Abstracts | Teaching & Learning

Evaluation of the educational effectiveness of patient narratives and discussion of experiences of care in the Irish Healthcare System using the Jefferson Scale of Empathy in a final year medicine cohort

Authors

  • Donnelly S, Butler M, Drumm B

Background

Empathy is essential for high quality care but is difficult to define and measure. The Jefferson Scale of Empathy (JSE) is a validated instrument “to measure empathetic qualities”. We designed a learning intervention to promote empathy using a  “narrative” approach and measured empathy in final year students using the JSE.

Aim

To evaluate the effectiveness of a patient centered “Care Seminar” on student empathy using the JSE and a method of contrasting groups.

Method

The seminar was designed by a multidisciplinary educational team as a 3-hour patient centered discussion of experiences of care with student interaction. All students in final year were asked to complete an online version of the JSE ( Student version). Statistical comparison of scores investigated the role of  various factors on JSE scores. Other evaluation included detailed follow up feedback . Statistical comparisons were made using the method of Bonferroni (SPPS) for the following variables

  1. UEM 5, UEM6 and GEM Programmes
  2. Gender
  3. Previous healthcare  work
  4. Care seminar attendance
  5. Age
  6. GPA

Results

92 of 180  final year students completed the questionnaire.  53 had attended a Care Seminar at the time of completion , 39 had not.  KMO and Bartlett's Test were fulfilled and Cronbach’s alpha= 0.803. Empathy scores were normally distributed [mean 113 ( max possible score 140) , sd=10], lower than reported scores in other populations. NO statistical difference in JSE scores was found for any variable tested.  Score analysis from the subscale “perspective taking” indicated an unexpected FALL in individual question scores for those who had taken a Care Seminar.

Discussion & Conclusions

The lack of relationship between empathy scores and gender is not in keeping with international reports and has prompted a full validation of the JSE in the UCD medical student population. We thus draw no conclusions about the efficacy of the “Care Seminar” measured by the JSE, noting that feedback via other methods was strongly positive in relation to empathy and care.  We did note statistically significant increases in individual questions on the JSE, and unexpected and paradoxical falls (ns) on ‘perspective taking” questions for seminar attenders . We postulate that either the seminars offered “too much perspective” or that the instrument is inappropriate for measuring  “perspective taking” due to specific item wording in this subscale. We acknowledge that the instrument was neither designed or validated for subscale analysis of this sort and conclude that measuring the educational effectiveness of interventions to engender empathy may require a more sophisticated instrument responsive to a deepening understanding of the patient’s perspective.

NeuroSKILL: Increasing training and skills in dementia through a new neuroimaging initiative in the Ireland Wales region

Authors

  • Ciblis A

Background

Currently, more than 41,700 people in Ireland and 12,000 people in North Wales are living with dementia, and the number of Irish people with the disease is likely to rise to 147,000 by 20411 due to increased life expectancy. Dementia frequently remains undiagnosed, however, depriving many of early interventions. The aims of NeuroSKILL2 are: (i) the production of training and skills programmes to increase capacity, knowledge and expertise regarding neuroimaging techniques in dementia for healthcare professionals in Ireland and Wales, (ii) the development of innovative techniques for utilisation of neuroimaging information by health care professionals, and (iii) the provision of increased knowledge and awareness of the diagnosis, treatment and living with dementia through a web-portal.

Methods

Using state-of-the art technology, the project involves the development of web-based and in person training courses to increase knowledge and skills in neuroimaging techniques in dementia among healthcare professionals. The programmes will be aimed at general practitioners, neurologists, psychiatrists, psychologists, geriatricians, radiographers, radiologists, and specialist nurses. A web-portal for patients and their carers along with a parallel portal for healthcare professionals increases knowledge and awareness of dementia and enables the provision of online training courses for healthcare professionals.

Results

The provision of training courses in neuroimaging in dementia increases the knowledge and skills of healthcare professionals in the region and improves understanding of the diagnosis. The combination of several imaging modalities enables improved diagnostic capability. More accessible neuroimaging information facilitates a better comprehension of neuroimaging in dementia. The provision of a web-portal enhances awareness and knowledge of dementia and allows for the provision of online training courses.

Discussion and Conclusions

Early diagnosis of dementia is essential for the provision of adequate treatment and care. Yet dementia is currently underdiagnosed while the capability of neuroimaging in the diagnosis and understanding of dementia is underutilised. Through improved diagnostic capability and the provision of online and in person training, NeuroSKILL enhances skills and furthers the use of neuroimaging in the diagnosis and understanding of dementia in the region.

  • NeuroSKILL is a collaboration of University College Dublin, Trinity College Dublin, and Bangor University in Wales and is funded under the EU ERDF INTERREG 4A Ireland Wales Scheme.

An Evaluation of the Introduction of an Interprofessional Problem Based Learning Module

Authors

  • Cusack T, O’Donoghue G, Butler ML, Blake C, O’Sullivan C, Smith K, Sheridan A, O’Neill G

Project

Patient care is complex and demands that health professionals work together effectively. Interprofessional education (IPE)1 encourages collaboration by educating students from different professions together.

This study examined the effectiveness of IPE in terms of changing students’ perceptions of teamwork, professional identity, role, competency and autonomy, and the need for interdisciplinary co-operation.

Two multidisciplinary cohorts (n=51 and n=48) of health science students (medicine, diagnostic imaging, nursing and physiotherapy) elected to participate in an interprofessional problem based learning module (PBL). The module included problems addressing areas of professional identity and cases requiring a multidisciplinary team approach.

Evaluation was undertaken using the Readiness for Inter-Professional Learning Scale (RIPLS) and the Interdisciplinary Education Perception Scale (IPES). Regarding the RIPLS, both cohorts reported significant (p<0.05) improvements in their perceptions of teamwork, collaboration, and positive professional identity. Regarding the IEPS students’ perceptions of professional competency and autonomy improved significantly (p<0.05) in both cohorts. An IPE module delivered using PBL appears valuable for professional development.

Experiences of using Prezi in medical education

Authors

  • Duffy R M, Guerandel A, Casey P, Malone K

Project

Prezi is a free cloud based presentation software allowing lecturers to create a zoomable canvas on which to develop ideas. The software can also produce a mind map; which are much harder to produce using conventional presentation software. Prezi facilitates learners in gaining both an over view of a subject and understanding where more complex issues fit into the overall picture. This study examines student’s experience of lectures presented using Prezi both in the lecture theatre and for their personal study. It then considers the steps that can be taken my medical educators to appropriately use Prezi, maximising on its benefits while avoiding potential

Methods

Prezi was used to lecture delivery and presentation in 25% of all lectures delivered in Psych 40150 (psychiatry for the final year medical students) in the Mater Misericordiae University Hospital. These lectures were available on Blackboard and students were free to download the lectures in their own time. The rest of the lectures were delivered using more conventional presentation styles. This cross sectional study used a questionnaire with both open and closed questions to assess student’s experience of the software.

Results

97% (32/33) of students found Prezi to be a more engaging experience compared to other styles of lecture delivery. 93% (31/33) said it provided them with a useful overview of the subject. On the whole the media was not found to be distracting or confusing. Problems arose when students tried to use Prezi in their personal study with 48% (16/33) reporting some difficulties. These were mostly technical problems but for a minority this was with the medium itself.

Conclusion

This study highlights the potential Prezi has in providing students with an engaging and stimulating educational experience. However for Prezi to be effective the lecturer using it has to understand and be familiar with the software and its appropriate use as this can be the cause of the drawbacks highlighted in this study. It is essential that teachers planning to use Prezi familiarise themselves with it. It is important that teachers equip students to get the most out of it too. Information gained from feedback from students can inform them on how to improve Prezi delivery. This experience can then be used to support other teachers to avail of the benefits offered by Prezi. Many pitfalls can also be avoided by following basic rules in designing a presentation. Prezi’s potential uses in medical education extend beyond the classroom; with straight forward inclusion of video media opening up possibilities for online lectures and providing visual, interactive overviews of courses or subjects.

The development of interactive virtual patient simulations for an undergraduate medical psychiatry module

Authors

  • Holloway P, Malone K, Last J, Guérandel A

Introduction

Patient simulations may offer some solutions to the challenges posed to medical education by changing patterns of patient care but actors and patient simulators help but can be costly and impractical, text-based branching clinical vignettes can lack the necessary fidelity for engagement and watching video encounters can lack the necessary agency to make them optimally effective. We have developed a suite of 9 virtual patients to help students to get more benefit from actual patient and tutor encounters.

Materials and methods

  • Core functionality for the resources was defined through consultation.
  • The development process was iterative with multiple reviews.
  • Scripts were developed by multiple subject matter experts.
  • As a pilot project use of 4 virtual patients was integrated into the curriculum and the students’ reflections on these encounters were formally assessed in meetings with their tutors. The documentation from these assessment meetings was used to infer the students’ attitudes towards and experiences of the virtual patients.

Results

182 students were given access to the resource and all used it. Feedback was available from 155 students. Each student was required to cite at least one aspect of each of the 4 cases that they found difficult and at least one aspect that they found straightforward. There were 28 statements (of a minimum of 728) that cited technical difficulties or that questioned the relevance of the activities. 28 students (15%) stated that they found the structured and thorough nature of the first clinical lab helpful. 81 (45%) of the students stated that they found it difficult to construct a formulation. However, 36 of those 81 (20% of the total) went on to state that in subsequent exercises they now found formulation straightforward.

Conclusion

It is feasible to create virtual patients that appear, at this stage, to be usable and acceptable to students and aid learning of case formulation. However, more formal assessment of student attitudes and educational impact is required.

TubeTag: The development of an online image annotation tool for developing medical e-Learning resources

Authors

  • Holloway G P, Le Roux C

Introduction

Labelled images available online are poor substitutes for image interpretation in the presence of an expert who will provide timely feedback. To this end tubeTag was created in consultation with a variety of educators experienced in teaching the identification and interpretation of features in medical images. It is an online tool with a shallow learning curve that allows medical educators to easily create effective, distributable e-Learning resources.

Materials and methods

Following development of a pilot desktop application, a group of medical educators was recruited to contribute to the user needs analysis of a more developed version. Opinions were gathered using informal, semi-structured interviews. Functionality that was commonly sought and deemed to be deliverable within the development timeframe was incorporated. To facilitate ease of access and testing the tool was developed as an online web application. The experts were given access to the tool and asked to submit feedback via an online questionnaire.

Results

Four medical educators were recruited for the user needs analysis. Ease of use, the ability to rapidly update content, the capacity to request bespoke features, and “levels of difficulty”. The pathologists and radiologists wanted the tool to be able to use the large specialist file formats associated with their specialties but were willing to be limited to the more common formats in the interests of usability.

These teachers joined by 4 others for the alpha testing. Only 3 of the testers had used e-Learning creation software previously but 7 of the 8 testers reported that the software was either very or extremely user-friendly. 7 testers reported that the software crashed or froze “not at all often”. 6 of the testers found the software either extremely or very successful at its intended task.

Conclusion

It is possible to produce a stable online application that is usable by medical subject matter experts with no training to create bespoke reusable learning interactions for a spectrum of medical domains from pathology to rheumatology.

Parent attitudes towards medical student review of children waiting for Emergency Department assessment

Authors

  • McGlacken-Byrne S M, Hawkes C P, Murphy S

Background

Increases in the numbers of medical students and in the workload of non-consultant hospital doctors (NCHDs) has resulted in reduced learning opportunities for undergraduate medical trainees on the wards. We propose that patients awaiting NCHD review in the Emergency Department (ED) could be assessed by medical students, as a method of enhancing patient-centred education. As an initial step, we aimed to ascertain if parents would be amenable to this in the paediatric ED setting.

Methods

Over 50,000 children attend The Children’s University Hospital’s ED annually. Parents of patients awaiting review in this ED completed questionnaires outlining attitudes towards an initial review by medical students. We also recorded the child’s presentation, age, time spent waiting in Aand E and the time of day.

Results

All (n=100) parents approached agreed to participate in this study. 91% would have allowed a medical student to see their child while waiting. We stratified parents’ responses by their age (mean 4.7, SD 4.1), hours spent in Aand E (mean 1.73 hours, SD 1.81) and clinical presentation. The most common presentations were acute respiratory illness, gastroenteritis and minor trauma, accounting for 58% of the total. There was no consistent factor that increased the likelihood of a negative response.

Conclusions

Medical student assessment of patients awaiting NCHD review in the paediatric ED would provide an excellent learning opportunity. Feedback to enhance learning would be guaranteed as all patients would subsequently be assessed by an NCHD, and prompt learning points would efficiently be imparted. We have shown that parents would be open to the introduction of this in a paediatric setting. Potential difficulties with the introduction of this include limited space in many EDs and the need for close supervision to ensure that evolving severe illness in a previously medically unassessed patient is detected.

A Profile of Physiotherapy Clinical Education Settings 2009-2012

Authors

McMahon S, Waters N, ODonoghue G, Cusack T

Background

According to the Department of Health and Children directive Primary Care – A New Direction 2001 – Primary care is the appropriate setting to meet 90-95 per cent of all health and personal social service needs.[1] With the ongoing reform of the Irish Health service it is likely that future employment opportunities for physiotherapy graduates will be in primary care. In order to adequately prepare a future workforce, pre-registration physiotherapy courses must respond to the change in focus of healthcare delivery.

Aim

The purpose of this study was to examine clinical education placement data in order to provide a profile of settings of clinical placements in the four schools of physiotherapy in the Republic of Ireland (UCD,TCD, RCSI and UL) over a three year period 2009-2012

Method

All four schools of physiotherapy were asked to categorise clinical placement allocations under the following six headings (1) Acute Hospitals (2) District Hospital / Specialised Rehabilitation (3) Primary Community and Continuing Care services (4) Private Hospitals / Clinics (5) Overseas and (6 ) Other

Results

A total of 3142 placements were used in the three years from 2009-2012. Of these, 73.5% (n= 2310) were in Acute Hospitals, 17.2% (n= 542) were in District hospitals / Specialised Rehabilitation services, 5.4% (n=171) were in Primary care services, 1.3%( n=41) in private hopsitals / clinics and 2.2 % (n=72) were overseas placements. Specifically looking at the number of primary care placements, the trend was as follows; 2009/10 and 2010/11 4% of placements were in primary care settings and this increased to 7% in 2011/12.

Discussion

The findings of this study indicate that the vast majority (73.5%) of clinical placements take place in acute hospital settings. This is at odds with the shift in Irish healthcare delivery, from secondary / tertiary, to primary care. Possible reasons for the results of this study are discussed.

Conclusion

Although the allocation of clinical placements to primary care services increased slightly over the three years, acute hospitals are the predominant settings for clinical education. Further research is needed to explore and address issues providing placements primary care settings.

Undergraduate surgical education: A multi-institutional analysis

Authors

  • Mulholland D, McDermott R, Hogan N, Quinlan C, Foley N, Kelly R, Hogan A, McEntee G

Introduction

A significant amount of valuable undergraduate medical teaching may be informal, unscheduled and delivered by non-consultant hospital doctors (NCHDs).

Methods

Questionnaires were distributed to NCHDs and consultants working in Irish teaching hospitals. The aim was to quantify the level of unscheduled teaching carried out in these hospitals and the manner in which it was performed. Medical students, NCHDs and consultants were surveyed to elucidate preferred teaching methods and to identify potential targets for improvement.

Results

A significant majority of doctors who replied are independently teaching undergraduate medical students, without any association to a formal curriculum, including the majority of interns and senior house officers (SHO). Students tend to prefer small group teaching. A majority of students feel they could benefit from more surgical teaching time. Most students receive what they consider valuable unscheduled teaching at least once a week and rated intern teaching as beneficial. No interns surveyed were scheduled to teach as part of a formal curriculum.

Conclusions

A significant amount of unscheduled teaching by interns and senior house officers takes place in the hospital setting. It may prove beneficial to surgical education to incorporate interns into scheduled surgical teaching curricula.

Engaging medical students in teaching about delirium

Authors

  • Ni Chorcorain A1, MacSuibhne S2, Guerandel A3, Malone K3

Aim

This poster is intended to a discussion of the reality of implementing structural changes in tutorials using medical education principles.

Background

Delirium is one of the most acute medical presentations, and it is under-recognized. It is associated with increased rates of mortality and morbidity including inappropriate prescribing of sedative and antipsychotic medication, increased length of stay, increased usage of multidisciplinary team resources. In University College Dublin Psychiatry teaching there is an emphasis on student-focused, interactive teaching which addresses the entire range of learning styles.

Method

There are detailed e-learning resources on the topic of delirium available. Therefore a tutorial was designed to consolidate existing knowledge rather than to impart new learning, and was aimed to work on higher levels of Bloom’s taxonomy of learning. The educational objectives were in the cognitive domain. Clinical importance of delirium was underlined to the students, highlighting its prevalence and the importance of recognizing it. Baseline entry knowledge was assessed using an MCQ, which corresponds to evaluation as termed by Bloom.

This was done individually with students personally completing a questionnaire on differences between delirium and dementia, and then as a group. A series of video clips demonstrating different clinical scenarios lead to a discussion on the differences between dementia and delirium. The learning strategy was to foster deep learning so that learners actively construct their own personal interpretation and there is lasting behavioral changes.

Discussion

One obstacle to this was apparent student unfamiliarity with the lower-level knowledge domains, which were a pre-requisite for the tutorial. Therefore time in the tutorial was spent teaching in a more didactic way than planned. Given that learning material was available both through lectures and online that was intended to address these purely knowledge based domains, this may point to a difficulty with educational approaches that aim to enhance student autonomy – they are dependent on a positive view among students of this approach.

The tutorial forms part of a course designed with the ambitious ultimate aim of effecting long lasting behavioral change, level three of Kirkpatrick’s hierarchy. Measurement of this behavioral change and subsequent final results is challenging and would require longer-term follow up. It is ethically (and logistically) impossible to examine delirium as a long case in final medical exams or in an OSCE . Assessment utilising virtual patients however may be a possible way forward for evaluating students on this topic.

A reflection on continuing professional development

Author

  • O’Loughlin K

Project

Our paper discusses the importance of reflective practice in the context of the continuing professional development of post-graduate trainees.

The Irish Medical Practitioners Act (MPA) 2007[1] has given formal recognition to the need for clinicians in Ireland to maintain and develop the knowledge, skills and attitudes relevant to their professional work. Trainees need to be encouraged to manage their own professional growth by developing a broad range of skills and competencies in their own work and personal environments and integrate these with the established evidence base derived from CPD activities.

The term ‘reflective practice’ was initially used by Donald Schön[2, 3]. _ENREF_12At the root of Schön’s work was an attempt to outline how professional knowledge is unlike the kinds of knowledge presented in textbooks, scientific papers and academic journals. He noted that clinicians often find themselves responding to a wide variety of complex situations that are poorly defined. The primary reason for consciously and systematically engaging with the process of reflection in these contexts is to consider to what degree the influences from our past overlap with the requirements of whatever clinical situation we now face.

A reflective practice model of CPD implies that psychiatrists are actively involved in their own personal and professional development, critically analysing their clinical environment, evaluating their decision making and drawing on this insight to help identify what activities are likely to be of most benefit in addressing personal deficits in knowledge or competence.

In this paper we outline the processes involved in reflective practice and the detail how such processes can link day to day clinical encounters to CPD activities relevant to the trainee clinician. The merits of clinical supervision, peer review, reflective diaries and online discussion boards in enabling this reflection are delineated.

We discuss how traditional CPD activities, if undertaken in a judicious manner by the trainee, have the potential to both enable the process of trainee reflection and address deficits in trainee knowledge or competency. The importance of case conferences, balint groups and clinical audit are outlined in this context.

We detail how reflective practice may be assessed and discuss the implications for patients care.

Providing undergraduate physiotherapy clinical education in the primary care setting – the barriers and facilitators

Authors

  • McMahon S, Cusack T, ODonoghue G

Background

Traditionally, clinical education opportunities for undergraduate physiotherapy students have been centred around secondary care, focusing on acute services in large teaching hospitals. With the worldwide shift in health care from secondary to primary care, employment opportunities for newly qualified physiotherapists are likely to be in the primary care setting. For contemporary physiotherapists to become effective first-contact primary care providers, they must be exposed to the primary care environment during their undergraduate education.

Objectives

To explore the concept of and identify perceived barriers and facilitators to providing physiotherapy undergraduate clinical placements in the primary health care setting

Design

A three round Delphi survey was used. Participants were asked to answer open-ended questions with regard to (a) student preparation for and (b) provision of primary care placements (Round 1). Content analysis was employed to identify themes. These themes generated statements for round 2. In round 2, participants were asked to rate their level of agreement/ disagreement with the generated statements. In round 3 a final process of rating was conducted. Level of consensus was established as ≥75% agreement, with a mean rating ≥3.5 and coefficient of variation ≤ 30%.[1]

Participants

  • 198 primary care physiotherapy staff.

Results

120/198 (response rate 60%), 84 /120 (70%) and 64/84 (76%) respondents replied to rounds 1, 2 and 3 respectively. All seven key facilitators identified reached consensus. They included additional support for staff taking students and motivated students. Barriers identified included shortage of resources such as staff and a lack of tradition; in other words, students are not by tradition educated in the primary care setting.

Conclusions

This study reveals there is support for providing physiotherapy clinical education in the primary care setting. Through careful consideration with clear planning and collaboration with all stakeholders, it may be possible to convert the main barriers identified into facilitators to ensure there will be an adequately prepared physiotherapy work force in the future.

Clinical placement in developing countries: perceptions of undergraduate physiotherapy students

Authors

  • O'Sullivan C, McMahon S, Garrett S

Aim

The aim of this study was to explore students’ perceptions and experiences following a 5 week clinical placement in Africa

Methods: All 6 students who had undertaken placement in a developing country during summer 2012 volunteered to participate. Placements took place in Uganda (n=3) and Ghana (n=3) in June 2012.

A structured group feedback approach was employed (O’Donoghue et al 2011), where students were presented with open ended questions in relation to (i) pre-departure preparation; (ii) teaching and learning during the placement; and (iii) environmental/cultural aspects of the experience.

Results

Students’ perceptions of their placement experience were very positive. Students reported that they were adequately prepared in terms of background physiotherapy knowledge but suggested that further preparation regarding the cultural aspects of working in a developing country would be beneficial. Positive results in the teaching and learning domain included: diverse patient population, good physiotherapy resources (equipment and space), benefits of peer learning and that their placement goals were patient treatment orientated rather than grade orientated.

The development of generic skills was emphasised as follows: improved communication, improved confidence, improved confidence when working in a multi-disciplinary team, innovative with treatments, improved self-motivation and adaptability. Students reported feeling more competent as physiotherapists, as they had a larger scope of practice than they would on placement in Ireland. Negative aspects included lack of resources for patients and different systems of physiotherapy assessment. Under environmental aspects, the students reported that the working environment was relaxed, which improved their confidence. Language was reported as a common barrier to rehabilitation

Conclusions

There is evidence that overseas placements in developing countries develop generic skills in physiotherapy students. More research is required to further evaluate the effects of clinical placement in developing countries on health professions students and their host communities.

Cultural attitudes to learning

Authors

Shah B, Holloway P, LeRoux C

Introduction

Students prefer different teaching methods. The cultural background of students may impact preference for teaching methods. The role of electronic learning (e-learning) in teaching Pathology in a multicultural classroom is controversial.

It is important to understand students’ opinions and adjust our teaching accordingly to cater their needs to make our teaching more effective and efficient for their learning(Vaughn and Baker, 2001).

Materials and methods

Questionnaires were distributed to stage 4 undergraduate and stage 2 graduate entry medical student cohorts. Students were asked to indicate the value of different learning methods which included attending lectures, reading around lecture notes, attending small group tutorials and using electronic resources. The usefulness of different electronic resources was also enquired.

Result

One hundred and thirty three students (43%) responded to the questionnaire; of which, 106 (79.7%) were undergraduate and 27 (20.3%) were graduate entry medical student cohorts. The responders were divided into two groups: students with English as first language and students with other than English as first language. A group of 105 students (79.5%) had English as their first language and a group of 28 students (20.5%) had other than English as their first language, of which Malay was the commonest language (67.9%).

The most useful teaching methods in Pathology were ranked in following order: small group tutorials, reading around lecture notes, e-learning and attending lectures. There was statistically significant difference (p=0.0139) between both the groups of students for lectures as their learning method. Lectures were more popular among our students with other than English as their first language (41.7%). Self-study (97%) remained the students’ choice for studying medicine. E-learning appears to increase as students’ progress through medical college. Online interactive activities top our list of e-learning resources.

Conclusion

Small-group tutorial format and reading around lecture notes were perceived as the most useful learning methods in Pathology by the students. Cultural background appears to affect students’ choice for lectures. However, other teaching modalities do not seem to be affected by cultural variation. Delivering medical education through a variety of lectures, small group teaching and electronic format remains preferable, but increasing the number of small group tutorials and developing interactive electronic resources may aid the teaching in Pathology.

Medical student responses to different formats for teaching delivery in a Dublin medical school

Authors

  • Somers C, Guerandel A, Malone K

Project

The Irish Working Group on Undergraduate Medical Education and Training and the General Medical Council (UK) published key recommendations in relation to standards of delivery for teaching medical students These included different teaching and learning opportunities providing a balance between large and small teaching groups; the provision of practical classes and opportunities for self directed learning; the incorporation of new teaching technologies including simulation as a method of delivery. In University College Dublin medical school some of these recommendations are being implemented for the teaching of psychiatry.

In the present report medical student responses, by self completed questionnaire, on the psychiatry component of a teaching module were evaluated for 2 successive student streams in 2011 (n=187) and 2012 (n=224). Evaluation included collating data about large group (didactic teaching; 8 lectures of 1 hour duration delivered to entire group) small group teaching (8-16 in composition, dialectical, 3 x 2 hours duration) and web based e learning units.

Overall questionnaire response was 38.5 % for both streams (31, 46%). Preference for small group interactive workshops compared to lectures 96.5% (95%; 98%). Perceived relevance of the course material 80% (69%; 91%), perceived helpfullness of E learning material 70.5 % (62%, 79%), perceived clarity of learning goals or outcome 73% (74% 72%), perceived encouragement of reflection 75% (68%, 82% ), tutors perceived as supportive 82% (79%, 85% ); student colleagues perceived as supportive 74% (64%, 84%), quality of course organisation 71% (71%, 71%). Perceived relevance of what was taught to described course outcomes 74.5 % (73%, 76%).

The results indicate that students significantly preferred small group workshop delivered teaching to didactic lectures. A 2/3 majority found the course material relevant or valid. A majority described the e learning material as helpful in both streams. Their tutors were perceived as more supportive than student colleagues in stream 1, but both groups were considered supportive by 84% in stream 2. A limitation of the study is the low response rate at 38.5% compared to value of 75% + 2.8 reported for medical students for 40 studies in different countries.

This low response rate may be attributable to the questionnaire being handed out immediately preceding a composite module assessment test. In future, we will time the collecting of similar data differently.

What do students perceive as the educational value of PBL in a systems based graduate entry curriculum and does it promote development of teamworking?

Authors

  • Liston A, Heaphy P, Donnelly S

Background

UCD GEM has a bespoke 4 year curriculum in which the first two years feature integrated clinical material in a systems based modular design. Clinical material is delivered by methods which include a modified form of PBL (1) . PBL was chosen to promote development of clinical reasoning skills and to enhance (1) learning of science in clinical context ; (2) teamworking (3) self direction and (4) reflection. PBL is acknowledged to be resource intensive and, as student numbers increase, it is important to ensure that PBL delivers .

Aim

The purpose of this study was to determine how students viewed the “educational value” of PBL in their curriculum and evaluate its impact on development of teamwork.

Method

Students completed a paper questionnaire following the final PBL tutorial in Stage 2. Students chose their “Top 5” opportunities as afforded by PBL to their overall learning/ development. Students scored overall team performance on a 1-100mm scale and rated domains of team performance on a 1-5 Likert scale. Tutors also scored their groups.

Results

61 of 93 students completed the questionnaire. The “TOP 5” educational opportunites of PBL were to:

1. Identify and address knowledge gaps through independent study

2. Document progress in a developmental learning log

3. Develop clinical reasoning skills

4. Reflect on personal strengths/ areas for improvement in teamwork

5. Be self-directed

Team performance: Mean of the team mean scores was 74 /100 (range 68-85 ; n=7) ; higher than recorded tutor scores.

The top and bottom 3 ( of 10) domains of team performance were ranked as

1. Respect for one another ( 67% ranked as good or excellent for the team )

2. Managing different personalities. (56% )

3. Professionalism (52% )

The bottom ranked 3 domains each scored less than 38% “good or excellent” and were

8. Punctuality and settling into task

9. Managing time effectively

10. Sharing ideas and resources

Discussion and Conclusions

PBL in this mixed curriculum is rated highly by students as a developmental opportunity for skills fundamental to lifelong learning and of high programmatic importance- the opportunity to self assess, self direct, address knowledge gaps and to reflect. These were key drivers of the original educational rationale for PBL and it is both refreshing and encouraging to note that these are similarly valued by current students. We also provide evidence that graduate students do value learning activities which have emerged from adult learning theory such as PBL , a fundamental assumption in original curriculum design.

In terms of team performance, students self assessed more flatteringly than did the tutors. Aspects of team performance considered to merit improvement by students broadly matched those of the tutors. External factors such as larger group size pose challenges for time management in PBL which may require attention by curriculum managers. Less easily addressed is the poor rating given to sharing of ideas and resources amongst team members, suggesting that there is more to do to promote the emergence of true “team players” from PBL.

The effect of clinical placement on students’ attitudes towards interprofessional learning, interprofessional interaction and communication skills

Authors

  • Waters N, McMahon S, Keddy J, Phelan D

Background

The effect of university-based Interprofessional learning (IPL) activities has been shown to have a positive influence on attitudes of healthcare students (medicine, physiotherapy, nursing, occupational therapy and social work) towards future interprofessional working. Hospital-based IPL has also been investigated in some countries and shown to be equally beneficial. Currently in the Republic of Ireland, anecdotal evidence suggests that there little interaction between healthcare students while on clinical placement.

Aim

The aim of this study was to investigate whether clinical placement has a positive or negative effect on the attitudes of physiotherapy students towards interprofessional working.

Methodology

Permission was sought and granted from the University of West England (UWE) to use the UWE Interprofessional Questionnaire. This questionnaire was designed to explore health and social care students’ attitudes to IPL, interprofessional interaction and communication skills (Pollard and Miers, 2008). The questionnaire was distributed to 34 stage 3 physiotherapy students, in the first and final week of a sixteen week clinical placement block in a number of acute teaching hospitals and district hospitals.

Results

  • Interprofessional interaction Scale -A statistically significant change in perception occurred, towards a more negative perception of interprofessional interaction, following clinical placement (P=0.04).
  • Communication and Teamwork Scale -Although self-assessment of communication and teamwork skills was more positive post-placement, the improvement was not statistically significant (P=0.2).
  • Interprofessional Learning Scale -Median scores for attitude towards IPL showed no change between pre- and post-placement, remaining in the ‘positive’ category at the end of the placement block.

Discussion

The results of this study indicate that clinical placement experience has a negative effect on physiotherapy students’ attitudes towards interprofessional interaction. Possible reasons and solutions for this are suggested.

Conclusion

Further research is required to investigate whether a formal interprofessional workshop for medical, physiotherapy and nursing students carried out during clinical placement blocks, improves the students’ attitudes towards interprofessional interaction. The workshop could take the form of a patient-centred discharge planning meeting.

Who donates their body to science? An international, multicentre, prospective study

Authors

  • Cornwall J1* Perry G2, Louw G3, Stringer D1

Aims/Objectives

For centuries, Human cadavers have been an invaluable resource for medical education. Medical schools in many countries depend on the generosity of altruistic individuals who self-register to donate their bodies following their deaths. The inconsistent supply of donated bodies has prompted some medical schools to teach anatomy without cadaver dissection; a few schools reinstated this resource after discovering that medical students’ knowledge of human anatomy declined when human dissection was withdrawn or restricted.

Given that successful body donation programs are important for medical education, surprisingly little is known about individuals who donate their bodies to science. A better understanding of donor populations may assist the development or improvement of donor recruitment strategies.

The aim of this study was to determine and compare the contemporary characteristics of registered donors from three separate international institutions. Individuals registering as a body donor during a single calendar year (2010) at three institutions, University College Dublin, Ireland (IE), University of Otago, New Zealand (NZ) and the University of Cape Town, Republic of South Africa (RSA) were prospectively surveyed to identify donor characteristics. Two hundred completed surveys were returned (IE 92% response rate, NZ 85%, and RSA 67%).

Research Findings

This was the first international, multicenter, prospective study of donor characteristics. Results indicate that donors in Ireland, New Zealand and the Republic of South Africa share certain characteristics; however, some variations between locations were noted including donor age at the time of registration and the mode of programme awareness. This information could be important for assisting the identification of potential body donors in new and established Body Donation Programmes.

Individuals who donate their bodies to medical science are most often older than 60 years of age when they register. However, registrants in Ireland were significantly younger than the other two groups (P<0.01). The mean age of donor registrants was 60 ± 15 years (Ireland) compared to 68 ± 13 years (New Zealand) and 69 ± 12 years (South Africa). Sources of program awareness varied significantly among the three countries but relatives and friends were the single largest source of information.

Ireland showed the highest proportion of internet-derived awareness (22%, as compared to 2% in New Zealand and none in South Africa). With this better understanding of the profile of donors it may assist in developing or improving recruitment strategies. This study has been expanded in 2012 following the successful recruitment of thirteen international medical schools in an attempt to get a broader and deeper understanding of who donates their body for the advancement of medical education.