View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CLoK Theme: Basic Science/ Biomedical Teaching & in practice and to “unpack” or reflect on the role the principles played in disease and patient care. By providing deliberate practice with this, we hope that stu- Assessment dents will begin to notice these principles in action as they progress through their training. Accepted as: Short Communication The findings also revealed that we have opportunities to better support and en- hance integration by providing faculty and resident development. The more our Paper no. 001 students can see and hear this type of thinking being modeled by the teams they So What? Exploring learners’ integration of basic and work within the clinical setting, the easier it may be for them to apply this think- ing to new contexts and future practice. clinical sciences during clinical rotations Future research will explore if there is a relationship between student perfor- Author(s): Jennifer Meka mance on the principle in action write up and standardized exam performance as Corresponding Author institution: Jacobs School of Medicine well as clinical evaluations. Further research should be pursued to determine the Background Learners often struggle with integrating knowledge from different most effective methods of assessment to support and enhance integration. sources and synthesizing in a way that creates deep and durable learning (1,2). Development of a rubric to assess cognitive integration through multiple modali- The purpose of cognitive integration is to “achieve a conceptual, cognitive con- ties is needed to effectively measure this important concept. nection between different types of knowledge” and is essential for performance References in professional activities (3,4). As more US institutions are shifting required li- 1. Bandiera G, Kuper A, Mylopoulos M, Whitehead C, Ruetalo M, Kulasegaram K, censing examinations, such as the United States Medical Licensing Exam (USMLE) Woods NN. Back from basics: Integration of science and practice in medical educa- Step 1, to post-clinical phases of training, there is an urgent need for revisiting tion. Medical Education 2018;52(1):78- 85. https://doi.org/10.1111/medu.13386 the basic and health systems sciences throughout the clinical phase of training. 2. Dahlman KB, Weinger MB, Lomis KD, Nanney L, Osheroff N, Moore DE Jr, Cutrer To address this, many institutions have incorporated “back to the basics” didactic WB. Integrating foundational sciences in a clinical context in the post-clerkship sessions throughout the clinical phase to promote retention of basic science curriculum. Medical Science Educator 2018;28(1):145- 154. concepts (e.g., acid base, salt water balance, etc.) in preparation for these board 3. Glaser BG, Strauss A. The discovery of grounded theory: Strategies for qualita- exams. The science of learning, however, provides robust support for the use of tive research. New York, NY: Aldine, 1967. active learning strategies, such as the generation effect, elaborative interroga- 4. Jones M, Alony I. Guiding the use of grounded theory in doctoral studies-An tion, collaborative testing, and contextual variation to support long-term reten- example from the Australian film industry. International Journal of Doctoral tion and transfer. In an effort to promote the use of evidence- based learning Studies 2011;6:95- 114. strategies, we designed an integrated sciences curriculum to be implemented 5. Kulasegaram KM, Martimianakis MA, Mylopoulos M, Whitehead CR, Woods NN. longitudinally across the clinical phase that incorporated best practices in teach- Cognition before curriculum: Rethinking the integration of basic science and ing and learning to support the use of effective learning strategies and promote clinical learning. Academic Medicine 2013;88(10):1578- 1585. https://doi. meaningful integration of the sciences in clinical practice. org/10.1097/acm.0b013 e3182 a45def Methodology We developed a curriculum for sessions that incorporated key in- 6. Lincoln Y, Guba E. Naturalistic inquiry. Beverly Hills, CA: Sage Publications, structional strategies that have been found to support cognitive integration in- Inc. 1985. cluding collaborative testing, contextual variation, and elaborative interrogation. 7. Woods NN. Science is fundamental: The role of biomedical knowledge in clini- At the end of each clinical block, students were required to complete a “Principles cal reasoning. Med Educ 2007;41:1173–1177. in Action” written assignment. The goal of this assignment was to promote cog- nitive integration by having students examine and elaborate on a basic science Theme: Basic Science/ Biomedical Teaching & principle to one of their personal clinical experiences. Students provided a brief synopsis of a patient case, explained the clinical concept and underlying basic Assessment science principle that were involved in the case, and then examined how the basic science principle impacted patient care or their next steps in Accepted as: e- poster management. In this study we used a rubric to assess students’ responses in terms of: clarity of Paper no. 002 explanation of the principles as they relate to the clinical concepts; integration What Can Workplace- based Assessment Data Tell Us about of explanation with experience; and description of the impact of the principle on next steps in management or patient care. After reviewing the responses as a Student Engagement with Clinical Skills? Author(s): Kaiwen Wang, Alicja Piotrkowicz, Jennifer Hallam, Vania Dimitrova whole, we used a grounded theory approach to analyze the written responses as Corresponding Author institution: University of Leeds it provides a detailed and systematic method of analysis as well as the ability to explore the data and allow issues to emerge (Jones and Alony, 2011). Student Background Clinical placement is an important aspect of medical education. responses to the prompt related to cognitive integration (“So What? Explain how During placements students complete workplace- based assessment (WBA), which the basic science principle impacts patient care or your next steps in manage- provide valuable data for educators to understand student engagement. We de- ment of the patient.”) were analyzed through inductive coding of responses us- scribe methods to analyse formative WBA data for clinical skills. We focus on Year ing constant comparison method (Glaser and Strauss, 1967). Data was separated 1 medical students, who only start to develop self- regulation skills, and it is into discrete “incidents” (Glaser and Strauss, 1967) or ‘units’ (Lincoln and Guba, crucial to support them effectively during placements. 1985) and sorted into categories and themes were identified. Methodology We used WBA data of Year 1 cohorts across three years (16/17, Results The results identified several themes from a process perspective includ- 17/18, 18/19), comprising of: clinical skill title, assessor role, location, times- ing that true integration inside a learner’s head may not be reflected through tamp, feedback, and student comment. To assess the feasibility of a data- driven current assessment practices. We also found that integration is enhanced when approach on this type of data we used readily available methods: feature engi- students are engaged with applying their learning to relevant topics. Additionally, neering, process mining (ProM), and text analytics (scattertext). in reviewing responses from a content perspective, students whose responses Results (1) Across all year groups, diagnostic procedure skills (blood pressure) reflected deeper levels of integration demonstrated a better understanding of key were completed most frequently, followed by consultation skills (history, com- features of the underlying basic science concept and how it informs next steps in munication). Number of skill categories increased in later years, from mostly di- care and management. agnostic procedures in 16/17 to other categories such as infection prevention, The next step for data analysis is to look for correlation between depth of re- clinical management, and professionalism. sponse and performance on standardized exams as well as clinical evaluations. (2) All groups showed a spike in the number of completed assessments near the Discussion The findings from the current study further our understanding of in- end of placement when students were reminded to complete their WBAs. Students structional and assessment strategies in promoting cognitive integration. The in primary placement tended to start completing WBAs later than those on sec- findings highlight key areas that should be considered when developing curricu- ondary placement. lum that aims to support integration. We found that we needed to provide direct (3) The range of assessor roles showed a decrease in 18/19, while the frequency and explicit expectations for students to pay attention to basic science principles of peer assessment increased. © 2020 The Authors. The Clinical Teacher published by Association for the Study of Medical Education and John Wiley & Sons Ltd. 8 THE CLINICAL TEACHER 2020; 17 (Suppl. 1), 8–196 (4) Students showed very diverse pathways of choosing clinical skills. Most com- The median overall quality score (QS) was 48% (range 27- 62). The highest me- mon subprocesses focused around basic clinical skills i.e. pulse, blood pressure, dian QS was 73% (33-80) for data analysis; lowest median QS was 20% (7-40) for temperature, respiratory rate.