literature includes the rationale for teaching students of private (46%) and public (62%) medical professionalism, examples of teaching programmes and colleges who responded as ethical. assessment strategies. However, little is known about what students understand by “professionalism”. While there is

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Conclusions/take-home messages: Perhaps students in teacher has great influence over students. Students self-financed institutes take learning more seriously. It is observe and copy what their teacher does and his/her for the educators to realize that their most minor gestures role modeling can be a gateway to a student’s character or attitude during day-to-day interactions may lead to a building. profound and disturbing impression on their students. A

Short Communications 7N Understanding teaching and learning

7N 1 Relationship between personality traits and low (<0.66). Historical data throws doubt on reliability of cognitive style within Medical School KLSI to characterize students correctly. A volunteer changed learning styles ‘according to mood’. It is possible Paul F Wimmers, Marije van Mannekes* and Gerard J Baars that learning styles change according to mode of instruction (University Medical Centre Rotterdam, Erasmus MC, PO Box preceding the taking of the inventory. 1738, Rotterdam 3000 DR, NETHERLANDS) Conclusions and take home message: Learning styles as Objective: The question if cognitive style is based in judged by KLSI are not immutable. The construct validity personality traits or a product of the learning environment of learning styles however needs careful reexamination. is still a topic of debate. In this study, it is investigated whether differences in cognitive style and personality traits are related to study choice at the beginning of academic 7N 3 Medical students’ views of medical training. knowledge: a report from the Copenhagen Method: Vermunt’s Inventory of Learning Styles (ILS) that longitudinal study of medical students integrates four components of learning (i.e., processing learning and professional development strategies, regulation strategies, mental models of learning, and learning orientations) and Eysenck’s Five Factor Ingeborg Netterstrom*, Bettina Tjagvad, Knut Aspegren and Personality Inventory (FFPI) are administered among 127 Lars Kayser (Center for Educational Development in Health Sciences, PUCS, Teilum Dept. 5404, 9 Blegdamsvej, first-year students (45 health management and policy Kobenhavn 2100, DENMARK) students; 82 medical students). Aim of presentation: To describe how the students’ Results: Significant differences between the groups are establishment of a study strategy is connected, not only found in regulation strategies, mental models of learning, with their experience of the teaching, but also with the and learning orientations. In particular, health management way they envision medical knowledge. and policy students seem to be more test orientated and less focused on learning and vocation than medical Summary of work: A cohort of students is followed students. Several correlations are found between throughout medical school. Methods: Semi structured personality traits and cognitive style. For example, interviews and observations of teaching. This presentation elaborative processing has a positive relationship with is based on 19 interviews with students (approximately of FFPI’s intellect factor (r = .40, p <.001), and test 1 hour duration) conducted in their 3rd semester. orientation with FFPI’s consciousness (r = .25, p < .001). Summary of Results: In general the students see the study Conclusion: There are stable associations between of medicine as a huge lump of factual knowledge that components of learning and personality traits, although they literally have “to push into their heads”. They regard no significant differences in personality traits are found medical knowledge in terms of quantity and define it as between the groups. unambiguous. Their strategy is to find the most efficient way to transfer the knowledge into their mind. They refer to two ways of studying: memorizing and understanding. 7N 2 Changes in student learning styles a year But as a result of the way they envision medical knowledge after admission to the Aga Khan University they think their study strategy must be memorizing. Medical College Conclusions: In spite of a recent curriculum reform, the Jamsheer J Talati*, Veerta A Ujan, Rukhsana W Zuberi and students seem to adopt a surface approach to learning. Iqbal Azam (The Aga Khan University, PO Box 3500, Stadium Further investigation will focus upon how this view of Road, Karachi, PAKISTAN) medical knowledge will affect their perception of which Aim: To determine direction and intensity of changes in competences are important in their future profession. learning styles after a year of instruction in a Medical College. 7N 4 Developing a framework for the study of Summary of work: Prospective cohort study. Two entire relevant variables of feedback processes in classes were administered Kolb’s Learning Style Inventory clinical education (KLSI) at admission, and a year later. A volunteer took the KLSI repeatedly. Complete data available in: 51 and 58 Monica van de Ridder*, Karel Stokking and Olle ten Cate (University Medical Centre Utrecht, School of Medical Studies students in the two cohorts (60 and 69% of the class (Stratenum 0.304), PO Box 85060, Utrecht 3508 AB, strength). Raw scores and quantified learning preferences NETHERLANDS) were analysed by paired t test and repeated measures of ANOVA. Qualitative group and individual changes were Background: Although feedback in clinical education also noted. literature is acknowledged as important, not many studies are focused on the influence of feedback on learning. Summary of results: There was no difference in the learning Studying feedback processes in clinical education requires dimension scores of the two cohorts; or between those decomposition of the feedback process into its significant scores on admission and after one year, when analysed variables. for cohorts as groups. However, 43% and 55% of individuals in the two cohorts changed their scores by over What was done: To study quality and effect of feedback it 20% between year one and two. Individual preferences is necessary to have an overview of relevant variables that changed in 59% and 45% of individuals (of cohorts I and might influence the quality of provided feedback and the II). Reliability (Cronbach’s alpha, Spearman Brown) was effect caused by this feedback. A literature search has

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been conducted to answer the following questions: Which will be forgotten soon after graduation. However, few feedback models have been described in literature? Which studies have actually tested this belief. Therefore, we variables are considered relevant? constructed a test which measures factual knowledge of four basic science disciplines (anatomy, physiology, Results: A provisional sequential model is constructed. It biochemistry, and pathophysiology) and recruited consists of a chronological dimension and a dimension physicians who were willing to make this test. Seventy- where different parties - the recipient and the provider of five participants returned filled-in test forms; they were feedback - methodology and circumstances are portrayed. assigned to different groups, representing different The answers of the research questions are integrated in retention intervals: ranging from 0-7 years for the most the constructed model. recently graduated group to 50-55 years for the oldest Items for discussion: The two dimensions of the model group. The scores of 37 advanced medical students served will be explained. We will discuss the classified dependent as a baseline. The results showed a steady decline of and independent variables, the relationship between knowledge for all four basic science disciplines with variables and their impact on the process of feedback. increasing retention interval. However, expressed as a proportion of baseline knowledge, even after many years participants retained a substantial amount of basic science 7N 5 Very long-term retention of basic science knowledge, thus refuting the popular belief. In all groups, knowledge anatomy knowledge was better remembered than Eugène J F M Custers* and Olle Th. J. ten Cate (University knowledge of any of the other three domains. These results Medical Center Utrecht, UMC School of Medical Sciences, will be discussed in light of the problems inherent in this PO Box 85060, Stratenum, Room 0.304, Utrecht 3508 AB, type of research, such as a cross-sectional design, NETHERLANDS) differential rehearsal, and curricular developments. Popular belief in medical education holds that much, if not all, of basic science knowledge learned in medical school

Short Communications 7O General practice/family medicine 1

7O 1 Evaluating the effectiveness of a medical 7O 2 Developing training about dealing with educational intervention of Evidence-Based somatisation: using comments of simulated Medicine (EBM) on the knowledge, patients and residents to get it right attitudes, clinical behavior of Primary Care Evelyn van Weel-Baumgarten (University Medical Centre Physicians and patient outcomes in Israel: a Nijmegen, Department of Medical Education & General controlled trial and qualitative study Practice, PO Box 9101, KTC 224, Nijmegen 6500 HB, NETHERLANDS) S Reis*, E Berkovitz, D Netzer, S Linn, M Brezis, Y Hexelman and K Shuval (Technion Medical School, Department of Family Summary of presentation: In clinical practice doctors offer Medicine and Medical Education, The R & B Rappaport reassurance when no explanation is found for physical Faculty of Medicine, The Technion - Israel Institute of symptoms. But for somatising patients who keep looking Technology, PO Box 9649, Bat-Galim, Haifa 31096, ISRAEL) for a physical cause, reattribution is a better alternative. Aim of presentation: Describe a multifaceted educational Reattribution is difficult and was not trained during general EBM program in Israel targeted to change the behavior of practice residency. Recently a new training programme primary care physicians (PCPs). with simulated patients was developed, using comments of residents and simulated patients in the process. Summary of work: Primary care clinics comprising similar patient and physician characteristics were divided into two Summary of work: It is a one-day programme with groups. Clinics were then randomly assigned to the theoretical preparation followed by a skills training. In small experimental or control group. Study participants: 44 groups using simulated patients (trained in role and primary clinics of the Clalit Sick Fund from three regions feedback) third year residents practise aspects of in Israel; including 240 PCPs. reattribution in three follow-up consultations. A questionnaire with open and closed questions (5 point Main Outcomes Measured: The main outcomes examined scale) was used to collect opinions of residents and are drug prescription and test ordering performances, in simulated patients about the try-out training sessions. addition to patient hospitalization rates. Additional outcomes consist of the clinicians’ knowledge, skills, and Summary of results: The residents were positive about attitude towards EBM and the intervention. the practical part of the two try out sessions in May and October 2004 (4.2). The simulated patients were highly Evaluation: The intervention is evaluated by both appreciated for roles and feedback (4.7). The theoretical quantitative and qualitative approaches. Clinicians’ programme was considered too long (3.8). The simulated knowledge and skills in EBM will be assessed using two patients asked for a better tuning with the group- validated tools: an EBM questionnaire and evidence-based supervisors and suggested adding an explanation about practice skills test in a computer lab. Attitudes towards physical symptoms to the content. EBM and the intervention will be examined via questionnaire and focus-groups. Conclusions/take-home messages: A training programme using simulated patients on this subject seems feasible Summary of results: The intervention is due to end on during residency training. Feedback from participants as June 30th 2005; preliminary results will be available for well as simulated patients was helpful to adjust the reporting at the AMEE conference. programme, which will be implemented in the third year Conclusions/take-home messages: EBM training is rarely residency programme starting September 2005. evaluated. This is an attempt to systematically evaluate it in Primary Care.

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7O 3 The effectiveness of distance learning CME Work: Highlights of the 3 day visit: Presentation on for General Practitioners euthanasia by Dutch GPs; Visit to large GP run diagnostic laboratory; Tours of single handed, group and hospital Michou T Mastboom and Saskia S L Mol* (Dutch College of based practices; Presentations and discussion on vocational General Practitioners, PO Box 3231, Utrecht 3502 GE, training; Excursion to the Dutch National Centre for NETHERLANDS) Postgraduate GP training. Background: The Dutch College of General Practitioners Results: GP trainees in both countries completed a has published booklets for individual CME on 50 topics questionnaire (N=15) assessing the educational visits’ key during the past five years. Each booklet, in some thirty learning points. Areas of value expressed: Ethical, social pages, covers the content of a national guideline, e.g. and political debate; Cultural understanding; Comparison cardiovascular risk management, vaginal discharge, of work environments and ethos; Team bonding; redness of the eye. It consists of exercises, knowledge Presentation skills; Vocational training development. We tests and reflection on the topic, and includes a worksheet will present these finding in more depth at the conference. which is returned to the National College, upon which accreditation follows. A quarter of the Dutch GPs have a Conclusions: Overseas educational trips have many subscription, which indicates that it is a successful product. benefits and European GP registrars should have the But is it effective in terms of changing one’s behaviour? opportunity to be involved in one during their training. They boost lateral thinking, develop key skills and overall Method: To study this a questionnaire was sent to the 230 help a registrar gain a better insight into what being a subscribers who had returned the work sheet on redness family doctor in Europe today really involves. of the eye. Topics were: satisfaction, what they had learned and whether it brought about any changes in behaviour. Results: The response was 70%. Ninety-five percent of 7O 5 Developing a national selection process for the respondents reported that they enjoyed working on general practice training the booklets for individual CME. Regarding the booklet Simon Plint*, Fiona Patterson and Pat Lane on behalf of the “Redness of the eye” 68% cited one or two items that GP National Recruitment Steering Group (Oxford PGMDE, they had learned and remembered, and half of the The Triangle, Roosevelt Drive, Oxford OX3 7XP, UK) respondents reported that they had actually changed their behaviour regarding these items. The behaviour changes UK Directors of Postgraduate General Practice Education were small and specific. have been given responsibility for the development of a national selection system for GP vocational training. Conclusions: The booklets for individual CME are effective Analysis of 3500 multiple applications held on the national in changing behaviour on small and specific items, but database in 2003, shows astonishing lack of reliability seem less effective in developing and working out new between Deaneries of selection outcome for the same ideas. Further study is indicated on the effectiveness of candidate. Underlying reasons include lack of common the online individual CME format, which is now being person specification and different selection methods. developed. Research is described identifying a Competency Model for General Practice based on job analysis, and its further 7O 4 Overseas educational visits for trainee validation by GP trainer national questionnaire. A General Practitioners (GPs)? competency based assessment process has been developed which has been shown to correlate with Kay Brennan*, Hannah Watson and Em Buttman (Airedale subsequent job performance. The competency model has Vocational Training Scheme for General Practice, 8 Parkland been adopted as the National Person Specification for GP Avenue, Carlisle, CA1 3GN, UK) recruitment, and further research is being undertaken each Aim: 15 English GP Registrars and trainers visited a group selection round to develop the most effective and predictive of Dutch GP Registrars and trainers in 2004 to compare selection methods, together with a national training and contrast the way family doctors live, work and train in programme for selectors. The deadline for adoption of a a European neighbour. We show how much value standardised and reliable national selection system is educational trips overseas can provide to trainee GPs from August 2007, with the reorganisation of General Practice both countries involved. vocational training as part of Modernising Medical Careers.

Workshops 7R, 7S, 7T & 7U

7R Tobacco Treatment Education: strategic whole group for discussion and feedback. During the final planning for successful curricula section, panelists will discuss the approaches to tobacco cessation curricula at their institutions, including the John F. Mahoney (University of Pittsburgh School of Medicine, planning process and examples of specific innovations with M-211 Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261, an emphasis on the generalizability of the approach used. USA), Frank T. Leone (Jefferson Medical College, Philadelphia, USA) and Maurice S. Clifton (University of Objectives: Participants will be able to appraise and select Pittsburgh, USA) curricular approaches for teaching about a behavioral Background: Much of medical school focuses on diagnosis counseling technique such as tobacco cessation that would and management of disease, yet most morbidity and be successful in their own institutions. mortality results from health risk behaviors. Teaching Who should attend: Attendees should have an interest in students how to counsel their patients to make behavioral or be in a position to implement behavioral interventions changes has great potential to impact their patients lives. in a health science curriculum. Tobacco cessation will be used as a model for teaching students how to perform behavioral interventions. Level of workshop: Because of the interactive nature of the presentation, all levels of attendees will benefit. Structure of workshop: After a brief introduction, participants will create five learning objectives and an approach to assessing each, within a behavioral counseling curriculum. Next, participants will present these to the

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7S A framework for analyzing the quality of Speakers: multiple-choice items 1. Hans Jacob Westbye (Norway, IFMSA SCOME Director 2003-2004) André F De Champlain1, John R Boulet2 and Marta van Zanten2 (1National Board of Medical Examiners, 3750 Market Street, 2. Elsmarieke van der Giessen (Chair of the Dutch medical Philadelphia PA 10104, USA) and 2Educational Commission student organization LMSO) for Foreign Medical Graduates, Philadelphia, USA) 3. Mrs. Dr. J.A.A.M. van Diemen (Educational Director Background to the topic: The purpose of this workshop is VUMC in Amsterdam) to provide participants with an overview of routine analyses 4. Katja Kovac (Slovenia, IFMSA SCOME director 2004- undertaken to judge the quality of multiple-choice 2005) examination items. Emphasis will be placed on the practical 5. Torstein S. Hansen (President of the Norwegian Medical application of these methods as well as interpretation of Student Association) findings using several data sets. Workshop convener: Paul de Roos (Chair of the VUMC Workshop content and structure: The first part of the board of students 2004-2005) workshop will focus on the use of item-level statistics for Who should attend: Students, teachers, management. assessing the difficulty, discrimination and “misinformation” of items. The second part of the workshop will be devoted to the interpretation of tabular displays of multiple-choice 7U The role of needs assessments in designing item information. Finally, the workshop will close with an teacher training programmes for medical outline of the reliability coefficient and standard errors of residents measurement as useful tools to gauge the precision with which scores are estimated. Jamiu O Busari and Bart H M Wolf (Department of Paediatrics, St Lucas Andreas Hospital, Jan Tooropstraat 164, Amsterdam, Intended outcomes: Participants attending this workshop NETHERLANDS) will gain a solid grasp of not only the indices themselves but importantly, an understanding of how to interpret them Background: Presently, medical residents are prominently with actual examinations at their home institutions. involved in the education of medical students and peers in many medical institutions. The evidence in the literature Intended audience: Medical educators who routinely shows, that the medical educational process benefits from involved in the development and scoring of multiple-choice the teaching medical residents provide and that teacher- examinations. training courses are effective in improving their teaching Level of workshop: Though it would be useful to have a skills. An often-encountered problem is how to effectively grasp of basic statistics, this is not compulsory. design, implement and evaluate such programs. Consequently, this should be viewed as a “beginners’” level Educational needs assessment is an educational strategy workshop. that has been found to be effective and useful for this process.

7T Student involvement in quality Workshop content and structure: (1) Introduction; (2) Brainstorming in group; (3) Feedback from exercise; (4) improvement of medical education Conclusions. The workshop consists of 4 groups - each P D G de Roos, M Al Dulaimy and S J van Luijk (VUMC, group consists of a chairman and a speaker. A different Amsterdam, Netherlands) task is assigned to each group: Group 1: Identify educational needs; Group 2: design intervention; Group Objectives: (1) To get familiar with student involvement 3: Implement intervention; Group 4: Evaluate effect of in the improvement of medical education in faculties in intervention. Participants choose a topic to work on for different countries; (2) Learn about student involvement the exercise, and the interaction is active. from perspectives of different student organizations as well as the faculty management; (3) Get familiar with the roles Intended outcomes: (1) Participants understand the that different student organizations could play in your relevance of “needs assessment” in designing educational faculty; (4) Exchange knowledge and discuss a vision of interventions; (2) Participants get a sense of the important student involvement in the future when it comes to quality elements required in developing educational interventions; improvement of medical education; (5) Learn different (3) Participants are provided with an insight of the potential strategies to advocate student involvement in your own pitfalls associated with designing and implementing faculty; (6) Learn about research done after student educational interventions. involvement. Intended audience: Medical residents, Clinical teachers, Method: After a short introduction, 5 different speakers Educationalists and Curriculum planners. will speak about their experiences and their vision on Level of workshop: intermediate (some knowledge/ student involvement in quality improvement of current experience desirable) medical education. Each speaker will have an 8 minutes presentation, followed by 2 minutes for questions. There will be a 25 minutes discussion with the speakers and the audience following the presentations.

Posters 7 Onyx 1 Curriculum planning

7 Onyx 1.1 Like many other faculties of medicine all over the Europe, Our experiences with new teaching we have changed the curriculum of our Faculty to cope methodology with explosion of scientific knowledge and modern technology and to better prepare medical doctors for the T Jovanovic*, D Micic, V Bumbasirevic, V Bosnjak-Petrovic, new health needs and expectations of society. The main N Lalic, P Pesko and B Djuricic (University of Belgrade, School changes included preferential orientation to professional of Medicine, Dr Subotica 8, Belgrade 11000, SERBIA AND instead of academic education with early contact of MONTENEGRO) students with patients from the first year of study. The changes of teaching methodology comprise predominant

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participation of practical lessons and interactive seminars first time. The total of 900 hours of education yearly vs. lectures within the small discussion groups to promote encompasses 10% of elective courses. A lot of options active participation of the students in the learning process will be offered to students according to their interests. and enhance students’ skills. Electronic teaching classes Detailed results of the study will be presented at the and computer assisted learning assist active student conference. learning and provide the basis for life long learning. Evaluation is continuous, based on observed participation, effort put into courses and the level of understanding of 7 Onyx 1.4 knowledge and skills, tested several times during the school Does changing the duration of medical year. We have measured the input and outcome of all undergraduate training from 6 to 5 years teaching activity and the results will be considered in the impact on preparedness for internship? final exam. E N Kwizera*, E L Mazwai and A B Nganwa-Bagumah (University of Transkei, Department of Pharmacology, Faculty 7 Onyx 1.2 of Health Sciences, P Bag X1, Unitra, Umtata 5117, SOUTH AFRICA) Faculty of Nursing: module profiles in accordance with European nursing education Background: The University of Transkei (UNITRA) medical school was established in 1985 to address the shortage of M Visnjic*, D Pavlovic, G Kocic and A Visnjic (Faculty of black doctors in South Africa. In 1992, the curriculum was Medicine Nis, Bul. Dr Zorana Djindjica 81, Nis 18000, SERBIA changed from ‘traditional’ to ‘problem-based’ and & MONTENEGRO) ‘community-based’; and in response to changes in Serious reform in medical education, proposed through government policy on the length of the pre-registration the Bologna Declaration, has established the prototype of period, the duration of undergraduate training was changed European medical education: a university medical school, from 6 to 5 years in 2000. Students completing in 2004 subject to quality control systems regarding student were a mixture of 6th years (admitted in 1999) and 5th admission, teaching personnel selection and evaluation of years (admitted in 2000). We thus had the once-off the teaching programmes. The Nursing Program is being opportunity to compare the preparedness for internship transformed into a three year university-based educational of students from the 6-year with those from the 5-year programme according to the established standards of curriculum. European nursing education and local needs. The Nis Summary of work: In October 2004, at the end of their University Faculty of Medicine has a 50-year long tradition final year, 5th and 6th year medical students were in educating medical doctors and dentists with a large administered an adapted Association of American Medical number of master and doctoral degree holders. It now Colleges Graduate Questionnaire. Resultant data was prepares graduates for employment as Graduated Medical captured on to a database and comparatively analysed. Nurses. The courses are designed to provide a comprehensive, integrated introduction to professional Summary of results: Despite a few differences in the skills with the use of new technologies. There are eight students’ perceptions of their training, both sets of finalists basic courses in the first year, reinforcing the importance were equally prepared for internship; and their confidence of basic mechanisms required for an appreciation of clinical relating to this preparedness was equal or greater than disease aspects as well as of its prevention and treatment. that of their American counterparts. The second year is aimed at increasing the students’ Conclusions/take-home messages: We conclude that the practice of medicine. The new curriculum integrates third change in the duration of medical undergraduate training year of study into seven learning modules (Intensive Care had no negative impact on graduate preparedness for Units, Surgery, Pediatrics, Gynecology, Neurology, internship. Anesthesiology, Rehabilitation), in order to offer the chance for competence development in corresponding nursing practice. 7 Onyx 1.5 Faculty members’ opinions toward 7 Onyx 1.3 designing of lesson plans in Ahvaz Joundi- New medical curriculum at the faculty of Shapour University of Medical Sciences medicine, University of Novi Sad B Dashtbozorgi*, A Shakurnia, M Motlagh, M Fakoor (Ahvaz Joundi-Shapour University of Medical Sciences, Educational S Popovias, M Simiae, N Seèen*, Dj Pova•an, A Milièiae and Affair Central Office, Golestan Avenue, Ahvaz, IRAN) D Klajiae (Faculty of Medicine Novi Sad, Bramimira Cosica 42, Novi Sad 21000, SERBIA AND MONTENEGRO) Background: Planned teaching is one of the accepted principles of modern instruction. Lesson planning is a Background: Curricular changes in medical education at method which helps the teacher to ensure that he or she our Faculty have been made in accordance with the is meeting educational goals. The purpose of this study is curricula of relevant institutions worldwide. Faculty of determining faculty members’ opinions about lesson Medicine Novi Sad is going to put into practice a new planning. curriculum with the new evaluation and accreditation system for the new school year 2005/06. Summary of work: In this descriptive study of non-clinical faculty members, the data collection tool was a self- Summary of work: Structuring the new medical curriculum administered questionnaire that includes 16 closed schemes results from the fact that studies were prolonged questions. The return rate was 70% and the data were (average time of study being about 8 years). Remodeling analyzed by SPSS. of the existing medical curriculum is aimed at restructuring preclinical subjects and giving advantage to medical Summary of results: Most of the faculty members practice. Introductory clinical courses are put in the first emphasised the importance of lesson planning (81.3%). school year. The courses are modulated as follows: normal They believed that lesson planning helps the teacher in morphology subjects are in the first year, as well as the the instruction process. More than 50% of faculty members general education subjects; the normal function subjects are satisfied with their implementation of a lesson plan are in the second year; the pathological function and (52.1%). 34% of faculty members indicated that the lesson morphology subjects are in the third year. The majority of plan was not appropriate with the instructional system clinical subjects are taught until the sixth year of study. that exists in medical university of Ahvaz. Most faculty One-semester courses make up around 64% of the members designed their own lesson plan (94.8%). They teaching process. The other courses last two semesters. stated they need help from EDC in designing a lesson The new subjects, such as geriatrics, care of terminal plan (44.8%). patients and emergency medicine are introduced for the

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Conclusions: Although faculty members’ attitudes about curricula of North Korea, the rationale for reunification, lesson planning are positive, more rigour must be applied the future of Korea after reunification and the possibility in their design and implementation. for meeting with doctors from North Korea. In terms of course type, an elective course (57.3%) was more favored than a required course (4.7%). Based on this finding, the 7 Onyx 1.6 school authority permitted planning to be undertaken for Education state of Iranian undergraduate a new elective course on this topic. The contents of the nursing students about disaster: viewpoints proposed course will be presented. of students and their teachers Seyed Reza Mazloum* and Maryam Azizi (Mashhad University 7 Onyx 1.8 of Medical Sciences, Nursing Faculty, Ibn Sina Street, Daneshgah Street, Mashhad, IRAN) The integration of dental medicine in family medicine curriculum: The Buddhachinaraj Introduction: The occurrence of disasters and the number Hospital School of Medicine, Naraesuan of casualties have increased during the past 10 years. Nurses have a key role in the health care team in disasters, University model so we decided to assess the educational status of Iranian Wallop Jansawang* and Yongyos Jariya (Buddhachinaraj undergraduate nursing students to deal with this. Hospital, School of Medicine, Medical Education Center, Naraesuan University, 90 Srithamatripidok Road, Muang, Method: A 41 items questionnaire was used to evaluate Pitsanulok 65000, THAILAND) educational level, learning level and level of readiness for disasters of 135 undergraduate nursing students in the Background: At present, the content of medical education final year of their course and 45 nursing teachers in Iran for medical students does not seem to prepare adequately Universities. in dental medicine. In a major initiative, Buddhachinaraj Hospital has launched Dental Medicine, a course as part Results: Average score of 68.6% of students about of the Family Medicine curriculum designed for 4th year disasters was 15-17.5 (scale 1-20). Students scored the medical students. average of their self educational level 37.4±14.9%; and learning level 39.5±31.9%. Nursing teachers evaluated What was done: The pilot course which contains 3 major the educational level 21.1±7.7% and its necessity topics: Background knowledge of dentistry, Child oral 94.6±6%. Students estimated their self level of readiness health care and Adult oral health care with specific oral in disasters 50.3±22.4% in scientific aspect, 48.1±26.5% problems, is expressed through General Instructional in practical aspect, and 57.3±29.9% in emotional aspect. Objectives that are essentially board statements of Nursing teachers stated that scientific readiness of students competencies to be acquired. These are defined according is 28.6±12.1%, their practical readiness is 34.3±15.1%, to Required Abilities and Skills. There abilities and skills and the emotional readiness is 41.4±26.7%. Male students are examples of behaviours which indicate the objective evaluated their practical and emotional readiness more has been achieved. There will be 8 hours of literature and than female students (p<0.01). 80% of students believed one-week clinical attachment in dental clinic. that theoretical education, and 88.6% believed that Conclusions: The challenge this presents is successful when practical education about disaster isn’t enough. Multiple evaluated by competency examination. Improvements can regression coefficient test for assessing the related factors be made throughout medical education to provide the with level of readiness of students showed that learning knowledge and skills to provide families competently with level in faculty classes, participation in extracurricular oral health guidance, prevention, and possible therapeutic classes of disasters, and also attending the scene of treatments. disasters have a significant and positive correlation with level of students’ readiness. Take-Home messages: A process of change thus will require further research in the future to achieve a definite Conclusions/take-home messages: It seems necessary to commitment to improve medical education. revise the undergraduate nursing curriculum and to add practical courses and adopt efficient teaching methods. 7 Onyx 1.9 7 Onyx 1.7 Development of a new profession and new professional educational program: the Incorporating social issues into medical education – the case for developing a physician assistant in the Netherlands medical educational course in South Korea G van den Brink, R S G Holdrinet and K Harbert (Arnhem Nijmegen University, Verlengde Groenestraat 75, Nijmegen about North Korea and unification 6525 EJ, NETHERLANDS) WooTaek Jeon*, Hyun-chul Kim, Chong-chan Lee and Sun Kim Aim of presentation: Discussion of the design and (Yonsei Medical School, Department of Medical Education, School of Medicine, Yonsei University, CPO Box 8044, Seoul, development of a new professional graduate educational REPUBLIC OF KOREA) program for Physician Assistants in the Netherlands. The Arnhem-Nijmegen University of Professional Education Background: It is not easy to incorporate the current social (HAN) developed this new professional graduate education issues into medical education contents because of the program after assessing the need for extending the services tightness and rigidity of the medical education curriculum of the University Medical Center physicians. and the lack of appreciation of students and professors that medicine is a synthetic science which is linked to the Summary of work: This program was developed based on social sciences. Nevertheless, the effective and sensitive social needs, continuous discussions with providers and incorporation of important social issues into medical educational platforms already in place in the United States. education will have significant meaning for the overall scope The design and development of the program, assessments, of medical education. Despite being the most important curriculum and current outcomes will be discussed. social issue in South Korea since 1945, no regular medical Summary of results: The didactic and clinical curriculum school education course has dealt with the issue of North combines service learning with a concentrated medical Korea and reunification. The preparatory survey presented education model. Concepts focused on establishing core here was therefore performed to develop such a course. competencies and outcomes vital for defining the future Summary of work: 150 medical students of one medical of Physician Assistant in the Netherlands. school in Seoul, South Korea were randomly sampled from Conclusions/Take-home message: This new health care 483 to answer the survey questionnaire. 21.1% wanted profession in the Netherlands was developed focusing on to take a related course. They expressed their interest in increasing access to health care delivery and reducing the topics of the medical system and medical school

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physician workload. The HAN developed an effective, will be the “bright shining stars” of its first graduating efficient program grounded in the best practice model of class and their acceptance as providers of quality health credibility, reliability, and sustainability. The final outcome care by physicians and patients.

Posters 7 Onyx 2 Self assessment and formative assessment

7 Onyx 2.1 Envisaged Results: It is envisaged that students will How students on rotations think about their overestimate their competencies for individual procedures pharmacotherapeutic abilities and how they and examinations when compared with OSCE results. These results will provide an essential and valuable revision really do in practice tool for students due to the use of component groupings. E A Dubois*, K L Franson, J H Bolk and A F Cohen (Leiden University Medical Centre, Onderwijscentrum divisie 2, C5- Q, PO Box 9600, Leiden 2300 RC, NETHERLANDS) 7 Onyx 2.3 Background: Due to curricular changes at Leiden University Self-assessment of performance: a Medical School, students received little pharmacology perspective from medical students teaching in the preclinical years. During the clerkships Annie Murray (University of Adelaide, Medical Education Unit, students receive structured pharmacotherapy teaching. Do South Australia 5153, AUSTRALIA) their pharmacotherapeutic abilities improve during the Background: Medical students graduate into a profession clerkships? guided by principles of life-long, self-directed learning. Self- Methods: 57 students filled in a questionnaire before and directed learning involves the process of assessing oneself. after their internal medicine clerkship and rated their According to the literature, there is no good evidence that confidence in pharmacotherapeutic abilities. These ratings medical students can accurately self-assess. The majority were compared to an evaluation of their therapy plans of these studies have also used a quantitative approach. submitted at the end of the preclinical years and after However, what do medical students understand the their internal medicine clerkship. meaning of ‘self-assessment’ to be and does this impact Results: The percentage of students feeling confident about on their ability to self-assess? their pharmacotherapeutic abilities had increased after the Objectives: This is a qualitative study and explores the clerkship: describe pharmacological mechanisms - 16% meaning of self-assessment from the perspective of medical before, 61% after; analyse the indications for drugs - 53% students in an undergraduate problem-based learning before, 81% after; choose rational therapy - 9% before, course. 70% after; monitor therapy - 26% before, 84% after. What was done? The study commenced in July 2004 and Students’ score on the therapy plan slightly increases from consists of three parts. Part one involved 6 focus groups an average of 14 points (of 32) on the pre-clerkship therapy with second and fourth year Medical Students. The insights plans to 18 points on plans during the clerkship. drawn devised the interview themes for the second, and Conclusions: Students’ confidence in pharmacotherapeutic main part of the study. This involved interviews with abilities is improved after clinical rotations. However, their students in second, fourth and sixth year (n=48). The ability to write a therapy plan is still insufficient. This third part was field observations in the teaching hospital discrepancy between perception and competency may be with final year students undertaking their trainee a case of “you don’t know what you don’t know”. internships. Conclusions/Take-home message: I will report on the 7 Onyx 2.2 analyses to date of the student interviews. Preliminary Are student self assessments good results show complex and varied interpretations of self- predictors of achievement within Objective assessment. This has implications for progression in a self- directed, problem-based learning medical course. Structured Clinical Examinations? A J Smith (University of Liverpool, Clinical Skills Resource Centre, 2nd Floor, E Block, The Infirmary, 79 Pembroke Place, 7 Onyx 2.4 Liverpool L69 3GF, UK) Facing uncertainty: medical and dental Aim: It is the aim of this proposed study to determine students’ perceptions and performance in whether student self assessments completed in Clinical self-assessing a formative examination in a Skills Drop In Sessions can be used as an accurate predictor problem-based curriculum of performance within OSCEs and therefore a specific aid G Maudsley and P Dangerfield* (University of Liverpool, to revision. Department of Public Health, Whelan Building, Quadrangle, Methods: Students attending Drop In Sessions complete Liverpool L69 3GB, UK) a self assessment proforma for the skills they choose to Background: Students use self-assessment skill to identify practice in the week prior to undertaking their OSCE. The learning needs and progress in problem-based learning study will limit itself to 2nd, 3rd and 4th year medical (PBL). Research about this skill uses various reference students and also to practical procedures and measures. examinations. The self assessment proforma will require students to determine their ability to complete specific Aim: To explore medical students’ perceptions about self- component groupings in respect of procedures and assessing a formative written examination and accuracy examinations. These component groupings will be a of students estimating a related mark reflection of objective assessment mark sheets used within What was done: Participants comprised Year 1 medical OSCEs in respect to preparation, demonstration and closure and dental students (Liverpool problem-based curriculum, of each skill. 2004/05), self-assessing formative open-ended questions These sheets will be scanned by OCR and direct comparison that sampled three of four core themes (population made to OSCE results to determine whether they are good perspective, behavioural science, professional predictors to performance. development). Evaluating self-assessment included: (1)

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Likert scoring: perceptions of utility and timing; whether students of all years) didn’t. 4 from the 25 teachers used they thought they would pass and whether these themes formative assessment. appeared problematic (pre-/ post-exercise); (2) Comments Summary of results: 94% of the students from group 1 on process: analysed inductively; (3) Comparing self- find formative tests useful. In group 2 only 46% would estimated mark on extended-matching items (not self- find it useful. Moreover, all the students find a formative assessed) with actual score test more useful when it is similar to the final exam. The Results: 276/279 (98.9%) medical students, 26/32 majority of the teachers find formative assessment not (81.3%) graduate-entry and 42/63 (66.7%) dental really useful. students collected and completed the form. Generally, they Take-home messages: Give the students a possibility to were positive about the exercise, specifically about what participate in a formative evaluation and they will to expect of examinations, and expectations of their experience the usefulness! learning (breadth; depth), but some found facing uncertainty uncomfortable. Self-estimated marks were revealing. 7 Onyx 2.7 Conclusion/take-home: Implementing meaningful self- Can rubric scoring be used as formative assessment well for so many students is challenging, but assessment? Student opinion, Naresuan achievable. University, Thailand, 2005 N Suchat (Buddhachinaraj Hospital, 305/16 Pichaisongkram 7 Onyx 2.5 Road, T.naimuang, A.muang, Phitsanulok 65000, THAILAND) Analysis of evaluations by examiners and Aims: A rubric describes levels of performance for a student self-evaluations in OSCE particular complex performance task and guides the scoring of that task consistent with relevant performance Takato Ueno*, Ryuichiro Sakata, Tetsuhara Oriishi, Michio standards. Formative assessment is used to aid learning. Sata and Ichiro Yoshida (Kurume University, School of Medicine, Research Center for Innovative Cancer Therapy, 67 In an educational setting, formative assessment might be Asahi-Machi, Kurume 830-0011, JAPAN) a teacher (or peer) providing feedback on a student’s work, and would not necessarily be used for grading purposes. Summary of work: The Japanese Ministry of Education, Science and Sport has introduced competency tests Summary of work: In January 2005, questionnaires were including Objective Structured Clinical Examinations (OSCE) sent to 62 medical students (year 5th) Naresuan University and Computer-based Testing (CBT) for use nationwide in and Buddhachinaraj Hospital Medical School learning the preclinical evaluation of medical students, and these community medicine course for 3 weeks at community tests were performed from 2001 to 2005. At the Kurume hospital in Phitsanulok, Thailand. The question was “Do University School of Medicine, OSCE were administered to you agree that assessment by using rubric scoring every 4th year medical students this year (2005) using 7 stations, week can be used as formative assessment?” consisting of patient interviews, physical examinations of Summary of Results: Return answers were male 31(50%), the head and neck, chest and heart sounds, abdomen, female 31(50%). Age 21-26 (age 21=1.6%, 22=25.8%, neurological system, basic surgical treatment and 23=59.7%, 24=6.5%, 25=4.8%, 26=1.6%). Strongly emergency treatment using problems specified by the agree 4(6.5%), agree 39(62.9%), disagree 13(21.0%), Ministry of Education, Science and Sport. The students strongly disagree 4(6.5%), not answer 2(3.2%) were evaluated by two examiners and also carried out th self-evaluations for each of these stations. We statistically Conclusions: 70% of 5 year medical students at Naresuan analyzed the correlation between the evaluations by the University and Buudhachinaraj Hospital Medical School examiners and the student self-evaluations. Summary of agree that weekly assessment by using rubric scoring can results: Results showed significantly positive correlations be used as formative assessment. in the relationship between the evaluations made by the examiners and student self-evaluations at each station, 7 Onyx 2.8 except for physical examinations of the neurological system. Formative assessment of student nurses’ clinical skills using simulated patients Conclusions: These results suggested that the evaluations by the OSCE examiners and the student self-evaluations Jane Coupe* and Jane Fisher (University of Bradford, Nursing were in substantial agreement, and that both parties were Division School of Healthcare Studies, School of Health, Unity Building, Trinity Road, Bradford BD5 0BB, UK) able to carry out their evaluations coolly, objectively and accurately. The recent publication and implementation of the Making a Difference (MAD) curriculum (DOH 1999) has sought to re-focus the emphasis of clinical skills development within 7 Onyx 2.6 pre registration nurse education. In order to assess student Formative assessment: experience the nurses’ skills acquisition at the end of year one, simulated usefulness by doing it! scenarios were set up for the students to work through in groups of 3-4. Students rotated the role of nurse, patient Marta Witkowska* and Elke Struyf (Catholic University of and examiner and peer assessed each other. The students Leuven, Faculty of Medicine, Centre of Medical Education, Minderbroedersstraat 17, Leuven 3000, BELGIUM) evaluated this arrangement positively but suggested that the use of real patients may enhance the experience. In Background: Evidence shows that high quality formative spring of this year a similar peer assessment exercise was assessment has a powerful positive impact on students’ facilitated using simulated patients. This paper will discuss learning. First year students at the Faculty of Medicine of firstly, students’ reactions to the exercise generally. It will the K.U.Leuven get the opportunity to participate in also focus on their reactions to using simulated patients formative assessment. We examined the students’ and the as the assessment tool and will include the simulated teachers’ point of view concerning this evaluation. patients’ feedback on the general performance of the Summary of work: We carried out semi-structured students. Some anecdotal evidence has suggested that interviews with 100 undergraduate students and 25 nurses are not competent in some clinical skills therefore teachers. All interviews were recorded and analysed an outcome of this exercise may lead to more formal according to the qualitative research methodology. Group assessment of clinical skills perhaps in the form of objective 1 of the students (31 first year students) had a possibility to participate in a formative assessment (computer-based multiple choice questions with feedback) and group 2 (69

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Posters 7 Topaz 1 Outcome based education

7 Topaz 1.1 7 Topaz 1.3 Applying Bloom’s Taxonomy to educational Appreciation of specialty training by Dutch objectives for professional behaviour. A paediatric residents case report M F Raphaël*, G C B Bindels-de Heus, M F Schreuder, F C M Heiderose Ortwein*, Claudia Kiessling and Sebastian Schubert Noom, S J van Luijk and J A A M van Diemen-Steenvoorde (Charité Medical School, Abteilung fuer Anaethesie und (Van Walbeeckstraat 58 1 hoog, Amsterdam 1058 CV, operative Intensivmedizin, Campus Mitte, Schumannstr. 20- NETHERLANDS) 21, Berlin 10117, GERMANY) Background: A modernisation of the Dutch educational Background: Bloom’s Taxonomy is widely recommended program for paediatrics will lead to the introduction of the in the medical education literature to define and analyse CanMEDS 2000 model. Evaluation of the current program educational objectives. This is stated to be a prerequisite could identify specific aspects appreciated or disapproved for developing a test blueprint. However, experience with by residents. its application has rarely been published. The authors Methods: Final-year paediatric residents were asked to report the use of Bloom’s Taxonomy to classify educational return a questionnaire concerning the educational program objectives for testing professional behaviour. before implementing CanMEDS 2000. Summary of work: Three researchers assigned the first Summary of results: In total 55 questionnaires (response 22 objectives (out of 104) independently to the six levels rate 73%) were returned. Residents rewarded their of the cognitive and the five levels of the affective domain. specialty training with a mean score of 7.2 (range 4.8-9) Unfortunately, the agreement was low. It was easier to on a 0-10 scale. Non-academic teaching hospitals were agree on the domain than on the levels. Subsequent better rewarded than academic hospitals, 7.6 versus 6.5 discussion revealed different interpretations of levels’ (p<0.001). Though most respondents (63%) found meaning. Even after a consensus agreement, many themselves fully responsible for the final result of their objectives were assigned to both domains at various levels. training, only 30% of the residents set up a personal Conclusion: To reach a distinct assignment of objectives training plan with specific goals. Most residents (77%) to domains and levels, objectives must be very detailed perceived themselves as capable medical experts. The and narrow. In consequence, the 104 objectives need to teaching program was considered to be of good quality, expand up to approximately 300 objectives or objectives but feedback on and coaching in daily clinical skills was must be categorised using a different tool. Nevertheless, hardly ever received. using Blooms taxonomy was a useful tool to clarify and Conclusions: Dutch paediatric residents are generally modify the educational objectives. satisfied with their educational program, even though feedback and coaching are lacking. Although residents find 7 Topaz 1.2 themselves highly responsible for their own education, they hardly take any responsibilities in it. From learning objectives to competencies W Georg, W Burger*, C Kiessling and D Scheffner (Humboldt University of Berlin, Arbeitgruppe Reformstudiengang Medizin, 7 Topaz 1.4 Charité, Schumannstr. 20/21, Berlin 10117, GERMANY) Teaching principles instead of facts Background: Since 1999 a problem-based, integrated Ute Tautenhahn*, Peter Kube and Joerg Pelz (Charité, curriculum, organized in blocks runs as parallel track at Prodekanat Studium und Lehre, Schumannstr. 20/21, Berlin the Charité Universitätsmedizin Berlin. For the new program 10117, GERMANY) goals and preliminary objectives were defined, which was Background: Medicine is a knowledge based enterprise. rather uncommon in German Medical Schools at this time. The rate of change in medical knowledge has accelerated Despite the overall goals, for the curriculum the final steadily. The doubling time of the biomedical knowledge definition of learning objectives for the respective blocks base is about 19 years currently. Traditional teaching was governed by specialties contributing to the theme. responded to this “information crisis” by trying to extend Over the years we realized that in spite of widespread the amount of information to be learned. Time available interdisciplinary discussions the objectives were rather in a curriculum sets a natural limit to this palliative. Medical randomly assembled and the relation to the general knowledge is increasing at a rate many times faster than educational was weakened. This was critically discussed formal courses can disseminate it. There are too many amongst student and teachers and changes had to come facts. about. Summary of work: Personal interviews with experts in Summary of work: A curriculum committee was different fields of basic sciences were conducted, asking implemented to evaluate the present curriculum. After for the principles of their disciplines that were thought to detailed discussion it was decided to further build on a be essential. Principles were pragmatically defined as high competency based curriculum. Next steps were the level statements of the fundamentals of a discipline that definition of nine domains of competencies which will guide should be stable so as to withstand changes in the the restructuring of the curriculum. We will report on the knowledge base. The principles are accompanied by process and outcomes of this endeavor. rationales that explain their importance. The statements Conclusion: The construction of curricula requires clearly of each principle should remain constant. However, the defined competencies to be achieved by the students to rationales and implications will evolve over time. guide structure and contents to avoid discrepancies Principles mentioned by different experts in one field were between learning objectives and educational goals. compared and the consensuses extracted. Teaching of principles was carried out exemplarily in medical genetics. Knowing the principles proved to be not sufficient - they had to be applied to different relevant scenarios.

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7 Topaz 1.5 Summary of work: We devised a survey-questionnaire in Competency-based training: are we training which we asked our teachers about the following issues: workers or professionals? teaching content; learning outcomes; assessment tools for the desired learning outcomes; how the integration of C Allan*, E A Campbell and G Bagnall (University of Glasgow, teaching and learning will create the best doctors; Psychology Directorate, Westhouse, Gartnavel Royal Hospital, instructional cooperation with other departments; whether 1055 Great Western Road, Glasgow G12 0XH, UK) the current curriculum is adequate for the integration of Summary of work: This paper will describe findings from teaching and learning; and whether the new curriculum is a recent study to identify the training needs of educational well designed for physician training at the highest level. supervisors in Clinical Psychology which relate to the Summary of results: We found that most teachers checked transmission of ethical values and professional practice. better scores in all except assessment tools for the desired This was carried out using qualitative and quantitative learning outcomes and whether the current curriculum is methods and included a questionnaire survey of all clinical good enough for the integration of learning and teaching. psychologists in Scotland, interviews with pre-registration As this result corresponded with AMEE guide No.25, we trainees, a focus group with key staff and a Delphi decided to devise activities for our teachers so that they exploration with expert groups. might improve our assessment tools for the new curriculum Summary of results: The training needs that emerged fell to ensure quality in our training programs. into four distinct categories, two of which were clearly linked to the development of trainees as professionals. These were the transmission of legal, ethical and 7 Topaz 1.7 professional standards and the integration of trainee needs Identify core clinical skills for the with professional requirements and service needs. undergraduate medical curriculum in Conclusions/take-home messages: Educational supervisors Taiwan were clearly aware that they need training in these areas Min Liu, Yu-Sheng Huang and Keh-Min Liu* (Kaohsiung to help them equip trainees for their roles. The content of Medical University, Department of Anatomy, College of these two categories will be described and how best to Medicine, No 100, Shih-Chuan 1st Road, Kaohsiung 807, meet these needs will be explored and developed. TAIWAN) Educational supervisors in the NHS in the UK have a pivotal Background: Although medical students ideally should have role in ensuring the transmission of clinical skills within an acquired sufficient knowledge and skills upon graduation ethical and professional context. This aspect of a to work as junior doctors, researchers have found that supervisor’s role needs to become more explicit as training not only does students’ experience in clinical training vary, increasingly emphasises a competency framework. but their skills fall short of faculty’s expectations. This may be due to the lack of a set of clearly-defined objectives in 7 Topaz 1.6 clinical training. The aim of this study is to identify the core clinical skills that medical students in Taiwan should Attitudes of teachers before their introduction develop. to an outcome-based curriculum Summary of work: We developed a list of clinical skills Bussaya Sujitranooch*, Usa Siriboonrit and Anupong based on European and American documents and curricula, Suthamnirand (Chonburi Hospital, Chonburi Medical and we asked the deans and clinical faculties of all medical Education Centre, T.bansuan, A.Muang, Chonburi Province schools in Taiwan whether they considered each skill a 20000, THAILAND) “required competency”, i.e. something a medical graduate Background: Since 2003, Chulalongkorn University, in should be able to perform independently. Representatives Bangkok, Thailand, has based its medical education on an from all medical schools then studied the results of this outcome-based curriculum. Chonburi Hospital, as an survey and agreed upon as required competencies 34 affiliated center that teaches medical students from Year examination skills, 5 image interpretation skills, 8 laboratory 4 through Year 6, will adopt this same curriculum beginning skills, 25 procedural skills, 20 therapeutic skills, 4 in 2006. Before this change, we determined that we should communication skills, and 7 kinds of attitudes. This set of find out first what our teachers thought about this skills will be used as core learning outcomes by all medical curriculum. schools and teaching hospitals, to ensure that medical students in Taiwan receive sufficient training in clinical skills.

Posters 7 Ruby 1 Postgraduate assessment

7 Ruby 1.1 questionnaire. 76% of SHOs presented a portfolio/logbook. Never mind the quality, feel the width? A GPVTS (General Practice Vocational Training Scheme) SHOs closer look at SHO RITAs made significantly more use of available tools. For 93% of RITAs, assessment forms were available, 30% of which Ann Cadzow, Fiona French and Allyson Still (NHS Education included input from multiple sources. In 17(14%) cases, for Scotland, Forest Grove House, Foresterhill Road, Aberdeen assessors viewed the evidence as inadequate, but AB25 2ZP, UK) nevertheless assigned a grade for 15 of these. Background/rationale: The RITA (Record of In-training Conclusions/take-home messages: Most SHO respondents Assessment) process for Senior House Officers (SHOs) is are maintaining a portfolio – a good baseline to build on. now established in North Scotland. A pilot in January 2004 Educational input may encourage SHOs to optimise the suggested the assessment information varied in quality quality of the contents, particularly for tools such as and quantity. This study considered the documentation Significant Event Analysis. Clinical units would also benefit SHOs presented at RITA interviews, other evidence from educational support to extend the multi-disciplinary available and assessors’ views of these. team contribution to SHOs’ assessments. Guidelines should What was done: In June/July 2004, 132 SHOs completed be available to assessors. a questionnaire immediately prior to their RITA interview. For 95% of these, assessors also completed a

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7 Ruby 1.2 and Logbook are administered to evaluate the doctors’ The relationship between written and abilities. The medical audit is part of the training program clinical elements of a postgraduate realized by didactic teaching about the audit cycle. The aim of the training: to form the trainees’ attitude towards assessment in paediatrics the audit, as an effective method for the improvement of Sian Williams* and Tom Lissauer (Royal College of Paediatrics current medical practice. The medical audit has been & Child Health, Examinations Department, 50 Hallam Street, introduced as an opportunity for GPs to evaluate London W1W 6DE, UK) information by using their own observations, each others’ Aim & Summary of work: The Royal College of Paediatrics experience; applying scientific data (evidence based & Child Health runs postgraduate exams for doctors wishing medicine). to specialise in paediatrics. Membership to the College is Summary of results: First results show that medical audit dependent on passing two written exams (Part One and can be painful and be accompanied by some reluctance of Part Two Written) and a subsequent clinical exam (Part health workers to probe too deeply into problems of medical Two Clinical). The Part Two Written and Clinical practice. But as an educational tool, audit reflects upon assessments are conceptualised as testing different one’s work, and the opportunity to have team input and competencies whilst still being related. To investigate the group decisions, resulting in the development of agreed validity of this hypothesis scores on the Part II Written working procedures. exam and scores on the stations comprising the Clinical exam were correlated. 7 Ruby 1.5 Summary of results: Scores on the written exam were Assessment of the oral examination in an correlated with scores on the clinical exam (r = .18, p < .001), but less so than any of the ten stations within the Anesthesia residency training program clinical (item-total correlation range: .20 - .43). Written P Pukrittayakamee* and J Wacharasin (Mahidol University, scores were most correlated with scores on the video Department of Anaesthesiology, Faculty of Medicine, station of the clinical exam (r = .16, p = .001) and least Ramathibodi Hospital, 270 Rama VI Road, Ratvithe, Bangkok correlated with scores on the history taking station (r = 10400, THAILAND) .04, p = .35). Background: The oral examination is one of the major Conclusions: These findings suggest that while elements of educational assessment but is most liable to performance on the written exam is related to performance bias. The pattern of oral examination in anesthetic training on the clinical exam, the clinical exam goes beyond has undergone several changes but the success is largely assessing the ‘know how’ to assessing the ‘show how’ dependent on the cooperation of the Examination Board. Summary of work: The present study was conducted in 7 Ruby 1.3 the Anesthetic Department, Ramathibodi Hospital, Thailand, using a modified format of the oral examination Formative assessment of family medicine of the American Board of Anesthesiology. The attitudes residents in Catalonia: 2004-2005 and opinion of examiners and candidates towards the oral J M Fornells*, R Descarrega, M Ezquerra, M Bundo, D Fores, examination system were evaluated in the 2004 anesthetic P Solanas, G Foz, J M Martinez-Carretero and A Martin-Zurro residency examination. (IES/ACEM, Institute of Health Studies, c/Balmes, 132-136, Summary of results: The majority (60.7%) of the people Barcelona 08008, SPAIN) involved responded to the questionnaire: 7/10 examiners Background: Formative assessment allows detection of and 10/18 candidates. All the examiners agreed and were progress in learning, identification of weaknesses and satisfied with the examination format but only 3/10 introduction of educational improvement mechanisms. candidates were satisfied. The questionnaire assessed Summary of work: In Catalonia, after a pilot test to evaluate forms for grading, a scoring system, and the administration its feasibility and acceptability, a formative assessment of the examination system. All questionnaire responders project was conducted among the whole Catalan residents: gave one or two additional suggestions of how to improve 600 residents distributed in 60-health accredited units. the format and conduct of the oral examination. Each resident has two formative sessions per year. A Conclusions/take-home messages: The results of the session has two parts: in the first part a clinical case is present study encourage a standardization of the oral administered to analyse progress in competencies using examination and suggest that the participation of both different formative assessment methods (SP, computer examiners and candidates would help to improve the based cases, mannequins, and so on). In the second one, quality of the oral examination. in a structured feedback session, residents together with their tutors analyse the first part, writing a report on topics covered in the meeting with strengths and weaknesses 7 Ruby 1.6 detected in competencies. Afterwards, participants Candidates’ self reported knowledge and undertake an opinion questionnaire. Through the skills during postgraduate training in questionnaire 4 different areas are evaluated, using a Likert psychiatry scale, relating to organization, pertinence of case, learning method and learning impact. Analysis of data will be John Chr. Fløvig* and Olav Linaker (NTNU, ST Olavs Hospital, Østmarka Psychiatric Department, Trondheim University discussed. Hospital, PB 3008 Lade, Trondheim N-7048, NORWAY) Aim of presentation: We describe a method of evaluation 7 Ruby 1.4 based on the candidates’ self-report and the national official Medical audit as an educational tool in curriculum for psychiatric specialization. We also report postgraduate GP-training in Uzbekistan some results from use of this method. Dilbar Mavlyanova (Tashkent Pediatric Medical Institution, Summary of work: All candidates completing a mandatory 223 J. Abidova Street, Tashkent 700140, UZBEKISTAN) course during psychiatric specialization in Norway were asked to fill in a questionnaire. The candidates reported Summary of work: The Centre of General Practice at the to what degree they felt they had learned enough in 109 Tashkent Paediatric Medical Institute in Uzbekistan different subjects divided on knowledge and skills. The regularly offers training for GPs from the rural policlinics. subjects cover the national curriculum with a few additions These courses are funded by Zdrav plus (US-AID) and by suggested in a proposed European curriculum and a survey “Health” Project (Health Ministry of Uzbekistan). The from the World Psychiatric Organization. We also asked training programs are problem-oriented and case-based. questions on the candidates and their educational At the end of the course OSCEs, MCQs, Oral examinations, situations. All answers were anonymous.

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Summary of results: 60 of 66 candidates filled in the Take-home messages: Through self-registration of clinical questionnaire. More than 90% of candidates reported decisions trainees perceive a gain in knowledge about the having learned enough on affective disorders, involuntary guidelines and improvement of implementation. Trainees admissions and use of ICD 10. Less than 30% reported discuss the value of objective feedback. However, it is having learned enough on ADHD, mental retardation and questionable whether trainees are capable of valid self- autism. assessment. Trainees do not seem to be eager to be assessed, this has to be taken into account when Conclusion: The candidates’ self report during a single implementing assessment procedures. session shows large differences in perceived learning of different subjects in the national curriculum for psychiatry. We find these data useful in the assessment process of 7 Ruby 1.8 the individual candidate, the education and the curriculum. Assessing Foundation Programme year 2 trainees 7 Ruby 1.7 Helen Baker and Howard Young* (Cardiff University, Wales Assessment of clinical performance in College of Medicine, School of Postgraduate Medical & Dental postgraduate training in general practice Education, Heath Park, Cardiff CF14 4XN, UK) L Plas*, A W M Kramer and B J A M Bottema (UMC St The UK Modernising Medical Careers initiative has set out Radboud, Centre for Postgraduate Training in General to establish two-year Foundation Programmes that will, Practice, 229 Kwazo, Geert Grooteplein-noord 21, Nijmegen for the first time, require doctors to demonstrate their 6525 EZ, NETHERLANDS) abilities and competence against set standards. As a result Background: Formative assessment of clinical competence a suite of competency based assessment tools are currently is part of postgraduate training in general practice. What being piloted throughout the UK. Assessment tools include is lacking is a tool for assessment in daily practice. the mini-Clinical Evaluation Exercise (Mini-CEX), Direct Observations of Procedural Skills (DOPS), Mini-Peer Work done: Through self-registration trainees at the Assessment Tool (mini-PAT) and Case Based Discussions beginning of the training collected data about clinical (CBD). These assessments are trainee led with the trainee decisions they made in practice. The trainees received determining the case to be assessed, the timing and the feedback about the extent to which they had followed observer, which could be a consultant or specialist registrar national guidelines. The feedback was discussed with the for the mini-CEX and an appropriate nurse for the DOPS. GP-teacher at the institute or GP-trainer at the practice. This poster summarises the experiences of the Welsh Conclusions: The trainees asserted that, through Deanery in piloting these assessment tools for prototype registration, they gained knowledge about the guidelines Foundation Programme Year 2 posts. The poster discusses and their implementation of the guidelines improved. Half the problems encountered in implementing these tools, of the trainees found feedback about their performance variations in the scores given by assessors and the use of unnecessary because it didn’t contribute to their knowledge these tools as indicators for performance. Preliminary or implementation capabilities. The trainees also claimed evidence suggests a difference in the assessment scores that they checked their performance themselves by given to trainees from consultants and nurses, although comparing their clinical decisions with the guidelines. this may be correlated to the complexity of the case/ procedure.

Posters 7 Ruby 2 Standardized patients and clinical teaching

7 Ruby 2.1 knowledge that is transferable to everyday practice. In Using patient simulations to ensure August 2005 data are available from an extensive experience with the most important clinical questionnaire among students, evaluating this patient simulation method. pictures in gynaecology and obstetrics in an undergraduate clerkship Take-home message: Our patient simulations are a feasible way of ensuring experience with and basic knowledge of P W Teunissen*, K Boor and F Scheele (Sint Lucas Andreas the most relevant topics in gynaecology and obstetrics in Ziekenhuis, Jan Tooropstraat 164, Amsterdam 1006 AE, an undergraduate clerkship. NETHERLANDS) Objectives: Undergraduate medical students follow an 8- week gynaecology and obstetrics clerkship. We developed 7 Ruby 2.2 a feasible variant of patient simulation to improve student Education or examination – different strains education during the clerkship. In our variant there are on standardized patients roles for three students: ‘patient’, ‘doctor’ and ‘observer/ M Schrauth*, N Schmulius, G Gross, A Kowalski, S Zipfel and consultant’. The project’s goal was to ensure experience U Martens (University Clinic of Tübingen, Department of with and basic knowledge of gynaecology and obstetrics’ Psychosomatic Medicine and Psychotherapy, Silcherstrasse 5, most important topics. Tübingen D-72070, GERMANY) Summary of work: In our department we obtained Background: Standardized patients (SPs) – amateur actors agreement on the thirty most relevant clinical pictures. impersonating ill people for teaching purposes – have been Per subject, we created a standard patient scenario, based well evaluated in terms of performance quality. Little is on national guidelines and/or hospital standards. Twice a known about the impact of playing patients on SPs week, students play two scenarios followed by feedback themselves. Methods: An anonymized questionnaire from a supervisor, which, together, takes no longer than containing items about strains due to their actual work 40 minutes. Students can use a booklet, with a short was given to SPs directly after performance. The SPs acted context for each subject, for preparation. in front of medical students in a practical multi-step- Summary of results: Initial responses from both students examination (OSCE) and/or a seminar in psychosomatic and physicians are positive, indicating increased student medicine. involvement and satisfactory learning-output resulting in

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Results: One hundred questionnaires from 55 SPs were patients from earlier projects, Expert Patients reflected collected; the response rate was 89,3%. Students´ together on their own illness journeys and their educational behavior was mostly rated as appropriate. In the OSCE, experience with other patients. They developed models role-playing was reported to be physically stressful above validating simulated patient teaching and with patients as all (e.g. abdominal pain after repeated palpation of the teachers, for undergraduate and professional learning, and liver). The roles played in the psychosomatic seminar, for a new programme of student workplace however, were experienced as emotionally intense and interprofessional learning. All members reviewed videos stressful. The SPs felt more uncomfortable impersonating and notes of sessions in an iterative evaluation process. patients with psychosomatic diseases in the seminar than Conclusions/take-home messages: Expert Patients are an physically ill patients in the OSCE (35,3% versus 3,6% excellent resource for an effective patient voice. Structures “medium stressful” to “very stressful” on a six-step scale). to support this effort are needed: the Faculty has appointed There was no difference between female and male SPs. patient advocates to take the work forward. Conclusions: Attention should be paid to the different settings SPs are working in as well as the roles they play to improve recruitment, training, performance and well- 7 Ruby 2.5 being of SPs. Using self directed learning packs to support clinical skills training in 7 Ruby 2.3 undergraduate medicine Standardized patients in nursing education G Hogg*, L Ambrose and J S Ker (University of Dundee, – a success for all Clinical Skills Centre, Ninewells Hospital and Medical Centre, Level 6, Dundee DD1 9SY, UK) Claudia Schlegel* and Maya Shaha (Berufsschule für Pflege Berner Oberland, Weissenaustrasse 33, Unterseen 3600, Background/Rationale: Self directed learning is a central SWITZERLAND) concept in adult education (Mezirow 1985) and can be supported early in the medical curriculum by the use of Background: A pilot project was developed and learning packs. The clinical skills programme in year 2 of implemented to compare nurse students’ learning success the Dundee Undergraduate Medical Curriculum is in a traditional programme with students’ learning success structured to ensure students have the opportunity to learn in a programme employing skillslabs and standardised and practice relevant skills and procedures in a safe patients (SP). environment without compromising patient care. One of Procedure: The programme was about ‘acute pain’. Two the major challenges is ensuring students have adequate classes with students (N=32) at the beginning of their support to reinforce newly learnt skills. second year in nursing education participated in the Methodology: Five self directed skills learning packs have project. A randomised post-test only control group design been developed and evaluated using a modified Delphi was selected to evaluate the trend of students’ learning approach with an interprofessional group of skills tutors successes. A written case was given to the control group and practising clinicians for junior medical students. Each who discussed it with a lecturer. The intervention group pack provides relevant Anatomy and Physiology, current met with an SP with whom the same case was enacted. evidence based information on the clinical applications of For post-test all students (N=32) had to complete an each skill and a procedural checklist. Students are given anonymous knowledge test and met again with another opportunities through the pack activities to assess their SP. own learning in relation to their skill development. Students Findings: The intervention group demonstrated a can complete the pack in their own time. The packs have significantly more competent handling of the SP as opposed been evaluated positively by the students. to the control group (F=5.13, df=1.30, p=0.03). Students Conclusions/take home message: Self directed clinical skills maintained that skillslabs and SP reduced the theory learning packs provide an opportunity not only to support practice gap. self directed learning but can set skills training standards Conclusion: Learning with the help of skillslabs and SP for all health care professionals. This will ensure a flexible has a significant positive influence on students’ human skilled workforce is ready to meet the needs of patients. empathic handling of patients. Promotion of such aspects is key to nursing, as nurse professionals spend the majority of their time in direct contact with the patient. 7 Ruby 2.6 7 Ruby 2.4 Dr WHO: development of a workshop for Patients as teachers: expert patients and House Officer presentation for final year professional learning about the patient’s medical students journey G Baillie*, J Gaffan, L Dunkley, D Wallace, M Klingenberg, C Phillips and J Dacre (Royal Free & University College London, Andrea Armitage, Gill Bowskill, Julie Symons*, Fiona O’Neill, RF & UCL Medical School, Clinical Skills Centre, Hampstead Penny Morris, Sue Kilminster and Trudie Roberts (University Campus, Rowland Hill Street, London NW3 2PF, UK) of Leeds, Medical Education Unit, Level 7 Worsley Building, Clarendon Way, Leeds LS2 9NL, UK) Background: The Immediate Life Support Course (ILS) is taught to final year medical students. Feedback from Background: Involving patients in decision-making and previous courses has been positive but highlights common management of care is the core of clinical communication themes for improvement: (1) Assessments could be learning but remains a challenge for many professionals replaced with more teaching; (2) The course should include and students. We present collaborative work at Leeds that how to treat ‘live’ critically ill patients. addresses this through exploring ethical and effective ways to engage with the patient voice. Work done: In response the authors developed the DR WHO course – Direct Response Workshop for House Office Summary of work: Projects with patient and carer groups, preparation. The course combines the HELP course (How community groups and mental health service users have to Eliminate Life-threatening Problems) taught to Pre- developed their contribution to learning and assessment, registration House Offices and the ILS course. This one- and the learning of the Faculty of Medicine and Health day course contains two lectures and small-group about engaging with them. This work involved patients workshops, where in the morning students learn how to from the Expert Patient programme pilot, where patients assess and treat critically ill patients using DR ABCDE with chronic illness help other patients to manage their assessment. In the afternoon students revise the ALS own illness. Led by medical and nursing teachers with algorithm concentrating on cardiac arrest workshops and

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defibrillation. Students are assessed using a scenario which critical situation. It is even rarer for this IV access to fail. covers the day’ teaching. Students complete a feedback However, in such situations it is essential that physicians form grading all components. To date 10 courses have and paramedics have a tool and easily learnable skills with been taught to 200 students. Feedback shows a mean a high chance of success. The hypothesis was that life score of 4.5 out of 5; the lectures scoring 4.2 each, and can be saved by improving and standardising the the workshops achieving a combined mean of 4.8. equipment for the intraosseous infusion (IO set) and the Students’ comments include: ‘This is the best day I have education (IO workshop). spent in medical school in the last 5 years’; ‘I feel much Work done: Twenty six hospitals and ambulance services better prepared for doing it for real’. took part. Set orders were coordinated by the University Aims and further work: By the end of April 2005 we will Hospital of Berne, so any attempted or successful IO have delivered the course to 400 final year medical punctures could be validated by an interview. 35 students. We hope to include final year undergraduate applications on 30 patients with a total of 50 punctures nursing students to the course. were included. On 5 of these patients, the IO puncture was not successful. The success rate was not dependent on occupation and experience but on attendance at the 7 Ruby 2.7 standardised IO workshop which augmented the success Failed IV access on children – intraosseous rate from 78% to 100%. infusion Conclusion: Rarely used skills are well teachable and Christoph A Pfister* and Lars Egger (Regional Hospital learnable at a standardised workshop. A tool for the Meyriez-Murten, Spital des Seebezirks, Murten 3280, situation failed IV access is now validated clinically and SWITZERLAND) should be readily available in all locations where children Background: It is rare for children younger than 6 years are treated in emergency situations. old to need an intravenous access as a result of a very

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Symposium 8AUD Assessment in the context of postgraduate training

8AUD Assessment in the context of care team, and the presence of skilled clinician- postgraduate training educators offer a rich environment for assessment. The symposium will explore the challenges and opportunities John Norcini (FAIMER, 3624 Market Street, 4th floor, offered by assessment in the context of an Philadelphia, PA 19104, USA) (Chair), Julian Archer apprenticeship model of education. The methods (University of Sheffield, UK), Eric Holmboe (ABIM, Philadelphia, USA) and Lesley Southgate (St. Georges particularly well-suited to this setting will be briefly University of London, UK) described with an emphasis on those that make efficient use of routine patient and/or professional encounters. The setting of postgraduate training presents unique Critical to the effectiveness of many of these methods challenges and opportunities for assessment. The are clinician-educators who have an understanding of advanced patient care and procedural skills expected how to conduct reliable and valid assessments. A of trainees are not well assessed using traditional discussion of the characteristics of good examiner methods. Further, the educational programs themselves training will be stimulated by presentation of an example are smaller and less structured with fewer resources of an examiner-trainee interaction. Finally, many of than medical schools. Consequently, it is neither as these methods offer the opportunity for educational efficient nor as effective to use locally developed feedback based on observations of patient encounters. standardized tests based on MCQs and OSCEs. The nature of good feedback and the faculty training However, the routine interactions between trainees and necessary to acquire skill in this area will be presented patients, the relationships among members of the health and discussed.

Short Communications 8A e-learning and postgraduate education

8A 1 On-line learning networks for General surgery, orthopedics, urology or plastic and reconstructive Practitioners: a pilot project surgery. Part of this program is a series of three-hour courses in applied surgical anatomy and comprises theory John Sandars (University of Leeds, Medical Education Unit, and hands-on sessions using dissected human cadavers. 20 Hyde Terrace, Leeds LS2 9LN, UK) Considering the indispensable value of imaging techniques, Aim of presentation: To increase awareness of the practical applied radiological anatomy has been incorporated. issues related to providing on-line learning networks. There What was done: Radiological faculty participates in three is increasing interest in developing on-line opportunities courses (Wrist, Knee, Ankle), using computer-based for general practitioners to share knowledge as part of learning (CBL). The CBL program is case based, focusing continuing professional education. on radiological anatomy using various radiological Summary of work: A pilot project was performed that techniques (plain film, Ultrasound, CT, MRI). By means of offered a web-based structured discussion board to a group a clinical problem the resident is guided through various of general practitioners. There was an initial socialisation aspects of anatomy, radiological techniques (physics), phase, followed by an action learning set. frequently encountered pathology. The CBL program is scheduled for 25 minutes for each resident. The CBL Summary of results: There was a low level of on-line program is implemented in Macromedia Authorware 6.5. network activity throughout all of the project and the on- A Likert scale assessment is used for evaluation. Residents line discussions were superficial. Despite the provision of rated the program on a 1-10 scale. an on-line socialisation phase, participants described a low level of trust between members and this inhibited on-line Conclusions: The CBL program is evaluated highly discussion. There was a low level of confidence in the use informative, very clear in design and tailored to the needs of technology and this also inhibited participation in the of the residents. It was rated 8.4. network. Take home message: Radiology education via a CBL- Conclusion: This was the first UK study to describe an on- program is a successful component of the surgical common line learning network for continuing professional trunk educational program. development by general practitioners. Future plans to develop on-line learning networks should address the issues related to developing trust, such as providing initial 8A 3 E-learning methods for effective surgical and on-going face to face meetings. Participants need to training increase their confidence and competence in using K M Harikrishnan*, S Marsh, C Erdal, G Singh and C Hughes technology. (Colchester General Hospital, Postgraduate Medical Centre, Computer Aided Learning Room, Turner Road, Colchester, Essex CO4 0ND, UK) 8A 2 Postgraduate anatomy education: radiological contribution via computer- Aim: To impart effective surgical training under the European Working Time Directive (EWTD) conditions. based learning Summary: The traditional “apprenticeship” method of C A Tipker*, R J Oostra, C N van Dijk, S D Strackee, F M M teaching surgical skills is no longer tenable in today’s Griffioen, J S Laméris, J J van Lanschot and M Maas (Academic Medical Centre, Department of Radiology, Meibergdreef 9, climate of EWTD and reduced hours of training time. Web- Room C1-210.1, Amsterdam 1105 AZ, NETHERLANDS) based, e-learning techniques, simulators and voluntary “off-time” learning can help improvise surgical training. Background: An education program, common trunk, has Our Computer Aided Learning (CAL) centre coordinates a been developed by the Dutch College of Surgeons for large variety of surgical input, consisting of operative video- residents during the first years of their traineeship in clips, photographs and notes on interesting cases, quizzes,

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helpful hints and archived presentations from workshops VETstream is still running. First results (n=15) show that and grand-rounds. All this is available on the hospital VETstream is useful (1.25; 1=yes, 4=no), that it is a good intranet. The e-learning site has hyperlinks to other surgical addition to the abstracts (1.33) and that the users wish resource sites, literature search and statistical analysis. more conferences to be documented like this (2.0). There is also a large array of surgical software available In conclusion, it is possible to document whole conferences for self study. Such software is “launched” periodically by with justifiable effort and great profit for the participants. senior staff where its special features are explained and demonstrated. Trainees are encouraged to take periodic self assessment tests to evaluate their progress. Computer 8A 5 E-learning in General Practice: barriers and based simulators are available for practising operative skills, chances in undergraduate and postgraduate including laparoscopic procedures. Additionally, hands-on medical training in Germany workshops help trainees to improve their skills in a supervised environment. Trainees are also encouraged to Uta-Maria Schmidt, Andreas Sönnichen, Horst-Christian undertake voluntary “off-time” apprenticeships in elective Vollmar, Katja Gilbert and Jochen Gensichen* (Johann and emergency settings. It is anticipated that by these Wolfgang Goethe University, Institute for General Practice, methods, basic and advanced surgical skills can be acquired University Hospital, Frankfurt D-60590, GERMANY) in the shorter time frame now available to trainees. Aim: To obtain an overview on current E-Learning activities Message: E-learning techniques can help offset the in under- and postgraduate General Practice-training, to reduction in surgical training hours. identify barriers and chances of these learning methods and to develop a strategy for future efficient use. Summary: Electronic media and online teaching ‘E- 8A 4 First experiences with VETstream – Learning’ is used for delivering resources to individual streaming-video-technique for veterinary learners: Medical students, GP-trainees and practising GPs continuing education (CME). Barriers remain: Differences in context, culture and organisations, and in using this technology. Teachers from J P Ehlers*, Sybille Ehlers, Jutta Friker and Ulrike Matis (AK mulTIERmedia, Agnesstr.1, Muenchen D-80801, GERMANY) different universities started the initiative to assess E- Learning activities in German under- and postgraduate VETstream was presented at the AMEE conference 2004 GP-training. as a tool for veterinary studies and continuing education. VETstream-clips are online lectures (clip of lecturer + slides) The process: Phase I is to arrange a national expert in a streaming-video-format (.mpg4). In 2005 the Annual meeting to discuss experiences, barriers and chances in Meeting for Reproductive Medicine (38. Jahrestagung für GP-training - using a delphi-approach. Phase II is to fund Physiologie und Pathologie der Fortpflanzung und a national network to balance educational and technical gleichzeitig 30. Human- Veterinärmedizinische standards, to coordinate the development of teaching Gemeinschaftstagung) was documented as VETstream. modules, and to peer-review the products. Phase III is to This conference consists of a scientific part and a part for evaluate E-Learning in GP using systematic research (e.g. veterinary continuing education. In the scientific part 64 RCTs). lectures were held, 56 (87.5%) lectures agreed to Conclusions: GP-training in community setting needs publication in the internet or on CD-ROM. In the part for creative strategies of distance learning. This German continuing education 27 (90%) of 30 lecturers gave their initiative might be successful, when respecting cultural and agreement. With the VETstream-clips it was possible for organisational differences of E-Learning in GP. Flexibility the participants of the conference to work on the whole may require parallel use of traditional educational methods data of the lectures. The Evaluation of the users of (blended learning).

Short Communications 8B The OSCE 2

8B 1 Weighting OSCE checklist items Conclusion: Weights can be an important aspect of examination development in that varying the weights will T J Wood*, S M Smee and D E Blackmore (Medical Council of affect which specific examinees pass or fail. This is most Canada, 2283 St Laurent Boulevard, Ottawa, Ontario K2E 5E5, CANADA) evident around the pass/fail cut point. Aim of Presentation: The use of checklists with Objective Structured Clinical Examinations (OSCE) is widespread in 8B 2 Comparison of children’s and examiners’ the assessment of medical students, residents, and assessment of medical students in an OSCE physicians in practice. The checklist is most often used to record whether or not an examinee adequately performed V Walker*, J E McDonagh and V Diwakar (Birmingham Children’s Hospital, c/o Education Department, Steelehouse a salient aspect of a given patient encounter/case. For Lane, Birmingham B4 6NH, UK) scoring purposes, the common practice is not to assign weights to the individual checklist items; i.e. each item The views of patients, whether adult or children, are carries the same weight and contributes equally to the important in high stakes examinations. Students need to pass/fail decision for that case. The practice of the Medical demonstrate an adaptable, skilled approach to children Council of Canada is to apply weights. This paper outlines and young people. the reasons why checklist item weights are felt to be Methods: Final year medical students at Birmingham important in the context of a high stakes licensing University undertake a paediatric OSCE, including 3 clinical examination and will further work previously reported by examination stations using child patients. Children >6yr the latter two authors. completed a simple 3 item questionnaire using age Summary of Work: Scores from one administration of a appropriate visual analogue scales in the two minute gap high stakes clinical examination (14 stations) were analyzed between students. Scores were compared with examiners’ using both weighted and unweighted checklists. scores. Summary of Results: Analyses, including reliability, Results: 22 children participated, median age 14 years descriptive statistics, and pass/fail information, support (range 4-17 years). Each child saw, on average, 4 students the use of item weights for checklists.

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(range 2-10). There was no statistically significant 8B 4 The effects of assessor training on criterion correlation between the children’s and the examiners’ based assessment assessment, (range of rank correlation coefficient -0.79 to 0.052). G Pell*, T E Roberts and C McClure (University of Leeds, Medical Education Unit, Room 7.20 Worsley Building, Leeds Conclusions: Poor correlation between children and LS2 9NL, UK) consultant examiners’ assessment may reflect different While standardised tests of clinical skills, such as OSCEs perspectives. Children’s assessment is not reliable enough are widely used to assess clinical competence, both at the for use in high stakes decisions1. Children’s opinions should undergraduate and postgraduate levels, the issue of setting be sought and could provide valuable qualitative feedback the pass marks or passing standard remains contentious. for students. Active participation in medical education has This paper looks at data collected at Leeds Medical School the potential to give children a more positive outlook on OSCE assessments from both year 3 and year 5 chronic illness. undergraduate students. In a large medical school such 1Crossly J et al,(2005) Children and their parents assessing as Leeds with cohorts of 250 students, an OSCE the doctor-patient interaction, Medical Teacher 27 (in assessment can require up to 300 assessors. The policy press) at Leeds is to train assessors, although according to Newble this has little effect. With such a large number of assessors, it is not always possible to ensure that every one has been 8B 3 Undesirable sources of error variance in trained. This paper compares the marks awarded by trained assessment of communications skills with and untrained assessors, and further subdivides the two an OSCE categories by gender. Interim findings from approximately 500 assessors, assessing a similar number of students Peter H Harasym*, Wayne Woloschuk, Les Cunning and Doug Lawson (University of Calgary, Faculty of Medicine, indicate the following: There is a tendency for untrained Department of Community Health Sciences, 3330 Hospital assessors to award higher marks. The effects training are Drive NW, Calgary AB T2N 4N1, CANADA) different for male and female students. There seems to be an interaction between training, the gender of the Background: There has been an increased effort to teach assessor and the gender of the student at station level. proper communication skills to medical students and residents. Communication skills are believed to be a generic process that transcends all clinical problems. Examinee 8B 5 Assessing communication skills in OSCE communication abilities are assessed within OSCEs using a common, generic rating scale. Currently, it is unknown Yvonne Aders*, Thorsten Schäfer, Bert Huenges, Hille Lieverscheidt and Herbert Rusche (Ruhr-Universität Bochum, whether what sources of error variance is introduced into Medizinische Fakultät, Büro für Studienreform, UHW 1009, examinee scores. This study looked at the effect variation D-44780 Bochum, GERMANY) in cases and/examiners had upon assessment of communication skills. The course “Medical Interaction” is an integral part of the medical reform curriculum at Ruhr-University Bochum. It What was done: The communication performance of 113 runs through the whole study in a high frequency form. clinical clerks was assessed on six OSCEs. Their Preclinical and clinical parts of study are both taught from performance was rated on the 28 item Calgary-Cambridge the beginning. The curriculum for Medical Interaction is Communications Guide. A multi-facet Rasch analysis was also based on clinical paper- or video-cases in order to performed on the data to determine if the amount of train health-supportive skills. OSCE-I after the first year variance in candidate scores was significantly altered by of study contains one assessment center for communication different cases and examiners. Findings revealed that the skills. Two raters used a standardized checklist and variance and reliability scores were: communications skills evaluated students at using communication skills to (0.18 and 0.89), examiner stringency/leniency (0.27 and standardized simulated patients. We present the results 0.96), and case (0.05 and 0.94), respectively. of this OSCE center with its reached points of 41 students Conclusions: Although the reliabilities of scores were high of the first class. To reach the maximum of 19 points one (0.89-0.96), there was a significant amount of error had to succeed in 24 items. The results show a high variance in OSCE the communication scores due to cases interrater-reliability with means of 12,75 and 14,63 (0.05) and examiners (0.27). evaluated by the two raters. Index of difficulty is shown with mean of 0,72. For assessing communication a new Take home message: The level of examinees’ standard must be developed. The evaluation in OSCE communication skills can be altered significantly by case shows an interesting start and gives an idea how it could and drastically by examiner stringency/leniency effect. be practised in future assessments.

Short Communications 8C Staff/faculty development 1: Staff/faculty development in action

8C 1 Fellowship support for advanced degrees in degree which might distract them from education or push medical education their career path away from it, fellows could satisfy the necessity for a degree by further training in education, W P Burdick*, P S Morahan, J J Norcini and L M Johnson making that their primary interest. Investing in fellows (Foundation for Advancement of International Medical Education and Research, FAIMER, 3624 Market Street, 3rd who have become well known to us through the Institute Floor, Philadelphia PA 19104, USA) experience will also allow us to have a strong sense of applicants’ language ability, cognitive and leadership An individual mentorship model for a fellowship in medical potential. This group may then be able to serve as education has been supported by the Foundation for leadership and faculty for Regional FAIMER Institutes. Advancement of International Medical Education and Seven FAIMER Institute alumni were selected for support Research for many years. It is now being replaced with a of a master’s degree in medical education. Evaluation of pilot program to support pursuit of a master’s degree in this pilot program will be through an outside evaluation medical education after prerequisite participation in the team, using feedback from awardees, assessment of FAIMER Institute. The degree will increase the likelihood professional networks, career progression, and effect on of academic advancement in the awardee’s home their home institution. institution. However, instead of pursuing a basic science

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8C 2 Impact of a mandatory residents as 8C 4 Effective teacher training for UME-teachers teachers program on residents’ perception M Hofer* and S Soboll (Heinrich-Heine University, Department towards teaching – 5 year study of Diagnostic Radiology/Surgery, Medical Education Pilot Project, Moorenstr. 5, Duesseldorf 40225, GERMANY) Meenakshy Aiyer*, Lynne Meyer, Anita Vanka and Gwen Lombard (University of Illinois College of Medicine at Peoria, The rationale of this study was to design, test, evaluate Saint Francis Medical Center, 523 NE Glen Oak, Peoria Il and implement effective teacher trainings in didactic skills 61614, USA) and methods for medical teachers in Undergraduate Aim: Resident physicians play an important role in medical Medical Education (UME). student education. At our institution, we implemented a Methods: a two-day workshop with 12 theoretical and 9 mandatory Resident’s As Teacher (RasT) program 5 years ‘hands-on’ modules has been designed and stepwise ago. The one-day workshop focuses on microteaching adjusted according to trainees’ feedback. They were trained skills, orienting learners, providing feedback and evaluation in small groups (6 to 10 participants/workshop). Covered and an OSTE exercise. This study reviewed the attitudes topics were ‘communication of goals’, ‘methods to trigger and perceptions of the residents towards teaching before interactivity’, ‘ppt-slide design’, ‘effective feedback and after participation in the program. techniques’, ‘use of media’, ‘skills teaching’, ‘assessment Methods: A questionnaire was administered to all methods’ (OSCE…), ‘evaluation’ and ‘presentation skills’. participants (2001-2004) before and after completion of The trainees underwent repeated microteaching exercise the mandatory RasT retreat using a 5-point Likert scale with intermittent video-supported feedback. The evaluation (5=always, 1=never) on 34 items. The questionnaire was based on two approaches: 1) Trainees’ scores in two addressed issues such as ability to teach, preparedness OSTEs (Objective Structured Teaching Examinations) to teach, use of clinical teaching micro skills to teach, ability before and at the end of the workshop: ratings of 15 to 20 to set expectations to the learner, and provide feedback. external viewers were checked for significant differences SPSS was used to analyze data for pre- and post-test in 17 acknowledged criteria of high teaching quality. 2) differences. The trainees’ rated 20 reaching competencies in a retrospective ‘pre post analysis’ (self assessment Results: 186 residents completed the pre-RasT and 192 questionnaire) 6 to 12 months after the training. The results completed the post-RasT questionnaire. At then end of revealed high significant improvements in 15 of 17 OSTE the workshop, the residents perceived a statistical increase criteria and in 19 of 20 items of the pre-post analysis, pre- in their preparedness to teach (p value- <0.005), dominantly estimated to be ‘persistent’. In conclusion, the confidence about their teaching ability (p value <0.005) designed workshop has effectively enhanced the didactic setting expectations and understanding the difference skills of participants. It’s also available for external teachers between evaluation and feedback (p value- <0.005). and institutions. Conclusions: The RasT program improves the residents’ attitudes and willingness to teach medical students. Further studies need to be done to identify if this change in attitude 8C 5 The Resource Archive for Teacher Trainers persists on long-term follow-up. (RAFTT) Nigel Purcell (University of Newcastle, LTSN-01, Catherine Cookson Centre for Medical Education & Health Informatics, 8C 3 The pedagogical partnership program: A 16/17 Framlington Place, Newcastle, UK) model for improving the integration of Aim: To introduce the Higher Education Academy Subject science and clinical teaching Centre for Medicine, Dentistry and Veterinary Medicine Maria Athina (Tina) Martimianakis*, Brian Hodges and (HEALTH-01) resource archive for teacher trainers (RAFTT) Donald Wasylenki (University of Toronto, Wilson Centre for and to explore the ways in which it can be used to foster Research in Education at University Health Network - TGH, effective teacher development. 200 Elizabeth Street, 1EN-565, Toronto, Ontario M1K 3V9, CANADA) Summary of work: RAFTT is a bank of learning and teaching resources intended to support the delivery of short courses The impact of the Pedagogical Partnership Program (PPP), on teaching to health care professionals and teaching designed to improve the integration of science and clinical certificate and diploma programmes to health care teaching in the Department of Psychiatry, University of professionals. The resources consist of a range of reusable Toronto is evaluated. The PPP partnered ten clinical learning objects (RLOs), classified using a metadata teachers and ten research scientists for one year in a six structure developed in accordance with the BIOME part faculty development program. Semi-structured small database protocols. Each resource will have an and large group interactive sessions encouraged accompanying history of use and contextualising collaborative learning. Partners also participated in each information. other’s teaching, reflecting on these interactions in journals. Pre and Post surveys were used to evaluate the Summary of results: The resources are being developed effectiveness of the program and attitudes towards by practising educators of medical educators. At present teaching. Observations and notes from the sessions and we are planning a residential workshop to draw together participant journal entries were analyzed using qualitative practitioners in the field to review and evaluate existing methodology, revealing differences between scientists and and newly submitted materials. We envisage that there clinical teachers with regard to perceptions about the role will also be an on-line submission and evaluation process. of science in clinical teaching. Following the PPP, Key messages: The resources need to be: annotated to participants advocated for a number of departmental facilitate effective use; quality assured by practitioners; changes to resolve structural and cultural barriers to structured and classified to facilitate access; fed into an integrating science and clinical teaching. Researchers active community of practice. identified ways to participate more actively and effectively in clinical teaching and clinical teachers reported increased facility in identifying and using scientific resources to 8C 6 Educational Development Centre (EDC), enhance their teaching. Partnered faculty development Faculty of Medicine, University of Khartoum: employing principles of collaborative learning can assist in 30 years experience identifying and resolving structural and cultural barriers to integrating science and clinical teaching. Ahmed H Fahal (University of Khartoum, Department of Surgery, Faculty of Medicine, PO Box 102, Khartoum, SUDAN) EDC was established at the Faculty of Medicine, University of Khartoum in 1980 in response to the growing demand in the Sudan and the region for qualified teachers. The

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EDC set out to offer effective teacher training programmes, emphasis on Mother and Child Health Care and Family consultation on curricula development, and innovative Planning. These target groups included nursing staff, teaching and evaluation methods for the health professions. sisters, health visitors, midwives and medical assistants. Since then EDC has enjoyed an international and regional Efforts for interdisciplinary approaches for introduction of reputation of professional excellence. EDC organized a nutritional education in collaboration with Ministries of good number of courses, symposia, workshops and various health, education and information were coordinated. It other activities for different institutions of varying helped in the initiation of community oriented educational dimension and academic profile both at the regional and programs for the medical students and other members of local levels. The EDC personnel in collaboration with WHO, the health professions. The EDC had produced medical EMRO have actively participated in the regional academic and health learning material for education, training and and professional programmes and activities and this has health promotion. It developed a clinical-skill laboratory laid the foundation for the establishment of EDCs all over where human models are used for learning of different the Eastern Mediterranean region. The centre trained a clinical skills. The centre had created excellent links with target group of medical and health staff to support the other similar institutes locally regionally and internationally. implementation of primary health care programmes with

Short Communications 8D The education environment

8D 1 Clinical education environment in a Conclusions: It is possible to improve the educational radiography course culture without expensive initiatives by focusing on the educational aspects of everyday clinical practice. All kinds Luis Lança* and Cecilia Galvão Couto (Escola Superior de of introductions should include educational aspects. Use Tecnologia da Saúde de Lisboa, Av. D João II, Lote 4.69.01, of portfolios can improve the everyday communication Parque das Nações, Lisboa 1990-096, PORTUGAL) between tutor and learner. Measured improvement Clinical educational environment (CLE) variables and indicators are only applicable in the specific department, students’ perceptions of CLE could be among the factors but the method can be applied in general. that influence the students’ outcomes, satisfaction and Take-home-messages: The least expensive and most success. important factor in improving educational culture is The aims of this study were to identify 3rd year radiography management focus on educational aspects of everyday students’ perceptions about CLE; evaluate positive and work. negative aspects; and make suggestions to improve CLE. Five analytical dimensions were identified to describe the CLE in the clinical education of radiographers. A fifty-item 8D 3 Can the DREEM inventory be useful in action questionnaire using a Likert scale and open questions was research studies of climates of health developed, tested and delivered to 30 students. The CLE professions education environments? as perceived by our students is very positive as shown by the scores obtained for each analytical dimension: quality Hettie Till (Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, Ontario, M2H 3JI, CANADA) of clinical teaching (88%); supervisors’ performance (85%); school support (82%); learning climate in the The aim of this study was to determine whether the DREEM clinical setting (87%); and assessment methods (79%). Inventory could be used to indicate whether remedial The correlations found between dimensions range from r curriculum changes made in response to identified = 0,734 to r = 0,907. The qualitative data collected from weaknesses of a new curriculum would lead to an the questionnaires seemed to reinforce the statistical improvement in students’ perception of the educational results. The results show that there is a need to improve environment. Administration of the DREEM Inventory to some aspects such as school support and assessment the first three years of a chiropractic programme in methods. These studies seem to be useful and should be February 2002 indicated some serious concerns from implemented as a routine to promote and improve the particularly the 3rd Year students. Consequently, quality of CLE of radiographers’ education. substantial changes to the 3rd Year curriculum were implemented in September 2002. In the first 3 months of 2003 and 2004 the inventory was again administered to 8D 2 Improving and monitoring educational culture students as part of a longitudinal quality assurance process. Carsten Hering Nielsen, Claus Möger, Sven Felsby and Peder These results showed significant improvements in all 5 Charles* (Aarhus University Hospital, Department of domains of the DREEM inventory for the 3rd Year students Endocrinology & Metabolism, Aarhus Amtssygehus, Tage- as compared to the 1st and 2nd Years, where no change Hansens Gade 2, Aarhus DK-8000, DENMARK) in the students’ perception of the education environment Background: A three-year project on improving was noted. The fact that it was only the results of the 3rd postgraduate learning, applied several methods to improve Years that improved since 2002 might be an indication and monitor educational culture in three departments that the remedial changes made to their curriculum had a (Endocrinology, Orthopaedic Surgery and Anaesthesiology) positive effect on the students’ perception of the at Aarhus University Hospital, following the reform of educational environment. The DREEM Inventory could thus postgraduate education in Denmark. 246 doctors be a useful tool for action research studies of climates of participated. The aim was to improve educational culture health professions education environments. using limited extra resources. Actions: Means to facilitate improvement were selected, 8D 4 Assessment of the educational environment including introductory and follow-up interviews to individual at the College of Medicine of King Saud training plans, changes in work scheduling, e-portfolio, University communication courses etc. The concept of ’Culture Monitoring’ was introduced. Through measuring separate Ibrahim Al-Ayed* and Shafi Ahmed Sheik (College of Medicine & King Khalid University Hospital, Chief Pediatric Ambulatory values of importance and assessment, a set of Care Unit, Department of Pediatrics (39), King Saud ‘improvement indicators’ was established and monitored University, P O Box 2925, Riyadh 11461, SAUDI ARABIA) by psychologists, both before and after intervention. Every six months the doctors completed a questionnaire survey.

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Aim: To assess the educational environment at the College Teachers (r2=0.000), Academic (r2=0.015), Environmental of Medicine of King Saud University using The Dundee (r2=0.001) and Social (r2=0.000), Pearson correlation test. Ready Education Environment Measure (DREEM) inventory. Perceptions reached Apprenticeship 57.9, Teachers 63.9, Academic 63.4, Environmental 65.0 and Social 64.7. The Summary of work: The Arabic translation of the DREEM mean grade for the group was 56.90. Apprenticeship inventory was revised and refined. It was produced in a achieved higher correlation with all remaining perceptions. combined format (Arabic & English). A covering letter indicating the purpose of the study, the anonymity of Discussion: DREEM indicates the school’s learning and respondents and the optional status of the response was teaching climate. There was an expectation to see whether attached. 223 responded. Data were entered in MS-EXCEL it would correlate with OSCE-based assessment grades and analyzed using SPSS PC+ statistical software. Students’ for better climate, the higher the grades. Although t-test for single sample and two independent samples, perceptions reached a good correlation, the grades have and one-way analysis of variance were used to compare not been akin to an expected performance. domain values of Quantitative Variables (Scores) across Conclusion: The school’s climate seems not to have the Qualitative Variables. Duncan’s new multiple range was influenced clinical examination performance for Residency used to perform pair-wise comparison of scores. admission. Results: 222 questionnaires were analyzed. The overall score was 44.95% (89.9/200). A score of 40.69% (19.53/ 48) for students’ perception of learning, 48.27% (21.24/ 8D 6 Assessment of the medical environment at 44) for students’ perception of teachers, 46.31% (14.82/ NUI, Galway Medical School using the 32) for students’ academic self perceptions, 44.38% DREEM questionnaire (21.30/48) for students’ perception of atmosphere, and Gloria Avalos*, Fidelma Dunne and Ciara Freeman (National 46.29% (12.96/28) for students’ social self-perceptions University of Ireland, Medical Informatics & Medical was obtained. The scores of first year students were Education, Clinical Science Institute, Galway, IRELAND) significantly higher. Gender was not a statistically significant variable. The educational climate in the Faculty of Medicine at the National University of Ireland Galway was assessed using Conclusion: The results revealed a uniform gap in all the validated Dundee Ready Educational Environment aspects of educational environment. (DREEM) questionnaire. The current curriculum is delivered by a traditional didactic approach over six years. The 8D 5 DREEM questionnaire could not preview DREEM questionnaire was distributed by a researcher to 476 enrolled students (Years 1-6) at the end of the first residency admission grades in an OSCE- term 2004/2005. The response rate was 82% (n=389). based test Data was analysed using SPSS. The overall score achieved Maria Patrocínio Tenório Nunes*, Thelma Suely Okay, Itamar was 130 (max 200) indicating that the perceived de Sousa Santos, Júlio César de Oliveira, Cristina Helena environment is more positive that negative. This score is Ferreira Fonseca-Guedes and Joaquím Edson Vieira similar to that achieved in other medical institutions in the (University of São Paulo Medical School, Av. Dr Arnaldo 455 UK. The score was higher in females than males in relation Room 1216, São Paulo CEP 01246-903, BRAZIL) to social self-perception (p = 0.04). Irish students Background: The DREEM questionnaire evaluates study perceived a more positive atmosphere and social self- ambience. To provide selection for Residency programs to perception (p<0.001) compared with non-Irish. Two areas a public Hospital in Brazil, 2004, the Observed Structured of concern were highlighted by all years: I am unable to Clinical Examination (OSCE) was adopted. We compared memorise all that I need; There is a good support system OSCE scores with DREEM perceptions. for students that get stressed. Methods: Data from 314 physicians were obtained. Right Conclusion: Continuous improvement and innovation are after the OSCE assessment students were invited to answer essential in any medical school; the DREEM is a reliable a 50 items questionnaire. Data from the OSCE were method of identifying areas which serve to inhibit students’ correlated to scores from questionnaires. full learning potential. The use of DREEM as a monitoring tool permits timely interventions to remediate problematic Results: There was no correlation for assessment grades educational environments. and DREEM perceptions – Apprenticeship (r2=0.001),

8E AMEE Fringe 2

8E 1 Collegial dispute: toward an international effectively fulfil their roles as professionals, collaborators dialogue in conflict resolution in health care and health care advocates. settings using standardized professionals Objectives: This interactive session will explore various Kerry Knickle and Nancy McNaughton (University of Toronto, sources of conflict and attempt to uncover practical SPP-CRE, 200 Elizabeth St, 1 Eaton South, Room 565, Toronto, strategies for handling them. Through reflective story ON, M5G 2C4, CANADA) telling technique, dialogue, and live simulation exercises, participants will be encouraged to reflect on and problem Background: In today’s era of patient-centered care, it is solve sensitive and emotional collegial situations: ironic that healthcare providers are not better armed with understand the role that power and anger play in collegial the skills and techniques necessary to manage conflict dispute; explore the communication techniques and within their own environments. Without clear policies and strategies needed in conflict situations with colleagues; training opportunities in place, the conflicts that arise gain knowledge of the complex communication skills between colleagues over issues of team hierarchy, patient- required in the resolution of challenging inter-professional care, decisions surrounding end of life care and the conflict; engage in an ongoing international dialogue, with allocation of resources are increasingly common. Such the goal of enhancing conflict resolution knowledge and conflicts are a significant source of distress, consume skills within diverse health care cultures. considerable time and may lead to lasting difficulties for the patient-care team. Healthcare professionals need Methods: We will use interactive and experiential activities various communication and conflict resolution skills to in large and small groups. These include: reflective exercises which promote exchange of ideas; problem

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solving exercises; role playing with standardized existence as long as such protection does not conflict with professionals; demonstrations, and presentations; question the First or Second Law. We discuss the many conflicts and answer opportunities. We are hoping that the between the principle of “patients’ interests come first”, participants will be interested in engaging in a long-term the eminence-based recommendations of the Attending discussion about the changes and challenges they face in Physician, the consumer-minded requests of patients and handling collegial dispute issues within their professional families, and the duty to balance necessity of care with settings. modern medical economics. As the Intern is charged with resolving the intrinsic paradox that makes medicine human across both space and time, the humanism of the Intern 8E 2 Jeopardy feedback is itself brought into question. Laura Jayne Nelles and Kerry Knickle* (University of Toronto, Standardized Patient Program, 1 Eaton South Rm 565, 200 Elizabeth St, Toronto, ON, M5G 2C4, CANADA) 8E 4 The medical gameshow: an alternative format for formative exams Developed by a team of communications experts at the University of Toronto, this highly interactive Elizabeth Thorsteinson (United Arab Emirates University, communications game is intended as instruction and review P O Box 17666, Al Ain, UNITED ARAB EMIRATES) of the main characteristics of and strategies for providing Background: The Faculty of Medicine and Health Sciences effective feedback. It includes a review of communication (FMHS), United Arab Emirates University, has introduced techniques used in patient-centred interviewing and medical gameshows for some end of module formative encourages participants to focus their communications exams. The gameshow format has provided an opportunity feedback on specific, observable behaviours. This fun and for students to work as a team and to learn from each adaptable tool has implications for use in the training of other by providing explanations to their answers. Standardized Patients, students, faculty, and preceptors in giving feedback. Past participants have found this game Method: Questions previously used in written formative to be enjoyable, effective and highly addictive! exams are adapted to the Learningware “Gameshow Pro” program format. The program has various game formats that can accept questions with text, audio, or digital 8E 3 I, Intern images. The program has timed questions, has correct and incorrect answer sounds, and keeps track of team William Hu (Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA) points. A faculty member who has taught in the module is selected to be the “Gameshow Host”. Students divide Internship can be a stressful and life altering experience. themselves into teams, and each team must answer Pressures from patients, consulting staff, and endless selected questions under various subject categories. paperwork, exacerbated by sleep deprivation, can Following the answer, students must provide a rationale dehumanize the new physician and make them feel like for their answer. an automaton. Isaac Asimov introduced the three “Laws of Robotics” that governed the acts of robots in their service Conclusions: The gameshow is a very popular alternative/ to humans. Here we present the Three Laws of supplement to the traditional formative exam. It is highly “Internobotics”: First Law: An Intern may not injure a motivating, and provides an opportunity for students to patient, or, through inaction, allow a patient to come to learn from each other, and to work together in groups. We harm. Second Law: An Intern must obey orders given it have found it especially effective in the knowledge based by Attendings except when such orders would conflict with subject areas of the basic sciences. the First Law. Third Law: An Intern must protect its own

Short Communications 8F Introductory/transitional courses in medicine

8F 1 The online introductory course: a further at Florence University IT Centre, to allow the possibility of distance help for candidates at Italian following online the teaching activities. The lessons are Faculties of Medicine available also off-line (http://www.med.unifi.it/precorso- online/). The user feedback was guaranteed by an A Conti, M R Guelfi, M Masoni, A A Conti*, F Paternostro electronic questionnaire, to be filled in optionally. More and G F Gensini (University of Florence, Department of than 100 questionnaires were completed, from all over Critical Care Medicine and Surgery, Viale Morgagni 85, Italy, showing the important approval met by this initiative. Firenze I-50134, ITALY) In Italy the admittance to health degree courses is regulated by an admission multiple choice questionnaire, 8F 2 A course to introduce freshmen to an concerning biology, chemistry, mathematics, physics and innovative medical curriculum logic and general culture. For ten years the Faculty of M J Costa*, A Salgueira, R P Andrade, P Oliveira and J Pinto- Medicine of Firenze has organized a structured orientation Machado (Universidade do Minho, Medical Education Unit, and teaching activity, aimed at preparing for the entrance School of Health Sciences, Gualtar Campus, CPII, Piso 3, exam. Braga 4710-057, PORTUGAL) As further help, in the last three years the Faculty has The medical degree of the school of Health Sciences of activated the Online Introductory Course. This initiative the University of Minho is innovative in its curriculum and allows the students to make use of the teaching material educational strategies. From the start, admitted students not only disregarding spatio-temporal bounds, but also are challenged in aspects that they generally do not following the learning modalities most appropriate for each anticipate: i) the development of a permanent sense of one. The success of the Online Introductory Course was personal and professional development; ii) the adaptation evidenced by the more than 2.600 online accesses to the to a new in-class teaching strategy of learning by lessons usable via the Web, registered in August and objectives; iii) the development of self-directed learning September 2003, and from approximately 8,850 accesses methods; iv) the mastery of essential laboratory and in the same 2004 period. In the last edition, lessons were information technology skills; v) the attainment of basic retransmitted in live streaming with the collaboration of proficiency in using descriptive statistics. In Portugal,

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medical schools do not participate in the process of student of this training unit was to improve student integration by selection. The school anticipated problems in freshmen providing training in skills and hospital procedures. adaptation and devised a course on “Introduction to the Methods: Components of the introductory week were Medical Degree”, which was set as the first in the developed based on a needs assessment and included curriculum. It presents freshmen with a holistic perspective anamnesis collection, handling laboratory forms and of the degree and provides room in the curriculum for patients’ files, repetition of practical skills (nasogastric tube, educational readjustments and a preliminary reflection on arterial puncture, ECG, Doppler ultrasound), introduction professionalism. The course has now been taught for 4 to the DRG-system with ICD-coding and preparation of a years to 217 students. Present retention rate of the school discharge letter. In order to ensure high quality practice is under 4%. This work describes the course and provides the training units were case-oriented and used evidence of its effectiveness in attaining adaptation and standardized patients. Evaluation of acceptance and self- the development of important basic competences in newly efficacy and a follow up-evaluation at the end of the 4- admitted students. month term in internal medicine were carried out. Results: Overall satisfaction was very high (n=21; 1.38 ± 8F 3 A new thorough introductory course 0.5; 1 = very good, 6 = insufficient). In self-assessment Göran Thomé*, Margareta Troein and Martin Garwicz (Lund students estimated that their knowledge and skill University, Centre for Medical Education, P O Box 117, Lund, performance had improved significantly (p<0.01). SE 221 00, SWEDEN) Relevance of the issues was highly rated even at 4-month follow-up. Background/rationale: Course evaluations indicated that the former introductory course (2 weeks) was much too Conclusion: A structured introduction to elementary ward short for students to obtain an overview of the medical procedures enables a better integration of final-year program, an introduction to the profession, to studies at students into the ward. the Faculty of Medicine, a glimpse of medical research and a good grasp of PBL. 8F 5 Professional approach to introduce What was done: A longer (8 weeks) introductory course structure, content and requirements at with components representing different parts of the medical program was developed. Particularly skilled medical school to freshman students teachers and tutors were recruited and a portfolio was A M Böthern, N Griepentrog*, H van den Bussche and O introduced. The course has by now been given 5 times. Kuhnigk (Universitätsklinikum Hamburg-Eppendorf, Students’ reactions are strongly positive. They profit from Modellstudiengang Medizin, Haus N16, Martininstr 52, the PBL method (5.5 on a 1-6 Likert-scale), they are able Hamburg 2046, GERMANY) work with a portfolio (5.6), and they have achieved an Background: German universities are bound to offer a well overview of the program (5.1). The research part scores defined “introduction unit” at the beginning of 1st term. It somewhat lower and it appears that the students’ interest is usually organised by students without any quality control in research has not grown. by the office for student affairs. To achieve short and Conclusions: The students have appreciated the principles successful studying and low drop-out-rate, a specific study of the new course although some students consider it too behaviour and a high degree of understanding of the long. A smooth transition to the more normal study curriculum is required. Therefore a task group of the office situation must be developed. for student affairs and the “Modellstudiengang Medizin” developed a concept for the introduction unit with the Take-home message: A thorough introductory course is following content: teaching of study and examination worthwhile and gives students a good start. It is, however, structure; encouragement to reflect on one’s own study important to prepare teachers in the following courses for behaviour; dealing with specific learning strategies for their students’ new experiences. medical studies. Methods: Elaborated didactic methods support self-directed 8F 4 Introductory week for final-year medical learning, e.g. supervised self-study units with a students for better integration on ward “studyguide” as a reference book about the medical curriculum and medical school. The introduction unit itself B Kraus*, J Juenger, M Schrauth, P Weyrich, S Zipfel and C last one week and will be realized by trained student tutors. Nikendei (Medical University Hospital, Medizinische Universitätsklinik, Abteilung Innere Medizin 2, Im Take home message: In the introduction unit learning Neuenheimer Feld 410, Heidelberg 69120, GERMANY) strategies are taught on the basis of content and structure Background: Integration and high efficiency of assignment of the medical curriculum. Hence, the concept allows on ward are often difficult for final-year medical students teaching of both content and study behaviour in a short to achieve. Therefore, we developed a one-week period of time. Concept and evaluation approach will be introductory program for final-year medical students doing presented. their full-time assignment at our University Hospital. Aim

Workshops 8H & 8J

8H Teaching Professionalism: principles and For a variety of reasons, reliance upon this method alone practices is no longer adequate, and most schools of medicine have found it necessary to establish formal programs of Yvonne Steinert, Richard Cruess, Sylvia Cruess and Linda Snell instruction to complement and improve role modeling. Over (Centre for Medical Education, Faculty of Medicine, McGill the last eight years, McGill University has introduced the University, Montreal, CANADA) subject of professionalism at the student and resident level, Background: For generations, professionalism and the developed educational methods and resources for teaching attitudes and behaviour patterns necessary to sustain it professionalism, and designed faculty development were communicated from physician to physician by programs to support this initiative. This workshop will respected role models during the process of socialization. outline the steps and methods needed to teach

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professionalism across the continuum of medical education purposes, is of significant dimension. Doctors have little and give participants an opportunity to discuss the time to read everything they need to solve all the problems principles involved in developing such a program, including they face when seeing patients. What is needed is a system the need to present the cognitive base of professionalism, of knowledge that can be assessed on a real-time basis, is the value of promoting self-reflection, and the benefits of scientific sound, and easy to use. Handheld computers – linking evaluation with teaching. During this workshop, Personal Digital Assistants (PDA) – can serve as a excellent participants will also examine diverse strategies for tool to support medical decision making in this setting, teaching this subject matter (e.g. case vignettes; portfolios; since they are easily portable, can fit in a lab pocket, can observation and feedback), learn from each other’s be used in every setting of care (outpatient clinic, hospital experiences, and begin to develop an educational plan wards, intensive care units, emergency rooms) and have pertinent to their setting. enough memory to be able to carry significant amounts of Objectives: By the end of this session, participants will be medical information under different formats. PDAs have able to describe the core attributes and behaviours of the potential to improve quality of medical care, diminish professionalism, identify general principles for designing errors and organize medical practice. For example, one educational programs that promote the teaching and can have several types of software in a PDA that are of learning of professionalism, and discuss common methods potential use for doctors in several areas: medications for teaching this content area. They will also be able to (indications, dose, administration, etc.), drug-interactions, discuss the challenges inherent in designing such programs differential diagnosis, formulas and calculations, medical and design an educational program relevant to their bibliography, textbook type of information. context. Workshop content and structure: Welcome and needs Suggested audience: Medical educators, program directors, assessment; Presentation of PDA platforms: Palm and clinicians, and teachers responsible for teaching Windows CE; Types of software, sources, downloading professionalism at all levels of the curriculum. techniques; Practical demonstration with an HP Pocket PC. Intended outcomes: (1) To find out some facts about the 2 major existing platforms for PDAs – Palm and Windows 8J Lab coat pocket knowledge: the PDA as an CE – in terms of advantages and problems for medical aid to medical and teaching decision- practice; (2) To identify major areas where PDAs can be making: a course for beginners used to improve care and teaching; (3) To select the sources in the Internet where specific software can be Antonio Vaz Carneiro and Madalena Patrício (University of Lisbon School of Medicine, Av Prof Egas Moniz, 1649-028 downloaded (free or not). Lisboa, PORTUGAL) Intended audience: Doctors and educators that are Background to the topic: The amount of information a interested in IT in medicine, specifically using PDAs. doctor must have for patient care, as well as for teaching Level of workshop: Beginners.

Short Communications 8L Teaching and learning clinical skills 1

8L 1 A qualitative study of the learning of clinical 8L 2 The proper use of the simulation laboratory: skills by medical students a strategy to challenge attrition in medicine Paul Bradley*, Pamela Bradley and Robin Oswald (Peninsula M Martin*, D Dorion, G Bisson and R Lemieux (University of Medical School, Research Way, Tamar Science Park, Derriford, Sherbrooke, CHUS, 12th Avenue North, Fleurimont J1H 5N4, Plymouth PL6 8BU, UK) CANADA) Aims of presentation: Clinical skills learning is an important Aim of presentation: A rational use of the simulation part of the undergraduate medical curriculum, yet little is laboratory to maintain competence in procedural known about how students learn these skills. This study knowledge in medicine using cognitive task analysis (CTA), aims to explore what influences students’ learning of clinical kinesiology (KIN) and mental representation (MR). skills. Summary of work: CTA is a process of deconstructing an Summary of methods: 9 students participated in semi- expert’s knowledge of a task and adapting it to the needs structured interviews exploring their perceptions of what of the educational model. KIN is a decomposition of influenced their learning of clinical skills. The interviews movements used to better mentally represent the were recorded and transcribed verbatim. The transcripts procedure taught. By using such a strategy, we studied were coded and analysed for emergent themes. the dynamic of attrition on three subgroups of medical students. Summary of results: 6 major themes emerged from the data. These related to the clinical skills course itself, the Summary of results: The repeated OSCE test done on the teaching, learning and feedback, the clinical skills tutors subgroup using the mental representation program showed and other healthcare professionals, access to and use of no attrition phenomenon after 2 years of teaching a surgical self-directed learning, student motivation and the procedure without any further practice in the laboratory importance of assessment in driving learning. while the attrition phenomenon has started in the other two subgroups. Conclusions: Important factors affecting the learning of clinical skills have been identified. A model for supporting Conclusions: The simulation laboratory has been recently clinical skills learning is presented although additional advocated to teach procedural knowledge in medicine. We research, both qualitative and quantitative, is needed to submit that a proper strategy of learning must be used in explore this issue further. order to challenge the attrition phenomenon and rational use of these simulation laboratories.

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8L 3 Comparison of basic skills levels of old and of pre-recorded Korotkoff’s sounds was adjusted to mimic new curriculum graduates those heard in patients. Students were examined using BPSTAs calibrated to read 105/75 mmHg or 136/90mmHg. G Peeraer*, A Scherpbier, B Y De Winter, R Remmen, K Post OSCE, students completed questionnaires which Hendrickx, J Weyler, P Van Petegem and L Bossaert (University included questions relating to demography, competence of Antwerp, Faculty of Medicine, Universiteitsplein 1, Gebouw S2, Wilrijk 2610, BELGIUM) and confidence in BP measurement. Aim of presentation: In 1998, the University of Antwerp Of the 94 students, 82 obtained an answer which fell within started a new and integrated medical curriculum with the pre-determined limits for this study. Analysis of student extensive skills training. We investigated whether there questionnaires is progressing. was a difference in basic skills level between old and new Conclusions: BP training was a successful, although time- curriculum graduates. consuming exercise. Preliminary analysis suggests that Summary of work: We did an OSCE assessment in the training has improved students’ technique, procedural students’ final year: one sample from the traditional understanding of, and confidence in, BP measurement. curriculum (n= ) and one from the renewed curriculum (n = ). 8L 5 A transitional clinical programme between The OSCE consisted of 15 stations. We tested students’ the early clinical exposure of the junior basic clinical skills levels on completeness, systematic years and the clinical clerkships leads to approach and proficiency. The sum of these 3 scores led rapid growth in clinical confidence, to a total score per station. competence, knowledge and professional Summary of results: The global OSCE-scores (mean scores maturity of third-year students of 15 stations) were statistically significant higher for new curriculum students. On a station score level, however, Richard Hift (University of Cape Town, 98 Louis Thibault they scored statistically significantly (p<0.01) better on 6 Drive, Edgemead, Cape Town 7441, SOUTH AFRICA) stations, whereas traditional curriculum students scored Aim of presentation: We describe a successful programme significantly better on 3 stations. On the other 5 stations, facilitating the entry of students into clinical clerkships. no significant difference was found. Summary of work: On entering the sixth semester of our Conclusion: New curriculum students score better on the problem-based curriculum, students have already learnt overall OSCE scores thanks to their integrated skills training diagnostic clinical skills with limited exposure to medical program. Further insight on the role of clerkship experience patients. We designed a new programme for the semester on obtained skills levels is needed. with these objectives: Increase confidence in working with patients; Deepen experience through intensive patient exposure; Broaden skills and experience to other categories 8L 4 An investigation into first year medical of patient; Continue patterns of active, self-directed and students’ competence and honesty in group-based learning into the clinical programme. recording blood pressure (BP) using a Life/ We designed a 16 week rotation incorporating adult health, form® Blood Pressure Simulator child health, mental health, women’s health, perinatal Debra Patten*, Jane Roberts, Richard Gott and Sheila Nunn medicine and dedicated skills training. Exposure to patients (University of Durham, Phase 1 Medicine, Queen’s Campus, was maximised. Student-centred, self-directed and group University Boulevard, Thornaby, Stockton-on-Tees TS17 6BH, learning were promoted. Activities were recorded in a UK) portfolio of learning; assessment centred on a portfolio- Ability to accurately measure BP is a core skill required of based interview, separately evaluating clinical knowledge, undergraduate medics. Studies suggest that there are still utilization of learning opportunities and growth in deficiencies in the teaching and performance of BP professionalism. measurement, but there is a paucity of data regarding Summary of results: Students demonstrated rapid growth students’ honesty/professionalism in a clinical skills setting. in clinical confidence, competence, knowledge and This study evaluates: training and competence in BP professional maturity, and the programme was highly rated. measurement and students’ confidence and professionalism. 94 students watched an in-house video Conclusions/take-home messages: A well-constructed production illustrating the technique for manual BP transitional semester between the early clinical exposure measurement in patients and using BPSTAs. Students of a modern curriculum and the clinical clerkships is practised the technique with trained facilitators and valuable in inducing rapid maturation in clinical skills, colleagues. Ability to measure BP was subsequently knowledge and professionalism. assessed in a formative OSCE using BPSTAs whose volume

Short Communications 8M General practice/family medicine 2

8M 1 The needs of general practitioners for The researcher compiled a model that depicts the synthesis continuous professional development in of the literature study, entitled “Best evidence CPD model” South Africa and the recommendations of this study are linked to this model. The main findings of the results of a questionnaire Elmie Castleman* and M M Nel (FPD, PO Box 74789, were as follows: It was clear that venues and the time of Lynnwoodridge 0040, SOUTH AFRICA) CPD events had a lesser effect on general practitioners The overall goal of the study was to make a contribution than that of cost. The principal reasons for attending CPD to the effective and efficient implementation of the CPD events are personal interest in a topic and the content. system for medical general practitioners in South Africa There was a close correlation between the clinical CPD through identifying their CPD needs with regard to content, needs identified; the most prevalent conditions as indicated cost, time and learning situations and to ultimately support by the respondents and also with the National Health health care in South Africa through education. priorities. The non-clinical needs identified were closely

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related to either the lack of these topics in the 8M 4 The GP vocational training curriculum: undergraduate curriculum or to new developments. provision, experience and needs CPD providers who want to improve the efficacy and Julie Bedward, Ian Davison, Mike Deighan, Stephen Field, efficiency of CPD programmes should consider adopting Adam Fraser, Stephen Kelly* and Hywel Thomas (West and applying the “Best Evidence CPD Model” compiled by Midlands Deanery, Institute of Research & Development, the researcher in this study. Birmingham Research Park, Vincent Drive, PO Box 9771, Edgbaston, Birmingham B15 2XE, UK) 8M2 General practice in the foundation years: is Background/Rationale: As part of its review of the training curriculum for general practitioners, the RCGP undertook there added value? a review of the relevant literature and surveyed GP S Cavendish*, E Steventon and R Higgins (LNR Postgraduate Registrars, newly qualified GPs and trainers and course Deanery, Lakeside House, 4 Smith Way, Grove Park, Enderby, organisers on the issues identified. Leicester LE19 1SS, UK) What was done? The literature on the appropriate The Leicestershire, Northamptonshire and Rutland curriculum for training general practitioners highlights key Postgraduate Deanery is conducting an action research issues as: the length of training, its distribution between evaluation of the local implementation of a new style 2- hospitals and general practice, the specific content of the year Foundation training, with pilots running from August training programme and continuity with other phases of 2004 to 2005. The key question addressed by this paper training. A national questionnaire survey received replies is: Does the GP experience in FY2 provide added value for form 817 GPRs, 521 newly qualified GPs and 1559 trainers all trainees regardless of their future intended specialism? and course organisers and is currently being analysed If so, what is this added value? against these issues. 35 trainees entered the Foundation Year 2 (FY2) Conclusions: Initial analysis shows clear views on the length programmes comprising 3 x 4 month posts, with one post of training and the distribution between hospital and in General Practice and two in hospital. Qualitative data general practice. We also show the relationship between was gathered through email, telephone and face-to-face actual and preferred experience in hospitals and views on interviews. Thematic analysis of the preliminary data has significant omissions in the content of training. been undertaken. At the start of the evaluation, 38% of the trainees showed a strong preference for a future career Take-home messages: The data show clear preferences in General Practice, all but one were female. Benefits of for more training to be based in general practice. The General Practice experience include: More appreciative of previous experience of GPRs raises questions about the preventative issues; Awareness of difficulties in dealing match between actual experience in hospital posts and with discharged patients; More exposure to gynaecology training preferences. and dermatology; More teaching and senior support; Time to consider psychological problems; Opportunity for 8M 5 Newly qualified GPs: well-equipped or community work; Improving knowledge of drugs and under-prepared? prescribing; Recognising and diagnosing disease; Team work. Ian Davison*, Mike Deighan, Steve Field, Adam Fraser, Stephen Kelly and Hywel Thomas (University of Birmingham, School of Education, CRMDE, Edgbaston, Birmingham B15 8M 3 Changing GP vocational training: perspectives 2TT, UK) from trainers and course organisers Rationale: This study explores the attitudes of participants Julie Bedward, Ian Davison, Mike Deighan*, Stephen Field, and educators regarding the scope, length and quality of Adam Fraser, Stephen Kelly and Hywel Thomas (University of the GP vocational training scheme and the two-year post- Birmingham, School of Education, CRMDE, Edgbaston, qualification Higher Professional Education scheme. The Birmingham B15 2TT, UK) nature of both schemes is currently being debated in the Background/Rationale: Trainers and course organisers have context of Modernizing Medical Careers in UK. a key role in the training of future general practitioners. What was done? As part of the Royal College of General How they view proposals for changing GP training and its Practitioners’ curriculum review, GP Registrars, newly implications for their role may well influence the success qualified GPs, and trainers and course organisers of any changes that are introduced. It is against that completed questionnaires. The response rate was 61% context that the RCGP commissioned a survey of trainers (2,897 out of 4,734). Questions concerned the content and course organisers. and quality of training, time for curriculum areas, learning What was done? A literature review on trainers and course needs, and possible improvements. The Higher Professional organisers highlights the importance of their teaching skills, Education leads in the 14 English regions were interviewed the nature and complexity of the relationship between during the national evaluation of this scheme. trainer and trainee and the need for ensuring that Conclusions: Data are still being collected and analyzed; forthcoming changes allow the developmental nature of however, preliminary analyses indicate high satisfaction the relationship to be protected. The subsequent national with GP registrar training, but greater ambivalence towards questionnaire survey elicited replies from 1559 trainers hospital based training. Overall, the GP educators are less and course organisers (69% response). Questions were satisfied and place more emphasis on performance issues posed on: the length of experience as a GP before such as dealing with clinical uncertainties rather than becoming a trainer; time spent on supervision; the clinical knowledge and skills. importance of the one-to-one relationship; the tensions in Take-home messages: Newly qualified GPs are broadly the roles; and their influence over the training curriculum. satisfied with their training, but there are numerous (partly Conclusions: Analysis of these data is currently in progress conflicting) suggestions for improvement. and will be reported at the conference. Take-home messages: There is broad agreement among educators on the need for significant changes in general practice education and on what those changes should be.

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Short Communications 8N Competency based postgraduate education

8N 1 Curriculum planning by consensus: national 8N 3 Centralized training of general strategies in UK Emergency Medicine competencies of different postgraduate Darren Kilroy (Faculty of Accident & Emergency Medicine, programmes Stepping Hill Hospital, Stockport, Cheshire SK2 7JE, UK) Jan Borleffs*, Inne Borel Rinkes, Hanneke Mulder and Olle Aim: To describe how, using a national structured Delphi ten Cate (University Medical Center Utrecht, School of Medical strategy, the UK Faculty of Emergency Medicine is working Sciences, Universiteitsweg 100, Utrecht 3584 CG, NETHERLANDS) to establish a consensus-based anatomy curriculum of core knowledge for postgraduate trainees. The findings of this The Dutch College of Medical Specialties has presented project will provide clarity for learners as well as help inform guidelines for modernisation of postgraduate specialty examination content by ensuring that only relevant training programmes in the Netherlands. These guidelines knowledge is incorporated into assessment. include the definition of seven general competency fields derived from the CanMEDS 2000 model (medical Summary of work: A 3-round Delphi process, administered performance, communication, collaboration, knowledge to 40 UK Consultants in Emergency Medicine, has been and science, community performance, management, employed to seek opinion in relation to relevant core professionalism). By 2006 all postgraduate specialty anatomical knowledge which trainees should possess in training programmes will be based on these competency order to practise safely in the specialty and to maximise fields. When applying this model, many general success in specialty examinations. competencies, important for specialists, will become Summary of results: The project is ongoing and exciting. explicitly part of training programmes. Roughly, the Early rounds have met with a response rate of 85%.The competencies can be divided into discipline and non- completed consensus document will be available to view discipline specific competencies. Formulation of discipline at AMEE 2005. Within the Faculty, we plan to extend the specific competencies will be done by each society of project into other aspects of core basic science knowledge. medical professionals. However, it would be inefficient if Take-home message: Establishing curricular content for each society would also generate competencies that turn basic sciences at postgraduate collegiate level using a out to be non-discipline specific objectives. Therefore the consensus methodology has not previously been described. University Medical Center Utrecht has presented a blueprint identifying subjects that will cover the non-discipline It promises to be a significant means of achieving clarity specific competencies for all residents in the region. for trainees and assessors and has widespread implications for an international audience. Subjects that have been selected include Evidence Based Learning and Protocols, Communication Skills, Patient Safety, Education Skills, and Management. Currently, we 8N 2 Competency-based learning objectives for a are in the process of designing the courses dealing with Canadian family medicine residency program these subjects. The process of identification, selection and construction of the courses will be presented during the Danielle Saucier* and André Bilodeau (University of Laval, conference. Department of Family Medicine, Local 1327, Pavillon Vandry, Quebec, QC G1K 7P4, CANADA) Aim of presentation: Describe the process and results of a 8N 4 Negotiated learning agreements in competency-based approach to writing learning objectives postgraduate specialist training representative of our discipline’s unique characteristics, Simon Edgar* and Phillip Evans (8 Church Hill, Edinburgh for Laval’s Family Medicine residency program. EH10 4BQ, UK) Summary of methods: Nine working groups, helped by Aim: With the establishment of PMETB (Postgraduate physicians in different practice settings, identified the key Medical Education and Training Board) in the UK, major areas of competency needed to practice in our country in changes are taking place in the field of medical education. the near future. Fundamental to these changes are the establishment of Summary of results: The 166 “Objects” covering the competency-based curricula for all specialties. It is evident essential curriculum (i.e.: Acute abdominal pain, Anemia, that the need for postgraduate self-directed learning will Interdisciplinary work) were described into intermediate increase and these opportunities and experiences are and terminal competencies. We organized them within 6 explored through negotiated learning agreements. domains of competencies of care for specific patient Summary: Having assessed the drivers and constrainers populations: Care of children, youth, families and women, for Negotiated learning, we used the competency-based Ambulatory problems, Adult health/ambulatory medicine, curriculum for Anaesthesia in the UK as our model. Learning Critical- and in-hospital care, Mental health, and Care of agreements were established with a cohort of anesthetists elderly and palliative populations; and 3 domains of in training and compared with a control group. The transversal competencies, presented as necessary basis agreements established the generic learning outcomes for for practice: Community-oriented care, Professional attachment to our unit and modified those based on current relationships, Professional tools. competence. Agreements established how evidence of Conclusion: This approach clearly describes the unique progression would be attained and finally made explicit features of family practice in Canada and the level of the standard of performance expected. The contracts were competency expected at the end of the residency, instead evaluated by a satisfaction index and these results of a specialty-oriented description of training. It includes triangulated by interviews with an independent observer newer areas of training expected from our society. on an individual basis. Residents find it a practical tool to focus their learning Results: This is work in progress. We hope to demonstrate: toward the key issues dealt with by family physicians. Improved learner satisfaction. Evidence of flexibility in attainment of learning outcomes based on initial competence. Evidence of increased ownership of learning process by learners and teachers.

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8N 5 Consensus methodology: developing a 8N 6 Task analysis and clinical educational needs competency-based training programme in assessment for General Practitioners in intensive care medicine Islamic Republic of Iran H Barrett*, J Bion, S Field, A Bullock, A Hasman, J Askham, A Shahram Yazdani, Saeid Hatami*, Mohammad Hosseinzadeh, Kari and P Mussalo on behalf of the CoBaTriCE Collaboration Fakhrosadat Hosseini and Ramin Homayouni (Shaheed (University of Birmingham, Dept of Anaesthesia and Intensive Beheshti University of Medical Sciences, Educational Care, North 5, Queen Elizabeth Hospital, Edgbaston, Development Center, Tabnak Street, Shaheed Chamran Avenue, Birmingham B15 1TH, UK) Evin, Tehran 1985717443, IRAN) Aim: To describe the consensus methodology used to Aim of presentation: Considering the GPs’ major role as identify and articulate the core competencies required of health care providers in Iran, we did a detailed description a specialist in Intensive Care Medicine (ICM) across national of GPs’ tasks and subsequently, a theoretical and practical borders. clinical needs assessment. Summary of work: The CoBaTrICE (Competency Based Summary of work: Disease entities extracted from ICD- Training in Intensive Care medicine in Europe) project aims 9CM and reduced through several revisions to 1300 disease to harmonise standards of training in ICM. We used a entities in 20 disciplines formed the basis for GPs’ tasks modified Delphi process and Nominal Group techniques analysis in seven sections of diagnosis treatment, referral, to involve all interested stakeholders - individual health follow up, prevention, and patient education. A coding care professionals, educators, national organisations, system of 3 to 6 levels specified the task levels patients and relatives - in the development of an comprehensively in each section. Theoretical clinical needs internationally acceptable set of core competencies. assessment were defined in 10 sections of definition, Summary of results: From over 5250 suggestions, an epidemiology, etiology, pathophysiology clinical manifestation, paraclinic investigation diagnostic approach, iterative editorial process produced 169 competence stems therapeutic approach, complication prognosis, and to which four levels of expertise could be applied. A nominal group of 12 international professionals selected the prevention with a two dimensional coding system including minimum level of expertise required of a safe practitioner necessity of study, and level of study text books (16 for each competence stem, before rating importance. This possible states). 430 medical faculty members in teaching, two step process offered valuable insights into the diversity research, and managerial position participate in the needs assessment through Delphi technique and focused groups. of ICM practice worldwide. Level of expertise influenced participants’ ratings of importance. A second round Delphi Summary of results: The project was completed in 4 years generated constructive comment which informed the final (2000-2004).The results were analyzed and the final selection of core competencies. version published in a series of 20 books. Take home message: Consensus development of Conclusions: The results of this study had invaluable competencies ensures that the interests of all stakeholders implications in health system and medical education such are considered, thereby promoting ownership and uptake. as its contribution in development of medical textbooks, Detailed outcomes will be reported to the AMEE conference outcome-based student evaluation, clinical guidelines, legal 2006. and development of higher policies in health and insurance company reimbursement system.

Short Communications 8O Curriculum management and the stakeholders

8O 1 Health service user involvement in medical users be involved? How can service users get involved? education: key stakeholders’ views and Who can be involved? Where can involvement take place? experiences When can service users be involved? What considerations relate to service user involvement? C Rees*, P Lings, L Knight and N Britten (Peninsula Medical School, St Luke’s Campus, Heavitree Road, Exeter EX1 2LU, Take-home messages: Educators are encouraged to involve UK) service users in medical education in a thoughtful and considered way. Background/rationale: The Department of Health, UK (1999) states that clients of healthcare services should be more involved in medical education as teachers, assessors 8O 2 Introduction of new curricula - special and curriculum developers, rather than their traditionally features and resistance of a faculty: a passive role as “teaching material” (Spencer et al, 2000). qualitative research approach to describe Although research (Hendry et al, 1999) has demonstrated change processes at a medical school the effectiveness of service users as teachers, there is a dearth of literature outlining key stakeholders’ views and D Koenecke*, M Bullinger and O Kuhnigk (University Medical experiences of service user involvement in medical Center Hamburg-Eppendorf, Modellstudiengang Medizin, education. Martinistr 52, Hamburg 20246, GERMANY) What was done: Eight focus group discussions are being Background: A curriculum based on PBL (for the first 3 conducted with different stakeholders (i.e. medical years) was implemented in 2001 parallel to the traditional students, service users, clinical and non-clinical educators). curriculum. In the beginning of the reform project many Participants are discussing their views and experiences of obstacles occurred (e.g. drop-out, little acceptance of PBL service user involvement in medical education. All by teachers). Retrospectively, the necessity of taking into discussions are being audio taped, transcribed verbatim account certain steps of preparation as well as the necessity and three authors are applying ‘Framework’’ (Richie and of monitoring change processes was examined. Spencer, 1994) analysis to the data to determine emergent Summary of work: Which implementation strategy is themes. essential to optimize reform processes, especially to make Conclusions: So far, seven themes have emerged from exchange of experiences more useful? Exemplarily, the the data and key findings within these themes will be curriculum change process at the University of Hamburg discussed: What is the ‘right’ language? Why should service is described. It serves as a review of essential prerequisites

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and implementation steps needed for reforming medical The aim of this presentation is to provide evidence of the schools. Relevant persons participating in the reform attitudes to and experiences of Dental Chairside teaching project “Modellstudiengang Medizin” were identified. They from the perspective of final year dental undergraduate were surveyed with a semi-structured interview. The students. The data are drawn from a larger scale study analysis of the interview is carried out with a qualitative funded by the LTSN to evaluate the Chairside teaching in content analysis. Dental Schools across the UK. The study was planned and will be undertaken in two phases. Phase one, which has Results: Data are still being analyzed. Research approach already been competed, took as a case study, one Dental and results will be presented. School in Wales in the UK. Using a mixed methods approach Take home message: How to manage change has not been of survey, semi structured interviews and focus groups, sufficiently considered while reforming medical curricula. the practice of clinical Chairside teaching was explored We assume that active designing of change processes is from the perspectives of the patients, the students, the helpful to minimize resistance at medical schools and is dental nurses and the dental tutors. Phase two which is also helpful to present a satisfactory as well as a successful currently work in progress will take the form of a national change process. survey across dental schools in the UK. The focus of this presentation is to consider the key educational issues that emerged as significant themes from the analysis of the 8O 3 The implementation of a framework focus group interviews conducted with three fifth year agreement between Teaching Hospital student groups (n=24). The conclusions focus around Trusts and Birmingham University Medical learning and teaching and highlight the ways in which School: a follow up study of attitudes students recognise and respond to educational activities amongst teachers and students that are well structured, interactive and underpinned with a solid theoretical base. Celia Popovic* and Andrea Bolshaw* (University of Birmingham, Medical Education Unit, The Medical School, Edgbaston, Birmingham B15 2TT, UK) 8O 5 Developing the patient voice to enhance Aim of the presentation: to describe a research project learning and partnership working in health which explored the effect of the introduction of a Generic care Framework Agreement between a UK Medical School and Penny Morris, Fiona O’Neill, Andrea Armitage*, Julie Symons, Teaching Hospitals. Rob Lane and Trudie Roberts (University of Leeds, Medical Background: Following a rapid increase in the number of Education Unit, School of Medicine, Worsley Building, Level students on the MBChB programme, Birmingham Medical 7, Leeds LS2 9NL, UK) School has expanded the number of hospitals (National Medical schools are urged to serve their communities by Health Service Trusts) involved in the course. The Quality transferring knowledge developed in that community. Assurance Office designed and implemented a Generic Health policies and professional curricula in the UK Framework Agreement (GFA): a formal contract between increasingly focus on the involvement of patients in the the medical school and each Trust. This specifies what the management of illness and ensuring patient safety. Working Trust should provide in return for SIFT funding. in partnership remains a challenge for professionals, due Work Done: Teachers and students were surveyed before partly to barriers to learning in the working culture: this is the GFA was implemented and again a year later. Analysis our focus. Collaborative work in the Faculty of Health and of closed and open questions revealed an interesting Medicine at Leeds University addresses the issue. We have phenomenon. explored ways to develop the capacities of patients and the community to contribute to the curriculum. Results Conclusions: Students showed broad satisfaction or are diverse inputs by patients, users of mental health improvement in all aspects surveyed. Teachers showed services, carers and community group members to learning improvement in tangible aspects such as teaching facilities and assessment, particularly about communicating and and knowledge about the specific content of the curriculum, decision-making. We are now applying the ethos and but deterioration in satisfaction with less tangible aspects models developed to locally based leaders and managers such as rewards and incentives for teaching. of health services and the voluntary sector, supported by Take Home Message: Just as assessment drives learning, Knowledge Transfer funds. We have interim findings from quality control can determine service delivery and pilot programmes, using an iterative evaluation framework improvements. to analyse surveys, interviews with participants and workshop processes, involving 60 senior managers together with clinicians and patients as teachers. New 8O 4 Dental chairside teaching: valuing the learning approaches need to be created by productive experience? dialogue to build supportive organisational cultures, systems knowledge and professional skills. Lesley Pugsley*, John Sweet and Jeff Wilson (Cardiff University, Academic Department of Postgraduate Medical & Dental Education, School of Postgraduate Medical & Dental Education, Wales College of Medicine, Biology, Life and Health Sciences, Heath Park, Cardiff CF14 4XN, UK)

Workshops 8R, 8S, 8T & 8U

8R Let’s agree to disagree: quality assurance Background to the topic: From July 1998 to April 2004, procedures in standardized patient approximately 38,000 candidates were tested as part of assessments the ECFMG Clinical Skills Assessment (CSA). Valuable lessons regarding the development and monitoring of cases Danette McKinley, John (Jack) R. Boulet and Marta van Zanten and SPs were learned. Analyzing the characteristics of (Educational Commission for Foreign Medical Graduate, successful (and unsuccessful) case scenarios and checklists Philadelphia, USA) can provide useful information for the development and

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administration of other SP-based assessments. Technical A number of young clinicians have chosen to commit a problems can arise with standardized patient examinations significant amount of their time to work in medical regardless of the care with which cases are prepared. Cases education. This new group of Young Educators will benefit may prove to be too easy or too hard for an effective from a special international Interest Group with which they examination. may share their concerns, challenges in the field and future Workshop content and structure: An overview of the career plans. The newly established Forum of Young methods used to review case scenarios and checklists at Educators within AMEE – and the workshop will be the various phases (i.e., SP training, field trials, and ongoing second meeting for planning such a Forum. performance) will be provided. Criteria related to content Workshop participants will develop topics for the Forum’s review and statistical performance will be presented. agenda and will define the need for training programs in Audience members will participate in a simulated review areas of mentoring and leadership in medical education, session. tailored specifically for young medical educators. We will Intended outcomes: The purpose of this workshop is to also discuss and suggest membership criteria for joining provide an overview of the various quality assurance the Forum, networking, and research activities for career techniques that can be used through many of the phases advancements in an international context. of the examination to ensure more valid and reliable assessment of candidate proficiencies. Potential problems 8U Mastering the scholarly process with case scenarios and checklists will be identified. Statistical procedures that can be useful in the case William McGaghie (Northwestern University Feinberg School evaluation process will be presented and the utility of case of Medicine, Ward 3-130, Mail Code - W117, 303 E Chicago Avenue, Chicago, IL 60611, USA) statistics in the test development process will be highlighted. Background: Medical schools worldwide are academic environments, organizations where scholarship in several Intended audience: All medical educators forms is advanced in many disciplines. Academic work done Level of workshop: intermediate (some knowledge/ by medical school faculty - teaching, original research, experience desirable). research synthesis, application and consultation - is scholarly by definition and tradition. Individual faculty members, especially those in early career, frequently 8S Substituting for nature: a continuing struggle at becoming productive scholars. This workshop educational challenge will address ways that medical faculty can increase the Daniel D Federman (Harvard Medical School, Boston MA, quality and quantity of their scholarly work. USA) and Laurence B Gardner (University of Miami, Florida, Objectives: Participants will: (1) Recognize that scholarship USA/National Board of Medical Examiners, USA) in medical schools is expressed in at least four ways: Background to the topic: Errors in care of a patient with a teaching, original research, research synthesis, application complex illness, serve to illustrate the challenges of ongoing and consultation; (2) Practice skills of planning, organizing, education in the clinical settings. Several ACGME self-management, and networking toward the goal of competencies were assessed here and found inadequate. increasing the quality and quantity of their scholarly work; (3) Begin to form a collegial network with other faculty Workshop content and structure: Presentation and Analysis interested in medical education scholarship; (4) Increase of the Clinical Case; discussion of the educational issues their fund of “tacit knowledge” about scholarship in medical and challenges. Evidence of learning as a consequence of schools. interventions and then open discussion of the applicability and utility of similar methodologies in other settings and Structure: Opening remarks, framing the session, environments. introductions; Discussion: “tacit knowledge” about scholarship in medical schools; Skill development: planning, Intended outcomes: Improved understanding of organizing, self-management, and networking; Participant approaches used worldwide in teaching and learning in reports; Wrap-up. the clinical setting. Relevance of the ACGME competencies to these central questions. Outcomes/take-home messages: Scholarship is expressed in several ways; Scholarly productivity does not occur by Intended audience: Educators working in or around the chance; Planning, organizing, self-management, and clinical setting. networking are keys to success; Medical faculty should Level of workshop: Appropriate for all. manage their careers actively Who should attend: Medical school faculty in early career; 8T Young Educators’ Group Senior medical faculty (prospective mentors). Soeren Huwendiek (University Children’s Hospital Heidelberg, Level of workshop: Appropriate for all. Dept of General Pediatrics, Heidelberg, Germany) and Stewart Mennin (Sao Paulo, Brazil)

Posters 8 Onyx 1 Problem based learning 2

8 Onyx 1.1 of Case based learning in medical education. The aim of Case-based learning in medical education – our study was to perform a systematic literature review a literature review on the use of case based learning. Jonas Nordquist*, Björn E Eriksson and Jörgen Nordenström Method: A systematic literature review has been conducted (Karolinska University Hospital Huddinge, Department of for publications between the years 1990-2004. Major Medicine M62, Karolinska Institutet, Huddinge, Stockholm 141 databases were used (MEDLINE, EMBASE, CINAHL, ERIC 86, SWEDEN) & PubMed). The search terms were derived from MeSH. Irrelevant articles were sorted out. All articles covering Background: Despite a number of articles on problem CBL were classified into different medical areas and based learning (also using cases) there is no known review

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analysed on an aggregated level in quantitative and Summary of results: Several factors were identified that qualitative forms. The BEME-guide was used when either limit or enable PBL implementation and some classifying the articles. relationships between this method and students’ performance and attitudes toward the course were found. Results: We found 195 articles meeting the predefined criteria. Out of these 95 articles were identified to be of Conclusions/take-home messages: It is suggested that PBL relevance. The four medical educational fields reporting may work as an alternative for students’ knowledge most publications concerning Case based learning were acquisition and that students perceive PBL relevance for Medical education (12 %) followed by Medical ethics the development of important skills for their future (11%), Preventive medicine (8%) and General practice professional practice. (6%). Conclusion: This study provides a systematic understanding 8 Onyx 1.4 on the use of cases in the medical world and ideas of how Frequently Asked Questions (FAQ) web site case based learning could be used. As far as we understand this is the first review on case based learning in medical for knowledge acquisition of medical education. students during problem-based learning activities: 10 years of experience at University of Montreal 8 Onyx 1.2 Does case study fill the gap between basic M M D Julien*, J P Messier, Huu da Tran and R Lalande (University of Montreal, Département de Pneumologie, Hôpital science and clinical subjects? du Sacré-Coeur de Montréal, 5400 Gouin Ouest, Montréeal Erika Nagle (Latvian Medical Academy, Department of QC H4J 1C5, CANADA) Medical Biology, Riga Stradina University, Dzirciema Str. Background: Medical students at University of Montreal, 16,Riga LV-1007, LATVIA) acquire knowledge through problem based learning Background: The weakness of most basic science curricula sessions (PBL). For classes of up to 225 students/year for medical students is the absence of patients for with a tutor/student ratio of 1:8 in small group sessions, illustration and better understanding of a problem. It many questions are asked about definitions, learning causes the situation that medical students cannot recognize objectives, controversial topics and/or to understand the link between basic science and clinical subjects. This physiopathological phenomenons. problem partly could be solved by case study. Summary of work: To allow homogeneous transmission of Summary of work: Clinical cases were used as an approach information, a Web site was developed in 1995 for these to teaching and learning medical genetics for the 2nd year FAQ. Students were asked to read first the answers to students of the faculty Stomatology at the Riga Stradiòð previously asked questions before sending any new University. In the academic year 2003/2004 clinical cases question. They could remain anonymous to preserve from for better understanding genetic dental pathology and discrimination among peers. Professors in charge of each metabolic disorders were used, but in 2004/2005 – for course were answering new questions twice a week. studying syndromic craniosynostoses. As an information Accessing the Web site with a password protected from source for clinical cases databases such as “Scirus”, fraudulent information and made answers reliable. This “ScienceDirect”, “ELSEVIER”, and “PubMed” were used. exercise needed approximately 1 hour a week for professors but saved them time during lectures or PBL Conclusions/take-home messages: Like other variants of sessions. It also gave coherent messages available for all PBL, case study is the method that gives students students and also for tutors of individual small groups. On opportunities to direct their own learning, and it helps average, for professors utilising the Web site, there was also to identify that the science underpins realistic approximately 2.5 questions/credit/year. situations. Case study as an additional teaching/learning method could be applied in teaching basic science for Conclusions/take-home messages: We conclude the Web medical students. site for FAQ was useful for both professors and students. It transmitted homogeneous information accurately and efficiently. 8 Onyx 1.3 PBL in healthcare sciences: a case study on curriculum innovation 8 Onyx 1.5 Combining medical subjects in inter- Hermínia Dias* and Isabel Chagas (Escola Superior de Tecnologia da Saúde de Lisboa, Av. D. João II, Lote 4.69.01, disciplinary seminars – a new way forward Lisboa 1990-096, PORTUGAL) Maria Feldman*, Katharina R Spatz and Sebastian Schubert Background: Problem-Based Learning (PBL) is an (Charité, Universitätsmedizin Berlin, AG Reformstudiegang Medizin, Schumannstr. 20/21, Berlin 10117, GERMANY) educational method that aims to stimulate multidisciplinary skills through planned problem situations. Through self- Background/Rationale: At the Charité in Berlin a parallel, learning and small group discussions students develop problem-based reformed medical curriculum (RMC) was problem solving skills and acquire basic knowledge. PBL started in 1999. Beside PBL, interdisciplinary seminars are is an innovative method in Portuguese higher education one of the basic teaching methods. In these seminars two institutions where traditional approaches prevail, showing lecturers (one basic scientist and one clinician) teach a poor results in students’ outcomes and satisfaction. group of 21 students. The intention is to consider a medical problem from a basic science and a clinical perspective. Aims: To create PBL activities in a lung function tests The aim of this poster is to present these seminars and course; to describe the implementation process; to analyse their evaluation by the lectures. the effects on students’ performance and attitudes; and to characterize the generated learning environment. What was done: The opinion of teaching staff in the fifth semester was sought using a written questionnaire, Summary of work: The research design included two developed and carried out by two medical students. 30 of phases: construction of PBL-based activities followed by 45 lecturers responded. implementation and research on the effects. Participants were 28 students of a cardiopulmonary course in a higher Results: The lecturers consider the interdisciplinary work education school in Lisbon. Data collection methods were as enriching and sensible for the teaching of their field. participant observation, semi-structured and informal They enjoy teaching in the RMC, and perceive the students interviews, questionnaires and document analysis. as more active and motivated than traditional track students. Detailed results will be presented on the poster.

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Conclusions: Combining basic medical science with clinical particular aspects of orientation that students found helped teaching in individual seminars is a valuable new way of them in a new situation. teaching and the response has been positive. Summary of work: Both qualitative and quantitative data was gathered from questionnaires, interviews and meetings 8 Onyx 1.6 with both students and staff. Using an orientation module to prepare Summary of results: Both staff and students suggest that medical students for Problem-Based the orientation module could play a vital role in providing Learning the assistance that students need to prepare for PBL. Many students gave favourable feedback to staff, particularly D M Appalasamy (University of Cape Town, Faculty of Health the different support activities in the orientation module Sciences, Anzio Road, Observatory 7729, SOUTH AFRICA) for PBL. Creative ideas as well as limitations of the module Aim of presentation: The Nelson R Mandela Medical School are also discussed. introduced a three-week orientation Module in 2002 to Conclusions/take home messages: The results present the prepare first year medical students for Problem Based benefits of using preparation and training for students, Learning (PBL). One of the curriculum development issues particularly in the South African context. Staff suggest that facing institutions in the South African context is the debate an orientation module could be a valuable tool in laying around how students cope with the PBL process and is it the foundation for PBL. conceptually “easily adapted to” for students as some staff perceive. This paper addresses this debate as well as

Posters 8 Onyx 2 Postgraduate medical training

8 Onyx 2.1 employees. This paper describes a model for managing Impact of an intervention to improve and supporting doctors in training with physical and mental dictation skills of medicine interns disabilities. J B Bundrick*, K F Mauck and C West (Mayo Clinic, 200 1st What was done: A case study of 6 composite ‘cases’ is St. SW, Rochester MN 55905, USA) described, with interventions offered by the Associate Dean for Educational Support. Anonymised examples of physical Aim: We designed and studied a pilot intervention aimed and mental disability (visual impairment, spinal cord lesion, at improving the dictation skills of first-year medical Asperger syndrome, memory impairment, bipolar residents. depression, alcohol dependence) are analysed to identify Summary of work: A total of 16 first-year residents were significant themes, principles, barriers to progress and randomly assigned to either the standard training group effective resolutions. or the intervention group. Members of both groups had Conclusions: Doctors with disability require specific up to four dictations each evaluated in a blinded fashion additional supports during postgraduate training. These both before and after the intervention group received brief may include: coordination of training rotations; support specialized training in effective dictation strategies. for Educational Supervisors; Mentorship; constructing Changes in performance were calculated for each group, personal education plans; liaison with Royal Colleges over and data were analyzed using the Wilcoxon-Mann-Whitney examination regulations; liaison with trusts over workplace test. adjustments; risk assessment documentation; career Summary of results: The intervention group showed both counselling; specific training programmes; support groups; clinically and statistically significant improvements in liaison with GMC over restrictions. Not all disabled doctors dictation quality (p=0.028). Improvements were also noted could continue practising medicine. in transcriptionist evaluations of the dictations and Take-home messages: Disabled Doctors can make an efficiency measures such as words dictated per minute, important contribution to medicine with appropriate although these did not reach statistical significance. supports in training. UK employers risk contravening Conclusions: We have shown in a small pilot randomized legislation if they fail to make reasonable adjustments to trial that a brief intervention targeting dictation strategies training posts. Deaneries have an important coordinating can result in meaningful improvements in dictation quality. role. Further study is needed to determine which elements of patient dictations are most affected by this intervention, and whether this will prove useful to other provider groups 8 Onyx 2.3 such as medical students, non-medical residents, mid-level Identifying factors that influence workplace providers, and faculty. learning in postgraduate medical training Lisette Stok-Koch*, Sanneke Bolhuis and Raymond Koopmans (UMC St Radboud, Department of Nursing Home Medicine, 8 Onyx 2.2 Internal Postal Code 229, PO Box 9101, Nijmegen 6500 HB, Supporting doctors with disability in NETHERLANDS) postgraduate medical training Aim of presentation: In their postgraduate training Heather Payne*, Maria Tsouroufli and Howard Young (Cardiff programs physicians are immersed in a complex workplace. University, School of Postgraduate Medical and Dental To improve their training program, it is necessary to gain Education, Wales College of Medicine, WIMAT Office, Cardiff insight into factors that influence workplace learning. Medicentre, Heath Park, Cardiff CF14 4UJ, UK) Summary of work: Our research questions addressed Background/rationale: Doctors may encounter personal postgraduate physicians’ and supervisors’ perceptions of health problems and disability which cause major disruption factors that influence workplace-learning, differences to postgraduate training. UK Disability Discrimination between students at different levels of their education and legislation in force since October 2004 requires employers differences between students and their supervisors. 118 to make reasonable workplace adjustments for disabled Postgraduate nursing home physicians and their

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supervisors participated in semi-structured group shown a few concept maps from other fields. One resident interviews, in which they discussed four questions drew the map on his own and the other was given a few regarding workplace learning. Qualitative analysis of the concepts to start with. data was performed to establish a framework of factors Results: The process of building the map is described and influencing workplace learning, within which comparisons concept maps will be presented. between groups could be made. Significance was determined by means of the 2-sided Fisher’s exact test. Conclusions: Concept maps aided the identification of different aspects of postgraduate training. They also Summary of results: A framework consisting of 56 factors exposed the residents’ way of thinking and aided in finding was identified. These were grouped into 10 categories, growth areas for them. Concept maps provided a way to which covered four domains: the work environment, visually structure the postgraduate education and show educational factors in the workplace, student characteristics key concepts and skills required. and supervisor characteristics. The factor ‘social integration’ was cited most often. First year participants focused more on the availability of information. Supervisors reported 8 Onyx 2.5 more often educational factors and postgraduate students Training requirements in a dental medical reported more often impediments. emergency management course Conclusions: The training relationship may be improved S Weber*, M Mueller, K Gelbrich, U Johne and T Koch when supervisors explicitly discuss the learning process (University Hospital Dresden, Department of Anaesthesiology and learning conditions within the workplace, thereby and Intensive Care Medicine, Fetscherstr. 74, Dresden 01307, focusing on postgraduate physicians’ needs. Special GERMANY) attention needs to be given to aspects of social integration. A good start may be provided by the question of how to Summary of work: As a provider of courses in management establish a basic feeling of ‘knowing where you are’ and of medical emergencies for primary care dental practice ‘how to go about things’ to make postgraduate students teams we wanted to identify the training requirements of feel comfortable enough to focus on the learning process. dentists. In a postal survey questionnaires were sent to all dental practices listed in the Saxony State Dental Council Register 8 Onyx 2.4 in January 2005. Concept mapping as a tutoring tool in postgraduate medical education Summary of results: There were 573 returns from the 3000 mailed anonymous and not coded questionnaires, a Erna Kentala (Helsinki University Central Hospital, response rate of 19% within the 4 weeks cut-off period. Department of Otorhinolaryngology, PB 220, Helsinki 00029, 62,8% of the dentists stated, that they are interested in FINLAND) emergency management. 23,3% took part once and 68,3% Background: Postgraduate medical training is a complex took part more than once in a medical emergency training educational setting. The residents are required to attain after graduation. Apart from 5,6%, all courses included theoretical, clinical and behavioral skills during their basic life support (BLS) but in 9,9% also advanced life rotation. Evaluation and feedback can be sparse, support (ALS). supervision is often related to technical skills and teachers In further courses only 33,6% are interested in BLS training are frequently changing. A clear vision of the route to but 48,2% in ALS training. Other subjects of high training specialist may well be unclear. interest (> 40% each) are intravenous techniques and iv Objectives: To help residents envision the postgraduate medication, defibrillation, ECG recognition, blood glucose training and to enhance their metacognition, concept maps measurement and airway management. were introduced as tutoring tools. Conclusions/take-home messages: Practically-orientated Methods: Two residents at the department of medical emergency management courses for dentists otorhinolaryngology in Helsinki University Hospital were should especially include basic medical skills training as asked to draw a concept map of their postgraduate training. well as the use of equipment to become competent and Concept maps were defined so that, concepts are islands safe. and the links between the bridges. The residents were

Posters 8 Topaz 1 Assessment: clinical, 360o and portfolio

8 Topaz 1.1 Summary of work: A PPL scoring grid was adapted from a The Patient Problem List and education in prior cognitive task analysis of PPL construction to create clinical reasoning: development of an a scoring key from the PPLs of 8 experts. Medical students’ PPLs for the same patient case before and after a pre- evaluation instrument clerkship course in internal medicine were collected and Jeffrey G Wiseman* and Linda S Snell (McGill University, scored using the experts’ key for the same case. Students’ Royal Victoria Hospital, Medical Teaching Office, Room pre- and post- PPL scores were correlated with their M10.02, 687 Avenue des Pins, Montreal, Quebec H3A 1A1, traditional performance scores for the course. CANADA) Summary of results: Inter-rater reliability for PPL scoring Aim of Presentation: Clinical reasoning in Internal Medicine and face and construct validity data will be presented. requires diagnosis and management of patients with multiple problems. Medical students learn to create and Conclusions/Take-home messages: PPLs can be used to use patient problem lists (PPLs) during everyday practice evaluate as well as teach complex clinical reasoning. with real patients. Although PPL-based teaching strategies foster students’ practical reasoning, there are no PPL-based evaluation methods. This study describes the development and validation of a tool to assess student clinical reasoning displayed in PPLs.

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8 Topaz 1.2 8 Topaz 1.4 The clinical aptitude exam to assess Formative 360 degree feedback for trainee competencies in residents of pediatrics at doctors – an evaluation Facultad de Ciencias Médicas y Biológicas Bryan Burford*, Jan Illing, Susan Hrisos, Julian Archer, Moira ‘Dr Ignacio Chávez’ Livingston and Tim van Zwanenberg (University of Newcastle, PIMD, 10-12 Framlington Place, Newcastle upon Tyne NE2 María de Jesus Ortiz G* and Baltazar Casimiro P (Universidad 4AB, UK) Michoacana, Rincón de Eratzicua No 96, Fraccionamiento los Fresnos, Morelia, Michoacán 58088, MEXICO) Aim: The potential of the 360° method for responsive Objective: Design the CAE in order to assess clinical feedback to on-the-job development has provoked great competencies in residents of pediatrics. interest in bringing the method to medical education. In this paper we aim to inform this debate with early results Materials and Methods: Investigation development project from an ongoing project to evaluate a 360° feedback tool. based on empiric and theoretical methods. Survey instruments: Questionnaire and interviews, half structured Summary of work: A 360° formative feedback tool forms and anonymous. Population: residents of pediatrics as part of a Learning Portfolio developed by the Northern Deanery in its implementation of the Foundation subjects of this study, code informants and experts. Programme for postgraduate doctors. We present here Statistically frequency analysis and percentages were used. some preliminary findings from a study which provides Results: Surveyed population consider direct clinical quantitative and qualitative evaluation of the reliability, observation and problem clinic cases as the best ones to validity and usability of this tool. The tool was completed feedback learning, although these are less used in this anonymously by senior doctors, nurses, and other health stage of our study; > 90% of them expressed that professionals working with pre-registration doctors on the assessment influences competencies achieved by pilot Foundation Programme. They were then interviewed residents; 57% of residents considered their own about the form, with a particular focus on face and content competency as regular; 71% of residents and > 51% of validity. Following feedback, the trainee doctors were also professionals agreed that new instruments such as CAE interviewed about their use of the feedback, and their are needed to assess competencies; they expressed a perceptions of validity. favorable opinion about this kind of exam and suggested its frequent use. Summary of results: We present results of qualitative analysis of the interview data, and quantitative reliability Conclusions: CAE is proposed as a kind of written analysis of the tool. instrument, designed by theoretical simulation through problem clinical cases, to assess competencies of clinical Conclusions: Initial headline findings from these analyses method in pediatric residents, enclosed in active method are presented with reference to the implementation of 360° education and critical thought that may improve clinical feedback in postgraduate medical education. development of future pediatricians. 8 Topaz 1.5 8 Topaz 1.3 360 degree appraisal for doctors in training Clinical decision-making test in 6th year Jason Raw*, Nitin Arora and Romesh Gupta (Lancashire NHS internal medicine clerkship: an instructive Teaching Hospitals Trust, Chorley and South Ribble District tool for clinical teaching General Hospital, Preston Road, Chorley, Lancs PR7 1PP, UK) Aim of Presentation: The traditional consultant led appraisal Halil Ibrahim Durak*, S Ayhan Calýpkan and Serhat Bor (Ege fails to assess all the competencies of a training doctor. University, Department of Medical Education, Faculty of Medicine, Izmir 35100, TURKEY) 360° appraisals appears to offer better assessment of all clinical and non clinical professional competencies which Rationale: Giving more emphasis of positive educational they are required to achieve during their training. This impact of assessment concept, a formative, stationary, study was undertaken to find out what doctors in training written, clinical decision-making test has been using in think about 360° appraisal and how they feel it compares 6th year internal medicine clerkship since 2000. We with the current system. borrowed various concepts of Patient Management Problems, OSCE and Key Features Approach for Summary of Work: A questionnaire containing some development of our format. This presentation aims to share background information about 360° appraisal was filled in our limited experience of using this instructive hybrid tool. by 60 junior doctors across 4 hospitals. The results were collated and analysed. What was done? Selected common clinical problems were derived by faculty members and written as test cases. Summary of Results: 85% of respondents found 360° Depending on required decision-making tasks; the cases appraisal appealing. Most junior doctors would want their sliced, key features were identified and structured as Consultant, middle grade on their team and ward nurses stations. One or two problems were presented at each (all 100%) with doctor colleagues (93%), secretaries exam in 7-11 stations. Six exams were held in 2000-2001 (78%) and inpatients (74%) the other popular appraiser with 382 students. Mean duration was 27 minutes. Case- choices. 66% thought 360° appraisal was better than the based question answer sessions followed the exams. present system but only 55% felt it would be more Students evaluated the tool by a questionnaire. Exam objective. 78% junior doctors would be agreeable to a records reviewed for corrections of curricular weaknesses. trial period of the new system but most (63%) would want more information about it. Results and conclusions: The non satisfactory performance rate was 2,36%. Exams were well accepted. Students Take home Message: Most junior doctors think 360° found the format “fair”, the content “instructive, highly appraisals would be an improvement but would want a relevant and not difficult”. They asked to take similar test trial period and more information before it is formally weekly-based. Although time and effort cost is very high, started. staff members appreciated the collaborative work and valued their experience as demanding integrative effort. Take home message: Instructive test and following case- based discussion seemed as a high potential “teaching tool” in clinical decision-making domain for advanced novices at clinical learning environment.

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8 Topaz 1.6 Background: There are two core, related, requirements to Competency of doctors at the District portfolios which are a) to aid a student’s reflection on their Hospitals under the project of increasing learning experience and b) to document professional or other targets for which the student must present evidence rural doctors in Thailand to claim achievement. Sirijitt Vasanawathana* and Noimay Mungkorn (Khon Kaen Summary of work: We have been piloting a paper-based Hospital, Medical Education Center, Srijan Road, Amphur Maung, Khon Kaen 40000, THAILAND) portfolio with a cohort of graduate entry medical students. The completion of the portfolio was supported by a series Background: Collaborative Project to Increase Production of review meetings with the individual students’ personal of Rural Doctors (CPIRD) is aimed at alleviating shortage tutor. The reactions of students and staff to the pilot was of doctors in rural areas among Regional Hospitals and assessed by questionnaire and semi-structured interview. Medical Schools. Recruited potential local residents study pre-clinicals in Medical Schools, and clinical levels at the Summary of results: Students found the portfolio regional hospitals with a commitment of working in rural documentation valuable. Students were asked to review hospital. progress towards meeting their outcomes weekly but they felt this to be too frequent and too time-demanding. The Summary of work: 33 CPIRD doctors were evaluated by review meetings were also seen as valuable, but they were self-assessment, and 913 questionnaires from their local also perceived by both staff and students as being too health colleagues. 90% of the doctors are satisfied to work time-consuming. in the hospitals. 93% of the colleagues said these doctors had good and very good medical background, 92% treated Conclusions/take-home messages: If portfolios are to be their patients well to very well. 84% appreciated their skills successfully embedded in the curriculum, they need to in appendectomy, Cesarean section, venesection, evoke a high compliance. We are proposing to maximise cardiopulmonary resuscitation. 94% impressed on their the amount of data that is collected, stored and transmitted confidence of good working and 92% had good electronically, to minimise the number of face-to-face responsibility. 83% had a good relationship and 85% meetings, and to provide training for both student and worked well in teams. 82% regularly and politely educated supervisors. their patients with simplified language about the diseases and self-care. Finally 81% wrote very good and good 8 Topaz 1.9 medical records. Portfolio learning and clinical settings: the Conclusion: Doctors graduated from Khon Kaen Hospital Liverpool student experience under the CPIRD program are working competently and are satisfied with working in the district hospitals. M Chamberlain*, R Griffiths, D Taylor and A Garden (University of Liverpool, 107 Railway Street, Southport, Merseyside PR8 5BD, UK) 8 Topaz 1.7 Background: During the final year at Liverpool students Avoiding the Blizzard – an electronic must complete five clinical placements. Educational application of MultiSource Feedback supervisors must use a portfolio to assess students. The portfolio contains Record of In Service Training Assessment P Bright*, A B Whitehouse, D Twist and C Decon (West (RITA) documentation. This provides ‘descriptors’ of the Midlands Deanery, Birmingham Research Park, 97 Vincent Drive, Edgbaston, Birmingham B15 2SQ, UK) minimum competencies required to graduate and prescribes a ‘three-step’ portfolio construction and Background: Multi-source feedback (MSF) is a tool assessment cycle for each placement. assessing professional behaviour, used in the UK Foundation Programme (FP) and other postgraduate Summary of work: At the end of the 2003 and 2004 programmes. In the Team Assessment of Behaviour (TAB) academic years, interviews (n = 62 in total) and journals version of MSF used in the West Midlands and elsewhere, (n= 31) were used to identify students’ experience and trainees ask 10-15 assessors to complete a TAB form and perceptions of portfolio learning and assessment. A short return it to the Education Centre. Birmingham Heartlands questionnaire was also administered (n = 179). Hospital has 69 FP trainees, generating 10-15 x 69 (690- Summary of results: While students highlighted the 1035) returned TAB forms each assessment round. strengths of the portfolio, they felt the educational value Trainees must verify a minimum of 10 returns. The paper of some of its elements could be made clearer to them, system was labour intensive for all involved. and that they and their supervisors needed more faculty Summary of work: We describe an electronic system for led support and guidance. Finally, they felt that conflicting completion of forms at computer terminals by nominated service and training commitments affected how supervisors assessors using the Hospital intranet. Returns are logged approach the role of ‘portfolio assessor’. and a summary is produced for each trainee and Conclusions/take-home messages: These findings highlight educational supervisor. The system allows real-time the importance of paying attention to students’ experiences monitoring of the number of returns which is accessible and perceptions when developing learner-centred to trainees and trainers. educational tools such as portfolios. Further research is Summary of results: In the pilot round of assessments 58 underway to identify the impact of changes introduced as trainees obtained 10 returns; 10 (all in General Practice) a result of these findings, as well as what guidance and 5-10 returns. support supervisors feel they need. Conclusions/take-home messages: We recommend this system as a good best way of managing MSF in any large 8 Topaz 1.10 hospital. The West Midlands Deanery is now adopting a Reflective practice in a portfolio system system based on this pilot for all postgraduate trainees. designed for formative and summative assessment 8 Topaz 1.8 Elaine Dannefer* and Lindsey Henson (Cleveland Clinic Developing portfolios to support student Lerner College of Medicine, of Case Western Reserve learning in the early years of a medical course University, The Cleveland Clinic/NA24, 9500 Euclid Avenue, Cleveland OH 44195, USA) D C M Taylor*, J Strivens and P J Lunt (University of Liverpool, School of Medical Education, Cedar House, Ashton Street, Background: Reflective practice is at the center of the Liverpool L69 3GE, UK) debate around the tradeoffs between formative and summative use of portfolios for assessment. Our portfolio

– 155 – Session 8 THURSDAY 1 SEPTEMBER Session 8

system promotes reflective practice and accomplishes both Background: From August 2005, the post-graduate training formative and summative assessment of students’ of doctors in the UK will begin with a Foundation achievement in an outcomes-based program. Programme (FP). The key educational changes will be a shift to a common, generic curriculum and the use of a Methods: All performance assessments in the program are learning portfolio. The evidence documented in the portfolio purely formative. Students and their advisers analyze will be used to support a recommendation for full GMC feedback as it is collected to monitor student progress in registration. For the past two years trainee doctors in the meeting our nine competencies. Students periodically Northern Deanery have been piloting the use of a learning prepare Formative Portfolios that include reflective essays, portfolio. learning plans, and student-selected evidence and discuss them with their adviser in formal meetings. Students also Aim: To evaluate how the learning portfolio was use their formative assessments to construct yearly experienced from the perspective of the trainee doctors Summary Portfolios for review by a separate faculty and educational supervisors. promotions committee. The adviser plays a non-evaluative Methods: Two postal surveys of all PRHOs and their role in the summative process by providing feedback during educational supervisors using the learning portfolio in 2004 the development phase, confirming that the portfolio is and 2005. the student’s own work and that the selected evidence is representative of the student’s performance across the Results: In 2004 35/59 (59%) Pre-Registration House year. Officers (PRHOs) and 33/55 (60%) Educational Supervisors (ESs) returned a questionnaire. In 2005 45/252 (18%) Conclusions: We use the same evidence and portfolio PRHOs and 38/129 (30%) ESs returned the questionnaire structure for both formative and summative assessments. to date (returns in progress). Both of these surveys are Distinctly separate processes and reviewers ensure that clearly indicating concern over excessive paperwork and reflective practice is not compromised by the rigor and lack of protected time to complete the learning portfolios. judgments required for making promotion decisions. Conclusions: Currently there are plans to develop a single national learning portfolio. While welcomed, such a 8 Topaz 1.11 development needs to consider the concerns raised from The Northern Deanery learning portfolio: earlier developments. the first two years Jan Illing*, Tim van Zwanenberg, Susan Hrisos, Azlina Mohd Kosnin, Moira Livingston and Rich Bregazzi (University of Newcastle, Postgraduate Institute for Medicine & Dentistry, 10-12 Framlington Place, Newcastle upon Tyne NE2 4AB, UK)

Posters 8 Ruby 1 Teacher evaluation

8 Ruby 1.1 8 Ruby 1.2 Providing effective feedback to tutors: the Development of a Spanish-written perceived utility of the clinical teaching instrument to evaluate the quality of clinical effectiveness instrument teaching Jan Coles, Mary Lawson and Carol Lawson (Monash Marcela Bitran*, Beltran Mena and Rodrigo Moreno University, Centre for Medical and Health Sciences Education, (Universidad Católica de Chile, Centre de Educación Médica, Building 15, Clayton Vic 3800, AUSTRALIA) Escuela de Medicina, 6 piso, Alameda 340, Interior, Santiago, CHILE) As health care professionals strive to shorten the length of training, the quality of clinical education becomes critical. Background: Medical schools require sound instruments The Clinical Teaching effectiveness instrument (CTEI) was to evaluate the quality of clinical teaching. While several developed to evaluate quality. Reliability and validity of English-written instruments are available, there are no this instrument have been reported1. We introduced this available validated instruments in Spanish. method in an Australian context with all tutors teaching Aim: To develop an instrument suited for the evaluation of clinical skills on the undergraduate medical course at clinical teaching in Latin-American countries. Monash University. One way of improving quality is to increase teachers’ receptivity and responsiveness to Methods: Starting with a 40-item questionnaire, we feedback provided on their teaching. In this study we have developed a 30-item instrument (PUC30) after 2 years of evaluated tutors’ perceptions of the utility of feedback from iterative modifications based on feedback by faculty and the CTEI in comparison to other methods. We determined students, and on the results of applications of different what they found useful and what they have acted upon. versions of the questionnaire. All skills’ tutors received feedback on their teaching via Results: PUC30 describes specific behaviors associated to the CTEI. Four tutors were interviewed in depth to 8 cardinal factors of teaching excellence. Using a Likert- determine the scope of a survey to be used for all tutors. type scale, students rate the observed frequency of these Both interviews and surveys highlighted important issues behaviors in their teachers. The overall Cronbach coefficient in the way that feedback is delivered to individuals and of PUC30 (calculated from 475 questionnaires) was 0.93, used by tutors. The importance of the instrument and the and the corresponding values of the factors ranged preferred mode of feedback are both discussed. between 0.75 and 0.91. While 8 factors explained 75% of 1Copeland HL, Hewson MG. Developing and testing an the total variance, factor analysis indicated that PUC30 instrument to measure the effectiveness of clinical teaching behaved as having 5 empirical factors. in an academic center. Academic Medicine 2000; 75, (2): Conclusions: PUC30 is a reliable instrument that measures 161-6 fundamental aspects of clinical teaching. It can be used to give specific feedback to teachers, and reliable information to authorities of Latin-American medical schools, to improve the quality of clinical teaching.

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8 Ruby 1.3 Aim: To increase doctors’ motivation and interest, as well Developing or daunting? – An exploration of as students’ influence on their training positions. the peer review experience Method: A feedback model “birch and roses” was Janet MacDonald (Cardiff University, School of Postgraduate introduced on the twenty weeks course in surgery. The Medical & Dental Education, Wales College of Medicine, model includes: (1) Each week the students for 15 minutes Heath Park Campus, Cardiff CF14 4XN, UK) have the opportunity to orally express positive and negative criticism to the head teacher. (2) The students elect the Background: Over recent years it has become increasingly three most appreciated teachers from the weekly nominee important for University lecturers to adopt a more list. (3) The three teachers are each awarded a prize of professional framework towards their teaching. In two movie tickets, and their names and the nominee list consequence a variety of strategies have been implemented are published in the intranet of the hospital. (4) The head at institutional level to accommodate these concerns. Peer teacher personally delivers negative criticism to the doctor review is one strategy which has been developed but concerned. A follow up is made with a questionnaire to several difficulties have been reported in implementing teachers and students. this process. Results: The students experienced a greater commitment Summary of work: This small scale study sought to identify to their studies. The doctors focused more on the students some of the perceived benefits, concerns and difficulties and were competing with each others to get most tickets. experienced by medical education and healthcare lecturers who have participated in the peer review process as Conclusion: This is a method of getting the student reviewers and reviewees. Qualitative semi-structured committed to improve their educational environment and interviews were conducted with the participants to allow the doctors experience their teaching efforts are rewarded them to express their perceptions of this process. These and the educational part of their work is paid attention to. data were then analysed using a thematic coding frame and this report identifies the key themes which have emerged in relation to the study. 8 Ruby 1.6 Medical students’ views about their Summary of results: The main findings indicate that curriculum: is it not time that medical individuals, whilst feeling positive about the benefits obtained from feedback received in the process, are schools should listen to these? nonetheless anxious both about receiving and giving Pantelis Stavrinou, Georgios Souretis, Evandelos Drosos*, feedback to their peers. These dichotomous findings hold Polydoros Vogiatzis and Ioannis Dimoliatis (University of true for both novice and experienced lecturers. These Ioannia, Department of Hygiene and Epidemiology, Medical issues will be explored and discussed in relation to staff School, Macedonias Street 10, Kozani 501 00, GREECE) development and CPD. Aim of presentation: Evaluation procedures are not yet a first line priority of medical schools in Greece. Our aim was to address these issues from the students’ perspective. 8 Ruby 1.4 Natural semantic networks on the concept Summary of work: A questionnaire was administered to professor-student relationship half the students of the Medical School of Ioannina, Greece. It tried to elicit students’ views on an evaluation strategy Nancy Fernandez-Garza* and Carlos de la Garza-Gonzalez of the educational activities of the school. It also asked (Universidad Autónoma de Nuevo León, Facultad de Medicina, the students to assess certain aspects of the teaching Beltran Nuno de Guzman 309, Col Cumbres, 3er Sector, performance of their teachers. Monterrey, N.L. c.p. 64610, MEXICO) Summary of results: 188 replies were received. 88.9% of Aim: The aim of this research is to compare in medicine the students stated that their school should implement an students the conceptual representation and organization evaluation strategy and 94.1% reported that the teaching of the concept professor-student relationship, using the performance of the academic staff should be assessed semantic networks technique proposed by Figueroa. regularly. A large majority (81.9%) mentioned that it should Summary of work: A total of 44 second year medicine be compulsory for teachers to attend “teaching the students took part in the study. At both the beginning and teachers” courses prior to commencement of their end of the physiology course, each of them listed a total appointment. As regards their teaching performance, of 12 concepts related to professor-student relationship students believe that their teachers follow behaviouristic and ordered them from the most to the least important. educational principles and give them poor marks for their humanistic educational characteristics. Summary of results: The results show that the base concept chosen by students at the beginning of the course Conclusions/Take home messages: Evaluation of teachers as well as at the end of it was respect, followed in both by their learners is a useful tool in order to assess their cases by friendship and help. The total of different concepts teaching performance and should be used more often by written at the end of the course was smaller (J=129) than medical schools in Greece. those written at the beginning (J=180). It is interesting to note that from the ten most frequent concepts given at the beginning of the course, nine of them were about the 8 Ruby 1.7 quality of the professor-student relationship, and only one Correlation between university rank of about receiving something from the other (help), and the comprehensive basic exam in different same happened with the concepts given at the end of the lessons and teachers evaluation at course. Kermanshah University of Medical Sciences in 1992-2004 8 Ruby 1.5 Shirin Iranfar*, Mohammad Reza Abasi and Mansour Rezaie Student feed-back to medical teachers (Kermanshah University of Medical Sciences, E.D.C, increases their motivation in student learning Ketabkhaneh Markazy Daneshgah Olom Pazeshki, Shaheed Beheshti Blvd, Kermanshah, IRAN) Staffan Sahlin (Karolinska Institutet, Department of General Surgery, Danderyd Hospital, Stockholm 182 88, SWEDEN) Introduction & Objective: This survey was carried out to determine the correlation between university rank of the Background: During clinical practice medical students do comprehensive basic exam in different lessons and not always meet doctors/teachers interested enough in teachers’ evaluation at Kermanshah University of Medical teaching. An undevoted treatment from the teacher leads Sciences in 1992-2004. to uninterested students.

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Methods & materials: The correlation descriptive study Background: Research in Medical Education constitutes was carried out. An information form was designed to one of the cornerstones of the academic tasks. At the collect data. The variables were exam years, score and Tucumán Medical School, this area had a progressive rank of university in different lessons, sex, mean age of growth since the First Argentinean Conference on Medical students, minimum pass level and score of teachers’ Education was held in Tucumán (1999). Before, there were evaluation. The collected data were analyzed by correlation very few credited research projects. coefficient (Spearman, Pearson), mean, and percent. Work done: A descriptive retrospective research was Findings: Teacher evaluation has showed a positive and carried out, in order to analyze the factors that affected negative correlation coefficient in Physiology and health this fast growth. The following main factors were identified, lesson respectively. There were positive correlations among others: (1) Institutional context: Legal frame given between single and female students and scores in the by the Argentinean Law of Higher Education (1995), and comprehensive Basic sciences exam. There was no Resolution 535/99 (Ministry of Education) related to the correlation between results of teachers’ evaluation and Standards for Medical Careers; Organization of a special rank of the exam in the university. Committee on Research in Medical Education; Establishing of academic activities for the discussion and for the diffusion Conclusion: Using the students’ viewpoints is not a suitable of the Research in Medical Education. (2) Academic way to evaluate teaching activities. It is recommended Context: Creation of the Postgraduate Career in Medical that other ways of evaluation should be used. Teaching (1997); Creation of the Master in Medical Education (1999) and its later projection to other University 8 Ruby 1.8 centers in the country; Wide participation in Medical Evolution of research in medical education Education Conferences held once a year in Argentina; at the School of Medicine of Universidad Increase in the participation of academic staff in postgraduate courses on subjects related to Medical Nacional de Tucumán, Argentina Education. H Deza*, C Daud, L Tefaha, M L Mónaco, M Naigeboren, H Conclusions: There was an important production of Rojo, R Blanca, S R Blanca and V Fagre (Universidad Nacional research papers and educational innovations that de Tucumán, Facultad de Medicina, Lamadrid 875, 1 Piso, Tucumán 4000, ARGENTINA) strengthen the academic activities.

Posters 8 Ruby 2 Teaching and learning theory; peer-to-peer learning

8 Ruby 2.1 8 Ruby 2.2 Previous knowledge: its influence in new Learning styles of students in health care learning professions Carlos E de la Garza-Gonzalez*, Nancy E Fernández Garza, Antonio F Compañ*, Antonio Aguiree, Justo Medrano, Manuel Norberto López Serna and Ma Esthela Morales Pérez Díez, Asunción Candela and Maria Teresa Pérez-Vázquez (Universidad Autóonoma de Nuevo Leon, Facultad de (University Miguel Hernandez, Departamento de Patología y Medicina, Administracion de Correos no 3, Apartado postal Cirugía, Division de Cirugía General, Campus Universitario no 712, Col. Mitras Centro, Monterrey N.L. 64460, MEXICO) de San Juan, Ctra Alicante-Valencia km 87, San Juan de Alicante 03550, SPAIN) Background: The educators face the task of facilitating knowledge to students who are exposed to different factors Background: Evaluation of learning styles can be an which may influence their outcome. In our case one of effective way for successful education. It could increase those factors is if learning embryology in their first or the efficiency of students, adapting the teaching style of second semester has any influence in the new course’s professors to learning style of students. grades. Aim: To know the predominant learning style of the Summary of work: We analyzed two student cohorts, students in Health Sciences at Miguel Hernández University n=363 and n=332. Included in this study were the students and to examine if there are distinctions between styles who took all the four partials and the final embryology used by the students of the different studies. tests. Each cohort was subdivided in two: S1 and S2 (first Summary of work: University students of Health Sciences and second semester, respectively). The grades were of five different professions: Medicine, Pharmacy, compared and to the results the z test was applied. Physiotherapy, Chiropody and Occupational Therapy were Summary of results: In both cohorts the grade average asked to complete a self-evaluation 80-item questionnaire, was higher for the students in their second semester. A the Honey-Alonso Learning Style Test. According to this significant difference was found for the grades of the questionnaire, on the basis of cognitive styles, we can second and third partial tests. Also a difference was found divide people into four groups: 1. Active learning style, for the final test in one cohort. Despite that for the course based on direct experience. 2. Reflexive learning style, grade there is no significant difference between the groups, based on observation and data collection 3. Theoretic the number of students who pass the course is higher learning style, based on abstract conceptualization and among those who have already taken Gross Anatomy. formation of conclusions and 4. Pragmatic learning style, based on active experimentation and search of practical Conclusions: According to our results, previous knowledge, applications. We show the results of the five professions in this case Gross Anatomy, has a positive influence on in our poster. the students’ results in embryology. Conclusions: We consider that the development of this methodology is useful in the field of educational research in order establishing the model of predominant learning styles.

– 158 – Session 8 THURSDAY 1 SEPTEMBER Session 8

8 Ruby 2.3 8 Ruby 2.5 Educational strategies for undergraduate The comparative learning strategy between students in health sciences: andragogy successful and unsuccessful Jahrom medical versus pedagogy from the lecturer’s point of students view Sedighe Najafipour* and Mitra Amini (Jahrom Medical School, Umur Sakallýoglu*, Hülya Köprülü, Melek Kalkan, Ebru Education Development Center, Jahrom, IRAN) Özsezer and Murat Yenisey (University of Ondokuz Mayýs, Aim: This study was designed to compare learning Faculty of Dentistry, Department of Peridontology, Samsun strategies between successful and unsuccessful Jahrom 55139, TURKEY) medical students. Aim: In the present study, opinions and evaluations of Summary of Work: From 220 students that participated in lecturers engaged in the healthcare professions were this study, 163 were female and 57 male. 119 of them collected and scrutinized about adult learning to put were medical students, 68 nursing, 17 anesthesia and 16 forward an idea for the validity of andragogy in operating room students. We used a standard undergraduate education of health sciences. questionnaire for this research and the data were analyzed Design: An interview with lecturers of different academic by T-test and SPSS software. degrees and belonging to the Faculties of Medicine, Summary of result: The results showed that there is a Dentistry, Veterinary and High School of Nursing in significant difference in using learning strategies between Ondokuz Mayýs University, Samsun, Turkey was carried successful and unsuccessful students regardless of sex out via a questionnaire which was mainly composed of 2 and field. The most frequent cognitive strategy used by sections. Section 1 included statements that were expected successful students was rehearsal and the most frequent to stimulate discussion of potential differences in children meta cognitive strategy was planning. There was no and adults, whereas section 2 scheduled statements that significant difference between male and female in using adult learners’ characteristics were modified to health these strategies regardless of being successful or not and science students. also no significant difference was shown in using strategies Results: 116 subjects (25.86% Prof., 11.20% Associate between the students of the four mentioned fields. Prof. and 62.93% Assistant Prof.) participated in the survey. Conclusion: Medical students use different learning 75% of statements in section 1 and 100% statements in strategies such as rehearsal and planning for better section 2 were responded correctly by >50% of the learning. participants. Again, 33.33% of statements of section 1 and 63.63% statements of section 2 were responded correctly by >90% of the subjects. 8 Ruby 2.6 Conclusions: Under the limitations of the study, our results Experiential learning theory in practice suggest that lecturers of undergraduate healthcare Marzieh Moattari (Shiraz University of Medical Sciences, professions actually believe in the validity of adult learning Faculty of Nursing & Midwifery, Farhang Shati Street, Shiraz in health sciences and therefore, they may easily be 71859 77873, IRAN) adapted to educational programmes including adult Introduction: Kolb experiential learning theory is one of learning strategies, independent of their basic knowledge the most accepted theories in the teaching and learning about andragogy. process. Kolb cyclic learning theory is composed of four different components including: Experiencing, Reflection, 8 Ruby 2.4 Conceptualization and Planning. The value of reflection in A survey on learning styles of medical improving professional learning and integrating theory into practice is well recognized in the literature. As we did not students have any formal practice of reflection in our traditional Massoud Hosseini*, Fereydoun Azizi and Ali Khanzadeh curriculum, we decided to test out the feasibility of Kolb (Mashhad University of Medical Sciences, Education experiential learning theory in practice. Development Center (EDC), Daneshgah Street, Mashhad, IRAN) Method & Material: 20 senior nursing students participated in this study. They were asked to reflect on their clinical Background: Several factors may influence the teaching- experiences in their weekly journals. After 10 weeks’ learning process. One of them is learning style. Teachers reflection on action they expressed their views on the must consider students’ learning style to enhance their course of reflection in 2 focus group sessions. academic performance. Results: Based on qualitative data analysis and the Objective: The aim of this survey was determination of emerging themes all the components of Kolb learning cycle the learning style (based on Kolb theory) among medical were found in the students’ views. Furthermore a new students of an Iranian medical faculty. theme named motivation was found to be capable of being Methods: This is a descriptive study carried out in 2001- integrated into Kolb cyclic learning. 2002 academic year. Questionnaire (including demographic Conclusion: Kolb experiential learning is feasible in our questions and Kolb learning style inventory) was used to traditional curriculum. Motivation as one of the most gather data. 229 persons (from a total of 340) participated important components of learning may be added to Kolb in survey by completing the questionnaire. experiential learning cycle. In this case the experiential Findings: Results indicated that most of the students were learning cycle will become more dynamic with all its assimilator (43.1%) and the others were converger elements being in direct or indirect interaction with (38.1%), diverger (9.6%) and accommodator (9.2%). motivation. Most of the students in basic science period were assimilator but in clinical period the most were converger. 8 Ruby 2.7 Other findings will be presented. Final years, cadavers and first years: a Conclusion: Findings suggest that most medical students feasibility study in developing peer-assisted tend to apply assimilating and converging learning styles. learning in anatomy classes It seems that individual learning style is affected by learning environment and tasks, although more research is Carol A Parker*, Matthew Prime, Andrew J Wilson and necessary. Teachers must consider different learning styles Deborah Gill (University College London, Department of of students in their teaching. Medicine, 5 University Street, London WC1E 6JJ, UK) Introduction: Peer-assisted learning (PAL) is extensively utilised within the Royal Free and University College Medical

– 159 – Session 8 THURSDAY 1 SEPTEMBER Session 8

School, including student selected component (SSCs) and Conclusions: Senior students were well motivated to voluntary initiatives involving senior students teaching volunteer to be peer tutors to improve their own teaching clinical skills to junior students. Feedback is invariably skills and their own clinical skills. They felt they benefited positive, and junior students highly value the time spent from knowing more about the subject and developing their with senior students. There are a number of problems own teaching skills. Drawbacks included insufficient with anatomy teaching at the medical school; preparation time and exposure of a lack of knowledge. predominantly due to large student to staff ratios and a Suggested improvements included more opportunities, lack of junior doctors available as demonstrators. Previous updated preparation material, making peer tutoring part studies have championed the use of PAL in anatomy1 but of the core curriculum. other authors have highlighted logistical difficulties2. Changes made in response to the evaluation include: Objectives: To assess and detail the feasibility of creating improved preparation material; more patient contact. a 5th year PAL SSC in anatomy demonstrating. Methods: Interviews with anatomy and surgery faculty, 8 Ruby 2.9 curriculum managers, senior students and other External challenging of the musculo- stakeholders and a questionnaire survey gathering the opinions of year 5 and junior students regarding the skeletal system: a collaborative learning usefulness of such an initiative. experience for first year medical students Results: Results of the feasibility study and a pilot J A Palha*, L Torrão, J Cerqueira, H Tavares, L Gonçalves, A programme will be presented along with advice and Almeida, J Correia-Pinto, N Sousa, A Salgueira and M J Costa (Universidade do Minho, Medical Education Unit, School of suggestions for those who have an interest in setting up Health Sciences, Gualtar Campus, CPII, Piso 3, Braga 4710- PAL initiatives in their own institutions. 057, PORTUGAL) 1 2 Nnodim (1997) Clin Anat;10:112-7; Wadoodi & Crosby Background: Collaborative experiences promote deeper (2002) Med Teach;24:241-4 learning and are helpful in developing student expertise in teamwork. 8 Ruby 2.8 Work done: The curricular area “Organic and functional Evaluation of a peer tutor programme in systems” is a systems based course which integrates the ambulatory care teaching disciplines of anatomy, biochemistry, histology and physiology. This work describes a collaborative experience L E Owen*, J S Ker and L Ambrose (University of Dundee, that made use of the “Jigsaw” strategy: a member of each Clinical Skills Centre, Level 6, Ninewells Hospital and Medical team was trained as a specialist in one of the four areas School, Dundee DD1 9SY, UK) before being returned to their respective teams, with the Rationale: Peer tutoring is increasingly being utilised in mission of finding evidence in the literature for effects of undergraduate medical education (Topping, 1998). The environmental stimuli – pregnancy, cycling, alpinism, Dundee curriculum incorporates a peer tutor programme caffeine, erythropoietin or MDMA - on the musculo-skeletal in the Ambulatory Care Teaching Centre (ACTC). Volunteer system. The aspects that were investigated included: type peer tutors lead a teaching session in a dedicated simulated of muscular fiber influenced/requested, metabolic and out patient area. Peer tutors indicated that they found it a substrate preference of the fibers, serum markers of useful experience so an evaluation of their views was activity, type of musculo-skeletal lesions expected and bone carried out. densitometry parameters. The exercise involved first year Methodology: All fourth and fifth year peer tutors in ACTC undergraduates, organized in teams of four. Final papers during the academic session 2003-2004 were sent an were presented orally to the whole class. This work online evaluation using a customised e-assessment presents preliminary evidence, gathered from written package. The peer tutors were asked to evaluate their inquiries, on the effectiveness of the strategy to develop experience including their motivating factors, perceived integrative teamwork in 1st year medical students. benefits, drawbacks and suggestions. Conclusions/take home message: Collaborative teaching strategies are useful to foster the development of teamwork and integrative skills in medical students.

– 160 – Session 9 FRIDAY 2 SEPTEMBER Session 9

9AUD Symposium

9AUD Student involvement in medical education – it is hard to get the teachers to listen to suggestions that involve changes….? Students, including: Ozgur Onur (IFMSA), Carl Savage (IFMSA) and Hans Jacob Westbye (IFMSA) (Chair); Teachers, – assessment of the classes and teachers is a waste, including Peter McCrorie (St George’s Hospital Medical nothing happens anyway…? School, London, UK) and Albert Scherpbier (University of Maastricht, Netherlands) Do the teachers think that: This symposium is intended for students and teachers, – the students do not have the knowledge needed to see where the goal is to explore the effects of student the whole picture….? involvement in medical education, reflect on the good and – they are not appreciated enough by the students…..? bad experiences from both sides and hopefully end up – changes have to be initiated by the teachers, not by the with some constructive take home messages for both students….? groups. The symposium will be the place to air all your frustrations, Do the students think that: all your good experiences, and the possible solutions when – the teachers do not care about teaching, research is it comes to students’ involvement in medical education. more important…..? We hope that everyone attending will learn something from these experiences of other students and teachers.

Short Communications 9A International medical education; the Bologna Declaration

9A 1 An overview of the world’s medical schools Method and data: The data used in this analysis were the official texts. We first focused the comparison on the J Boulet*, C Bede, D McKinley and J Norcini (FAIMER, 3624 “means” (medical schools, teachers and funding) and the Market Street, 4th Floor, Philadelphia PA 19104-2685, USA) key “processes” (curriculum, students’ selection). We then Currently, there are over 1,800 medical schools operating linked the main characteristics of each country with its throughout world. The characteristics of these institutions own cultural and historical basis. vary considerably, both as a function of location and in terms of the features of their educational programs. The Results: In a centralized country like France, means and Foundation for Advancement of Medical Education and processes are highly standardized. It is assumed that Research (FAIMER®) maintains the International Medical application of standards guarantee the homogeneity and Education Directory (IMED®), a listing of the world’s the quality of physicians. Thus, there is a belief that there medical schools. The purpose of this study was to compare is no need for further evaluation. Consequently, France and contrast the characteristics of medical schools, both has almost no national assessment. By contrast, Canada, currently and historically. At present, there are 1,847 which leaves medical schools free to design the medical “active” medical schools in IMED, located on 6 continents. curriculum, implement national controls at several levels Most of these schools are located in Europe (n=389) and of the organization of training. These differences are more Asia (n=792). Interestingly, while nearly 14% of the world’s easily explained by historical issues than by a robust base population is in Africa, only 6.7% of all medical schools of evidence. are located there. In the past 5 years (2000-2004), over Conclusion: Educators wishing to understand or change 60 medical schools have begun training physicians. Since systems of medical education should understand the medical schools govern the education of physicians, it is historical roots that give them their character. important to have both up-to-date and historical information on their locations and operations. These data provide baseline information as to the supply and training 9A 3 Bologna and Medicine of physicians, and can be used, in combination with R Peter Nippert* and M Zuehlsdorf (Westfälische Wilhelms- emigration statistics, to help describe potential future Universität, Medizinische Fakultät, Institute of Medical healthcare provider imbalances. Education & Student Affairs, Von-Esmarch-Str 54, Münster D- 48129, GERMANY) 9A 2 Educating physicians in France and Canada: A second cycle of the Bologna Survey that was started last year has been conducted. are the differences based on evidence or history? It covers all 273 medical schools of the EU countries and centers on the attitudes of medical schools toward the Christophe Segouin* and Brian Hodges (Université Paris 7, Bologna declaration related curricular changes as well as Unité MSI, Groupe Hospitalier Lariboisière-Fernand Widal, on the state of the preparations to comply with the Bologna 2 rue Ambroise Paré, Paris 75475, FRANCE) requirements. Differences and progress made compared Introduction: In every country, we hope that physicians to the results from the 2004 survey are described and are trained in the best way to become competent discussed in detail. Among medical schools across Europe physicians. We also like to assume that education the Bologna Declaration requirements for medical methodology is evidence based. The following comparison education still meet reservation, ignorance, and reluctance will highlight the core differences between the two systems that need to be changed at the faculty level. of education, highlighting the important role of history and tradition in the structure of each system. However differences are also based on cultural factors related to the history of each country.

– 161 – Session 9 FRIDAY 2 SEPTEMBER Session 9

9A 4 Medical education and the Bologna Process 9A 6 Adaptation of Ukrainian medical education – a GMA (German Section of AMEE) to European requirements perspective Iryna Bulakh and Marina Mrouga* (Testing Board at Ministry W Gerke*, J Forster, H G Kraft, W Oechsner, O Onur, C Schirlo, of Public Health, 22 Pushkinska Street, Suite 307, Kyiv 01601, M Tullius and W Wennekes, for the Working Group of the GMA, UKRAINE) German Section of AMEE) (University of Zurich, Medical Background: In 2004, Ukraine was among the few Faculty, Office of Medical Education, Zurichbergstrasse 14, countries that didn’t join Bologna Declaration. However, Zurich CH 8091, SWITZERLAND) as Ukrainian foreign policy is aimed at Europe, joining the Background: The Bologna Process is a trend gaining Bologna Declaration in 2005 or 2007 is very likely. Now momentum in European higher education. The discussion Ukraine runs several pilot projects in this area. Ukrainian about the participation of Medical Education in Germany medical education falls between a rock and a hard place. has started quite recently. From one side, it must apply Bologna principles as other What was done: A working group was set up by the GMA. educational areas, from another – there are specifics that In a consensus process several aspects of the Bologna prevent this. Moreover, the European medical education process related to medical education were discussed. This community doesn’t demonstrate a uniform view on the presentation gives a summary and comprises (1) an application of Bologna principles. analysis of chances and risks, with special emphasis on Summary of work: In 2004 Ukrainian Ministry of Public the two cycle system, (2) a proposal for a potential Health initiated a project on adaptation of medical bachelor/master-model and (3) for general education to European requirements: Bologna Declaration, recommendations regarding implementation. Doctors Directive, WFME standards. The current Conclusions/Take home messages: Many elements of the achievements include: (1) Development of new ECTS- Bologna declaration can easily be applied to medicine. Most based one-tier undergraduate curriculum that is controversial is the two cycle structure. Interfaces for harmonized with Europe. (2) Introduction of new students willing to leave medical school with a bachelor or summative and formative assessment approaches into the for those willing to enter medicine for a master programme new curriculum; (3) White papers on reform of PGME and should be handled individually and must not put at risk CPD for medical doctors. The new curriculum will start in the priority of vocational training. Opening undergraduate 2005-2006. The presentation reflects the process and key medical education to interdisciplinary exchange seems points of new curriculum development, differences between possible by further developing elective or special study current and new curricula and problems that Ukraine faces modules. Nevertheless the implementation of the bachelor/ in adapting its higher medical education to European master model in undergraduate medical education should requirements. be an option, not an obligation unless further evidence and experience is available. 9A 7 Site visit experience – Faculty of Medicine, Cairo University 9A 5 Curricula changes at Zagreb Medical School Madiha Khatab, Nadia Badrawi, Esmat Sheba, Zinab Hamed, due to Bologna Declaration Lamis Ragab, Hala Salah and Mostafa Seleem (Faculty of Medicine, Cairo University, Cairo, EGYPT) M Vrcic-Keglevic*, D Bradamante, G Pavlekovic and Nada Cikes (University of Zagreb, “A. Stampar” School of Public Background: The Faculty of Medicine at Cairo University Health, Medical School, Department of Family Medicine, conducted a self study based on the World Federation for Rockefellerova 4, Zagreb 10000, CROATIA) Medical Education (WFME) global standards for basic Medical School, University of Zagreb is a traditional medical medical education as a benchmark. WFME is interested in school with a curriculum organised in three parts: basic testing the value of the WFME standards as an important sciences, pre-clinical and clinical disciplines. It is also aim of the WFME-WHO partnership to improve medical discipline based, with a low amount of horizontal or vertical education. The Faculty of Medicine at Cairo University integration and with less than ten percent of electives. invited WFME to make an external evaluation based on Since 2001, when the Croatia representative signed the the self study. A team formed of 7 members of our faculties Declaration, many changes within the medical curriculum headed by the Dean held many meetings to prepare for are going on: a) a mission of the school and «final» product the visit. A facilitator was nominated and attended a (medical doctor) is defined according to the needs of the workshop about the role of a facilitator during the site society and profession; b) educational goals are defined visit. The site visit lasted from 4-8 December 2004 and as competences; c) specific competences are defined for the site visit team was composed of Prof Hans Karle, each subject; d) specific modules based on integration President WFME, Prof Leif Christensen and Prof Jorgen are introduced, they are organised as PBL; e) about 20% Nystrup, Senior Advisors to WFME. A presentation of the of teaching time is devoted to electives, and they are also preliminary report and oral feedback were conducted on PBL; f) the European Credit Transfer System is introduced the last day of the visit and the final report was sent on 25 for each subject, defined as amount of learning time; g) April. direct student-teacher contact hours (lectures or seminars) Conclusions/take-home messages: This is the first site visit are lowered to 20 per week; h) active methods of learning to a medical school in the Middle East, Arabic and African (individual projects, small groups) became most important; countries. We advise other medical schools not to miss i) final exam is organised partly as OSCE, and diploma the experience of a site visit as a beneficial step before work is compulsory; j) training of teachers are prerequisite the real site visit by the national accrediting body. for advancement. Still many changes are in front us, because it is not easy to switch from a traditional way of thinking.

– 162 – Session 9 FRIDAY 2 SEPTEMBER Session 9

Short Communications 9B Standard setting

9B 1 What standard setting method provides a 9B 3 Setting content-based standards for a high- fair and defensible pass mark in clinical stakes clinical skills examination skills OSCE within the resources available? Melissa J Margolis*, Brian E Clauser, Monica Cuddy and D Collier*, L Wilkie, R Fewtrell, S L Fowell, P Owens and P J Gerard F Dillon (National Board of Medical Examiners, 3750 McLaughlin (University of Liverpool, Clinical Skills Resource Market Street, Philadelphia PA 19104, USA) Centre, 2nd E Block, Old Infirmary, 70 Pembroke Place, In June 2004, a multi-site clinical skills examination was Liverpool L69 3GE, UK) implemented as part of the United States Medical Licensing Background/Rationale: Students demand assessments to Examination. This abstract describes an initial approach be fair and equitable, Universities require valid, fair, to setting content-based performance standards for this defensible assessments testing appropriate areas of examination. Thirty-five content experts provided learning. Within clinical skills, a pass mark of 80%, set in judgments about the adequacy of examinee performance 1996 using the Hofstee method has remained unchanged. during three three-day meetings. Following orientation, The School of Medical Education is moving to implement training, and practice, judges reviewed an initial set of standard setting in all summative assessments. To conform performances. Initial judgments were analyzed and judges to this the Clinical Skills Resource Centre compared were given feedback regarding: 1) the impact of judgments standard setting methods for OSCEs. on a group of test takers; 2) the relationship between individual judges’ decisions; and 3) the relationship Methods: Three standard setting methods were compared between judges’ impressions of examinee performance to the original 80% pass mark on examiner led stations and their actual judgments. Following the feedback, judges over second and fourth year OSCEs. The approaches used reviewed and judged a final set of performances. Final were an expert panel based - a modified Angoff method, judgments were used to project cut-scores onto the score an examiner based - Borderline group method and a result scale, and resulting fail rates were considered by based - Hofstee method. policymakers when making final policy decisions. Results Results: The three standard setting methods returned a provided policymakers with important impact information result very close to the preset 80% pass mark. based on actual examinee performance and expert Conclusion: There was little difference between the results judgment. While content-based standard setting is a critical from the three standard setting methods and our original step in the decision-making process, the results provide 80% pass mark. The drawbacks are: Time consuming only one source of information. It is also important, for (Angoff); Training for judges/examiners (Angoff & example, to consider the input of other stakeholders in Borderline); Potential examiner bias (Borderline); Time to the process so that policymakers can make well-informed publication of results slowed (Hofstee). Further work is decisions based on as many relevant data sources as required to devise the optimal standard setting method possible. and frequency needed to give defensible assessment pass marks. 9B 4 An A B C of standard setting a paediatric undergraduate OSCE using borderline groups 9B 2 A technique for combining examination A Reece*, T Cook, E M K Chung, A G Sutcliffe and R M scores and setting pass-marks Gardiner (University College London, Department of Paediatrics and Child Health, Royal Free and University Gary Cole*, Curtis Lee and Nadia Mikhael (Royal College of College Medical School, Bloomsbury Campus, The Rayne Physicians & Surgeons of Canada, Educational Research & Building (4th Floor), 5 University Street, London WC1E 6JJ, Development Unit, 774 Echo Drive, Ottawa, Ontario K1S 5N8, UK) CANADA) Aim of Presentation: Objective Structured Clinical Aim: The Royal College of Physicians and Surgeons of Examinations (OSCE) are used in high-stakes Canada is responsible for certification examinations for 49 undergraduate assessments. Following a Child and Family specialties. Many of these specialties have two or more Health block, 129 second-clinical-year Undergraduates examination components (e.g., written and OSCE) and the undertook a summative OSCE. With no universally applied decision to pass or fail candidates is based on the composite methods for OSCE standard setting, we report our efforts of these components. Combining the results of these to standard set this assessment using Borderline components is problematic because they are often on Regression1. different scales. It was necessary to develop a unique solution to this challenge as typical solutions such as Summary of Work: The OSCE comprised 12 ‘scoring’ differential weighting of the components or using stations: 10 involved an examiner marking each candidate standardized scores are inadequate. out of 5 in three domains according to Behaviourally Anchored Rating Scores. A Global Rating of ‘clear fail’, ‘bare Summary: The Royal College developed a one step process fail’, ‘bare pass’ or ‘clear pass’ was also given. Candidates to combine scores and make pass mark decisions. The rated ‘bare pass’ or ‘bare fail’ were regarded as borderline; system is used by 13 specialties. The stability of the pass their average score used to set the pass mark for these mark decisions were examined and the pass mark decisions stations. were compared with results obtained using more traditional techniques. Summary of Results: Numbers of borderline candidates ranged from 13 to 89; implying examiners not basing global Results: The process is relatively efficient and easy to use rating decision on station score. Too few borderline and has been well received by examination boards. The students would reduce validity. Range of borderline system meets fundamental criteria for setting pass marks. candidates’ average scores: 8.18 to 9.41 (average 8.8) It has shown stability and yields results that are consistent out of 15 marks. Pass rate using criterion-referenced with other techniques. method 96.1% (5/129 failed); compare 97.7% (3/129 Conclusions: The grid technique is a highly effective failed) if norm-referenced. method for combining scores and setting pass marks for Conclusions: Borderline Regression allowed a criterion- medical examinations involving two or more components. referenced, defensible standard.

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Take-home messages: An A B C for successful Borderline 9B 6 A comparison of two standard setting Regression: A - Adequate numbers in borderline groups, methods for computer adaptive testing B - Borderline group created by Global Rating, C - Calculation of mean station scores for borderline candidates C Touchie, T O Maguire, R Wassef and A P Boulais (Medical providing pass-mark. Council of Canada/The University of Ottawa, The Ottawa Hospital, General Campus, 501 Smyth Road, LM-14 (box 209), 1Wilkinson TJ, Newble DI and Frampton CM. Standard Ottawa, Ontario K1H 8L6, CANADA) setting in an objective structured clinical examination: use The pass/fail standard for the multiple-choice questions of global ratings of borderline performance to determine (MCQ) of the Medical Council of Canada Qualifying the passing score. Medical Education. 2001 November; Examination Part 1 was traditionally set using a 35(11):1043-1049. modification of the Nedelsky procedure (NP). This requires judges to offer an opinion on distractors of every question 9B 5 Comparing norm-referenced standard evaluated. The calculated passing score is translated to a continuum scale for the adaptive testing format. The Global setting with holistic evaluation in an OSCE Judgment procedure (GJP) examines the item as a whole, assessing first clinical skills identifying the passing level on the continuum scale. This E Macri, F Ferrando* and G Garces (University Hospital, study compared passing scores calculated using the NP Rambla O’Higgins 4865/502, Montevideo CP 11400, and the GJP. Six discipline committees had 6-8 judges, URUGUAY) each making judgments about items using both the NP In 2004, an OSCE to assess students’ clinical skills was and GJP. Passing scores were calculated for each procedure reported. The first standard setting was norm referenced. as a point on an ability continuum. Judgments were made Score to succeed OSCE stations was the mean minus 1 on 318 items by 46 judges. Data from all 6 committees SD. In the third OSCE experience, raters were asked to fill were combined to obtain total passing scores. Calculated an holistic scale from 1 to 4 (1, 2 not sufficient, 3 borderline, passing scores differed for both procedures (-1.36 VS – 4 sufficient). We compared student’ performance in this 1.15; calculated using the maximum likelihood procedure). scale with calculated cutting score in each station. Although the GJP was simpler to perform, the passing score differed from that of the NP. Using GJP alone may Results: not be sufficient in setting standard for high stake Norm Ref Setting examinations but may supplement data obtained from the Examiner Global Scale Fail Succeed NP. HT 1 fail 100% 0% borderline 51% 49% 9B 7 Recent graduates and experienced teachers succeed 7% 93% as Angoff standard setters PE 1 fail 96% 4% James Ware*, Shekhar M Kumta, Ho K Ng and Paul Lai borderline 48% 52% (Chinese University of Hong Kong, Teaching and Learning succeed 12% 88% Resource Centre, R/103, F/1, Block A, Prince of Wales Hospital, HT 2 fail 71% 29% Shatin NT, HONG KONG) borderline 35% 65% Evidence suggests that recent graduates (RGs) are more succeed 4% 96% accurate standard setters than Faculty Teachers (FTs). This PE 2 fail 85% 15% was investigated with half (n=100) of a Finals Surgical borderline 34% 66% MCQ Examination and then compared results from six succeed 2% 98% previous examinations (1999 – 2004). HT 3 fail 89% 11% The FTs set a standard of 62.0% + 6.3% (mean + 1SD) borderline 47% 53% compared with 52.6% + 4.8% for the RGs, p<0.001. The succeed 8% 92% pass-fail cut-score was set with group means minus 1SD PE 3 fail 83% 17% from the last six Finals, 51.4% + 1.4%, which versus RGs’ borderline 21% 79% estimates (NS). If the Angoff scores were applied to the succeed 2% 98% six previous finals, the FTs would fail 62% of candidates PE 4 fail 81% 19% and RGs 18%, against an actual fail of 15%.The RGs set borderline 29% 71% two substantially different standards for tests of recall (K1) succeed 4% 96% versus reasoning (K2), 57.3% + 5.3% versus 46.0% + HT history-taking 5.2%. If these predictions are used to determine the cut PE physical examination score in 2004 which had a K2:K1 ratio of 57:43, they would be 99% accurate in determining the cut score by the relative standard used. The RGs’ standard may not reflect In all stations, examiners concordance between both the desired standard, as determined for a criterion evaluation methods was high in students who failed, and referenced examination. acceptable with succeeding students. Conclusions: Global rating training is necessary to improve quality of OSCE examiners for future high-stake exams.

Short Communications 9C Staff/faculty development 2: learning outcomes and rewards

9C 1 A changing and sweet refrain in higher notion “Publish or Perish” prevailing. Only research education: teach and flourish excellence leading to fundamental discoveries has been considered scholarly work deserving the highest Matthew Gwee (National University of Singapore, Faculty of institutional accolades, recognition and rewards. Yet, Medicine, Medical Education Unit, Block 11, 10 Medical Drive, paradoxically, frequent exhortations urging teachers to Singapore 117597, SINGAPORE) excel in their teaching abound, but teaching excellence is The teaching-research divide is still a vexing and not accorded the same institutional status as research contentious issue in higher education with the familiar excellence. However, in 1990, the late Ernest Boyer strongly

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advocated the need to redefine the meaning and appraisal Conclusion: The use of educational change strategy led to of academic scholarship to include excellence in the the development of courses for educators based on intellectual rigours of teaching and learning. Boyer’s competencies and learning outcomes. advocacy has provided a major impetus to further nurture Take home messages: Change management can be and enhance professionalism and excellence in the achieved using established methods. scholarship of teaching and learning in medical education to match the significant shifts in educational paradigm Involvement of stakeholders leads to shared values and (PBL, SPICES, BEME, learner-centred/inter-professional ownership. Delphi groups are useful in identifying key education, communication skills, self-directed/lifelong/ issues. Outcome based learning is effective for curriculum integrated/attitudinal learning) and to optimise the development. intended educational outcomes for students. Consequently, to ‘Teach and Flourish’ is now a gentle sweet refrain echoed in higher education. More enlightened faculty development 9C 4 Identifying roles of a good tutor for medical programmes and appraisal of academic scholarship are students during a research project required to firmly embed Boyer’s insightful advocacy in H M J Raghoebar-Krieger*, W M Molenaar, M Penninga and and for the advancement of academic medicine. F M Haaijer-Ruskamp (University of Groningen, Onderwijsinstituut, A. Deusinglaan 1, Groningen 9713 AV, NETHERLANDS) 9C 2 Teachers need rewards – teaching should be rewarding Background: Faculty staff tutor 1st year medical students in scientific research. Yet, the kind of roles tutors should B Marschall* and R P Nippert (Institute of Education and have is unknown. We tested the applicability of a theoretical Student Affairs (IfAS), Medical Faculty of Westf. Wilhelms instrument of teacher roles to tutors of scientific research. Universität Münster, Domagkstr. 3, Münster D-48149, Tutors were asked about these roles: (1) their importance; GERMANY) (2) the tutors’ mastering. Unlike medical research and patient care where rewards What was done: A questionnaire was sent to all tutors are immanent and available, medical teaching lacks (n=31), with 23 statements (five theoretical areas: immediate rewarding structures. Although inroads into information provider, role model, facilitator, assessor, faculties’ meritorial systems have been made, teaching resource developer) reflecting the behavior that good tutors still comes third when academic merits are evaluated. This should have. The percentages of tutors that assess the situation in mind, Medizinische Fakultät of Westfälische roles as important were analyzed, as well as those that Wilhelms-Universität Münster has decided to try a newly master the roles. devised scheme to improve clinical teaching. It aims at improving clinical competence in interns and, at the same Conclusions: Eighty three to 100% of the tutors identified time, improving job satisfaction in clinical teachers. As all five areas above as important. The roles ‘help in teaching in affiliated hospitals is traditionally performed statistical questions’ (64%) and ‘assessment of professional by junior medical staff, it was decided to stimulate their behavior’ (77%) were perceived as less important. These effort by financial rewards. The scheme is simple: Interns 2 roles are also the roles which were mastered by less are required to give evaluations on the teaching efforts teachers (respectively 58% and 54%). The other roles in during their clinical education on a daily basis. For this the five areas were mastered by 72-96%. purpose, an online platform for interns was established, Take-home messages: The theoretical teacher roles are to evaluate their clinical teachers. This evaluation is the valid; the instrument provides needs assessment for tutors basis for the financial reward which is transferred directly and can be used to provide them with feedback. to the private bank account of the clinical teacher using a tax break for individuals who may earn income tax free 1.847 Euros per year. The maximum amount for effective 9C 5 Designing a curriculum for educational and adequate clinical training was set at 10 € per day and policy committee members: how to be an student trained. Detailed results from the first semester effective member experience will be demonstrated and discussed. It is expected to yield a significant improvement in students’ Mary Thoesen Coleman (University of Louisville, Office of clinical skills and diagnostic abilities at the end of the Medical Education, 500 South Preston Street, Room 305, internship. At the same time it is expected to produce a Louisville KY 40202, USA) spin off regarding the position of clinical teachers and their Aim: To share a mini-curriculum for educational policy work in the meritorial system of Münster medical school. committee members. Summary of Work: Appointed and elected members of an 9C 3 Competencies and learning outcomes in educational policy or curricular committee often receive courses for educators no training or formal preparation for their roles on a key committee responsible for curricular oversight. To prepare Victor Schrieber (West Midlands Deanery, Northumberland committee members for their task, a mini-curriculum was House, 437 Stourport Road, Kidderminster DY11 7BL, UK) designed using a six-step method of curriculum design: Rationale: The aim was to develop a cohesive strategy for 1) Problem Identification and Needs Assessment, 2) Task courses for educators in the West Midlands Deanery. This Analysis and Expected Outcomes, 3) Goals and Objectives, involved identifying competencies and learning outcomes 4) Assessment and Instructional Strategies, 5) at basic and higher levels as well as methods of Implementation, and 6) Evaluation and Feedback. Adult assessment. learning principles: andragogy, motivational techniques, What was done: I developed an educational change cognitive information processing, metacognition, and strategy using the structure suggested by Skilbeck. This constructivism, were applied in the design. began with a situational analysis reviewing the current Results: We developed a program entitled: “PRICE” with provision followed by a needs assessment. Then goal five main components:1) Professional Development - skills formulation led to agreed competencies from which in running a meeting, understanding learning styles, learning outcomes and the methods to assess them were personality profiles, and negotiation preferences, 2) Roles refined. Programme building required sharing of best and Responsibilities - expectations regarding attendance, practice and agreement to adopt a curriculum, teaching participation, and governance, 3) Improvement - and assessment methods that were evidence-based and understanding curricular content, improvement science, approved by the Deanery. This resulted in the and curricular comparisons, 4) Collaboration - skills in implementation of a new style of course from which collaboration, and 5) Evaluation – participation in evaluation feedback was received to be analysed prior to future and interpretation of data. developments.

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Conclusions/Take Home Messages: Adult learning theory diverse groups, especially black doctors, get involved in can be applied to creation of a mini-curriculum that university education and training, and therefore academics addresses a gap in professional development essential to in many medical schools are of an older generation and improved curricular evaluation. predominantly white. The aim of the presentation is to offer some detail on a strategic management framework as well as on a manual on staff and skills development 9C 6 A snapshot of perceived knowledge in with a view to empower staff in medical schools. This student assessment among a select group research results in a set of proposed actions on of medical teachers in Asia-Pacific countries management, teaching and training as well as guidelines on how to transform medical schools in order to create a Zubair Amir*, Matthew Gwee, Hoon Eng Khoo, Chay Hoo Tan, Yap Seng Chong, Poh Sun Goh and Yiong Huak Chan (National friendlier and more accessible working environment, with University of Singapore, Department of Paediatrics, 5 Lower young and promising doctors, managers, education Kent Ridge Road, Main Building 1, Level 4, Singapore 119074, providers, and especially role models for a changing student SINGAPORE) population. Background: Medical faculty should have proper knowledge With this research a contribution is made with regard to and training in student assessment. The objective was to the empowerment of young professionals which enter into determine the current perceived knowledge of medical academic medicine by offering a management framework teachers in student assessment and their future needs. and guidelines in the form of a manual. Methods: This was a survey during 2nd Asia Pacific Medical Education Conference. The study participants mostly came 9C 8 Effective teaching behaviours: where is the from Asia-Pacific countries. The instrument contained 10 agreement between students and teachers assessment topics each with three statements indicating three different levels of proficiency (Limited, Modest, and in England and the USA? Substantial). Respondents indicated their current John Perry*, Walter N Kernan, Warren Hershman, Eric Alper, proficiency and desired future proficiency. Mary Y Lee, Catherine M Viscoli, Patrick G O’Connor and John Benson (Institute of Public Health, Robinson Way, Results: Of the total 143 eligible participants, 121 (84.6%) Cambridge CB2 2SR, UK) responded. Over 75% reported their current knowledge was Limited or Modest in nearly all topics. Respondents Aim: To identify concordance and disagreement between liked to improve their knowledge further in all topics areas GP teachers and students in England, and ambulatory care (p <0.001). Involvement in assessment and years of preceptors and students in the USA in valuing teaching experience had little effect on perceived knowledge. behaviours. Attendance in > 3 workshops had modest beneficial effect Method: We selected 50 faculty and 50 students at random in current knowledge and future need. Current knowledge from registers at each of the following universities: and need for future improvement was most pronounced Cambridge UK, Boston, Massachusetts, Tufts, Yale. All were in extended matching item, assessment of professional sent Kernan et al’s (2000) instrument that identifies 58 behavior, and portfolio-based assessment. teaching behaviours which respondents rate on two 5- Conclusion: This study with a select group of medical point scales judging their importance and effect on faculty indicates a significant deficiency of perceived learning. knowledge in student assessment. Encouragingly, Results: 301 questionnaires were returned. (Response rate: respondents demonstrated commendable insight in their faculty 68%, students 74%). In the American survey for knowledge deficiency and future needs. 22 of 58 (38%) behaviours there were statistically significant differences (p<0.05) between the views of students and faculty. In England views differed significantly 9C 7 A management framework and manual for for 13 (22%) behaviours and of these only 7 also reached the empowerment of staff in medical statistical significance in the USA results. Students were schools in South Africa more likely to emphasise the value of delegated M M Nel*, P P C Nel and G J can Zyl (University of the Free responsibility and faculty to value role modelling and State, Faculty of Health Sciences, Internal Box G14, PO Box consent. Only 4 behaviours appeared in both the USA and 339, Bloemfontein 9300, SOUTH AFRICA) English 10 behaviours where faculty and students were most in agreement. No official written policy, strategic management framework or manual for the empowerment of academic staff exists Conclusion: There is not only difference between students in Medical Schools in South Africa, although actions are and faculty within country but also between countries. taken from time to time that attempt to address the needs This challenges the assumption that effective teaching that are identified. Too few young professionals from behaviours have an enduring quality.

Workshop 9D Mastering bedside cardiology using Harvey, the Cardiopulmonary Patient Simulator

9D Mastering bedside cardiology using Harvey, training, practice, and testing. Studies show that repetitive the Cardiopulmonary Patient Simulator practice and self-assessment of these skills through the use of patients and simulation devices lead to enhanced Donald Brown1, Joel M. Felner2, 3Ira Gessner and 4Stuart 1 2 mastery of the cardiac bedside examination. This, in turn, Pringle ( University of Iowa School of Medicine, USA; Emory will lead to improved patient diagnosis and management. University School of Medicine, USA; 3University of Florida School of Medicine, USA; 4Department of Cardiology, As certification boards and accreditation processes required Ninewells Hospital and Medical School, Dundee, UK) documented mastery of essential clinical skills, simulation systems are becoming a necessary and required Background to the topic: While the cardiac bedside component of continuing professional development. examination is accurate and cost-effective, important auscultatory findings often go unrecognized for lack of

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Workshop content and structure: This workshop will use Intended outcomes: The objective of this workshop is to “Harvey,” the Cardiopulmonary Patient Simulator. “Harvey” demonstrate the effective use of simulation for learning simulates 30 cardiac conditions. The workshop will provide and assessing bedside cardiopulmonary skills. At the end a practical, hands-on, interactive experience for each of the workshop, participants will be able to: (1) recognize participant. The skills you will learn in this workshop will the essential cardiopulmonary bedside findings, (2) identify be based on an understanding of the cardiac pressure those that require further evaluation, and (3) implement and volume curves, involvement through interaction and techniques that effectively train internists in bedside mimicry of auscultation, and repetitive practice with cardiology. outcomes testing. This workshop will be carried out in an Intended audience: Clinical skills facilitators; Harvey users; interactive patient-centered format. Bedside findings will clinicians; educators interested in finding our more about be shared through video projection and audio Harvey; educators interested in using simulators in stethophones, including breathing, venous, arterial and multidisciplinary learning; clinicians and educators precordial impulses and auscultation. The workshop interested in clinical skills training. facilitators are cardiologists and educators with many years of experience in developing, refining and teaching with Level of workshop: All levels of participants will find this Harvey. workshop useful.

Short Communications 9E e-learning in action

9E 1 Strategies for effective e-learning: The are also being developed. These are enhanced by IVIMEDS experience highlighting clinically relevant structures and are presented with an external representation of the object to provide R M Harden and D A Davies (IVIMEDS, Tay Park House, 484 further guidance for the student. Perth Road, Dundee DD2 1LR, UK) The use of these models will add another dimension to The International Virtual Medical School (IVIMEDS) the traditional methods of teaching of anatomy and collaboration has as an aim the effective use of pedagogy potentially aid in the development of spatial reasoning. alongside high quality content and robust technology. IVIMEDS embraces six educational strategies: (1) Blended learning – e-learning is integrated with face-to-face 9E 3 The use of an open source e-learning platform learning; (2) Customised learning – the learning content to teach informatics to a large population of and the learning strategies are customised to the needs students in blended-learning modality of individual students. Learning strategies include: directive learning, problem based learning, exploratory learning and A R Formiconi, E Vanzi, M Masoni and A Conti* (Università adaptive learning. The instructional design is based on di Firenze, Dipartimento Fisiopatologia Clinica, Viale the use of content learning objects; (3) Contextualised Morgagni 85, Firenze I-50134, ITALY) learning – a virtual practice with virtual patients provides This paper deals with the teaching of basic informatics in an authentic context for the students’ learning; (4) university curricula; the problems are: (1) Informatics is a Structured learning – a framework for the students’ basic subject found in almost all curricula. (2) The student learning is provided by a curriculum map which is both a population is often large. (3) The background of students navigation tool and an organisational framework for the in informatics is extremely variable. We describe the use learning objects; (5) Intentional learning – embedded of E-learning tools to impart this kind of teaching in a within the curriculum map are the learning outcomes; (6) blended-learning modality. The system uses the “ATutor” Cooperative learning – peer-to-peer learning is integrated open source platform. In the first lesson the students learn into the learning environment with individual and small to use the platform and successively they can access the group collaborative learning both formal and informal. The platform from any location at any time. In subsequent six strategies will be illustrated in the context of the lessons, the teacher is available in the informatics lab for IVIMEDS implementation. those who need assistance. Course tracking, self evaluation tests, forum discussions and internal mail are extensively used. 9E 2 Using 3D models to enhance traditional teaching methods Results relative to the preceding academic year are reported. A population of more than 500 students with 24 C Newlands*, G McConnell and C Boulocher (The University curricula and located in Florence and in 4 other towns of Edinburgh, Royal (Dick) School of Veterinary Studies, within a radius of 50 Km was taught with this system by Summerhall, Edinburgh EH9 1QH, UK) only one teacher. Compared with the conventional method Aim: To improve learning of the complex structure of a applied to an analogous population during the previous wide range of anatomical regions commonly viewed for three years, with this system better results were obtained diagnostic purposes in the clinical context. and it was much easier to identify and assist those who Background: Students have problems understanding really needed help. complex 3D structures from 2D representations, but spatial reasoning is vital for surgery and to interpret 2D 9E 4 Use of web-based interactive eCourseware radiographs. to facilitate face to face radiology teaching Summary of work: 3D models are being created to enable – a follow up report students to overcome difficulties in interpreting complex 3D anatomical structures. By bringing clinical software P S Goh*, S C Wang, A Low, K H Lew and L Lim (National University Hospital, Department of Diagnostic Radiology, 5 developed at UCL Medical Physics into the e-learning Lower Kent Ridge Road, Singapore 119074, SINGAPORE) development process, we are able to create 3D models of structures taken from CT scans, and present a comparison Aim: To present a follow up report of our eLearning with 2D radiographs to aid interpretation. 3D Virtual programme since AMEE 2004. radiographs can also be generated which, when rotated, Summary of work: One year after AMEE 2004, we have can help students identify complex structures in the continued to obtain good user feedback and further standard radiograph. Interactive sequences of CT scans

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validated our Chest Radiograph eCourseware. A second personal device of the students. The students were asked “Skull Radiograph and CT head scan” eLearning module to choose an answer in a multiple choice setting or to surf has been completed and used successfully in blended internet for imaging guidelines. The chosen answers were medical student teaching over the last 6 months. We have directly shown, leading interaction. used these successes to obtain institutional buy-in. The Conclusions: Besides organizational and technical issues successful development and acceptance of the first two the introduction of wireless learning within education in eLearning modules has allowed us to progress to develop radiology enables students to influence the lecture and further radiology eLearning modules. These will be used gives the tutor more insight into the knowledge level of for both undergraduate and postgraduate teaching, in 4 the students. teaching hospitals, countrywide. Take home message: Wireless learning can be used as a Summary of Results: We will present our roadmap and means to a more flexible, student oriented education. It timelines showing the process of initial idea conception to offers the possibility to take the technology where current status. We will present usage and feedback data education actually takes place and not vice versa. on the CXR and SXR/CT head eLearning modules. Conclusions/Take-home messages: Successful development of a blended eLearning - face to face radiology 9E 6 An online bachelor degree in nursing: a new teaching programme requires 1) knowledge of best experience at the Medical School of Florence practice, 2) a foundation of sound pedagogy, 3) a University multidisciplinary team, 4) a commitment to continuous G F Gensini, P Bonanni, G Corradi*, A Conti, M R Guelfi and improvement with multiple plan-do-study-act cycles, 5) M Masoni (Università di Firenze, Facoltà di Medicina e institutional and teaching community buy-in. Chirurgia, Viale Morgagni 85, Firenze I 50134, ITALY) A relatively large number of student places is available for 9E 5 Improving clinical reasoning in radiology the Bachelor Degree in Nursing in Italian Medical Schools. through wireless learning, a pilot study Some Regions also offer substantial fellowships to many nursing students. Nonetheless the number of students R van der Togt, M Maas*, P Boxel, S Villan, R Sijstermans and entering the Nursing Curriculum and obtaining their Degree G J den Heeten (Vrije Universiteit, IVM Spatial Information is not high enough to fill all the vacancies in the National Technology, Meibergdreef 9, Suite C1-210, Amsterdam 1105 AZ, NETHERLANDS) Health System and in the private health structures. It is in this context that the initiative of the Medical School of Background: At the AMC there is a growing attention to Florence to start an Online Degree in Nursing collocates the ability of monitoring education progress. The itself. For a degree in the health field the student must possibilities which wireless learning offers in this context acquire the necessary practical abilities and capacities are explored. In its most basic terms, and from the during professional traineeships in hospitals and/or clinics, infrastructure perspective, wireless education is based on which must work in cooperation with the Medical School. the assumption that students have available a personal This new course represents an opportunity to increase device – portable computer, tablet, PDA or other – suitable the number of health professionals with higher education, to access a network from hot-spots (WiFi) located within something vital for the health system of the country, and the campus premises. The project was supported by at the same time it covers the needs of professionals funding of the ‘Digitale Universiteit’. already working in the health system, but without higher What was done: Within a lecture of clinical reasoning in qualifications. For them the flexibility of online educational radiology of chronic ankle pain, consisting of a group of packages represents a unique possibility for professional 25 students with wireless access to the internet through a retraining and upgrading. The work carried out in the last PDA or laptop, the tutor was able to post questions to the 18 months, to set up the online course, will be presented.

Short Communications 9F Teaching and learning about public health and health promotion

9F 1 The systematic or opportunistic approach to skills, critical appraisal, behaviour change strategies, health health promotion teaching in undergraduate enhancement programs, applied ethics and writing and curricula: preliminary reflections and oral presentation skills. King’s offer HP special study modules in years 2, 3 and 4 to small numbers of students, comparisons of two models but throughout the five years opportunities arise for tutors Ann Wylie*1, Craig Hassed1, Tangerine Holt1 and Ken Jones2 to address HP issues. (1Guy’s, Kings and St Thomas’ School of Medicine, Department of General Practice and Primary Care, 5 Lambeth Walk, Conclusion: The Monash Model is comprehensive HP London SE11 6SP, UK; 2Monash University, AUSTRALIA) content. King’s will develop systematic HP content in years 3 & 4 but probably have less % of core time. Sharing The presentation describes and discusses two approaches experiences from other universities is invaluable prior to to health promotion (HP) teaching: a systematic approach introducing HP core content. at Monash University; an opportunistic approach at King’s College. Summary of work: During a visit to Monash, Wylie observed 9F 2 Knowledge of public health is insufficient in various aspects of the Monash approach to consider what new graduates lessons could be learnt from the Monash experience and Angel Centeno*, Laura Llull and Cecilia Primogerio be transferable to King’s revised curriculum or other UK (Universidad Austral-Medicina, School of Biomedical Sciences, medical schools. Av Juan D Peron 1500, B1625 AHJ Derqui, Pilar, Pov Buenos Aires, ARGENTINA) Results: The systematic approach takes in access of 15% of core curriculum time in the first two years of a five-year In developing countries the need to teach Public Health in course and needs a committed team of tutors. In the medical schools has to be emphasized. In Argentina Monash program students undertake HP research group- teaching medical students the principles of public health projects and integrate HP learning with research and IT can be a good strategy to involve them in reformulating a

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health system that needs to be improved. We administered demonstrated good teaching skills) were generated. a survey to 78 new graduates who applied for a residency Students acknowledged the usefulness of the module, position at our school. We asked them to describe the describing opportunities to practise public health skills and type of formal teaching they had been exposed to, how see common public health emergencies. Some students they perceived their competence in this area, and what criticised the timing of the attachments as it clashes with the most relevant topics to be included in a graduate other attachments and projects. Steps are being taken to program were. Although 84% had had some formal rectify this in next year’s programme. teaching of public health during their graduate courses, they perceived themselves to be non-competent in Public Health administration (50%), planning (42%), politics and 9F 5 Key elements of a clerkship to teach regulation (55%), and economics (47%). The topics population health in a Middle Eastern country physicians considered most relevant were: national health Peter Barss*, Michal Grivna and Fatma Al-Maskari (United situation (98%), organization of health systems (60.6%), Arab Emirates University, Department of Community Medicine, health prevention (83.1%), primary health care (50.8%), Faculty of Medicine & Health Sciences, PO Box 17666, Al administration and management (32%), public sanitary Ain, UNITED ARAB EMIRATES) policies (22.5%) and environmental health issues (16.9%). Aim of Presentation: To describe a community medicine These data allowed us to plan for a redesign of Public clerkship to teach the practice of population health. Health teaching. An evaluation of a new graduate program and its impact is needed. Summary of Work: The goal of medical education, as declared by the World Federation for Medical Education, is “the improved health of all peoples”. Our faculty 9F 3 Practising skills in a public and occupational developed a clerkship to enable future doctors to do their health clerkship: the PREPARE-model share in meeting this goal. Marc B M Soethout*, Margreet Swagerman, Carel Thijs and Summary of Results: Working in small teams, final-year Johannes F Wendte (Vrije Universiteit Medical Centre, students identify a priority health issue, define a target Department of Public and Occupational Health, Van der population and how to sample it, and complete a cross- Boechorststraat 7, Amsterdam 1081 BT, NETHERLANDS) sectional survey. Teaching of each step leads to immediate In The Netherlands students follow during their clinical application. Week one includes development of a proposal training period a Public and Occupational Health clerkship. and questionnaire, teaching on surveys, review of pertinent Due to the variety in skills student are confronted with, epidemiology and biostatistics, and ethical review. Two we felt the need to develop an evidence based method to weeks of fieldwork is followed by two weeks for data structure the skills in Public and Occupational Health. The processing, analysis, report writing, and presentation. Many PREPARE-model that has been recently introduced in at projects are reported by media and at conferences. least three Dutch universities, integrates step wise, skills Reporting and prevention of disease and injury are also related to communication (presentation of the Problem), covered. Six weeks has proven optimal for such clerkships. analysing the determinants of the problem (Relevance for Conclusions: Diagnosis and management of health for Public and Occupational Health), evidence of effectiveness populations differ from other specialties, where one patient of interventions and prevention (Evidence), choice for a at a time is assessed. In countries with limited research, certain preventive action (Prevention), advising the population surveys are invaluable not only for teaching different partners (Advise), need for registration community diagnosis and intervention, but also to inform (Registration) and the use of feedback mechanism after students and faculty of local health priorities. the action has taken place (Evaluation). The final assessment of the students is based on a presentation, in which the students can demonstrate their skills in all the 9F 6 Sports medicine education for medical steps of the model. To our knowledge this model is a new students tool to improve the skills in Public and Occupational Health. S Lim* and Y Jariya (Buddhachinaraj Hospital, 90 Evaluation of the model by students and teachers is Srithamtripidok Road, Ampur Muang, Phitsanulok 65000, promising. The PREPARE-model and results of the THAILAND) evaluation will be presented. Background: In 2003, the consortium of faculties of medicine in Thailand launched the concept of a health 9F 4 Public Health Emergency Programme: an promotion curriculum in order to increase awareness of undergraduate module health promotion policy among new doctors which will lead to the positive attitude to advise their patients and Comfort Osonnaya*, Kingsley Osonnaya and Ian R Sanderson relatives to practise exercise. (Queen Mary, University of London, Epidemiology and Education Unit, Centre for Adult & Paediatric Summary of work: The course on sports medicine was set Gastroenterology, Institute of Cell and Molecular Science, up for the medical students in Buddhachinaraj Hospital, Bart’s and The London, School of Medicine & Dentistry, Turner School of Medicine. The learning experience was carried Street, London E1 2AD, UK) out by lecture, demonstration and practice. There has been a need to promote more public health Summary of results: Preliminary data analysis showed that issues in the undergraduate medical curriculum, leading time allocation for the study was not enough. There was to the initiative to increase the amount of selected study much basic knowledge and skill about exercise to be modules being offered to students. The community-based learned. Most of the students were satisfied with this course public health emergency programme was designed for 4th and would like to learn and practise more. year medical students at Queen Mary, University of London in response to this. Topics covered by the module include Conclusion: Although there was not much time to learn issues and initiatives in public health practice and how to about sports medicine the students perceived the idea of deal with public health emergencies and epidemics in the health promotion and got a positive attitude toward the community. The teaching and learning methods used concept of prevention by promotion of health. include clinical attachments, small group teaching, self- Take home message: Sports medicine may help the directed learning and problem solving exercises. All students to promote their own health as well as that of students completed standard unit evaluation forms, which their patients. generate scores for clinical exposure and to rate their teaching experience at their clinical attachments. The average clinical exposure score of 4.25 (where 1=insufficient, 3=adequate and 5=plenty of opportunities) and teaching score of 4.10 (where a teaching score of 4

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9F 7 Physical fitness of medical students during fitness were physical testing machines which are study in family and community medicine, standardized by the Sport Authority of Thailand. The data 2003-2005 were analyzed by using frequencies and percentages. Results: (1) From BMI, none of 4th-5th year but one 6th Teerasak Laksananun (Sawanpracharak Hospital, 43 Attakawee Paknampo District, Nakhonsawan, THAILAND) year student is overweight. (2) The vital capacity trend is to decrease by 6th year. (3) Hand grip is improved. (4) Background/Rationale: The purpose of family and Leg strength excellent: 4th year: six; 5th year: fifteen; community medicine is to take care of health and problems 6th year: thirteen. (5) Trunk forward flexion excellent: involving the community. Holistic care, assessment of 4th year – four; 5th year – nine; 6th year – seven. (6) community problems, community participation, good From the questionnaire, all of the students exercise attitudes in community and health promotion are involved. regularly or irregularly but 50% of 6th year students claim Exercise is important in this topic. Students should have that they have no time to exercise because they are experience in how to improve their health. Exercise working hard. sessions are arranged for students every evening. Physical fitness is used for evaluation. Conclusions: In 6th year, physical fitness decreased especially vital capacity and only 50% exercise continuously Method: A descriptive study was performed among 16 because of hard work during internship. students. Body mass index (BMI), vital capacity, hand grip, leg strength and trunk forward flexion were record during Take home messages: Add health promotion and especially a family and community medicine attachment, from 4th exercises in other curricula. Set up a regular sports project year to 6th year. The instruments used in measuring their for medical students.

Short Communications 9H e-assessment 2

9H 1 Creating a more student-centered written which allows control of access, availability and compilation assessment: the development of an of questions. Since December 2004 all students have electronic modified essay question paper generated 291 questions. So far 28 of 41 students voluntarily have passed the formative 20-item tests, which P Davy*, P Craig and R Clarke (University of Sydney, Edward were randomly drawn from the pool of questions. Students Ford Building (A27), New South Wales 2006, AUSTRALIA) could repeat tests of the same topic, but with new, This presentation will report findings from an electronic randomly chosen questions. Results ranged from 23 to 98 assessment project at the University of Sydney. The %, mean 70 %. Initial “Checkpot” results significantly University is developing an online format for Modified Essay correlated with the MEQ (r2 = 0.51, p < 0.004) after the Question (MEQ) written assessments used in its problem second semester. based learning medical program. The goals of this project We conclude that our “Checkpot” project not only include assisting students maximize their performance in familiarizes our students with continuous feedback of their the MEQ instrument in addition to achieving improvements learning progress, but also gets them used to the character to the practicability of written assessment administration. of assessment tasks as well as computer-based assessment Two trials of the eMEQ have been conducted and a third and forces them to further elaborate on their learning large-scale trial is planned for July 2005. Faculty and objectives. student feedback on the first two trials have been very positive. Students report that they have more time to plan and draft their answers and that the electronic format is 9H 3 Developing an on-line collaborative item more motivating than using the traditional paper banking system for certification examinations assessment instrument. Faculty report that the eMEQ facilitates marking and student feedback processes and Curtis Lee*, Gary Cole and Nadia Mikhael (Royal College of Physicians and Surgeons of Canada, 774 Echo Drive, Ottawa, enables examiner feedback comments to be appended Ontario K1S 5N8, CANADA) electronically to students’ answers, thus saving time. This project has achieved results that are consistent with recent After determining that commercial programs did not meet work on the design of effective assessment strategies and the item-banking requirements of our certification the use of assessment tools that enhance student examinations including matching our diverse examination motivation and also minimize extraneous sources of formats and blueprints and our CanMEDS competency cognitive load (Gergets and Scheiter, 2003) as students frameworks, the RCPSC has designed its own item-banking complete their assessment tasks. system. This on-line system has been designed to facilitate secure exam development collaboration throughout Canada with the construction of examination material such as 9H 2 ‘Checkpot’ – a computer-based student- OSCEs, orals and short-answer questions. The presentation generated continuous assessment in a PBL aims to summarize common needs, advantages, limitations, curriculum and solutions to the development of an item-banking system for certification bodies. Thorsten Schäfer*, Bert Huenges and Herbert Rusche (Ruhr- Universität Bochum, Medizinische Fakultät, UHW 10/1013, The RCPSC developed the specifications for an item Bochum D-44780, GERMANY) banking system to handle multiple formats that are used Assessment of the students’ progress in a PBL (problem- for medical education examinations and allow secure based learning) curriculum is challenging because of the remote access. This system is easy to use and includes high amount of self-directed learning. We therefore asked multiple data functions, stores item statistics, tracks the students (3rd semester, reformed medical curriculum, modifications, and handles diverse media. The item bank was reviewed by a variety of specialties. It was found n=41) to develop assessment tasks (multiple choice, compatible with a competency framework and can handle completion, sorting and assigning exercises) on their own based on their learning objectives. After professional at least five different formats used in medical education review, the questions were implemented as an internet- examinations. based test using the “Blackboard” e-learning platform,

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An item-bank is essential for efficient examination 9H 6 Internet-based assessment of development, production and psychometric analysis. ophthalmoscopic skills Carefully consider the processes used and the technology 1 2 1 available in order to choose an item banking system that Peter Asman* and Christina Lindén ( Lund University, can comprehensively handle the developmental needs that Faculty of Medicine, Department of Clinical Sciences, Ophthalmology, Malmö University Hospital, Malmö S-205 02, suit your developmental requirements. SWEDEN; 2Umeå University, Dept of Ophthalmology, Umeå, SWEDEN) 9H 4 Long menu-questions in a computerised Aim: The Swedish Board of Health stressed in 2002 the case-based assessment – a randomised importance of teaching ophthalmoscopy at medical school. controlled study Student evaluations at the same time deemed ophthalmoscopy particularly difficult to learn. These factors Th Rotthoff*, Th Baehring, H D Dicken, U Fahron and W A inspired the development of the internet-based software Scherbaum (University Hospital Duesseldorf, Department for for assessment of ophthalmoscopic skills presented here. Endocrinology, Diabetes and Rheumatology, Moorenstr 5, Duesseldorf 40225, GERMANY) Summary of work: This interactive software was developed in Malmö 2002. During ophthalmology rotation an optic Case-based computerised assessment offers the advantage disc photograph is obtained from each student. During to examine the linear process of a clinical case which is skills assessment each student performs ophthalmoscopy difficult to implement in a paper format. Apart from MC- on a fellow student. The software displays a subset of the questions the long menu (LM) question format, which is photographs including that of the examined student. The described as an acceptable replacement of open-ended task is to correctly identify, within the displayed subset, questions, can be used. We aimed to test LM against open- the particular optic disc viewed with the ophthalmoscope. ended questions in a concrete assessment setting. At the university computer centre we performed a case-based Summary of results: The assessment is mandatory in online assessment with 143 students who were randomised Malmö since 2002 and in Umeå since 2003. In total 389 in two groups. The assessment included seven cases of students have been assessed. All students have passed internal medicine with 25 questions in total. Beside identical the test. Student evaluations strongly support the MC-questions for both groups one group had to answer software’s continued use. nine LM-questions and the other group answered these Conclusions: The method allows objective assessment of as open ended questions. Of all LM-answers 15.2% were ophthalmoscopic skills in real eyes. It has been a strong falsely classified by the computer as incorrect and had to incentive for non-supervised skills training. We now plan be re-evaluated manually. The majority of these corrections to a) evaluate the method in non-trained students, and b) referred to three of the nine LM-questions, which offered use the software as a feedback tool for self-administered a more complex response possibility. Our study shows that training. LM-questions are well applicable if only very few synonyms for the answer of a question exist. If the question permits a complex linguistic answer the results tend to be partly 9H 7 OSCA: The Online System for Clinical incorrect. Assessment – an alternative to OSCE M Begg*, J M Scollay, L Dalziel, R Ellaway, H S Cameron and 9H 5 An electronic clinical assessment tool to R W Parks (University of Edinburgh, University Department evaluate skills in evidence-based medicine of Surgery, Lecturer’s Room, Ward 106, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, UK) Anita Duhl Glicken (University of Colorado, Health Sciences Center, Mail Stop F543, PO Box 6508, 4200 E. 9th Avenue, Objective Structured Clinical Examinations (OSCEs) are Aurora CO 80045-0508, USA) widely used to assess medical students’ competencies in data interpretation, clinical judgement and prescribing. Aim: This presentation describes the Clinical Medicine However OSCEs often run over several days and require Assessment Tool (CMAT), an electronic evaluation tool to significant clinical space and clinicians’ time and students collect, assess and evaluate data related to student view the system as unfair1. This project aimed to develop application of EBM principles. and evaluate an online examination that would improve Work Summary: A research model was adapted to develop efficiency and fairness while maintaining authenticity of an online electronic evaluation mechanism as a skill station the tasks assessed. Academics, administrators, and following a SP exam. Cold Fusion and Access were used learning technologists from Edinburgh University’s College to create a tool for use across the learning continuum for of Medicine and Veterinary Medicine worked together to a broad spectrum of cases assessing knowledge, skills and design the Online System for Clinical Assessment (OSCA). attitudes related to student application of EBM concepts. This has required the development of new types of dynamic forms to simulate authentic clinical tasks and systems for Results Summary: Flexible administrator forms change authoring, marking and archiving questions and visual cases and information depending on the SP scenario. A resources. Significant streamlining of staffing and randomized study design (abstracts report varying levels administration processes were also undertaken. Large of validity) assesses student ability to apply concepts. numbers of students undertake assessment simultaneously Student forms require a diagnosis and treatment plan under examination conditions but at an individualised pace. before receiving a randomized research abstract. Students Initial evaluation of the project will look at the impact the reconsider decisions and are offered an opportunity to OSCA has had on efficiency and acceptability of the change plans based on application of information. Student assessment, fairness including opportunities for student confidence in decision-making before and after abstract collusion, pressure on clinical accommodation and viewing is reported. CMAT is currently being piloted. educational aspects including resources for students’ Conclusion: CMAT doubles as a technology-based formative assessment. performance support tool. By presenting abstract and 1G Lloyd-Jones. The OSCE and student collusion. AMEE communication in electronic format (students access, input 2004. Abstract 9H4 and retrieve information electronically), simulated learning becomes more authentic. CMAT emphasizes tests and potentially strengthens student abilities in EBM.

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Short Communications 9L Education and professionalism

9L 1 Preserving our humanity, teaching the Background: The prominent demands for the teaching and Healer’s Art evaluation of professionalism for medical students placed a significant burden on medical institutes. Medical Pauline Abrahams* and Monica Branigan (University of professionalism must be taught clearly; core values need Toronto, 10 Fernwood Park Avenue, Toronto, Ontario M4E to be delivered explicitly throughout the curriculum, and 3E7, CANADA) then an effective evaluation is imperative. The cultivation of compassion, communication and intuitive What was done: We made a curricular reform for which knowing are core elements in the “Healer’s Art”, a the main purpose is to establish medical professionalism. curriculum developed by Dr Rachel Remen. Through the A six-year new programme provides continuous educational exploration of topics such as grief, service and mystery, opportunities to teach/learn professionalism. Starting with this course allows students to discover their own innate multiprofessional education for medical ethics, vertically abilities in these areas and to strengthen them throughout integrated modules to teach professionalism are the program. These elements are part of the non- incorporated. A constructivist approach to learning is intellectual skill set necessary for the practice of medicine, essential, in which knowledge and understanding is built especially appropriate in situations such as end of life care upon prior experience acquired in preceding phases of where the major emphasis is not on curing or fixing. At the programme. PBL is newly built to adopt multidisciplinary the University of Toronto, the Healer’s Art has been offered teamwork, self-directed learning, and critical thinking; also to interested first year medical students for the past three providing ample possible learning issues for ethical and years. Evaluation reveals this curriculum to be uniquely behavioral subjects. As like the ‘spiral model’, several core helpful for students. In particular, they were able to value subjects, especially ethical issues, repeatedly appeared themselves as individuals with unique contributions to offer throughout the curriculum. Although still in the programme to medicine and came to realize that a healing relationship transition, both students and faculties evaluated the merit requires more than just intellectual knowledge. Through of curricular change. exploring the role of physician beyond that of medical expert, the curriculum encourages students to make an Conclusions/Take-home messages: Professionalism has its active commitment to be compassionate, altruistic and own value to be handled in a medical school curriculum, respectful physicians who will be able to use their technical rather staying in a hidden curriculum. expertise with wisdom while recognizing the importance of their own humanity. 9L 4 The design of a short postgraduate course on professionalism 9L 2 The role of clerkship in oncology in the Claudia Turner, Heidi Phillips, Irnei Myemba, Kamila Al- education of professionalism Alawi, Matt Townsend and Mair Davis (Cardiff University, Netta Notzer* and Tur-Kaspa (Sackler Faculty of Medicine, School of Postgraduate Medical and Dental Education, 3 Unit of Medical Education, Tel Aviv University, pob 39040, Miller Road, Colliers Wood, London SW19 2DB, UK) Ramt-Aviv, Tel-Aviv 69978, ISRAEL) Altruism, honour, integrity, ethical and moral standards, How can students internalize professionalism? Probably accountability, excellence, advocacy and empathy are all very little via didactics and more significantly by role adjectives used to describe medical professionalism. If modeling. We studied specifically students’ perception of defining professionalism is difficult then how can one begin the contribution of a week clerkship in oncology. An open- to teach it? This paper discusses the design and questionnaire (7 topics) was circulated to students at the implementation of a short postgraduate course on end of the clerkship. The responses (87% out of 83 professionalism. The course is designed for junior doctors students) were analyzed. and is based on the use of feedback and participation. The aims of the course include the definition of Results: The students highly appreciated the professionalism by the participants themselves and the implementation of doctor-patient and the family obtainment of professional competences. The essence of relationship, and the multi-professional team work (over the course is to work with the student’s own core values, 50%), which makes the oncologist a different physician beliefs and assumptions rather than to attempt to impose from his colleagues (70%). They reported a major change a list of ‘desirable attributes’ that have been used to in their attitude to cancer patients to more optimistic as to describe professionalism. This is done through the use of the prognosis as a result of their exposure to treatments written case scenarios, designed to incorporate the and new knowledge (75%). Female-students noted, as student’s own context in everyday medical practice and compared to male-students, the contribution of the the reflection that discussion of the scenarios will hopefully behavioral aspects of oncology to their medical training, facilitate. The course also looks at how junior doctors may while men indicated a greater appreciation of the evaluate their professionalism through the use of portfolios, knowledge and technologies they encountered. videotaped clinical sessions and peer review. Conclusions: With the growing needs to deepen physicians’ empathy with patients and their families, especially with long-term diseases, oncology departments were found to 9L 5 Professionalism and institutional social serve as a unique site, suitable for students’ training. accountability Students expressed their preference to broaden exposure David Hawkins and Members of the Social Accountability to patients, palliative care and pain relief, rather than Steering Committee (Association of Faculties of Medicine of didactics. Canada, 774 Echo Drive, Suite 112, Ottawa, Ontario K1S 5P2, CANADA) 9L 3 Teaching medical professionalism: We contend that acquisition of professional attitudes by curriculum reform in a Japanese Medical students will be enhanced if medical schools espouse social accountability – “institutional professionalism”. A School consortium of our 17 medical schools has launched, with Mutsuhiro Ikuma* and Arata Ichiyama (Hamamatsu University federal support, several initiatives under this banner. They School of Medicine, First Department of Medicine, #416, 1- include: educating future physicians in end-of-life and 20-1 Handayama, Hamamatsu 431-3192, JAPAN) palliative care; improving health care for francophone

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minorities outside Quebec; enhancing aboriginal health Summary of work: During 1 hour educational interventions through curricular reform and recruitment of aboriginals; every 2-4 weeks, an actual critical incident that was re-integrating public health into the curriculum and experienced by a student during this period was presented promoting careers in public health; demonstrating the link by him/her. Subsequently all students wrote down their between professional development and quality health care; reflections on this situation. The session concluded with producing faculty development tools for supervisors of peer rating of the written exercises followed by in-depth international medical graduates; and hosting a Young group discussion of personal and general professional Leaders Forum to identify barriers to and enabling factors values. The quality and quantity of written reflections were for an ideal healthcare and health professional education also scored later by trained raters. Using a time series system for 2025. These issues were identified through a design with clerks entering fortnightly the 8-week clerkship, consensus process. AFMC has established committees to students attending the first session (“naive”) were disseminate the concepts of social accountability compared with those attending subsequent sessions (communications), identify activities within each school (“informed”). An observer-rated instrument was used to (inventory), and measure outcomes (evaluation). Other measure the students’ reflective skills. health professionals, public policy makers, consumers, Summary of results: A total of 16 sessions were held in governments and healthcare providers are brought which 46 students participated. Twenty-four students together regularly in a Partners Forum to provide feedback participated in at least two sessions. “Informed” students and set directions. had a better overall reflection score on average (improvement from 4.8 to 6.2 on a 10-point scale) and 9L 6 The effect of training medical students to mentioned more different aspects of the cases presented. reflect on professionalism during pediatrics Details on (changes in) reflection scores will be presented. clerkship Conclusions take home messages: A 1-hour reflection session as part of a pediatrics clerkship program, A D Boenink*, A K Oderwald, J A Smal, W van Tilburg and R comprising presentation of a critical incident, a written J B J Gemke (VUMC, Liaison Psychiatry, 2D20, PO Box 7057, Amsterdam 1007 MB, NETHERLANDS) exercise, peer assessment and facilitated group discussion, helps students to improve both the quality and the quantity Background: To study the effect of an educational program of their professional reflection. intended to foster reflective skills during a pediatrics clerkship.

Short Communications 9M Diversity and admission to medical school

9M 1 The effect of undergraduate mentoring on 9M 2 Are rural background candidates medical and dental applicants from socio- disadvantaged by the admission process? economically disadvantaged backgrounds Bruce Wright and Wayne Woloschuk* (University of Calgary, A W Kamali*, S Nicholson, T Fernandez and A Patel (Royal Faculty of Medicine, Health Sciences, Calgary, Alberta T2N London Hospital, 44 Anson House, Shandy Street, London E1 4N1, CANADA) 4SR, UK) Background: A shortage of rural practitioners is a world- Aim: Students from lower socio-economic groups in the wide concern. Many believe that rural background United Kingdom (UK) are under-represented in medical candidates are disadvantaged when they enter the medical and dental schools. They may be disadvantaged in gaining school admission process. places for medicine because they do not have the necessary What was done: Data from provincial applicants (N=4408) guidance with medical applications and extracurricular to the University of Calgary medical school were examined activities. over time (1991-1995 cohort; 1996-2000 cohort). The Methods: The SAMDA-BL (Student Assisted Medical and proportion of candidates with metropolitan, regional and Dental Applicants-Barts and the London) project is an rural backgrounds in each cohort at the application, undergraduate-led organisation which mentors and assists interview and admittance stages was analyzed using Chi- applicants with their medical and dental applications to square. Admission committee scores for candidates were UK Universities. This paper looks at the effect of the project analyzed using Anova. Findings revealed that at each stage on the offer rates from candidates from low socio- there was a significant increase in the proportion of regional economical groups and discusses which aspects of SAMDA’s background candidates over time. The proportion of rural assistance these applicants felt they benefited from. background candidates in each stage was relatively low and remained stable. Admission committee scores for Results: Applicants engaged in SAMDA’s activities during candidates with different backgrounds did not differ. a two year period demonstrated a rising trend in the number of offers received. The reasons given by applicants Conclusions: The proportion of regional background for this were: 1. Contact with undergraduate students, 2. candidates increased over time. The proportion of rural Help with the personal statement and 3. Value of mock background candidates did not change. Importantly, scores interviewing practice. Applicants valued the medical generated by the admission committee for rural expertise and support that undergraduates provided. background candidates did not differ from scores of other candidates. Conclusions: SAMDA’s activities were seen by the applicants as very important in securing offers, hence highlighting Take home message: Rural background candidates were the importance of such mentoring projects in widening not disadvantaged by the admission process. More of them participation to medical schools. need to apply to medical school to help alleviate the rural manpower shortage.

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9M 3 Academic achievement of medical students 9M 5 Increasing access to medical school via the with low matriculation score Newham Doc route S Thepmalee* and Y Jariya (Buddhachinaraj Hospital, School Sandra Nicholson*, Carmel Rooney and Kathryn Perry (Queen of Medicine, 90 Srithamtripidok Road, Phitsanulok 65000, Mary’s School of Medicine and Dentistry, Education THAILAND) Directorate, Medical Sciences Building, Mile End Road, London E1 4NS, UK) Background: More students from high school with lower matriculation score were recruited to study in Background: Lower socio-economic groups are Buddhachinaraj Hospital, School of Medicine. The objective underrepresented in medical undergraduate courses in the of this report was to study the outcome of these students. UK. This has implications both of equity and concerns that the medical workforce should reflect the social class Summary of work: The students were grouped by their structure of the population that it serves. Newham Doc matriculation score into upper one-third and lower one- Route is a multidisciplinary preparatory course that aims third group. Academic achievements were considered from to widen participation for medical applicants from an area the score on MCQ and GPA. Their delay to achieve their of economic and social deprivation. learning grade was considered to be a drop-out. What was done: The core of the proposal is to provide a Summary of results: The general achievement of the upper one year learning experience within Newham University group (mean 2.67) was lower than the lower group (mean Hospital NHS Trust or Newham Primary Care Trust that 2.73). The cognitive achievement of the upper group (mean would add educational value and extend local students’ 175.29) was higher than the lower group (mean 172.24). academic achievements sufficiently to directly enter the The upper group failed to accomplish the learning outcome first year of Queen Mary’s School of Medicine and Dentistry. in time (6 out of 20) more than the lower group (3 out of Students rotate through three placements: patient 20). All of the differences were not statistical significant. experience, basic science and clinical team, each having Conclusion/Take home message: Academic achievement three options. Each placement aims to introduce students does not depend on cognitive function alone. Students to aspects of patient care, professional roles, team working, with a lower matriculation score may achieve success in and effective communication, and cover the relevant basic learning at the same level as the upper group. science appropriate to the option chosen. Evaluation is by measuring students’ success in the short term, by their entry into medical school, and longer term during their 9M 4 Healthcare competence and disabled undergraduate studies. A qualitative analysis of students’ students views concerning their preparatory course is undertaken. Anne Tynan (DIVERSE, The Royal Veterinary College, Royal Conclusions: It is essential that mechanisms aiming to College Street, London NW1 0TU, UK) widen participation are evaluated, and if found to be The modernisation or development of disability legislation effective, maintained and further developed. in many countries is placing healthcare educators under increasing pressure to accept disabled people onto courses. If the same competences are to be expected of all students, 9M 6 Disabled students, disabled doctors – time however, to what extent is it possible to offer flexibility for for a change? those who are disabled? The session will explore this issue, Katharine Boursicot*, Alan Butler and Trudie Roberts based on the British experience of DIVERSE, the UK (University of Cambridge, School of Clinical Medicine, Veterinary Medicine Disability Project. For the past 3 years, Education Division, Box 111, Adenbrooke’s Hospital, Hills DIVERSE has united veterinary, medical and dental Road, Cambridge CB2 2SP, UK) educators in the quest for greater clarity about how The implementation of new legislation relating to students disabled students might meet essential professional with disabilities and their special educational needs, competences. This has resulted in the production of two together with some high profile cases have brought the key resources: ‘Time to Take Stock – Disability and issue of training disabled doctors into sharp focus in the Professional Competence’; and ‘In the Field – Disability in UK. This study was undertaken to explore the views of the Professional Working Environment.’ Although based different sections of society (professional and lay) towards primarily on the veterinary experience, these resources admitting disabled individuals to study medicine. Semi- can provide a template for the full healthcare spectrum structured interviews were conducted with 5 groups of and indeed other professional areas also. A concerted effort individuals: Admissions staff; Disabled medical students; is now required to develop this work but the findings are Non-disabled medical students; Disabled doctors; General already conclusive. Disabled people can be as competent public. The narratives from these interviews were examined as their non-disabled peers in exercising the functions of and responses categorised into the following themes: a healthcare professional. Healthcare educators must Attitudes to the idea of disabled doctors; Attitudes to therefore provide opportunities for them to receive the specific disabilities; Experiences with/as a disabled doctor; training necessary to follow these careers. Pre-course testing; Limited licensing; Tracking. The results, which will be discussed in detail, show that there is a general groundswell of opinion that individuals with certain disabilities should be welcomed into medicine. However there remain some concerns particularly around students entering or practising who have mental health problems.

Short Communications 9N Postgraduate education 1

9N 1 Learning styles in interns Background: The type of learning styles is related to medical career. Also adaptation of learning style to a Henk van den Berg (University of Amsterdam, Department of department has been noted. Changes in learning style are Paediatric Oncology, Academic Medical Centre, F8-242, PO Box 22660, Amsterdam 1100 DD, NETHERLANDS) presumed to be volatile. Learning styles were investigated during internships, which can either start with internal medicine, surgery or paediatrics.

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Methods: Data on age, past occupational activities/studies, data and clinical performance indicators. The aim has been preference and actual internship, career choice and to model the relationships between achievement, questions from the Dutch adaptation of the inventory confidence and competence as potential predictors of according to Honey and Mumford were obtained at the unsatisfactory performance during the PRHO rotation. start and at the end of initial internship (70 students) and Suggestions are offered for identifying ‘doctors at risk’ with at the moment of MD-certification (67 students). a view to developing targeted education/training interventions. Results/Conclusions: Previous jobs and other studies initially influenced learning style. Learning styles are linked with later career choice. Students with a later career choice 9N 4 Outcomes of flexible training compared to full for internal medicine specializations had higher scores for time training during specialist registrar grade reflective observation and abstract conceptualization. Students interested in surgical specializations had higher Helen M Goodyear*, Melanie J T Jones and Selena F Gray scores for both active experimentation and abstract (West Midlands Deanery, PMDE, PO Box 9771, Birmingham conceptualization. In students interested in paediatrics or Research Park, 97 Vincent Drive, Birmingham B15 2XE, UK) general practice, concrete experience and reflective Aims: The number of medical students who are female observation were predominant orientations. Learning styles increases each year and is currently 66%. Consequently, related to experiential learning in interns are not as volatile the demand for flexible (part-time) training is growing and as those reported using cognitive learning style inventories. 14% of Specialist Registrars (SpRs) work part-time. This study examines the outcomes of flexible training compared to full-time training for SpRs. 9N 2 Motivation and learning styles of trainees working on a neonatal unit Summary of work: A postal questionnaire was sent to flexible SpRs training between 1996 and 2004 in three UK N J Shaw (Liverpool Women’s Hospital, Mersey Deanery, deaneries and to 2 full-time controls for each flexible SpR. Crown Street, Liverpool L8 7SS, UK) 113 flexible SpRs and 191 full-time SpRs completed the Understanding the predominant learning styles of trainees questionnaire. 92% of those in flexible training obtained may help trainers to improve the learning environment, a Certificate of Completion of Specialist Training (CCST) and awareness of the trainees’ type of motivation may compared to 90% of those training full-time. 81% of help to facilitate career support. This study aimed to assess flexible trainees took up a post at consultant level compared motivation and learning styles of a group of neonatal to 77% of full-time trainees. Over 40% of flexible SpRs trainees. Between February 2001 to August 2002, in the reported that, had flexible training not been available, they last month of their post, each trainee was asked to would have taken a career break or moved into a non- complete a motivation assessment and a learning style training post. questionnaire. Forty-four trainees completed the Conclusions: Flexible training is just as likely as full-time questionnaires. There was no significant difference training to produce individuals with a CCST who take up a between the Specialist Registrars (SpRs) and Senior House consultant post. Adequate provision of flexible training is Officers (SHOs) with respect to their total intrinsic essential if the needs of both women doctors and the motivation, total extrinsic motivation, amotivation and current and future medical workforce needs are to be met. learning style domain scores. Both groups exhibited a predominant reflective learning style. SHO non-UK graduates had a significantly higher score for intrinsic 9N 5 U.S. duty hours compliance: two years later motivation and were significantly more likely to exhibit a Judith Armbruster (ACGME, 5555 N Sheridan, Apt 601, reflective learning style, compared to UK graduates. Chicago IL 60640, USA) Generally trainees scored low on the amotivation scale. In conclusion, the majority of neonatal trainees are highly The ACGME’s requirements imposing specific duty hours motivated. The increased propensity to trainees becoming limitations went into effect July 1, 2003, and the compliance more reflective practitioners possibly suggests an impact of residency programs in all accredited medical and surgical of the evidence based medicine culture and more specialties has been monitored in the two years since that enlightened postgraduate education. time. ACGME has tabulated the citations that have been issued by the residency review committees (RRCs) during their evaluation of programs in this two year period. This 9N 3 Confidence, competence and academic presentation will include the data showing the degree of achievement: can we predict poor clinical compliance by programs in various medical and surgical performance among junior doctors? specialty areas as well as the number and types of citations that have been issued by the RRCs that accredit these R Higgins* and S Cavendish (LNR Postgraduate Deanery, programs. The data show that there has been variation in Lakeside House, 4 Smith Way, Grove Park, Enderby, Leicester the degree of compliance not only at the residency program LE19 1SS, UK) level but also in the actions taken by the RRCs in different Preliminary analysis of medical school assessment scores specialties. Results of a resident survey on duty hours for a 2004-2005 cohort of pre-registration house officers compliance will be included. A brief comparison will be (PRHOs) identified some low academic achievers. Self- made to recently published information on compliance with confidence data obtained prior to their first PRHO post the European Working Time Directive. revealed low levels of clinical confidence amongst half of them. The remaining graduates seemed highly confident. If academic achievement is a predictor of clinical 9N 6 Perception of the impact of sleep performance then low achievers may need greater support deprivation on performance by surgical in the early years of their postgraduate training. Moreover, residents if some are overconfident, they may fail to recognise and address weaknesses to the detriment of patient care. S I Woodrow*, J Park, B J Murray, M Bernstein, R Reznick and S J Hamstra (University of Toronto, Wilson Centre for Studies have looked at relationships between Education, UHN, 200 Elizabeth Street, South 1-581, Toronto, ‘incompetence’ and over-confidence (Kruger & Dunning, Ontario M5G 2C4, CANADA) 1999). Others have explored links between confidence and clinical experience (Morgan & Cleave-Hogg, 2002). Background: Growing evidence suggests that sleep However, few robust studies have explored the deprivation may compromise physician performance. relationships between academic achievement, clinical Individual ability to recognize the effects of sleep confidence and competence in the hospital setting. This deprivation, however, has not been well studied. This study paper reports findings from further analyses of confidence examined the perceived impact of sleep deprivation on data, this time in relation to more detailed assessment performance amongst medical trainees.

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Methodology: A survey investigating work hours, in gender, age, surgical vs. non-surgical residencies. sleepiness, and daily functioning was mailed to all residents Although differences were not found, a tendency to a in medicine, surgery and psychiatry at our institution. reduction from baseline to the last post-graduate year in Included was a new Sleep Deprivation Impact (SDI) scale, EE, DP and BO was observed. a 12-item Likert-type scale designed to measure self- Conclusions: these results are concordant with EE, DP, PA perceived performance impairment resulting from sleep and BO observed in other countries. The resident BO seems deprivation. to be a universal phenomenon, apparently inherent to the Results: Overall, 95/152 surgical and 194/326 non-surgical residency system. residents completed the survey. Surgery residents reported working longer hours per week (83.0 versus 62.5, p<0.01), scored higher on the Epworth sleepiness scale (12.8 versus 9N 8 Introduction of the structured interview in a 9.2, p<0.01) and scored lower on the SDI scale (45.2 regional paediatric junior doctor selection versus 51.5, p<0.01) compared to other residents. Internal process consistency of the 12-item SDI scale was 0.89. D Jyothish*, V Diwakar and H Goodyear (Birmingham Conclusions: Despite evidence of increased sleepiness, self- Children’s Hospital, 107 Hagley Road West, Harbourne, perceived impairment due to sleep deprivation was lower Birmingham B17 8AD, UK) amongst surgery residents than non-surgical trainees. Aim: We describe the introduction of a structured interview Further research is needed to determine whether these for regional Paediatric Senior House Officer selection. findings represent actual resilience to sleep deprivation or misperception within a self-selected group. Methods: Data was collected from two interviews held 6 months apart. Shortlisting was based on application forms according to defined criteria. Candidates were interviewed 9N 7 Resident burnout in a University Hospital in by one of two boards, consisting of three panels with two Argentina members each. Three predetermined questions exploring empathy, professional integrity and interpersonal skills were E Durante*, F Augustovski, A Eymann, F Faingold and M asked and candidates rated on a predefined 0-4 scoring Figari (Hospital Italiano de Buenos Aires, Juan D Person 4272 system. (1199), Buenos Aires, ARGENTINA) Rationale: several studies have reported resident burnout Results: 230 candidates were interviewed. Short listing in different settings. Data about its prevalence in Latin- and interview scores showed poor correlation (Pearson America is lacking. coefficient 0.4). Inter panels scores differed significantly p=0.001. Inter-interviewer reliability within panels was Objective: to determine the resident burnout prevalence good (Kendall’s Tau-b 0.66). All candidates scored poorly in a University Hospital in Buenos Aires, Argentina. in Question 3. Female candidates performed significantly Methods: All residents (n= 214) were invited by intranet better (44% difference), as did morning candidates. mailing to complete the Maslach Burnout Inventory Conclusions: Shortlisting/interview score variations validated in Spanish. One hundred and ninety four residents demonstrate that both explore different candidate qualities (90%) from 26 medical and 1 lab residencies responded and should have due consideration at final selection. Inter to the Inventory. The 3 dimensions of Maslach Inventory panel and inter question score variability reflect candidate were dichotomized for statistical purposes (emotional response to differing situations and underlines importance exhaustion score (EE) > 26, depersonalization score (DP) of multi panel interviews. Morning/afternoon contrast can > 9, personal accomplishment (PA) score > 34). Burnout be attributed to allocation bias, interviewer fatigue etc. (BO) was defined if EE > 26 and/ or DP > 9. Further work on performance data of selected candidates Results: Prevalence of EE = 62.89% (122), DP= 62.37% will provide information about validity and reliability of the (121) and PA= 28.35 (55). Global BO rate was 76.29% structured interview. (148). Non-statistically significant differences were found

Short Communications 9O Outcome based education 1

9O 1 ‘Tuning’ of learning outcomes for under- process including a range of stakeholders – academics, graduate medical degree courses in Europe graduates, employers and professional bodies. The project will draw on existing European and global statements e.g. A Cumming*, G Lloyd-Jones, P Evans, H Cameron, H the UK GMC “Tomorrow’s Doctors” and the “Scottish Campbell, K Boyd and H Walton (University of Edinburgh, Doctor” framework. The presentation will describe the College of Medicine and Veterinary Medicine, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK) background to the project, report progress, and indicate how individuals and institutions can be involved. A new Thematic Network for Medical Education in Europe 1 (MEDINE) has been funded by the European Commission. Tuning Educational Structures in Europe. Ed Gonzalez J, Within this Network, the University of Edinburgh leads a Wagenaar R. European Commission, 2003 “Tuning” Task Force working towards harmonisation of 2http://europa.eu.int/comm/education/policies/educ/ learning outcomes/competences for undergraduate tuning/tuning_es.html medical degree courses in Europe. The European Commission wishes to see convergence of learning outcomes/competences for degree programmes in higher 9O 2 Constructing a national consensus on education. Their instrument is the Tuning Project1, 2. This competencies for an undergraduate medical began in 2001, underpinned by initiatives such as the education curriculum in palliative and end- Bologna Declaration, the Berlin Communiqué and the of-life care European Credit Transfer System. These emphasise the need for comparable and compatible qualifications in higher P N Byrne*, L Librach and EFPPEC Management Team education. All European governments are signatories. To (University of Toronto, Faculty of Medicine, The Donald R Wilson Centre for Research in Education, 200 Elizabeth Street, date, outcomes have been defined for 9 disciplines. The 1ES565, Toronto, Ontario M5G 2C4, CANADA) methodology involves rating potential outcomes in a Delphi

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In curriculum design and learner assessment an evolution defined for the medical specialist. In the Netherlands, this from unidimensional to multidimensional competencies is model is adjusted to the Dutch situation. Instead of roles occurring in medical education. Accordingly, a Canadian- seven competency fields are defined: medical performance, based, national organization, “Education Future Physicians communication, collaboration, knowledge and science, in Palliative and End-of-Life Care (EFPPEC)” developed a community performance, management and set of competencies, derived from CanMEDS 2000 and professionalism. To determine how final year medical specifically addressed to clinical decision making, students – who are about to enter their specialty training communication, interdisciplinarity, patient management – rate the importance of these competencies, a study was and psychosocial and spiritual needs goals. done at the University Medical Center (UMC) Utrecht, the Netherlands. Eight-three 6th year medical students The methodology to establish competencies was an expert answered a questionnaire in which they rated the Delphi approach in which local level leaders in each of the importance of each of the competency fields. Though all 17 Canadian Medical Schools provided a list of expert competencies were regarded as important, professionalism participants from his/her school. Each participant was and communication scored highest on the students’ rating. invited to respond to a survey of competencies with a Organization was assessed as least important. It is web link for completion. A total of 210 respondents interesting that young specialists-to-be acknowledge the (64.2%) completed the survey. A standard of 70% importance of other competencies than medical expertise respondent agreement for each competency was used as and performance. It confirms the opinion that educating a decision point for inclusion in a penultimate expert medical doctors involves much more than providing them defined set of competencies. Additional competencies with theoretical and clinical knowledge and skills. suggested by not less than 5 participants and agreed upon by EFPPEC were added to the original list. The penultimate list was presented to participants for final modification. 9O 5 Expanding and integrating competencies The process and objectives of this national initiative is beyond clinical expertise in a national viewed as innovative in establishing comparable competencies across medical schools and is conceived as examination process a model for other disciplines to follow. Henry Mandin, Robert Lee* and Dale Dauphinee (Medical Council of Canada, 2283 St Laurent Blvd., Ottawa, Ontario K1G 3H7, CANADA) 9O 3 Impact of the pilot assessment of the global Background: The Medical Council of Canada (MCC) has essential competencies of medical anchored its Qualifying Examinations around its behavioural graduates in China objectives since 1993. The approach focused on the M Roy Schwarz*, Andrzej Wojtczak, David Stern and Luxi Yi patient’s presentation to the physician, as a clinical expert. (China Medical Board of New York, Inc, 750 Third Avenue, It is called the presentation approach. In 1998 new 23rd Floor, New York NY 10017, USA) dimensions were incorporated into the MCC Objectives, dealing with the competencies around legal, ethical and Aim: To present changes that occurred in medical education organizational aspects of medical practice. Other key roles in 8 Chinese medical schools after administration of pilot for physicians, first described by the Education of the Future examination of global competencies (“GMER”) of their 384 Physicians of Ontario (EFPO) project, have come to the graduates performed in October 2003 by the Institute for light. Examples include: the CanMEDs roles of the Royal International Medical Education (IIME). College of Physicians and Surgeons of Canada; the general Summary of Work: The possession of an internationally competencies of the Accreditation Council for Graduate accepted set of 60 “core” outcome competencies (“GMER”) Medical Education; and the American Board of Medical was assessed by using a MCQ, OSCE and longitudinal Specialties for its maintenance of competency framework. faculty observations. Once the international group of Aim: While maintaining the presentations approach for experts agreed on what constitutes a competent medical the physician as expert, the MCC will nest the objectives graduate and international standards at the school-level surrounding communication, including cultural aspects of were set, confidential reports were sent to medical schools, practice, and the established legal, ethical and their students and the Ministers of Education and Health. organizational aspects of practice, within these other roles. They indicated areas of strengths and those that needed improvement. A recently performed evaluation of the Method/Results: The approach is undergoing focus group impact of this pilot assessment was based mainly on the testing currently. The results and a framework will be analysis of responses to a structured questionnaire sent presented, including the integration of cognitive principles to the cooperating medical schools. and recent research, to improve the scope and validity of the MCC Objectives. Summary of Results: Information received points to innovation in curricula content, use of modern assessment tools, establishment of clinical skills laboratories, faculty 9O 6 The Slovak doctor: in the footsteps of the training in the use of modern educational methods and Scottish Doctor on the road to the European innovative efforts in schools not included in this project. doctor Take-home Message: The assessment of graduates’ competencies as an outcome of medical education has Lukas Plank*, Jan Danko, Peter Galajda, Katarina Murcekova, Eva Rozborilova and Sona Franova (Comenius University, had a significant impact on the introduction of innovations Jessenius Faculty of Medicine, Dean’s Office, Zaborskeho c.2, in educational processes. This indicates the potential of Martin 036 45, SLOVAK REPUBLIC) this approach to improve the quality of medical education worldwide. Aim of presentation: To describe the origin and the first period of development of a national program “The Slovak Doctor” offering national undergraduate learning outcomes 9O 4 Dutch medical students’ assessment of of the general medicine program at all three Slovak Medical CanMEDS competencies Faculties in a period shortly after the Slovakia’s EU accession. Jany Rademakers*, Olle ten Cate and Nienke de Rooy (UMC Utrecht University, School of Medical Sciences, Postbus 85060, Summary of work: Finding inspiration in The Scottish Stratenum 0.304, Utrecht 3508 AB, NETHERLANDS) Doctor and reaching the agreement with our partners, In 2003 the Dutch Central College of Medical Specialties the “Slovak Dean’s Medical Curriculum Group February presented guidelines for modernization of all medical 2005" and the “Working Group of Vice-Deans for specialty training programmes in the Netherlands. These Pedagogical Activities” of all the faculties were established. guidelines are based to an important extent on the After the period of preparation, the Conference of the CanMEDS 2000 model, in which seven main roles are Slovak Medical Faculties will be held at our Faculty in May

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2005, with a participation of the coordinators of The 9O 8 Understanding the role of the qualified Scottish Doctor program and with the aim to reach the professional: a comparison of medical and Slovak consensus and to promote the project development dental students “in the footsteps of The Scottish Doctor”. Hillary Widdifield1, Tony Ryan*1 and Elenor O’Sullivan2 Summary and take home message: In the coming weeks, (1Department of Paediatrics & Child Health and 2School of working groups are going to be established from the Dentistry, Cork University Hospital, Wilton Cork, IRELAND) experts of all the faculties to re-evaluate the curricula of the faculties using similar approach as that one used in Background/Rationale: The Royal College of Physicians & the Scottish Doctor and to be able to coordinate the Slovak Surgeons of Canada developed a competency framework activities with the EU thematic network programs. to assist future specialists in responding to challenges as health care providers. The CanMEDS project described 7 essential roles of Specialist Physicians: Health Advocate, 9O 7 Survey of the opinion of students, teachers Manager, Scholar, Medical Expert, Professional, and general practitioners on the Communicator and Collaborator (HMSEPC2). This study undergraduate curriculum of the Faculty of investigated whether medical students and dental students in Ireland recognised these roles. Medicine, Cluj-Napoca, Romania What was done: Medical and dental students (year 1 and V Muntean (University of Medicine and Pharmacy ‘Iuliu year 4) were asked to mind map the responsibilities of Hatieganu’ Cluj-Napoca, CF University Hospital, 18 Republicii, Cluj-Napoca 400015, ROMANIA) qualified doctors/dentists. The comments on the mind map were applied to one of the 7 CanMEDS roles. Background/Rationale: In order to define the knowledge base and the abilities which will enable our graduates to Results: Students had the greatest number of responses make a successful transition to residency programs, we referring to the Medical Expert (257) and Professional (227) assessed the opinion of students, faculty and general roles. This was followed by Communicator (130), Scholar practitioners on the 125 conditions included in Clinical (107) and Health Advocate (82) roles. There were relatively Presentation List of Calgary University. few responses relating to Manager (12) and Collaborator (i.e. teamwork) roles (30). There were no differences in What was done: 102 general practitioners (GP), 38 medical responses between Dental Students and Medical Students students (MS) and 28 teachers (T) (response rate 38%, and between 1st year and 4th year students. Similarly there 44% and 66%, respectively) answered to an anonymous, were no differences between the responses of Irish structured, opinion questionnaire referring to the students (n =95; 68%) and International students (n =45; importance, competence (knowledge and abilities) and 32%). educational needs of the 125 clinical presentations. The correlation coefficient was calculated for opinions on: Conclusion: Students are aware of their role as Medical or clinical presentations importance (0.62 T/S, 0.34 GP/S and Dental experts (diagnostic and therapeutic skills) for ethical 0.06 T/GP), basic knowledge of the problems (0.62 GP/ and effective patient care (professional role). They are S), abilities to address the problems (0.28 GP/S), the somewhat aware of the Communicator, Scholar and Health quality of curriculum and learning environment (0.62 GP/ Advocate roles. They have little concept of the importance S) and educational needs (0.05 GP/S). of management skills (utilising resources effectively), and of collaboration (teamwork and consulting effectively with Conclusions: We observed an unexpected low correlation other physicians and health care professionals). between general practitioners’ and teachers’ opinion on the importance of different clinical presentations. There Take home message: Medical and Dental Educators and are different educational needs for every stage of Curriculum Committees should address these deficiencies professional growth, which should be specifically in the formal curriculum. addressed. Take-home messages: The survey data are now used in the process of medical curriculum, competence-based, reform which is currently ongoing in our University.

Workshops 9R, 9S, 9T & 9U

9R A consumer’s guide to Generalisability (G) to do it. Some knowledge of stats, particularly Analysis of Theory Variance, would be helpful but not necessary. Geoff Norman (McMaster University Medical School, Department of Clinical Epidemiology, 1280 Main Street West, 9S Using Team Learning teaching methods to Hamilton, ON, CANADA) promote multiple professional competencies Workshop content and structure: This workshop will guide Dan Mayer1, Paul Haidet2 and 3Dean Parmalee (1Albany the participant through the conceptual basis of Medical College, 2Baylor College of Medicine, and 3Wright Generalizability theory, beginning with its historical roots State College of Medicine in classical test theory. The approach will be more conceptual than computational. It will consist of lectures Background to the topic: Medical education is being asked and discussion plus a bit of individual work. to incorporate more active teaching strategies into curricula, yet most large group teaching settings rely on Intended outcomes: At the end, participants should be traditional didactic lectures, a predominantly passive able to determine when G theory should be used, what teaching mode. Team Learning (TL) is a method of large- the various coefficients are telling them, and why it has group teaching fostering active learning, self-study, advantages over classical test theory. advance preparation, and team communications. In this Intended audience/level of workshop: The workshop is workshop, participants will learn skills and principles of TL designed for individuals who want to understand more that have been shown to enhance student engagement in about applications of G theory, without actually being able large group settings. They will have the opportunity to acquire and practice TL to teach competencies involving

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content knowledge, communications, and problem solving. 9T Portfolios: joy or burden? Lessons learned New to medical education, TL was developed over 20 years from experience in undergraduate medical ago and furthered by grants at Baylor Medical College training (Houston, Texas, USA). TL has demonstrated wide appeal and interest to preclinical and clinical educators. Many TL Erik Driessen, Edith ter Braak, Hanke Dekker, Jan van Tartwijk workshops have been given in the USA and all have been and Cees van der Vleuten (Netherlands Association for Medical well received and highly evaluated. TL goes beyond the Education, Working Group Portfolio) simple presentation of facts and increases students’ interest Background: Portfolios are widely used in medical in the process of their education by focusing on the education, not only as a source of information for authentic application of knowledge in a manner that meaningfully assessment but also to stimulate students to reflect on enhances communication, clinical reasoning, and their experiences and development. teamwork, rather than a simple accumulation and regurgitation of retained facts. The presenters have Workshop content: In this workshop lessons learned from successfully used TL in the medical curriculum to teach experiences with portfolios in undergraduate medical various courses (Human Structure, Molecular and Cell training in three Dutch medical schools will be used as a Biology, Principles of Disease, EBM, and Pathology). The kick-off for discussion. Themes that will be addressed are: workshop will help attendees better understand how TL (1) the use of portfolios in early undergraduate education can be used to increase the competencies of learners at to stimulate reflection; (2) the possibilities of portfolios in all levels (UME, GME, and CME). We will demonstrate a TL the clerkships; and (3) the training of portfolio coaches. lesson and then explore how TL can be used to focus on The audience will be invited to discuss portfolio use from multiple competencies at once. the perspective of different stakeholders. Workshop content and structure: (1) The faculty will briefly Who should attend: Anyone with an interest in using present an overview of the TL process as used in their portfolios is welcome; students especially are invited to institutions. This will include a discussion of the proper participate in this workshop. assignment of learning teams. (2) The participants will be divided into small groups and will participate in a simulation 9U Accept, Revise, Reject: reviewing of TL for learning EBM using Readiness Assurance Tools educational research manuscripts (RATs) and application activities. (3) The small groups will practice developing RAT questions and application activities Steven Durning, Paul Hemmer and Louis Pangaro (Uniformed for a topic of their choice. (4) Participants will present Services University of Health Services, 4301 Jones Bridge their questions to each other and offer feedback. (5) The Road, Bethesda, MD 20814-4799, USA) presenters will offer feedback and present more information Specific Objective: The objective of this workshop is to about the TL process and some of the specific questions develop participants’ skills as reviewers of educational and activities that they have found useful to promote research manuscripts for journals and conferences using practice and assessment of multiple professional the Review Criteria for Research Manuscripts (published competencies with TL in a variety of settings. . in the September 2001 issue of Academic Medicine). Intended outcomes: At the conclusion of the workshop, Methods/Materials: This revised workshop, originally participates will be able to: (1) Explain the core principles designed by Dr. Sonia Crandall, has been developed by and methods of TL. (2) Describe what TL is like from the the research and medical education (RIME) section of the learners’ perspective (having had the opportunity to Group on Educational Affairs of the Association of American experience team learning in a simulated classroom.) (3) Medical Colleges. After an overview of the manuscript Indicate when and how to use RATs and Application review process, workshop participants will be divided into Activities. (4) Describe specific formats in which TL has small groups to review a specific section of the same been integrated into medical education courses at Baylor, submitted manuscript. Small group facilitators will be Albany, and Wright State Medical Colleges. (5) Write basic knowledgeable about the manuscript’s strengths and Readiness Assessment Tests (RAT) questions and weaknesses. Small Group 1 will review the Problem application activities. (6) Discuss how TL can be used to Statement, Conceptual Framework, and Research simultaneously evaluate student performance in multiple Question; Small Group Team 2 reviews the research competencies. Design; Instrumentation, Population and Sample; Small Intended audience: Faculty, teaching across the curriculum Group Team 3 reviews the reporting of Statistical Analyses (UME, GME, and CME) and interested in getting a hands- and Results; and Small Group Team 4 reviews the on and in-depth understanding of why, where, and, how Discussion, Conclusion, Interpretation, Presentation and to use TL in the medical curriculum. Documentation. Small group work will be followed by individual team reports to the large group about the Level of workshop: Beginners will benefit the most, but outcome of their small group work. At the conclusion of those with some experience or previous exposure will also the large group discussion, participants will vote on learn much from the exercise. manuscript recommendation to the editor. Finally, the published version of the manuscript will be reviewed and discussed. Who should attend: This workshop is designed for individuals who are interested in learning the skills of reviewing manuscripts in medical education research and development. A familiarity with the processes of learning and teaching in medicine and the general types of research in this field will be helpful, but is not required. All faculty are welcome.

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Posters 9 Onyx 1 Assessment of communication skills

9 Onyx 1.1 a screening methodology. These difficulties need to be Assessment for learning and assessment of handled sensitively. learning in communication skills studies Eeva Pyörälä*, Pirkko Heasman and Leila Niemi-Murola 9 Onyx 1.3 (University of Helsinki, Research and Development Unit for Intensive remediation in communication Medical Education, PO Box 63, Helsinki 00014, FINLAND) skills in an Academic Medical Center Aim: Most medical faculties offer communication skills Peter Barnett and France Doyle* (University of New Mexico, studies for the future doctors. The assessment of the Department of Emergency Medicine, MSC10 5560, 1 University students’ communication skills has become a major of New Mexico, Albuquerque NM 87131-0001, USA) exercise. This paper emphasises that both assessment for learning and assessment of learning communication skills Background: A small number of medical students at UNM are required. fail the OSCE exam because of deficiencies in communication skills. Likewise, a small number of faculty Summary of work: A communication skills study come to the attention of the Dean because of complaints programme was started in 1994 at the University of about their communication skills. Helsinki. A variety of experiential learning methods and assessment modes have been used throughout the years. What was done: An intensive 4½ day workshop focusing on communication skills was developed, based on a review Summary of results: Different modes of assessment, course given by the Bayer Institute for Health Care portfolios, feedback discussions, self-evaluation, peer- Communication. A combination of didactic presentations, evaluation and log books have been used. The assessment structured personal reflection and role-plays with mode best integrated into learning has been the standardized patients was used to enhance communication constructive feedback by the actor, the peers and the tutor skills. The workshop was given to four groups of students in the small group teaching modules based on role-plays and one group of faculty. with professional actors. Since 2000 high-stakes assessment of communication skills learning has been Conclusions: The workshop was rated very highly by the embedded into OSCE. Today, those failing OSCE for poor students and faculty who participated. All of the students communication skills are reassessed in a combination of successfully passed their subsequent OSCEs. Anecdotal an OSCE station and a feedback discussion. reports suggest that faculty improved as well. Take-home messages: Different modes of assessment Take-home messages: A small number of medical students should be used in communication skills studies, both those and faculty have difficulty with communication skills. An supporting learning processes and those assessing learning intensive remediation workshop is effective in improving outcomes. those skills.

9 Onyx 1.2 9 Onyx 1.4 Screening for communication difficulties: an Do students change their self-assessment of evaluation of a pilot programme for third their communication skills after watching year medical students themselves on video? D Dodwell, A Fraser*, M Jerwood, J Skelton, A Shanks, H Chris Harrison* and Val Wass (University of Manchester, Webberley and C Wiskin (The University of Birmingham, Division of Primary Care, Rusholme Health Centre, Walmer Department of Primary Care and General Practice, Edgbaston, Street, Manchester M14 5NP, UK) Birmingham B15 2TT, UK) Background: It is known that students are often inaccurate Background: Medical curricula increasingly emphasise the in their self-assessment. Video is known to be an effective importance of communication skills, enabling students to teaching tool, but it is uncertain whether it aids self- develop attitudes and behaviour suitable to become a assessment. doctor. Periodically at Birmingham, some students were Aim of work: To compare student self assessment of their found to have serious communication or attitudinal communication skills before and after they self viewed a difficulties during their final examinations. This pilot video of the interaction. programme aimed to identify language, communication and attitudinal difficulties among third year medical Summary of work: Medical students received 4 halfdays students, so that potential problems could be addressed of training on basic consultation skills and giving feedback at an early stage. to peers. Six weeks after completing this course, they were videoed while conducting timed 10 minute interviews with What was done: Every third year student undertook a ten a simulated patient. Students completed a previously minute role-play and five minute structured viva. All validated self-rating questionnaire on different aspects of students received written formative feedback. Referred their communication skills both immediately on completing students also received individual verbal and video feedback. the interview and then immediately after watching the Subsequently, referred students repeated the role-play and video on their own. viva. Students referred a second time received a programme of intensive coaching before sitting a final OSCE Conclusions: Ratings were similar on both occasions, with assessment. An evaluation of the first two years of the a small but non-significant increase in the rating after programme will be presented watching the video. However, students’ ratings on the question ‘encouraging the patient to confide in you/tell Conclusions: The screening process consistently identifies you their concerns’ was lower after watching the video, around 15% of students with difficulties. The majority of but did not reach statistical significance. these improve following individual feedback, but a small number have persistent serious difficulties. The screening Take-home messages: Viewing videos in isolation is not process created significant anxiety amongst students. enough. Students need specific training and/or support if it is to be an effective self assessment tool. Take-home messages: A number of communication and attitudinal difficulties can be identified using role-play as

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9 Onyx 1.5 (47.4%), discuss psychosocial and emotional factors How closely are students’ communication (36.0%), elicit patient’s concerns and perspectives skills related to clinical skills? (36.0%), discuss how health problem affects patient’s daily life (21.9%), express empathy (14.0%), negotiate with S Scheffer*, I Muehlinghaus, A Froehmel, W George and W patient for plan of action (68.4%), ask whether patient Burger (Charité, Universitätsmedizin Berlin, AG has any further issues to discuss (33.3%). Reformstudiengang Medizin, Schumannstr 20/21, Berlin 10117, GERMANY) Conclusion: The medical students who had completed clerkship couldn’t perform well in patient-centered Background: Communication skills (CS) classes run interviewing. The current medical curriculum should be continuously throughout five years of study in the Reformed changed to educate medical students to perform patient- Medical Curriculum at the Charité-Universitaetsmedizin centered communication and the education method Berlin. Clinical skills are assessed regularly with OSCEs. focuses on a behavior change initiative. Students’ CS are not evaluated in a standardized way up to now. The context specificity of CS is a possible confounder that makes the assessment of CS difficult and 9 Onyx 1.7 reduces validity. Social representations of residents toward Summary of work: The aim of this study is to validate a patients of different cultural background: translated global rating scale (Hodges & McIlroy, 2003) in implications on medical communication order to assess CS in OSCEs in the future: 22 third year students were evaluated in an OSCE station regarding their Carine Layat (University of Geneva, Faculty of Medicine, clinical skills with a detailed checklist and regarding their CMU-UDREM, 1 rue Michel-Servet, Genève 4 CH-1211, SWITZERLAND) CS with the global rating scale. The videotaped OSCE encounters were then evaluated by a second rater with Purpose: To define residents’ social representations the same assessment tools. towards non-adherent patients of different cultural backgrounds. Conclusion: The context specificity as a correlation between students’ achievement in clinical skills and their CS will be Introduction: Patient-physician communication is essential presented and discussed. to provide the quality and efficacy of health care. Social representations of the physician towards the patient is Take-home message: Implications for the future use of one of the most essential factors influencing the instrument to assess students’ communication skills communication. will be outlined. Methods: 14 residents of Internal Medicine and 14 of Family Medicine interviewed 2 standardised patients, one Swiss 9 Onyx 1.6 and one migrant from Kosovo. We collected qualitative Medical students’ patient centered attitudes data (videotaped medical interviews, stimulated recall and and communication skills case presentations). We used thematic analysis and checklists for the medical interviews. Chang-Jin Choi* and Jeong-Lim Moon (The Catholic University of Korea, Department of Family Medicine, College Results: The migrant standardised patient was often of Medicine, 505 Banpo-dong, Seocho-gu, Seoul, KOREA) perceived as non-adherent, which provoked strong Background: Physicians’ patient-centered communication emotions in residents, especially for those in Internal is known to increase patient satisfaction, compliance, good Medicine. The residents who felt not at ease or frustrated doctor-patient relationship and health outcomes. The aim reported more general difficulties (e.g. language, values’ of this study is to evaluate medical students’ patient- understanding, emotions) and particularly in using more centered communication skills and attitudes after their elaborated communication techniques. clerkship. Conclusion: Residents’ social representations are linked Method: To evaluate medical students’ communication to their own perception of the patient’s adherence to skills, OSCE was performed on 114 fourth year medical treatment. They might play an important role in students who had completed a clerkship. After OSCE, we communication, especially with the migrant patient. This used structured questionnaires to survey the subjects for suggests that residents should be trained to self-assess their attitudes toward communication skills learning and their own representations and to acknowledge their own patient-centeredness. emotions and how they influence communication. Results: The accomplished frequency of patient centered Take-home messages: Social representations of communication items were as follows: allow patient’s professionals towards their “client” influence the way they narrative thread (88.6%), open-to-closed-ended questions communicate.

Posters 9 Onyx 2 Multiprofessional education

9 Onyx 2.1 A large number of participants from a variety of Open meeting: a model for backgrounds (people with learning disabilities, school multiprofessional education? teachers, physiotherapists, speech and language therapists, social workers, learning disability nurses, Jim Blair (Kingston University, Faculty of Health and Social doctors, mental health nurses, students on healthcare Care Sciences, Room 72, 2nd Floor, Grosvenor Wing, St courses and lecturers) attend meetings on a regular basis. George’s Hospital Medical School, Cranmer Terrace, London The focus is on collaboration, networking, sharing SW17 0RE, UK) information and delivering best practice. There have been Over the last decade there has been a push for two evaluations relating to the effectiveness of the meeting multiprofessional healthcare education and practice within and the general feedback is that the meetings have led to the UK. In reality this has proved to be much harder to improved professional relationships by sharing information, achieve than at first envisaged. The open meeting was developing networks and continuing professional set up to form inter-professional relationships for those development within all sectors. The meetings have who use and deliver healthcare.

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enhanced education planning and promoted evidence 9 Onyx 2.4 based shared practice. Professional boundaries and A multiprofessional approach to difficulties in working with service users have been broken accreditation of medical and paramedic down as a result of these meetings, thereby realising the potential of all participants. The hope is that this model education programs will be adapted within the wider teaching and learning Judi Walker*, Hugh Grantham and Ian Pickering (University community. of Tasmania, Rural Clinical School, PO Box 3513, Burnie, Tasmania 7320, AUSTRALIA) 9 Onyx 2.2 All health care professions are facing the same challenge Interprofessional training in ward rounds of having the workforce they need to provide equitable, accessible, sustainable, timely, safe health care. for medical and nursing students: a feasibility study In Australia paramedic education is currently provided by a number of ambulance-based state education units and Birgitte Dahl Pedersen*, Inger Kuch Poulsen, Anne Marie a number of independent tertiary education institutions. Frandsen, Pernille Hinge, Rikke Hedeland Larsen and Torben Expectations are changing as ambulance is being V Schroeder (Copenhagen University Hospital, Centre for challenged to move from a primarily transport model to Medical Education, Rigshospitalet, Dept 5404 (Teilumbygningen), Blegdamsvej 9, Copenhagen DK 2100, the need for a more definitive pre-hospital medical DENMARK) treatment/primary health and social care model. This has enormous implications for paramedic education and is a Background/Rationale: Ward rounds are an important part key workforce role redesign issue. Paramedic education in of the everyday routine for both doctors and nurses. This Australia, unlike medicine, nursing and many allied health paper reports on a pilot study of an interprofessional professions, does not have an external accreditation system training course in conducting ward rounds for medical but there is now general acceptance by the industry that students in their ninth of twelve terms and nursing students some external process of evaluation of education programs in their sixth of seven terms. and the quality of graduates of these programs is required. Methods: A cohort of 24 students will attend a one-day The Australian Convention of Ambulance Authorities has training course aiming at developing understanding of commissioned a major project to develop a set of guidelines knowledge, skills, roles and duties of the other profession for the assessment and accreditation of paramedic and to stress the importance of good communication for education programs. A key feature of this project is teamwork and for patient care. The participants will be engagement with other health professional accreditation working together in small groups training communication bodies to develop a multiprofessional approach to and collaborations skills using a structure for ward rounds accreditation of education programs for the future. in a realistic clinical setting/environment with simulated patients. The study will be evaluated by questionnaires and focus group-interviews with regard to feasibility and 9 Onyx 2.5 relevance to students’ clinical education Identifying barriers and factors for facilitating interprofessional team working Results: As this pilot study will take place 17-19th of May this year, we will be able to present the results during the in the primary care setting AMEE meeting Melissa Owens*, David Pearson, Liz Allen and Jacqui Hutchinson (Bradford City PCT, Apartment 3 Number 19, Low Beck, West Yorkshire, Ilkley LS29 8UN, UK) 9 Onyx 2.3 Aim of Ppresentation: This presentation will describe the Teacher preparation for IPL: emerging findings of a project examining interprofessional learning issues from the PIPE Project activities between general practitioners and related health Gill Young*, Julila Bray, Elizabeth Howletts, Katy Newell care professionals. Jones, Maggi Lord and Bee Wee (Thames Valley University, Summary of work: Working with six general practices in Faculty of Health & Human Sciences, 32-38 Uxbridge Road, West Yorkshire, England, the project is being implemented London W5 2BS, UK) in three phases: examination of learning activity, The Promoting Inter-Professional Education (PIPE) project identification of interprofessional learning and is a three year HEFCE funded FDTL4 project. The project recommendations for its enhancement; the introduction aims to develop and improve the preparation of teachers of new learning practices and; evaluation of the whole and facilitators to effectively manage inter-professional project. Findings from phase one of the project will be learning in a range of settings. The aim of this paper is to presented. explore with participants our educational research findings Summary of Results: Focus group interviews were and recommendations based on survey data, a Delphi study undertaken with uni-professional groups and transcriptions and focus groups which have emerged from the PIPE analysed using a grounded theory approach and the project. software package NUD*IST. Preliminary findings show a In the paper we will use our findings to seek to address clear relationship between positive, interprofessional these two key questions: (1) Do inter-professional groups learning activities and enhanced, interprofessional working. require unique approaches to teaching? Or do they the Those factors that facilitate the achievement of high quality pose the same challenges as other complex, diverse interprofessional learning activities, however, are complex. groups? (2) How do we best prepare teachers and This presentation will provide examples of positive changes facilitators for inter-professional learning? to working practices found, and describe interprofessional We will also be using Illeris’s 3 Dimensions of Learning learning activities that led to these achievements. (2002) to explore tensions around pedagogical theories Take-home messages: It appears close interprofessional of learning underpinning IPL. learning activities are linked with close interprofessional Illeris, K. (2002) The Three Dimensions of Learning. working. The nature of this link will be explored. Issues Frederiksberg: Roskilde University Press for consideration in developing interprofessional learning activities will be identified, based on the findings of this The project is hosted by The University of Reading in project to date. collaboration with six other organisations within the Thames Valley, UK.

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9 Onyx 2.6 9 Onyx 2.7 Can an educational intervention help to Literature as a pedagogical tool for reflective improve situational awareness in operating learning – an interprofessional study theatre teams? Annika Sääf-Rothoff* and Björn Eriksson (Karolinska Jon Allard*, Alan Bleakley, James Boyden, Adrian Hobbs and Institutet, Inst CLINTEC, Enheten för Logopedi och foniatri, Linda Walsh (Peninsula Medical School, Research Unit, Huddinge, Stockholm 14186, SWEDEN) Knowledge Spa, Postgraduate Medical School, Royal Cornwall We performed a study to promote interprofessional Hospital Trust, Truro, Cornwall TR1 3LJ, UK) reflection with speech pathology students and medical Aim of presentation: To report on the role of an educational students together. The aim was to foster and enhance intervention in improving situational awareness in the multi- individual and group reflections on the professional role. disciplinary activity of surgical intervention and care. Methods: Speech pathology students (n=5) and medical Summary of work: Non-technical skills such as effective students (n=5) volunteered (10 seminars during 10 communication are prerequisites for safe and effective months). The students answered a questionnaire and performance in the operating theatre. Within operating wrote two short essays. The students read novels, plays teams a shared understanding of certain situations and and discussed them in a semistructured way in class (with procedures is vital for ensuring tasks are completed to an seminar group leaders from each profession), in small optimal level and patient safety is maintained. Explicit groups and as individual written reflections. The literature communication is vital for this. Video cameras in two ranged from Sofocles to Saramago (5 novels and one play). orthopaedic theatres record live practice. Tapes are edited This was followed by a semistructured interview of each for team debriefs. A linguistic coding system has been student (45 min) made by a person not involved in the developed for recording interaction (explicit project. communication). 30 operations have been recorded and Results: The medical students estimated that their analysed. Data is fed back to teams as an educational curriculum gave them few opportunities to develop the intervention. professional role through reflection (2,88 of 10 compared Summary of results: Communication within operating to 8,7 among speech-pathology students). The discussion theatre teams is dependent upon a number of key factors based on the two professions involved was considered to including: team dynamics, time-pressure and difficulty of be valuable and important for individual reflection and for procedure. These however have to be made explicit in understanding of the other profession. The students dynamic circumstances. Feeding this back to teams through pointed out the necessity that more time should be video review changes practice positively. scheduled for reflections in future curricula. Conclusions/take-home messages: Explicit communication Conclusion: Literature could promote reflection and plays an important role in maintaining shared situational interprofessional understanding. awareness. Video and oral feedback focussing on communication patterns has the potential to heighten situational awareness.

Posters 9 Topaz 1 Evaluation of problem based learning

9 Topaz 1.1 Conclusions/take-home messages: We have not found Gender is a more significant predictor of significant differences in anxiety, depression or self-esteem anxiety, depression and low self-esteem between students in the traditional or new curriculum. Of concern is the significant gender effect with increased than the type of curriculum or ethnicity in anxiety, depression and lower self-esteem in female an undergraduate medical programme students. Rae Nash*, Cathy Ward and Richard Hift (University of Cape Town, Box 200, Muizenberg, Cape Town 7950, SOUTH AFRICA) 9 Topaz 1.2 A comparison of problem-based learning and Aim of presentation: We undertook a comparative study to determine the prevalence of anxiety and depression in traditional medical students at the University students in the traditional and new problem-based of Hamburg: a longitudinal evaluation curricula. M Kandulla*, O Kuhnigk and M Bullinger (University of Summary of work: Subjects: third-year class of the old Hamburg (UKE), Modellstudiengang Medizin, Martinistr. 52, curriculum (n=165); second-year class of the incoming Hamburg D-20246, GERMANY) new curriculum (n=180). Instruments: Beck Depression Background/rationale: In winter term 2001/2002 a problem Inventory, Self Rating Anxiety Scale, Du Bois Self-Esteem based learning (pbl) curriculum for the first three years of Scale. undergraduate education has been implemented parallel Summary of results: No significant differences in depression to the traditional curriculum. Self-rating questionnaires (p=0.4), anxiety (p=0.7) or self-esteem (p=0.1) between were filled out each semester in order to evaluate pbl- the old and new curricula. We demonstrated significant and traditional students with respect to condition of gender differences: depression scores (p=0.003) and studying, learning styles and environment, performance, anxiety scores (p=0.01) were higher, self-esteem (p=0.04) contentedness and personality. lower in females. Ethnic origin significant for depression What was done: Standardised and self-designed scales (0.03) and self-esteem (p=0.04). Multivariate analysis are used to compare pbl- and traditional students (n=90). indicated that the more favourable scores in white students Groups are compared in terms of significant differences were restricted to males; white females being comparable and for the long-term perspective by means of analysis of to others. No significant interaction between curriculum variance with repeated measures. and gender, or curriculum and ethnicity.

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Conclusions: A first glance at the data show that pbl- and ideal learning experiences and questions about students perform better in terms of vitality and mental guidance during the field contacts. A total of 140 students health. They also tend to be more motivated and more (response 77%) filled in this questionnaire. The results content concerning studying. They seem to learn more show a large variation in learning activities and related continuously and assess themselves more practical skills learning experiences and significant differences between and more theoretical knowledge than the traditional the three settings. Students prefer a variety of learning students rate themselves. However, traditional medical activities, learning activities that give them responsibility students seem to spend more hours per week at university and a specific type of guidance that emphasizes a focus and suffer less from the feeling that they cannot cope on learning process, curriculum and explicit modelling. with the amount they have to learn. The results described above exist over all semesters in our longitudinal research. 9 Topaz 1.5 Graduates perception of science education in 9 Topaz 1.3 a traditional and a problem-based curriculum The perception of the medical education Willemina M Molenaar*, Jan Jaap Reinders, Jelle Geertsma concepts and its influence on the study and Janke Cohen-Schotanus (University Medical Center behaviour of students – presentation of a Groningen, Center for Professional Development of Teachers, qualitative research approach as an Ant Deusinglaan 1, Groningen 9713 AV, NETHERLANDS) extended perspective on PBL-based and Aim of presentation: In 1993 the medical faculty in traditional curricula Groningen replaced the traditional curriculum by a problem based curriculum. The science program included basically A M Böthern*, M Bullinger and O Kuhnigk (Universitäts- klinikum Hamburg-Eppendorf, Modell-studiengang Medizin, the same compulsory and elective elements in both Haus N16, Martinistr 52, Hamburg 20246, GERMANY) curricula. This study explores how graduates perceive their science education 3-4 years after graduation. Background: In Hamburg, a PBL based curriculum for the first 6 semesters was implemented in 2001 parallel to the Summary of work: Graduates of the last cohort of the traditional medical curriculum. traditional (n=146) and of the first cohort of the problem based curriculum (n= 151) were asked by telephone to A qualitative interview was developed to investigate the grade the overall level of the science in their curricula, perception of students regarding: (1) Structure and their preparedness for scientific issues (scale 1-10) and realisation of their curriculum (e.g. applicability of learning the extent to which the curriculum influenced their interest matters); (2) Influence of the perceived aspects of the in science (1: strongly decreased to 5: strongly increased). curriculum (PBL vs. traditional curriculum) on process variables (e.g. motivation); (3) Consequences of the Summary of results: Both cohorts graded the overall perceived aspects of the curriculum on the results of scientific level as adequate (6.0 and 6.2, respectively), intervention (e.g. learning effectiveness). but felt that their interest in science was decreased (1.7 and 1.8, respectively). Graduates from the traditional Methods: 21 PBL students and 21 matched traditional curriculum felt marginally prepared in relation to scientific students were surveyed. Analysis of interviews was carried issues, whereas those from the problem based curriculum out by content analysis (Mayring 2003). scored only slightly better (5.9 vs 6.2; p<0.05). Hypotheses: (1) The education concept influences study Conclusions: Perception of science education among behaviour, but it is unpredictable in which way. (2) Students graduates from both the traditional and the problem based perceive different aspects of the curriculum as important. curriculum is worrisome, although the problem based (3) This different perception is decisive for the influence curriculum appears to give graduates more confidence in on students‘ study behaviour (e.g. if the applicability of their scientific skills. learning objectives is almost irrelevant for the students, it will hardly influence their study behaviour). Conclusions: Work on data is still on progress. Research 9 Topaz 1.6 approach, results and conclusions will be presented. The Comparison of reflection in learning, qualitative approach is a reasonable complement to the approach to learning and self-efficacy in quantitative approach. It points out new perspectives on self-directed learning at medical schools teaching concepts in medical education. with different curricula A Grant*, P Kinnersley, M Field and H Houston (Cardiff 9 Topaz 1.4 University, Department of General Practice, Llanedeyrn Health Significant learning experiences of students Centre, Llanedeyrn, Cardiff CF23 9PN, UK) during field contacts in the third year Background: In previous work, we found that students at psychomedical cluster of a new PBL-based different schools had different approaches to learning. At curriculum a school with a problem-based curriculum students described a deeper approach and higher self-direction of W S De Grave*, E Rooijakkers, D H J M Dolmans and A J J A learning. Scherpbier (Maastricht University, Department of Educational Development and Research, PO Box 616, Maastricht 6200 MD, Method: Participants: All final-year students at two medical NETHERLANDS) schools: one with an integrated curriculum and one with a problem-based curriculum. The students will be asked to In the academic year 2003-2004 the third year of complete: The Reflective Learning Scale (1) measures “Curriculum 2001” – the New Maastricht medical curriculum metacognitive activity and ability to integrate learning. The - was started. Year three emphasizes integrated exploration Learning and Studying Questionnaire (2) measures surface of theory and practice and a large number of patient and deep approaches to learning and learning orientations. encounters in which students take on an active role. The year is divided into four clusters of 10 weeks, each cluster The Self-Efficacy in Learning Scale (3) measures learners’ covering a particular field with various themes. In the perception of their competence to direct their own learning. psychomedical cluster students have field contacts for one Generalisability of results: The combination of instruments day a week in three different mental health care institutions. being used in this study means that there is the potential The field contacts are related to the pbl-process in the to detect differences in characteristics of learning which tutorial group. We compared the learning experiences of are widely recognised as indicators of good quality learning. year 3 students in the three institutions using a questionnaire that consisted of questions about factual A difference in approach to learning or in self-efficacy between students at different schools will be significant.

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It will signal the need for further research to determine Take home message: The occupational medicine program the reasons for the differences both in the intake and the is a curricular requirement in German undergraduate curricula of the respective schools. medical education. Traditionally it ranked low in students’ esteem. When submitted to a rigorous program overhaul introducing a PBL and Project Based Teaching concept as 9 Topaz 1.7 well as an anonymous evaluation by participating students, Comparison of nursing students’ learning in it was continuously improved. Improvements were two methods of problem-based and lecture- measured in two dimensions: students’ acceptance and based (from lesson plan) in course of satisfaction and objective summative examination results. fundamentals of nursing Leila Moslanejad (Jahrom Medical School of Science, 9 Topaz 1.9 Motahari Street, Fars, Jahrom 74148, IRAN) Influence of the preclinical problem-based Background: Problem-based learning (PBL) is one of the learning curriculum on the learning attitude most successful methods in achieving higher educational and social competence in the clinical years: objectives. Various advantages and disadvantages of this the students’ perception method have been addressed in different studies. Banu Yuerueker and Barbara Stadelmann (Studienplanung Methods: In this experimental study, and for evaluating Medizin, Faculty of Medicine, Murtenstrasse 11, Bern 3010, the effect of this method in learning, we compared two SWITZERLAND) educational methods: problem-based learning and lecture- In 1996 the Faculty of Medicine of the University of Bern based learning in ten topics of Fundamental of Nursing implemented Problem-Based learning, PBL, as didactic were chosen after holding discussion meeting. The principle in the preclinical years of medical education. students were divided randomly in two groups. Each topic Initially, PBL was introduced as a pilot project, with 64 was taught to the two groups of students using both randomly assigned students in parallel to the traditional methods alternately. Students’ learning was evaluated with lecture-driven curriculum. To date, all three preclinical years post test exams in each session. have been completely transformed into a PBL- curriculum. Result: The mean score of knowledge in first stage was However, the very first PBL cohort is of outstanding interest (8/48 1/92) and (9/21 1/85) in lesson plan and problem for the following reasons: (1) they were the first cohort at base learning respectively, and in the second stage mean the Medical Faculty in Berne going through a PBL-based score of knowledge was (10/57 2/40) and (9/90 1/9) in learning experience during the two initial years of medical two groups paired to test in two groups was not significant. education; (2) subsequently to the first two PBL-years, these students went through the “non PBL”, traditionally Conclusion: Considering the exchange of methods between taught third preclinical year, together with their colleagues the two groups, according to the obtained data and of the traditional curriculum; (3) this allows to compare regarding the higher effectiveness of the lesson plan their attitudes and competences with the learning lecturing, it is possible to use this method as a basic method behaviour, skills and attitudes of their peers in the parallel for teaching and to simultaneously use the problem base traditional track. Out of 29 questioned candidates 27 learning as an adjunctive method (when the students are confirmed, that PBL has had an outstanding impact on more familiar with the lecture). their subsequent clinical years, especially in terms of learning strategies, including “seek for effective and 9 Topaz 1.8 adequate information”, “self-directed learning” and Occupational medicine – a PBL and project “flexibility in regard of a ever changing work team (social based teaching concept competence)”. N Binding*, S Woltering, R P Nippert and U Witting (Wilhelms- Universität Münster, Institut für Arbeitsmedizin der 9 Topaz 1.10 Westfalischen, Robert-Koch Str 51, Münster D-48149, A comparative study of students’ knowledge GERMANY) from two methods of problem solving (one Background: Since 1999 the occupational medicine method of improving critical thinking) and program for undergraduate medical students has been lecture presentation in nursing students restructured using a PBL and project study concept. It features student research groups visiting selected industrial Mahdi Abdolahi*, Leila Moslanejad and Saeed Sobhanian (Jahrom School of Medical Science, Motahari Street, Fars, plants, studying possible occupational hazards and Jahrom 74148, IRAN) preventive concepts to eliminate or diminish the hazardous working conditions. During a finalising colloquium, the Background: The literature tends to equate problem- learning effect of the program is documented. The program solving with patient-centred problems or the Nursing as a whole has been evaluated from the beginning, the process. It is also a skill used in managing the work role, results of this evaluation are presented. working in a team and managing a health care unit. Method: At the end of each program the undergraduate Methods: This experimental study was applied on nursing students fill in a questionnaire that consists of 22 questions, students of Jahrom medical school (388 students). The dealing with the teaching/learning concept and an overall students were divided randomly into two groups. Half of evaluation of the program. The statistical analysis is based the students were taught by problem solving method, and on the answers of 1020 students who participated in the the control group were taught according to the traditional program since its beginning. lecture method in one topic of nursing psychiatry. At the end of the course students’ knowledge was assessed by Results: Over the study period of four years a consistent short answer essay questions into both groups. The data improvement of students’ ratings concerning the program were analyzed by SPSS software using t-test. as a whole could be demonstrated. Successful program participation correlated significantly with variables of Result: The mean score of knowledge was (8/48 1.9) and program acceptance, and those of personal interest for (9.21 1.85) in control and experimental groups respectively. the discipline correlated significantly. Since the program There was a significant difference between the knowledge implementation, the State Board controlled central medical score of the experiment and control groups (p <0 .05). exams in Germany showed consistent and continuous Conclusion: The present study revealed that problem improvement in these exam results (MCQ format) for solving method was successful compared to current Münster undergraduate students. learning methods. More studies are recommended to consider replacing the current educational methods with the problem base learning method.

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Posters 9 Ruby 1 Postgraduate education and continuing professional development/continuing medical education

9 Ruby 1.1 9 Ruby 1.3 An educational programme for General Variations in the ability of general medical Practitioners (GPs) with a special interest in practitioners to apply two methods of gynaecology: evaluation of programme and clinical audit: a five-year study of impact on referral rates and GP knowledge assessment by peer review base Linsey Semple*, John McKay, Paul Bowie and Murray Lough Jane MacDougall*, Pauline Brimblecombe and Caroline (NHS Education for Scotland, 2 Central Quay, 89 Hydepark Cooper (Addenbrooke’s Hospital, Department of Obstetrics & Street, Glasgow G3 8BW, UK) Gynaecology, Hills Road, Cambridge CB2 2SW, UK) Aim of presentation: Clinical audit has a central role in the Background/Rationale: The NHS plan called for the NHS clinical governance agenda. However, concerns have introduction of 1000 “specialist GPs”. They need easy been raised about the ability of practitioners to apply audit access to advice, support and professional development methods. One method of making informed judgements from hospital based specialists. There has been little on audit performance is by peer review. In the west of research on how to provide this educational support nor Scotland a voluntary peer review model is open to general whether it has an impact on referral numbers and quality. practitioners, while general practice registrars are Do GPs with a special interest in gynaecology alter the compelled to participate as part of summative assessment. referral patterns of their practices if they attend regular The study aimed to compare the peer review outcomes hospital based educational sessions? Does their self- for two methods of audit undertaken by these groups of perceived knowledge base in gynaecology improve? doctors. What was done: A gynaecologist and 2 GPs established Summary of work & results: Participants submitted a an educational programme in gynaecology. 6 evening criterion audit or significant event analysis in standard seminars were arranged over 9 months in 2004. One GP formats for review by two GPs using appropriate with an interest in gynaecology was invited from each of instruments. Of 1002 criterion audit submissions, 552 20 local practices. They were encouraged to act as (55%) were judged to be satisfactory. GP registrars were “experts” within their practices and as a resource for their more likely than GP trainers (P<0.001) and other colleagues. Each educational session was evaluated. GPs’ established GP groups (P<0.001) to gain a satisfactory knowledge base was assessed before and after the 6 peer review. Of 883 SEA submissions, 541 (65%) were sessions using questionnaires. Referral numbers and quality judged as satisfactory, with all groups gaining a similar were assessed before and after. proportion of satisfactory assessments. Conclusions/take home messages: Benefits of an Conclusion & take home message: A significant proportion educational programme include a better dialogue between of GPs may be unable to adequately apply audit methods, primary and secondary care and creation of a supportive potentially raising questions about the effectiveness of audit peer group in addition to updating individual knowledge. as a health care improvement policy in general practice. Improved patient care is a perceived benefit but this is difficult to quantify. 9 Ruby 1.4 Family physicians’ perceptions of academic 9 Ruby 1.2 detailing GP underperformance – remediation in the Michael Allen*, Suzanne Ferrier and Isobel Fleming Wales Deanery (Dalhousie University CME, 5849 University Avenue, Halifax, Mary Bett* and Phil Matthews* (Wales College of Medicine, Nova Scotia B3H 4H7, CANADA) School of Postgraduate Medical and Dental Education, Section Aim: Dalhousie CME has had an Academic Detailing Service of Postgraduate Education for General Practice, Heath Park, since 2001. Records show that 414 (46%) family physicians Cardiff CF14 4XN, UK) have never used the Service, 110 (12%) have used it once, Aim: Description of a model of remedial training for General and 375 (42%) have used it more than once. Our purpose Practitioners in Wales: we have developed a network to was to determine the factors that affect physicians’ use of assist GPs with significant identified learning needs. academic detailing and how we can improve it. The work: An Advanced Training Practices Network (ATPN) Work done: Questionnaire mailed to each of the three was established in 2002. Training focussed on delivery, groups (never used, used once, used > once) and recording and reporting of education appropriate to the interviews with 5 to 10 physicians from each group. Overall needs of the individual doctor. We have developed a questionnaire response rate was 33% (N=288). reporting mechanism where the trainer submits a weekly Results: Interview and questionnaire data indicate that report to the Department and in addition reports are the factors most likely to encourage participation in submitted at 2, 6, 12 and 18 weeks that are then forwarded academic detailing are 1) adopting an evidence-based to the referring organisation. At the end of the placement approach; 2) covering topics useful to practice; and 3) a final report is submitted to the referring organisation. To providing useful handout material. Factors most likely to date we have had two referrals following an National discourage participation are 1) spending office time doing Clinical Assessment Authority (NCAA), one referred by the CME; 2) scheduling time for the academic detailer; and 3) General Medical Council and one referred by the Local having access to CME in other ways. Health Board. Funding for all these placements has been provided by the Local Health Boards. Indications from the Conclusions: All three groups value evidence-based NCAA are that there are at least 9 GPs who have information. Scheduling time to see the detailer and undertaken assessments that may require placements in spending office time for CME discourage some physicians the next 12 months. We have therefore taken the decision from using academic detailing. Providing innovative ways to expand the network and will undertake induction training of delivering academic detailing may encourage for new practices in Spring 2005. The poster will focus on participation by physicians who find it difficult to spend learning outcomes and results to August 2005. office time doing CME.

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9 Ruby 1.5 9 Ruby 1.6 Higher degrees for General Practitioners Attitudes of Higher Professional Education (GPs); the creation of modern Prometheus (HPE) host practices to the HPE scheme for or of workers complicit in a brave new new GPs in Mersey Deanery world? J C Howard* and J A Fox (Mersey Deanery, The Hungerford Marion Lynch* and Derek Gallen (Oxford PGMDE, GP Medical Centre, School Crescent, Crewe, Cheshire CW1 5HA, Education Department, Stoke Mandeville Postgraduate Centre, UK) Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK) Aim of Presentation: English Deaneries have operated an Background: The NHS is changing and the role of GPs HPE scheme for newly qualified GPs for 4 years; we being questioned. Transparency, life long learning and previously evaluated participants’ development (http:// professional regulation are at the centre of this drive for www.postgradgpliv.com/HPE/hpe_evaluation.doc). The improvement. Within the modern NHS General Practice Department of Health requires scheme payments to be seems to be ‘under review’. The ‘imposed’ changes may paid to a host practice to ensure locum reimbursement be undermining professionalism, perhaps even the role of solely replaces service sessions. Practices’ attitudes to pilot General Practitioners. Merging funding streams, multi HPE schemes were explored in early studies; no studies professional approaches, outcomes based education, even have examined practices’ attitudes to the formal HPE revalidation all influence GP postgraduate education. New scheme. We present the results of a survey of host roles for GPs, new types of practitioners in Primary Care practices. and changing patient expectations will all influence the Summary of work: We undertook a postal survey of senior future work for GPs. In addition GPs are expected to work partners and practice managers who have been involved with other healthcare professionals to influence the future in HPE over the last 4 years in Mersey Deanery. The of primary care. Others working at such an influential level questionnaire was similar to that used for previous HPE are expected to be educated and skilled to Masters level. pilots1. Such higher education for GPs could be a help, or hindrance, to their inclusion or influence on the future. Summary of results: Most practices readily support new GPs undertaking HPE although there is loss of consultation What was done: A survey of 1600 GPs in the Oxford Region time. Reimbursements paid through practices to replace Deanery (PGMDE) has been undertaken to establish service commitment do not guarantee replacement and perspectives on the usefulness of Masters Degrees, either simply add complexity to the payment system. completed or contemplated. Conclusions: The HPE scheme should be amended so that Messages so far: Ethics approval for research into education reimbursements go directly to the HPE participant. is harrowing and time consuming. Questionnaires are being 1 analysed. Conclusions will be ready by conference. L F P Smith et al (2000) Higher Professional education for GMPs; postal questionnaire survey. BJGP 50, 453, 288- 193

Posters 9 Ruby 2 Teaching and learning communications skills

9 Ruby 2.1 Conclusion: The views of all the faculty members about The viewpoints of clinical faculty members teaching communication skills regardless of their sex, age, about teaching communication skills to specialty field and teaching experience was positive. Thus, teaching these skills to students as one of the formal medical students subjects seems necessary. A Zamani*, B Shams, Z Farajzadegan, M Tabaeian and F Goli (Isfahan Medical University, #322 Fajr 3, Ostadan Ave., Hezar Jarib Street, PO Box 81746 73793, Isfahan, IRAN) 9 Ruby 2.2 Introduction: The clinical competencies of a physician are Method suggestion for communication skills usually judged based on his/her communication skills. training: Psychodrama Teaching communication skills is one of the important O Sürel Karabilgin*, Aliye Ercan and Perihan Etiz (Ege subjects in medical education, although it is not included University, Medical Faculty, Boronova, TURKEY) in the medical education curriculum in Iran. This study was performed to determine the faculty members’ Rationale: Developing physician-patient communication viewpoints with regard to teaching communication skills skills is one of the most important issues in medical to medical students. education. There are different methods for developing communication skills. Psychodrama is one of these. Methods: In this descriptive-analytic study 142 faculty Psychodrama employs guided dramatic action to examine members from 17 departments in the Medical School of problems or issues raised by an individual or a group. For Isfahan were selected by simple random sampling method. 2004-2005, at Ege University Faculty of Medicine, we The data collection tool was a questionnaire consisting of planned Special Study Modules. One of them related to three parts: demographic, attitude and open questions. psychodrama. The validity of the questionnaire was confirmed by experts and its reliability by split-half method. What was done? 17 second year students participated in eight sessions, total 32 hours. Working subjects; family Results: 85% of faculty members had a very positive relationships, self-presentation, team working, dealing with attitude toward teaching communication skills to medical negative emotions, non-verbal communication skills, students. There was no difference in the attitude according empathy, problem solving skills. The warm-up, the action to the sex of the faculty members. The younger faculties, and the sharing were used as methods. Students were aged between 30 and 40 years with 5 to 10 years of asked three open ended question about this application. teaching experience, had a better attitude compared to Replies were grouped. other groups. The specialty field had no role in their attitude toward the subject. Results and conclusions: The participants reported the following items as the benefits from this group work;

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building empathy (15), increase in self recognition (13), chart and asked to complete request forms for a hospital increase in problem solving skills (7), being more creative consultation, radiology and pathology and then produce a (4), increase in self-esteem (4), developing observation cogent concise discharge summary. Pre-and post skills (3), awareness about family relations (3), better self- evaluations have strongly supported this new, more presentation (2), pleasure about being a member of group realistic, method of teaching communication. (9), professional satisfaction (12). They suggested that this application should have more time and all of the student should have to participate. 9 Ruby 2.5 Use of standardized patients for improving Take-home messages: Psychodrama can be an effective method for communication skills training. the informed consent process for clinical trials Maurice Clifton*, Joanne Russell and David Barnard 9 Ruby 2.3 (University of Pittsburgh, School of Medicine, 3500 Terrace Psychosomatic medicine: how to teach Street, M-218 Scaife Hall, Pittsburgh PA 15261, USA) communication skills Aims: To develop an educational strategy designed to C Nikendei*, S Zipfel, C S Wilke, B Wild, W Herzog and J increase knowledge and skills of those who obtain informed Juenger (University of Heidelberg, Department of General consent for clinical trials. Internal & Psychosomatic Medicine, Medical Hospital, Internal Medicine II, Im Neuenheimer Feld 410, Heidelberg 69120, Summary of work: A set of thirty-two skills based on ethical GERMANY) concepts, communication strategies, and adult learning principles were defined and incorporated into a one-day Background: In psychosomatic medicine communication workshop. Instructional methods included lecture, video skills are indispensable working tools. We investigated how illustrating desired communication skills, and a session different kinds of communication training in the field of wherein participants used their own protocols to obtain psychosomatic medicine were assessed by medical informed consent from standardized patients (SPs) who students. portrayed four “difficult” subject types: distrustful, Methods: 65 medical students participating in the 12 week adolescent attitude, mild dementia, and overly eager. communication training were asked to rate different lessons Debriefing and feedback followed. Knowledge was of communication training involving (1) role playing (2) assessed with pre/post video questionnaires. Program interviewing standardized patients, (3) real patients visiting effectiveness was evaluated at the session and at three the course and (4) interviewing inpatients directly on ward. months, using a scale of one (lowest) to five (highest). Different lessons were rated with marks from 1 to 6 Summary of results: Fifteen experienced investigators and according to the German school grading system. coordinators participated in the workshop. Participants Results: The module in which real patients were reported that the course met their expectations (mean interviewed in the course itself (M=1.4; SD=0.51) was 4.4) and made a positive difference when communicating rated significantly better than the module in which with potential subjects (mean 4.5). inpatients were interviewed on ward (M=1.78; SD=0.57; The SPs were identified as the most useful part of the p<.019) as well as the module in which the interview program by 71% of participants at the session and 86% training took place with standardized patients (M=1.86; at three months. SD=0.68; p<.018). Role playing was rated moderately (M=3.01; SD=1.00; p<.001 compared to work with Conclusions: This innovative curriculum was well received standardized patients). and effective for teaching communication skills that facilitate the informed consent process. Conclusion: Interviewing real patients visiting the course was regarded as the best kind of communication training, followed by work with standardized patients and 9 Ruby 2.6 interviewing inpatients on ward, both rated equally. Role- A final year special study module in playing as a learning aid for the purpose of communicating veterinary communication skills with patients was regarded by students as less effective. Carol A Gray*, Rachel E Eves, Stephanie J Walsh and Camilla J Wilson (University of Liverpool, Veterinary Teaching 9 Ruby 2.4 Hospital, Leahurst, Chester High Road, Neston, South Wirral Teaching communication of patient CH64 7TE, UK) priorities to interns – OR – ‘yes, but do I Results from the first offering of a special study or elective need to come and see her?’ module in veterinary communication skills indicate that this is a useful addition to the veterinary curriculum. The Alistair Vickery* and Richard Tarala (Royal Perth Hospital, module is research-based, involving the use of videotaped Department of Postgraduate Medical Education, Level 4 MRF consultations and client/veterinarian questionnaires. Building, GPO Box X2213, Perth, Western Australia 6847, AUSTRALIA) Students devised their own projects. Topics selected for study included: measurement of the time to interruption Interviews with the supervising doctors (registrars and following an opening question; the closeness of match consultants) and focus group interviews with interns between the client’s main concern and the veterinarian’s suggested 2 major areas of difficulty for interns beginning interpretation of their main concern, and between the at this 800 bed teaching hospital. In the first hospital term, veterinarian’s and the client’s perceptions of the most interns had difficulty in communicating important priorities important piece of advice given; the client’s perception of in patient care with colleagues, and in writing meaningful the length of time that the veterinarian spent on physical discharge summaries conveying a sense of the discharge examination of the animal; analysis of non-verbal management plan. The communication between an intern behaviours in veterinary students conducting first-opinion and registrar of the priorities of a sick patient is a skill that consultations; the use of jargon by veterinary students in is not taught in medical schools. Complex cases are referral and first-opinion consultations, and types of carefully prepared and presented to the learned consultant question used when gathering information. Students ran in the setting of a teaching environment. By contrast, a seminars for the subjects of the research projects, leading harried intern is expected to quickly convey a sense of discussions on skills shown by each of the participants. priority for a busy, tired registrar. At orientation we Assessment was via oral presentations to staff and introduced a ‘typical’ patient chart to each intern. Interns students, and the submission of written reports. Feedback were expected to quickly read the admission chart and was universally positive. This elective module will continue then present a summary to a registrar as they would over to be offered each year. the phone. The interns were then given the hospital-stay

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9 Ruby 2.7 teachers from a course of Clinical Methodology was Does the speciality influence the resident’s constituted, and coordinated by the Authors. Based on communication skills? knowledge of adult and professional learning we put the staff members at the centre of a cyclic process. Throughout A Nogueras*, G Lucchetti, S Herranz, A Casanovas, J Real, G this we explicitly valued and drew on their personal practical Giménez and E Berlanga (I. Universitari Parc Tauli (UAB), experience as clinicians while at the same time critically Hospital de Sabadell, Sabadell, Barcelona 08208, SPAIN) examining their assumptions in order to generate ideas Improving doctors’ communication skills is a priority. for curriculum development, and appropriate application Students at the University Schools of Medicine in Spain of educational principles. The outcome was a first set of were not offered specific training in communication and by-products (doctor-patient videos for group discussion, we don’t know to whom it should be offered at the post evaluation grids) and a preliminary model of grade. communications skills, derived from other models available in the international literature. Subsequent analysis built Summary of work: Setting: Sabadell (Spain) Hospital with further group awareness concerning teaching and 18 medical post grade programme specialities, near assessing clinical communication. This facilitated the Barcelona. Subjects: 99 junior residents during 4 years. production of a second video set of simulated clinical None of them was previously exposed to the video or to encounters and the construction of assessment criteria any communication training course. which formed the basis for the teaching module. Material: A validated videotape (GATHA-res score 4/13) of a simulated encounter of a doctor in the emergency service, dealing with a complaint from a patient’s relative. 9 Ruby 2.9 There are many communication arguments on the video Communication skill modules in the to be improved. curriculum of the University of Szeged Procedure: Viewers scoring the doctor’s communication Katalin Barabas, Peter Nagyvari and Lajos Mester (University skills on a scale from 0 to 10. Statistical analysis: Anova, of Szeged, General Medical Faculty, Department of Psychiatry, Bonferroni. Section of Behavioural Sciences, Szentharomsag u 5, Szeged H-6722, HUNGARY) Results: grouped specialities (mean, SD): Core 4,97 (1,40), Medical 5,12 (1,69), Surgical 5,86 (1,51) and Central Background: The teaching of communication skills has only Service Specialities 6,63 (1,02). P=,004. recently been implemented into the graduate and postgraduate curriculum of the university. The newly Conclusions: (1) There are differences in communication elaborated training system has given us the possibility of skills between specialities. (2) Even the most competent harmonizing graduate and postgraduate skill development. must improve their competence. (3) A post grade specific training in communication skills should be offered to all Summary of work: Communication skills are developed in junior residents in their different specialities. a module system. We use various teaching strategies: in the 1st year observation of medical interviews, in the 2nd and 3rd years role plays and reactions to critical incidents, 9 Ruby 2.8 in the 4th year communication during simulated doctor- Combining curriculum and staff patient consultation analysed by video recording and during development in the design of a teaching residency practising special situations at simulated doctor- module on communication skills patient consultations. Students’ performance is evaluated by the help of a checklist, which is filled in both by the Fabrizio Consorti*, Stefania Basili, Huon Snelgrove* and Italo trainer and the patient separately. The quality assurance Nofroni* (University of Rome ‘La Sapienza’, Dipartimento di of the training is promoted by the feedback of the students. Medicina Sperimentale, V. le Regina Elena, 324, Rome 00161, ITALY) Data are processed by SPSS. Curriculum development and staff development are two Summary of results: The results of 500 students have facets of the same process, especially when dealing with proven that communication skills could and should be sensitive subjects such as teaching/learning improved with success. Doctor/patient-centred communication skills. A process of change must be consultations are adequately applied in the residency negotiated, entered into and supported if success in training, and residents make good use of the available personal and organisational learning is to be achieved. time, and their verbal and non-verbal communication has We adopted a participatory action research methodology become more sufficient. to research the changing conceptions of learning and Conclusion: Although communication training has no teaching among our staff members, and to design and traditions at the Hungarian universities, the newly develop a new teaching module on communication skills introduced training modules have gained more and more for medical undergraduates. Action research is a cyclical ground in the medical curriculum, which used to focus or spiral iterative process involving planning, acting only on conveying knowledge. observing and reflecting. A multidisciplinary team of 14

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Symposium 10AUD Selection for medicine

10AUD Selection for medicine selection using an application form, referees’ reports and an assessment centre will be presented. The Janet Grant1, Richard Hays2, Ben van Heerden3, Fiona symposium will address the difficult questions: (1) Is Patterson4 and Alan Cliff5 (1Open University Centre for Education in Medicine, Walton Hall, Milton Keynes, MK7 the continuing struggle to find new criteria for selection 6AA, UK; 2James Cook University, Australia; 3University justified in terms of outcomes? (2) Given that academic of Stellenbosch, South Africa; 4City University, London, UK; attainment and motivation to study medicine are the 5University of Cape Town, South Africa) most powerful predictors of success, should we use This symposium will raise a spectrum of controversial other criteria at all? (3) Where secondary education is and innovative issues in selection. Complementary and inadequate for some social groups, should medical contradictory findings and views will be presented for schools themselves take action to make up for this analysis and discussion. The relationship between deficiency? (4) What is the relative effect on outcomes selection policy and the social context of medical schools in areas other than academic attainment of selection will be a central theme: selection policies seem to have and of the medical education that follows? (5) Given little impact on student cohorts in schools in developed that medical schools should produce a range of countries possibly because academic criteria are always graduates able to practise in all areas of clinical central to selection. Lessons from two approaches to medicine, public health and laboratory medicine, should developing entrance tests with predictive and added we skew the range of entrants by using selection on value will be discussed. At postgraduate level, lessons grounds such as personality? from a competency based triangulated approach to

Short Communications 10A Use of simulators

10A 1 Virtual reality – the faceless surgical Summary of Work: Anaesthetic emergencies are trainer uncommon but can have potentially serious adverse outcomes if not managed effectively. Since 1999 all M A Memon*, D Brigden, B Memon and M I Memon (Whiston trainees new to Anaesthesia in Scotland have attended Hospital, Mersey Deanery, University of Bolton/Chester, a simulator based course designed to help them prepare Preston PCT, 11 Key View, Darwen BB3 2JG, UK) for the recognition and management of such Aim: To evaluate the benefits of virtual reality (VR) in emergencies. The course is held on 10 days per year the training process of surgeons, and its future with a maximum of 6 participants per course. Analysis implications on medical education. of the performance of the trainees when managing these Summary of Work: A comprehensive search of the simulated emergencies has provided an opportunity to English-language literature from January 1990 to review the effectiveness of teaching in this area. December 2004 was performed to identify literature in What was done: In response to some consistently poor the field of VR and surgical training using Medline, areas of practice a new educational intervention was Embase, Science Citation index, Current Contents and devised by an expert group and distributed to trainees PubMed databases. and teachers. Review of video-recordings of the most Summary of Results: A number of studies have looked recent and current cohorts is currently underway to at the role of VR surgical simulators in acquiring, identify the present state of the strengths and enhancing, measuring and validating various aspects of weaknesses of the teaching programme in response to surgical skills. These studies have focused on: (a) the new educational intervention. differentiating novices versus experienced laparoscopic Summary of Results: Results will be available for August surgeons; (b) impact of the VR trainers in teaching and 2005. enhancing psychomotor skills; (c) transfer of skills from Take Home messages: Simulation can provide feedback the VR trainer to operating room; (d) aptitude of trainees at the level of individual trainees but can also provide in learning laparoscopic skills; (e) monitoring surgical feedback on the effectiveness of the educational competence; and (f) recertification and skills upgrading. programme. Conclusions: VR as a training tool has many potential applications which include (a) teaching new surgical skills; (b) reduction in alternative training costs such as 10A 3 Learning on incrementally complex tasks cadavers, animal labs; (c) transferring those skills onto leads to the same performance as skills a real patient; (d) measuring and monitoring objectively specific learning for laparoscopic suturing the technical competence of the trainee; and (e) excellent tool for revalidation of surgical competence. Adam Dubrowski*, Jason Park, Carol-Anne Moulton, James Larmer and Helen MacRae (University of Toronto, Department of Surgery, 200 Elizabeth Street, Eaton South 10A 2 Simulation as an educational quality IE 583, Toronto, CANADA) assurance tool Introduction: Laparoscopic skills can be taught in full complexity under 2D conditions, or alternately, in Ronnie Glavin and Jonathan Salisbury* (Scottish Clinical increasingly more difficult steps under 3D conditions prior Simulation Centre, Stirling Royal Infirmary, Stirling FK8 2AU, UK) to performing the entire skill in 2D. This study compared which of these two approaches optimized the learning Aim of Presentation: To demonstrate the use of simulation of laparoscopic knot tying skills. as a quality assurance tool.

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Methods: Junior residents (N=24) were randomized to Summary of work: 202 laypersons were asked to perform (1) suturing in full complexity under 2D conditions or (2) 5 minutes of single-rescuer-CPR in cardiac arrest simple cone transfer drills under 3D and then 2D scenario. In a crossover design the groups were tested conditions followed by suturing under 3D and then 2D on two time points. Primary endpoints: rate of ECC: 90- conditions. Pre and post and delayed (1 week) 110/min; compression depth: 40-50 mm. Secondary laparoscopic suturing performances were assessed using endpoints: rate of incorrect decompression; incorrect objective motion efficiency and timing variables, and final hand positioning. product analyses by blinded evaluators. Summary of results: Comparing the endpoints on day 1 Results: Participants in both groups showed dramatic the ECC with CPREzy was significant improved (rate improvements on all measures that were well retained correct: n=104 vs. n=18, p ≤ 0,01; depth: n=79 over the one week period (p< .01), with no differences vs. n=31, p d” 0,01). The group tested with CPREzy between the two learning approaches. initially on the 2nd day, improved significantly in the compression rate (n=7 to n=32, p d” 0,01) and Conclusions: Despite spending less actual time practicing compression depth (n=15 to n=27, p d” 0,02). The suturing, the step-wise learning group performed as well control-group without CPREzy (n=55) demonstrated bad as the group who practiced the entire task in full performance in both evaluations constantly (rate correct: complexity. This has potential implications for minimizing n=11/n=14, depth: n=16/24). teaching resources and training costs. Whether this step- wise approach provides more general manipulative skills Conclusions: The usage of CPREzy by laypersons shows that can improve performance on a wider range of an improved performance of ECC in simulated cardiac laparoscopic tasks needs further investigation. arrest. Supported by Physician’s Services Incorporated Fund. 10A 6 Integrating the Bovine Rectal Palpation 10A 4 A three dimensional computer model and Simulator into a veterinary curriculum. tracking system to aid training of injection Part 2 – customised sessions and student procedures in anatomical preparations feedback Jostein Halgunset*, Jørn Ove Saeternes, Håkon Olav Leira, S Baillie*, D J Mellor, S Brewster and S W J Reid (University Geir Arne Tangen, Jon Harald Kaspersen and Toril A of Glasgow, Department of Computing Science, 17 Lilybank Nagelhus Hernes (NTNU, Department of Laboratory Gardens, Glasgow G12 8QQ, UK) Medicine, Children’s and Women’s Health, St Olav’s Hospital, Background: The Bovine Rectal Palpation Simulator, a Trondheim, N-7006, NORWAY) virtual reality based teaching tool, has been developed There is a need to increase and improve student skills in for training veterinary students and was introduced into intraarticular and similar injection procedures. Anatomical the curriculum at the University of Glasgow Veterinary preparations lend themselves to training, but it is difficult School during 2003/2004. to assess and correct the students’ performance, since Summary of work: Students were offered two training the tip of the needle can not easily be seen while the sessions. The first session covered basic skills and procedure is being performed. To overcome this hurdle students completed a questionnaire afterwards1. Further we have developed a computer assisted training system. feedback was gathered after subsequent examinations A three dimensional computer model is made from serial of cows and during a focus group. This information was CT slices of the anatomical preparation, which has been used to design a second session, customised to individual studded with positional markers. The syringe to be used student’s needs. Scenarios were included: students for injection training is also provided with markers which examined virtual cows, representing typical fertility cases, can be continuously followed by a double camera tracking and discussed treatment options with the teacher, who system. During the training session, the student can acted as the farmer. Students then completed another observe the needle on a computer screen, which shows questionnaire. in real time its exact position related to a simultaneously displayed semi-transparent, three dimensional model of Summary of results: The feedback after both sessions the preparation. In order to provide optimal control of indicated that the simulator was a useful supplement to the advancement of the instrument, the screen view can existing teaching methods. The training increased be freely rotated in all directions, or the user may choose confidence to perform procedures, equipped students a stereoscopic view mode. Several models have been with skills to search for and identify structures, and the prepared from different body parts. When subjected to scenarios were rated as a particularly beneficial way of students’ evaluations, the system reaches very high learning. scores in terms of educational value. Conclusions: Teaching with the simulator was successfully integrated into the curriculum and, importantly, student 10A 5 CPREzy ™: A new device to improve quality feedback provided useful information for improving the teaching protocol. The simulator provides a safe and of cardiac massage? flexible environment where students develop and S Beckers*, M Skorning, S Beuerlein, M Derwall, M Fires, J integrate skills.

Bickenbach, R Kuhlen and R Rossaint (University Hospital 1 Aachen, Department of Anaesthesiology, Pauwelsstrasse 30, Baillie S, Mellor, DJ, Brewster, S and Reid SWJ. Aachen D-52064, GERMANY) Integrating the Bovine Rectal Palpation Simulator into a veterinary curriculum. Student feedback: Part 1 - Aim of presentation: External cardiac compressions (ECC) immediately after the initial training session. In: are an essential part of cardiopulmonary resuscitation Proceedings of Association for Medical Education in (CPR) either by laypersons or professionals and are Europe; 2004 Sept 5-8; Edinburgh, United Kingdom. performed without any adjuncts usually. Different devices in the past were developed, but none was implemented as standard in patient care. The CPREzy is a simple device to help the user to perform ECC.

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Short Communications 10B Problem based learning: results from different approaches to evaluation

10B 1 Differences between students from a Take-home messages: Preliminary data suggested that traditional and a PBL curriculum regarding the introduction of a PBL-based curriculum decreased formal and self assessment of clinical withdrawal rates after year 3 of an undergraduate medical program. This finding deserves further exploration. competence Janke Cohen-Schotanus*, Jelle Geertsma, Johanna Schoenrock-Adema and Willemina M Molenaar (University 10B 3 Perceptions of traditional and PBL Medical Centre Groningen, Research and Development curriculum students about the medical Medical Education, Faculty of Medicine, Ant.Deusinglaan school learning environment 1, Groningen 9713 AV, NETHERLANDS) Meral Demiroren, Ferda Ozyurda, Sabri Kemahli, Ozden Aim of presentation: In September 1993 the medical Palaoglu, Olcay Tiryaki-Aydintug*, Tumer Corapcioglu and faculty in Groningen replaced the traditional pre-clinical I.Hakki Ayhan (Ankara University, Faculty of Medicine, curriculum by a PBL curriculum. The final two clinical Departments of Medical Education and Pediatrics, Karanfil years were the same for both curricula. This study Sokat 29/2, Kizilay, Ankara 06650, TURKEY) explores whether students from these curricula differ in The traditional curriculum of Ankara University Faculty formal assessment scores and self assessment scores of of Medicine has been changed to a problem-based hybrid clinical competence. curriculum starting from the academic year of 2002-2003. Summary of work: Included in our study were the last This survey has been carried out to evaluate if there is a cohort of the traditional curriculum and the first cohort difference of learning environment perceptions between of the PBL curriculum. The formal assessment scores students in traditional and PBL curricula. The medical from both curricula were obtained from faculty school learning environment scale has been given to 1823 administration for eight clinical disciplines. The graduates students and 1129 replies were received. It has been were interviewed and asked to assess themselves on found that PBL students perceive the learning different (clinical) competencies. environment more student-centred, fostering active Summary of results: No differences in formal assessment learning, structured to accomplish competency-based scores were found in any of the disciplines. In contrast, learning compared with the traditional curriculum PBL students assessed themselves significantly higher students. Learning objectives are also perceived more on communication skills, clinical problem solving and defined. These students see the teachers as more insight in social context of patients. Traditional students communicative, giving feedback, respectful to students assessed themselves significantly better on knowledge and competent. PBL students seem to build a better link of basic sciences. between their professions and what they learn, develop better problem solving skills. However there was no Conclusion/take-home message: The higher self difference between the two groups about rote learning. assessment scores of PBL students suggest that they It can be concluded that PBL students perceive the did start their medical career with more confidence. medical school environment as more student-centred, competency-based, and having more communication with teachers. These results show that the new curriculum 10B 2 Impact of a PBL-based curriculum on has achieved its goals. student progression and withdrawal rates between year 3 and the final examination, in an undergraduate medical program 10B 4 Medical students’ perception of a traditional and PBL course: does PBL fulfil J N Hudson* and A L Tonkin (University of Adelaide, The Queen Elizabeth Hospital, Clinical Education Office, the GMC objectives? Woodville, South Australia 5011, AUSTRALIA) M Field*, J Burke, R D Matthew and D Lloyd (Glasgow Background/rationale: As medical education is a costly University, Medical School, University Avenue, Glasgow G12 8QQ, UK) business for all stakeholders, student progression and withdrawal rates are outcomes worthy of consideration Aim: To present perceptions of final year medical students when comparing integrated PBL curricula to more following training in conventional and PBL courses. traditional approaches. Summary: Glasgow University Medical School recently What was done: After replacing a more traditional changed to a PBL course to comply with GMC undergraduate medical curriculum with a new fully recommendations. This study investigated student integrated PBL course, we compared progression and opinions of their learning using questionnaires based on withdrawal rates between the year 3 and final Perry and Entwhistle and compared views of students examinations, for the last and first student cohort of the from PBL based and conventional courses. Results were old and new six-year courses respectively. The curriculum analysed using Chi-Square test and effect size (ES). format had little effect on the proportion of students who Results: Conventional course students perceive their progressed to the final examination without deferrals or learning preferentially encourages rote learning and repeated years after passing in year 3 (78.5% from 2001 memorisation of detail (p<0.00001, ES 2.7 and 1.6 and 78.3% from 2002; NSD). Students of the new respectively). By comparison, PBL trained students curriculum were four times less likely to withdraw from suggest that this learning method promotes problem the course than from the old one (withdrawal rates 1.7% solving and thinking independently (p<0.00001, ES 1.4 vs 7.8%; p<0.05). and 1.6). PBL encourages gathering and analysing Conclusions: The introduction of a PBL curriculum had information (p<0.00001, ES 1.6) and integrating different little impact on overall progression rates but reduced subjects or topics in order to solve problems (p<0.00001, the withdrawal rate in the first cohort. Further data are ES 1.4). Therefore students consider that PBL promotes needed to determine the reproducibility of this finding, development of learning along the lines recommended and to explore how new curricula may impact on student by the GMC and uses a constructivist approach which withdrawal rates. should encourage lifelong learning.

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Conclusions: Students graduating from this PBL course tutors’ responsibilities; (2) a trend away from considering perceive that their learning is more in line with the GMC general practice as a career. recommendations than those from our conventional Conclusion/take-home: Learning approaches showed course. some positive developments, but the trend, despite ‘community-orientation’, away from general practice 10B 5 Changing outlooks: Patterns and trends in careers was less intuitive. medical students’ learning approaches, career intentions, and expectations of 10B 6 The subject based evaluation for PBL and tutors in a problem-based curriculum integrated curriculum in medical school G Maudsley (University of Liverpool, Department of Public D Agustian*, S P Dewi, M Ghozali and D Setiabudi (Medical Health, Whelan Building, Quadrangle, Liverpool L69 3GB, Education Research and Development Unit (MERDU), UK) Medical School, Universitas Padjadjaran, JL. Sadang Tengah More longitudinal data would complement expanding III, No 17, Bandung 40134, INDONESIA) evidence about how problem-based learning (PBL) affects The curriculum reform trend to adopt problem based medical students’ learning outlook. learning, integrated and competency based approach has Aim: To explore medical students’ learning approaches been widely accepted with a doubt that the graduates and expectations over time in a problem-based will have inadequate mastery of the subject content curriculum, related to other changes in outlook because they would rather only learn about how to learn and gain generic competency which is not based on What was done: Medical students in Liverpool problem- fundamental content knowledge of sciences. The Medical based curriculum completed questionnaires: Year 1 start/ School Universitas Padjadjaran had developed an end (2001 entry), mid-Year 3 (1999 entry), including: evaluation system that enables the curriculum board to Entwistle learning approaches (18 items: ‘Approaches assess the mastery of subject or discipline content for to Studying’ short version); good tutor’ (38 items); career every student taught with PBL and integrated curriculum. intention (closed item): at same points plus Year 1 start/ The data of the assessment item which is classified as end (1999 entry. Building on earlier work, longitudinal knowledge based is entered into a database and the analyses linked individual data to show temporal changes subject or discipline based score is produced for each in preferences and intentions, with open answers about student. The results produce feedback for the weakness experiencing PBL (plus a closed item on satisfaction) of student achievement in the mastery of some subjects providing further insights. or disciplines. The system also shows the contribution of Results: Main questionnaire responses: 201/283 each department in developing the new curriculum based (71.0%), 198/279 (71.0%) for 2001 cohort, Year 1; 159/ on the item developed and gives a picture of curriculum 204 (77.9%) for 1999 cohort, mid-Year 3. Findings changes direction. This evaluation system is very feasible included: (1) certain patterns and statistically significant for adoption by schools in the process of changing the differences in learning approaches and conceptions of curriculum for PBL and integrated approach to effectively control the changes and give feedback of weakness in the mastery of subject or discipline knowledge by the students.

Short Communications 10C Staff/faculty development 3

10C 1 How well do medical teachers run peer and answers give helpful information on what is coaching sessions in real classes after implemented into teaching practice and how peer teachers’ training? coaching is run and valued by the participants. Maria Lammerding-Koeppel (Kompetenzzentrum Medizin- didaktik Baden-Wuerttemberg, Faculty of Medicine, Elfriede 10C 2 Development of a workplace-based Aulhorn Str 10, Tuebingen D-72076, GERMANY) certificate in medical education In order to ensure the transfer from training workshops E H Baker*, M Harris, A Kent, J Porter, A Hall, A Kirk, P into classroom practice, participants run peer observation Sedgwick, C Starkey and P McCrorie (St George’s Hospital and collaborative reflection in real classes. A structured and Medical School, Cardiac and Vascular Sciences format is to follow in a step-by-step process. The peer (Respiratory), Cranmer Terrace, London SW17 0RE, UK) coaching session is documented in a four-pages-form, Aims: Distance learning qualifications provide a including open questions, rating scales and free space theoretical background in medical education, but do not for comments. Standards are based on the contents of directly review teaching. We developed a certificate in the training workshops. In 2003, two examiners medical education based on practical contribution to evaluated and rated independently 248 forms, one of teaching. them was involved neither in workshop delivery nor in any contact with the participants. Criteria for evaluating Methods: The programme required teaching contribution the observed person form are e.g.: briefing the observer in 3 modules: Course Planning and Lecturing; Small on the learner group, objectives, teaching strategies as Group Teaching and Facilitation; and Assessment and well as reflection on feedback consequences. Criteria for Evaluation. Trained reviewers observed teaching, the observer form are e.g.: observation notes, comments supported reflection on teaching and assessed teaching on strengths and weaknesses as well as suggesting delivery. Scholarship was promoted through workshops development targets. and critical writing. Educational supervisors supported participants during the certificate. Results: Overall grading of (1) observed teacher forms: excellent 19 %; good 49 %; acceptable 32%. (2) Results: The certificate was validated in December 2003 observer forms: excellent 29 %; good 60 %; acceptable and has had 21 participants (6 graduated) to date. 14/ 11%. Data from 2004 are on the way. Detailed 21 participants were clinical teaching fellows (junior quantitative and qualitative evaluation of the comments doctors with teaching role) and 3 participants were non-

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clinicians. On evaluation (1=poor, 4=excellent) discussion and activities. They conclude that the participants (n=6) rated the certificate overall as 4.0+/ document deserves to be used more widely as a stimulus -0.0 (mean+/-SD), teaching review as 3.8+/-0.4, to both enhance the metacognition of trainees and educational supervision as 3.7+/-0.5. Participants expand the activities of supervisors in making the most commented that the certificate increased their interest effective use of educational opportunities of the in teaching and supported career progression. Foundation Programme. Conclusions: We developed a certificate in medical education based on practical teaching contribution and 10C 5 Supporting teacher development in clinical teaching observation which was highly rated by settings through observation and participants. This has been welcomed by intermediate grade clinicians and scientists as support for careers ‘professional conversation’: experiences incorporating teaching. with 1,000 hospital consultants in the Kent, Surrey and Sussex Deanery 10C 3 Distance tutors and academic Kath Green (The KSS Deanery, Postgraduate Medical & Dental Education, 7 Bermondsey Street, London SE1 2DD, departments: learner support needs in UK) remote environments Almost 1,000 consultants have now undertaken the Kent, Stephen Brigley* and Clare Kell (Cardiff University, School Surrey and Sussex Deanery’s Certificate in Teaching of Postgraduate Medical and Dental Education, Heath Park, programme. This consists of an introductory half-day Cardiff CF14 4XN, UK) seminar on ‘Principles and Values in Teaching’ followed A distance learning postgraduate certificate course in by a series of at least three observations of each medical education allocates a distance tutor (DT) to all candidate’s teaching within their normal everyday clinical registered learners. An investigation was conducted to context. Each of these observations is followed by an explore the perceived and actual DT roles from the extended ‘professional conversation’ between the viewpoints of the learners, the DTs themselves and the consultant and his/her Education Adviser. I lead a team central academic department (CADp) based in Cardiff. of 12 Education Advisers who work on this popular Scaled responses to self-generated bi-polar constructs programme and we meet regularly to discuss issues of ‘ideal’ and perceived ‘actual’ DT roles were elicited emerging from our work. In this brief presentation I will from all parties resulting in a qualitative triangulated focus on: (1) Creating the conditions for a ‘learning methodology. Some interesting differences emerged. community’; (2) The importance of articulating While both DTs and learners saw the ideal tutor role professional thinking in practice; (3) The crucial role of becoming essentially academic support over time, DTs feedback in learner development; and (4) Encouraging perceived a greater, early pastoral support role than the reflection on practice. In addition, the ability to learners. The tutor’s academic role, highly valued by the communicate thoughtfully and sensitively with patients CADp, was of lesser importance to learners who also and the intellectual curiosity so often shown by valued an approachable personality, administrative consultants in their role as clinicians seem to be important availability and advice on resources. The results (explored qualities in their development as educators. further in a DT consultation day) have informed a redefinition of the DT role, the issuing of new guidance on roles to all parties and more direct modes of 10C 6 The effect of educational intervention on communication and support from the central academic the learning of clinical faculty members at department to DTs. The investigation has emphasised Tehran University of Medical Sciences the necessity of communication and discussion between (TUMS) all parties involved in the provision and engagement of Sorayia Soheili* and Zinat Nadia Hatmi (Tehran University distance learning courses. of Medical Sciences, Ghaemmaghame Farahani Ave, Eight Street, No 7, Fourth Floor, 15868 Tehran, IRAN) 10C 4 Training the Trainers – using ‘Liberating Background: Knowledge of the teaching and learning Learning’ to help prepare trainers and process is increasingly recognized as an essential part trainees for the full implementation of of the educational knowledge of the faculty members in Modernising Medical Careers (MMC) our University. Summary of work: In line with this fact this quasi David Bridgen* and Andrew Sackville (Mersey Deanery, Postgraduate Medical & Dental Education, University of experimental study was designed to determine the effect Liverpool/NHSE, Hamilton House, 24 Pall Mall, Liverpool, of an educational intervention on the clinical faculty L3 6AL, UK) members of the medical school at TUMS. 15 clinical faculty members through convenient sampling were Mersey Deanery was one of the pioneers in developing selected to attend a two full day workshop on teaching training courses for educational supervisors and other learning processes. Participants were given a pre and staff engaged in clinical education. It used a number of post-test on the subject content, then the results of the one day events, before developing longer programmes two tests were analyzed by the SPSS 11.5. which include a 10 month Postgraduate Certificate in Teaching and Learning for Clinical Practice and an MA in Summary of results: The minimum grade on the pre test Clinical Education. was 5 and the maximum was 14 with a mean of 9.86 and sd of 2.03. For the post test the minimum was 11 The advent of MMC has led to a review of training for and the maximum 19, with a mean of 15.84 and sd of educational supervisors. Whilst there is still a clear role 1.95. The paired differences for pre and post-test was – for extended programmes aimed at clinical educators, 5.83 with a sd of 3.43. This finding was significant with there is also a need to induct and support the larger P=0.001. numbers of professionals who are involved in Foundation training as educational supervisors. The publication in Conclusions/take home messages: It is concluded that the autumn of 2002 of the COPMED document ‘Liberating the educational intervention positively affected the Learning’ provided a catalyst for developing workshops participants’ knowledge. In service training is not to be for supervisors and trainees of Foundation training. The neglected. authors describe and evaluate the sessions they have been running using the document as a framework for

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Workshop 10D Best evidence simulation-based training using Harvey, the Cardiopulmonary Patient Simulator

10D Best evidence simulation-based training including blood pressure, breathing, venous, arterial and using Harvey, the Cardiopulmonary Patient precordial impulses and auscultation. The presentation Simulator will also incorporate evidence-based strategies that lead to most effective learning. These will be based on the S Barry Issenberg and Ross J Scalese (University of Miami faculty’s recent BEME systematic review of high-fidelity Miller School of Medicine, Center for Research in Medical simulation. The workshop facilitators are internists and Education, 1430 NW 11th Avenue, PO Box 01690 (D-41), medical educators with many years of experience in Miami FL 33101, USA) applying best evidence approaches to using simulation Background to the topic: Studies show that the technology to teach and assess skills. cardiovascular bedside examination is accurate and cost- Intended outcomes: At the end of this workshop, effective, and that these skills are lacking in those we participants will be able to: (1) recognize essential train. “Harvey” simulates 30 cardiac conditions and is cardiovascular and pulmonary bedside findings, and (2) the only proven self-learning system to master cardiac implement evidence-based learning strategies that bedside skills that are transferable to live patients. A maximize the effect of simulation-based training. recent Best Evidence Medical Education (BEME) systematic review identified the ten key features that Intended audience: Clinical skills facilitators; Harvey lead to effective use of simulation for training. users; clinicians; educators interested in finding out more about Harvey; educators interested in using simulators Workshop content and structure: This workshop will use in multidisciplinary learning; clinicians and educators “Harvey,” the Cardiopulmonary Patient Simulator. The interested in clinical skills training; educators interested workshop will provide a practical, hands-on, interactive in best-evidence approaches for simulation. experience for each participant. This presentation will be carried out in an interactive, patient-centered format. Level of workshop: All levels of participants will find this Following a focused history, bedside findings will be workshop useful. shared through video projection and stethophones,

Short Communications 10E Clinical teaching and learning

10E 1 Can teaching the typical be problematic? 10E 2 Early memorisation in 5th and 6th year Kelly L Dore* and Kevin W Eva (McMaster University, medical students: the role of structuring MDCL, Huravinski ERDC, Room 3510, 1200 Main Street the data offered West, Hamilton, Ontario L8N 3Z5, CANADA) A E R Arnold*, A B Bijnen, M Stikkel, J A A M van Diemen- Aim of presentation: A fundamental aspect of medical Steenvoorde and H J M van Rossum (Free University Medical training is gaining understanding of the relationship Centre, Institute of Medical Education, Dennenlaantje 3, between features and diagnoses. In attempting to convey Schoorl 1871 CE, NETHERLANDS) this information to students, there is a temptation to Background: For clinical reasoning sometimes large present typical cases, paying little attention to variability numbers of differential diagnoses are needed. Chest pain between cases. We attempted to assess whether learning is an example with 30 causes. We postulated that offering the diagnosticity of cardinal features can impede learning the data structured in a 3x3 format (e.g. ‘heart, lung, the diagnosticity of less common features. other’) with three sub-trees for each branch (e.g. for Summary of work: Students were taught to diagnose ‘heart’: ‘coronary insufficiency, pericarditis, mitral valve via case presentation. Four features were assigned to prolapse’), could enhance early memorisation. each diagnosis. In the high condition, three features Methods: 5th and 6th year medical students received a (80%, 60%, and 20% diagnostic) were presented. sheet with 30 causes of chest pain. At random, half of Participants in the low condition had the 80% diagnostic the students were given a structured list and half a simple feature replaced with a 40% diagnostic feature. listing in one row. Students were asked to read the listing Summary of results: Test cases included the 60% and carefully for 10 minutes. Thereafter, each student was 20% diagnostic features of two disorders (one from each asked to reproduce the listing in 5 minutes by heart. condition), making them objectively equiprobable. The number of reproduced items was compared in the 2 Blocking is indicated by biased decision-making toward groups. the diagnosis learned in the low condition. We also asked Results: Ninety eight students were randomised to either participants to estimate the strength of the relationship the structured approach or a strategy of a simple listing between features and diagnoses. of items. There was a tendency in the group with a simple Conclusions: The results have implications for case-based listing to reproduce more items (18.7 versus 16.7 out of curricula. Many have been implemented in a way that 30 items, P=0.02). leads students to focus on one problem per tutorial, Conclusion: Structuring the data by the teacher does potentially creating knowledge that is excessively context- not always add to the building of knowledge bases in bound. individual students and might even be counterproductive.

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10E 3 Effect of ‘level of expertise’ on laboratory 10E 5 Changes in critical thinking among nursing test-ordering behavior: implications for students upon completion of Baccalaureate medical education Nursing Program Steven L Kanter* and Laura Torbeck (University of Acharaporn Sripusanapan* and Natthawan Suwan (Chiang Pittsburgh, School of Medicine, 100 Burry Road, Mai University, Faculty of Nursing, 100 Intavaroros Road, Bradfordwoods PA 15015, USA) Muang District, Chiang Mai 50200, THAILAND) Aim: To explore the effect of “level of expertise” on Nursing profession requires critical thinking in their laboratory test-ordering behavior during a patient case practice. Critical thinking can be developed during the simulation and to consider implications for educating learning process through a nursing program. This students. descriptive comparative study aimed to examine changes of critical thinking skills in nursing students after their Summary of work: Computer-based patient simulations completion of baccalaureate nursing program. The play an important role in evaluating professional research was conducted with 120 senior nursing competence of medical students. Selection of appropriate students, academic year 2003, using the Personal laboratory tests is key to making a correct diagnosis. We Information Questionnaire, and the California Critical analyzed laboratory test selection of 79 subjects (7 Thinking Skills Test (CCTST). The findings showed that pediatric faculty, 9 pediatric residents, 33 medical 95.8% of students had never been trained to develop students, 30 pre-baccalaureate students) who completed critical thinking. Overall score of critical thinking skills a text-based simulated case of pediatric bacterial during their senior year was statistically higher than those meningitis. in their freshman year (t = 3.95, p < = .001). For the Summary of results: A set of 87 laboratory tests were scores of critical thinking subscales, those of evaluation available in nested menus. Pre-baccalaureate students and inference were increased upon the completion of collectively chose from a subset of 80 tests, medical the program. The findings suggested that critical thinking students from 28 tests, residents from 17 tests, and skills of nursing students were enhanced during the study. faculty from 11 tests. As expertise increased, the subset As such, the nursing curriculum should provide a variety from which laboratory tests were selected became of teaching methods to foster the development of critical smaller. thinking especially analysis skill. Conclusions: Increasing expertise is associated with a higher level of selectivity of laboratory test-ordering. This 10E 6 Fourth year medical students’ practice of suggests that improved ability to delimit a problem space (i.e., decrease the number of choices by eliminating evidence-based medicine incorrect options) is a characteristic of increased levels Simona F Deutsch*, Steven R Simon, Robert H Fletcher and of expertise. Educational strategies should be designed Antoinette S Peters (Harvard Medical School, Office of to help students learn how to delimit a problem space Educational Development, 384 TMEC, 260 Longwood effectively. Avenue, Boston MA 02115, USA) Aim: Describe how medical students use evidence-based medicine (EBM) during clinical education. 10E 4 A case-study: the role of biomedical and clinical knowledge in nursing clinical Summary of Work: Although students learn EBM skills decision making – differences between early in medical school, how they apply those skills in clinical practice is unclear. Through in-depth interviews, experts and novices 20 fourth-year medical students enrolled in clinical H Eshach*, T Fleishman, H Balik, Y Sharabi and C Margolis clerkships described the following: (a) their use of the (Ben Gurion University of the Negev, Department of Science medical literature; (b) their perception of the educational and Technology Education, The Institutes for Applied environment for using EBM. Interviews were recorded, Research, PO Box 653, Beer Sheva 84105, ISRAEL) transcribed and then coded to identify key themes. Clinical decision-making (CDM) is based upon clinical and Results: Students searched the literature either when biomedical knowledge (C&BK). To improve nurses’ CDM, assigned or when curious about an unusual disease. educators should understand the role of C&BK in CDM Uncritical readers, they relied upon expert vetting of processes. This exploratory research examined the level research: articles in prestigious journals, experts’ of C&BK of 5 experts and 5 novice nurses and its relation syntheses or research written or recommended by their to the quality of their CDM regarding a hypertension case. faculty. They expressed the belief that EBM is “not for Participants were presented the case during 2.5 hour everyone”, that physicians or students who did not interviews. Additional information was provided practice EBM instead attended more to the humanistic depending upon what the participant required for decision aspects of care. They reported that student-initiated making. Based upon the interviews, CDM algorithms were discussions of EBM were often viewed by peers as constructed for each participant, and C&BK levels were showing off and rebuffed by faculty. Some students measured. In addition, the compiled algorithms were believed that primary care faculty felt that student- compared with a standard algorithm to measure the initiated use of EBM challenged their authority. quality of CDM. Results indicate that: 1) The biomedical knowledge of both experts and novices was low. 2) Conclusion: Students’ use of EBM is determined more Clinical knowledge was greater than biomedical by social context than intellectual curiosity or patient knowledge. 3) No statistical significant differences were care. found between experts and novices concerning C&BK and the quality of CDM although differences were found between individuals. 4) Only among experts was the quality of CDM and clinical knowledge statistically correlated. Educators must work on the increase of C&BK in nurses and understanding the connections between clinical and biomedical knowledge. Taking into account individual differences between nurses might also improve CDM.

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Short Communications 10F The student in difficulty

10F 1 What is a ‘failing’ student? The reasons for disparity between graduation rates of minority and non-minority matriculants are poorly Stewart Petersen (Leicester Warwick Medical School, understood. In this study, we explored burnout, Department of Medical and Social Care Education, Faculty of Medicine, P O Box 138, Leicester LE1 9HN, UK) depression, and quality of life (QOL) among minority and non-minority medical students to determine if differences Assessment often aims to place students reliably on a in distress and well-being may explain this disparity. All unitary continuum of ‘ability’. Teachers often feel weak 1090 medical students in the state of Minnesota were students are qualitatively different. We analysed the surveyed with validated instruments measuring burnout performance of 450 students to test whether the pattern (Maslach Burnout Inventory), depression (Primary Care of performance of weak students is distinctive. Our final Evaluation of Mental Disorders), and QOL (SF-8). examination is by direct observation of student Descriptive statistics formed the basis for analysis. Among consultations with 8 real patients. Two examiners rate the 545 responding students (response rate 50%) 84 the student on five categories of competence. Written (15.4%) defined themselves as belonging to an ethnic examinations have 30 scenario-based questions with 10 minority. Minority students were more likely to originate elements in each. Pass-fail is based on the rate of errors from outside Minnesota (P<0.001) and have children (performance below that required of a new doctor), with (P=0.0122). Minority students had lower mental QOL no compensation. In the clinical examination the errors than non-minority students (41.7 vs. 44.3; p=0.0523). of strong students are randomly distributed, but weak The incidence of burnout (45%), a positive depression students concentrate errors by case. Sometimes they screen (56%), and mean physical QOL scores were equal perform very well others they perform very badly. They among minority and non-minority students. Minority are especially vulnerable to case specificity. We also students in this multi-center study had lower degrees of analysed the objectively scored written examination in mental QOL and differences in measures of social support the same way. Again errors are over concentrated on (distance from place of origin) and personal responsibility some scenarios; a pattern often obscured by (having children). Further studies are needed to explore compensatory mark schemes. The performance of weak the relationship between personal distress, social support, students is therefore worse because it is much more and non-professional responsibilities and attrition among erratic. This vulnerability to case specificity may come minority students. from erratic exploitation of learning opportunities due to chaotic attendance and work patterns. It may be that this characteristic is a more relevant predictor of future 10F 4 Referred doctors: referred students: the competence than estimating ‘ability’. methods and effects of remedial communication skills teaching at 10F 2 Problematic behaviour of medical students Birmingham Medical School outside the learning environment E L Jones* and J R Skelton (University of Birmingham, Interactive Skills Unit, Primary Care & General Practice, Benno Bonke (Erasmus University, Department of Medical Clinical Sciences Building, Edgbaston, Birmingham B15 2TT, Psychology & Psychotherapy, PO Box 1738, Rotterdam 3000 UK) DR, NETHERLANDS) Background/Rationale: There is widespread recognition Background/rationale: Occasionally – and perhaps more that effective communication is a central clinical skill. frequently than in previous years, faculties encounter Teaching these skills involves a tiny amount (for problematic behaviour of medical students outside the Birmingham undergraduates, 0.1 %) of dedicated learning environment. curriculum time, and substantially more, appropriately, What was done? Examples of more or less serious in the context of supervised patient contact. This misconduct of medical students were listed and classified curriculum pattern means there is relatively little according to situational variables and severity. dedicated time for individuals who have serious Suggestions were formulated as to when medical schools communication problems. Yet there is a small proportion might or might not need to take appropriate action in of students each year whose communication is so poor the form of sanctions. they would be unlikely to graduate, and communication Conclusions: It is advised that medical schools keep an is often cited as a principal cause of patient complaints against doctors. One way of dealing with this problem is open eye for problematic behaviour, both within and to offer targeted, remedial training. This study reports outside the learning environment, also because documented unprofessional behaviour during medical on the last two years of Birmingham’s efforts to do so. training is a predictor of professional misconduct as a Methods: Over two academic years staff from the physician. The possibility is raised that faculties demand communication skills team offered personal tuition to from medical students – before entering clerkships and/ thirty undergraduates (averaging eight hours) and fifty or before graduation – a certificate of good conduct to qualified doctors (four hours.) Role-play was a key method prevent those convicted of serious felonies or acts of and teaching was responsive to individual needs. indecency from graduating. Furthermore, the institution Conclusions: Apparently poor communication is of a national or local board that may independently associated with a wide variety of problems, including investigate – and give advice on – relevant cases, will be language skills, attitude and personality, which are discussed. discussed. Remedial training, targeted beyond the level of communication skills where necessary, can be 10F 3 A multicenter study comparing burnout, successful. depression and quality of life in minority and non-minority medical students in the US L N Dyrbye*1, M R Thomas1, J L Huntington1, K Lawson2, P Novotny1, J Sloan1 and T Shanafelt1 (1Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA and 2University of Minnesota, USA)

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10F 5 A national survey of patient-initiated in clinical clerkship in March 2005 were invited to assaults on medical students in Canada participate. A E Waddell*, M R Katz, J Lofchy, J Bradley and B Hodges Conclusions: Less than 5% of students in clinical clerkship (University of Toronto, The Donald R Wilson Centre for experience physical assaults by patients. Students identify Research in Education, 200 Elizabeth Street, 1ES565, physical, emotional and educational impacts of these Toronto, Ontario M5G 2C4, CANADA) incidents. Faculty identify the high-risk areas of a hospital Background/Rationale: Patient-initiated assault is for assaults (e.g., emergency department) however they recognized as an occupational health concern. Studies are not aware of the safety training students receive or involving postgraduate trainees indicate 40% of trainees of the legal rights of students who may be injured at in psychiatry and internal medicine have experienced an work. assault during their training. A preliminary survey carried Take Home Messages: Patient initiated assault against out at the University of Toronto demonstrated that at medical students occurs infrequently (<5% of trainees least 3.4% of third year students experienced an assault in clerkship). by a patient. Brief educational interventions targeted at students What was done: A survey of all English language medical immediately prior to clerkship and for faculty may help schools (12) in Canada. A non-random sample of faculty to reduce the impact of these infrequent but serious involved in clerkship was surveyed. All students enrolled incidents.

Short Communications 10H New challenges for the curriculum

10H 1 Integrating genetics into health care Presentation of the project: The medical curriculum of professional education the University of Witten/Herdecke is characterized by problem based learning (PBL), early and continuous Catherine Bennett* and Peter Farndon (National Genetics clinical education and an integrated curriculum focusing Education and Development Centre, Clinical Genetics, on developing professionalism. Additionally, it offers Norton Court, Birmingham Women’s Hospital, Edgbaston, Birmingham B15 2TG, UK) possibilities in studying different aspects of CM. Our ISAM- program started in 2004. Oriented on the specific Healthcare changes resulting from genetic advances will contents of AM, it focuses on developing abilities to require improved genetics training for all health care consider the spiritual dimension of medicine. This includes professionals. The Department of Health in England has looking at illness in the biographical context of a patient, therefore established the NHS National Genetics using conventional, natural and homoeopathic drugs and Education and Development Centre. the application of art therapies. In order to promote the The Centre aims to facilitate the integration of genetics dialog with orthodox medicine (OM), ISAM is integrated into pre- and post-registration education and continuing in the conventional medical education, offering seminars professional development for health professionals. Initial focusing on of PBL and clinical clerkships in hospitals work programmes involve three NHS staff groups – practicing OM and AM. Seminars reflecting the medical practitioners; nurses, midwives and health perspectives of different points of view do enhance the visitors; and pharmacists – and focus on assessing curriculum. genetics educational needs, developing and evaluating Conclusion: A curriculum of CM has been developed curricula, competency frameworks and educational considering the specific contents of AM and the need of resources. Initial work by the Centre’s collaborative a perspective dialog between OM and CM. multidisciplinary team confirms that to engage health professionals, genetics must be shown to have relevance in everyday professional practice. The patient is therefore 10H 3 Getting back to basics: reducing the at the centre of our work. Through partnership we are tensions in multidisciplinary education seeking to discover what different health professionals Craig Lord* and Robyn Beirman (Macquarie University, need to know about genetics, and to use patients’ Department of Health and Chiropractic, Nth Ryde, Sydney experiences to demonstrate the clinical utility of genetics. NSW 2109, AUSTRALIA) The Centre is working with existing professional bodies and providers of training and education to integrate The introduction of chiropractic education into the science genetics into existing curriculum topics in order to avoid faculty of Macquarie University generated substantial curriculum overload, and to keep responsibility for problems beyond just ideological differences. Ten years provision of education within current mechanisms and of disharmony culminated in a major change in providers (www.geneticseducation.nhs.uk) management. Within the new structure opportunities arose to address fundamental issues hampering the integration of ‘alternative’ health modalities. A systematic 10H 2 A curriculum of complementary medicine: approach was undertaken to assess the impediments to Integrated Studies of Anthroposophical integration. To the surprise of many, systemic failures of Medicine (ISAM) management, more so than ideological issues, were found to be the major causes of disharmony. Programs were C Scheffer*, F Edelhaeuser and D Tauschel (Universitäat developed to clarify the basic expectations of academic Witten/Herdecke, Begleitstudium Anthroposophische and administrative operations. ‘Getting Back to Basics’ Medizin, Alfred Herrhausen-Str 70, Witten D-58448, was the cornerstone of the program. Substantial inroads GERMANY) were made in the establishing of role expectations and Background: Complementary medicine (CM) is highly reducing bureaucratic processes. The program benefited requested by patients. In Germany more than 70% of by the inclusion of all stakeholders; academic staff, patients are being treated by different forms of CM. On administrative staff and students. Within two years the other hand CM is not or barely taught at medical substantial and measurable improvements in staff universities of Germany. relationships, curriculum quality and research output were recorded. With staff energies now focused on quality outcomes rather than internal politics the evidence

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reveals that integration of diverse health care modalities 10H 6 Crisis intervention: concepts, indications is less impeded by ideological differences than misguided and application management practices. Integration requires effort, but with a focus on the basics the benefits can be significant Ken Harbert* and Arthur Freeman (University of St Francis, and rewarding. College of Nursing and Allied Health, 4401 Silver Ave, Suite B, SE, Albuquerque, New Mexico 87111, USA) Aim of Presentation: Health Care Practitioners need to 10H 4 Collaborating to develop an undergraduate have a clear understanding of the core concepts, curriculum in palliative and end-of-life care indications and application of crisis intervention within the clinical setting. This program focuses on the core Pippa Hall, Albert J Kirshen*, Denise Marshall, Doreen Oneschuk, Cori Schroder and Dana Winterburn (Mount Sinai elements needed to manage traumatic events. Hospital, The Temmy Latner Centre for Palliative Care, 600 Summary of Work: The Basic Crisis Intervention program University Avenue, Toronto, Ontario M5G 1X5, CANADA) is a comprehensive, systematic and multicomponent Our lack of success in integrating education in palliative/ program offering practical tools for addressing the broad end-of-life care into the undergraduate medical spectrum of traumatic events from mild to severe that curriculum in universities across Canada has been impact patients’ lives. 1 documented . The Undergraduate Committee of the Summary of Results: This program offers medical Canadian Society of Palliative Care Physicians (UC-CSPCP) students, physician assistants, and nurse practitioners a has been working on a national initiative to address this credible, reliable and sustainable method of applying crisis need. The Educating Future Physicians in Palliative and intervention in their daily practice. End-of-Life Care (EFPPEC) Project has recently surveyed faculty at all seventeen medical schools as to the core Conclusions/Take Home Message: This innovative competencies required by graduating medical students. program has been incorporated into the traditional clinical An inventory of current undergraduate educational curriculum. It includes role-playing, small group exercises experiences/resources and means of evaluation has also and practical approaches for the management of been established. As a component of curricular renewal, traumatic events. This Basic Crisis Intervention program representatives of five Ontario universities have offers a best practice approach including a number of collaborated as the Ontario Palliative Undergraduate basic crisis intervention techniques allowing providers Network (OPUN) to develop a set of objectives in palliative to help others help themselves. and end-of-life care for undergraduate medical students, using the competencies of CanMEDS, and identifying the 10H 7 Smoking cessation skills in undergraduate necessary knowledge, skills and attitudes for each competency. This presentation will briefly review the curricula – more than just content change collaborative process, discuss the OPUN objectives in Ann Wylie and Mark Richards* (Guy’s, Kings and St Thomas’ the context of the EFPPEC Project, and propose next School of Medicine, Department of General Practice and steps using “Pain” as an exemplar. Primary Care, 5 Lambeth Walk, London SE11 6SP, UK) 1Oneschuk D, et al. J Palliat Care 2004; 20(1):32-37. Aims: Smoking cessation services are now established in the UK via General Practices. These approaches follow agreed guidelines. Medical students need to become 10H 5 Case-based, facilitated small group familiar and skilled with current practice. Medical students discussions: overcoming deficiencies in have opportunities to discuss smoking within the clinical undergraduate and postgraduate end-of- arena but inconsistencies exist in teaching and life education assessment. We explored three components – clinical practice, assessment and curriculum development: R W Damant*, J Weinkauf, B Leier, B Russel and P Byrne (University of Alberta, 9746-83rd Avenue, Edmonton, Alberta, (1) a questionnaire survey of 160 teaching practices to CANADA) establish what smoking cessation services they provide and their willingness to teach these skills to medical End-of-life care is an important aspect of health care students; (2) a retrospective exploration of OSCE delivery. Those caring for patients nearing death must questions to establish how many opportunities existed be proficient in the principles and skills of palliative care. for students to gain marks related to interactions about This study evaluated facilitated, small group discussions smoking behaviour, and how they performed; (3) a focusing on illustrative cases (cognitive simulation) to qualitative review of the curricular development being teach/learn this essential knowledge. Consenting medical piloted in 2004-5, introducing into therapeutics seminars, students and resident physicians were given a “primer” theoretical and practical approaches to smoking reviewing end-of-life care (numerous guidelines exist). cessation. They then participated in two group sessions (they were asked to manage a hypothetical patient dying from Results: 65% (response 52%) of teaching practices advanced COPD) and completed questionnaires. 100% willing to teach smoking cessation; Students confident of participants agreed or strongly agreed that “end-of- to assess smoking status (80%) based on 79 relevant life management is an important part of health care OSCE stations; Seminars must be developed in delivery”, and that it would be an “important part of (their) partnership with practitioners. future careers”. However, 100% disagreed that “end-of- Conclusion: Newer areas of practice and skills need life care is well-represented in the curricula of the training careful consideration before they can be subsumed into programs in which I have been enrolled”. 57% and 43% curricula. strongly agreed or agreed that “small group discussions are an excellent way to learn end-of-life care”. Conclusion: end-of-life care is likely underrepresented in medical training across Canada. Case-based, facilitated small group discussions are a highly acceptable method with which to teach and learn end-of-life care.

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Short Communications 10L Approaches to assessment

10L 1 Open-book examination: a method to 10L 3 Student responses to the CAT assess knowledge management (Computerized Adaptive Testing) Marjolein Penninga*, Jan Kuks, Johanna Schönrock-Adema Mee Young Kim* and Sun Huh (Hallym University, and Janke Cohen-Schotanus (University of Groningen, Department of Family Medicine, Institute of Medical Faculty of Medical Sciences, Institute for Medical Education, Education, College of Medicine, Hangang Sacred Heart A. Deusinglaan 1, Groningen 9713 AV, NETHERLANDS) Hospital, 94-200 Youngdungpo-dong, Seoul 150-030, KOREA) Background: The recent rise of information and communication technologies resulted in an expansion of The precise estimates of examinee ability can be achieved knowledge. These developments make new demands on using CAT that is shorter than PAP tests and efficient in professionals. This implies that students should not only terms of examinee time. We took the CAT for the final acquire knowledge, but also learn how to manage examination of 4th grade students (N=98) of medical knowledge. Because the examination program is the college in 2004. We prepared 1,050 IRT pre-calibrated strongest regulator of the learning process, both aspects test items, which had been used in 2003. The computer should be reflected in examinations. A solution could be was programmed to administer questions until the IRT- the use of open-book examinations. We explored estimated difficulty of the items matches the estimated differences in results of open- and closed-book ability of the candidate. We took the questionnaires before examinations. and after the examination. The students’ estimated ability was 0.3513-0.9097 and it showed the normal distribution. Work done: A difference was made between core There was no significant estimated ability difference knowledge, which students have to know by heart and between the response of students in questions about supported knowledge, which students have to manage knowledge and experience of CAT, computer use and with help of sources. Core knowledge was assessed by anxiety before and after the examination. They were closed-book examinations and supported knowledge by dissatisfied that they could not recheck their responses open-book examinations. (49%), and the questions were not enough (24%). 78% Conclusions: Preliminary results show that more students of them didn’t complain of any difficulty on using the failed open-book examinations compared to closed-book computer. 63% of them wanted to expand CAT. The examinations in the first year, although the degree of students had some anxiety about CAT, but it did not difficulty was equal for both examinations. These results influence the estimated ability and they wanted to expand are not reflected in the second year sample. The reason this kind of test. could be differences in examination preparation and habituation. 10L 4 Testing in postgraduate medical education Take-home message: Open-book examination may be Vendula Bilkova* and Jana Krejcikova (IPME - Institute for suitable for assessing whether students know how to Postgraduate Medical Education, Ruska 85, Prague 10, manage knowledge, and a way to cope with the 10005, CZECH REPUBLIC) expansion of knowledge. IPME, Institute for Postgraduate Medical Education, is a state educational organization whose goal is to provide 10L 2 An open syllabus exam: an assessment and postgraduate and continuing medical education. Although educational tool the medical teachers of IPME have a long-term experience Shamina Dhillon*, Neena Natt and Amindra Arora (Mayo in this field they continuously improve their work and Clinic, Division of Gastroenterology & Hepatology, 200 First follow educational trends. The history of testing in the Street SW, West 19, Rochester MN 55905, USA) IPME comes dates from 1960s but in that time it was only simple classical test (pencil and paper). From 1980s The development of self directed learning techniques IPME started with computer based knowledge testing must be encouraged among medical students as they with MCQ application. In the late 1990s an Open Testing enter a profession which requires life long acquisition of System (OTeS) was implemented, which enabled high knowledge. Traditional closed book format exams may variability of test construction, automatic question be associated with poor retention of the learned subject generation, a multiple-choice question application, and may encourage development of test-taking individual time for examinees to complete the test and strategies. The aim of this study was to determine if the so on. At the end of 2003 a pilot was introduced aimed use of an open syllabus exam: 1) encouraged mastery at an e-learning implementation in National Reference of the syllabus, 2) stimulated self directed learning, and Centre, IPME department. During the year 2004 the pilot 3) allowed the test itself to be a learning opportunity. e-course “Introduction into DRG” and e-dictionary Forty-four first-year medical students enrolled in the focused on DRG were created. Our experience with digestive disease physiology course took an exam testing will be presented. comprised of 4 essays. Half the group answered essay questions 1 & 2 using the open-book format and the other half answered questions 3 & 4 using the open– 10L 5 A processing time study to test the book format. The remaining questions were answered psychological validity of script with the traditional closed-book format. Students were concordance tests surveyed with a questionnaire. The mean scores between the open-syllabus vs. traditional format were not Bernard Charlin*, Robert Gagnon, Louise Roy, Monique St- statistically different for any of the 4 essays. Thirty Martin, Évelyne Sauvé, Henny P A Boshuizen and Cees van der Vleuten (Université de Montréal, Faculté de Médecine - students (68%) felt that permission to use the syllabus direction, C.P. 6128, succursale centre-ville, Montréal, during the exam encouraged mastery of the content Québec H3C 3J7, CANADA) before the exam, and 37 students (84%) used the syllabus as the predominant source for learning digestive Background: Scripts, according to theory, contain physiology. Twenty four students (54%) learned new expectations about clinical features associated to facts during the exam. This study suggests that an open illnesses, and about the range of values for the features syllabus exam encourages self-directed learning and can that are acceptable or not acceptable for each illness. be a useful educational tool in addition to an assessment The study investigated differences in information tool. processing as a function of its typicality and acceptability.

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Method: Thirty students and thirty geriatricians passed short retention. Afterwards, if the student passed, limited a test. Information was categorized depending on each effort is put into correcting misunderstandings and filling hypothesis as typical, atypical or non-acceptable. The gaps in the subject knowledge. test was administrated on a computer. The dependant Small-group sessions were arranged in association with variable was processing time. written examinations of different types. The students Results: For all participants, typical information is were asked to fill in a questionnaire (scale 1-5 with 5 as processed faster than atypical and non acceptable most positive/valuable) on the value of the group activity. information. Not acceptable information is processed The students in general appreciated group discussions faster than atypical information as improving their learning (3.3-4.4) and experienced a good learning climate during the group sessions (3.8- Conclusion: It is possible to predict what kind of 4.7). Specific tasks were less valued than the group information will be processed faster, depending on the discussions when it included peer evaluation (2.9-3.2) typicality and acceptability of clinical data for given and construction of MEQ-questions for the students’ hypotheses. individual preparations before examinations (1.4). A Take home message: These results provide arguments higher level of appreciation was found when self on the validity of the theory on which the script evaluation was included (3.4-3.5) and when MEQ- concordance test is built. questions were constructed for a following written test (3.8). Some students wanted more detailed information on expected answers or access to a teacher in each group 10L 6 Group discussions as part of examinations during the discussions. Conclusion and take-home E Persson*, F Ander, A Hoppe and G Birgegård (Uppsala message from these activities is that use of group University, Faculty of Medicine, Educational Unit, reflection on subject matter, associated with a written Kunskapscentrum, Entrance 61, 1st Floor, Uppsala examination and with limited teacher resources, can add Akademiska Hospital, Uppsala SE 751 85, SWEDEN) learning value for the students. Before an examination, many students study intensively, ending up with merely surface learning and a risk of

Short Communications 10M e-learning clinical skills

10M 1 Blended learning for basic surgical skills project by the American Academy on Physician and training Patient in collaboration with Drexel University College of Medicine, supported by a grant from the Arthur Vining K Pierer*, J Farhadi, T Lehmann, D J Schaefer and G Pierer Davis Foundation. Doc.com is seeking to reach its goal (University of Basel, Faculty of Medicine, Studiendekanat in combining the best talents with state of the art der Medizinischen Fakultät Basel, Klingelbergstrasse 23/1, Basel CH-4031, SWITZERLAND) technology. A renowned specialist, providing an instructive text plus instructional videos, hosts each A well implemented strongly psychomotor skills oriented module. The videos are technologically enhanced, course should be adapted to the overall bio-psycho-social allowing the learner to ask for an explanation of the philosophy of the curriculum. Advantages of blended specialist’s reasoning (a technique used effectively in learning are to be used to optimize the learning “Headache Interactive” which was awarded the European experiences for students in courses and in skills lab. A Academic Software Award for this achievement). Special case based access to skills and knowledge acquisition attention is given to the assessment that goes far beyond was chosen to support the interdisciplinary approach. A multiple-choice questions. Among other means, blended learning course of basic surgical skills was technologically enhanced computer videos are used to designed, which considers the national blueprint of assess the students’ understanding of situations and learning goals. The needs of students, clinicians and processes. nurses were evaluated by semistructured interviews beforehand. The design of this blended learning unit is Summary of work: The first 19 DocCom modules are congruent with the curricular didactic concept for skills available in June 2005. training. The E-learning element has four main tracks: a A demo version is available at http://web traditional expert observation track, a self directed campus.med.drexel.edu/demo/doccom/ learning track on an explorative basis, a quiz for self Results: First results are expected to be available at the assessment and a glossary. The implementation has been AMEE conference. surveyed with the routine evaluation inventory for courses and by the student’s performance in two OSCE stations. Conclusion: An elaborate and comprehensive online resource for the learning and assessment of The E-learning element could be smoothly integrated communication skills is about to become available. into the teaching and learning process. The bio-psycho- social approach, first time used in a surgical skills training, proved to be very well accepted by students. A blended 10M 3 Breaking bad news: development of a learning concept supports acceptance and integration computer-based learning package for of E-learning and avoids stand alone products. foundation trainees J A Cleland, N M Hamilton, S Navabian and K Walker* 10M 2 doc.com: 40 interactive online modules to (University of Aberdeen, Department of General Practice & teach and assess physician patient Primary Care, Foresterhill Health Centre, Westburn Road, communication skills Aberdeen AB25 2AY, UK) Dennis Novack, Bill Clark, Ron Saizow and Christof UK postgraduate medical training has introduced Daetwyler* (Drexel University College of Medicine, 2900 Foundation Programmes, a two-year planned programme Queen Lane, Room 114L, Philadelphia PA 19129, USA) of general training. Relationships with patients/ communication skills is highlighted as a key clinical Aim: Doc.com is a set of 40 web-modules to teach and competency. Flexible and practical curricula delivery is assess Physician Patient communication skills. It is a

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seen as essential given clinical demands on Foundation that allows visualization, with multicast audio and video trainees. We present the development of a computer- streaming, of real-time examinations coming from the based learning package for communication skills, various diagnostic modalities and multimedia specifically breaking bad news. This results from presentations. Professors and students can use collaboration between NES Scotland, Clinical videoconference for discussing about cases of scientific Communication (Undergraduate) and the Medi-CAL Unit, or didactic interest. The Java-based system allows University of Aberdeen. Using the Calgary-Cambridge integration of diagnostic modality source, electronic model of communication skills as a theoretical basis, short documents and live camera for videoconference and e- video clips using consenting patients present good and learning applications. Analog video signals are obtained less effective examples of clinician communication. Users from heterogeneous sources: video camera and will be directed to specific micro-skills to assess explicit diagnostic modalities. Such signals are collected into a learning objectives. Identification of key skills, reflection video mixer, which allows the user to select one or more on these and knowledge of alternatives is required to (up to four) sources to be streamed by a server in MPEG4 work through the programme. Patient perspectives are format, multicasting it on the LAN. Images, audio and provided throughout, and reflection on these encouraged. video can be acquired in analog or digital format from Monitoring mechanisms are inbuilt to encourage further CT, RM, US, Angiography. During remote lectures are reflection. Current evidence on the benefits of using good delivered the audio coming from professor’s microphone, communication skills is presented throughout, linked to the video captured by a DV cam and a stream selected specific video clips. Assessment methods include on-line by the video mixer. Students can watch at the diagnostic assessment of trainees’ notepads. “Live” assessment of modalities monitor, listening to the audio coming from communication skills is planned after trainees have the exam room and to the professor’s explanation. worked through the e-learning programme. Obviously patient sensitive data are anonymized with an ad hoc mask on the screen. 10M 4 VirtualSkillsLab.net Raphael Bonvin*, T Fredrik Bosman et al (University of 10M 6 The development of a web-based practical Lausanne, Unité de Pédagogie Médicale, Rue du Bugnon skills teaching package for undergraduate 21, Lausanne 1005, SWITZERLAND) medical students Virtual Skills Lab (VSL) is an interactive video-based web Sue Cowley and Ashley Self (The University of Sheffield, application for learning clinical skills. The didactical Academic Unit of Medical Education, Clinical Skills Centre, approach of VSL with its structure and content will be Vickers Corridor, Northern General Hospital, Herries Road, presented along with a short demo. VSL is aimed at Sheffield S5 2AU, UK) medical students learning clinical skills. The various skills Aim: To demonstrate a web based resource, which are grouped around organ-system modules (heart, lung, provides the student with twenty-four hour, online access ob & gy, abdomen, …). There is also a module on the to the nine standardised practical procedures that form basics of doctor-patient communication and one on the the basic clinical competence theme for the first three general examination. Each skill has an introductory part years. showing the skill as it is performed in daily routine. Then the skill is broken down in small steps and each step is Summary of work: Sheffield University has implemented explained and demonstrated in detail. Thereafter the a new outcome-focussed curriculum. Practical skills are user’s comprehension and knowledge of the skill is tested taught systematically by attending specific teaching with a short MCQ. Finally, he gets some information on sessions in the clinical skills centre. Each procedure is how the skills can be trained or what resources are demonstrated by the teacher, followed by supervised available for this at his university (if affiliated to VSL). practice on a manikin and individual feedback. An on- VSL represents only the first levels of the acquisition of line learning resource was developed within Minerva, the a skill (“know”, “know how”). The student needs to web-based Managed Learning Environment to demonstrate and later use the skill. Thus the curricular demonstrate each clinical procedure. Each practical skill integration of VSL is crucial. Scenarios of this integration consists of a real time demonstration, a breakdown of planned for the coming year at two Swiss Universities the skills and frequently asked questions. The procedures will be presented. are demonstrated on people not manikins to enhance the learning experience. To determine levels of usage of the online learning package, all users are logged 10M 5 Video streaming real-time diagnostic electronically through Minerva. examinations on the LAN Summary of results: The levels of usage will be presented Elisa Talini, Andrea Bertini* and Giovanni Cardia at the meeting. (Department of Diagnostic and Interventional Radiology in Conclusions: This on-line resource provides additional Pisa, via Roma, 67, Pisa, ITALY) opportunities for students to learn about the core practical At Department of Diagnostic and Interventional Radiology procedures, wherever they are attached for clinical in Pisa, we designed a system for Radiological e-learning placements.

Short Communications 10N Postgraduate education 2

10N 1 Use of operative data to evaluate ACGME and Plastic Surgery, developed a computerized (now web- surgical residency programs based) data collection system to assess resident and program operative experience. The program permits Doris A Stoll (ACGME, 100 East Bellevue Place, #19F, residents to enter their operative experience and provide Chicago IL 60611-5186, USA) a longitudinal record that categorizes each case Aim: To inform colleagues of a successful method to performed by anatomical and technical categories; by evaluate the quality of surgical residency programs. postgraduate year of residency; and by role, ie, assistant, surgeon, chief, teaching assistant. These data are used Summary of Work: In 1988, three ACGME Residency to provide information for clinical assignments, document Review Committees (RRCs), General Surgery, Urology,

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resident progression and accomplishment, and guide the content of the medical care, technical equipment and program director in advising and evaluating residents. size and composition of the medical staff. The meaning The RRCs use these data to evaluate the quality of of process is how the resources for education are used individual residency programs, confer accreditation and the educational climate, for example how professional actions, track surgical trends, establish program and guidance is organized and whether there is a personal resident benchmarks, and for educational policy tutor. decisions. This transcript of resident data provides a The first results show that the review activities affect permanent record of operative experience for interviews the internship in a positive way and all over the country and credentialing purposes, and supports application for there is an increasing interest for the reviews. The the Board Certification Examination. procedure and the experiences from the reviews will be Conclusions/take-home messages for participants: This presented at the conference. systematic approach to data collection provides a quantitative method for evaluating a program for accreditation purposes and serves as a transcript for the 10N 4 Quality of supervision as perceived by surgical graduate. specialist registrars. A comparison between an academic and non-academic clinical setting 10N 2 Evaluation of the residency program in pre-and post-renovation in Japanese M Bruijn*, J O Busari, K Boor and B H M Wolf (Sint Lucas Andreas Hospital, Rustenburgerstraat 377-3, Amsterdam residency system 1072 GV, NETHERLANDS) Masanaga Yamawaki*, Mikako Masuda, Atsushi Ookawa and Background: Clinical supervision promotes the Yujiro Tanaka (Tokyo Medical and Dental University, professional development of specialist registrars (SpRs). Department of Professional Development, Yushima 1-5-45, Bunkyo-ku, Tokyo 113-8519, JAPAN) Our objective was to investigate and compare the perceived quality of supervision (PQS) in a university Background: In Japan a new postgraduate clinical training teaching hospital (UTH) and non-university teaching for medical doctors had been implemented in 2004. Our hospital (NUTH) and identify aspects of supervision that aim is to investigate whether this renovation affects the could be improved. residency program from the viewpoint of residents. Methods: The Cleveland Clinic’s Teaching Effectiveness Methods: Resident surveys before and after the Instrument (CCTEI) was used to measure the quality of implementation of a new program were compared. We supervision of attending doctors. 15 Items reflecting good assessed the first-year residents (24 in 2003 and 38 in teaching ability were rated on a five-point Likert-scale 2004) in internal medicine in TMDU hospital. An on-line (1-5 = poor-excellent). SpRs rated 47 attending doctors evaluation system, EPOC (evaluation system of using the CCTEI. A total of 416 ratings were obtained. postgraduate clinical training) which was designed and conducted in Japan, were used. Results: Overall, the mean PQS was 3.85 (SD=0.29) in the NUTH and 3.56 (SD=0.44) in the UTH (p=0.02). A Results: Support for developing technical and integrative significant difference in PQS was found in 6 supervisory competencies, care for work-loads, and standards of roles. The supervisors in the NUTH scored better on all teaching skills were significantly improved in 2004 (p < of these items. The best predictor of PQS was the item 0.001). Items related to resident-preceptor (p < 0.001) “Organizes time to allow for both teaching and care and resident-resident (p < 0.05) interactions became giving.” satisfactory, while resident-nurse collaboration was not always satisfactory. Although working hours and work/ Conclusions: Overall, PQS was better in the NUTH non-work balance were improved (p < 0.05), the average compared to the UTH. In both settings, generating a score remained unsatisfactory in the ratings. good learning environment and respecting the autonomy of the SpRs were scored favourably. Supervisory roles Conclusions: Support for developing competencies and focussed on improving cost-effective practice and working circumstances was improved after residency communicative skills are strongly recommended. renovation. Some points concerning working hours and collaboration in the medical team are shown to be linked to reform. Standardized evaluation with EPOC is an 10N 5 Scholarly outcomes associated with an informative tool to evaluate residency programs. academic career development curriculum for internal medicine trainees 10N 3 Internship – review and quality Furman S McDonald* and Joseph C Kolars (Mayo Clinic, development Hospital Internal Medicine, Old Marian Hall 2-142, 200 First St SW, Rochester MN, USA) Hanna Frydén (Swedish Medical Association, Box 5610, Stockholm 114 86, SWEDEN) Presentation Aim: Demonstrate scholarly outcomes of internal medicine trainees associated with an academic The Swedish system leading to registration as a doctor career development curriculum. involves medical studies for 5½ years followed by basic clinical training (internship) for a minimum of 18 months. Work Summary: In academic year 2000-2001, an During these months, the house officers circulate Academic Career Development Curriculum was begun between internal medicine, surgery, psychiatry and family at Mayo Clinic Internal Medicine Residency, Rochester, medicine. A problem with the internship mentioned by MN. Successful academic physicians identified areas they the house officers is that the quality of the education felt were important to career development. Residents often differs between the hospitals and the process to identified in which of these areas they felt least well improve the education has been quite slow. The informed. After this two-way needs assessment, the foundation for Quality in Medical training, founded by curriculum was implemented around four domains: 1. the Swedish Medical Association and the Swedish Society Academic Career Opportunities; 2. Choosing a Research of Medicine, has initiated national review activities of Project; 3. Optimizing the Mentor Relationship; 4. internship aiming to improve the quality of the education. Manuscript Preparation, Submission, and Review. After two years of preparatory work, the review activities Results Summary: Scholarly outcomes of 145 internal started in 2004. They are offered to hospitals and county medicine residents from graduating classes since the councils at cost. Two reviewers look upon the internship inception of the scholarship curriculum are reported: from two aspects; structure and process. The meaning of structure is material and personal factors such as the

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Year Projects Publications Presentations Awards site visits and feedback from training providers and consumers. Little is known about the effectiveness of 2002 176 18 105 5 these strategies. We compared the perceptions of trainers 2003 188 28 82 8 and trainees regarding training quality for Specialist 2004 251 62 122 12 Registrars in Geriatric Medicine in our region. Work: 11 core areas of the Royal College of Physicians Increases in projects, publications, presentations (at curriculum for Geriatric Medicine were graded from A national or international meetings), and national research (highest) to D, separately by trainees and lead trainers awards are significant with P<0.05 for all trends. from each hospital. We described agreement between Conclusions: Research is important to the career ratings and quantified this for each topic separately using development of academic physicians. The knowledge, the kappa statistic. skills, and attitudes necessary to enhance academic Results: Paired data was available from 13 sites. Ratings career development can be taught systematically. for the region’s training overall showed good agreement Scholarly outcomes after implementation of this between trainers and trainees - grade A 5% v 2%, B curriculum were significantly increased in this cohort. 33% v 33%, C 39% v 39% and D 23% v 26%. For individual departments there was complete agreement 10N 6 Comparison of trainers’ and trainees’ in 43%, difference by one grade in 47% and by two perceptions of training quality grades in 10%. S Briggs*, E Fielding, S McCracken, O Otaiku, A Thomson* Conclusions: There was good agreement between and P Baker (North Western Deanery, Education Centre, trainers and trainees overall. Given objective criteria to Royal Bolton Hospital, Minerva Road, Farnworth, Bolton work by, most providers and consumers give a similar BL4 0JR, UK) judgement. More work is needed on refining grading criteria and education in their application. Aim: Most medical training in the United Kingdom is in the context of service. Quality control methods include

Short Communications 10O Outcome based education 2

10O 1 Assessment assessed The medical course provides a general basic education with skills for lifelong learning with graduates continuing I Vandenreyt*, M Maelstaf and M Vandersteen (Limburgs their studies in a variety of medical specialties. It is Universitair Centrum, Department MBW, Physiology, Universitaire Campus, Gebouw D, Diepenbeek B-3590, therefore appropriate that the medical students receive BELGIUM) education in the broader women’s health issues rather than obstetrics and gynaecology (mostly a postgraduate Aim of presentation: As a part of assessment quality area); although a large proportion of general O&G is control we wanted to check the degree of correlation contained within women’s health. The content of (alignment) between educational objectives, instructional ‘women’s health’ was established using a questionnaire activities, and assessment. to general practitioners and obstetricians and Summary of work: First we interviewed all teachers of gynaecologists. This was utilised for the O&G curriculum the second and third year Bachelor of Medicine using a at the University of Queensland. The latter was one of semi-structured questionnaire. Then we developed a 14 specialist groups representing the medical schools in procedure, using the two-dimensional Taxonomy Table Australia and New Zealand that developed a women’s (Anderson and Krathwohl, 2001) and analysed the health core curriculum.This presentation attempts to educational objectives of all learning units within the specify the depth of knowledge for medical students using bachelor years. learning outcomes based on this core curriculum. A scale was developed based on the work of Miller (1990), Rolfe, Finally we asked the teachers to analyse the instructional Pearson, Sanson-Fisher, Ringland & Bayley, (2002), and activities and assessments in terms of the Table. Harden, Crosby & Davis (1999). A pilot questionnaire Summary of results: The objectives and current was administered to a group of general practitioners and assessment methods (both summative and formative) obstetrician and gynaecologists. The results illustrate the of the second and third year are mapped. The overall difficulties in gaining consensus on the learning outcomes picture will be completed next year after analysing the for medical students. first year. We diagnosed strengths (multiple forms of assessment, transparency, acceptable validity and reliability) and weaknesses (formative assessment, 10O 3 Outcome-based medical education: should assessment of general competence, and case-based it be prescriptive or a prescription? assessment were insufficient). After classification from Graham Stephenson (University of Queensland, Department three sources (i.e., objectives, instructional activities, and of Medicine, 4 Waghorn Street, Ipswich, Queensland 4305, assessment), the Table presents evidence of both AUSTRALIA) alignment and misalignment. Background: At AMEE 2004 in Edinburgh, Professor Conclusions/Take-home message: Teachers can use the Harden asked the question ‘How prescriptive should procedure to increase the overall alignment of objectives, outcome-based education be?’ Prior to being prescriptive teaching methods, and assessment. i.e. ‘laying down or imposing authoritatively’, one needs a prescription. This research attempts to develop a prescription that is efficacious in preparing medical 10O 2 The Women’s Health Curriculum: content students to diagnose and manage patients as interns, and depth especially in the absence of supervision. V O’Connor (University of Queensland and Bond University, What was done: The needs of interns in terms of their 114 Harts Road, Indooroopilly, Brisbane QLD 4068, tasks; patients; time; expertise; and situational context AUSTRALIA) were examined and fashioned into a prescription. This

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involved a list of clinical presentations, which because of the use of Simulated Patients (SP) can bring a CCP to their emergency nature, severe symptomatology, or life in the ITA setting. idiosyncrasy, require definitive management within 1 to What was done: Dundee Medical School has a purpose- 2 hours, and a set of instructions for responding to such designed ITA. The outcome-based curriculum is delivered presentations involving the use of ‘rules’ or procedurally in three phases. Phase 1 (1 year) and Phase 2 (2 years) focused propositional knowledge. An intervention using provide system-based learning of normal and abnormal this prescription was successful. Factors considered by structure, function and behaviour. During Phase 3 (year participants to underlie this success correlated with 4&5) students satisfy curriculum outcomes by spending elements of the prescription. 4-week blocks in clinical practice covering approximately Conclusion: The prescription developed in this research 100 CCP. This paper describes an ITA session during has been shown to be efficacious in a particular research which SP gave a history of abdominal pain (a CCP) caused situation. Others need to consider whether such a by different underlying conditions. Supportive material prescription should be prescriptively applied to was used to integrate knowledge at the Phase 1 stage. comparable situations. Students worked in small groups using the SP scenarios as triggers, supplementary material, and tutor support Take-home message: Examining need is the window to (basic scientist & clinician). The session received a prescribing. positive feedback. Conclusions & Take Home Message: CCP involving SP 10O 4 A framework to formulate specific learning can be used with other supportive material in a purpose- objectives for the first clerkship year designed ITA to integrate basic & clinical sciences. F Ferrando*, I Fernández, C Cancela, E Macri and E. 1Khogali et al. (2004). The value of a purpose designed Rugnitz (Brenda 5785, Montevideo CP 11400, URUGUAY) Integrated Teaching Area. Paper presented at AMEE Background: During the first clerkship year students annual conference, Edinburgh 2004. acquire their clinical skills in a hospital setting, assessed by a final OSCE. The Exam Committee (EC) faculty staff faced special needs on specific (well-defined) learning 10O 6 Assessment of nursing students’ views objectives (SLO) (Garcés et al, 2004). about clinical competency What was done: A framework to formulate SLO was Zohreh Parsa Yekta, Rahad Ramezani Badr* and Alireza developed in four stages: 1) workshop on SLO formulation Khatooni (Tehran College of Nursing and Midwifery, Tohid Square, Tehran 141118, IRAN) (Des Marchais and Delorme, 1993); 2) inventory and classification of SLO based on prevalence, importance to Background: Competence is a complex concept that diagnosis and pertinence criteria, 3) SLO selection and encompasses such attributes as knowledge, skills and classification according to assigned course time and attitudes. Nurses who are registered are required to structure (Bloom et al 1974), and 4) consensus demonstrate competence. They are accountable for their development. actions and they take responsibility for the supervision of enrolled nurses. Results: First three stages concluded in a list of 124 SLO on history-taking and physical examination skills Material and Methods: The purpose of this descriptive- acquisition (59/126; 46.8%) and knowledge (65/126; analytic study was to assess nursing students’ views 53.2%). Medical Psychology Department will formulate about clinical competency and their degree of SLO from a list of 10 general goals on communication achievement. The participants consisted of 91 skills. The specific SLO list was delivered to students. undergraduate nursing students from Tehran School of Their perceptions about usefulness in daily training will Nursing and Midwifery. Data were collected by be assessed next year. EC found this work very questionnaire (Likert type) contain 8 parts: demographic useful,especially during OSCE checklist design. The fourth characteristic, systematic assessment and data gathering, remaining stage begins in March 2005, when a modified care planning, ethical points, professional improvement, Delphi technique (Murphy et al, 1998) including Internal client and family comfort, effective care management Medicine and specialities faculties, advanced students in and collaboration with health team. clinical training and residents will be performed. This Conclusion: among 92 students, 70 cases participated will detect predictors of better consensus, making the in this study. The results showed that most of the next processes of SLO formulation easier and more students’ views about systematic assessment and data effective. gathering (81.4%), care planning (78.6%), ethical points (81.4%), professional improvement (78.6%), client and 10O 5 The use of simulated patients in a purpose family comfort (84.3%), effective care management (78.6%) and collaboration with health care team (80%) designed integrated teaching area were completely in agreement. Also most participants’ Shihab Khogali*, Alexander Harper, Jane Illés, Nicholas Part views about their achievement in relation to systematic and Jean Ker (University of Dundee, Division of Medical assessment and data gathering (58.6%), care planning Education, Curriculum Office, Ninewells Hospital & Medical (52.9%), ethical points (68.6%), professional School, Level 7, Dundee DD1 9SY, UK) improvement (64.3%), client and family comfort (60%), Background and Rationale: The value of using Core effective care management (64.3%) and collaboration Clinical Problems (CCP) as a mesh (involving patients’ with health team (60%) were moderate. Also there were scenarios together with supportive material) in a purpose- significant correlations between demographic designed Integrated Teaching Area (ITA) has been characteristic of participants and their view about clinical previously described1. This paper aims to describe how competency.

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Workshops 10R, 10S, 10T & 10U

10R Playing the game – the role of games and 10T Reflective Practice: how to use it to improve simulations in medical education your clinical teaching Lynne Allery, Janet MacDonald and Lesley Pugsley (Wales Lee Randol Barker (Johns Hopkins University School of College of Medicine, Heath Park, Cardiff, CF14 4XN, UK) Medicine, Baltimore, USA) Background to the topic: Gaming provides an interactive Background to the Topic: Clinical teachers should advocate and innovative opportunity to engage learners; however for three persons: (1) Trainees: Their development as a it remains a relatively untapped resource in medical physician; (2) Patients: Their good health; (3) Themselves: education. The importance of ensuring learning emanates Their continued development as a teacher. This workshop from the experience is a key consideration for the trainer. on Reflective Practice addresses advocating for oneself, a Whilst games provide the vehicle for learning, the learning clinical teacher. In Reflective Practice, one uses a results from the experience of playing rather than from heightened awareness of an experience to learn from that the subject matter of the game. This experiential technique experience. Of a clinical teaching encounter, the reflective remains a useful addition in the repertoire of any trainer practitioner would ask the following types of questions: (Allery, 2004). Learning can be fun, take a chance and (1) What assumptions (pre-conceived ideas, etc.) were join us for a fun session underpinned by sound educational affecting me during this teaching encounter? (2) Was I principles. aware of any changes in my assumptions during this teaching encounter? (3) What did I do that worked well Workshop content and structure: Highly interactive and that I would like to continue doing? (4) What workshop. Play the game. Reflect on the value for medical alternative approaches would I like to try in future teaching education. encounters like this one? The hypothesis underlying this Intended outcomes: To experience a game as a vehicle workshop is as follows: That one’s growth, or “perspective for learning; To explore the concept of gaming; To consider transformation” (Mezirow) as a clinical teacher depends the value of gaming in medical education; To reflect on upon the accumulation of clinical teaching experiences the key principles of gaming in an educational context. reflected on critically. The conceptual and empirical bases Intended audience: All those interested in playing the for this hypothesis are derived for the work of Mezirow, game. Schon, Brookfield and many others. Level of workshop: No prior experience/knowledge Workshop Content and Structure: required. • 10 minutes – Check in: Each participant introduces himself/herself to the group Allery L. A. (2004). Educational games and structured experiences. Medical Education 26:4 504-5 • 20 minutes – Facilitator’s Presentation: Facilitator will illustrate how Reflective Practice is used in the Johns Hopkins University School of Medicine Faculty 10S Integration of ethics in the undergraduate Development Program in Teaching Skills. medical curriculum • 40 minutes – Group Work: Registrants will present their Babatunde A Gbolade and Suzanne Kite (The Leeds Teaching pre-workshop Reflective Practice Narratives so that we Hospitals NHS Trust/University of Leeds Medical School, can explore personal and groups ways to use Reflective Leeds, UK) Practice. (NOTE: Approximately two weeks before the AMEE meeting, workshop registrants will receive Background to the topic: The British General Medical instructions for completing a Reflective Practice Council’s document “Tomorrow’s Doctors” which makes recommendations on undergraduate medical education, Narrative, which they should bring for presentation at lists ethics as one of the requirements of a comprehensive this workshop) medical degree. In response, the University of Leeds • 20 minutes – Facilitator’s Presentation: The facilitator Medical School in co-operation with the School of will describe the conceptual basis for using Reflective Philosophy set up the Ethics Theme (ET), which uses a Practice. This presentation will draw on the preceding variety of teaching methods. Its overall objectives are to exploration of registrants’ Reflective Practice Narratives. integrate fully philosophical teaching within the clinical • 15 minutes – Closure: Participants who wish to will voice curriculum and, over time, help students develop their to the group ideas that they have gotten for further use ability to recognise, reason about, understand and, possibly of Reflective Practice in their clinical teaching even resolve, ethical issues. environment. Workshop content and structure: Negotiation: History of • Registrants will write a brief Reflective Practice Narrative the development of the medical ethics theme at University on their experience in this workshop. of Leeds Medical School; Difference between medical law • Participants will receive take home copies of the and ethics; Practicalities of getting time within the facilitator’s transparencies and an annotated curriculum for medical ethics. The Leeds Approach: The bibliography. Medical Ethics curriculum at Leeds University Medical school; The themes at different levels of the medical school Intended Outcomes: Through participation in this curriculum; SSC. Teaching styles: The teaching workshop, each participant will: (1) Increase their methodology; The assessment process. conceptual understanding of Reflective Practice. (2) Be Intended outcomes: Learn the processes and practicalities able to use a four-question Reflective Practice Narrative of integration of medical ethics at the appropriate stages Worksheet. (3) Increase their awareness about themselves of the undergraduate medical curriculum as a clinical teacher. (4) Increase their interest in incorporating Reflective Practice in their home teaching Intended audience: Medical educators who wish to environment. integrate medical ethics or streamline medical ethics within the undergraduate medical curriculum. Intended Audience: Clinical Teachers. Level of workshop: Beginners to intermediate. Level of Workshop: Beginner to advanced.

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10U Consent for patient recordings in healthcare recordings in the educational setting. Participants, working education in small groups will reflect on real-life examples to draw up draft guidance for practitioners on consent in those Helen Cameron, Michael Ross and Rachel Ellaway (University contexts, and will present their conclusions. Finally of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 participants will consider workflow to ensure secure storage 9AG, UK) and tracking of consent in their institution. Background to the topic: Clinical information is essential Intended outcomes: Participants will appreciate a range for authentic healthcare education. From earliest times of current international perspectives and practices. patients, their clinical photographs, images and data have Participants will be more aware of the issues related to enriched teaching and learning. However with the advent collecting and using patient recordings in educational of digitised picture archiving and communication systems settings. Participants will be better informed about current in clinical practice and the increasing use of electronic guidelines, their relative strengths and limitations. resources in online teaching, clinical recordings can now Participants will develop outline guidance frameworks and be copied and disseminated rapidly. There is potential for review electronic systems for managing consent processes. great harm if the interests of the patient are not safeguarded. Intended audience: All those who use patient recordings, as well as staff with responsibilities for managing and Workshop content and structure: We will challenge supporting education processes and developing policy. assumptions and provoke discussion through a series of ‘grey cases’ to explore the issues of consent for patient Level of workshop: All levels.

Posters 10 Onyx 1 International medical education; Language proficiency

10 Onyx 1.1 by patients and other health care providers. Physician Can international medical graduates be Assistant education is efficient and flexible and the PA integrated into foreign health systems in a model can be easily adapted to the specific health needs of other nations. cost effective, efficient manner? S Child* and G Naden (Auckland District Health Board, Clinical Education and Training Unit, Private Bag 92024, 10 Onyx 1.3 Auckland 1003, NEW ZEALAND) Building and sustaining capacity in The integration of International Medical Graduates (IMGs) healthcare education through the into the foreign medical hospital systems is a problem that development of dual masters’ programmes faces most countries in the world. This study, from between the UK and Russian institutions Auckland, New Zealand, describes the results of a 6 month pilot, “Ready to Work” programme. Participants completed Kath Start* and Maria Ponto (Kingston University & St George’s Hospital Medical School, Faculty of Health & Social an initial skills assessment, patient communication surveys, Care Sciences, Cranmer Terrace, London SW17 0RE, UK) a formative and summative OSCE skills assessment with regular tutorials, feedback and run evaluations. Programme Background: Across Europe, the quest for robust education outcome assessments were completed with comparison standards in healthcare courses has resulted in a greater to IMGs not participating in the programme. Full evaluation requirement for professional preparation of teachers, data with costings are presented nurses and other specialists in healthcare subjects. This has resulted in growth of more focussed courses intended to develop nurse specialists and education managers to 10 Onyx 1.2 take healthcare education forward. The standing of nursing Global applicability of Physician Assistants would improve if more nurses had higher qualifications. Furthermore, our partners also believe that some of the Christine Legler, Wilton Kennedy, Kathy Jane Pedersen, Marie L Bensulock, Patricia A Castillo, Kirsten Thomson, Justine higher qualified nurses could then be attracted to teaching Strand and Marie-Michele Leger (Association of Physician nursing. Assistant Programs, International Affairs Committee, 4637 NW Rationale: In Russia there are currently 7 federal regions Imnaha Ct, Portland, OR 97229, USA) (Presented by Anita of healthcare which are subdivided into 98 districts and Duhl Glicken) are managed by nurses. Only one third of these nurses Many nations throughout the world are exploring or re- have a University qualification and very few of the nurses exploring the Physician Assistant concept as a way to who hold managerial positions have management quickly and efficiently train and employ highly autonomous qualifications. and flexible health workers to address their nation’s health The programme is designed to:- (1) meet local care needs. The Association of Physician Assistant requirements for professional healthcare teachers and Programs along with the American Academy of Physician mentors in both countries using models applicable to any Assistants is actively involved with sharing information healthcare teaching; (2) provide sufficient flexibility to about the PA profession to other countries. Several recognise local needs; (3) prepare and equip healthcare countries are utilizing U.S. trained PAs in pilot programs specialists and nurses to design education programmes, and currently have established or will begin a PA program deliver education using the latest learning and teaching within the next year (Canada, Netherlands, United strategies, deliver high quality training for clinical skills, Kingdom). Other countries are actively examining the PA implement workplace learning, prepare students for change model (South Africa, Ghana, China, and Taiwan). In management and competently research healthcare issues addition, many PA programs have affiliation agreements within their local milieu. with institutions outside of the United States to host PA students for clinical rotations and there is an ever-growing interest by students for international rotations. In the United States, the Physician Assistant model has proven to be a cost-effective way to train quality primary care providers with a high degree of acceptance of the PA role

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10 Onyx 1.4 10 Onyx 1.6 Development of a medical education and Cultural awareness amongst second year institutional profile database in Central Asia medical students at two northern UK Kathleen Conaboy, Zhamilya Nugmanova*, Saltanat medical schools: a work in progress Yeguebaeva and Emily Fedullo (American International Health Jane H Roberts1* and Val Wass2 (1University of Durham, Phase Alliance, 6351 Meadow Crest Circle, Reno NV 89509, USA) 1 Medicine (MBBS), Queen’s Campus, University Boulevard, 2 Aim: Demonstrate progress in the development of a Thornaby, Stockton-on-Tees TS17 6BH, UK; University of regional database, using internationally accepted and/or Manchester, UK) pilot models. Background: Students in the western world now face Summary: The Central Asian medical education community unprecedented challenges of practising medicine amongst is working with international partners and advisors to increasingly diverse populations. What can be done to aggregate data from four countries into a centralized, facilitate this aspect of professional development? regional database to support accreditation, quality Aims: (1) To explore students’ perceptions of how their measurement, and policy development efforts. The 31 level of cultural awareness is encouraged and facilitated medical academies and post-graduate institutes comprising by: the curriculum, peers and contact with patients and the CAR Council of Rectors participated in the pilot test of local communities and their own feelings towards cultural the expanded IMED database; one academy participated diversity. (2) To probe the group’s collective understanding as a pilot site with the WFME’s undergraduate global of a range of terms associated with cultural diversity. standards project; and seven academies that are partners Summary of work: A qualitative study using audio-recorded in a USAID-funded project have analyzed the how, what focus groups of year 2 students at two medical schools and why of data collected in the region. with contrasting approaches: a case-led course with Results: The COR and the partnership recommended the extensive local community contact versus an entirely paper- rationale, structure and logistics for a regional database based PBL programme. to health and education ministry representatives and to Findings: Emerging themes include students’ personal USAID. Voluntary participation in a pilot effort will begin disregard of cultural identity as important against in Fall 2005. discomfort when drawing attention to cultural difference. Conclusions: Progress on the database development is Students felt extracurricular work experience offered slowed by national autonomy issues and the lack of a greater exposure to diversity of cultures in comparison to regional body to endorse or fund the effort. However, the early patient experience. Formal curriculum content on process is successfully being used to drive the development cultural awareness was limited and often marginalized. of a regional accreditation process and engage ministry Informal learning from peers in PBL groups was valued. officials in dialogue with medical educators. Conclusion: Students value but feel threatened by issues of cultural diversity. In the early years they learn more 10 Onyx 1.5 about cultural awareness from their personal experiences Relevance for medical students of but would welcome a greater curricular focus on cultural issues. international experiences in primary care Fernando Mora-Carrasco, Victor Rios-Cortázar, Claire van Nispen tot Pannerden* and Pieter Emans (Universidad 10 Onyx 1.7 Autónoma Metropolitana (Xochimilco), Calzada del Hueso The implementation of the quality 1100, Colonia Villa Quietud, Distrito Federal C P 04960, management system in KSMA MEXICO) I R Kulmagambetov, F N Nurmanbetova*, Sh S Kalieva and A Structured international rotations for medical students are S Kalina (Karaganda State Medical Academy, 40 Gogoly Street, normally described in terms of practical experience gained, Karaganda 100008, KAZAKHSTAN) or the increased awareness by the students of other social and medical realities. This is especially true in exchanges Background: Ministry of Education and Science has centered in primary care work, from the viewpoint of the developed the National System for the Higher Education student coming from a developed country to a less Quality Assessment and stressed the importance of developed one. On the other hand, the students going implementation of the Quality Management System at the reverse way are supposed to learn modern medical Kazakhstan’s universities making it a requirement to practices, or frontier medical knowledge. Based on our 8 enhance their position as leading education and research year experience of student exchanges between Mexico providers nationally and internationally. and The Netherlands we have perceived that this essentially Summary of work: KSMA started to implement its Quality asymmetric relationship present only a superficial view of Management System according to this strategy, formulated the learning process taking place. the quality policy and mission, identified the processes Although it is true that the increased cultural awareness and developed the quality system documents, KSMA mentioned above (including language competency) is a Guidelines for Quality Assurance and the Strategic Plan relevant result of the exchanges, far more relevant is the 2004-2008, which will be annually updated. epistemological “rupture” undergone by the students. This Summary of results: The experience of this implementation has to do with the self questioning that the student does allowed us to research and understand customers needs when facing a different culture, including different and expectations, measure customers satisfaction, conceptions about health and disease, and the very establish a clear vision of the organization’s future, significant differences in medical practice. Orienting the motivate, commit and involve staff within the organization, student towards understanding his/her system of values, focus on factors such as resources, methods that will and how they were build up, could be the educationally improve the key activities of the organization, analyze data most relevant component of this educational experience. and information using valid methods, provide the We shall attempt, starting from case studies, to construct appropriate infrastructure for teaching and research, the general relevance of the experiences. including library resource and services, plan and manage the processes necessary for the continual improvement. The Quality Management System of KSMA has been assessed and approved by the Representative of the Certification body NQA Global Assurance Limited, UK - NQA- Russia.

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Conclusions: The implementation of the Quality setting, language skills are crucial. We have created a web Management System helps to achieve the universities’ site for medical language to facilitate mobility and objectives in the most effective and efficient way. communication between different countries.

10 Onyx 1.8 10 Onyx 1.10 The correlation between English proficiency Student-centered vs standard syllabus score and GPA of the sixth year medical approach to EFL teaching to medical cadets, Phramongkutkloa College of students at TUMS Medicine, Thailand Ahmad Sabouri Kashani* and Sorayia Soheili (Tehran Yupa Phonphok*, Koonphol Pongmanee, Kanokpun University of Medical Sciences, 111, 321 St Enghelab Ave, Prapaitrakul and Supatra Singhakamram (Phramongkutkloa Mehrshahr, Karaj, Tehran 3185815711, IRAN) College of Medicine, Department of Microbiology, Rajavithi Considering the half-life of the findings in medicine, and Road, Bangkok 10400, THAILAND) the fact that the language of instruction in Tehran University English competence has an important role in the study of of Medical Sciences is Persian while the latest publications medicine for countries where English is not the official are available in English, TUMS medical school pays special language. It is quite difficult to persuade the senior high attention to effective teaching-learning in general and school students to pay attention in the English class. medical English courses. This study compares the achievement of the majority of the admissions for the Objective: To determine the correlation between English academic year 2002-2003 following the established proficiency test and GPA of the sixth year medical cadets, syllabus with that of a small group of the same admission Phramongkutklao College of Medicine, Academic year being taught English following a student-centered approach 2001-2004. where the students decided which materials they should Study design: Retrospective descriptive study. work with on each session. The new admissions were Methodology: The English Proficiency Score and GPA of screened for their English knowledge and were grouped the 158 medical cadets, class 23th-26th, Phramongkutklao into homogeneous classes on the basis of their English College of Medicine, Academic year 2001-2004 were proficiency. After five semesters, they sat for the national recorded. The correlation between English Proficiency comprehensive exam and the performance of the two Score and GPA were analyzed by the Pearson’s Product groups on the English test on this exam was compared. Moment correlation. The students following the standard syllabus did better on the test. The careful monitoring and evaluation system Result: The Pearson’s correlation between English of the standard program seems an effective mechanism Proficiency Score and pre-medical year GPA, pre-clinical motivating students to do their best while the other group years GPA, clinical years GPA and total GPA of the 158 rejected examinations as a stressful agent from the medical cadets in academic year 2001-2004 are 0.06, 0.08, beginning. Tension caused by good tests helps Iranian 0.13 and 0.12, respectively. It is clear that English learners and should be differentiated from tension proficiency plays are important role in the clinical study. distressing the general learner. Conclusion: The relationship of English Proficiency Score to GPA in pre-medical and pre-clinical levels is not quite 10 Onyx 1.11 clear. This should be further studied using a bigger sample size. Students’ comprehension of medical texts and their views regarding English for medical purposes 10 Onyx 1.9 Maryam Heydarpour Meymeh (Shahid Beheshti University of Development of a resource for medical Medical Sciences, Faculty of Paramedical Sciences, Tajrish language and culture at the Karolinska Square, Darband Avenue, Tehran, IRAN) Institute Background: English for Special Purposes and English for Tobias Alfvén, Hanna Brauner* and Hanna Valenta Medical Purposes courses are being taught in different (Karolinska Institutet, MTC, Nobelsvag 16, Box 280, Stockholm universities, however the efficacy of these courses are not S 171 77, SWEDEN) examined precisely. The purpose of this study is to examine Background: Approximately half of the medical students, the effect of language level and field of study on and an increasing number of the other students at the performance in reading comprehension tests. The students’ Karolinska Institutet (KI) study part of their education views about the courses are also analyzed. abroad. The Bologna process will further increase the Methods: 120 undergraduate students completed a international exchange. The vocabulary and culture of the questionnaire and a reading comprehension test to evaluate medical profession varies greatly between countries, and their reading ability. They were assigned into 4 groups on is not covered by the ordinary language education at the the basis of their status in terms of being/not being exposed schools in Sweden. Today there is no resource for medical to EMP instruction and their academic subject areas, language at the KI. Optometry and Audiology. Aim: To encourage students to participate in international Results: Students who had experienced EMP were more exchanges and to facilitate learning and adaptation during successful on reading test than students reporting no such studies in another country. experience. The study revealed that the variable “subject Summary: Focus groups were conducted with students area” was also related to test performance. Taken together, from different educational programs and semesters. Many the results of the study revealed that although the students students expressed a need for a better language support. with EMP instruction significantly performed better than A web site was constructed. It contains medical words those with no such instruction, the language ability and and phrases in different languages and examples of case reading level of all students were relatively poor. The sheets and gives cultural information on for example the efficacy of the EMP courses was regarded to be high. organization of the wards. Parts of the students’ travel Conclusion: Students admitted the great role of English in reports are also available, and there is a discussion forum. their academic and professional life and preferred Conclusion: We live and work in an increasingly autonomous learning study and liked to get more involved internationalized world. Medical students are encouraged in authentic language use in their EMP classes. EMP courses to study parts of their degree abroad. But to be able to are effective for students of Optometry and Audiology (it learn, communicate and interact in a different cultural can be just the same for all medical students). They believe

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that more materials should be provided for them and more 10 Onyx 1.13 emphasis should be made on class participation. Assessing communication skills of International Medical Graduates (IMGs). A 10 Onyx 1.12 comparison between IMGs and first year English as the medium of instruction in doctors entering the health workforce Norwegian medical training G Naden* and S Child (Auckland District Health Board, Clinical Education and Training Unit, Private Bag 92024, Monika Borgan (University of Oslo, Institute of Educational Research, Sem Selands vei 7, PO Box 1092, Blindern, Oslo Auckland 1003, NEW ZEALAND) 0317, NORWAY) International Medical Graduates (IMGs) make up a Background: Experiences have shown that language significant part of the New Zealand Health care system. barriers are a major obstacle to recruiting foreign students IMGs who have passed the Medical Council of New Zealand to university studies in Norway. To meet these challenges, licensing exam still face considerable obstacles to working The Faculty of Medicine at University of Oslo initiated a 3 in the health system. They are perceived as having year internationalisation project with English as the medium considerable communication difficulties and are often of instruction for one full term as the key component. offered jobs at times of acute shortage when there is less support available. The Clinical Education and Training Unit What was done: The project was implemented in the 9th at the Auckland District Health Board is piloting a 6 month semester of the medical programme where paediatrics and Transition to Work programme for IMGs over a two year gynaecology and obstetrics are the main topics taught. period. This new initiative for New Zealand includes a mix The students are offered different types of instruction; of structured supervision and clinical work with an PBL, plenary lectures, courses and bedside teaching – all emphasis on communication skills. conducted in English and for mixed groups of Norwegian and foreign students. An evaluation of this project was Good interpersonal skills in the consultation process are a conducted in 2004, emphasizing the educational major component in assessing the competence of the consequences of instruction in English. practising doctor. One of the outcome measures of this programme is the rating by patients of the communication Conclusions: After having observed different types of skill level of the IMG. Patient feedback on the IMGs was teaching, collected survey data from both teachers and sought by means of anonymous questionnaires at the end students, and interviewed representatives from both of the programme. Results are compared with patient groups, the analysis indicates that instruction in English feedback on first year New Zealand trained House Officers results in somewhat poorer teaching quality – with fewer after the same period of time within the healthcare system. details and less spontaneous use of examples. However, Results will be discussed and implications reviewed. this does not seem to substantially affect the students’ learning outcomes or their study habits. The majority of the Norwegian students also report to have improved their English proficiency.

Posters 10 Onyx 2 The OSCE

10 Onyx 2.1 stations. This suggests that video stations test knowledge Video OSCE stations: a statistical analysis of and interpretation rather than examination skills. performance Jonathan Round* and Su Li (St George’s Hospital Medical 10 Onyx 2.2 School, Paediatric Intensive Care, Lanesborough Wing, St. The use of video in paediatric OSCE George’s Hospital, Blackshaw Road, Tooting SW17, UK) stations: candidate perspectives Setting: Paediatric stations are often predictable, unreliable Su Li*, Peter McCrorie and Jonathan Round (St George’s and subjective. Therefore, stations featuring video of ill Hospital Medical School, Paediatric Intensive Care, children with short answer questions were developed. Lanesborough Wing, St. George’s Hospital, Blackshaw Road, Aim: To identify correlates of good performance in Tooting SW17, UK) paediatric video stations, comparing this with conventional Aims: Paediatric OSCE stations are predictable and stations. unrepresentative of clinical paediatrics. Video stations Methods: 197 students were examined in the 4th year showing acutely ill children with short answer questions, high-stakes OSCE and written paper. Video station focussing on observation and interpretation of signs were performance was compared to other sections of the developed to improve assessment. Candidate perceptions assessment. and experiences, preparation techniques and suggestions for improvement were evaluated for this study. Results: The paediatric video station mean score was 71% (5th-95th range 54 to 85%), higher than that for the other Methods: 20 students attended semi-structured interviews stations (62%, 41 to 82% respectively) (p<0.0005). Video following a high-stakes examination incorporating a video station performance was poorly correlated with overall station. OSCE mark (r=0.24) and it was the least well correlated Results: Content, validity and preparation: Candidates said station. OSCE performance was well correlated with the the station required ‘fast thinking’, testing observation, written assessment mark (r=0.58). Correlation between interpretation of signs and ‘knowledge recall’. However, individual stations and the written assessment ranged from some stated interaction with children was not tested, just r=0.17 to 0.28. Best correlated with the written exam ‘looking for signs’. Some couldn’t ‘predict what would come was the video station. up’, so could not revise strategically. Others revised likely Conclusions: Despite intending to test observational skills, systems (‘respiratory’, ‘development’), or saw ‘more paediatric video station performance best correlated with patients’, ‘paying more attention to observation’. Many written examination performance, rather than other OSCE requested videos for revision.

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Reliability: Students said it was ‘more standardised’, ‘very suffering from chronic pain are often depressed”, 41.03% objective’ with ‘no interpersonal bias’. were neutral and none disagreed. Technical aspects: Many worried that ‘not enough (video) Conclusion: Attention should be paid to educational loops would be seen’, that ‘no examiner (was) present to methods about helping the students to implement the provide instructions’ and about ‘picking up a lot’ quickly. learned knowledge in their practice. Formative assessment of both knowledge and skills is essential for the Conclusions: Most thought it better than traditional development of a functional pain curriculum. stations, being fairer, more reliable and less stressful, but said examining and interacting with children was not tested. Most concerns were technical. 10 Onyx 2.5 Do trained examiners agree in their 10 Onyx 2.3 assessment of students’ communication Evaluation of standardized ethical OSCE of skills? Results of a validation study the last year medical students I Muehlinghaus*, S Scheffer, A Froehmel and W Burger W Thianjaruwatthana*, S Vasanawathana and N Makachen (Universitaetsklinikum Charité Berlin, HU zu Berlin, (Khon Kaen Regional Hospital, Medical Education Center, Reformstudiengang Medizin, Trainingszentrum fur Aerztliche Srijan Road, Amphur Maung, Khon Kaen 40000, THAILAND) Fertigkeiten (TAEF), Schumannstr. 20/21, Berlin 10117, GERMANY) Objective: To develop objective structured clinical examination (OSCE) to assess the competency of clinical Background: In the Reformed Medical Curriculum at Charité ethics of last year medical students from Khonkaen Universitaetsmedizin Berlin students have to take part in Hospital, and evaluate inter-rater agreement. a communication skills (CS) training program for ten semesters. Standardized patients (SPs) are employed as Method: Ten interns were used to develop the OSCE before an important tool to teach CS. Students‘ clinical applying it to 33 last year medical students. Ten four-minute competencies are assessed with OSCEs. CS were not yet OSCE stations were developed using VCD between examined as an own entity. physicians and standardized patients. Five six-minute stations were developed using standardized patients and Summary of work: The goal is to introduce a global rating families, and each student was scored on his interaction. scale (GRS) (Hodges & Mc Ilroy, 2003) to assess CS in the Checklists had equal values each station, rating by two OSCE. Therefore the first step is to validate a translated independent observers. The validity was evaluated version of this GRS in a different context. In this study CS compared to the direct observation score, based on attitude of 22 third year students were assessed in one OSCE station and performance of taking care of patients through year by two trained OSCE examiners and three trained SPs rating from staff. Spearman’s correlations and Intraclass independently. Correlation Coefficient (ICC) for inter-rater reliability were Conclusion: It will be presented how the raters agree in used. terms of inter-rater-reliability in their assessment of CS Results: The student who had the lowest score was match and how the results contribute to validity. Further steps in exactly with the score from direct observation through the the assessment of CS at our institution will be outlined. year. Inter-rater reliability for two-rater scores ranged from Take-home message: A careful validation is necessary 0.48 to 0.90; 70% of the stations had coefficients more before implementing a new assessment tool. A rater- than 0.7, overall inter-rater correlation was 0.8 (p<0.05) training is crucial if CS are evaluated by a GRS. Conclusions: The OSCE had satisfactory validity and inter- rater agreement. It was suitable to evaluate the 10 Onyx 2.6 competency of ethics. Use of a Physician Extender (PE): adaptation to an Objective Structured 10 Onyx 2.4 Clinical Examination (OSCE) for a student Training medical students to manage a with physical disability chronic pain patient: both knowledge and Ximena Triviño, Maria I Romero and Fernando Pimentel* communication skills are needed (Universidad Católica de Chile, Escuela de Medicina, Noruega Leila Niemi-Murola*, Pirkko Heasman, Eeva Pyörälä, Eija 6595, Dpto 1804, Las Condes, Santiago, CHILE) Kalso and Reino Pöyhiä (Helsinki University, Research & Summary of work: The medical curriculum was adapted Development Unit for Medical Education, PO Box 63, Helsinki for a physically disabled student, implementing reasonable Fin-00014, FINLAND) accommodations. With this purpose, a PE was incorporated Aim: Most studies concerning pain education of to assess clinical performance of a female student with undergraduate medical students focus on knowledge, but artificial arms and legs in the OSCE for Introduction to little is known about the interviewing skills and pain Internship Course. The OSCE had 21 stations, including evaluation. cardiopulmonary resuscitation, immobilization and foreign body extraction. In this setting, the PE executes instructions Summary of work: At the end of the 5th study year the given by a disabled student. A woman accomplishing the students were asked to answer an electrical questionnaire requirements of not being disabled, responsible, reliable, to evaluate how the IASP curriculum on pain had been without medical knowledge and previous relationship with covered during the studies. Their interviewing skills were the student was selected. She received instructions of her assessed using an OSCE. The students met a SP suffering role: maintained an alert, active and neutral attitude, asked from postherpetic neuralgia, who was instructed to express questions only when not understanding and followed the depressive and exhausted feelings. The students’ attitudes student’s pace. The student, her classmates and PE were to chronic pain were asked at the beginning of the 6th surveyed to explore their perception on the study year. accommodation. Summary of results: There were 97 students in OSCE and Summary of results: OSCE average was 80.6% (SD 3.8). 35% of them responded to the IASP pain questionnaire The student scored 82% and the experience and with identification. All students evaluated teaching of performance of the PE were positively evaluated by her. postherpetic pain and antidepressant treatment as Her classmates stated that the accommodation did not sufficient. 88% of the students made the correct diagnosis constitute a disadvantage. PE stated no difficulties. in OSCE. However, only 35% asked about sleep disturbances and 16% about depression. Attitudes: Conclusions/take-home messages: A student with physical 58.97% of the students strongly agreed with item “patients disability can successfully accomplish the learning

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objectives. Literature reports that PE is a competent so that it justifies its application in the formative process assistance for clinical teaching. Our experience shows that of the students of medicine. PE can also be used for clinical assessment. 10 Onyx 2.9 10 Onyx 2.7 Changing from the modified Angoff to the Judging clinical competencies in pediatrics Borderline method of standard setting in third year medical students J M Scollay*, L Dalziel, P Warren, R W Parks and H S Cameron Nydia Bonet* and Mariana Tabares (University of Puerto Rico, (University of Edinburgh, University Department of Surgery, School of Medicine, Calle 4 #27, Villa Los Olmos, San Juan Lecturer’s Room, Ward 106/107, Royal Infirmary of Edinburgh, PR 00927, PUERTO RICO) 49 Little France Crescent, Edinburgh EH16 4SA, UK) Purpose: The evaluation of applied knowledge is a Background: The modified Angoff method of standard formidable task during the clinical years. Pediatric setting has been used extensively for OSCE by Edinburgh Clerkships need to evaluate students’ critical thinking using University. However recent interest in changing to the clinical cases. An OSCE was design using 19 new created Borderline method prompted an evaluation of the two cases for the end rotation clinical skills performance methods. The aim of this study was to determine what evaluation. difficulties may be encountered changing from one method to the other. Method: The evaluation design consisted of 3 stations of 17 minutes each; evaluating: health maintenance topic; Summary of work: Prior to a professional OSCE in June applied clinical knowledge in common pediatric illnesses; 2004, examiners were asked to complete an objective adolescent issues, physical examination skills, patient assessment sheet and award a global impression grade education, diagnostics, management and medical for each station. Pass marks calculated by the borderline prescription writing. Other topics evaluated included: method were then compared to the modified Angoff pass communication skills, nutrition, child abuse, manage care marks. Only the pass marks obtained by the modified and radiology. Angoff technique were used for summative assessment. Results: Over a 2.5 years period 286 students were Summary of results: Analysis of pass marks using the two evaluated. 96.50% approved the exam on the first take. methods identified several potential problems. Some The mean score was 81.92% (min. 59.40%, max. examiners failed to classify any students as borderline. In 98.90%). A tendency to improve over time was observed selected stations, pass marks obtained by the borderline in the performance of students along the academic year. method differed greatly from those obtained by the Students find this exam to be challenging. Opinions from modified Angoff method. Some students scored highly but students reveal satisfaction over this learning experience. were still be labelled as ‘fail’ by examiners. They suggest providing more time to the post encounter Conclusions/take-home messages: The borderline method session. of standard setting is a potential alternative to the modified Conclusion: This structured evaluation method can detect Angoff method. However introducing the borderline the weakness points of students and helps in guiding and method may be associated with marked discrepancies. developing students’ performance. Third year OSCEs also Examiners must receive appropriate training prior to using help students prepare for their 4th year CPX and for the this method. USMLE step 2 CS exam. 10 Onyx 2.10 10 Onyx 2.8 Applying an OSCE to assess next steps in Clinical competence in family medicine with clinical training in Uruguay the OSCE A Belloso, G Garcés*, S Soria, F Ferrando and E Macri J A Trejo*, S Morales, J Peña, J Cid, J Díaz and R Luis (University Hospital, Rambla O’Higgins 4865/502, Montevideo (Universidad Nacional Autónoma de Mexico, Calzada de CP 11400, URUGUAY) Guadalupe, 120 Mod. 23-601 Col, Ex - Hacienda de Coapa Background: In 2004, an OSCE to assess clinical skills was del Tlalpan, CP 14310, MEXICO) reported. 62% of students in the same cohort, now at the Aim: To evaluate the clinical competence of students in end of their second clerkship year, were assessed with Family Medicine with the OSCE. OSCE. Because of low funds, limited number of examiners and more challenging design of stations, the Summary of work: Standardization does not exist in the implementation was more difficult. We did not return to clinical assessment of students in the six areas of the ¨long case¨ final exam. undergraduate Internship, Surgery, Gynecology, Internal Medicine, Pediatrics, Emergencies and Family Medicine. What was done: OSCE was included as 8 stations, 7 We formed a committee to design the OSCE. We began to minutes each, assessing skills and knowledge on history evaluate the clinical practice with it to overcome the taking (HT) diagnosis, radiological and laboratory findings limitations indicated before. We evaluated 210 students interpretation, management and counselling. HT stations in 2003 and 2004. They had finished 2 months in a Family also assessed communication and organization skills. The Medicine service. Each exam consisted of 10 stations of checklists were designed by an Exam Committee (EC), in six minutes. Standardized patients participated in seven order to assure validity of contents. 154 students performed of these and three of them were studies of laboratory and the exam in 7 parallel tracks. 28 medical tutors acted as cabinet interpretations. observers. Simulated Patients (SP) were professional actors previously trained. Results: We obtained a reliability of 0.47 with the Cronbach á test and a weighted mean of 63. Results: Item-total correlation (ITC) was more than 0.21 in 6 stations, but was low for two stations (0.03 and 0.14). Conclusions/take home messages: The challenges are to Based on these results EC eliminated the station with the improve the clinical assessment and increase the lowest ICT. Reliability analysis showed a Cronbach alpha participation of professors of the other 5 areas. The results of 0.51. Cutting score for SP based stations was the mean confirm the advantages of this instrument which makes a minus 1 SD. Assessment of examiners’ and students’ better way to evaluate clinical skills and detect the level of satisfaction was performed. advances and deficiencies in the development of these,

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Posters 10 Topaz 1 Professionalism and attitudes

10 Topaz 1.1 should be put on the socio-historical nature of professional Ambition and the health professional competence in medical practice. teacher; mirror, mirror on the wall Susan J Lieff (University of Toronto, Department of Psychiatry, 10 Topaz 1.3 Baycrest Hospital, 3560 Bathurst Street, Ste 4E44A, Toronto, Medical students’ approaches to gender Ontario M6A 2E1, CANADA) issues in the physicians’ work and career – Ambition is a desire for achievement and success. Health Women “personally engaged” and men professional teachers have both primary and secondary “positive in principle” ambitions. Primary ambition is defined as a desire for the development of competence and a professional identity in Katarina Hamberg* and Eva E Johansson (Umeå University, the students. Health professional academics often serve Department of Family Medicine and Professional Development, Umeå 901 85, SWEDEN) in multiple roles including: teacher, clinician, administrator, educator, researcher and other. Secondary ambitions are Background: Gender aspects are nowadays acknowledged defined as aspirations for success and achievement in their as important in medical research, clinical practice, professional and academic work beyond student physicians’ working climate and careers. This awareness competence and identity. How an academic health calls for implementation of gender perspective also into professional defines these multiple secondary ambitions medical education. At the medical faculty in Umeå, Sweden, will vary according to the roles and contexts in which they such efforts have been tried for some years. In this are focusing. A conceptual framework for the examination presentation I will describe the students’ reactions and of these secondary ambitions will be proposed. Extrinsic approaches to discussions about gender aspects in ambition is defined as a desire for success and achievement physicians’ working life. that is external to the teaching learning relationship e.g. a Summary of work: As part of a course in professional researcher will desire achievement of grants and development, the third term students attended seminars publications, whereas intrinsic ambition is a desire for and shadowed and interviewed physicians. The success and achievement that is realized within the examination was a written reflection about their future teaching learning relationship e.g. a teacher may desire job – including gender aspects. In 2002, 104 students that students feel satisfied. When these secondary (46 men, 63 women) agreed that their reflections were ambitions are monitored for alignment with student needs, used in research. Their narratives were analysed there is a tremendous potential for productivity and qualitatively according to grounded theory and four satisfaction in both parties. These secondary ambitions approaches to gender issues were identified; ‘Essential can, however, directly conflict with student learning needs and engaging’, ‘In principle important’, ‘Irritating’, and and when misaligned can suppress learning and ‘Neglecting’. development in ways that may not be apparent to the teacher. Application of this model can assist teachers in Summary of results: Men and women were found in all their ability to distinguish and monitor the multiple categories but while 62% of the female essays were motivations in their work with students in order to facilitate assessed as “essential and engaging” only 22% of the an optimal learning environment. male essays were. For teachers, this difference in interest between men and women is important to handle, and suggestions concerning curriculum, literature and group 10 Topaz 1.2 building will be addressed. Professional competence in medical practice: an alternative study of action 10 Topaz 1.4 theories among medical students, their The suggestions of the basic qualities for teachers, young and seasoned practitioners medical professionalism in Medical of medicine Education in Korea Glen Helmstad* and Goran Thomé (Lund University, Department of Education, POB 199, Lund SE 22100, Pock Soo Kang, Kwang Youn Lee*, Choong Ki Lee, Dong Hyup SWEDEN) Lee, Young Hwan Lee, Jae Ryong Kim and Jae Beum Bang (Yeungnam University Medical School, Department of Medical The ongoing changes of the contexts of work require Education, 317-1 Daemyung Dong, Daegu 705-717, KOREA) education that prepares for continuous development of Background: Social requirement of the professionalism in professional competence, and work organisations that medical education enforces the medical educators in Korea sustain such processes. The guiding ideas suggests that to try to introduce new learning contents and to revise professional competence involves understanding of the the existing curriculum. For this, they need to know the character of the work, what it takes to do a good job, how meaning and norm of educating professionalism in the professional competence is developed in that work, etc., Korean environment of medical practice. In the majority and that understanding is transformed in intelligent of the medical schools in Korea, there are 2 stages of conversations. The purpose is to describe how persons in premedical and medical courses of 2 and 4 years medical education and practice understand and explain subsequently. This study is focused on basic qualities of the meaning of “professional competence”. The study medical professionalism in premedical education. The involves interviews with sixteen persons. The interviews selected 40 expert medical educators completed the were transcribed word for word. The analysis suggests questionnaire which is composed of 4 dimensions related that the general gist of the participants’ utterances is that to: 1) acquiring the basic qualities of medical professional competence in medical practice involves a professionalism; 2) supplementing the most deficient of broad and working knowledge base in medicine and a those qualities; 3) relevance between fostering those functioning way of relating to patients and colleagues as qualities and being well-grounded on liberal arts and social living knowledgeable bodies. It suggests also that the more sciences; 4) providing learning experiences to foster those experienced you are as a physician the more aware you qualities. The important basic qualities of medical are that professional competence is shared between the professionalism are basic knowledge in medicine, members of the communities of practice that you are a cooperation with other persons, the ability to gather and part of. Consequently, it is argued that more emphasis

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integrate information, and various sociocultural was preferred. CME and CE could facilitate the comprehension that is the most lacking. And to have implementation of a recertification system. students foster the basic qualities, they need to develop Conclusion: According to the results, Catalan physicians the programs for learning human knowledge and society. show an encouraging sense of social accountability and The contents of the learning programs should consist of they believe in the professionalism. sympathy and care of others, various comprehensions about human life, and the fundamental questions about human existence, in depth. 10 Topaz 1.7 Assessing professionalism: a postal expert 10 Topaz 1.5 rating to verify best answers in a paper- Making sense of emotional intelligence and-pencil-test through an ethnographic study of medical Claudia Kiessling*, Heiderose Ortwein, Antje Remus, students’ distributed learning in small Sebastian Schubert, Ulrich Schwantes and Oliver Wilhelm (Arbeitsgruppe Reformstudiengang Medizin, Charité, H U groups Berlin, Augustenburger Platz 1, Schumannstr. 20/21, Berlin N Lewis*, C Rees and A Bleakley (Universities of Exeter and D-10117, GERMANY) Plymouth, Peninsula Medical School, University of Plymouth Background: Developing multiple choice questions (MCQs) Campus, Room C301, Portland Square, Plymouth PL4 8AA, UK) is difficult and becomes even more difficult when there are no single right answers but single best answers. The Background/rationale: Emotional intelligence (EI) has a vital question is how to justify your best answer and to large academic and popular literature and is beginning to find attractive distractors. One solution is consensus-based be discussed within medical education journals. Where expert ratings. conventional models describe EI as an internal, static and measurable trait, we propose a model of EI as distributed, Work done: The authors report on a postal expert rating emergent and dynamic based on ethnographic using two different answering scales, a Likert-like scale observations of affective learning in small group contexts: and a rank order to review a paper-and-pencil test on the problem-based learning and the integrative ‘jigsaw’ professional behaviour in doctor-patient contact and group (where students reflect on their community teamwork. The test contains 17 descriptions of typical placement experiences). situations each with one to three stems and five to seven alternatives. The experts were either asked to use a four- What was done: Fourteen small group sessions with two point rating scale from “adequate” to “not adequate” to groups of first year medical students were observed and judge the answers (23 experts) or to rank the alternatives videotaped. Individual and group interviews were from 1 (best) to seven (worst) (19 experts, 25 non- conducted after the observations. Observational and experts). interview data are being analysed using intervention and thematic analyses respectively. Conclusion: Experts’ ratings and comments were helpful for reviewing the descriptions, stems, and alternatives. Conclusions: Preliminary analyses suggest some evidence Results from rank orders were easier to interpret than of individual emotional sensitivity within the groups (e.g. from Likert-like scales. The control-group was helpful to empathy). However, analyses so far indicate that identify questions that were too easy. Additional “super” distributed emotion (e.g. group emotional climate) is not experts were needed. The question remains: Who is the being managed effectively in these small groups by ultimate expert of professional behaviour in medicine? facilitators or students. Take-home message: Affective learning in small groups 10 Topaz 1.8 for medical students could be improved through attention to distributed EI. Cross-curricular integration of ethical basis for medicine students’ professionalism skills development 10 Topaz 1.6 Claudia Hernández Escobar*, Graciela Medina Aguilar, Physicians’ education and maintenance of Araceli Hambleton Fuentes, Leticia Elizondo Montemayor, competence: a view point from Catalan Antonio Dávila Rivas, Enrique Saldivar Ornelas, Mary Ana Physicians Cordero Díaz, Luis Alonso González, Daniel Dávila Bradley (Tecnologico de Monterrey School of Medicine, Hospital San J Palés*, A Gual, C Gomar, H Pardell and M Bruguera (Consell Jose/Ciencias Clinicas, Av. Morones Prieto No 3000 PTE, Català de Formació Mèdica Continuada (CCFMC), Còrsega Monterrey, Nuevo Leon 64710, MEXICO) 257, Barcelona 08036, SPAIN) Professionalism in Medicine Project’s objective is the Summary of work: In November 2004 the Catalan Medical development of professionalism skills, related with the Association organized the I Congress of the Catalan Medical continuous search of the patient’s well being, on the Profession. The session devoted to Physicians Education students at the various levels throughout the medical had three panels: Undergraduate Education, Postgraduate career. Medical ethics is considered among these Education and Continuing Medical Education (CME) and professionalism skills, laying the foundations for a decision Competence Evaluation (CE). For each panel several closed making process which is matured on its moral judgment. questions were exposed by a rapporteur and discussed The integration of the ethical basis contents throughout by the delegates. Their opinions were recorded by an the Medicine Bachelor’s career curriculum is considered electronic secret ballot. The number of delegates for each as a part of this project’s specific objectives. Likewise it is panel was 414, 429 and 431 respectively. the establishment of observable actions by means of which Summary of results: The relevant opinions supported by the student will substantiate both the contents and the more than a 50% of the delegates were: Panel I: Our development of moral judgment in order to achieve an Medical Schools have to define a common core curriculum ethical decision making process. The “ethical basis” which with humanistic subjects and increase practices. Faculties will constitute the reference frame for reflection, debate have to include society/profession representatives on their and practice for the student’s critical judgment throughout government committees. Panel II: It is necessary to the various stages of his/her professional training has been improve both the graduate educational program and the established, integrating the above-mentioned into different entry exam. Panel III: CME will be mandatory, during courses throughout his/her curriculum. Several didactical working time and including specific sanctions. A non and evaluation tools have been developed. Their validation punitive system of CE managed by professional is presented in this Abstract. With the aforementioned it organizations and complemented by a physicians’ register is sought, on the one hand, to have an impact on the

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student’s moral judgment development, the same that he/ Take-home messages: Abstract experiences of ethics in she will experience throughout his/her professional undergraduate medical education are not sufficient to equip practice; and, on the other hand, to stimulate the student’s students to deal with real life ethical challenges. Students critical judgment before both personal and professional need additional support in clinical settings. situations he/she will face on his/her daily chores and on his/her medical practice. 10 Topaz 1.11 Improving attitudes of final year medical 10 Topaz 1.9 students Empathic emotional tendency evaluation in medical graduating students: correlation S Saranrittichai*, S Vasanawathana, W Thianjaruwatthana and N Sensai (Khon Kaen Regional Hospital, Medical Education with gender and vocational aspects Centre, Ministry of Public Health, Sreechan Road, Muang R D Gallotti*, P L Bellodi, J C Oliveria, M A Martins and I F District, Khon Kaen Province 40000, THAILAND) L C Tibério (São Paulo University School of Medicine - USP, A low attitude to the medical profession is the obstacle to Faculty of Medicine, Rua Prof Pedreira de Freitase 151, ap medical practice. The strong student selection processes 91, São Paulo-SP CEP 03312-050, BRAZIL) did not guarantee their good attitude. Introduction: Although in modern medicine patients, Objective: To explore medical profession attitude, and physicians and society establish even more complex attitude improvement of final year medical students. interactions, empathy is considered one of the most important and essential humanistic characteristics, being Work done: 33 medical students completed questionnaires fundamental for consolidation of the physician-patient and participated in focus groups at the beginning of sixth- relationship. Although technical competencies are of great year to assess medical profession attitude. We constructed importance, empathy is critical for patient satisfaction in activities such as student-mentor relationship, role model, the health care process. small group discussion, and formative evaluation to improve the attitude. At the end of the year we evaluated the Objectives: To evaluate empathic tendency in graduating attitude by administered questionnaires, focus group medical students considering the influence of gender, discussion and in-depth interview. technical graduation scores, residency speciality choice and vocational personality aspects. Casuistic: We applied the Results: There was significant attitude improvement standardised Empathic Emotional Tendency scale (EET) (p=0.02) due to self esteem establishment and and a vocational questionnaire to 44 last year-medical participation in the health team. Reasons why they studied students. These data were correlated to final graduation medicine were social value, career security, caring for family scores and speciality residency choice. members, and parents’ need. For career dissatisfaction were patients’ complaints, workload, stress, and high Results: EET score (mean±standard error) was 43.7±3. responsibilities. Only two students did not change their There were no differences in gender and final scores. low attitudes because they planned to work in areas non- Students approved for clinical residency have higher EET related to medicine. scores (P=0.02). Regarding aspects influencing medical choice, higher EET scores were found among students Conclusion: Mentoring, adding proper activities and whose vocational option was influenced by altruism awareness were the keys to improving the attitude towards (P=0.03). the medical profession. Conclusions: The application of EET contributed to the Take-home messages: Self-esteem is important to improve comprehension of medical students’ profiles regarding the attitude. speciality choice. Altruism, as a vocational characteristic that begets patients’ trust, was associated with more empathic tendency mainly for clinical residents. 10 Topaz 1.12 What is a good doctor? Experiences with a seminar on good medical practice at the 10 Topaz 1.10 Charité, Berlin Medical students’ confidence and perception of support in ethically challenging situations Rita Leidinger* and Claudia Kiessling (Arbeitsgruppe Reformstudiengang Medizin, Charité Universitaetsmedizin Catherine Hyde*, Chris Bundy, Sarah Peters, Bryan Vernon Berlin, Schumannstr. 20/21, Berlin D-10117, GERMANY) and Lis Cordingley (University of Manchester, Medical School, The Faculty of Medicine, Dentistry, Nursing and Pharmacy, In Winter 2004 we offered a seminar on good medical Room 2.522, Stopford Building, Oxford Road, Manchester M13 practice. It was part of the special study module “Principles 9PT, UK) of Medical Theory and Practice” at the reformed medical track in Berlin, which comprises a variety of disciplines Aim of presentation: Medical ethics teaching now forms (e.g. ethics, sociology, history). Students must participate part of the core teaching in most UK medical schools. There in four seminars during five years of studies. They can is growing evidence that students regularly face ethically choose seminars of their interests from a set range. Our challenging situations throughout their undergraduate seminar aimed at sharpening the awareness for different learning. This research aims to investigate how equipped definitions of a good doctor and which relevance they have students feel to deal with such situations, and the amount for professional life and education. First we gave a and types of support they receive in the clinical setting. theoretical introduction about medical codes developed Summary of work: A cross-sectional web-based survey of from the Hippocratic Oath. Then students were medical students from years 3-5 at 3 UK medical schools teamworking on definitions of different actors in health was undertaken over a two-month period. Students were care. (The good doctor viewed from medical association’s asked about types of ethically challenging situations they professional code of conduct, individual doctors, patients, had experienced, their confidence in dealing with them public and medical students; a further focus was the view and sources of information and support. Data from 615 on unhappy doctors.) Philosophical and ethical terms such students were analysed using the relevant descriptive and as altruism, burnout, medical care and autonomy, univariate techniques. professionalism and the importance of ideals were discussed. The concept and structure of the seminar Summary of results: The majority of medical students (discussions, literature studies, teamwork) proved experienced ethical challenges during undergraduate successful in course evaluation based on questionnaires. teaching. Levels of confidence in dealing with such Our presentation gives a critical survey of the course, situations were low. Whilst students used a wide variety considering the students’ evaluation as well as our own of sources of support the majority felt that they needed experiences. more support.

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Posters 10 Ruby 1 Teaching and learning about research methods and evidence based medicine

10 Ruby 1.1 10 Ruby 1.3 Legitimacy in medical education research: Integrating evidence based medicine to a current debates, future directions medical school curriculum Mathieu Albert*, Brian Hodges, Glenn Regehr and Lorelei Hamdi Akan, Atilla Elhan, Aydan Ikinciogullari, Yildir Atakurt, Lingard (University of Toronto, Wilson Centre for Research In Sabri Kemahli*, Yasemin Oguz, Olcay Tiryaki Aydintug, Tumer Education, Toronto General Hospital, 200 Elizabeth Street, Corapcioglu, I.Hakki Ayhan (Ankara University, Departments E.S. 1-565, Toronto, Ontario M5G 2C4, CANADA) of Medical Education and Pediatrics, Faculty of Medicine, Morfoloji (Dekanlik) Binasi, Sihhiye, Ankara 06100, TURKEY) Medical education research (MER) has recently experienced tensions about the nature of the research that should be In year 2002 Ankara University Medical School decided on prioritized. This study explored these tensions to better a major curricular change and developed a problem-based understand their sources and impacts. Twenty-three well- hybrid curriculum. Evidence-based medicine course was established researchers in MER, including journal editors introduced as one of the innovations in the new curriculum and directors of research units, were sampled to represent as a 3-year program. The first part is basic computer major viewpoints on MER. Interviews focused on their education performed in a computer laboratory. This conception of “legitimate” science and methodologies. A program is followed by a module called “Forming of a commonly perceived challenge facing MER is the lack of Scientist”. The second year begins with a module called coherent progress resulting from the predominance of “Medicine and Health”, followed by a program of “Applied projects that are small-scale rather than multi-institutional, Biostatistics in Medicine”. In the third year, the first part is and opportunistic rather than based on a sound knowledge a small module called “Medical Informatics” followed by of the literature. Participants identified structural and “Principles of Clinical Research”. After this, “Advanced cultural constraints. Structural constraints included Statistics” practice is given. The rest of the third year is insufficient research funding, service obligations to their based on Evidence Based Medicine and divided into 2 parts: medical schools, and a lack of venues to report theory- The first module is “How to find and use the Evidence in based research. Cultural constraints included the field’s Medicine?” and “Practice in Clinical Research and attempt to integrate social science epistemology into a Epidemiology”. All these modules are given as lectures, biomedical science culture and the need to develop skill developing practices and computer based learning. legitimacy in medicine. Discussion regarding MER’s future The assessments are by multiple choice exams, student might profit by framing the debate not only around presentations and computer-based practical examinations. structural constraints but also around cultural constraints. This is a dynamic program which is open to any changes Indeed, MER’s development is linked to its recognition as that will make it efficient and targeted and may serve as a a social science, and as such, as a scientific endeavor good example. endowed with its own specificity. 10 Ruby 1.4 10 Ruby 1.2 Use of scientific information resources Understanding and applying scientific among medical students methods during medical school: results of a Matti Aarnio* and Kalle Romanov (University of Helsinki, workshop and a student conference at the Research and Development Unit for Medical Education, Charité Faculty of Medicine, PO Box 63, Helsinki 00014, FINLAND) Philip Burgwinkel*, Waltraud Georg, Thomas Keil, Claudia Aim: We surveyed (Nov. 2004) the use of scientific Kiessling and Jacqueline Muller-Nordhorn (Charité Berlin, information resources among medical students. They were, Schumannstr. 20, Berlin 10117, GERMANY) among other things, asked the frequency and purpose (studies, research) of using electronic information Background: The Reformed Medical Curriculum at the resources (Medline, fulltext articles, Cochrane Library, etc.). Charité, Berlin, includes a mandatory 4-week research The survey was addressed to 924 students (response rate: elective at the beginning of the fourth semester. The 45.2%). purpose is to allow students to pursue a medically-related, individually set up research project. Finding a hypothesis Results: The use of scientific information resources among and organizing a supervisor is entirely the student’s medical students increases evenly towards the end of their responsibility. At the end of the elective, students have to studies. The exception is Cochrane Library, which is hand in a written report or design a poster summarizing relatively rarely used before the final year (C1-5 41% vs. their results. In addition to the help provided by their C6 68%). The frequency of using computers in general is supervisors, students can participate in voluntary only moderately correlated (.15) with the use of information concurrent sessions on scientific methods such as defining resources. a research question, performing a literature search, Conclusions: These results may be explained by the fact collecting and analysing data and reporting their results. that the students are doing more independent work As these sessions were evaluated below average in the (theses) at the end of their studies. Then they also need last years, the format was changed. Instead of weekly more intensive clinical perspective of various topics, which sessions during the elective in previous years, this year is attained by clinical training and reading articles of clinical we offer a comprehensive two-day-workshop on scientific research. The students commonly search scientific methods at the beginning of the elective. Additionally, a information resources from electronic databases, however, student conference at the end of the semester is planned the fulltext articles are not used as often as their references where all students will present their results. and abstracts are searched for. Thus, in order to promote Methods: Questionnaires were handed out to students to the students’ scientific perspective, the use of these evaluate the two-day-workshop, the elective, and the information resources should be encouraged in the student conference. Quantitative and qualitative results curriculum. will be presented and compared with last year’s course evaluation.

– 216 – Session 10 FRIDAY 2 SEPTEMBER Session 10

10 Ruby 1.5 Teaching and assessing critical thinking skills in an undergraduate curriculum 10 Ruby 1.7 Alan Castle (University of Portsmouth, Centre for Radiography Medical dissertation: long-term results of Education, St George’s Building, Portsmouth PO1 2HY, UK) the graduate programme at Berlin’s Charité Aim of presentation: Enabling students to develop critical J Klank*, D Schnapauff, E Zimmermann, E Schönenberger and thinking skills is one of the key aims of higher education M Dewey (Charité - University of Medicine Berlin, Department and in preparing health professionals for future practice. of Radiology, Promtionskolleg, Schumannstr. 20/21, Berlin The aim of the poster is to compare students’ self- 10117, GERMANY) perception of their critical thinking skills to their actual Aim: We aimed at determining the efficiency and long- written assessment performance and to suggest ways to term effects of the peer education graduate programme improve the teaching and assessment of critical thinking at Berlin’s Charité. skills. Summary of work: Thirty-one workshops took place Summary of work: Students were asked to self-report how between October 2001 and February 2005. They were they thought the course had developed their critical student-organised, problem- and in part computer based thinking skills and the outcomes of this exercise was (see session 2M1, AMEE 2003 for details). The participating compared to the scores of previous assessments that students answered an anonymous questionnaire to required the demonstration of these skills. evaluate the quality of the workshops (range: 1=very good Summary of results: The results indicate that whilst to 5=unsatisfying). In addition, thirty-three participants students report having developed critical thinking skills of the initial four workshops were asked two years later to during the course, the results of written assessments determine the long-term effects. suggest little attempt to use these skills in their written Summary of results: The response rate was 93% (257/ work. 277 students). Ninety-seven per cent of the responders Conclusions/take-home message: Thirteen components of would definitely recommend other students to participate critical thinking are proposed, together with ways in which in the workshop. Students’ assessment of their own skills they could be incorporated into the curriculum. It is for pursuing a dissertation before and at the end of the suggested that educators may need to review the workshop were 3.54±0.79 and 1.94±0.53 (p<0.001), constructive alignment of their curricula and re-assess their respectively. Additionally, after two years, the participants teaching and assessment strategies in order to effectively indicated a relevant improvement in skills for pursuing a encourage students to develop their critical thinking skills. dissertation. Ratings for certain parts of the workshop, e.g. Literature research and Statistics, significantly improved over the four years (p<0.001). 10 Ruby 1.6 Medical students’ opinions on medical Conclusions/ take home messages: This peer education workshop of the graduate programme at the Charité enjoys research, before and after science education a high acceptance among students. Daphne Bloemkolk*, Mandy van den Brink, Franciska Koens, Ronnie van Diemen-Steenvoorde and Maarten Boers (VUMC, Department of Clinical Epidemiology and Biostatistics, PO 10 Ruby 1.8 Box 7057, Room PK 6 Z 179.1, Amsterdam 1007 MB, Diagnostic errors are the errors of clinical NETHERLANDS) reasoning Aim of presentation: Research is a necessity for medicine Andrey Kuimov and Irina Kuimova (Novosibirsk Medical in general. Nevertheless, few medical students are Academy, Selesneva 52-20, Novosibirsk 630112, RUSSIA) motivated to perform medical research. The purpose of this study was to investigate students’ opinions on medical Aim: The analysis of clinical misdiagnoses on the data of research before and after a course Science Education (SE). post-mortem examination was done to evaluate the errors of clinical reasoning. 200 cases of the discrepancy between Summary of work: We developed a 25-item (5-point Likert clinical and autopsy diagnoses were examined in the 1st scale) questionnaire, consisting of six categories: (1) Clinical Hospital of Novosibirsk. intrinsic motivation, (2) extrinsic motivation, (3) personal interest, (4) explorative curiosity, (5) future expectations Summary of work: All diagnostic errors were divided in and (6) doctors and medical research in general. Second two groups: objective and subjective ones. The first group year medical students (n=340) of the VU University Medical (objective errors) is considered as the fault of diagnostic Center were asked to fill out this questionnaire before and skill, knowledge base and experience. The second one after SE. (subjective errors) is dependent on the inability to interpret data, generate hypotheses and establish clinical diagnoses. Summary of results: Response rates were 55% and 30% The first group consists of 38% errors compared with 62% before and after SE respectively. Preliminary results showed errors in the second group. 93% of objective errors were no significant differences in student ratings before and due to lack of time to examine the patient (less than one after SE. Most students agreed that medical research is hour). Most of the errors of clinical reasoning (second important and expected to use research results in their group) were due to incorrect identification and future practice (average scores 4.2, categories 5 and 6). interpretation of the clinical information – incorrect main However, they were neutral (average scores 3.2) in their syndrome (36%), incorrect hypothesis and its testing motivation to perform medical research themselves (20%) and incorrect clinical diagnosis and its complications (categories 1 and 2). (6%). Most of the reasoning errors were made on the 1st Conclusion/take-home message: Students acknowledge day of hospitalization – 35, 6% and over two weeks – 25, the importance of medical research, but are neutral in 9%. their opinion to perform medical research themselves. Conclusions: Analyzing the errors of clinical diagnosis with autopsy data, we confirm the position that the ability for clinical reasoning is independent of skill and experience and appears to be the dominant reason for clinical practice errors.

– 217 – Session 10 FRIDAY 2 SEPTEMBER Session 10

10 Ruby 1.9 10 Ruby 1.11 Teaching evidence-based medicine to Feasibility of eLearning distance course – medical students experience in Continuous Medical Education T Siriarchawatana* and Y Jariya (Buddhachinaraj Hospital, (CME) School of Medicine, 90 Srithamtripidok Road, Phitsanulok Kalle Romanov*, Leena Lodenius, Juha-Pekka Turunen, Timo 65000, THAILAND) Tolska and Helena Varonen (TUKE, University of Helsinki, Background: The recognition that the EBM process was Research and Development Unit for Medical Education, PO an important tool to improve medical care had led us to Box 63, (Haartmaninkatu 8), Helsinki Fin 00014, FINLAND) introduce an “introduction to EBM” course to the 4th year Aim: To assess utilization of a four weeks distance course medical curriculum of Buddhachinaraj Hospital, School of (free, 6hrs CME) in EBM, Medline, Cochrane databases. Medicine. Participants were recruited during 4h-course of informatics Summary of work: We incorporated 4 two–hour sessions in Finnish Medical Convention Jan 2005. Dec 2004 we of “introduction to EBM” course into the family medicine sent advance information of the distance course. 133 of block. The learning experiences consisted of lectures, 186 (72%) attenders enrolled in the distance course after workshops, computer lab and student presentation. The the lectures, where supplements were given (booklet, CD- contents include concept of EBM, formulating clinical ROM). questions, research methods, computerized searching Results: 80 doctors actually visited WWW site to medical database, critical appraisal and critically appraised participate, 63% of them completed the course topics. The course was evaluated with a paper successfully; 65% of specialists and 56% of GPs. The questionnaire. average number of visits to WWW was 17.1. Among Summary of results: Most students were satisfied with trainees, 9.9 working hours (SD 6.5) was reported, 62% the course contents and structure, convinced of the need of which was in WWW. Number of visits to WWW correlated to use EBM in their future medical practice. positively with number of the trainee’s own discussion messages, but neither of these were correlated with WWW Conclusion: To incorporate the teaching of EBM concepts hours. Visits and messages were significantly associated and skill into 4th year curriculum is satisfying from the with completion of course. Correlation of visits or discussion student’s viewpoint. The course may encourage them to messages with working hours was low (0.21, n.s.). Hours practice the EBM process in their future career. spent with supplements were correlated (.40) with WWW hours. 93% of trainees would recommend the course to colleagues. We observed sex differences in enrollment and 10 Ruby 1.10 commitment. Testing the face validity of a new EBM research evidence pathway Conclusions: Compliance to attend distance course was moderate (60%). Commitment was also moderate, 63% A Jones-Harris and P Miller (Anglo-European College of completed. Chiropractic (AECC),13-15 Parkwood Road, Boscombe, Bournemouth BH5 2DF, UK) Though the principles of Evidence-based practice (EBP) 10 Ruby 1.12 have been widely adopted throughout medicine, the Medical Education Bibliography between teaching of critical appraisal skills, at either undergraduate 1949-2004 or postgraduate level, does not necessarily translate into Surakrant Yutthakasemsunt* and Naruphon Yutthakasemsunt their use in practice. Although evidence-based health care (Khon Kaen Regional Hospital, 91-95 Ruamjit Road, Tamon and critical appraisal are being incorporated into the Naimuang, Muang District, Khon Kaen 40000, THAILAND) curriculum at many chiropractic colleges they do not seem to be greatly utilised in college clinics. It is likely that there Objective: To verify literatures related to “Medical are numerous reasons for this, however, one of the education” and establish “medical education bibliography”. perceived barriers to the implementation of EBP has been Method: We searched and retrieved term “Medical found to be deciding what constitutes the best research education” with 3 search-fields (any/keyword/title) in evidence with which to answer a particular clinical question. PubMed publication between 1949-2004. Then we have A set of evidence-based pathways were therefore done “Medical education bibliography”. constructed to aid the practitioner in this decision. The Result: “Direct WWW searching” and “Procite 5.02 pathways were based upon existing tables of evidence as software” got nearly the same amount (79690/79638), well as the qualitative research literature. They were starting with 22 articles in 1950 increasing to 3490 in 2004. designed to act as a simple to follow, desktop, “ready Any-search retrieved the most articles (144176/79638/ reckoner”, with the aim of facilitating both the teaching 11446) with the first one in 1949. Between 1950-1964, and clinical implementation of EBP, and furthermore to be title-search retrieved more articles but since 1965 keyword- inclusive of qualitative research methods. The current study search had a higher result with the best related content. aims to test the face validity of this EBP research evidence English is the most published language, then 33 other pathway; does it help individuals to determine the best languages and 101 undetermined articles (81%, 18.87%, research evidence with which to answer a given clinical 0.13% respectively). There are 27494 abstracts. Finally question? The data are currently being collected and the we have done an “Electronic medical education results will be available prior to the AMEE 2005 conference. bibliography 1949-2004” indexed by authors, keyword subject and medical education subject (35 categories of AMEE 2005). We have planned to appraise full articles as “Annotated medical education bibliography”. Conclusion: This is the “Electronic medical education bibliography 1949-2004” that needs worldwide cooperation to broaden publication forum in medical education. It is free bibliography about medical education.

– 218 – Session 10 FRIDAY 2 SEPTEMBER Session 10

Posters 10 Ruby 2 Undergraduate training in primary care

10 Ruby 2.1 10 Ruby 2.3 Positive undergraduate experiences deliver A multicenter study evaluating the effects more GPs to the NHS….or do they? of personal well-being on specialty choice B Noble*, P Croft, S Perkins and A Nonyane (University of among US medical students Birmingham, Department of Primary Care & General Practice, M R Thomas*, L N Dyrbye, K L Lawson, J L Huntington, P J The Learning Centre, Edgbaston, Birmingham B15 2TT, UK) Novotny, J A Sloan and T D Shanafelt (Mayo Clinic, 200 First Introduction: General Practice (GP) in the UK is Street SW, Rochester MN 55905, USA) experiencing recruitment and retention difficulties. Aim of presentation: We explored relationships between Although recently there has been a slight increase in the burnout, depression, quality of life (QOL) and U.S. students’ number of doctors recruited to GP, numbers are still far career plans. below government targets. Anecdotal data suggests that Summary of work: All 1,090 medical students in the state undergraduate experience of GP has a profound effect on of Minnesota were surveyed in 2004. Of this sample, 575 subsequent career choice. third and fourth-year students were eligible for this study. Method: This study developed a 4-minute structured Specialties were categorized as Primary Care, Surgery, and questionnaire looking at factors affecting GP career choice. Controllable Lifestyle. QOL, depression, and burnout were The questionnaire was piloted in March 2004 with GP assessed using validated instruments. vocational trainees (n=23) in the West Midlands. Following Summary of results: 232 returned surveys; of these, 123 this, redeveloped questionnaires were posted to all doctors planned a primary care, 68 a controllable lifestyle, and 41 (n=500 approx.) on the West Midlands GP vocational training course during April 2004. Responses were a surgical residency. Women were more likely than men to plan a primary care residency (58.9% vs. 46.3%, anonymous, and were collated, and analysed using SPSS p=0.05). Age (p=0.44) and debt (p=0.55) were not and Nvivo software. associated with specialty choice. Mean physical (p=0.16) Results: Initial results showed that there were two distinct and mental (p=0.69) QOL scores were similar across groups of GP registrars, UK and overseas trained. Early specialties. No differences in specialties were observed results suggest that a positive undergraduate experience based on overall burnout (p=0.61), symptoms of is likely to be a more significant factor in career choice in depression (p=0.85), or degree of emotional exhaustion UK trained students. (p=0.73) or personal accomplishment (p=0.36). Increasing Discussion: This presentation will report on the results depersonalization, however, was associated with a lower obtained and offer preliminary conclusions about the key likelihood of selecting a primary care specialty (p=0.03). factors affecting career choice in GP. Conclusions: We found no association between global measures of burnout, depression, or QOL and specialty choice in 3rd and 4th year U.S. medical students. Increasing 10 Ruby 2.2 levels of depersonalization were associated with a lower Undergraduate first year medical students likelihood of selecting a primary care related specialty. meet the community and local health services 10 Ruby 2.4 Joaquim Edson Vieira, Paulo Eduardo Mangeon Elias, Isabela UEA MS/BS: in primary care, distributed Martins Benseñor and Milton de Arruda Martins* (University of São Paulo, Medical School, Rua Ganges 168, Represinha, teaching leads to standardized knowledge Cotia, SP 06717-725, BRAZIL) acquisition Background: Primary Care discipline proposes health and Victoria Holliday* and Amanda Howe (University of East diseases as a social phenomena. We investigate the impact Anglia, School of Medicine, Health Policy & Practice, Norwich of Family Physician Program on freshman medical students. NR4 7TJ, UK) This Program relies on the work of community health Background/rationale: The UEA MB/BS has an innovative agents – local dwellers hired and trained to interact with model of community based learning for its students, families within a Primary Care Service. whereby 10 students attend the same practice over a year, Methods: After one year of working weekly with community seeing patients whose problems are matched to the agents from a Health Basic Unit in a city boundary, students objectives of the relevant Unit and problem based learning answered a Delphi questionnaire to point out qualifications cases. and a questionnaire with skills levels (0 – don’t know to 5 What was done? Primary care learning outcomes were – experienced) for the expected aims. developed for years 1-3 (comprising 61 weeks of primary Results: 162 students (93%) chose their acquired care based teaching) by the Unit Team consisting of qualifications as the understanding of 1. Social reality, 2. consultants, GPs and GP Tutors, covering topics such as Health agents’ duties, 3. Program principles, 4. Primary Locomotion, Circulation, the Senses, and Reproduction. Care principles and 5. A closer relationship with locals. Structured learning outcomes for each teaching day are Ability to identify areas or situations of high risk for health given to the GP Tutors who then customise their own reached a 3rd to 4th skills level while mapping the area Teaching Plans for the day, permitting flexibility and reached only 1st. variability. The GP Tutors are supported by three faculty development days a year, a dedicated Practice Discussion: Frequent scheduled practice allows recognition Development Tutor etc. Criteria were determined to and self-evaluation of abilities and attitudes related to a evaluate distributed teaching leading to standardized Community Oriented Medical discipline. Written assessment knowledge acquisition in primary care: Number of patients confirmed acquired aims. and conditions seen; Practice based testing; Summative Conclusion: Delphi questionnaire points out the needs for assessments; Student feedback. community oriented aims which enable students to develop Conclusions: Success of learning outcomes in primary care a critical perspective of health as a social phenomenon. teaching can achieve balance between predefined curriculum and flexible provision.

– 219 – Session 10 FRIDAY 2 SEPTEMBER Session 10

Take-home messages: Can satisfy standardized educational 10 Ruby 2.7 needs in highly distributed manner, managing variation CASEing the community…A Community through staff development and peer support. Preceptorship Course M Singh, S Griffiths*, V Ibrahim and A Coulter (Case School 10 Ruby 2.5 of Medicine, 2550 Kemper Road, no 109, Shaker Heights, OH Toward building a family medicine research 44120, USA) culture: curriculum strategies for student, Aim of presentation: Medical students are often taught resident and faculty development history and physical examination skills in their preclinical years, without the opportunity to reinforce learning of these Alan J Smith (The University of Kansas Medical Centre, 3901 highly valuable tools. In addition, students do not Rainbow Boulevard MS 1060, Kansas City, Kansas 66160, USA) experience first hand how socioeconomic factors dictate health care decisions until their clinical years. Background/rationale: Medical students do not presently perceive family medicine as a discipline in which to develop Summary of work: We propose a longitudinal ambulatory an academic or research career. Moreover, relatively few model which will be required of all second year medical family medicine residency graduates pursue fellowship students. Preceptors will be recruited from primary care training in research or faculty positions in academic family and subspecialty programs. The course will be divided into medicine. Yet, it is widely acknowledged that scholarship two 4 month blocks. Each student will spend ½ day a and the development of a research base are critical to week in their preceptors’ office during their assigned 4 defining family medicine as a medical discipline and to month block. An online curriculum, to assure standard advancing the specialty’s academic standing. learning of key ambulatory care topics (writing SOAP notes, understanding insurance choices, etc), will be an integral What was done: We established an “incubator part of the course. environment” for family medicine research within our medical school, residency program, and department by Summary of results: A group of students have tried this implementing an integrated research/clinical experience model as part of the Primary Care Track. Their feedback for medical students, a longitudinal research curriculum on both the clinical experience and online curriculum has for family medicine residents, and a career development been favorable with over 80% of students rating their program for faculty researchers. experience as “excellent”. Comments included (paraphrased), “It is creative and applies to medicine in Conclusions: Implementation of the “incubator” model has general, the entire class should be asked to complete it – resulted in increased student participation in family not just primary care track students.” medicine research; increased quantity and quality of faculty contributions to the peer-reviewed literature; more Conclusions: The Community Primary Care Preceptorship researchers involved as investigators on successful projects course has been successful and should be expanded to and grants; expanded core of faculty researchers serving the entire second year class. as mentors for students, residents, and other faculty; and increased faculty promotion. 10 Ruby 2.8 Take-home messages: A comprehensive approach, Closing the curriculum implementation gap: involving students, residents, and faculty, can increase the practical use of theory in curriculum scholarship, improve academic standing, and further evaluation develop family medicine’s research base. Patricia Régo* and Marie-Louise Dick (University of Queensland, School of Medicine, PO Box 1247, Indooroopilly, 10 Ruby 2.6 QLD 4068, AUSTRALIA) How does a log-book influence the feedback Using a utilization-focused evaluation of a General Practice and interaction between GP and medical & Community (GP&C) rotation in the University of student? Experiences from the Berlin Queensland’s medical program, this paper demonstrates Reformed Track at the Charité, Germany the way theory can be used practically to explicate problem areas in medical curriculum delivery, conceptualise Ines Lange*, Claudia Kiessling, Susanne Pruskil and Dagmar evaluations, and support the development of action plans Rolle (Charité Universitaetsmedizin Berlin, Reformstudiengang to facilitate the implementation of change. Many areas Medizin, Schumannstr. 20/21, Berlin D-10117, GERMANY) raised by students as needing improvement appeared to Background: In a course called Praxistag, each have arisen as a consequence of the “newness” of the undergraduate medical student is taught by one GP GP&C rotation within the medical program, and the lack (General Practitioner) once a week from second to fifth of any coherent way of responding to student feedback. semester in order to improve clinical and communication As a consequence, Diffusion of Innovation theory and the skills, patient management, and practical procedures. To knowledge-utilization literature were applied in the analysis improve communication between GP and student a log- of the findings, and in the development of a plan of action book was introduced which includes all expected practical for immediate and future amelioration of problems. The skills to one cohort. The log-book helps the GP to know relative autonomy of clinical teachers means Schools of what to teach and provides the students with a catalogue Medicine are often constrained by the extent to which they of items in which they record the quality and quantity of can formalize the execution of a program. What effects do the requirements. The Praxistag is evaluated by students information dissemination gaps have on students and their concerning overall satisfaction, perceived feedback, teachers? Without reflection on information derived from application of knowledge into practice, and log-book after evaluations and concomitant action, there is a danger that every semester. The feedback tool of the log-book was ‘change’ to a program may simply be an adaptation made further adapted after one semester of application. We to fit (not alter) the status quo. expect a change in feedback-behaviour and self-reflection of students. 10 Ruby 2.9 What was done: The evaluation results of two cohorts Opinions of physicians about the relevance were compared over two consecutive semesters in order to analyze the progress in giving Feedback and students between content of M.D curriculum and self-reflection. Only one cohort (second-year-medical their professional needs student) was provided with log-book. Moreover, within this M Khaje Daluee*, A Derakhshan, H Karimi Moonaghi, T cohort the effect of further improvement of log-book (giving Hosseini and M Shayeste Khooy (Mashhad University of feedback) were analysed. The results will be presented. Medical Sciences, EDC, Mashhad, IRAN)

– 220 – Session 10 FRIDAY 2 SEPTEMBER Session 10

Introduction: Medical education is a complex process that 10 Ruby 2.10 aims to train the students in situations that they will meet Which factors influence the career choice of in the future in hospital, clinics, health care centers and medical students related to family their offices. So, first, it should be established how much the curriculum of medical education meets the professional medicine? needs. Peter Frey (Institute of Medical Education, Inselspital 38, Bern CH-3010, SWITZERLAND) Method: Questionnaires were designed and distributed among 125 physicians (GP) with one to two years Over the last years the number of undergraduate medical experience. The questionnaire was scaled from 1 to 10 students choosing family medicine as a career has steadily (from least relevant to the most relevant). declined. Studies have demonstrated that career preference at the time that students begin medical school Results: According to this research general practitioners may be significantly associated with their ultimate career graded the relevance of content of the medical curriculum choice. We sought to identify the career preferences to professional needs as 7.03±1.56. They mentioned that students have at the end of the medical school and the the ratio of ambulatory medical education to bedside was factors which influence the original career choice during nearly 2.5 to 1. Approximately 73% of them indicated that study time related to family medicine. ‘their needs in ambulatory education were fulfilled’ as low and very low, whereas 71% of them indicated that ‘the A questionnaire was administered to students ending amount of fulfilment of bedside education’ was sufficient medical school programs at the University of Bern, and highly sufficient. Switzerland. Students were asked to indicate their career choices and to rank variables influencing their career choice Conclusion: This study showed that the contents of the during the undergraduate medical education. The results medical curriculum are not completely relevant to GP and conclusions will be presented at the meeting. needs, especially in basic science. The recommendation is that there needs to be a shift in the emphasis from hospital to the community, and particularly to ambulatory centers.

– 221 – Session 11 FRIDAY 2 SEPTEMBER Session 11

Plenary New learning technologies

11.2 Information and communication 11.3 Needs and opportunities for more efficient technologies in higher education: Evidence- education within resuscitation based practices in medical education Tore Laerdal (Laerdal Medical AS, P O Box 377, Tanke Martin Valcke (University of Ghent, BELGIUM) Svilandsgate 30, N-4002 Stavanger, NORWAY) This contribution builds on an overview of the current Two thirds of deaths from sudden cardiac arrest and trauma potential of the information and communication occur out of hospital. Patient survival is dependant on a technologies (ICT) for higher medical education. Moreover, well functioning Chain of Survival, with early call for help, the talk will analyse current and future technologies in early CPR, early defibrillation, and early advanced life view of their potential for different phases in the active support. Therefore, beyond health care personnel with a learning process of students. The talk will especially focus primary duty to respond (physicians, nurses, ambulance on ICT that fosters the active organisation and integration personnel), large groups with a secondary duty to respond of new knowledge in the knowledge base. Building on a (fire fighter, police, occupational health personnel, cabin number of empirical studies, evidence-based design- attendants, etc) - and ultimately the population at large - guidelines will be put forward that can direct integrated must be trained in lifesaving rescue techniques. Issues uses of ICT in education. The focus will for example be on with traditional training methods include inadequate time the implementation of collaborative learning technologies for hands on practice, shortage of instructors, high costs, in medical education programmes, and their impact on and poor retention of skills. This presentation will review cognitive processing and performance. Reflection of opportunities of modern technologies and new educational medical practitioners, teachers and students will be approaches in dealing with some of these issues. presented, along with empirical results of quantitative studies.

– 222 – WEB POSTERS

Web Posters are available to view on the AMEE website (www.amee.org) but will not be presented at the Conference.

WBS The basic sciences

WBS 1 The relation between cadaver dissection WBS 3 “Keep the pot boiling” – How the first and anatomy learning preclinical years influence motivation and F Javadnia* and M Baazm (Ahwaz Jundishapour University interest in medical students of Medical Sciences, School of Medicine, Anatomy Goetz Fabry*, Marianne Giesler, Daniela Goos and Department, PO Box 61335, Ahwaz, IRAN) Waltraud Silbernagel (Albert-Ludwigs University of Aim: The aim of this study is to consider arguments Freiburg, Department of Medical Psychology, Rheinstrasse relating to the use of cadavers in anatomy learning. 12, Freiburg 79104, GERMANY) Introduction: Anatomy learning is generally seen as Background: Among the motives to study medicine one essential to medicine and exposure to cadavers is might be the positive anticipation of the future generally seen as essential to anatomy learning around professional life as a doctor. This anticipation is based the world. The gross anatomy course in medical on individual perceptions, conceptions and ideas at education provides the first opportunity for instructors hand which might be challenged by peers, teachers or to help students to appreciate patients as whole contents when students enter the university. Whether persons. Dissection is the most universal and universally motivation is maintained, enhanced or diminished recognisable step in becoming a doctor. Cadavers are during the course of studies will depend on how the referred to as great teachers and treated accordingly. interaction proceeds between these individual, The following points should be considered: (1) interactional and situational characteristics. Dissection gives students an important three- Summary of work: Against this background we asked dimensional view of human anatomy, dissection approximately 300 first year medical students in a reinforces and elaborates knowledge that is acquired longitudinal design about their motivation to study in lectures and tutorials; (2) It can be argued that medicine. We used a questionnaire that contained experience with dissection gives students a better questions on the vocational intentions and individual understanding of normal variation in human anatomy; aims in life. Furthermore we asked students for their (3) Removal or attenuation of cadaver dissection is perception of the working conditions in medicine and bound to impair the student’s ability to apply the of the public-debate concerning health-care issues. scientific method during diagnosis; (4) Working in the Finally we wanted to know how students managed so dissection room is also often perceived as good self- far, how they assessed their teachers concerning directed learning and team working. support and encouragement and if instruction met with Conclusion: A significant research programme will be their interests and needs. required to explore the above. Results: We are currently analysing the findings of our survey and will present the results at the conference. WBS 2 Facilitating anatomy education by Conclusion: The results will be discussed with regard enhancing the quality of plastinated to their relevance for medical education especially specimens curriculum design in the preclinical years. A Raoof*, C Baumann, K Falk, N Hendon, L Liu, A Marchese, L Marchese, R Mediratta, M Mirafzali, J Munch, WBS 4 The effect of education in the M Wells and H Zhao (University of Michigan Medical Microbiology Department on achieving School, Division of Anatomical Sciences, Office of Medical Education, 1135 E. Catherine Street, 3767 Medical Science the educational objectives II, Ann Arbor MI 48109-0608, USA) Foroogh Nejatollahi (Jahrom University of Medical At the University of Michigan Medical School, plastinated Sciences, Jahrom Medical School, Jahrom, IRAN) specimens have become an essential part in Background: The Microbiology Department is one of undergraduate, medical, and dental anatomy education. the major departments of basic sciences. Due to the The newly implemented, system-based, integrated important role of this department in educating about medical curriculum necessitated the introduction of a infectious agents and the relation of this education to different set of specimens that are more relevant to future clinical practice, we decided to determine the the new curricular approach. The aim has been to success rate of this department in achieving the provide specimens suitable to reflect systemic approach educational objectives. and essential concepts in anatomy to promote students’ Summary of work: A questionnaire based on goals was independent learning. Medical and undergraduate designed and 50 medical students participated in this students participated in preparing these specimens. study. Innovative approaches to enhance the quality of plastinated specimens were implemented such as Summary of results: The results showed that in 1st coloring neurovascular pathways and casting viscera and 2nd objectives (morphology, identification and to facilitate learning. The validity of these specimens pathogenesis), more than 70 percent of students and was tested through surveys administered to students. in 3rd and 4th objectives (diagnostic laboratory tests Also, a pilot study was conducted whereby the and control of infections), about 60 percent of students performance of a test group of medical students, who reported that the education is good. In 5th and 6th reviewed anatomy using the new set of specimens, objectives (clinical finding and treatment), 70 percent was compared to that of a control group using the of students had problem in understanding the clinical traditional set of specimens. Results indicated an overall features of infections and treatments. Female students acceptance of the new set of specimens as a valuable were better than males (P<0.05). resource for learning anatomy. The new approach in Conclusions: In conclusion the results of this study show preparing these specimens is planned for a wider the educational program of the Microbiology application in the future to assist faculty and students Department is good in morphology, identification, in the effective utilization of the time allocated to pathogenesis, diagnostic laboratory tests and control anatomy.

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of infections, but this department should pay more this important basic science with clinical microbiology attention to educating medical students about clinical and infectious diseases in our educational curriculum. findings and treatment. It seems necessary to integrate

WCA Clinical assessment

WCA 1 Final pilot trial of national CAT-OSCE for the need to further review instrument design, rater’s undergraduate medical students training and rating process to minimize personal bias errors: generosity to competent and severity to not Ichiro Yoshida*, Hiroki Inutsuka, Hitoshi Abe, Masayuki competent groups, and halo effect. Watanabe and Takato Ueno (Kurume University, School of Medicine, Office of Medical Education, 67 Asahi-Machi, Kurume 830 0011, JAPAN) WCA 3 Evaluation of an OSCE in “pain Background: Japanese medical education is facing management” drastic change such as privatization of all national W Georg* and M Schenk (Charité - Universitaetsmedizin universities (2004), a new accreditation system (2004), Berlin, AG Reformstudiengang Medizin, TAEF, a new model core curriculum (2002), a new preclinical Schumannstr 20/21, Berlin 10117, GERMANY) common achievement test (CAT-CBT and CAT-OSCE, 2005-2006), advanced OSCE in national board Background: In 2003 the undergraduate medical examination (2007-2009?) and a new postgraduate curriculum at the Charité- Universitaetsmedizin Berlin training program (2004). This paper describes the was changed due to new federal regulations which results of four pilot trials of CAT-OSCE at Kurume encouraged more interdisciplinary courses. Under the University in 2002-2005. supervision of the Department of Anaesthesiology a new interdisciplinary course “pain management” was Summary of work: In 2001-2002, the first pilot trial on developed and implemented for the first time in the CAT-OSCE was implemented with only 12 medical winter term 2004. At the end of the course students schools including Kurume University. In 2004-2005, all had to pass an OSCE, which was designed for the first 80 medical schools have decided to join for the final time. pilot trial on CAT-OSCE. One focus of these pilots will be to ensure that the clinical competencies can be Summary of work: Most of the 251 students had never assessed and make certain students are ‘fit for clinical run through an OSCE and were unfamiliar with this clerkship’. During the trial period, we experienced assessment format. Students answered an evaluation external rater system, improving the curriculum for ICM, form after the OSCE with questions regarding the establishing the clinical skills laboratory, common six organisation and content of the OSCE, correlation with core stations with standardization of case materials, course content and self-assessment of their own nationwide FD for assessment in CAT-OSCE, team performance. The response rate was very high (94,4 approach to make a good OSCE and change of learning %) and we will use the results to discuss and change attitude among medical students. the structure of the course and the assessment format. Conclusions: We believe that introduction of national Conclusions: A thorough evaluation of an exam provides CAT-OSCE will improve the undergraduate medical important information not only on the exam itself but education for basic clinical skills. also on course structure and content. We will report on the critical aspects of the OSCE and their implication for further course and assessment design. WCA 2 Objective Structured Clinical Examination (OSCE): use of checklist and global rating WCA 4 Standardized patients’ performance in a to measure clinical performance pain management OSCE Ximena Triviño*, Maria I Romero and Luis Villarroel (Universidad Catholica de Chile, Escuela de Medicina, B Kampel*, A Froehmel, S Townsend and W Georg (Charité, Noruega 6595, Dpto 1804, Las Condes, Santiago, CHILE) Universitaetsmedizin Berlin, AG Reformstudiengang Medizin, Schumannstrasse 20/21, Berlin 10117, Background: Global rating was added to improve the GERMANY) assessment quality of each station of a traditional OSCE. Background: For the first time, and within the Objective: to measure agreement between the two boundaries of the new general regulations of study, a types of scoring. new course on pain management was introduced at Summary of work: A total of 106 Clinical Course the traditional track of Charité-Universitaetsmedizin students were scored on a 10-station OSCE involving Berlin. 251 fourth year students were assessed on this standardized patients. Scoring at each station was subject by means of an Objective Structured Clinical performed by the same evaluator while observing the Examination (OSCE). student performance, using simultaneously a checklist Summary of work: An interdisciplinary group under the (%) and a general impression as global rating supervision of the Department of Anaesthesiology and (competent/not competent). Data were analyzed the staff of the Reformed Medical Curriculum developed through SPSS. Spearman and Kappa were calculated. the pain management course and OSCE. The case Summary of results: Considering each of the 10 histories presented were, for example, somatoform stations, 72% to 99% of the students were assessed disorder, different cancer cases and herpes zoster. After competent. The mean scores by station were 61.7% the assessment the students filled out a short to 83.1%, being different for the competent (62.4-84%) questionnaire regarding their first experience with compared to not competent group (35.7-77.1%). standardized patients in OSCEs. The authenticity of Comparing the two types of score, Spearman by station: standardized patients within the OSCE was rated. 0.551 to 0.857, with one R2 higher than 0.7. Two Conclusion: We will outline the strengths and stations obtained Kappa higher than 0.8. There was weaknesses of the standardized patient assignment in poor agreement between checklist and global rating a pain therapy OSCE. used as clinical performance assessment, pointing out

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WCA 5 The viewpoint of nursing instructors WCA 7 Assessment of clinical skills in about clinical evaluation undergraduate students S H Yektatalab*, M Dehghani and S Najafipor (Jahrom B Rosales*, S Morales, H Pineda, K Mendoza and U University of Medical Sciences, Motahari Street, Fars, Guzman (Universidad Nacional Autónoma de Mexico, Jahrom 74148, IRAN) Ofiuco No 13. Col Prados de Coycacán Delgación Coyoacan, Mexico DF CP 04810, MEXICO) Introduction: One of the most important parts of nursing education is the clinical environment. Clinical evaluation Aim: To evaluate the development of clinical skills in is important for assessing the effect of educational students of third grade of Medicine. programs, reaching objectives of the course, changing Summary of work: The study is a cross-sectional, students’ behaviour, improving teaching problems, and descriptive. A simple non-probabilistic, randomized also can result in psychological confidence in students, sample was selected and 110 students were evaluated. nurses and society. Nursing instructors should be aware They had finished the course of Propaedeutica and of clinical evaluation by participating in workshops and Physiopathology with a duration of 20 weeks. The educational courses. instrument used was a check-list of clinical history. It Materials and methods: This is a descriptive study. The explores three aspects: doctor-patient relationship, the subjects were 60 nursing instructors of Jahrom clinical skills for the history taking and the physical University of Medical Sciences who were selected by examination. The scale of grades was from 0 to 100 objective oriented sampling. Data were collected by a considering 60 the minimum. questionnaire which was prepared by researchers. Results: In the aspect of the doctor-patient relationship, Results: Results indicated that the awareness of about 36.4% of the students obtained passing scores, and 50% of instructors in clinical evaluations criteria was 63.6% obtained less than 60 points. In the interrogation weak and 20% was good. The awareness of 40% of 10% of the students obtained passing scores and 90% instructors in criteria of instruments for clinical less than 60 points. In the physical examination 17.28% evaluation was moderate, 40% weak and 20% good. of the students obtained passing scores and 82.72% The awareness of 80% of instructors in validity and less than 60 points. reliability of clinical evaluation instruments was weak Conclusions: The use of an objective instrument of and 50% were moderately aware of different clinical assessment with a check-list permits reliable results evaluation instruments. about the degree of development of clinical skills that Conclusion: 40% of instructors’ awareness was weak, students have acquired. 20% good and 40% moderate. Clinical evaluation workshops are suggested. WCA 8 Self evaluation and teacher evaluation of students’ practical skills WCA 6 How can the medical student’s progress Saeed Sobhanian* and Leila Mosalanejad (Jahrom School in the practical course of general of Medical Sciences, Jahrom Medical School, Motahari medicine be assessed? A comparison of Street, Fars, Jahrom 74148, IRAN) the assessment done by the training Background: Clinical evaluation is critically important doctors and the students themselves because competency in practice ultimately will Paul Jansen*, Michael Baur, Martin Butzlaff and Monika determine the future of advanced practice in nursing. A Rieger (Universität Witten - Herdecke, Fakultäat für Method: In this descriptive analytic study 51 students Medizin, Alfred-Herhausen 50, Witten 58448, GERMANY) were enrolled into the trial by a simple sampling Background: At the University of Witten/Herdecke, the method. The data were collected by questionnaire. medical students are trained by general practitioners The practical skills of each student were evaluated in their practice during six periods (each two weeks) subjectively (self evaluation) and objectively (teacher spread over five years of medical studies. This practical evaluation) by three teachers. The subjective training has to be assessed. The judgement of the evaluations were compared with objective values and students´ progress as reflected in the evaluation given the data statistically analyzed by Pearson correlation by the training doctors should be compared with the test. evaluation by the students themselves. Results: The mean score of numbers showed that Summary of work: Students and their training doctors students’ subjective evaluations were lower than the were asked to fill in a short questionnaire after each teacher evaluation values (mean students’ evaluation: period of practical training. The students stayed with 15/94, mean teacher evaluation: 17 (teacher 1), 16 their doctors over all training periods investigated. The (teacher 2), 17 (teacher 3). There was a significant questionnaire focussed on knowledge, competence and difference between the teacher evaluation (P=0.00) attitudes. Data were available for five student years, but not between the subjective and objective evaluation each covering 42 students. (P=0.197). Summary of results: The results of the students´ Conclusion: With respect to the results of subjective questionnaires showed rising values over the clinical and objective evaluations we suggest the use of student periods especially for the fields of knowledge and self reports in addition to teacher reports. More competence. This trend was consistent in all student evaluation techniques (peer/self/teacher) could be years investigated as well as in the pooled students utilized and might increase the self esteem of students. sample. In contrast, the general practitioners´ evaluation resulted in a heterogeneous course over the different clinical periods. The doctors´ values generally were higher than the students´. Conclusions/take-home messages: In order to make the doctors assessment more reliable, training of the teaching practitioners seems to be necessary.

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WCS Communication skills

WCS 1 Assessment of communication skills in transcriptions of audio data, for both ethical and medical students of University of practical reasons. This presents trainers with a dilemma Barcelona through the clinical interview because training in non-verbal communication techniques relies on impressionistic rather than in the last year of study research-led evidence. This presentation focuses on A Vallès*, R Sender, M Valdés and M Salamero (University how one method of analysing non-verbal behaviour may of Barcelona, Facultat de Medicina V.B., Casanova 143, be employed to inform such training. Barcelona 08036, SPAIN) Summary of work: Analysis attempts to describe non- Background: This study attempts to analyse the quality verbal communication from a corpus of 50 video of resources provided along the career by the School consultations collected in a Primary Care setting from of Medicine in relation to doctor-patient communication. 5 practices in central England; these practices were Since the third year of study, medical students have selected for demographic variety. been in contact with patients and experienced some clinical practice, so the final year of academic learning Results: Using a discourse analytical approach, the can be an appropriate time to evaluate their abilities, results describe when aspects of non-verbal in order to detect possible deficiencies and insecurities. communication impact on turn-taking sequences of Currently, our schools of medicine have no tradition in consultations, particularly looking at what specific non- teaching these matters and the correct professional verbal features encourage patients to open their own performance of future doctors used to depend on their agendas and facilitate more relationship-centred personal sensitivity to deal with people, without specific encounters. The results also look at variables such as professional training. gender and ethnicity in terms of non-verbal behaviour. Summary of work: In the academic course 2004-2005, Conclusions: The analysis presents evidence, albeit communication skills in a total sample of 150 medical small-scale, of the impact of non-verbal behaviours from students were evaluated by three questionnaires both doctor and patient on the course of Primary Care completed by a) the student, b) a simulated patient consultations. This will inform training in an area where (an actor) and c) an observer specifically trained. guidance was previously limited. Personal introduction, communication, anamnesis, record of psychosocial data, diagnosis, instructions and WCS 4 A survey of the communication skills of farewell were the elements particularly assessed. Our purpose is to present the preliminary results of the Ahwaz east health center personnel study, before the publication of the definitive report. T Marashi* and E Asady (Ahwaz Jondishapour University of Medical Sciences, School of Health, EDC Department, Ahwaz, IRAN) WCS 2 How do standardized patients assess Introduction: Communication skills are divided into students’ communication skills using verbal and non-verbal skills. The study looked at the patient opinion questions? interpersonal communication skills of Ahwaz east health A Froehmel*, I Muehlinghaus, S Scheffer and W Burger center personnel. (Charité - Universitaetsmedizin Berlin, AG Reform- Summary of methods: The cross-sectional study studiengang Medizin, Schumannstr 20/21, Berlin 10117, gathered data from all 57 female personnel working in GERMANY) Ahwaz east health center, who completed a 20-item Background: The Reformed Medical Curriculum at questionnaire. The choice ‘very poor’ was scored as Charité-Universitaetsmedizin Berlin provides zero and ‘very good’ was scored as 5. communication skills (CS) training and a standardized Results: The results show the mean as 77.75, the patient (SP) program throughout the entire curriculum. median 78, the lowest 55, the highest 100. Also 5.2% SPs are working in the fields of history taking, had an intermediate ability. They need an intermediate interviewing and counselling skills as well as in Objective training. 94.8% had high communication skills. 62.1% Structured Clinical Examinations (OSCE), but not yet of them scored between 61-80. 32.8% of them scored as examiners. between 80-100. Summary of work: To compare SP ratings using two Conclusion: Health service providers should have good different instruments: patient opinion questions (POQ) interpersonal communication skills to do their tasks (O’Neill, Williams & Kay, 2003) and a global rating scale more efficiently. In this study 94.8% of the personnel (GRS) (Hodges & McIlroy, 2003). The POQ as well as had high communication skills ability. They need to be the GRS were translated and adapted to fit our context. encouraged to improve their skills even more. The aim of this study was to find out SPs’ inter-rater- reliability regarding POQ and correlation between the two instruments. WCS 5 Teaching communication skills by role Conclusion: On this poster we will present and discuss play method in pre-medical education the results. Soo-Jung Lee* and Sun Kim (The Catholic University of Take-home message: Implications for a future Korea, Department of Psychiatry, St Mary’s Hospital, 505 integration to assess students’ CS will be described. Banpo-dong, Seocho-gu, Seoul 137-040, KOREA) Background: There is a rising demand for teaching communication skills in medical education as it is one WCS 3 Non-verbal communication: a video of the essential traits of medical professionalism. For analysis from a primary care setting such purpose, the Catholic University of Korea College A J Shanks*, P Croft and J R Skelton (University of of Medicine offers a communication skills course for Birmingham, Department of Primary Care, Learning pre-medical students in year 2. We performed this study Centre, Primary Care Clinical Sciences Building, to see the changes in the students’ level of Edgbaston, Birmingham B15 8TT, UK) communication skills by a role-play method for the Aim of presentation: Published research into the process communication skills course. of medical communication relies mainly on

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Summary of work: 125 pre-medical students in their communication and had the possibility to hear lectures second year in 2004 took ‘Communication skills’ course. about patient-centred communication earlier in the year. Students were divided into twelve small groups in order to perform role-play scenarios of various conflicting situations. The scenarios were purely made by the WCS 7 Needs assessment on family planning student themselves and each group performed their counseling skills in personnel of health role-play in front of the class. The students worked centers, Mashad, Iran, 2004-5 through the conflicting situation to solve the problems Afsaneh Nvaiian* and Talat Khadivzadeh (Mashad they faced. Through a student survey, students’ level University of Medical Sciences, School of Nursing and of communication skills and changes were assessed. Midwifery, Ebne Sina Street, Mashad , IRAN) Results and Conclusions: Students acknowledged Background: Counselling is a key competency for health communication as a very important skill in the doctor- workers. This study was conducted to determine the patient relationship and the student survey result need of personnel of mother and child health units of showed improvement in the level of students’ health centers in Mashad relating to counselling skills communication skills. in year 2004-5. Summary of work: In this descriptive research, 100 WCS 6 Role-play in communication training family planning providers were randomly sampled. Data enhances comprehensive knowledge about counselling skills were gathered by observation through a session of counselling with a client, using a Magnus Petersen (University of Southern Denmark, Faculty checklist. Data about demographic characteristics were of Health Sciences, Winsloewsvej 17, 1.s, Odense DK-5000, DENMARK) gathered by interview. Summary of work: To evaluate the effect of teaching a Summary of results: The performance of 62% of course on communication skills it was investigated providers in communication and greeting the clients, whether students who participate in a role-play training and performance of 18% in history taking and physical gain better results in a written test. Students’ exam and asking client needs, was good. In 22% of improvement in skills assessments through role-play counselling sessions the health workers, and in 54% training is shown in the literature. In this study the the clients, made a decision about the family planning mean of marks and the frequency of failure for students methods. 46% of health workers performed well in who participate are compared to those who do not. explaining the selected method, 74% suggested routine The written test with essay questions tests the level of follow up visits, whereas 68% of them hadn’t any students’ comprehensive knowledge in patient-centred suggestion on additional visits or occurrence of side communication and their ability to analyse a given effects of the selected method. Client privacy was consultation. considered in 18% of cases. Family planning counselling satisfied 32% of clients. Summary of results: Students who participate in a non- mandatory 30 lessons role-play training gain Conclusions: Most of the providers performed poorly significantly better results in the following examination. on taking history, physical examination and helping Their marks are statistically significantly higher clients select a method. Based on the findings of this (p=0.007). Students who do not participate in the research a plan of “instruction of family planning course have no other courses in the same period of counselling skills to providers” is being designed. In- time and are preparing for the examination by reading service education on counselling skills and control of the recommended literature. All students have written family planning health workers’ performance in a paper on conversation analysis of doctor-patient counselling is suggested.

WCEL Computers and e-learning

WCEL 1 Student input in strategic planning for improve the quality of technology-mediated learning information technology experiences; has increased student satisfaction with CIT services and provided the opportunity for students M Marquez*, E Martinez and D Adams (University of to play an active role in strategic planning. Puerto Rico, School of Medicine, PO Box 365067, San Juan 00936-5067, PUERTO RICO) Conclusions: Student input is a valuable resource for information technology strategic planning at medical Background: University of Puerto Rico School of schools; students are the main consumers of CIT Medicine has integrated information technology into services. its curriculum and allocated an annual operating budget for technology infrastructure. In addition, each student is charged with a tuition supplement for technology. WCEL 2 The teacher’s role in creating an The School’s Strategic Planning Committee and the interactive virtual learning environment Center for Informatics and Technology (CIT) are responsible for decisions on utilization of new Maggy van Hoeij*, Anke Bootsma, Sandra ter Horst and technologies. Willie Hols (UMC Utrecht, Onderwijsinstituut, afdeling ICT in Onderwijs, Str 0.304, Universiteitsweg 100, Utrecht 3508 Summary of work: To effectively serve and meet student AB, NETHERLANDS) needs, the CIT created a student advisory committee Aim: Our goal is to improve the use of the virtual with four representatives (one per class), the CIT learning environment (VLE) in biomedical education and Director and the CIT Administrative Assistant. This to achieve a situation where teachers use the VLE also committee has the responsibility of measuring student for interactive and collaborative learning and not just needs and satisfaction, presenting recommendations, for communication and delivery of content purposes. and overseeing the use of tuition supplement funds to assure its optimal utilization. Summary of work: 1) A reviewer has examined existing WebCT courses for appropriate didactical use. 2) In a Summary of results: The Advisory Committee has survey bachelor students and teaching staff members created an environment for the active exchange of ideas were asked for their opinions and expectations on the between students and CIT staff; has contributed to use of WebCT within the educational program.

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Summary of results: 1) Most courses make moderate demonstrate a high attitude toward the computer and use of the VLE. The courses are mainly used for internet technology and our data regarding their use organisational purposes and delivery of content, were parallel to those obtained in other Asian countries. whereas interactive tools like discussions and It is suggested that students be educated in the use of assessment are hardly used. 2) Although students find communication technology for research work. the VLE easy to use and teachers stimulate them in using it, students don’t use the VLE very often. Teachers indicate that they are not familiar with the didactical WCEL 4 Survey of knowledge and application of possibilities of the VLE, however they have a strong nursing students about Information desire to manage and design their own courses. Technology (IT) in Tehran University, Currently, this is done by a professional WebCT design 2005 team. Fatemeh Noughani* and Jamileh Mohtashami (Tehran Conclusions: In order to create a more interactive University of Medical Sciences, Faculty of Nursing and learning environment teachers should gain more VLE- Midwifery, Nursing Research Centre, Tohid Sq, Tehran oriented didactical awareness. Professionalisation of 141118, IRAN) teachers through courses, examples of good practice Background: The ability to use the Internet is an and the organisation of technical as well as didactical essential skill for nursing students, both to support their support is needed. studies, especially as nursing students spend a lot of their time on placement away from the university WCEL 3 Use of information and communication campus, and to support their development of skills in nursing through what is becoming an increasingly technology among medical students essential tool for professionals. In the context of Davar Aldavood (Medical University of Jahrom, developing the student’s information technology (IT) Ghasrodasht St59-p247, Shiraz, IRAN) skills, the variety may give rise to additional problems Aim: The aim of this study was to investigate the current of inefficient and inappropriate use of expensive knowledge, skills, and opinions of undergraduate computing resources. medical students at the Jahrom University with respect The potential diversity in the student body means that to cybernetics. it will always be difficult to predict accurately the Summary of work: Medical students from the second, breakdown of expertise among recruits to a typical third and fourth years were asked to complete a nurse education course. This study set out to explore questionnaire. About 100 students participated in this several issues relating to the experience and attitudes study. Summary of results: 61% had access to of incoming nurse education students. computers at home. However 41% did not use a Summary of work: This descriptive study assessed computer regularly. Male students had more regular knowledge and application of information technology and longer use of computers than females (p<0.05). A by 143 nursing students, females and males, selected significant number of students (50%) judged through cluster random sampling. Data were collected themselves competent in information technology skills. by a questionnaire that included four parts: All students had access to the internet at the university, demographic status, knowledge and skill relating to the and 59% had access at home. A high percentage of computer and attitude to IT. students (95%) indicated they were comfortable using Summary of results: Result showed that 48.6% (N=69) the internet, 65% said they were confident in the have already trained in IT, and only 21.3% (N=30) are accuracy. Students used the internet more for personal expert in how to use a computer. According to results reasons than for studying research works. of this research, 63.1% (N=89) of students had a good Conclusions: Medical students have access to attitude to information technology and use of substantial information technology resources and computers.

WCE Curriculum evaluation

WCE 1 Student evaluation of teaching in respondents (85%) felt that rating scales undermined undergraduate physiotherapy education their relationship with their students. Significantly, 67.2% of the respondents reported that changes made M Blackburn* and G Brown (University of Nottingham, in teaching depended on their energy levels, as well as Division of Physiotherapy Education, School of Community on their internal motivation (48.1%). Four clusters were Health Sciences, Hucknall Road, Nottingham NG5 1PB, UK) identified. Three clusters of respondents considered rating scales to be more an indicator of student Background: Evaluation has become an integral part satisfaction than of teaching effectiveness. of accountability in higher education. This study investigated the views of lecturers in undergraduate Conclusions/take home messages: Lecturers in physiotherapy education on the use of student rating physiotherapy education did not think that student scales for the improvement of teaching. Additionally, it rating scales were a good basis for making changes in aimed to establish whether there are groups of teaching. physiotherapy educators identifiable by their views. Summary of work: Following an initial exploratory WCE 2 Quantitative data of medical graduate phase, using three semi-structured interviews, themes evaluation: do we teach requirements of were identified and questionnaire items were the Thai Medical Council? constructed. The questionnaire was distributed in P Supasai, Y Tongpenyai, P Ambua, S Ambua, P England and Ireland to lecturers in 32 Universities. Thanomsingh, T Asawavichienjinda* and T Himman-ngan Summary of results: The initial findings highlighted that (Maharat Nakhon Ratchasima Hospital (MNH), School of respondents considered students unable to judge the Medicine, The Collaborative Project to Increase Production teaching and perceived a lack of commitment, by the of Rural Doctors (CPIRD), The Ministry of Public Health, students, in the evaluation process. A high number of 49 Changpeuk Road, Muang District, Nakhon Ratchasima Province 30000, THAILAND)

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Objective: To evaluate medical graduates’ performance majority of respondents (28,8%) were third year and competency following requirements of the Medical students. Council of Thailand. Summary of results: The following tendencies were Method: Questionnaires with five rating scales (5 = noted: (1) In the students’ view, no subject achieved excellent, 4 = good, 3 = fair, 2 = poor, and 1 = very an ideal balance between the theoretical course of poor, need improvement) were conducted to explore lectures and practical classes; 2) It is necessary to graduates’ performance and competency in 10 aspects improve the quality of materials and (3) students following requirements of the Thai Medical Council, appreciate practical classes at the clinics. The students 2002. The questionnaires were used to ask opinions of want an appropriate environment for classes and the graduates’ colleagues during graduate visiting at their best technical furnishings as well as equipment and hospitals, and were distributed to graduates for self instruments for scientific research. Overall the students administration. Data analyses were mean and standard appreciate the intellectual potential of lecturers but deviation. occasionally note excessive arrogance resulting in withdrawal on their part. Results: Total 141 colleagues and 36 graduates responded to the questionnaires. Mean scores of all Conclusions/take home messages: Results of the aspects were above 4 or nearly reached 4 but their investigation can help improve the quality of medical basic knowledge and competency in clinical education. epidemiology, evidence-based medicine, and research methodology got lowest score from both colleague’s opinion, and self assessment. WCE 5 Measurement of medical interns’ knowledge about common infectious Conclusion: Graduate evaluation reassured the school diseases about curriculum quality that its graduates have reached requirements of the Medical Council of Thailand. Mohsen Moghadami* and Mitra Amini (Shiraz Medical Moreover, the data from the evaluation can be deployed School, Internal Medicine Department, Namazee Hospital, in curriculum revision and improvement. Shiraz, IRAN) Background: Educating physicians and preparing them for their future responsibilities in diagnosis and WCE 3 Quality assurance in Buddhachinaraj treatment of diseases is the main objective of medical Hospital, School of Medicine education. In this study we evaluate the interns’ P Kaewprasit* and Y Jariya (Buddhachinaraj Hospital, knowledge about epidemiology, diagnosis, treatment School of Medicine, 90 Srithamtripidok Road, Phitsanulok and prevention of four infectious diseases (Tuberculosis, 65000, THAILAND) Brucella, Malaria and Leishmania). Background: After the educational act in 1999, every Summary of work: A questionnaire was designed for educational institute in Thailand had to submit their this purpose and 41 interns participated in this study. self assessment report (SAR) to the Office of Educational Summary of results: The mean scores out of 20 for Standard. The aim of this report is to describe how interns’ knowledge about Tuberculosis, Brucella, Malaria Buddhachinaraj Hospital submitted the SAR. and Leishmania were 13.58, 13.50, 12.82 and 12.93 Summary of work: A Quality committee was set up, respectively. There was no significant difference with every head of department as a member and the between interns’ knowledge in these four diseases director was the chairman of the committee. After close (p>0.05). The knowledge of male physicians was better examination of the key performance indicators of every than females (p<0.05). component of QA, a draft SAR was developed for pre Conclusions/take-home messages: The results of this audit before submitting the SAR for external authorized study showed that it is necessary to re-evaluate our audit. educational programs about infectious diseases. Summary of results: The primary results of audit showed that the Research Component got a very low score (1 out of 5). The other 8 components were better. WCE 6 Interns’ self-evaluation to identify insufficient competencies in neurosurgery Conclusion: The result of audit reflected the real 2000-2001 situation in the hospital. The medical teachers in Buddhachinaraj Hospital had done too little research. Mohammad Reza Ehsaei*, H Gholamo, M Dashti This should be the point in the development plan. Rahmatabad and Ali Mohammadi (Mashad University of Medical Sciences, No 344 Daneshamouz 19, Mashad, Take home message: QA is the tool to improve the IRAN) teaching and learning process by picking up the weak Introduction: It is important to evaluate the quality of points to develop. teaching in our clinical setting (in neurosurgery field). Materials & Methods: During the academic years of WCE 4 Quality of the study process organization 2000-2001 five groups of interns who had completed in medical education at the Riga Stradins their rotation in neurosurgery received a detailed University questionnaire which included a list of problems/clinical presentations which undergraduate medical students Janis Vetra*, Irena Upeniece and Uldis Teibe (Riga Stradins University, Dzirciema Street 16, Riga LV 1007, LATVIA) might encounter during their rotation in neurosurgery. The list was prepared with 18 problems in neurosurgery. Aim: The aim of the investigation was to examine factors The response rate was 90% (N=50). All of the students that influence the quality of medical education and to were interns in sixth year of graduation that had taken identify possibilities to perfect it. It is a longitudinal, the course in two hospitals in the School of Mashhad five year cycle with a cross-sectional study and random University of Medical Sciences Iran. selection of respondents. Results: The students believe that they need substantial Method: Anonymous questionnaire. Appropriate supervision or they do not have sufficient knowledge statistical methods are applied in data processing. and skill to manage patients with such problems or Hypothesis: there is insufficiently realized potential of clinical presentations. These problems or clinical innovative interaction and integration between the presentations are divided into 4 groups. Group 1 is the university’s front office, lecturers and students. In the list of problems on which more than 75-100% of 2003/04 year questionnaire 785 medical students took students believe they need substantial supervision or part. The questionnaire covered 18 subjects. The they don’t have sufficient knowledge and skill to manage

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patients with such a problem. Group 2 is the list of 47.5% agreed with integrating research and education problems identified by 50-75% of students. Group 3 is departments as a solution to increasing interaction of the list of problems identified by 25-50% and Group 4 research and education, 25%stated that faculty should is a list of problems identified by less than 25% of engage pure research academic members. students. Conclusion: Opinions of MFMs can guide faculty leaders Conclusions: We have some useful results that will be in making better decisions especially when members’ important for teachers who are eager to improve their contribution and interaction is needed. teaching. WCE 8 Analysis of the pathophysiology exam WCE 7 Opinions of Medical Faculty Members on F Majidi*, M H Meshkibaf and M Hosinzadeh (Fasa academic department organization in University of Medical Sciences, College of Nursing, Ebne Shaheed Beheshti Medical School, Sina Sq, Fasa 74616 86688, IRAN) Tehran, Iran 2003 Background: Evaluation is an integral part of any H Peyravi*, M Mardani, M Rahnavardi, A Khirmand and educational system, which is carried out by various Z Gheibi (Artesh University of Medical Sciences, Faculty methods for different purposes. One of these is of Medicine, West Dr Fatemi Avenue, Shahid Etemadzadeh evaluation of the students’ exam at the end of each Avenue, Tehran, IRAN) semester, which uses multiple choice questions. In this Background: Medical Faculty Members (MFMs) are study we have aimed to analyze various indices of the accomplished and experienced in medical education. exam question such as its normalcy and difficulty index. Shaheed-Beheshti Medical School (SBMS) is the second Summary of work: A total of 1200 pathophysiology largest faculty of medicine in Iran with 667 MFMs and multiple choice questions were included in this study 32 Academic Departments (ADs). We gathered opinions and each of these questions and its discrimination index of MFMs of SBMS on best options for AD chairman and as well as its normalcy and degree of difficulty were MFM contribution in education and research in 2003. analyzed. Summary of work: 386 out of 667 MFMs (57.9%) Summary of results: The evaluation of questions in responded anonymously to a self-administered different parts of the pathophysiology course such as questionnaire on target subjects. Of these 382 public health (61 questions), infectious diseases (132 (98.96%) were enrolled. questions), neurology (54 questions) and internal Summary of results: The majority, 173 out of 382 medicine (32 questions) shows that public health has (47.9%), agreed with the possibility of maximum two a difficulty index of 66%, infectious diseases 75%, consecutive periods of election of one MFM as AD neurology diseases 72% and internal medicine with chairman. On concomitant election of one MFM for both difficulty index of 80%. Among the various subject the ward chief and AD chairman, 39.7% disagreed, 31.2% internal medicine questions had the highest difficulty agreed and 29.1% had no opinion. Monthly AD index which was 30% higher than our standard whereas meetings were preferred by the majority, 192 (50.7%). the other 3 subjects had a moderate difficulty index Enhancing faculty members’ standing in society though we know the accepted difficulty index should (63.4%), providing members with more facilities not range from 20 to 80%. (45.3%), facilitating research project acceptance Conclusion: It can be concluded that the pattern of the process (64%) and drawing members’ trust in questions, their difficulty index, discrimination index collaborating with research projects by faculty (49%) and easy type questions should be at the average of were proposed way of increasing MFMs’ contribution 50%. However, as a whole both the very difficult in education and research activities. While 54% thought questions and very easy type questions have a low all MFMs should participate in research activities, and discrimination index value.

WCP Curriculum planning

WCP 1 Curriculum change is easy, agreement strategy initiated. However, there is worry among some and implementation is not! faculty members and students at one of the two teaching hospitals that 80% core will not be sufficient Nils Danielsen*, Göran Thomé and Gudrun Edgren (Lund to learn all a doctor needs to know. The other teaching University, Medical Faculty, Centre for Medical Education, hospital is more positive to the change. The student PO Box 117, Lund SE 221 00, SWEDEN) organisation supports the reform. Aim: The medical programme at Lund University Take-home message: The importance of information undertook a curricular reform in 1991, aiming at and agreement can never be overestimated. integration, student-centred group activities and early patient contact. It has worked well in the first 2 years of the program with the clinical part lagging behind. WCP 2 Clinical sciences integration in the new The problems to be addressed in the new reform were: medical curriculum of the Portugese lack of systematic clinical training, inconsistent expression of objectives and assessment; curricular Faculty of Health Sciences in Covilha overload; few options. I Neto*, J M Calheiros, M Castelo Branco and J Fermoso (University of Beira Interior, Faculty of Health Sciences, Summary of work and results: The reform work was Rua Marquês d’Ávila e Bolama, Covilha 6200-001, undertaken by special task groups and resulted in: (1) PORTUGAL) A core curriculum defined as outcome objectives and 102 clinical situations that the students shall be able to The new medical curriculum in the Faculty of Health handle at graduation; (2) Four areas of competence Sciences started in 2001 and is now in the 4th year. defined; (3) A common document describing expression The curriculum is organized as a spiral by organs and of course objectives; (4) A curriculum with 80% core systems. In the first two years students learn the normal and 20 selectives/electives; (5) Work on an assessment function in an integrated way: there are no disciplines and in each organ/system block students learn the

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physiology, anatomy, biochemistry, histology and Conclusion: A more practical approach is suggested embryology. Similarly, in the clinical blocks an integrated during the basic science course. Finally an integrated approach by organs and systems is used. In the Clinical/ education of clinical and basic sciences courses is Surgical Module students learn the specific pathologies, recommended. integrating the clinical approach with pathophysiology, ethiology (including microbiology), epidemiology and prevention, diagnostic methods (including pathology WCP 5 Learning styles of students starting and imaging), prognostic and therapeutics. This medical school learning process is contextualized by clinical contact Aysen Melek Aytug Kosan*, Meral Demiroren, Sabri with patients and diverse pathologies in hospitals and Kemahli and I Hakki Ayhan (Ankara University, Faculty of primary health care centers. There is also a vertical Medicine, Karanfil Sokak 29/2, Kizilay, Ankara 06650, integration between basic sciences and clinical sciences TURKEY) by introducing clinical problems in the 1st and 2nd year Background: The traditional curriculum of Ankara blocks and basic themes in clinical modules. This University Faculty of Medicine has been changed to a methodology is believed to facilitate students’ learning problem-based hybrid curriculum starting from the process and to promote knowledge use in a integrated academic year of 2002-2003. Student characteristics way. affecting the learning process should be known in order to design a teaching-learning environment in WCP 3 Role of medical doctors in training the accordance with these features. There are various medical students in Health Care Centers methods of achieving and processing knowledge and each student may prefer a different one. These in Bandar Abbas, Iran preferences form the learning styles of students. Styles O Safa*, A Noorian and A Razmara (Hormozgan University contain a number of strengths and weaknesses that of Medical University, Office of Vice-Chancellor for differ among individuals according to what they try to Education and Research, Shahid Mohammadi Hospital, accomplish as their learning tasks. Jomhoori Eslami Blvd, PO Box 79145-4545, Bandar Abbas, Hormozgan, IRAN) Summary of work: Kolb Learning Style Inventory has been given to 273 first year Medical students. Background: In the health care system, the medical doctors should be the medical and health care system Summary of results: The most common style has been directors as well as doctors. Despite the community found to be the assimilator learning style (62.1%), medicine courses, there was a lack of a more specific followed by converger (20.7%), diverger (12.6%) and management course needed for management of accommodator (4.6%) styles. Statistical analysis medical and health care centers. (ANOVA) showed that the end-of-module multiple choice exams, OSCE marks and PBL performances did Summary of work: We started a project in which a few not vary according to learning styles. medical doctors who had this experience and were successful doctors of medical and health care centers Conclusions: It is thought that in a curriculum which were involved in the design of a curriculum of the contains various teaching-learning methods and where practical management course in cooperation with PBL is the major method, different learning styles are community medicine lecturers. The students started supported. However students should be followed up to training with this curriculum under the supervision of see whether various learning activities support different these medical doctors. needs of individual students. Summary of results: The practical course strongly affected the vision of the management of medical and WCP 6 Relationship between tutor evaluation health care centers and helped in solving health and academic performance problems of their society and region. Mehmet Ozen*, Tanju Aktug, Fevzi Atacanli, Sabri Kemahli, Ozden Palaoglu and I Hakki Ayhan (Ankara University, WCP 4 A survey of intern medical student Faculty of Medicine, Karanfil Sokak 29/2, Kizilay, Ankara opinion on the usefulness of basic 06650, TURKEY) science, physiopathology and clinical Background: Undergraduate Medical Education has education for their success been changed to a problem-based hybrid system at Ankara University Faculty of Medicine. This analysis was A Shamsdin*, A Ebrahimi and B Zegordi (Fasa University based on tutor evaluations of students’ performances of Medical Sciences, Microbiology Department, Ebne Sina during PBL sessions at the end of 8-week modules and Square, PO 7461686688, Fasa, IRAN) students’ end-of-module examination scores. Background: In addition to various parameters of Summary of work: Each PBL tutor was asked to score medical education evaluation, considering viewpoints 10 students in his/her group in the following 5 areas of students who have just completed the course may with a 20-item questionnaire: (1) interaction with help in improvement of the educational program. group/participating in group activities, (2) knowledge Material and methods: For this study the intern acquisition process, (3) communication, (4) problem students’ viewpoints were collected through a solving and critical thinking and (5) professional questionnaire and the results were analyzed. attitudes. The questionnaire was completed on 5 point Likert scale and the total points of each student in each Results: The results obtained in this study shows that area was transformed to a score over 100. Correlations 57% of the students consider that basic science theory between these PBL performance scores and end-of- is useful for their medical practice and 76% believed module examinations (comprised of OSPE, OSCE and that the practical subjects are useful during internship MCQ test) were calculated. and externship. 87% of students considered that where they have learned in the presence of a patient at a Summary of results: No correlation was found in any polyclinic and hospital was very useful. However, the area, which shows lack of relationship between PBL effect of conference and journal club by academic staff performances and exam scores. This is thought to be on their success was about 70%. Also the students’ mainly due to the fact that most MCQ test items are opinion of the presence of their specialist and their based on rote learning. Conclusions: These results imply medical teacher in the hospital and its effect on their that student assessment should be multi-dimensional success was 86%. and credit should be given to students with a better performance during PBL tutorials.

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WCP 7 The evaluation of a multi-professional Summary of work: Questionnaires were sent to the training programme for the delivery of first cohort of approximately 24 trainees. 2 multi- out-patient anti-coagulant care professional focus groups were also held. L McIlwaine*, E MacGregor, C McLean, J Hamley and P Summary of results: 8 pharmacists and 9 nurses G Cachia (Dundee University, Clinical Skills Centre, returned the questionnaire and were very positive about Ninewells Hospital and Medical School, Dundee DD2 1NY, the course. Pharmacists found obtaining the capillary UK) sample the most difficult, whereas nurses were anxious regarding warfarin dosing. The focus groups revealed Background: Monitoring of warfarin therapy has practical differences between the professions with traditionally been doctor-led in hospital outpatient significant impact on the trainees’ safety. For example, clinics. Recently, portable analysers have been pharmacists reported they were not routinely developed which can be used by non-laboratory trained immunised against Hepatitis B. staff and provide the significant benefits of near-patient testing. A pilot training programme was developed to Conclusions/take home messages: The multi- enable nurses and pharmacists to deliver community professional training programme for anti-coagulant care anticoagulant care. They were trained to a single was well received, but highlighted safety issues related standard to provide the whole service (capillary to the profession of the trainee which need to be sampling, INR analysis, internal QC, etc). This study urgently addressed. evaluates their views of the multi-professional course, focusing on professional boundary issues.

WPG Postgraduate education and CPD/CME

WPG 1 Development and evaluation of a multi- to complete the log diary recording activities and to fill deanery appointment process (M-DAP) to in an anonymous questionnaire. year 1 Foundation posts Summary of results: Two hundred log diaries were Robert Palmer* and Jonathan Howes on behalf of the M- examined. All the respective trainees responded to the SAP Committee (West Midlands Postgraduate Deanery, questionnaire. Overall, the majority of the students Birmingham Research Park, 97 Vincent Drive, Edgbaston, thought that the quality of their clerkship program’s Birmingham B15 2SQ, UK) assistance was satisfactory or good, the exposure to rooming-in wards and transitional care unit being The 4 Deaneries of Trent, LNR, Yorkshire and West excellent. Ninety six per cent reported that bed side Midlands have successfully collaborated to develop and teaching is an effective way to teach professional skills. deliver an on-line appointment process for Foundation Nevertheless, all the respondents indicated no current Year One posts that commence in August 2005. All exposure to either NICU or delivery room section. communication between candidates, Deaneries and Trusts was via the internet only and there were no Conclusions: Despite the insufficient amounts of time interviews. Candidates’ applications were scored using available, the trainees were unanimous about the a combination of automated scoring for medical school relevant training opportunity. modules, prizes and degrees and panel scoring of personal statements. Panels had medical, non-medical and lay representation. The score of a candidate WPG 3 A social capital strategy for growing determined the order of allocation of post. All postgraduate medical education components of the scheme were successfully completed Peter Mack* and Ling-Huey Chua (Singapore General on time. Hospital, Department of General Surgery, Outram Road, There were 983 applicants for 1127 posts. 26 did not Block 6, Level 7, Singapore 169608, SINGAPORE) get posts because for each of their options there were Background: Set up in 1821, the Singapore General other candidates with higher scores. More than 40% Hospital (www.sgh.com.sg) has a long-standing of candidates received posts that were their 1st tradition of excellence in clinical care and undergraduate preference and 85% received posts in their top 10 medical education. The emphasis on postgraduate choices. education is more recent but has been increasing in Following a second round of allocation all applicants tempo over the past decade. had received posts. Remaining posts are now being Aim: This paper examines how a certain educational filled through a Clearing scheme (in progress). strategy at the organisational level has contributed An evaluation has highlighted strengths and weaknesses effectively to the growth of postgraduate medical of the scheme and overall it has been very successful, education in a teaching hospital. achieving all initial aims and objectives Summary of work: The Hospital has trained more than 450 doctors from 33 countries over the last 10 years. It hardly levies training fees and even offers financial WPG 2 Training in neonatology during a clinical support through various hospital and department clerkship – the trainee’s perspective funded fellowships. The Hospital establishes linkages J M V Amaral*, L Pereira-Silva, T Neto, F Leal, F Chaves with other higher education institutions regionally and and G Henriques (Universidade Nova de Lisboa, Faculty internationally, including Stanford University. It of Medical Sciences, Rua do Lobito, Lote 74, Parede 2775- leverages on its monthly interactive telemedicine CME 229, PORTUGAL) programmes to develop ties with other similar Aim: To determine the educational value of an institutions in Hong Kong and the Philippines. The undergraduate clerkship in Neonatology during the pre- Hospital staff conducts hospital management registration year. programmes in China and serves as external examiners for postgraduate medical examinations in Pakistan. In Summary of work: A study was conducted in a teaching addition, it also supports volunteer medical missions pediatric hospital to obtain the students’ perceptions and has in place procedures to respond quickly to concerning the clerkship and to determine the natural disasters (e.g. tsunami in December 2004). enjoyment of various activities. Each student was asked

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Take-home Message: The development of social capital Conclusions: A more systematic assessment of NLS through liaison with external counterparts is intertwined qualification levels in pediatric SpRs helps to assess with the enrichment of postgraduate medical education. and establish baseline requirements for NLS courses In our experience, this strategy is central to the for SpRs and to identify elements that require attention development of win-win situations in lifelong learning. or further training in individuals.

WPG 4 Intangible Return on Investment (ROI) of WPG 6 Mentoring overseas doctors to achieve a Continuing Education Office entry for specialist training in UK Ling-Huey Chua* and Peter Mack (SGH Postgraduate S K Mukherjee (Kent, Surrey & Sussex Deanery, 7 Medical Institute, Singapore General Hospital, Block 6, Bermondsey Street, London SE1 2DD, UK) Level 1, Outram Road, Singapore 169608, SINGAPORE) Background: Overseas doctors have experienced Background: The SGH Postgraduate Medical Institute difficulty in entering a specialist training programme in (SGH-PGMI) is a continuing education office fully funded UK. Mentoring was used as a strategy to help these by the Singapore General Hospital (www.sgh.com.sg). ‘stuck’ doctors. These are usually Staff and Associate Established in 1994 to centralise the Hospital’s specialists who find it extremely difficult to re-enter postgraduate training activities, it was re-positioned in the training grade. 1996 as a regional postgraduate centre offering a wide Summary of work: A cohort of 7 doctors was selected range of learning opportunities. Its 3 key focus areas for this process. One experienced Consultant acted as are (1) fostering a learning culture (CME, CPD, mentor. Process included: career advice, identification publications), (2) opening doors (e.g. fellowship training of aims and objectives, reflective log and feedback. programmes) and (3) building alliances with established Initial interviews were one-to-one discussion and also institutions. With an annual operating budget exceeding group discussion was used. Examples of good practice SGD1million, the SGH-PGMI constitutes a significant were shared amongst the group. Only those who were investment for a local hospital to undertake. sufficiently motivated were selected. Confidentiality of Aim: This paper examines how SGH-PGMI analyses the the mentees was protected and wider information on intangible assets it brings to its parent hospital and the mentor/mentee scheme was discussed. justifies the investment made. Summary of results: 4 successfully secured entry to Summary of work: Existing accounting practices focus General Practice and 3 to hospital based specialities. on the measurement of ROI (return on investment) in Five required 2 or more attempts. terms of financial returns and physical assets (e.g. Conclusions: Mentoring is a useful tool in helping buildings). Paradoxically, training contributes to overseas doctors achieve their potential. These should intellectual capital, which is an intangible asset that be structured and flexible. Potential advantages need confers a competitive advantage to its organisation in to be raised so that doctors are keen to participate. a knowledge-based economy. By structuring its activities Support from the employer is also of paramount along its 3 key focus areas, the SGH-PGMI contributes importance. a wealth of intellectual capital (sum of human, customer, social, and structural capital) that in turn enhances the Hospital’s brand equity, another intangible asset. WPG 7 Internal evaluation: continuous quality Take-home Message: In the absence of appropriate improvement process indicators for ROI, we have found the intellectual capital M Agah*, M Nouri Avarzamani and R Ahranjani (Shahid framework useful in helping us to justify to our parent Beheshti University of Medical Sciences, Anesthesiology organisation the importance of teaching beyond dollars Department, Labbafinejad Medical Center, Boostan 9, and cents. Pasdaran, Tehran 1666894914, IRAN) Aim: We discuss changes and modifications made WPG 5 Competencies in neonatal life support in through the internal evaluation process, by emphasizing first year pediatric specialist registrars the necessity of the implementation of internal evaluation as an effective tool in achieving quality Bianca Weeteling*, Reinoud Gemke and Ruurd van Elburg improvement of educational programs. (VU University Medical Center, Department of Neonatology, De Boelelaan 1117, Amsterdam HV 1018, Summary of results: We will present the findings from NETHERLANDS) the process, resulting in quality improvements to the anesthesia residency program, and also will be Background: Acquisition of resuscitation skills is highly emphasizing the role of the internal evaluation process relevant for pediatric specialist registrars (SpRs). as a means of making changes and recognising the However, level of training and experience have not been strengths and weak points. systematically evaluated in first year pediatric SpRs. The aim of this study was to assess the qualifications Conclusions: We believe that internal evaluation has of neonatal life support (NLS) in first year pediatric its own process and procedure which results in SpRs. improving quality. It is not necessary to wait for completion of the project and from the beginning of Summary of work: During a course on acute the evaluation process, we will follow up and implement disturbances of vital functions, all first year pediatric the considered changes. SpRs in the Netherlands filled out a questionnaire on how frequently they had performed NLS elements: airway and breathing (9), circulation (9), CNS (2) and WPG 8 Survey of outpatient satisfaction with integrated elements (4). For each element, 4 general physicians in Shiraz, Iran qualification levels were assessed: (1) study of theory (2) practice in skill stations (3) supervised practice in Fatemeh Najafipour*, Sedighe Najafipour, Fereydon Azizi patients and (4) non-supervised practice in patients. and Mehdi Saberfirouzi (Shiraz University of Medical Sciences, Valfajer Clinic Center, Shiraz, IRAN) Summary of results: Qualification levels of all NLS elements of first year pediatric SpRs in the Netherlands Patient satisfaction is often considered a broad measure will be presented. The level of training and experience of quality of care which is composed of a technical of all NLS elements varied widely. Skill stations were quality component and a service quality component. used relatively infrequently, despite the possibility to In addition dissatisfaction depends on the mismatch practise without potential adverse effects. between patient expectation and actual performance of the health care system. We conducted this study to

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determine the level of outpatient satisfaction with was about respectful behavior of physicians with general physicians in Shiraz. patients (88.9%) and the feeling of responsibility for care (83.5%). Satisfaction about patient education by Summary of work: This was a descriptive cross– physicians was 82.7%. Patients described less sectional study. The data gathering tool was a satisfaction with support in solving their personal questionnaire based on a 5 point Likert scale. The problems (15.6%). questionnaire was distributed among patients referred to the private office and public clinic. Conclusion: It seems that patient expectation and patient physician communication determine the level Summary of results: Over all, 76% of patients express of outpatient satisfaction. their satisfaction at a moderate level. Most satisfaction

WP Professionalism

WP 1 Culturally competent care - a book of Organisational skills include multi-tasking, flexibility, case-studies for medical students prioritisation, presenting information, reflecting, dealing with the unexpected and regaining control of situations. Conny Seeleman* and Jeanine Suurmond (AMC/University Managerially, leading change, team working and of Amsterdam, Department of Social Medicine, PO Box mediation are relevant. Education skills require the 22700, Amsterdam 1100 DE, NETHERLANDS) ability to teach, learn, counsel and guide. The doctor Background: Medical teachers and students are must demonstrate common sense, courage and interested to learn about immigrant patients, yet ambition tempered by understanding limitations, whilst educational material is scarce. In response to this lack showing concern. Being a role model is important as is we are developing a book of case-studies about having a sense of humour. These characteristics are immigrant patients. underpinned by professionalism and altruism. The Outline of project: Studying national and international doctor must have the confidence to practise literature the most significant problems in care for independently and the wisdom to do so well; and thus immigrant patients were identified. Subsequently, to inspire. physicians from different disciplines were approached about cases concerning these specific problems. In WP 3 The development of an instrument to semi-structured interviews with the physician as well as with the patient further information about the specific measure gender awareness in medical patient was obtained. Patients differed in ethnic students background. P Verdonk*, Y Benschop, H de Haes and T Lagro-Janssen Summary of results: The cases confront students with (Radboud University Nijmegen Medical Centre, Postbox 9101 HAG 229, Nijmegen 6500 HB, NETHERLANDS) a versatility of problems. Students are taught intercultural competences like: recognizing own ideas Aim of presentation: Physicians’ awareness of gender and prejudices, being open to patient’s illness issues in health and illness is important, amongst other experiences, knowledge about different prevalence of reasons, to decrease gender gaps in health and illness diseases, and students are encouraged to develop and improve quality of health care for both genders1. (intercultural) communication skills. In total 20 case- So far, medical education has not sufficiently addressed studies will be written. The book will be published in these issues2,3. The aim of this study is the development autumn 2005. of an instrument to measure gender awareness in medical students. Take-home messages: (1) The entire medical curriculum should pay attention to diversity/immigrant patients Summary of work: Three subsidiary components of instead of merely addressing this subject in specific gender awareness are distinguished4. (1) gender courses. (2) Students should not just have knowledge sensitivity or insight into gender issues in health and about cultural differences, this easily results in illness, (2) gender role ideology or gender stereotypes stereotyping. More importantly, they should develop and (3) knowledge. The instrument is developed in attitudes and skills to deal with diversity. This will benefit three phases to establish feasibility, reliability and all patients. validity. Summary of results: Factor analysis shows that the WP 2 Defining generic qualities of senior gender awareness model fits for the two affective components sensitivity and gender role ideology and hospital doctors reliability of the subscales varies between .87 and .85. P W Johnston (Aberdeen Royal Infirmary, Department of Sixth year students are more gender aware than first Pathology, Aberdeen Royal Infirmary, Foresterhill, years and female students are more gender aware than Aberdeen AB25 2ZB, UK) male students. More results will be available after The vital role of senior doctors in health care cannot submission of this abstract. be underestimated. Defining qualities that characterise Conclusions: The Nijmegen Man-Woman-Doctor-Patient these doctors enables training and setting standards scale is a reliable and valid instrument. In the future, for continuing assessment. The following definitions the instrument may be extended with other diversity determine good practice and provide a framework on issues such as culture, ethnicity, social-economic status which to base values and doctors’ belief in their own or age. worth. The knowledge and skills attained in training 1 2 grades is assumed as the baseline upon which specialist Zimmerman & Hill (2000). Verdonk, Mans & Lagro- 3 experience is built. Senior doctors must display Janssen (2005). Zelek, Phillips & Lefebvre (1997). 4 knowledge in general, specialist, generic, systematic King, Vogt, King & Keehn (2002) and educational spheres. Clinical skills include diagnosis, problem solving, technical ability and communication. Professional skills of judgement, intuition, intellect, responsibility and leadership must be demonstrated.

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WSD Staff/faculty development

WSD 1 A rural campus’ response to staff WSD 2 An evaluation of workshops to develop development appraisal skills in consultants working A Currie* and M Laing (Undergraduate Teaching Centre, with doctors in training 7th Floor, Raigmore Hospital, Inverness IV2 3UJ, UK) Pam Shaw*, Hazel Platzer and Jo Tait (KSS Deanery, 7 Background: We are a rural campus with no staff Bermondsey Street, London SE1 2DD, UK) development programme previously in place. Background: Appraisal is a key component of the Objectives: (1) Encourage more interest and new ideas ongoing professional development of doctors in training in teaching; (2) Enable doctors to become more and is linked to educational supervision, assessment confident in teaching and in the assessment process; and re-validation. (3) Provide documentary evidence of participation for Summary of work: Workshops were offered to appraisal purposes. consultants to develop their skills in conducting annual Methods: Lunchtime workshops were arranged over appraisals. The aim was to help them conduct appraisal five consecutive weeks. Topics included: Small Group as a structured process of facilitated self-reflection in Work, Microteaching, Teaching Large Groups the style of a professional conversation and with the Interactively, Assessment and the Struggling Student. use of a portfolio. Such a process should ensure that Certification of attendance was sent out. An evaluation learning needs are identified enabling junior doctors form using a Likert scale was completed at the end of to develop the qualities of Good Medical Practice each workshop. enshrined in the General Medical Council’s recent Fitness to Practise reforms. The key skills focused on Results: The mean number of doctors who attended in the workshops were how to provide support and each workshop was 10. All respondents felt that these challenge through identifying strengths and seminars should be run again, with 70% saying that weaknesses, giving effective feedback and realistic goal- they should be run twice a year. Formal certification of setting. The workshops were evaluated through semi- attendance did not rate highly as a reason for attending structured interviews with consultants and focus groups but all participants planned to use this in their appraisal with trainees. The aim of the evaluation was to find folder. out to what extent consultants had taken on an ethos Conclusion: Our local staff development programme of developing a learning culture for junior doctors and on teaching has been well attended and received. It any educational progress in junior doctors which had proved to be an inexpensive and convenient way to been facilitated by the process of appraisal. The meet our initial objectives. Further programmes should evaluation is currently in the piloting phase and work prove of continuing value to clinicians and students. in progress will be presented.

WSS Special subjects in the curriculum

WSS 1 What we talk about when we talk about potentials and relevance of integrating humanistic medical humanities disciplines in the medical curriculum. Jakob Ousager (University of Southern Denmark, Health, Man and Society, Institute of Public Health, J B Winsløws WSS 2 Education in military medicine: the Vej 9B, Odense C DK-5000, DENMARK) Swedish model Aim: Humanities are to an increasing extent integrated Sten-Ove Andersson* and Lars Lundberg (Swedish Armed into medical curricula. However, the literature shows Forces Medical Centre, Hammaro SE-66381, SWEDEN) great variety in the conception of medical humanities - what it is, and whether/why it is relevant. This The Swedish Armed Forces Medical Centre is nationally investigation is part of a larger research project aiming responsible for the qualified education in military at displaying ideas and suppositions underlying teaching medicine. Studies at university level for conscript of medical humanities, and gaining knowledge about medical personnel were introduced in 1997, with the decision makers’, medical teachers’, and students’ course Battlefield emergency care for nurses (7,5 ECTS expectations to the outcome of these learning activities. points). Two years later, a parallel course for physicians was started. Other courses have also been studied at Summary of work: A previous work (under submission) university level. Starting in 2001, a total of fifteen units examined discursive constructions of medical throughout the country have arranged the Basic course humanities in a series of articles in Journal of the Danish in battlefield emergency care for Medical Orderly (15 Medical Association and in course descriptions from ECTS points). The units have received academic support the medical curriculum at University of Southern from local colleges and universities, while curriculum, Denmark. The analysis revealed a number of opposing study literature, supervision and examination have been tendencies: Very divergent understandings were the responsibility of the Armed Forces Medical Centre. represented in texts that on a first reading had much The present reorganisation of the Swedish Armed Forces in common in terms of presenting humanities as will result in a situation where the entire military medical essential in medical education. Results from the education will be located in Gothenburg. Physicians, abovementioned investigation are now being nurses and medics will be educated at the same supplemented by conducting and analysing qualitative campus. A close connection to the University of interviews with medical students and teachers. Gothenburg has been established, in order to promote Summary of results: The investigation is on-going. The the educational process of military medicine. Teachers analysis will i.a. focus on to what extent students and at the Medical Centre will have positions as lecturers teachers share common sets of beliefs regarding the at the university, which will be favourable for the students in their acquisition of knowledge.

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WSS 3 Medical research training in context: Summary of work: In January 2005, we (quasi students’ perceptions of a new curriculum randomly) selected twenty-two 2nd-year medical course students to participate in the pilot study of MRT. After the course, all students filled out a 100-item structured Mandy van den Brink*, Daphne Bloemkolk, Franciska questionnaire concerning the contents, structure, and Koens, Ronnie van Diemen-Steenvoorde and Maarten Boers organization of the course, and joined a plenary group (VUMC, Department of Clinical Epidemiology and discussion. Biostatistics, PO Box 7057, Room PK 6 Z 179.2, Amsterdam 1007 MB, NETHERLANDS) Summary of results: The pilot group perceived the new Background/rationale: In September 2005, a course as instructive and motivating, but also labour- competence-based, assessment-driven and context- intensive. In their opinion most learning took place in situated medical curriculum will start at the VU the small group sessions and research teams, and less University Medical Center. In the new medical research by self study. They felt restricted in planning time and training (MRT) course, teams of 4 students assess data study schedules. For some this ‘obligatory’ learning style on lifestyle and health, perform their own research conflicted with their personal learning style and project and learn epidemiological concepts in supervised extracurricular activities. small group sessions. In contrast, the current program Take-home message: Future students need to be well is mostly lecture based. We analyzed perceptions and informed about the contents and expectations of results (see companion abstract of Koens et al., 6C1) medical curricula to be able to choose the university of this new course in a pilot study. that fits their personal interests and learning style.

WS Students

WS 1 Communication skills and burn-out in Summary of results: Three qualitatively different medical education categories of professional identity as a physiotherapist were identified and described as the Empowerer, the Efharis Panagopoulou* and Alexis Benos (Aristotle Educator and the Treater. University Thessaloniki, A.Svolou 2, Thessaloniki, GREECE) Conclusions: A variation of concepts in professional Aim: The aim of this cross-sectional study was to identity questions the extent to which educators explore burnout in undergraduate medical students, consider how they guide the development of and the role of communication skills in buffering the professional identities which fit the expectations of effects of burnout. stakeholders and which are able to respond to promotion and development of the profession in the Summary of work: The sample of the study consisted changing fields of health care. of 200 students attending pre-clinical years, and 200 students attending clinical years of undergraduate medical training. Coursework, stressors associated with WS 3 Why failed? A study on Ahvaz Joundi studying, burn out, and communication skills were Shapour University of Medical Sciences measured using a questionnaire. medical students Summary of results: Mediation analysis indicated that M Motlagh*, H Elhampoor and A Shakurnia (Ahvaz Joundi competence in communication skills mediated the Shapour University of Medical Sciences, Educational relationship between coursework, stressors associated Affairs, Golestan Ave, Ahvaz, IRAN) with studying and burnout. Results of the study are Background: The issue of medical students’ dropout is discussed in terms of the importance of communication of topical importance in higher education. Dropout not skills training in undergraduate medical education. only wastes resources, but also causes some psychological and social problems in students and their WS 2 Physiotherapy students’ professional families. An analysis of the underlying reasons for identity on the edge of working life withdrawals may indicate educational performance of the University, offering a chance to find a solution to Ingrid Lindquist*, Margareta Engardt, Liz Garnham, Fiona this dilemma. Poland and Barbara Richardson (Karolinska Institutet, Neurotec Department, Division of Physiotherapy, Summary of work: This was a causal research study. Zanderska Huset 23 100, Huddinge 141 89, SWEDEN) 100 “failed” students and 100 “not-failed” students as control group were studied in 2003. The data were Aim of presentation: The aim is investigate collected through 7 validated questionnaires, and characteristics of graduating physiotherapy students´ analyzed by SPSS software. professional identity before leaving the university. Summary of results: The study showed that a large Summary of work: Market expectations of number of the students were male, occupied in the physiotherapists reflect changing demands of health private sector earning a livelihood. The average score care for client centred, community based management of precollege years was low and with less self-directed of chronic disease in an ageing population. This study learning methods. The average age of the students forms a component part of a longitudinal study of was more than the control groups, and they were less students’ socialisation throughout their education motivated in their course of study and also their parents programme examining the outcome of professional were less educated. From the mental health issue they identity. The aim of this study was to explore were at a lower level of stability having more negative characteristics of graduating students´ identity. An speculation about their future. The multi factorial interview guide was used to focus the semi-structured regression showed that factors such as stressors due interviews. The phenomenon of professional identity to the graduating probabilities, precollege average of eighteen students was studied through their score, the place of high school education, self-directed perceptions of their role, practice, vision, beliefs and learning methods, gender, lack of motivation, scope of practice as physiotherapists. A educational background of students, the parental phenomenographic approach was used for analysis. educational and occupational status can indicate the education performance of medical students to 79%.

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Conclusions: It is the responsibility of those in charge was equal to 75th and in Motivation was equal to 15th of university administration to develop effective percentile of the American student norm. solutions in eliminating the causes and consequences Conclusion: Findings indicate that students have good of this dilemma. performances on test-strategies, anxiety control and concentration, and have poor motivation. The use of WS 4 Relationship between students’ learning and study strategies in identifying students characteristics and academic background learning and study weakness and strengths, especially in unsuccessful students are suggested. and their use of learning and study strategies, Mashad University of Medical Sciences (MUMS) WS 5 Are medical students consistent in their various level of education? Talat Khadivzadeh*, Ali Akbar Seif and Naser Valai (Mashhad University of Medical Sciences, School of A Ebrahimi, Z Freidouni*, B Zegordi and L Iranmanesh Nursing and Midwifery, Ebne Sina Street, Mashhad, IRAN) (Fasa Medical University, Nursing College, Ebne Sina Sq, Fars, Fasa, IRAN) Introduction: Learning and study strategies improve academic success by facilitating learning and can be Introduction: Many academic staff believe that the the essential strategies for educational interventions. interest and motivation of most medical students will This research was conducted to explore the learning gradually reduce after joining the university due to and study strategies of students in MUMS in 1999 and several problems. In this study we have tried to assess to determine its relating personal characteristics and this idea. academic background and to compare it with American Method: The medical students’ (4 groups) exam results students norms. during their seven year medical course were analyzed. Summary of work: In this descripto-analytical research Results: The results show that the total mark of each study 412 first to third year students of medical, individual at each level and their improvement or dentistry and pharmacy schools were selected by a regression was significantly related (a =0/01). Also the stratified random design. The Learning and Study students’ mark during the medical course (G.P) were Strategies Inventory (LASSI ) consisting of 10 subscales, significantly related with those who succeed in the was completed by students. The profile of students’ postgraduate entrance exam (P< 0/05). learning and study strategies was compared to the American student norm. Discussion and Conclusion: The results show that the average marks of the students on the Basic Science Summary of results: Students gained higher scores in and Physiopathology course was low compared with Attitude and Anxiety control and Test Strategies (33, the Extern and Intern period. This may be due to quite 32 and 31) and less in Selecting Main Idea (19). high theory subjects in Basic Science & Physiopathology. Learning and study strategies had no relation with study Also during the extern and intern period a more practical field and academic grade. Females had better attitudes approach is considered. Therefore it is easier to learn, on education and males on information processing. memorize and understand the subjects. We should not Retained students had lower scores in Anxiety control, forget the disciplinary factors. As shown in our study Information Processing, Selecting Main Idea, Self- the more discipline students have, even though they Assessment and Test Strategies. Students mean score have similar life and job opportunity problems, their in Test Strategies was equal to 80th and in concentration success was consistent during the education.

WTL Teaching and learning

WTL 1 Multicentric clinical residencies: a model responsible for the involvement of the numerous clinical tutors – who supervise students in the affiliated J Pinto-Machado, N Sousa*, A Freitas and M J Costa (Universidade do Minho, Medical Education Unit, School institutions – and seminar chairpersons – responsible of Health Sciences, Gualtar Campus, CPII, Piso 3, Braga for clinical seminars that are delivered at the School. 4710-057, PORTUGAL) This work presents the model and discusses its constraints and future developments. Background: The Degree in Medicine in the School of Health Sciences at the University of Minho, Portugal, has entered its 4th year in 2004/2005. This was the WTL 2 Setting standards in private-public- starting point of “Clinical Residencies”, where most of partnerships at medical schools: what do the learning happens in clinical settings - Hospitals and pediatric practitioners expect from Health Centers. The success of clinical learning reflects every school’s particular organizational options and Heidelberg University? constraints, the available case-mixes and learning F Fehr*, S Huwendiek, S Skelin and H M Bosse (Karlsplatz opportunities, which are strongly dependent on the 3, Heidelberg 69118, GERMANY) sociological context. The School has devised a strategy Background: During their four weeks of pediatric to deliver the contents and develop the skills and the rotation in Heidelberg students can opt to participate professional behaviour implicit to a quality medical in four afternoon sessions in private practices in which degree. they are introduced to aspects of preventional Summary of work: We chose a multicentric approach pediatrics, i.e. aspects of psychosocial development of that affiliates the two largest hospitals in the region of toddlers and infants. Students have opportunities to Minho. This had a strong demand on the Residencies learn about the reality of a private pediatric practice, coordination processes which were addressed by a the national system of pediatric check-ups complex coordination network, to guarantee that the (‘Vorsorgeuntersuchungen’, standardized appointments residencies proceed according to the curricular plan. at 1st week, 4 weeks, 3 months, 6 months, 1 year, 2 Learning outcomes are defined by coordinating groups years, 4 years, 5 years and 12 years) with hands-on in major areas of medicine. Those groups are experience in history taking and physical examination and to meet families with mostly healthy infants for

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practising soft skills and the professional role of the Board of the Faculty. The collaboration of the other student. clinical departments has been also considered. We plan in the future the design and implementation of Objective Rationale: To facilitate rich communication between Structured Clinical Examinations (OSCE) for medical private practitioners and the curriculum commitee a students. codex of mutual agreements is established. Summary of work: Private practitioners and curriculum planners conducted semi-structured interviews. WTL 5 Effectiveness assessment of an evidence- based morning report training workshop Conclusions: Learning goals including operationali- zation, organizational and institutional requirements and for internists of a University Hospital quality management tools were agreed upon. M Rahnavardi, S Iravani*, F Pourmalek and M R Hashemi (Artesh University of Medical Sciences, Faculty of Take-home messages: To ensure a sustainable Medicine, West Dr Fatemi Avenue, Shahid Etemadzadeh cooperation in a private-public-partnership in a medical Avenue, Tehran, IRAN) school all parties should engage in developing a codex of mutual agreements. Background: Morning report (MR) is one of the most venerable training cornerstones in university hospitals. We compared Knowledge and Attitude (K&A) of WTL 3 Training of medical students by the internists of Army University of Medical Sciences expert health center personnel in Bandar (AUMS), Tehran, Iran, before and after a training Abbas, Iran workshop on Evidence-Based MR (EBMR). A Noorian*, A Safa, F Reisi, N Asghari and G Farshidfar Summary of work: A one-day workshop was held for (Hormozgan University of Medical Sciences, Medical and 19 internists of “501 University Hospital” of AUMS in Health Care Center No 2, PO Box 79145-4545, Bandar March 2005. Their K&A were assessed before and after Abbas, IRAN) the workshop with Likert type questions in ten main One of the important parts of education for medical EBMR topics each: objective, leadership, general and paramedical students is the practical training in atmosphere, educating method, duration and frequency, the medical and health care centers. In Iran, medical target group, case selection, primary diagnosis, data education and health services was joined a long time registration, and follow-up. Total scores for K&A were ago, but because the health care personnel are not constructed separately with principal components involved in the training and evaluation, there is a gap analysis. Pretest and posttest total scores were between the theory and the real experience. Therefore, compared for significant increase. with the cooperation of the university lecturers and Summary of results: Total knowledge score increased health service experts, we designed a project in which significantly from pretest to posttest (p=0.002), but the personnel who had at least 5 years of experience the increase in total attitude score was not significant. in health care centers and also had a degree of Instead, the insignificant relation of total knowledge Bachelors in one of the medical sciences, are involved and attitude scores in pretest, turned to a significant in training the students. A check list is designed and positive relation (p=0.006). this training is evaluated continuously by the team of university experts. After 2 years of this ongoing process Conclusion: Our one-day workshop on EBMR increased we have made progress in two major areas: firstly, the knowledge of internists regarding EBMR, significantly. students have a very practical training in the real field Significant improvement in attitude is a long term in which they will usually be employed after graduation. process. Using Knowledge-Attitude questionnaires is And secondly, the personnel improve their services and effective in evaluating the effectiveness of training in addition, they updated their knowledge by attending workshops on medical education topics. specific courses continuously. WTL 6 Generic Clinical Skills Education Course WTL 4 Improving the undergraduate medical (GSCE) curriculum by using clinical skills Maeve Keaney* and Ann Smalldridge (Hope Hospital, programme Reache North West, Stott Lane, Salford M6 8HD, UK) Dogan Izbirak, Guldal Izbirak*, Unal Uslu an Elvan Sarac Background: Reache North West is an education and (Yeditepe University, Faculty of Medicine, 26 Agustos drop-in centre for refugee and asylum seeker health Yerlesimi, Kayýsdagi, Istanbul 34755, TURKEY) professionals, which aims to help its members re-enter Yeditepe University School of Medicine offers six years their profession in the UK. We set up the course because undergraduate medical education. Although it was we found that refugee doctors have wide practical founded recently in 1996 our faculty gives particular clinical experience but less experience and importance to the quality of medical education. As understanding of some of the wider issues needed to medical knowledge, clinical skills are also an important work effectively in the NHS. and necessary part of clinical competence. Improving Summary of work: Each course ran for 10 days and the basic clinical skills will serve for a comprehensive was held three times in the first year. The group sessions approach to the patient-doctor relationship including covered: How to do a Personal Development Plan (PDP); medical interviewing, history taking, physical Audit; Communication skills – explaining, negotiating, examination and non-invasive and invasive techniques breaking bad news and dealing with aggressive patients which will strengthen the clinical training in clerkship using actors in clinical scenarios; Critical Appraisal; programmes in the future. For this reason, we Multidisciplinary Team Working; Assertiveness Training; established a clinical skills laboratory including the basic Presentation Skills; ‘Get that job’ – guide to CV writing equipment such as anatomical models, electronic and practice interviews. simulators and video cassettes. To achieve our main purpose we restructured the undergraduate medical Summary of results: A total of 28 students attended curriculum. We added five hours skill-lab to each the three courses – the feedback was excellent. committee dividing the students into four groups. Thus, Participants enjoyed the group work and role play and the clinical skills educational programme has been the communications skills session with simulated developed and implemented into the current curriculum patients. We have since restructured the course to run including phases I,II,III. Family Medicine Department weekly for half a day on a rolling basis so that is in charge of advising; estimated standards and participants can attend sessions that fit in with their procedures with the support from the Administrative other commitments.

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WTL 7 Which courses should be taught for the Background: The Breathe Pilots is a group of medical students of medicine in the Pediatrics students in Trondheim, Norway. We think young people Department? deserve real information about cigarette smoking consequences before they start smoking. Through M R Dehghani*, M H Fallahzadeh and Z Karimian (Shiraz governmental cooperation we can offer a free hospital University of Medical Science, Educational Development visit for school classes. Center Office, Zand Avenue, Shiraz, IRAN) Aim: An alternative way to prevent youngsters from Introduction: Usually those courses which should be starting cigarette smoking. prepared for clinical students in the pediatrics ward through a curriculum and in an educational course are Summary of work: School classes (age 14-15 years) based on educational objectives which are according from Trondheim are invited to visit the university to the signs and symptoms and common diseases. hospital. The teenagers get their own doctor’s coat for the occasion. Throughout a half-day at the hospital, Summary of work: This study is based on data collection they learn about the heart, the lungs, the cigarette during the last three years in a referral center among smoke and organ pathology. This is taught in simple those children who have been admitted to the pediatrics ways, including practices. They see a short coronary department (subspecialty, general and emergency bypass movie, and they see some real organs on ward).These data included: age, sex, signs or symptoms formaldehyde. The youths meet a COPD patient telling or primary diseases which have been cause of death, his story, which really makes an impression. Our and finally those data have been analyzed by SPSS strawrace gives the opportunity to learn how a lung statistical software. patient breathes. Summary of results: From 10,185 children admitted Summary of results: This is an alternative way of into the subspecialty, general and emergency ward, teaching which the young people find very interesting. 9.7% of all death patients showed signs and symptoms The medical students learn more about smoking of diarrhoea, 7.9% showed signs and symptoms of prevention, preventive medicine and communication abnormal movement, 7.1% shown signs and symptoms with teenagers. of respiratory difficulty, and common causes of children’s death were CHD (13.4%), ALL (9.2%), Cooley’s Anemia Conclusion: Through teaching on a simple level, medical (9%), Convulsion & Status Epilepticus (6.8%). students offer an alternative smoking prevention for youngsters. More of our teaching and practices will be Conclusion: To provide the educational programs, lesson presented in the conference session. plans which should be taught during an educational course have to be based on findings which may include the most common causes of mortality and signs and WTL 10 Profile of preferences about the ways symptoms related to mortality and morbidity. students and teachers assimilate and transmit knowledge while learning WTL 8 Comparison of Basic Life Support (BLS) María Eugenia Ponce de León* and Margarita Varela Ruiz self-learning and standard BLS training in (Universidad Nacional Autónoma de México, Camino Sta. nursing students Teresa 277 - Casa 15, Colonia Bosques del Pedregal, Delegacion Tlalpan CP 14010, MEXICO) R Nikandish*, A Ebrahimi, A Asghari and A Karamad (Fasa University of Medical Sciences, Ebne Sina Square, Fasa Aim: At the Medicine Faculty of the Universidad Nacional 74615-168, IRAN) Autónoma de México the professors set out questions: What are the preferences to assimilate, process and Aim of presentation: To compare students’ performance transmit knowledge between students and professors after self-learning with VCD and manikin versus from the different Academic Departments? Does a standard BLS training. correlation exist between the preferences of professors Summary of work: 20 first year nursing students were and students? Are the teaching strategies of professors divided into 2 groups randomly and provided with BLS consistent with students’ needs? instruction either in a standard format or with VCD and Summary of work: Two groups (A and B) were selected manikin without a tutor. Performance of students on from the first year of the Public Health Course. The the manikin were evaluated with a checklist including students had similar grades, the course was at the same all steps in BLS. time and the two professors used different teaching Summary of results: The mean students’ score with strategies. The questionnaire “Teaching and learning standard training was 45.2+/-3.91 and with self training Styles: VARK Strategies” by Neil D. Fleming (Visual, it was 46.3+/-3.86. There was no significant difference Aural, Reading/writing or Kinaesthetic) was applied to between the two groups (p>0.05). both groups. The preference profiles of students and professors was defined and compared. The teaching Conclusion: In the nursing students with no previous strategies used by the professors were analysed and BLS training, access to VCD and manikin provides correlated with the grades obtained by the students at immediate educational outcomes similar to those of a the end of the Course and with the students’ standard BLS course. Self-learning BLS with VCD should preferences. be enhanced with a period of hands-on practice. Summary of Results: A): 88% multimodal KVA, 12% R. (B): 80% multimodal KVA, 20% R. Both teachers WTL 9 Breathe pilots of the North are multimodal KAV and KRA. Regarding gender we Mari Rostad*, Karoline Aker, Torstein S Hansen and found a discreet preference by men for the Aural. No Kristian Espeland (Norwegian University of Science and age differences were found. Teaching strategies were Technology, Faculty of Medicine, Medical Technical correlating with students’ preferences. The research Research Center, Trondheim N-7489, NORWAY) will continue, increasing the number of groups (students and professors), in order to achieve more representative results.

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