Abstracts
Studying living anatomy: the use of portable ultrasound in the undergraduate
medical curriculum
Debra Patten, Leo Donnelly, Simon Richards
This paper describes the use of portable ultrasound imaging in the teaching of
living anatomy to undergraduate medical students. The paper outlines the rationale
for using portable imaging technologies in undergraduate anatomy teaching, as
well as the practical issues which must be considered in designing and delivering
such teaching activities. The following areas are discussed in the paper: obtaining
appropriate consent from the volunteers who are being scanned and ensuring their
health and safety during and after scanning, ensuring optimum set-up of the learning
environment, use of the equipment and designing appropriate learning activities
for undergraduate teaching.
Skills days are superior to experiential learning for the development of core
procedural skills for foundation trainees
Simon Lambden, Georgia Tunnicliffe, Nick Sevdalis, Roger Kneebone
Background: The effectiveness of a clinical skills course undertaken by doctors
in the first four weeks of Foundation Year 1 and 2 (F1 & F2) postgraduate
training was evaluated.
Methods: Participants completed multiple choice question papers and Likert
surveys of perceived competence before, at the end of, and two months after
clinical skills courses. For comparison, a group of F2 doctors, who had their
skills training two months after the study group, undertook pre-course assessment.
Results: Multiple Choice Questions (MCQ); The mean MCQ scores of both groups
showed significant improvement following the course; F1 doctors (n = 22)
from 73.5% to 79.5% (95% CI 2.9 % - 9.2% p < 0.01) and F2 doctors (n =
23) from 69.6% to 77.0% (95% CI 4.5% - 10.2% p < 0.01). At two months,
F2 doctors maintained statistically significant improvement over their pre-training
scores (p = 0.0025) and over those who had gained experiential learning alone
(p = 0.0152). Competence;
F2 doctors showed improvement in 5 of 6 skill areas which was sustained at
the two month analysis. The experiential learning group had significantly
lower reported competence in 2 areas at two months. F1 doctors displayed
significant improvements in 3 of 6 skill areas, sustained at two months.
Conclusion: Early clinical skills training offers sustained benefits compared
to experiential learning alone.
Learning diagnostic and clinical reasoning strategies through an interactive
board-game
Keith Taylor
Background: A number of studies have reported the educational benefits of
using games to reinforce aspects of teaching and learning. In this study
we evaluate a novel, collaborative tool that can be used to reinforce clinical
reasoning strategies in undergraduate medical students.
Methods: A pilot project was conducted with a cohort of 75 third year medical
students at Dundee Medical School (UK). All participants were asked to evaluate
the game after taking part in a small group session.
Results: The game was rated very highly in terms of its design, playability,
perceived learning benefit and enjoyment.
Conclusion: There is scope for using this tool as a resource to encourage
group learning, discussion and reflection across a broad range of curriculum
content. A similar structure could be adopted by other health professionals
at all stages of learning.
Use of a secondary task paradigm to measure medical student’s
mental workload during a simulated consultation
Michael Oliver, Huw Davis, Paul Jones, Carl Rowe, Aidan Byrne
The mental workload of medical students was measured using a secondary task
methodology with the aim of investigating whether their mental workload exceeded
their mental capacity during a simulated consultation. A method previously
used to measure the workload of anaesthetists during simulated anaesthesia
was applied successfully. The results suggest that mental workload is likely
to be a limiting factor in the performance of medical students and that under
these conditions poor communication may not be due to poor communication
skills.
Inter-professional simulation: the experience of occupational therapy and
child branch nursing students participating in a simulation and problem based
learning activity
Jane Davies, Dave Clarke, Pam Stead
This paper presents an innovative project that enabled occupational therapy
and child branch nursing students to participate in an inter-professional
simulation, supported by a two week problem based learning activity, which
centred upon exploration of the case presented in the simulation. The simulation
took place in a simulated residential flat environment and centred on the
case of a child returning home following a head injury and rehabilitation.
The simulation was a joint visit of the community occupational therapist
and community children’s nurse, with the aim of agreeing a joint discharge
care plan. The overall evaluation of the experience from students was extremely
positive, with all students actively engaging in all stages of the work and
making a positive contribution to the evaluation.
Communicating with confused elderly patients: development and evaluation of
an innovative teaching session for medical students
Muna Al-Jawad, Jo Brown, Jane Clatworthy
Clinical communication skills are an essential part of medical practice.
It is widely accepted that teaching communication skills to health practitioners
improves patient health outcomes. Approximately half of general hospital
inpatients aged 65 or over have dementia, delirium or both. Communication
with confused elderly patients may be challenging, however, it is possible
and worthwhile.
This article describes a new teaching session, with objectives to help medical
students identify and use complex communication skills with confused, elderly
patients. The session was developed according to the principles of constructivism
and experiential learning. It used group discussion, analysis of video clips
and tasks on the ward with feedback to develop skills. After piloting, it
was evaluated with 146 medical students in the first, second and fourth year.
A questionnaire was completed by students before and after the session. This
included ratings of their confidence in aspects of communication with confused
patients as well as qualitative analysis of their comments about the session
and what had been learnt.
Wilcoxon signed-rank test showed a significant increase in median confidence
after the session. This increase was most marked in the fourth year medical
students. Students’ comments showed that their learning had followed
the objectives of the session and feedback was overwhelmingly positive.
This is an important new approach to teaching about communication with confused,
elderly patients and has the potential to be useful in teaching geriatric
medicine in undergraduate, postgraduate and inter-disciplinary settings.
Perforator based soft tissue flaps for lower limb soft tissue defect
cover – evaluation
of a novel training model
Duncan Avis, Peter Drew, Ian Pallister
Lower limb soft tissue non-viability and loss is a recognised complication
of both trauma, metabolic and infective processes. The degree and site of
loss may pose complex problems with regards to treatment planning and surgical
care. Rotation flaps are a recognised method of such defect cover.
Training in this technique is difficult and the potential problems severe.
In the UK training is further compromised by decreased junior doctor clinical
exposure as a consequence of altered training patterns and working hour directives.
Clinically relevant simulation may enhance training and assure better understanding
of this approach both in plastic surgery and trauma & orthopaedics. We
have developed a model as a teaching aid to develop surgical skills with
regards to defect recognition, perforator detection, flap planning, dissection
of a fasciocutaneous flap and subsequent defect cover.
Questionnaires were given to surgical registrars attending our MSc Trauma
Surgery Course pre- and post-model use. The results demonstrate the teaching
model is an effective educational tool and significantly improves assessment
of these problems and the appropriate planning for this procedure.
Blood pressure measurement and clinical preparation: BSc nursing students’ perspectives
Liz Kingston, Jill Murphy
Traditionally blood pressure has been measured manually using a sphygmomanometer
and stethoscope, but in recent years electronic or automated blood pressure
machines have become popular. However, many question the accuracy and reliability
of these machines when used in the clinical setting. This study presents
the findings of BSc nursing students perspectives on their preparation to
perform the skill of blood pressure measurement both manually (MBP) and electronically
(EBP) during their first clinical placement. Results demonstrated that the
majority of students felt adequately prepared for practice and the use of
simulation in the clinical skills laboratories in preparation for practice
was positively perceived. Opportunities to practice both skills in placement
sites varied considerably. Findings suggest that in order to prepare students
for the real world of clinical practice it is important to teach both manual
and electronic blood pressure measurement skills.
The African Working Time Directive: a comparison of logbooks
Saqib Noor, James Aird, Tahseen Chaudhry, Tim Nunn, Andrew Hogg
Introduction: There are current concerns regarding the implementation of
the European Working Time Directive (EWTD) and the quality and quantity of
surgical training in the UK. Some UK junior surgical trainees are travelling
abroad to gain surgical experience in a new environment. This study highlights
the difference between the surgical logbooks of four UK orthopaedic trainees
who worked in Ngwelezane Hospital, South Africa, and compared the training
to the national average of orthopaedic trainees in the UK.
Results: On average, a trainee in South Africa is involved in 448 orthopaedic
trauma operations in one year, compared to a total of 841 operations for
trainees completing six years in the UK. Trainees in South Africa performed
more operations, including external fixation, intramedullary nailing and
tendon repairs, in one year than a trainee in the UK performed in a total
of six years.
Conclusion: This study highlights that there are significant opportunities
for training abroad in certain recognised institutions, and with concerns
over the quality and quantity of training in the UK, recognised training
abroad maybe a valid consideration.
Development of inter-professional simulation in the acute paediatric clinical
setting
Karen Tomlinson, Caroline Cocking
The National Service Framework for Children (UK) recommends that regular
scenario based teaching is undertaken by those working in acute paediatric
settings. Simulation can increase exposure to clinical situations. It is
a practical approach to education for medical and nursing staff in which
the management of paediatric critical incidences can be demonstrated.
The Derby Hospitals National Health Service Foundation Trust (UK) previously
had split site working; the simulation suite and the Children’s Hospital
were located five miles apart on different sites. Our original paediatric
simulation programme was poorly attended as the logistics of releasing staff
for training, with added time for travel across sites, were not cost effective
or practical. The project discussed in this paper was devised to encourage
and develop a diverse inter-professional simulation programme throughout
paediatrics, concentrating on management of the acutely unwell child. We
discuss why a clinically based simulation programme was developed, how it
was achieved and the findings from the participants’ evaluations.
Thirteen simulations took place over 14 months in acute paediatric settings,
providing 55 inter-professional evaluation results. 83% of participants ‘strongly
agreed’ it was useful to have the simulation practice in the Children’s
Emergency Department or Children’s Wards, with the remaining 17% ‘agreeing’.
This research suggests a sustainable method of delivering clinically based
training, incorporating an inter-professional approach. A fundamental aspect
of the project was the opportunity for participants to work together as a
team whilst managing an acutely unwell child and receiving consultant led
feedback on communication and clinical skills, as well as overall management
of the event.
Consultants’ feedback on medical graduates’ performance:
Universiti Kebangsaan Malaysia experience
Abdus Salam, Nabishah Mohamad, Nasri Mohd Awang Besar, Zainul Rashid Mohd
Razi, Wan Zurinah Wan Ngah
Background: Universiti Kebangsaan Malaysia Medical Centre (UKMMC) is the
second largest public university in Malaysia producing medical graduates.
Being a competent and safe doctor requires more than scientific knowledge
and clinical skills. The objective of this paper is to identify the overall
perceptions of various Malaysian Ministry of Health consultants on UKMMC
graduates’ performance.
Methods: This cross sectional study focused on consultants’ feedback
regarding UKMMC graduates’ performance who had received ‘houseman
training’ under the consultant’s supervision for 2 years prior,
at different hospitals within Malaysia. 110 consultants participated. Quantitative
and qualitative data was collected by questionnaire with particular focus
on graduates’ medical knowledge, clerking skills, English language
proficiency, communication skills and working attitudes.
Results: A total of 915 UKMMC graduates were supervised by 110 consultants.
Performance domains which were rated included medical knowledge, clerking
skills, English language proficiency, communication skills and working attitudes.
Open comments were generally positive, but also gave critical analysis.
Conclusion: Overall performance of UKMMC graduates is positive thereby providing
a platform for training of competent doctors giving quality patient care.
Diverse educational curricula are pivotal for the acquisition of essential
competencies and clinical skills. All medical schools should have a standardised
framework for evaluation of graduates, to help the continual development
and promotion of a high class education and continued professional development.
Practice does indeed make perfect, and with the right educational balance,
confidence in the student reaches the level required of a safe and competent
doctor.
Correspondence
Various Authors
"
To my horror, she opened her cases and began dispensing drugs after taking
a ‘two line’ history. Not a single patient was examined and no
investigations were ordered; a management plan was virtually non-existent.
There was not even a simple greeting to the patients; it was quickly obvious
to me how a single doctor was able to see such large volumes of patients,
as practicing in this way meant less than 2 minutes were spent per ‘consultation’…."
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