Impact of a Well-Designed Work Experience Programme for Budding Medical Students

Assessment

Participant Evaluation of a PaediatricPostgraduate Clinical ExaminationA Chinoy, A Mathew

A Chinoy, Department of Paediatrics, Worthing Hospital,Worthing, West Sussex, UK

Background: The MRCPCH Clinical is the final part of thePaediatric Membership exams with the Royal College of Paediatricsand Child Health (RCPCH) in the UK. This exam assesses whethercandidates have reached the standard in clinical skills expected ofsomeone entering their period of core specialist training. Hospitalsare invited by the RCPCH to host these examinations, and do sowith the help of suitable patients, clinical staff and volunteers.Methods: A questionnaire survey was conducted inviting allparents and children who participated in the exam, qualitativelyevaluating their views on various aspects of the examination dayand their involvement. Participation was voluntary and completedquestionnaires were anonymous.Results: Thirty-five percent of families completed their question-naire (42/120). Assisting in education and training was the mostpopular reason for participating in the exam, although 21% ofparticipants thought that it ‘may help in getting better care’. Theamount of time actually spent in the examination room by mostchildren was thought to be ‘just right’ (88%). Hospitality issuessuch as the waiting areas, refreshments provided and care andconsideration from staff and volunteers were rated very highly. All42 responders reported that they would be happy to participate inthese exams again.Conclusions: The limited response rate may not accurately reflectparticipants’ perspectives, with those less satisfied not responding,thereby skewing results. However it is encouraging that allresponders expressed willingness to participate in future exams.Improvement in managing families’ expectations prior to theexamination does seem necessary, but needs to be delicatelybalanced against deterring patients from participating. It isinteresting that 21% of participants thought that involvement inthese examinations ‘may help in getting better care’. This isparticularly disappointing, as such exams rely on the goodwill ofparents and their children, and one’s co-operation or refusal toparticipate does not have any implications on their future clinicalcare. Perhaps this needs further clarification when families are firstapproached to participate.Diligent preparation and efficient implementation, coupled withappropriate attention towards hospitality and information-sharingall contribute to successful clinical examinations, and is reflectedwhen participants are willing to participate again. It is howeverimportant to ensure that parents do not feel under any obligationto participate, and the expectations of their experience on the dayis appropriately managed.

Staff and Volunteer Evaluation of a PaediatricPostgraduate Clinical ExaminationA Chinoy, A Mathew

A Chinoy, Department of Paediatrics, Worthing Hospital,Worthing, West Sussex, UK

Background: The MRCPCH Clinical is the final part of thePaediatric Membership exams with the Royal College of Paediat-rics and Child Health (RCPCH) in the UK. This exam assesseswhether candidates have reached the standard in clinical skillsexpected of someone entering their period of core specialisttraining. Hospitals are invited by the RCPCH to host theseexaminations, and do so with the help of suitable patients, clinicalstaff and volunteers.Methods: A questionnaire survey was conducted inviting all staffand volunteers who helped in the exam, qualitatively evaluatingtheir views on various aspects of the examination day and theirinvolvement. Participation in the survey was voluntary and com-pleted questionnaires were anonymous.Results: Eighty-six percent of staff and volunteers completed thequestionnaire (18/21). Assisting in training and education wasthe most popular reason for contributing in the exam (beinggiven as a reason by 67% of responders). The opportunity to beinvolved in a potentially interesting day and that they werescheduled to help were other popular responses. Sixty-sevenpercent of staff and volunteers reported they had been ‘fully’prepared for the day, with 33% feeling they were only ‘some-what’ prepared. Eighty-three percent felt that their personalcontribution to the running of the exams was ‘very useful’. All 18responders agreed that the clinical exams had been ‘very’ well-organised.Conclusions: It was pleasing to note that the staff felt theircontribution to the day was ‘very useful’, an important facet to sucha task where each member of the team needs to be felt valued andrespected. That all 18 responders agreed that the exams were ‘very’well-organised highlights a successful team effort and carefulplanning and implementation so that the day ran smoothly. Asresponses were anonymous, it is difficult to categorise whetherthose who had central roles in the running of the exam were betterprepared than those involved more peripherally and as such it isimportant to note that a third of helpers only felt ‘somewhat’prepared prior to the examination. This needs addressing forfuture examinations by more detailed briefing to further ensuresmooth-running of the examination.Co-participation, by displaying appropriate intent, support andcommitment from all participants, was pivotal to the success of thisexamination, demonstrating many of the ideals of communities ofpractice.

members’ posters abstracts

ª 2011 The Authors86 Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117

Does UKCAT Predict Performance in the First Yearof an Integrated Systems Based Medical SchoolCurriculum?K Hanlon, G Prescott, J Cleland, R KMacKenzie

K Hanlon, Division of Medical and Dental Education, University ofAberdeen, Aberdeen, UK

Background and Purpose: The UKCAT was introduced in 2006 asa selection tool for medical schools. UKCAT aims to predictfuture success as a doctor1, testing ability in the domains ofQuantitative Reasoning, Verbal Reasoning, Abstract Reasoningand Decision Analysis. Previous assessment of predictive ability ofthe UKCAT has found it to be low2,3 but only in the context ofpre-clinical curricula.Our aim was to determine if the lack of early predictive power ofthe UKCAT is constant across curricula by analysing performanceon a traditional pre-clinical curriculum and an integrated, systems-based clinical course in the same medical school.Methodology: Anonymised data was collected from studentsmatriculated in 2007 and 2009. The 2007 cohort represented thetraditional pre-clinical curriculum assessed by written exam only,whilst the 2009 cohort undertook a new, systems-based, clinicallyintegrated curriculum assessed by both written and clinical OSCEexams.Spearman’s rank correlations were generated for each of the examoutcome measures. Linear regression analysis was performed usingUKCAT total as predictor. Adjustment was made for the potentialconfounders of age, gender and previous graduate status.Results: Correlations between UKCAT scores and written exams inthe traditional curriculum were very weak (between 0.2 and )0.2).This was found to be the same for the clinically integratedcurriculum OSCE scores as well as written exams.Linear regression analysis demonstrated that, at best, UKCAT scoreexplained around 5% of the variance in the traditional curriculumexam scores and 6% in the clinically integrated curriculum, evenwhen the regression analysis model was expanded to includeUKCAT domains and demographic data.Discussions and Conclusions: UKCAT domain and total scores didnot predict performance in Year one on either a pre-clinical or aclinically integrated curriculum suggesting that it remains a poorpredictor of success across both curricula. Given that UKCAT isintended to predict future clinical success it is interesting that it wasa poor predictor of success in the clinical OSCE exam. This study islimited by the fact that all subjects attended first year at the samemedical school, albeit in different year groups. It would beinteresting to compare UKCAT and performance across a numberof medical schools with very different curricula. Further researchshould aim to examine prediction of performance in later years ofstudy.References:1. UK Clinical Aptitude Test Board. UKCAT 2006 Annual Report.Nottingham: University of Nottingham, 2008;13.2. Lynch B, Mackenzie R, Dowell J, Cleland J, Prescott G. Does theUKCAT predict Year one performance in medical school? Med Educ2009;43(12):1203–9.3. Yates J, James D. The value of the UK Clinical Aptitude Test inpredicting pre-clinical performance: a prospective cohort study atNottingham Medical School. BMC Med Educ 2010;10:55.

Correlation among Medical Students’ BasicCommunication and Physical Examination SkillsPortfolios and OSCE and Written Knowledge-Reasoning ExamsR M Roger, L A Perula, I Salido, I Morales, A Alba Dios,C A Taberne, F G Pasadas

R M Roger, Department of Medicine, School of Medicine, CordobaUniversity, Cordoba, Spain

Background and Purpose: Interest in the use of portfolios withingraduate medical education has grown in Spain recently. This hasbeen mainly because portfolios seems to have potential toencourage reflective practice and self-directed learning, they canbe good tools for assisting formative assessment. Neverthelessmedical educators highlighted the difficulties associated with thelack of standarization of their content and so their limit to beused as summative assessment. We developed a reflective portfolioas part of the student’s third year training in basic communicationand physical examination skills. The aims of this study were todetermine the reliability of assessment criteria (1) and to assesstheir correlation with other summative tests.Methodology: Portfolio was carried out by 160 students. Wemodified the Rees&Sheard (1) proposal for the assessment ofportfolios. Those were evaluated by 2 raters (80/rater). Agreementbetween both raters was obtained in 30 portfolios by means of anintraclass correlation coefficient (ICC) for the total percentage anditem scores and by Simple Concordance Index or Kappa Coeffi-cient when possible, for the individual items. Spearman correlationcoefficient was used to assess the correlation among the scoresobtained in the portfolios and final medical written and OSCEexam. All these variables were categorized by quartils andcompared each other (Chi Squared).Results: We recovered 149 portfolios, the average score was 5.08(12 maximum score), but 70% of students scored < 4.5 (9maximum) in the reflective report. The total ICC was 0.941(95% CI: 0.880–0.972). Items A: 83.3%; 0.832; B1:0.51(K);0.857;B2: 0.55(K);0.675 and B3: 66.6%;0.713. Correlation betweenportfolios and written exam was positive and significant: Spear-man coefficient: 0.474 (P: 0.001). Quartils comparison was alsosignificant (22.5; P: 0.007). There were no correlation betweenportfolios and OSCE: 0.023 (P: 0.780). Quartils comparison(9.72; P:0.37).Discussion and Conclusions: The agreement for the total scores forthe assessment criteria was satisfactory, so these criteria could beused to discriminate reliably between low and high qualityportfolios. Most of the students seem to have difficulties articulat-ing a deep reflection upon their experience, but those that showthese abilities also got the higher scores in written exams aboutknowledge and reasoning. Conversely there is no correlationamong ability for reflection and practical skills scores. In this waythe reflective reports of portfolio could be used as an additionaltool for sumative evaluation of these domains but less for thoserelated to practical skills.Reference:1. Rees CE, Sheard CE. The reliability of assessment criteria forundergraduate medical students’ communication skills porfolios:the Nottingham experience. Med Educ 2004;38:138–44.

ª 2011 The AuthorsMedical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 87


Modelling the Use of Confidence Intervals with theBorderline Regression Method for Final YearUndergraduate OSCE at the University ofSouthamptonB McManus, N J Carr, F H Anderson, J A Holloway, J H Field,S M Rushworth

B McManus, Faculty of Medicine, University of Southampton,Southampton, General Hospital, Southampton, UK

Background and Purpose: We wished to model and pilot a noveluse of the confidence interval (CI) and standard error of themeasurement (SEM) with the borderline regression method, inline with recommendations by PMETB/GMC,1,2 and in place ofsimple examiner global judgements.Methodology: Students must satisfy 2 criteria to pass the BM finalsOSCE: aggregate score and minimum number of stations passed.The SEM has been equated with CI1 and applied to aggregatescore3–5. We wished to introduce it into our examination, and alsoproposed a novel strategy to calculate the CI in the cut score for asingle station. Using the standard error of the intercept andgradient we calculated the CI for these values, and used them in theregression equation to interpolate a new value of y when x isconstant. We modelled these techniques to maximise the sensitivityand specificity of both criteria.Results: In a cohort of 242 students, 6 failed > 3 stations on globaljudgement. For 2 of them the mean grade was also below thethreshold but none failed this criterion alone. Introducingborderline regression without adjustment, 23 students failed > 3stations but none on aggregate score. Recalculating the aggregatepass mark as mean cut score plus 1.96 · SEM (upper 95%CI)considerably improved the sensitivity of the aggregate scorecriterion, which 6 students now failed.For individual stations, using the gradient and intercept minus1.96 · SEM (lower 95%CI) provided an adjusted cut score for eachand considerably improved the specificity of this criterion. Studentsfailed if their actual scores were below the cut score for > 3 stations.Seven failed on this criterion. Considering both criteria 8 failed theOSCE, 5 of whom failed both criteria. Observed agreement withglobal assessments rose from 92.1% to 98.35% (Kappa 0.32–0.71).Discussion and Conclusions: The adjusted cut scores showedimproved sensitivity and specificity for both criteria and improvedagreement with global judgements. It was perceived to be fair tostudents, affording them the benefit of the doubt when consideringindividual stations, but protecting patient safety when decisionscould be reliably based on 16 assessments. Since most students whofailed did so on both criteria, the method was perceived to be morerobust. The authors plan to remodel this on another cohort ofstudents before considering incorporating into the exam regula-tions.References:1. Postgraduate Medical Education and Training Board. Develop-ing and maintaining an assessment system – a PMETB guide togood practice. PMETB 2007.2. General Medical Council. Assessment in undergraduate medicaleducation – Advice supplementary to Tomorrow’s Doctors (2009).GMC 2010.3. Dauphinee WD., Blackmore D.E., et al. Using the Judgments ofPhysician Examiners in setting the Standards for a National Multi-center High Stakes OSCE. Advances in Health Sciences Education1997; 2: 201–211.4. Smee, S.M., Blackmore D.E. Setting standards for an objectivestructured clinical examination: the borderline group methodgains ground on Angoff . Med Educ 2001; 35: 1009–1010.

5. Kilminster S., RobertsT. Standard Setting for OSCEs: Trial ofBorderline Approach. Advances in Health Sciences Education 2004;9:201–2097.

Collaborating with Medical Students to Develop anObjective Structured Clinical Examination (OSCE)for Assessing Knowledge, Psychomotor andAffective Competence in Emergency MedicineJ Acheson, R S Patel

J Acheson, Department of Emergency Medicine, Leicester RoyalInfirmary, Infirmary Square, Leicester, UK

Introduction: ‘Tomorrow’s Doctors (2009)’1 outlines the GeneralMedical Council’s expectation that graduates from UK medicalschools should demonstrate competence in diagnostic andtherapeutic procedures. Thirty-2 competencies are outlined andthe challenge for institutions is to ensure methods for assessingthese are robust and fit for purpose. The Objective StructuredClinical Examination (OSCE) is an assessment approach inwhich clinical competence is evaluated in a comprehensive,consistent, and structured manner2, using an examinationformat in which students rotate around a circuit of clinical taskstations.Methods: A 10-station OSCE was piloted to assess the feasibility andutility of this form of assessment at evaluating the competence ofstudents following an 8-week placement in the emergency depart-ment. A focus group with clinical skills staff and 10 volunteerstudents was conducted to inform the decision about whether aformal introduction of the OSCE into the curriculum should berecommended. Thematic analysis was used to code focus groupdata.Results: Students most valued the OSCE as an opportunity toparticipate in assessment as part of their preparations for finals.They disliked the set up in the suturing station, citing it was ‘tooconfusing’ and ‘encouraging bad clinical practice’. The clinical skillsstaff most valued the OSCE because it allowed them tocontribute further to the placement, beyond their routineteaching roles. Clinical skills staff had previously used itemchecklists, however, and disliked the responsibility of using globalrating scales. They felt uncomfortable making judgements aboutcandidates, which could potentially affect their progression onthe course.Conclusions: Valuable feedback could not have been obtained forevaluating the OSCE and facilitate a proposed introduction,without organising a pilot in collaboration with medical students.Inviting students to contribute their perceptions, and tailoring theassessment towards their needs as well as those of stakeholders, mayincrease it’s acceptance over the long-term. More data is requiredto improve reliability and validity of the OSCE before making anevidence-based judgement of it’s utility for assessing competence inemergency medicine.References:1. General Medical Council. Tomorrow’s Doctors 2009 (www.gmc-uk.org/Tomorrow_s_Doctors_2010.pdf_30373144.pdf).2. Harden, R. M. What is an OSCE? Medical Teacher 1998; 10:19–22.



Does Medium Fidelity Simulation Training in aDistrict General Hospital Improve Confidence to bea Part of the Medical Emergency Team (M.E.T): AnAnalysis of the Experience of TraineesA Leatherbarrow, W Dainty, M Cooksey, D Pandit

A Leatherbarrow, Medical High Dependency Unit, Russells HallHospital, Dudley, West Midlands, UK

Background and Purpose: Medium-fidelity simulation training isshown to improve a medical trainee’s ability to manage medicalemergencies1. It is a highly effective educational tool but is alsoexpensive and provides a sizable workload for medical educators.We have been running a simulation programme at this trust for thelast 2 years with a SimMan� to improve confidence of foundationyear doctors to perform as part of the medical emergency team andassess emergencies at the front door.Methodology: During the 2010–2011 academic year we conductedseveral multi-disciplinary simulated training sessions covering themanagement of medical emergencies using SimMan3G�. Scenarioswere based in real life M.E.T. calls attended in the hospital.Hundred medical professionals were provided with questionnairesto complete following the sessions to assess their experience ofsimulated training. A 14 point questionnaire was utilised. Under-graduates were invited as a part of Simulation training using a videolink and completed a questionnaire. An advanced nurse practi-tioner is involved in the sessions to initially assess the patient andthen calls the candidate to assess the patient.Results: We had 81 responses. The majority of trainees hadexperienced < 3 simulated training sessions. Seventy-nine (98%)agreed that simulated training was beneficial to learning. Sixty-three (77%) agreed the scenarios accurately reflected acutelyunwell patients. Seventy-five (94%) agreed the scenarios enhancedtheir ability to manage acutely unwell patients. Seventy-five (94%)agreed introducing simulated training as part of undergraduatetraining would be beneficial. Sixty (75%) would like simulatedtraining used as part of the formal assessment of foundationtrainees.Discussion and Conclusions: Our simulated training programme iswell received by a range of medical professionals both post/undergraduate. If offers a more realistic experience of medicalemergencies in a protected non-threatening environment. Itmimics the pressures of real world medicine while providing anenvironment where questions can be asked. Criticisms involved theinaccuracy of the scenario timescales (in relation to procedures andpatient response) and that it is harder to assess the patient as theydo not respond in a realistic manner. Candidates desired scenarioson reduced conscious level, arrhythmias and gastro-intestinalbleeds suggesting these are areas of trainee concern. We alsoutilised these sessions as a Case based discussion (CBD) to link inwith trainee e-portfolios.We achieved good feedback from deanery foundation qualityassurance visits and have shown better interaction between mem-bers of the M.E.T. We plan to roll out this programme to coremedical trainees and also integrate this into inter-professionaltraining (medical, nursing and physiotherapy students).References:1. Ruesseler M et al. Simulation training improves ability tomanage medical emergencies. Emerg Med J 2010 Oct;27(10):734–8.2. Miller MD. Simulations in medical education: a review. Med Teach1987;9(1):35–41.

Millar’s Pyramid Can be used as An Effective Guidein Assessing Authentic Performance ofConsultation Skills in the Ambulatory Care SettingN Patravali, J S Ker

N Patravali, Clinical skills Centre, University of Dundee, Dundee,UK

Introduction: Millar’s Pyramid is a very useful model in explainingthe levels of assessment of learning. Its phased structure allowseffective assessment of students to achieve competence andperformance authenticity. However it does present a challenge.Challenge to Assess Performance: ‘Performance’ is the ability todemonstrate skill in a real life situation. ‘Competence’ usuallyindicates what people can do in a contextual vacuum in nearperfect conditions. Most undergraduate curricula for teaching andassessment of ‘competence’ for consultation skills use simulatedenvironments reflecting the ideal context. To translate competenceto performance with unequivocal results is hence a challenge. WhatMillar’s pyramid can perhaps be utilized for is developing a stagedand more authentic simulated programme.Current model of Teaching and Assessment: ‘Knows’: In 1st year,students interact with patients and concentrate on the usage of‘open and closed’ questions. They build their knowledge aroundbasic clinical problems. They are assessed formatively using their‘reflective’ account of patient interaction as part of their portfolio.‘Knows how’: In the second phase of 1st year and 2nd year, thestudents consolidate their knowledge going through varioussystem-based blocks. They interact with patients using the ‘hot seatapproach’. A formative assessment is carried out during the processby individual tutor feedback and peer review. It is subject to interand intra observer variation, however through formatted teachinghas achieved unequivocal results improving ‘face validity’.Proposal for assessment of Ambulatory care teaching as the nextstep towards ‘authentic performance’.‘Shows how’: ‘Clinic Simulated environment’ at the end of 2nd yearmay allow assessing ‘Competence’. Assessment using remote video-link by trained assessors will reduce bias for ‘face validity’. Realisminvolved allows reliable ‘Predictive validity’ towards performance.This opportunity can be used to dictate research in performanceindicators for work-based assessments as part of continuousprofessional development.‘Does’: This final frontier to test ‘authentic performance’ may beassessed in students progressing to 3rd year. The designed workbased assessments can be used to assess consultation skills in thereal clinic environment. This would hence acknowledge the‘Construct validity’ of the process to achieve high performers.Conclusion: Millar’s pyramid acts as an effective guide to achieveauthentic performance in Ambulatory care setting. Its usage atthe moment is inadequate to assess and convert ‘competent’individuals to ‘performers’. The above-proposed model mayfacilitate this transition with complete utilization of the pyramid.This will also help overall development by improving inter-professional learning. Achieving high performers as end productscan implement positive changes in the health sector improvingpatient management.References:1. Miller, GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65(9):s63–s67.2. Dent JA & Harden RM (Eds). (2005). A practical guide for medicalteachers. Elsevier, Churchill, Livingston.3. Collins JP & Harden RM. 1999. The Use of Real Patients,Simulated Patients and Simulators in Clinical Examinations. AMEEGuide 13.



4. Dent JA, Ker JS, Angell-Preece HM, Preece PE. Twelve tips forsetting up an ambulatory care (ou tpatient) teaching centre. MedTeach 2001; 23: 345–350.5. Jennet P. Chart stimulated recall: a technique to assess clinicalcompetence and performance. Education for General Practice 1995; 6:30–34.

The Effects of Examiner Training on SelfConfidence in Long Case AssessmentS Atkinson, A Levy

S Atkinson, University of Bristol, Centre for Medical Education,Bristol, UK

Background and Purpose: Of all clinical assessment formats usedin undergraduate medical education, the validity of the long case isrecognised as high1. Arguments that inter-case reliability is ques-tionable compared to OSCEs are debatable: both methods can beshown to exhibit similar reliability2, 3. To try and further improvethe reliability of the assessment, a series of examiner trainingsessions were carried out and the effects of training on selfconfidence and perception of ability to make appropriate decisionsassessed using a feedback tool.Methodology: In each of our clinical academies training sessionswere offered to long case assessors. Three assessment tools weredemonstrated:1. Clerking proforma, with a series of aide memoires and keyquestions for assessors to consider.2. Long Case Descriptors allowed assessors to grade faults on thebasis of major and minor criteria, the former being omissions ormisinterpretations that compromise patient safety or hinder acorrect diagnosis and management.3. Behavioural Indicators4, brief descriptors of positive or negativebehavioural traits in a candidate, addressing such areas asempathy and sensitivity, communication skills and professionalintegrity.A series of video clips of senior students collecting the ‘History ofpresenting complaint’ under real test circumstances were thenshown, for assessors to consider as a group. Feedback was collectedafter the 3 hour session.Results: Feedback identified several outcomes of assessortraining:1. The confident assessor, who as a result of training became morecautious and more questioning of the validity and reliability of theLong Case assessment;2. The initially unsure assessor, who became more confident intheir judgements after training;3. The initially unsure assessor, whose confidence remained low orfurther diminished as a result of the training;4. The confident assessor, whose confidence in their judgement wasconfirmed by the training.Discussion and Conclusions: In a recent GMC visit, overwhelmingemphasis was placed on exam reliability over high validity. Part ofthe problem may be negative perceptions of the Long Case,encouraged by opinion leaders 5, 6 . We believe that qualifying inmedicine without being assessed clerking real patients is anoma-lous. There is evidence that reliability can match that of thecurrently preferred OSCE format, given appropriate modificationand rater training7, 8, 9, 10. Further work will quantitatively addressthis, but it also seems crucial to review assessor attitudes andconfidence: a statistically reliable assessment must also be perceivedto be so.

References:1. Ponnamperuma GG, Karunathilake IM, McAleer S, Davis MH.

The long case and its modifications: a literature review. Med Educ2009; 43(10):936–41.2. Wass V, Van der Vleuten C, Shatzer J, Jones R. Assessment of

clinical competence. Lancet 2004; 357:945–949.3. Norman G. The long case versus objective structured clinical

examinations. BMJ 2002; 324:748–749.4. Patterson F, Ferguson E, Norfolk T, Lane P. A new selection

system to recruit general practice registrars: preliminary findingsfrom a validation study. BMJ 2005; 330:711–4.5. Wass V, Van Der Vleuten CPM. The long case. Med Educ 2004;

38(11):1176–80.6. Wilkinson TJ, Campbell PJ, Judd SJ. Reliability of the long case.

Med Educ 2008; 42(9):887–93.7. Norcini JJ. The death of the long case? BMJ 2002; 324:408–9.8. Oyebode F, George S, Math V. Inter-examiner reliability of the

clinical parts of MRCPsych part II examinations. Psychiatric Bulletin31:342–344.9. Sood R. Long case examination – can it be improved? Indian

Academy of Clinical Medicine 2001; 24:251–55.10. Fletcher, P. Clinical competence examination – Improvementof validity and reliability. International Journal of Osteopathic Medicine2008; 11(4): 137–141.

Basic Science Education

Promising Findings for Additional Mediators ofHuman Melanocyte SenescenceC Asher, D Bennett

C Asher, Woodley, Berkshire, UK

The best established familial melanoma locus CDKN2A, encodes 2mediators of cell senescence, p16 and ARF. p16 at least is involvedin the proliferative arrest of naevi (moles) – benign growths of skinmelanocytes. p16 and the cell senescence barrier are lost inadvanced melanoma. However this senescence is still not fullyunderstood; it appears not to be mediated solely by p16, becausealthough all naevi express p16, not all cells within a given naevusseem to express it. Accordingly it seems likely that there are othergrowth inhibitors involved. Growth inhibitors other than p16 maybe additional mediators of human melanocyte senescence.My aim was to determine whether the expression of likely growthinhibitors (ARF, p27, p21, p15) rose as normal humanmelanocytes became senescent. These growth inhibitors wereselected based on demonstration of growth arrest typicalof senescence in murine studies and human fibroblasts.Subsequently, I would see whether similar tests on p16 deficienthuman melanocytes (which also senesce although after manyextra divisions) would reveal even higher expression of thepotential mediators.Normal and p16-deficient cells were grown, passaged and countedeach time, until senescent. This was confirmed by using a stain foracidic b-galactosidase. The expression of potential growth inhibi-tors was investigated using immunostaining which was used tocheck the location of any inhibitor that was expressed.Results and Conclusions: These findings were the first associationof ARF and p15 increase with cell senescence in normal humanmelanocytes. ARF was further elevated in senescent p16-deficientmelanocytes, suggesting a secondary/backup role in senescence inthe absence of p16. The results for p27 and p21 were relativelyconsistent with current evidence that suggests neither may beinvolved in human melanocyte senescence. This study suggests



novel candidates for additional mediators of human melanocytesenescence. Further research will help with the understanding ofmelanoma and perhaps diagnostic testing.References:1. Hayflick L. The limited in vitro lifetime of human diploid cellstrains. Exp Cell Res 1965; 37: 614–636.2. Kong N, Fotouhi N, Wovkulich P, Roberts J. Cell cycle inhibitorsfor the treatment of cancer. Drugs Fut 2003; 28(9): 881.3. Michaloglou C, Vredeveld LC, Soengas MS, Denoyelle C et al.BRAFE600 associated senescence-like cell cycle arrest of humannaevi. Nature 2005; 436: 720–724.4. Gray-Schopfer VC, Cheong SC, Chow J, Moss A et al. Cellularsenescence in naevi and immortalisation in melanoma: a role forp16? Br J Cancer 2006; 95: 496–505.5. Mooi WJ, Peeper DS. Oncogene-induced cell senescence—halt-ing on the road to cancer. N Engl J Med 2006; 355: 1037–1046.6. Bennett DC. How to make a melanoma: what do we know of theprimary clonal events? Pig Cell Mel Res 2007; 21(1): 27–38.7. Bandyopadhyay D, Medrano EE. Melanin accumulationaccelerates melanocyte senescence by a mechanism involvingp16INK4a/CDK4/pRB and E2F1. Ann N Y Acad Sci 2000; 908:71–84.8. Bandyopadhyay D, Timchenko N, Suwa T, Hornsby PJ, Campisi Jet al. The human melanocyte: a model system to study thecomplexity of cellular aging and transformation in non-fibroblasticcells. Exp Gerontol 2001; 36: 1265–1275.9. Sviderskaya EV, Gray-Schopfer VC, Hill SP, Smit NP, Evans-Whipp TJ et al. p16/cyclin-dependent kinase inhibitor 2Adeficiency in human melanocyte senescence, apoptosis, andimmortalization: possible implications for melanoma progression.J Nat Cancer Inst 2003; 95(10): 723–732.

Collaborative Development and Sharing ofUndergraduate Digital Teaching and LearningResources Across Scottish Dental Schools – a Modelfor Medical Education?J A Harrison, A H Forgie, D Dewhurst, J S Rennie

J A Harrison, NHS Education for Scotland, Thistle House,Edinburgh, UK

Background and Purpose: A recent scoping study revealed thatScotland’s 3 dental schools and the Postgraduate Dental Institutewere making little use of online teaching resources and that therewas a strong willingness to collaborate in their development andshare the outputs. Anecdotal evidence suggests that this trend mayalso be apparent in related healthcare areas such as pharmacy andallied healthcare professions. The Collaborative Learning Envi-ronment Online (CLEO) project funded by NHS Education forScotland (NES) aims to stimulate collaborative development,ensure best practice and enable sharing of new online healthcareresources.Methodology: Specific discipline and pedagogic expertise is avail-able in Aberdeen, Dundee, Glasgow and Edinburgh dental schools.Following negotiation and agreement, all Scottish Dental Schoolshave agreed to work together to prioritise areas of the dentalcurriculum where the creation of on-line resources would havemost benefit across Scotland. Each school, aided by an academicdental teacher and learning technologist is leading in the devel-opment of specific resources in line with their particular expertiseto collaboratively ensure that the dental curriculum is supportedand the student learning experience is enhanced.Results: CLEO is now well developed with strategic, operationaland financial management structures in place. The collaboration

has produced an impressive range of online resources, rangingfrom granular assets, to more complex aggregations and discretelearning activities. A peer review process is underway to ensure thatresources are quality assured, constructed to agreed technicalstandards and delivered in formats consistent with flexibility of use,technical interoperability, and accessibility. All resources are beingmetadata tagged and stored in an online repository accessible bythe whole dental community; it is hoped this should ensurelongevity. To date CLEO has delivered learning resources tounderpin oral biology covering microbiology, physiology, histopa-thology, tooth development, and clinical procedures many of whichwould be of interest to medical teachers. Various resource typeshave been developed: interactive tutorials with built-in learning andself-assessment activities; interactive cases/virtual patients; high-quality 3D animations; simulations of practical and clinical proce-dures; videos and histology/pathology resources based on the useof a virtual microscope.Discussion and Conclusions: The CLEO model is an example ofhow multi-institutional collaborative development and sharing ofhigh-quality, peer-reviewed digital teaching and learning resourcescan be achieved in support of dental education. Evaluations ofeducational effectiveness and impact are under way. The usefulnessof this approach as a model for supporting medical educationshould be considered.

Clinical Skills

Do Student Assistantships Help Achieve PracticalSkills Outcomes from Tomorrow’s Doctors?S Sihota, D Blaney, A Brown

S Sihota, Hull York Medical School (HYMS), University of York,York, UK

Background: Tomorrow’s Doctors 2009 lists diagnostic and thera-peutic procedures that students should achieve by graduation. Itrecommends final year students having at least 1 Student Assis-tantship (SA) where ‘assisting a junior doctor’ they undertake‘most of the duties of an F1’ and where ‘students must use practicaland clinical skills’. HYMS final year students have 3 8-week SAs inGeneral Medicine, Surgery and General Practice where, undersupervision, they manage patients and are expected to consolidatethese procedures and skills through this real patient managementexperience. We explored HYMS students’ experience of these skillsduring their SAs to see whether these outcomes are achievedduring these placements.Methodology: Questionnaires are being distributed to final yearstudents asking about their practical procedure experience gainedduring their SAs. The list of 36 practical procedures is based on theTomorrow’s Doctors 2009 list. A baseline questionnaire at the start ofthe year is being followed by repeat questionnaires after each of the3 SAs. In addition to estimating the frequency of how many timeseach procedure is performed, students are also being asked to self-rate their competency.Results: The baseline skills data has been grouped into 4 catego-ries based on the median number of times each procedure hadbeen performed; from the least where the median = 0 to the mostwhere the median was > 10 with skills examples given.

1. Median = 0.20/36 skills, predominantly therapeutic skills e.g. nebuliseradministration, nasogastric tube insertion, catheterisation.

2. Median > 0 and £ 5



10/36 skills, a mixture of diagnostic and therapeutic skills, e.g.fingerprick glucose measurement, i.v. cannulation, instructinginhaler technique.

3. Median > 5 and £ 103/36 diagnostic skills: body temperature measurement, pulseoximetry, multistix urinalysis.

4. Median > 103/36 diagnostic skills: automated device and manual bloodpressure measurement, venepuncture.

Self-rating as ‘competent to perform procedure without supervi-sion’ improved from group 1 to 4, with mean percentages for eachgroup being 12.5%, 50%, 91% and 97% respectively.Conclusions: The results show students have limited experience ofa large number of procedures on commencing the final year; theseare mainly therapeutic procedure skills. As expected their self-rating of competence is lower in these. The SAs, where students aredirectly involved in patient care management, should thereforeprovide the ideal opportunity to achieve these. Subsequentquestionnaire analysis will inform whether these skills are gained,and importantly in which SAs they are gained.

Continuing Education

Using a Learner-Designed Curriculum Map to HelpStructure A Learner’s Personal Development Plansand Self-Directed Learning – A Pilot StudyS H Y Tso, E C Y Tiong

S H Y Tso, Academic Foundation Year 2 Trainee, Whipps CrossUniversity Hospital NHS Trust, Leytonstone, UK

Background and Purpose: UK Foundation doctor and dentisttraining are based upon their respective prescribed frameworks1,

2. These newly qualified graduates are encouraged to devise theirnon-curricular personal development plans (PDP) and recordtheir PDP into their learning portfolio. At the Asia PacificMedical Education Conference 2011, we demonstrated theconcept of using a learner-designed curriculum map, based onKnowles’ five step model of self-directed learning3, can be usedto help learners to structure, monitor and evaluate their self-directed learning (SDL)4. This pilot study looked at theapplication of this concept into portfolio learning where curric-ulum mapping is used as a tool to help structure SDL aroundthe learner’s PDP.The concept Step 1: The learner states a personal development goal.Step 2: A set of learning objectives is created.Step 3: A learner-designed curriculum map is constructed based onthe objectives.Step 4: The curriculum map is used to map out the curriculumitems (the desired learning outcomes) that would be met throughcarrying out the learning activity. This facilitates reflection andplanning of learning.Step 5: The curriculum map profiles of individual learning activitiesare combined to produce a summary map. This illustrates thelearning that has occurred over a period of time and facilitatesmonitoring and evaluation of learning.Methodology: Two Foundation trainees applied the concept ofusing a personalised curriculum map to structure their SDL aroundtheir PDP.Results: The Foundation trainees designed their own curriculummaps and found them helpful in structuring and evaluating their

SDL around on their PDP. One Foundation trainee went furtherand added a reflective learning log of the learning activities and apeer/tutor feedback form.Discussion and Conclusions: Learners who want to add structureto their PDP and SDL will benefit from using this approach.However, this approach may be viewed as being overly focussedon what the learner desires to achieve in their PDP and mayhinder reflective thinking and evaluation of the learning that felloutside the curriculum. We suggest that adding a reflectivelearning log of the learning activity will help document thequality of learning and encourage reflection. The time requiredto build a curriculum map depends on how detailed thecurriculum items were. The curriculum map should be updatedwhenever the PDP of the learner change. We recommend thatlearners should be given guidance prior to developing theirpersonalised curriculum maps.References:1. The Foundation Programme Curriculum 2010, UK FoundationProgramme Office. [Accessed 8 Feb 2011] URL http://www.foundationprogramme.nhs.uk/pages/home/key-documents#curriculum.2. A Curriculum for UK Dental Foundation Programme Training,Committee of Postgraduate Dental Deans and Directors [Accessed8 Feb 2011] URL: http://www.copdend.org.uk/download/Den-tal%20 Foundation % 20 Programme % 20 Curriculum.pdf.3. Knowles M., 1975, Self-directed Learning: A Guide for Learnersand Teachers. New York: Associated.4. Tso S, Using curriculum mapping to help self-directed learnersto structure their learning. Abstract presented at the 8th AsiaPacific Medical Education Conference, 2011.

Comparison of Medical Student Feedback WhenTaught by Pedagogical Versus AndragogicalMethodsA Leahy

A Leahy, Respiratory Department, University Hospitals Bristol NHSFoundation Trust, Bristol, UK

Background: Traditional medical teaching favours a high lecturecomponent. This pedagogical approach is teacher dominated, andthe students remain relatively passive. In contrast, andragogicalteaching emphasises active and participative learning by thestudent.Aims: The author wanted to compare student feedback whenthe same topics were taught in lecture form compared with astudent-centred approach, involving regular learner activities.Methods: Two lessons were prepared on pleural diseases, lasting1 hour, covering the same topics, and involving the same teacher.Sixty third year Bristol medical students were allocated eitherlesson, with 30 per group. The pedagogical lesson was in lectureformat with PowerPoint slides, and no student interaction. Theandragogical lesson included teacher talk mixed in with variousstudent activities including; completing request forms for pleuralfluid, marking diagrams where to site drains, case studies withaudience voting, and creating posters about exudates and transu-dates. Evaluation questionnaires were collected from students.These used rater scores (ranging from 0 = strongly dissatisfiedthrough to 5 = strongly satisfied) and qualitative responses aboutthe sessions’ quality, usefulness, and least useful aspects.Results: Average rating out of 5 for session quality was 4.8 for theactive teaching and 3.0 for the lecture. Despite both sessions having



the same topics and length, students complained of feeling rushedand unable to consolidate learning during the lecture. The activelearners were extremely satisfied across all evaluation aspects, withaverage score of 4.8, and they had no negative comments. Theteacher noted that active teaching students had increased energylevels and enthusiasm for the subject. Those in the lecture groupfailed to stay interested and concentrate over an hour.Conclusions: The average person can concentrate on subjectmatter for about 5–15 minutes (Fontana, 1995). It is difficult forany student to remain focussed during a 60 minute lecture. Duringthe interactive session, the students were fully participative, makingtheir own decisions, and were more enthused and attentive thanthe lecture group. It will be interesting to compare the differencein learning between groups receiving either lesson in the future.Reference:1. Fontana D. Psychology for Teacher. London: MacMillan and BPSBooks, 1995.

Curriculum Planning

Positive 3-Year Outcomes of a Clinical IntroductoryAttachment for Second-Year Medical StudentsJ Wright, S Mallappa, J Thompson, A Jethwa, J Pitkin, R Soobrah

J Wright, Undergraduate Department, Northwick Park Hospital,Harrow, UK

Aims: For over a decade, UK universities have introducedundergraduate medical students to clinical medicine during theirfirst 2 years of study. The GMC has set out professional valuesand behaviour expected of students when working with multi-disciplinary team (MDT) colleagues. It is necessary they respectthe skills and contributions of other professionals, and developeffective communication with the MDT and patients [1].Hospital attachments can be organised to create a supportivelearning-environment and aid future transition [2]. We aimed toevaluate the 3-year outcomes of a clinical introductory attach-ment for second-year students, during a period of curriculumchange.Methods: A total of 149 second-year medical students completed a3-week attachment at our trust hospitals between 2008 and 2010.They attended MDT meetings, ward rounds, sessions with health-care professionals and visited hospital departments. They alsoparticipated in small-group tutorials and skills-laboratory sessions.Students were asked to complete an end-of-attachment feedbackquestionnaire.Results: Fifty-seven percent of the group were male. Nearly allstudents (98.3%) thought the attachment was helpful or relevant totheir training. Eighty-six percent rated their learning experience as‘enjoyable’; 94.2% understood the importance of an MDTapproach in patient care; 91.3% understood the roles of healthcareprofessionals. Throughout the 3-year period, despite curriculumchange, annual trends were similar. Before starting their attach-ment, 15.2% felt apprehensive; this reduced to 1.0% post-attach-ment. However, over half (51.8%) did not feel part of a teamduring their attachment and 6.7% (n = 10) felt unsure they wouldcontinue their medical career.Conclusions: Early clinical introductory attachments in a medicalstudent’s career can facilitate enjoyable and relevant learningexperiences. This study illustrates consistently good feedbackreceived from our students. Since an estimated 12% of medicalstudents ‘drop-out’ of university [3], these clinical attachments mayallow timely recognition of students who do not wish to becomedoctors. A significant proportion of our students did not feel part

of a team; despite understanding the MDT approach. Heavyservice-demands and the European working-time directive (EWTD)are impacting on NHS junior doctors’ shift-patterns and training[4], reducing continuity and time for supervision. Given theseconditions, we need to identify ways to be more inclusive ofstudents within our clinical teams.References:1. General Medical Council. Medical students: professional valuesand fitness to practice. Guidance from the GMC and the MSC.2009. London. http://www.gmc-uk.org/Medical_stu-dents_2009.pdf_27494223.pdf.2. Teunissen PW, Westerman M. Opportunity or threat: theambiguity of the consequences of transitions in medical education.Med Educ 2011; 45(1):51–9.3. Parkhouse J. Intake, output, and drop out in United Kingdommedical schools. BMJ 1996; 312: 885.4. Goddard AF, Hodgson H, Newbery N. Impact of EWTD onpatient:doctor ratios and working practices for junior doctors inEngland and Wales 2009. Clin Med 2010; 104:330–5.

Pre-Clinical Student Perceptions and Expectationsof Upcoming Clinical PlacementsV Vijayakumar, O Edafe, D Bee

V Vijayakumar, Academic Unit of Medical Education, University ofSheffield, Broomhill, Sheffield, UK

Introduction: The transition period from the preclinical phase toclinical years is a time of stress, uncertainty and difficulty amongstmedical students1. Various retrospective studies have identifiedcommon themes in these groups including anxiety, lack ofpreparation and abrupt transition1,2. However few perspective studieshave been carried out, so the researchers investigated students’perceptions and expectations just before starting their clinical years.Method Subjects were second year medical students at theUniversity of Sheffield. Using convenience sampling we identified28 students who were subsequently split into 4 focus groups (n = 9,n = 7, n = 6, n = 6). Each focus group was carried out by 4 differentresearchers, and open questions were used to gain students’opinions. Content analysis was used to identify common themes ineach group. The recordings from the groups was independentlyanalyse by the 4 different researches to improve the inter-raterreliability.Results: There were similar numbers of males and females in eachgroup and we gained appropriate contributions from all individualsin the group. Through discussions, we reached consensus onclustering various themes identified into a groups. We identifiedworkload & time, anxiety, interactions between medical profes-sionals, management of course, lack of clinical skills and knowledgeand travel & cost as issues.Conclusion: Themes that were elicited from the focus groupsreinforced many already identified in the literature like anxiety andworkload1, 3, 4. However we did discover new themes like travel costand organisation of clinical placement. Although plenty of time isspent by the faculty to address these problems, we felt that morestudent contribution to the planning of the clinical years can helpease this transition period.References:1. Radcliffe C, Lester H. Perceived stress during undergraduatemedical training: a qualitative study. Med Educ 2003;37:32–8.2. Moss F, McManus IC. The anxieties of new clinical students. MedEduc 1992;26:17–20.3. Prince KJAH, Boshuizen HPA, Van Der Vleuten CPM,Scherpbier AJJA. Students’ opinions about their



preparation for clinical practice. Medical Education 2005;39:704–712.4. Van Hell EA, Kuks JB, Schonrock-Adema J, Van Lohuizen MT,Cohen-Schotanus J. Transition to clinical training: influence ofpre-clinical knowledge and skills, and consequences for clinicalperformance. Med Educ 2008;42:830–7.

International Medical Education

Community- and Hospital-Based Teaching in theMedical Curriculum – Examples from Cuba and theUnited KingdomJ K F Wong, A Wylie

J K F Wong, Department of Primary Care and Public HealthSciences, King’s College London School of Medicine, London, UK

Background and Purpose: Medical schools in Cuba place a strongemphasis on community-based teaching within the main curricu-lum. In the United Kingdom, emphasis is placed on hospital-basedteaching. Cuba’s healthcare system is successful in providing goodhealthcare to her citizens and with good outcomes. For example, in2006, Infant Mortality Rate per One Thousand Live Births is thesame in Cuba and the United Kingdom (5 per 1000 live births)1.Within the National Health System (NHS) in the United Kingdom,there has been an increasing emphasis for significant clinical careto shift from the hospital to the community2, as well as primarycare-led services commissioning3. This work forms the foundationfor further research into community settings in which medicalstudents can learn.Methodology: We reviewed the advantages and disadvantages ofcommunity- and hospital-based medical teaching from the litera-ture and from staff experiences at the Department of Primary Careand Public Health Sciences, King’s College London School ofMedicine. We also compared the community component of 2medical curricula: Latin American School of Medicine (ELAM),Havana; and King’s College London School of Medicine (KCL-SOM), London.Results: We noted that 1 of the major advantages of learning in thecommunity is the development of the Five-Star Doctor4; namelybeing a care provider; decision maker; communicator; communityleader and manager. These qualities enable 1 to meet thefundamental values of a good healthcare system: relevance, quality,cost-effectiveness and equity. The disadvantages of learning in thecommunity include travelling, the varied standards of teachingreceived and the unpredictability of the cases encountered. Thepercentage of the medical curriculum spent in the community isapproximately 20% at the turn of the century for ELAM5, and 14%for KCLSOM6. A major difference is the greater continuity of timespent in the community at ELAM compared with KCLSOM.Discussion and Conclusions: Community-based teaching providesa useful setting to develop the Five-Star Doctor and the role fordoctors as ‘managers of resources, leaders in the public under-standing of difficult and contentious issues, and innovators andintegrators of new knowledge’7,8. Given the increasing role of theCommunity context in health care provision within the NHS,opportunities to increase community based teaching should evolve.Learning in the community, with clearly defined aims andobjectives, may therefore increase significantly. However the actualand perceived disadvantages will need to be addressed.References:1. UNdata Available at: http://data.un.org/Default.aspx. Accessed1/8/2011, 2011.

2. Professor the Lord Darzi of Denham KBE. High quality care forall: NHS Next Stage Review final report. 2008.3. Secretary of State for Health. Equity and excellence: Liberatingthe NHS.4. Boelen C. World Health Organisation. The five-Star Doctor: Anasset to health care reform? Available online at www.who.int/entity/hrh/en/HRDJ_1_1_02.pdf. WHO.5. del Rosario Morales Suarez, I., Fernandez Sacasa JA, DuranGarcia F. MEDICC Review: Cuban Medical Education: Aiming forthe Six-Star Doctor. 2008; Available at: http://www.medicc.org/mediccreview/index.php?issue=1&id=3&a=va. Accessed 1/8/2011,2011.6. KUMEC :Undergraduate :King’s College London Available at:http://www.kcl.ac.uk/schools/medicine/research/hscr/sections/primarycare/kumec. Accessed 1/8/2011, 2011.7. Levenson R, Atkinson S, Shepherd S. The 21st Century Doctor:Understanding the doctors of tomorrow.8. Royal College of Physicians. Future Physician: Changing doctorsin changing times.

Challenges of Continuing Medical Education inSaudi Arabia’s HospitalsA Alghamdi, J Spencer

A Alghamdi, School of Medical Sciences Education Development,Newcastle University, Newcastle Upon Tyne, UK

Background: Health care services in Saudi Arabia are expandingrapidly. However, the country is struggling to cope with the lack ofcompetent health professionals. Continuing Medical Education(CME) encounters some challenges that hinder learning pro-gramme from responding appropriately to professionals’ demandsand needs, and to the complexity of health care.Methods: The study used a mixed methods (qualitative andquantitative) approach. Depth, semi-structured interviews werefollowed up with a questionnaire (sent by email) listing all CMEchallenges identified by the interviews, asking participants to rankthem.Sampling Seven public hospitals were selected from differentgeographical areas (N = 7).

1. Snowball sampling targeted 33 medical education represen-tatives from different Medical and Para medical departments(N = 33).

2. Purposive sampling targeted 11 medical librarians (N = 11).Initial Results: The major CME challenges were identified anddivided into 5 themes:

1. Health care resourcesPoor medical library; location, space, and services provided(old textbooks, limited internet and e-journals subscription).Lack of the CME budget transparency.

2. Topics of learning programmeDuplicated.Not at the level of staff.Don’t reflect staff and department needs.

3. Designing of learning programmeMethods of identifying needs are limited.Activities are delivered using passive methods.Lack of planning and designing policy.Lack of formal written evaluation.

4. StaffDiversity of staff’s backgrounds and educational needs.Staffs lack interest to attend meetings.Resistance to changing performance.



5. Decision makersLack of knowledge about needs.Exerting influence over programmes.Developing programme for the sake of reputation.

Discussion: CME budget lacks transparency that may result inheavily reliance on pharmaceutical industry subsidy for CME eventsas well as to sponsor medical professionals’ trips. This may affectthe quality of the events or cause bias.Staff diversity was a major challenge as they came from differenttraining and educational backgrounds; however, learning pro-grammes lacked needs assessment, resulting in activities that maybe based on desires and wishes rather than on actual needs.Conclusion The study showed a strong correlation between thestakeholders’ lack of knowledge and support, and CME limitations,this primary problem as well received the highest ranking in thestudy.References:1. Grant, J. Learning needs assessment: assessing the needs. BMJ2002; 324:156–159.2. AL-Fouzan, K. S. Continuing education needs as reportedby dentist in Saudi Arabia. Saudi Dental Journal 2001; 13(2):75–81.3. Al-Shehri, A. M., Al Haqwi, A. I., Al Ghamdi, A. S., Al Turki, S. A.Challenges facing continuing medical education and the SaudiCouncil for Health Specialties. Saudi Medical Journal 2001; 22(1):3–5.4. Davis, D. Global health, global learning. BMJ 1998; 316: 385–389.5. El-Gilany, A., AL-Wehady, A. Job satisfaction of female Saudinurses. Eastern Mediterranean Health Journal 2001;7:1.6. Farooq, S. Continuing professional development forpsychiatrists in developing countries. Adv Psychiatric Treat 2003, 9:161–163.7. Towle, A. Continuing medical education: Changes in health careand continuing medical education for the 21st century. BMJ 1998;316: 301–304.

An ‘Introduction to Theatres Workshop’ as aTeaching Tool for Medical StudentsT G Martin, D R Clarke, D J Bowrey

T G Martin, College of Medicine, Biological Sciences andPsychology, University of Leicester, Leicester, UK

Background and Purpose: Attendance in operating theatres haslong been part of medical school curricula. This can be anintimidating environment for medical students (1), and a lack ofunderstanding of basic etiquette can be problematic for theatrestaff. It has been shown that medical students also have a deficit inknowledge of principles of infection control (2), and thereforethere is the potential for patient safety to be compromised. Whilstthere is some evidence that formal teaching relating to operatingtheatre etiquette does increase student confidence, as well asenhancing enthusiasm for surgery as a career (3), there is a lack ofvalidated teaching tools to deliver this information. Our aimtherefore, was to design and deliver a workshop that could bevalidated as an introduction to operating theatres, as part of anundergraduate surgical placement at a UK medical school.Methodology: Input from previous research (4) and question-naires sent to consultant surgeons and medical students were usedto develop a workshop teaching plan. This workshop was deliveredto 2 cohorts totalling 76 University of Leicester medical studentsundertaking a surgical placement. Feedback from the students wascollected on a 10-point Likert scale questionnaire.

Results: Consultant surgeons and medical students had similaropinions on what should be included in the workshop. Compe-tencies rated most important were principles of sterile fields/theatres and infection control, case preparation, surgical scrubtechnique, and theatre etiquette – these were subsequently selectedas teaching aims for the workshop. The need for the workshop wasreinforced by a perceived difference in current standards in thesuggested competencies between medical students and consultants(mean difference 2.25/10).On delivery, a large majority of students agreed that the workshopwas useful (87% rated the workshop as ‡ 7/10) and met thelearning objectives (99% ‡ 7/10). Eighty-four percent stated thatthey had increased confidence following the workshop (‡ 7/10)and 95% would recommend the workshop to their peers (‡ 7/10).Students highlighted that this workshop would be best run beforeany theatre experience.Discussion and Conclusions: Initial student feedback to this‘Introduction to Theatres Workshop’ for medical students has beenvery positive. Over the coming months changes will be made inresponse to feedback and the workshop will be delivered to theatre-naive medical students. Consultant surgeons will be sent a furtherquestionnaire to subjectively determine whether they feel there hasbeen an improvement in medical student learning in theatre, andassessments carried out to achieve an objective measure.References:1. Thomas P. A junior medical student meets the operating theatre.The Clinical Teacher 2006;3(4):202–205.2. Mann C, Wood A. How much do medical students know aboutinfection control? Journal of Hospital Infection 2006;64(4):366–370.3. Samman A, Tendick F, Ward D, Zaid H, O’Sullivan P, Ascher N.A Surgical Skills Elective to Expose Preclinical Medical Students toSurgery. Journal of Surgical Research 2007;1422:287–294.4. Fernando N, McAdam T, Cleland J, Yule S, McKenzie, H,Youngson, G. How can we prepare medical students for theatre-based learning? Medical Education 2007;41(10):968–974.

Students as Co- Educators Using E-Learning toStandardise Undergraduate Medical TeachingC Milner-Smith, O Jagger, J Williams

C Milner-Smith, Smith Centre of Medical Education, Bristol, UK

Background and Purpose: In year three, as medical students wehave the opportunity to develop innovative online learningmaterials as part of the Student Selected Components Programmeproviding opportunities for independent study and development ofnew skills. Our aim was to provide a core e-learning teachingresource for ear, nose and throat (ENT) that could be accessed byour peers on the Bristol Medical School online learning website.This would provide a standardised learning resource and addressthe variability in teaching that students experience because they aretaught in unconnected geographically-dispersed NHS-based Acad-emies1.Methodology: Results accumulated from qualitative research in theform of questionnaires identified that medical students prefer tolearn in a variety of ways. Based on this, we produced a user-friendly, problem-based, interactive and clinically relevant tutorial,which builds upon and tests students’ knowledge. We developedthe tutorial combining several tools: Final Cut2 to produceexamination videos, Dragster3 to produce pictorial labelling exer-cises, and eXe4 to combine these elements alongside core textbased materials.Results: Our tutorial received approval for both its design andmedical accuracy. User-testing to date has received positive



feedback. Students commented that it is a useful resource that theywill incorporate into their studies because it fills the ‘gaps’ in theirteaching. The tutorial will soon be accessible online allowing us torun more extensive user-testing and draw wider conclusions. Thetutorial production process has been an invaluable learningexperience. We have developed a range of skills includingtechnological skills, project management, problem solving, collab-orative team working and the ability to construct information insuch a way that it can be used to teach others.Discussion and Conclusions: The tutorial provides students with astandardised ENT learning resource, providing reassurance thatthey are all receiving the same core teaching. The skills we havedeveloped will be applicable throughout our medical career. Inparticular, all doctors have an obligation to teach and producingthe tutorial has developed our skills as medical educators at an earlystage in our careers. Following the success of our SSC, we believethe role of students as co-educators is important and one thatshould be expanded. Working with both clinical and e-learningexperts in this way provides an effective example of studentsengaging in and influencing their own curriculum5.References:1. Mumford D.B. (2007). ‘Clinical academies: innovative school-health services partnerships to deliver clinical education’. AcademicMedicine 82(5), 435–40.2. Final Cut Express 4.0 – http://www.apple.com/finalcutexpress/.3. Dragster 3 – http://www.webducate.net/products/dragster/.4. eXe – http//: http://exelearning.org/wiki.5. O’Doherty, D. (2010). ‘Student Engagement project’. A HigherEducation Academy Engineering Subject Centre Report http://www.heacademy.ac.uk/assets/York/documents/ourwork/student-engagement/student_engagement_project_report_engsc.pdf

Does Previous Degree Matter in GEP Courses?P Marvao, J Ponte

P Marvao, Depto. de Ciencias Biomedicas e Medicina, University ofAlgarve, Faro, Portugal

The Medical degree in University of Algarve was the first graduate-entry course with a 4-year, PBL-based curriculum in Portugal.We have students from different backgrounds and the questionarose whether there would be measurable differences in academicachievements between different groups and whether those differ-ences, if existing, would disappear during the course. We aggre-gated our first cohort of students (30), now in their second year, in5 clusters: nurses (11), health technologies (3), biological sciences(9), psychology (3) and pharmaceutical sciences (3) and comparedthe results obtained in 3 different types of assessment. The first wasa standardized progress test organized by the InternationalPartnership for Progress Testing; the second was an OSCE with 12stations and the third was a workplace-based assessment (WBA)performed weekly in the GP rotations. Second cohort students (31)were divided into 3 groups: nurses (12), health technologies (8),and biological sciences (5).We show results from 5 progress tests, 1 OSCE and 40 WBAs for ourfirst cohort of students and 2 progress tests and 10 WBAs for oursecond cohort. We found no significant differences in academicachievement between our 2 most numerous groups in the first

cohort in all progress tests but one. No significant differences werefound in the OSCE and WBA.In the 2 first progress tests of our second cohort the resultsachieved by the groups of biological sciences and health technol-ogies were significantly lower than the results achieved by thenurse’s group. The WBAs so far performed in the second cohort ofstudents showed no significant differences.The results from our first cohort seem to indicate that a student’sprevious degree has little or no effect on the overall academicresults. The progress tests of our second cohort, on the contrary,suggest that previous degree may affect academic results, at least inthat component. The explanation for this observation may simplybe chance, due to the small numbers studied, or it may be due tothe fact that the first progress test was applied to the first cohort inJanuary while the second cohort had its first test in October, at thestart of the course.We expect that, as further data is accumulated, it will become clearto what extent academic results in our graduate entry program areinfluenced by the type of degree the student obtained previously.

Student Conferences: Unique Opportunities forPersonal and Professional DevelopmentA Lawson McLean, C Saunders, L Hryhorskyj, P Palani Velu, K Hor

A Lawson McLean, Edinburgh, UK

Background: A career in academic medicine requires many skillswhich have been identified as fundamental requirements forjunior doctors. A student-led academic medicine society, ATRIUM,organised an annual conference inviting medical student dele-gates from across the UK to present their research in a student-friendly and accessible environment. We outline how participationled to the development of key skills and competencies fordelegates and organisers, and investigate what students believe arethe main incentives and disincentives of a career in academicmedicine.Methods: The conference was held successfully in November2010. UK-wide publicity led to 241 abstract submissions which,after anonymous marking, were accepted for 6 oral and 100poster presentations. After the conference, questionnaires weregiven to participating delegates and staff to address the study’sobjectives.Results: Feedback from completed questionnaires (n = 92) indi-cated that the majority of delegates were senior medical studentswho had previously completed an intercalated degree. Encour-agingly, 85% of delegates felt that the Conference improvedtheir confidence in presenting at national meetings. The mainincentive identified by delegates for a career in academicmedicine was a desire to carry out research, while the maindisincentive was competing pressures between clinical medicineand acadaemia.Discussion: Organising and presenting at the Conference led todevelopment of skills in key domains for both organisers anddelegates. These are transferable to the clinical setting and will beuseful for careers both in and outwith academic medicine.Therefore, we encourage students to attend and organise student-led conferences to enhance their professional and personaldevelopment.



Management and Administration

Leadership and Management Training: Are WeHitting the Mark?S Liu, Z Haider, G Gaskin

S Liu, University College London Hospital, London, UK

Background: It is well recognised that effective clinical leadershipis closely linked to organisational performance1. As the NHS shiftsinto a period of growing uncertainty, effective clinical leadership ismore important than ever. Increasingly there is recognition thatleadership and management training needs to been incorporatedinto the medical curriculum2,3. However 1 of the challenges is howdo we support the next generation of clinical leaders in developingthe competencies necessary for their future roles.Today’s postgraduate medical training is evolving to meet thesechallenges but how closely are we meeting trainees’ needs andexpectations?Objectives: To assess and determine how well trainees’ needs inleadership and management training are being met. To under-stand what aspects of leadership and management training aresignificant to trainees.Method: We conducted a survey of doctors across all disciplines intraining positions between Feb 2010 and May 2010 in a Londonteaching hospital. Eighty questionnaires were sent out and in total 59responses from doctors at various stages of training were received.Results: Sixty-four percent had been working in the NHS for over5 years. Despite this level of experience only 1 responder felt thatcurrent post graduate training provided adequate leadership andmanagement development opportunities. Informal and unstruc-tured ‘on the job’ learning provided the bulk of the experience.There was a strong desire to gain further teaching regarding;setting up of a clinical service, business planning, change man-agement, financial flows in the NHS and building effective teams.Conclusions: These findings clearly indicate there continues to be agap in post graduate clinical leadership and management training. Itsupports the need to continue development of training programmesto address the needs of tomorrow’s consultant. The findings also helpto inform on some of the areas that need to be addressed.References:1. Hamilton P, Spurgeon P, Clark J, Dent J, Armit K. EngagingDoctors: Can doctors influence organisational performance? : NHSInstitue for Innovation and Improvement, 2008.2. Tomorrow’s Doctors. London: General Medical Council, 2009.3. Levenson R, Atkinson S, Shepherd S. The 21st Century Doctor:Understanding the doctors of tomorrow. London: The King’sFund, 2010.

Leadership and Management Training: AnExecutive Shadowing Programme for TraineeDoctorsZ Haider, S Liu, K Holroyd, G Gaskin

Z Haider, UCL Partners Darzi Fellow, University College HospitalNHS Foundation Trust, London, UK

Background: There is increasingly a ‘disconnect’ between doctorsand medical management1. As future clinical leaders, traineedoctors will be expected to take an active role in developing clinicalservices. Unfortunately, trainees’ practical experience of servicemanagement is limited, although they typically attend classroom-

based ‘management courses’ prior to applying for consultant jobs.This approach ill prepares them for their future role.Objectives: To provide and evaluate a 4-month Executive Shadow-ing Programme for trainee doctors (funded by an award from theLondon Deanery) between October 2010 and January 2011 at UCLH.Method: The programme was advertised to UCLH specialistregistrars and 6 participants (level ST5 and above) selected.Following a 1 day introductory workshop, they were provided with amentor and attended a variety of committees and clinical boardmeetings, the selection of meetings tailored to meet their individ-ual learning needs. The trainees were asked to consider howactions are planned, monitored and outcomes evaluated, and howthe Trust responds to and resources the healthcare needs ofpatients.Meetings with mentors explored these issues further and stimu-lated additional conversations. Trainees were asked to take theirlearning back to their clinical team. A final meeting attended by thetrainees and mentors gave the trainees an opportunity to feedbackabout their experiences of the programme.Results: The feedback from the trainees was overwhelminglypositive. All said that they had a clearer understanding of the roleof managers and the relevance of management to their own clinicalspecialties. Quotes included ‘I am much more aware of trust goals,PCT demands and clinical priorities’, ‘I feel inspired to take on aleadership role’, ‘I have a clearer picture of how management fitsinto my clinical work’. All enjoyed the practical nature of theprogramme; 2 trainees had taken up audit projects with renewedvigour, understanding more clearly their relevance. Others hadapplied their learning to pathway redesign. Suggestions forimprovement of the programme were to increase the duration to6 months and to require each participant to undertake a projectduring the programme.Conclusion: This programme has provided trainee doctors with aunique and low cost opportunity to learn about managementwithin the Trust. Similar programmes in other trusts should beencouraged to enable doctors to gain a greater understanding ofthe role of management, address the learning needs of tomorrow’sconsultants and reduce the disconnect between doctors andmanagement.Reference:1. Degeling, P, Maxwell, A, Kennedy, J and Coyle, B. Medicine,management and modernization: a ‘danse macabre’? British medicaljournal 2003; 326: 649–652.

A Clinical Approach to the Management ofUnprofessional Behaviour in Medical StudentsH Pascoe, J West

H Pascoe, Medical and Social Care Education, Leicester, RoyalInfirmary, Leicester, UK

Background: The management of unprofessional behaviour inmedical students remains challenging for UK Medical Schools butimportant to recognise and document as particular patterns ofbehaviour can recur during postgraduate practice (Papadakis et al.2005). The GMC document: Medical students: professionalbehaviour and fitness to practise 2007 states that medical schoolswill decide if individual students are fit to practise by the time theygraduate, that thresholds for unacceptable behaviour should bedefined and decisions should be taken on a case-by case basis.Leicester Medical School has taken a diagnostic approach to themanagement of unprofessional behaviour in undergraduate med-ical students utilising a standardised referral tool and a team-based



approach to guide decisions, similar to clinical triage and assess-ment services used in community settings.Methodology: An iterative approach was taken to establish adiagnostic process in an academic setting following literaturereview. A series of case-based discussions involving senior academicstaff were used to define thresholds for intervention and categor-ised using a traffic light coding system. Anonymised past examplesof student unprofessional behaviour were reviewed by clinicalacademic staff to obtain a consensus opinion on the structure andcontent of a reporting tool. Further consultation with students,NHS and administrative staff was used to determine usability andacceptability. The Leicester Medical School professionalismreporting form (Yellow Form) was launched in 2009 at the MedicalSchool and all clinical areas.Results: The Professional and Academic Concerns group wasestablished in 2009 to monitor the performance of students givingcause for concern and has evaluated 430 students to December2010. The group meets regularly to consider all yellow formsubmissions, assigns and reviews codes and determines outcomebased on the nature, severity and frequency of the concern raisedfor individual students. The group operates a range of interven-tions from written work to promote reflection on professionalattitudes, through to sanctions including referral to Fitness toPractise proceedings.Conclusion: Leicester Medical School has successfully used adiagnostic approach based on a clinical model of care to improvethe documentation and categorisation of unprofessional behaviourin medical students to facilitate early intervention and activemanagement.Reference:1. Disciplinary Action by Medical Boards and Prior Behaviour inMedical School. Papadakis MA, Teherani A, Banach MA et al. NEngl J Med 2005; 353:2673–2682.

Assessing the Usefulness of the ProfessionalismConcerns FormH Pascoe, J West

H Pascoe, Medical and Social Care Education, Leicester, RoyalInfirmary, Leicester, UK

Aims and Objectives: 1. To assess whether professionalism con-cerns forms are a useful indicator of summative assessment results.2. To assess the difference in concern types between academicallystrong and weak students.3. To assess whether there is a link between student concern codingand summative assessment result.Introduction: It is necessary to monitor medical students’ profes-sionalism in order to comply with GMC guidance1. A profession-alism concerns form, adapted from a reporting system used at SanFrancisco School of Medicine2, was introduced to Leicester MedicalSchool in 2009. The form can be completed by any member of staff,and feeds in to the Professional and Academic Concerns Group(PACG), which makes decisions of student coding (green, amberor red), subsequent action to be taken, and referrals to FTP/APC asappropriate. This study was carried out to assess the validity of theseforms and concerns codes in predicting students who may be at riskof not progressing on the course.Method: First and Second Year Students were selected for studyand were subdivided into those who had been satisfactory (n = 265)and those who were unsatisfactory (n = 159) in their most recentsummative assessments. The concerns forms were then analysed toshow: total number of forms received; and category of concern.

The concern codings for all students prior to their most recentsummative assessment were also analysed to note the number ofstudents in each group.Results: 1. Seventeen percent of students who were unsatisfactoryreceived concerns forms, compared to 11% of satisfactory students.A chi-square analysis found a significant link between concernforms and summative assessment results.2. The proportion of concerns forms received for ‘diminishedrelationships with school’ and ‘unmet professional responsibility’were similar between satisfactory and unsatisfactory student groups.However, a higher proportion of concerns forms in the category‘lack of effort towards self improvement’ were received forunsatisfactory students.3. Twenty-seven percent of unsatisfactory students were already in thePACG system compared to 7% of satisfactory students. Of the codedstudents, 18% of unsatisfactory students were coded as amber and 8%as red, compared to 5% and 2% respectively in the satisfactory group.Conclusions: 1. Professionalism concerns are linked to academicprogression.2. Students who fail to engage with the remedial process are morelikely to be unsatisfactory at summative assessments.3. The PACG system is identifying students who are likely to beunsatisfactory in assessments.References:1. GMC. Tomorrow’s Doctors 2010.2. Papadakis MA. A strategy for the detection and evaluation ofunprofessional behaviour in medical students. Academic Medicine1999; 74:980–990.

Developing Quality Criteria for PracticesUndertaking Undergraduate Medical Teaching inScotlandS Law, K Foster, F Garton, J Hamilton, C Jackson, N Merrylees, KMillar, L McGuigan, S Tracy, A Williamson10

S Law, University of Dundee, UCME, Kirsty Semple Way, Dundee,UK

Background: In 2009 we presented, at this conference, a poster1

describing the development of a Scottish GP Tutor Group thataimed to offer a ‘bottom up’ approach to the development ofquality standards in General Practice Undergraduate Teaching.Comment was made that ‘Quality’ was very much on the NHSagenda and that this approach was likely to be very productive.The Schools of Medicine across Scotland place medical students onattachment in general practice for varying periods of time,dependent upon their own curricula. While the School of Medicinein Edinburgh tends to place most students in the local area, theother Schools use practices throughout Scotland and there issignificant amount of overlap in the sites used. Using differentsystems and personnel to approve these practices and tutors was, weconsidered inappropriate and wasteful of both time and resources.Methodology: A modified Delphi technique was used to undertakethis exercise2. Participants, all experienced experts in approvingundergraduate practices, reviewed their own processes and theliterature3, 4 in the light of existing quality criteria4.5. Initialthoughts suggested the need to develop criteria which related tothe Tomorrow’s Doctors Framework4, the NES Quality Frameworkfor Postgraduate Medical Training and which were both practicaland measurable. Subsequent meetings rationalised an initial list ofitems to a concise and workable framework.Results: Over a series of meetings and email discussions the groupdeveloped a set of criteria that sat under the headings



1. The Tutor as a Doctor.2. The Tutor as a Teacher.3. The Practice as a Learning Environment.

Conclusions: Five Universities have worked together to developquality criteria for the approval of undergraduate teaching prac-tices. The tool is now used by all Departments as they approve andrevisit undergraduate training practices. We plan to undertake anevaluation of the tool after it has been in use for 1 year.References:1. N Merrylees, S Law, C Jackson, S Tracey, J Hamilton A NewCollaboration: The Scottish GP Tutor Group presented at ASME,2009.2. Hsu C, Sandford B The Delphi Technique: Making Sense OfConsensus Practical Assessment. Research & Evaluation 2007; 12: 10.3. Cotton P Developing a set of quality criteria for community-basedmedical education in the UK. Education for Primary Care 2009; 20:143–51.4. Boendermaker PM, Conrad MH, Schuling J, Meyboon De JongB, Zwiersrta RP & Metz JCM Core Characteristics of the CompetentGeneral Practice Trainer, a Delphi Study. Advances in Health SciencesEducation 2003; 8: 111–116.5. General Medical Council Tomorrows Doctors General MedicalCouncil 2009 http://www.gmc-uk.org/education/undergraduate/tomorrows_doctors_2009.asp accessed 31 Jan 2011.6. NHS Education for Scotland NES QM Framework 2010 http://www.nes.scot.nhs.uk/disciplines/medicine/quality-management/nes-qm-framework accessed 31 Jan 2011.

Current Teaching Practices in Outpatients in aSmall Hospital; Are Teaching Clinics the Answer?K C Butcher, A G Martin

K C Butcher, Weston General Hospital, Weston-Super-Mare,Somerset, UK

Background and Purpose: Many small hospital trusts delivermedical undergraduate clinical programmes. Traditionally, districtgenerals are perceived not to have a strong teaching pedigree. Thecapacity to accommodate students in outpatient clinics can beharder to arrange than in large ‘teaching’ hospitals. Pressures fromthe clinical workload on the teacher can prevent delivery of a usefulexperience. Teaching clinics, where patient appointment times areextended, have been advocated as good learning experiences. Theycertainly encourage active learning by the student,1 but have

financial implications for the provider.2 The aim of this project wasto evaluate present clinic activity, and to assess the possibility ofsetting up teaching clinics.Methodology: A simple questionnaire was given to every consultantin the general outpatients department in 1 week. The question-naire asked about current attendance of students, and what theyfelt about students attending clinics in the future. There was anopportunity to express willingness to be involved in a teachingclinic.Results: Eighty-two percent of consultants replied. Twenty-sevenpercent were from visiting tertiary specialities. Every consultant feltstudents benefited from attending their clinic. One third accepted2 students in a clinic, with only 1 speciality, saying they were toobusy to accept students. Twenty-eight percent of those clinics whocurrently took 1 student, felt they could not accept any students.Students were expected to clerk and present the patient in half theclinics, the rest shadowed the consultant. One third of consultantssaid they had last seen a student in their distant memory, and thiscorresponded to an expression of preferring not to have studentsin clinic. No consultant said they saw students more than once amonth.The biggest constraint to accepting more students was unanimouslytime, space, and overbooked clinics. Fifty percent of consultantswould be interested in a dedicated teaching clinic. The willingnessto consider a teaching clinic did not reflect current clinic teachingpractices.Discussion and Conclusions: In our small hospital we haveconsultants who are willing to teach, including being involved inteaching clinics. Currently, service commitments inhibit them fromteaching students even though everyone 1 agrees experience in theoutpatient environment benefits students.As an educational provider we must continually reassess whatlearning opportunities we can provide. This may include theintroduction of regular teaching clinics with reduced patient load.This project has proven the willingness of our teachers, and weneed to consider how to utilise their enthusiasm and skills, in theorganisation of dedicated teaching clinics.References:1 Ashley P, Rhodes N, Sari-Kouzel H, Mukherjee A, Dornan T.‘They’ve all got to learn’. Medical students’ learning from patientsin ambulatory (outpatient and general practice) consultations. MedTeach 2009 Feb;31(2):e24–31.2 Stahl J, Roberts M, Gazelle S. Optimizing Management andFinancial Performance of the Teaching Ambulatory Care Clinic.J Gen Intern Med 2003; 18:266–274.



Postgraduate Education

Why Do General Practice in the Second Year ofFoundation Training?J Holmes, P Jones, D Fee, W Pearson, G Crackett, N Kumar

J Holmes, 29 Old Dryburn Way, St Leonards, Durham, UK

Introduction: The Collins report highlighted the need to exposejunior doctors to community medicine to develop doctorssuited to deal with the increasing primary care demands of anageing population1. As part of course evaluation we assessedFoundation 2 doctor’s perspectives on their general practiceplacements, within non GPVTS training practices withinNorthern Deanery.Methods: Fifteen FY2 doctors were invited to complete aquestionnaire exploring learning opportunities during theirGeneral Practice attachments. Questions were aimed at evaluat-ing clinical support, teaching experience, workload and influ-ences on career choice. Participants were encouraged to add freetext comments.Results: We had a 73% response rate (11/15). Six had plans toapply to and 4 were considering general practice. No doctor hadto work beyond the EWTD and they were all allowed to steadilyincrease their workload. All respondents stated that they hadteaching directed towards their learning needs, with constructivefeedback and adequate clinical support. Participants agreed thatthey had a better idea of the roles of the primary health careproviders and how to work within a multidisciplinary team.During the placements trainees had the opportunity to take partin joint visits, IT training, and 90% completed an audit. All hadtheir referrals reviewed and 90% had their medical recordsevaluated. Sixty percent reported experience of DOPS with 9different procedures described. Hundred percent enjoyed theirplacement and stated they would recommend this attachment.Table 1: Teaching Methods used.

Discussion: The results show that a high proportion of the doctorsinvolved in general practice placements were considering this as acareer, with 5 free text comments suggesting that the rotation had apositive effect on this career choice. Results found that doctorsenjoyed having an influence on their workload and found thesupportive atmosphere of general practice helpful in addressingtheir learning needs. Graded responsibility was appropriately given.Doctors had an array of learning opportunities available, includingseeing patients in their home environment and observing health-care at a primary level. Although DOPS are harder to achieve

outside of the hospital environment the survey suggests that thereare opportunities within the community to fulfil the foundationcurriculum.Conclusion: Community placements are felt to be increasinglyimportant within foundation rotations as pressures on primarycare increase. Responses to our survey show that they offer variedand high quality learning opportunities and enable foundationdoctors to address their learning needs and fulfil curriculumrequirements.Reference:1. Professor John Collins, Foundation For Excellence: An Evalua-tion of the Foundation Programme, Medical Education England,October 2010.

Foundation Doctors and Patient DeathG T Linklater

G T Linklater, NHS Education for Scotland, Roxburghe House,Aberdeen, UK

Background and Purpose: Patients die. Care of the dying isrecognised as important by the GMC and the Scottish Govern-ment.1,2 Many of the competencies identified within the Founda-tion Curriculum relate to care of the dying.3 We sought to performan educational needs assessment to inform the development of aneducational intervention for Foundation doctors based in theNorth of Scotland deanery.Methodology: A triangulated approach was used including aliterature review, questionnaire survey, analysis of expert opinionand other published curricula. The postal survey was sent to all(n = 132) year one Foundation doctors in the North of Scotlanddeanery 6–9 months after they had started their Foundation posts.Results: The survey confirmed that exposure to death was commonand distressing for junior doctors in the North of Scotland.Communication tasks around care of the dying were perceived asmore difficult than practical tasks. Lack of support (particularlyfrom consultants) and concerns about overtreatment were signif-icant issues.The synthesised educational outcomes resulting from the analysisof the literature review, questionnaire survey, expert opinion andother published curricula are presented as per Harden’s 3-circle,12-outcome model.4

Discussion and Conclusions: It is interesting to note that the needsidentified from the questionnaire and literature review of juniordoctor experiences relate more to emotional, analytical and personalcompetencies rather than cognitive or technical competencies. Toaddress these needs, a small-group, case-based teaching interventionhas been introduced to the North of Scotland Foundation teachingprogramme. This intervention has been positively evaluated, how-ever, ongoing concerns around educational supervision, lack ofsupport and negative role modelling may mean that any lessonslearned do not transfer well into the clinical environment.References:1. General Medical Council. The new doctor: Recommendationson general clinical training. 2006.2. Scottish Government. Living and dying well: A national actionplan for palliative and end of life care in Scotland. 2008.3. Academy of Medical Royal Colleges. Foundation Programmecurriculum. 2007.4. Harden RM, Cosby JR, Davis MH, Friedman M. AMEE Guide N0.14: Outcome-based education. Part 5. From competency to meta-competency: a model for the specification of learning outcomes.Medical Teacher 1999;21:546–552.



Aspirations for Intensive Care Training in NorthWest EnglandJ Bannard-Smith, R Clayton, M Holland, J Rogers

J Bannard-Smith, StR Anaesthesia & Intensive Care, Department ofAnaesthesia & Intensive Care Medicine, University Hospitals SouthManchester, Manchester, UK

Background and Purpose: Intensive care medicine (ICM) is arelatively young speciality in the midst of considerable political andorganisational change. National bodies are striving to unify andstandardise the speciality, not least in matters surrounding training.ICM trainees originate from a parent speciality and part of theirtraining comprises an ‘advanced year’ as a senior registrar. Thisstudy sought to evaluate the advanced year in North West Englandand ask: how can advanced training be improved to ensure traineesare better prepared for consultant roles?Methodology: A panel of 35 experts was recruited. The definitionof an expert was ‘any clinician with intimate experience orinvolvement in advanced ICM training’. The panel consisted of amixture of trainees and consultants including some heavilyinvolved in planning and delivering advanced training.Using the Delphi method, panellists anonymously submitted sugges-tions on how to improve advanced ICM training (Round 1). Panellistswere then shown all suggestions (Round 2) and asked to score them(1–5; 1 = poor, 5 = excellent). Finally panellists were presented withsuggestions with mean scores > 4.0 and standard deviations(SD) < 1.0 and asked whether they should be considered for imple-mentation (Round 3). An agreement level of 75% for Round 3responses identified suggestions for the final consensus view.Results: Round 1: 34 panellists (97%) provided 350 suggestions forchange to advanced training. Analysis of common themes andrepetitions by an independent researcher and the lead authorrefined this to a common list of 171 suggestions.Round 2: 29 panellists (83%) submitted scores. One hundred andthirteen suggestions were eliminated, leaving 58 that scored highly(Mean > 4.0 and SD < 1.0).Round 3: 31 panellists (89%) agreed (at the 75% level) that 39 of58 suggestions from Round 2 should be considered for imple-mentation and formed the basis of consensus opinion. Of these 39suggestions 14 related to improving the provision of non-technicalskills training relevant to critical care; another 14 concerned thepromotion and logistical organisation of the advanced year.Conclusions: The Delphi technique was useful in ascertaining aconsensus expert opinion on how to improve standards in advancedtraining with local resources and experience in mind. Particularfocus areas included non-technical skills training and refining thepromotion, organisation and delivery of the advanced year. Work hasbegun on a trainee directed checklist to address these areas. Weenvisage a more diverse and holistic training experience resulting inNorthwest trainees being better prepared for consultant roles.

Simulation before Reality. A Practical Course inEndoscopic Simulation Prior to Endoscopy inPatientsC Quah, E Wood

C Quah, Barts & The London School of Medicine and Dentistry,Whitechapel, UK

Introduction: Often endoscopy sessions are limited and timeconstrained thus restricting the number and range of trainees ableto learn endoscopy; or trainees have other commitments limiting

attendance to sufficient sessions1. Various studies demonstrate thatendoscopy simulation improves hand-to-eye co-ordination andlearning curves are reduced1, 2, 3, 4. We propose all endoscopy naıvetrainees must complete modules using endoscopic simulation(Simbionix GI Bronch Mentor) prior to performing endoscopywith patients – initially commencing on programmes for diagnosticoesophogastroduodenoscopy (OGD). Candidates include endos-copy naıve trainees who are prospective Medical Gastroenterologyor Gastrointestinal Surgical trainees, wishing to train in endoscopyat Homerton University Hospital NHS Trust.Objectives: 1. Introduce endoscopy-naıve trainees to endoscopy.2. Promote patient safety by ensuring trainees have basic skills priorto performing endoscopy with patients.3. Promote educational excellence by increasing number oftrainees given the opportunity to train in endoscopy.4. Use of endoscopic simulator:Trainees: complete assigned modules (4–5 cases per module)during self-directed learning timeTrainer: review trainees’ progress after each module, provideconstructive feedback before trainee proceeds to next moduleMethodology: An experienced endoscopist presents an introduc-tion to endoscopy to trainees via lecture format: including endo-scopic equipment, safety, patient consent and safe sedation as perJoint Advisory Group (JAG) curriculum; followed by induction to theendoscopic simulator. Trainees complete assigned modules. Eachmodule contains 4–5 cases for the trainee to practice endoscopy,taking approximately 45–60 minutes to complete allowing forpractical endoscopy time and writing of report demonstratingmanagement. Progress is reviewed by an experienced trainer(constructive feedback to improve performance5) at the end of eachmodule via video-replay of performance. If progress is satisfactoryand the programme of modules completed, trainees receive acertificate of simulation completion, and are assigned to a consul-tant-supervised endoscopy session, training with patients. Trainersassess further progress via double direct observed procedural skill(DOPS) assessment of trainee after 3 months of performing endos-copy with patients – aiming to perform approximately ‡ 200 OGDs, asrecommended by JAG. If performance is acceptable and safe then thetrainee is signed off (e-portfolio) and advances to other endoscopyprocedures if desired (e.g. therapeutic OGD, flexible sigmoidoscopy).Conclusions: This scheme was commenced in December 2010 andendoscopy naıve trainees are undertaking this training programme.Feedback from the trainees will be obtained after completionassessing if they found simulation and constructive feedback usefultowards their training.References:1. Clark JA, et al. Initial experience using an endoscopic simulatorto train surgical residents in flexible endoscopy in a communitymedical center residency program. Current Surgery 2005 Jan–Feb:62(1):59–63.2. Cohen J, et al. Multicenter, randomized, controlled trial ofvirtual-reality simulator training in acquisition of competency incolonoscopy. Gastrointestinal Endoscopy 2006: 64: 361–368.3. Gerson LB. Can colonoscopy simulators enhance the learningcurve for trainees? Gastrointestinal Endoscopy 2006: 64: 369–374.4. Haycock A, et al. Training and transfer of colonoscopy skills: amultinational, randomized, blinded, controlled trial of simulatorversus bedside training. Gastrointestinal Endoscopy 2010 Feb: 71(2):298–307.5. Kruglikova I, et al. The impact of constructive feedback ontraining in gastrointestinal endoscopy using high-fidelity virtual-reality simulation: a randomised control trial. Gut 2010: 59: 181–185.



Selection

Will Rising Tuition Fees Change the Demographicof Future Doctors and Dentists: A Survey of CurrentMedical and Dental Students?R H Kassamali, R Faruque, V Kokotsis, N S Lee, G Pabla, A Song, MS Spears, M P Sutcliffe

R H Kassamali, Academic Foundation Year 2, Heart of EnglandNHS Foundation Trust, Bordesley Green East, Birmingham, UK

Background and Purpose: The recent government vote toincrease tuition fees to a maximum of £9000/annum, will impactyoung people’s decisions to enter higher education. Students whochoose to study medicine or dentistry could face £45 000 ofstudent debt in tuition fees alone and an estimated £75 000 debtoverall1. In the last 5 years the government has invested signifi-cant amounts of money to give opportunities to lower socioeco-nomic groups, and to maintain diversity between students,however these efforts could be wasted2. Will this increase intuition fees during a time of global recession make low incomestudents believe that a career in medicine or dentistry isunattainable? Will doctors and dentists of tomorrow originatefrom a socio-economic group that is not representative of themajority of patients they will be treating?Methodology: A questionnaire was distributed among studentscontaining questions about current students background educa-tion, socioeconomic status, opinions on the tuition fee rise andtheir opportunity to study medicine or dentistry had this been thesituation at their time of entry. A paper copy of the questionnairewas distributed in student recreational areas and an online copy wasemailed out in a student bulletin. On completion of all thequestionnaires a focus group with 10 students will be completeddiscussing options for students hoping to fund these high fees.Results: One hundred and twenty questionnaires have beencollected to date and further responses continue to come in. Eightypercent of responses are from medical students, and 20% fromdental students. Preliminary results show a very small proportion ofmedical and dental students are from the lowest socioeconomicgroup. The majority of students are against the tuition fee rise,however those students who have had state funded education in thepast feel that these courses would have been unattainable had thecosts been this high at their time of entry. Following the focusgroup, options for coping with these financial burdens will bepresented.Discussion and Conclusions: The preliminary results show that a risein tuition fees will change the demographic of medical and dentalstudents. More students will come from independent schools ratherthan from state funded schools. This could have implications on thequality of future patient care. Forums and advice must be providedfor students who feel that these careers are unattainable due tofinancial constraints. The government could develop a scholarshipor assisted places scheme for medical and dental students.References:1. BMA Press Release. Tuition fee rise will leave medical students£70 000 in debt, warns BMA [updated Wednesday 03 Nov 2010,cited 15 Dec. 10]. Available from: http://web.bma.org.uk/press-rel.nsf/wlu/RWAS-8AUJJM?OpenDocument&vw=wfmms.2. BBC News. Access to medical school ‘not widening’. [updated 16Dec 2009, Cited 26 Jan 2011]. Available from http://news.-bbc.co.uk/1/hi/health/8411948.stm.3. Ng CL, Tambyah PA, Wong CY. Cost of medical education,financial assistance and medical school demographics in Singa-pore. Singapore Med J 2009 May;50(5):462–7.

4. Merani S, Abdulla S, Kwong JC, Rosella L, Streiner DL, JohnsonIL, Dhalla IA. Increasing tuition fees in a country with 2 differentmodels of medical education. Med Educ 2010 Jun; 44(6):577–86.5. Jim Reed. New medical students could ‘face £70k debt’ [updated08:57 GMT, Friday, 10 December 2010, cited 15 Dec. 10]. Availablefrom: http://www.bbc.co.uk/newsbeat/11960783.

Staff Development

Staff Attitudes Regarding Self-Harm: DoesTraining Help?K Saunders, K Hawton

K Saunders, University Department of Psychiatry, WarnefordHospital, Oxford, UK

Background: The attitudes held by clinical staff towards peoplewho self-harm (SH), together with their knowledge about self-harm, are likely to be important influences on their clinicalpractice and hence the experiences and outcomes of those theytreat1. We sought to explore whether training in this area wasassociated with any improvements in attitude towards this patientgroup.Method: We conducted a systematic review of both qualitative andquantitative studies of staff attitudes towards and knowledge aboutpeople who engage in SH where staff were involved in the provisionof services to them. A comprehensive search was performed of allrelevant electronic databases.Results: Of 69 studies that explored staff attitudes towardspatients who self-harm 10 reported the impact of training. Avariety of training models were used but all focussed on riskfactors and how to conduct an assessment rather than attitudesper se. Significant improvements in self-reported attitudes andconfidence were reported with training in both general hospitaland psychiatric staff in the majority of studies. Attitudinal changewas sustained at longer term follow-up in one UK study eventhough knowledge had deteriorated. The only study that failedto show improvement following training only made use of anotice board and information folder suggesting that a moreformal and interactive approach is required for training to besuccessful in changing attitudes.Discussion and Conclusion: The results provide support for theconcept that improvements in knowledge and understanding canlead to the development of more positive attitudes towardspatients. Formal training of all clinical staff in the managementof self-harm is a specific requirement in the NICE guideline(2004)2 however, at present there is no nationally agreedframework or curriculum for this and existing training oppor-tunities are often poorly attended due to the low value placed onthis client group. The shift towards non-medical staff carryingthe responsibility for frontline psychiatry is likely to mean thatassessors are less likely to be aware of the evidence base or tohave received formal training in the assessment of self-harm aspart of their professional training. If we are to truly understandthe impact of training more meaningful forms of assessment(e.g. patient feedback) should be used particularly given howdifficult attitudes are to truly quantify.References:1. Pompili, M. & Girardi, P. (2005). Emergency staff reactions tosuicidal and self-harming patients. European Journal of EmergencyMedicine 12(4):169–78.



2. National Collaborating Centre for Mental Health. (2004).Clinical Guideline 16. Self-harm: the short-term physical andpsychological management and secondary prevention of self-harmin primary and secondary care. National Institute for ClinicalExcellence.

Hi Fidelity, Multidisciplinary Point of CareSimulationS Burnell, L Warnock

S Burnell, Department of Anaesthesia, Betsi Cadwaladr UniversityHealth Board, Ysbyty Gwynedd Hospital, Bangor, UK

Introduction: There is little doubt that simulation is a useful tool inreducing risk within high-risk industries. It allows for the repeatedpractice of rare or dangerous events in a risk free environment andenables the real life event to be dealt with on the foundation ofdetailed rehearsal.In-situ simulation, where the simulated experience takes placewithin the familiar workplace offers many potential advantages.Here we outline a programme of in-situ, multidisciplinary teambased simulation in an actual operating theatre. The objective ofthe simulation was to train the teams to deal with demandingsituations and to help develop standard operating procedures fordifferent adverse incidents.Methods: Our hospital is a large, 550 bedded district generalhospital in North Wales, UK. We have 11 operating theatres withinthe main theatre suite and a number of ancillary operating theatresthroughout the site. During a period of shutdown for routinetheatre maintenance, we utilised a vacant theatre and an adjacentanaesthetic room to run a series of simulated critical incidents.The theatre was equipped with permanent IP cameras, attached toMetiVision, a digital audio-visual system. We utilised a wirelessMETI iSTAN high-fidelity mannequin in a theatre that was fullyequipped with all usual surgical and anaesthetic equipment. Priorto the entry of the multidisciplinary theatre team, the mannequinwas draped and prepared for surgery, in an identical fashion to anactual patient. The scenarios used were total power failure, fire inthe anaesthetic room and total pipeline failure.Simultaneously, in an adjacent anaesthetic room, the remainder ofthe theatre personnel were able to watch a live video feed of eventswithin the theatre. The non-participants were tasked with creating alist of problems identified during the scenario, with potentialsolutions.The video recorded was used as part of a focussed de-briefing forthe whole theatre team, targeting strategies for dealing with thesimulated emergencies. Following the de-briefing, a further,identical scenario was run with a different group of individualscomprising the theatre team. A second de-briefing then tookplace.Outcome: For each simulation, the strategies for dealing with theemergencies will be used to develop SOPs. The organisation alsobenefits from an increase in familiarity, understanding andengagement of staff with SOPs. The training was extremelywell received by all participants and was perceived as less threat-ening and more relevant than that occurring in a simulationcentre.

The Process of Creating a Postgraduate TaughtProgrammes Teaching and Learning Training andResource WebsiteS Coxall, J Boyd, H Broughton, H Lister, H Pugsley, N Webb, RWilliams

S Coxall, School of Medicine, Cardiff University, PGT StudiesOffice B2-C2 Corridor, Heath Park, Cardiff, UK

Background and Purpose: The School of Medicine, CardiffUniversity delivers 21 postgraduate taught (PGT) campus-basedand distance-learning (elearning) programmes across many disci-plines, to over 1600 students per year. The programmes rely on alarge number of tutors and lecturers, based in Cardiff andworldwide. Programme Directors expressed an interest in thecreation of an online support, training and resources area fortutors. Creating this area will allow the training of tutors to becentralised and more efficient, therefore improving the learningexperience for students and allowing tutors to feel valued. A cross-school working party consisting of academics, administrators andelearning specialists explored the needs of tutors involved in thedelivery of PGT programmes and how best these could be metthrough online support.Methodology: A meeting was held of academic leads and admin-istrators representing programmes across the School. Through aprocess of small group discussion activities they identified thecharacteristics of an effective tutor, a list of skills tutors shoulddevelop and what resources and information they require to beeffective. These were prioritised and the results were circulated toall programme leads for comment. An online needs assessmentsurvey was then made available to all individuals involved inteaching and learning. This requested prioritisation of featuresidentified by the programme leads, to see if the tutors’ expectedand actual needs were the same.Results: The 78 responses showed many similarities between whathad been identified as the tutors’ expected needs and their actualneeds. Areas highlighted as important included providing feedbackeffectively, facilitating online, delivering small group work sessions,developing study skills in learners, general information on aimsand objectives of the programme and details of students’ educa-tional backgrounds. Seventy-seven percent of tutors responded withwillingness to undertake formal education for their skills develop-ment, preferably as an online course.Discussion and Conclusions: Based on the results of the survey, apilot website will be developed containing programme specificinformation and teaching and learning resources related to theareas prioritised by the teaching teams and their tutors. Sixty-onepercent of the respondents to the needs assessment have agreed tobe involved in further consultations about the project. The longterm plan will be to develop specific teaching modules to make anaccredited programme. It is anticipated that we will report thefindings from the pilot project in the poster at the ASMEConference in July.



GPs’ Confidence in Diagnosing and Managing EyeDisease: A Cross-Sectional Questionnaire Study inLondonS Nageshwaran, V Nageshwaran, S Nageshwaran, I Khan

S Nageshwaran, Camden, UK

Introduction: Around ninety percent of General Practitioners(GPs) have only received undergraduate ophthalmology experi-ence and its inadequacy has been long established. NHS reformspressing for cost saving practices from physicians have put animportant emphasis on reducing inadequate referral to secondarycare. Ophthalmology represents a small proportion of presenta-tions to primary care, but accounts for a considerably large numberof referrals. Studies to assess GPs’ confidence with eye presenta-tions and the influence of this on their referral behaviour arelacking.Methods: A questionnaire of GPs working in London (n = 29)assessed self-rated confidence in diagnosing (Dx) and managing(Mx) 14 common conditions under the headings: ‘lid problems,’‘red eye,’ ‘sudden loss of vision’ and ‘gradual loss of vision’(GLOV) using a Likert scale (1-not confident to 5- very confident).Referral behaviour was also assessed for each condition in allparticipants. Access to and confidence in using basic ophthalmo-logical assessment tools, training information and opinions ontraining were also sought.Results: GPs were most confident with ‘red eye’ [Mean score:Dx = 4.1 (2–5), Mx = 4 (2–5)]. Least confidence was shown with‘GLOV’ presentations [Mean Dx: 3.1 (1–5), Mx: 3.1 (1–5)].Thirty-two percent of GPs with Snellen charts (n = 27) and 43%of GPs with ophthalmoscopes (n = 28) were not confident usingthem. Emergency and urgent referrals were seen to be morefrequent for those conditions clinicians were less confidentdiagnosing. The difference in overall mean confidence scores fordiagnosing eye conditions between those with (n = 2) andwithout (n = 27) postgraduate experience was of borderlinesignificance (P = 0.1). Thirty-eight percent felt they were lessconfident with ophthalmology than other specialties, 66% statedthat ophthalmology required a high level of technical expertiseand 66% had received < 4 weeks of training as an undergraduate(n = 29).Conclusion: The data suggests that most GPs have brief experiencein Ophthalmology as an undergraduate, may not be confidentmaking basic Ophthalmological investigations and consequentlyexhibit low levels of confidence in diagnosing certain treatablecauses of blindness. Our data also suggests that postgraduateexperience may not affect GPs’ confidence in eye presentations.There seems to be a clear lack of high quality training in thisspecialty for prospective GPs.

Educator Appraisal in the North Western DeaneryS Bishop, D Ahearn, S Agius, A Jones

S Bishop, Department of Anaesthesia, University Hospital South,Manchester, Wythenshawe Hospital, Manchester, UK

Background and Purpose: All hospital consultants are required tohave an annual appraisal, conducted by their NHS employer. Theappraisal should encompass all aspects of their role, including anyeducational elements. As the vast majority of consultants areengaged to varying degrees in medical education, as trainers,supervisors or managers, it is expected that their educator roleshould be appraised in some way. Deaneries must have structuresand processes to support and develop trainers.1,2 A survey was

designed to gather information on educator appraisal within thedeanery.Methodology: A survey of all hospital consultants in the NorthWestern Deanery (NWD) was conducted to obtain data oneducator appraisal. This online survey was conducted via aself-completion questionnaire, and data collected in a secure,anonymous way. The questionnaire was designed to collect bothquantitative and qualitative data. Data was analysed to providedescriptive statistics to summarise the main features of the dataset.Results: There was a response rate of 20.1%. Only 17.7% had beenappraised for their educator role, yet 91% of those who had nothad educational appraisal had received a NHS employer appraisal.Roughly half of educational appraisals occurred during NHSEmployer appraisal, predominantly by Clinical Directors. Of thosehaving an appraisal of their educational role, most had not usedthe appraisal guidance or documentation recommended by theNWD at that time. Of those that did almost all found it useful inhelping to decide what evidence to collect. 93.4% rated theirappraisal as moderately valuable or higher with 84.2% receivingconstructive feedback to develop suitable goals. Three-quarters ofappraisees felt reassured they were fulfilling their educational role.Similar numbers felt the process had helped them identify personaland trust/specialty educational development plans. Some apprais-ers may warrant guidance on accurately conveying appraisaloutcomes.Discussions and Conclusions: Formal appraisal of the educatorrole appears to be a valued and key component of educatordevelopment. Uptake has previously been suboptimal. The NWDhas now developed a simplified and specific appraisal frameworkwww.nwpgmd.nhs.uk/edudev/edroles.html, together with work-shops for lead educators to support development of educationalappraisal within Trusts and Schools. The uptake is being monitoredthrough the NWD quality management process.References:1. General Medical Council. Standards for Deaneries. April 2010.2. General Medical Council. Generic standards for specialityincluding GP training. April 2010.

Development of an Interactive Suturing SkillsResourceA Baker, F Grant, R Keenan, J Mann, A Renwick, M Vella, J Ker

A Baker, Clinical Skills Managed Educational Network, Universityof Dundee, Ninewells Hospital, Dundee, UK

Background: A key concept in the development of a Clinical SkillsProgramme is to create practitioners with skills appropriate to thehealth needs of the population, rather than the needs of thepractitioner or the health care system. The concept of shared fieldsof practice, of which suturing is an example, requires collaborationand equity among health professionals. This ensures that theimpact of change is for the benefit of the patient.One of the main criteria for the development of a suturingresource was that it would be relevant to all health care practitio-ners who have a requirement to carry out this skill as part of theircare of patients in either a secondary or primary care setting.Methodology: An interactive online resource was developed toenable health care practitioners to enhance their knowledge, skillsand competence in suturing skills.A standard development process ensures that resources areevidence-based and quality assured. An initial literature review wasconducted and content was developed using an iterative process.Review of the resource was by an expert panel. The resource was



also developed with representation from the relevant professionalgroups from different geographic locations within Scotland. Thismaximises transferability and eases implementation of the skill.Results: The theoretical online resource is interactive and theo-retical knowledge is assessed. The resource is also complementedby a series of workshops followed by a period of supervised practicewithin the workplace.Conclusions: A social constructivist approach to learning is usedwhich builds on theoretical and simulated practice and assessment,to enable supervised practice in the workplace.This multi-professional clinical skills resource aims to establish astandardised training for learning suturing skills for medical,nursing and relevant allied health care professions.

How Useful is Peer Led Education within theUndergraduate Medical Programme? A QualitativeStudy into the Learning Experiences of SecondYear Medical Undergraduates in a SingleInstitutionB Cole, J Dalgleish, B Parsons, I Colville, S J Atkinson

B Cole, Bristol University, Centre for Medical Education, Bristol,UK

Background/Purpose: Tomorrow’s Doctors1 emphasises the needfor teaching skills in medical graduates. Numerous studies haveshown peer led education to be a vital tool for the development ofthese skills. One such study2 identifies how peer led educationdevelops teaching skills in medical students. It stipulates that peerled education allows students to gain a better understanding ofteaching techniques, allowing them to become more effectivelearners, enhancing communication skills and improving theirability to interact with medical professionals and patients. Thisqualitative study evaluates the expectations and experiences ofmedical students undertaking the Student Selected Component:Peer Led Sex Education (PLSE) in the context of future benefits totheir career.Methodology: Data was collected from 19 Y2 University of Bristolmedical undergraduates studying PLSE. Common pre-course goalswere identified using data from initial expectations forms whichoutlined what students wished to gain from the programme. Post-course data was provided by reflective accounts of student learningthroughout the course. Through evaluation of these accounts weidentified common themes relating to the teaching and other skillsgained. These were then compared to the initial expectations,identified at the commencement of the course and conclusionswere drawn regarding the effectiveness of peer led education indeveloping students’ teaching skills, as well as what other perceivedbenefits students had gained.Results: Previous studies might lead us to expect benefits to thestudents beyond an immediate improvement in their skills asteachers.3,4 We expect to complete our analysis in the comingmonth. Based on previous studies,5,6 we anticipate that studentsmight feel more confident to discuss sensitive issues with peers, askill of importance in their future careers when dealing withpatients. We might also find that students perceive learning insmall groups to be more effective than conventional lecture-basedteaching. Due to the peer led nature of the course, students mayfind that they are able to learn more effectively as they understoodthe bases of teaching methods being employed and how to adapttheir learning to gain the most from them. Similarly, by under-standing optimal conditions for learning, they may be able to adopt

the most appropriate teaching methods to convey informationmost effectively.Conclusion We aim to report whether peer led education inmedical undergraduate study allows students to develop theirperceived teaching skills, meeting the guidelines in Tomorrow’sDoctors, as well as what additional benefits to intra and interpersonal skills have accrued.References:1. General Medical Council. Tomorrow’s Doctors. London: GeneralMedical Council, 2009.2. Dandavino M, Snell L, Wiseman J. Why medical students shouldLearn How to Teach. Medical Teacher 29(6):558–565.3. Knight AM, Carrese JA, Wright SM. Qualitative assessment of thelong-term impact of a faculty development programme in teachingskills. Medical Education 2007;41:592–600.4. Knight AM, Cole KA, Kern DE, Barker LR, Kolodner K,Wright SM. Long-term followup of a longitudinal faculty devel-opment program in teaching skills. J Gen Intern Med 2005;20:721–725.5. Busari JO, Scherpbier AJ. Why residents should teach: Aliterature review. J Postgrad Med 2004;50:205–210.6. Cate OT, Durning S. Peer teaching in medical education: twelvereasons to move from theory to practice. Medical Teacher 2007; 29:591–599.

Student Support

Effects of Pregnancy and Parenthood on StudyingMedicineK Khadjooi, P Scott, L Jones

K Khadjooi, Hull York Medical School, York, UK

Background: Medical training is demanding and medical stu-dents are faced with numerous course-related stressors such asrole overload, numerous assessments, placements, financial dif-ficulties and career choices. This psychological morbidity canpotentially be exacerbated by responsibilities for a child.The impact of pregnancy and parenthood on progression andmatriculation of medical students has not been adequatelyaddressed and the purpose of our study was to explore thisimpact.Methodology: Using self-completion questionnaires, we conducteda study of medical students and newly qualified doctors (FY1) froma UK medical school to assess the impact of pregnancy andparenthood on studying medicine and explore students’ opinions,choices and attitudes.Results: Total participants were 174 with age range 18–44. Table 1shows the demographics. 77.6% of respondents believe that thedecision to have a child is influenced by studying medicine. Twenty-three percent have delayed becoming a parent and 7.5% havechosen not to have children because of medical training. The mostcommon factors considered as a barrier for a parent/pregnantmedical student are:

1. Lack of time2. Financial difficulty3. Stressful, demanding and lengthy nature of the course4. Difficulty striking a balance between academic and social life

Among other factors, career progression, dispersed geographicalnature of the course, childcare and welfare of child, lack of peersupport and fear of discrimination in job applications andinterviews are notable. Female students feel particularly under



pressure by the burden of raising a family and many feel that takingtime out may jeopardise their career and they have to choosebetween career and parenthood. Only 9.2% of respondents areaware of support systems available for pregnant/parent students. Inour students’ opinion, studying medicine has implications on otheraspects of their life: decision to marry, choice of partner andnumber of children they plan to have.Discussion: The impact of pregnancy and parenthood on studyingmedicine is undoubtedly significant and considering more andmore mature and second career students are enrolling in medicine,medical schools will be dealing with this issue on a grander scale.To ensure full and successful participation of parent/pregnantstudents in learning, additional or specialised support should beprovided, including:

1. Flexibility in programs and placements2. Faculty support3. Specific psychological and academic counselling services4. Sufficient and affordable childcare facilities5. Providing information about available support systems and

financial entitlements for parent students (e.g. childcarefunding).

References:1. Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH,Tomenson B. Embarking upon a medical career: psychologicalmorbidity in first year medical students. Med Educ 1995;29:337–41.2. Firth J. Levels and sources of stress in medical students. BMJ1986;292:1177–80.3. Malik S. Students, tutors and relationship: the ingredients of asuccessful student support scheme. Med Educ 2000;34:635–641.4. www.nus.org.uk. Meet the Parents: The experience of studentswith children in further and higher education. National Union ofStudents, 2009.

5. Keller K, Jones W, Hoover K. Executive Summary: NursingEducation Barriers Identification Survey. Office of Nursing Work-force, Mississippi, 2003.6. Arhin AO, Cormier E. Factors influencing decision-makingregarding contraception and pregnancy among nursing students.Nurse Education Today 2008; 28/2:210–7.7. Cujec B, Oancia T, Bohm C, Johnson. Career and parentingsatisfaction among medical students, residents and physicianteachers at a Canadian medical school. Canadian Medical AssociationJournal 2000; 162(5):637–40.8. Kelner M, Rosenthal C. Postgraduate medical training, stress,and marriage. Canadian Journal of Psychiatry 1986, 311:22–4.9. www.bma.org.uk. Medicine in the 21st century – Standards forthe delivery of undergraduate medical education. British MedicalAssociation, 2005.

Teaching about Specific Subjects

Ophthalmology Teaching in Medical SchoolsL Jawaheer, R Dwivedi, K Hiew, J Hu, D Kirkham, R Moylan,T Quin, B Silver, C Sobajo, K Stanier, S S J Tiew, P Baker

L Jawaheer, Royal Bolton Hospital, Bolton, UK

Background: The place of specialty subjects within the under-graduate medical curriculum isn’t easy to define and teaching ofthese subjects varies widely from university to university. It isdifficult to be sure of the effect of the amount and type of specialtyteaching in medical schools.Purpose: This project gives some insight into the teaching ofophthalmology at undergraduate level. It looks at factors thatfavorably influenced levels of confidence in ophthalmicknowledge among students as well as student perception ofteaching.Methods: Questionnaires were distributed in 11 hospitals in theNorth West deanery among Foundation doctors during the firstrotation of their foundation track. Two hundred and forty-sixcompleted questionnaires were obtained.Results: 31.6% of the respondents had been taught for at least5 days (recommended time according to International Council ofOphthalmology guidelines1). Ophthalmic teaching was mainlydelivered via lectures (76.0%) and in a clinical setting (69.5%).Factors that significantly increased levels of confidence inophthalmic knowledge were: (1) being taught for recommendedtime or longer; (2) being taught in a clinical setting, i.e. by aconsultant ophthalmologist or a GP; and (3) having done aspecial study module in ophthalmology. 28.1% of the respondentsthought that the ophthalmic education they had received inmedical school was adequate to prepare them for their job as afoundation doctors. Student perception of ophthalmic teachingimproved with longer teaching time – 12.7% (n = 20) of thosewho had been taught for less than recommended time foundophthalmic teaching adequate, while 66.7% (n = 48) of those whohad been taught at least for recommended time found teachingadequate.Conclusions: The results show that the students having receivedmore teaching in ophthalmology were more confident in theirophthalmic knowledge, and were more likely to have found theteaching to be adequate. Unfortunately, the amount of ophthalmicteaching in medical schools was below international recommen-dations in more than two-thirds of the cases. Clinical exposure to

Sex Male 24.7%

%2.47elameF

Unanswered 1.1%

Year of study Year 1 17.8%

%8.712raeY

Year 3 20.7%

Year 4 19%

Year 5 17.2%

Newly Qualified 5.8%

Unanswered 1.7%

Current marital status Single 74.1%

%5.7deirraM

Living withpartner

16.1%

Separated 0

Divorced 0.6%

Unanswered 1.7%

Pregnant or parent students (either thestudent or the partner)

6.9%

Currently havechildren

Pregnant duringstudy

7.5%

21.3%Planning tohave children inthe near future

Figure 1: Demographics of study participants.



ophthalmology seems to increase confidence in ophthalmicknowledge. Nearly 3-quarters of the respondents thought that theteaching they had received was inadequate to prepare them fortheir foundation jobs.Reference:Principles and Guidelines of a Curriculum for OphthalmicEducation of Medical Students. Klinische Monatsblatter fur Augenh-eilkunde (‘Clinical Journal of Ophthalmology’) Nov 2006; 23(Suppl):S1–S19.

Medical Students’ Feedback on a ComprehensiveTeaching Schedule Offered in Geriatric MedicineI Natarajan, L Varadhan, K Mccarron

I Natarajan, University Hospital of Staffordshire, Stroke TeamsOffices, Royal Infirmary, Hartshill, Stoke on Trent, UK

Background: Geriatric medicine is generally taught integratedwith other clinical medicine rotations in medical schools. With anincreasing number of geriatric patients in any clinical setting, it isimportant to offer structured, specialty specific teaching which istailored to meet student needs and various learning styles. Theaim of our study was to assess the satisfaction levels of adedicated teaching schedule for medical students in geriatricmedicine.Sampling Methods: One hundred and thirty-two medical studentswere posted in geriatric medicine in 6 blocks of 4 week each, with 5sessions per week to be spent in the department. Students spendthe other 5 sessions at the university. The teaching within thedepartment was re-organized to meet the increasing learning needsof the students. A consultant-based teaching schedule wasorganized to offer 4 dedicated teaching sessions per week. Threedifferent types of teaching sessions were offered: dedicated bed-side teaching, seminars and small group teaching. Students rotatedthrough 3 different clinical environments were used: acute strokeunit, geriatric ward and community hospital. Three themes werecovered: stroke, falls and confusion assessment. Students filled inan anonymous intradepartmental questionnaire at the end of theblock, grading the general organization and the individual types ofteaching sessions, on a scale of 1–5. The students also filled in aformal feedback form for the university, which does not form a partof this assessment.Results: Eighty-eight feedback forms (67%) were received at theend of the academic year. The overall satisfaction scores were

1. General organization: 4.0/5.2. Bed side teaching: 4.2/5.3. Seminars: 3.9/5.4. Small group teaching: 4.2/5.

5. 86% (‡ 4) highly satisfied with the design of teachingprogramme.

6. 80% (‡ 4) highly satisfied with the role of the tutors.7. Very low satisfaction scores (£ 2) seen only in 2% each for

generic planning and seminars; 1% each for small group andbed-side teaching.

Conclusion: A dedicated and sufficiently long period of attach-ment to geriatric medicine, with a structured and dedicatedteaching schedule offered by experts in the specialty is met withhigh satisfaction rates from the medical students. It also shows thatan effective and satisfactory teaching schedule could be providedamidst busy clinical environment.

Awareness of Radiation Doses for CommonDiagnostic Radiological Procedures amongst Fifth-Year Medical StudentsR Soobrah, R F K Ng, J Pitkin, R Lingam

R Soobrah, Undergraduate Department, Northwick Park Hospital,Harrow, UK

Introduction: There has been a steady increase in diagnosticimaging studies, particularly computed tomography (CT), in alldeveloped countries. Statistics from the UK indicate a 12-foldincrease in CT usage over the past 2 decades1. It is generallyacknowledged that radiation from these tests involves some risk ofcancer 2 . Many studies have raised concerns about the limitedawareness of these risks among medical students and referringdoctors3,4.Methods: Between 2008 and 2009, ninety fifth year medicalstudents were given an 8-item multiple choice questionnaire priorto their radiology tutorials; the questions were designed tospecifically test their actual knowledge of radiation doses. The aimof this study was to assess the students’ awareness of relativeradiation exposures associated with common diagnostic imagingprocedures including abdominal radiographs, intravenous uro-grams, ventilation/perfusion scans and CT scans (chest, abdomen,head, urinary tract).Results: Only 31.5% (227/720) of the total questions werecorrectly answered. 44.4% (320/720) underestimated the radiationdose of all tests listed above. Detailed analysis of CT-specificquestions also shows significant underestimate of radiation doses(abdomen 93.3%, chest 73.3%, urinary tract 41.1%, head 10%).Only 22.7% of CT-specific questions were correctly answered. Themost correctly answered question was the radiation dose equivalentof an abdominal radiograph (79%). None of the students were100% correct on all 8 questions.Conclusion: This study shows a lack awareness of ionising radiationfrom diagnostic imaging among senior medical students. As futuremedical professionals, it is imperative that they are familiar withradiation doses associated with commonly requested radiologicialinvestigations. These shortcomings in medical students’ knowledgeregarding important aspects of radiation protection should beconsidered when developing the undergraduate medical curricu-lum and highlight the need for improved education.References:1. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br JRadiol 2008; 81(965):362–78.2. Berrington de Gonzalez A, Darby S. Risk of cancer fromdiagnostic X-rays: estimates for the UK and 14 other countries.Lancet 2004; 363:345–51.3. Soye JA, Paterson A. A survey of awareness of radiation doseamong health professionals in Northern Ireland. Br J Radiol 2008;81969:725–9.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

% A

nsw

ered

Time constraints

Financial Studying Social Other factors

Barriers or difficulties a parent/pregnant medical student may face

Figure 2.



4. Zhou GZ, Wong DD, Nguyen LK, Mendelson RM. Student andintern awareness of ionising radiation exposure from commondiagnostic imaging procedures. J Med Imaging Radiat Oncol 2010;54(1):17–23.

Impact of a Well-Designed Work ExperienceProgramme for Budding Medical StudentsR Soobrah, C Ashwin, A Patel, S Gupta, A Jethwa, J Pitkin

R Soobrah, Undergraduate Department, Northwick Park Hospital,Harrow, UK

Introduction: Gaining work experience is an essential part ofdeciding to become a doctor and it has the potential for motivatingstudents and enhancing their self-esteem1. All medical schoolsexpect applicants to have undertaken some health or social care workexperience, thus making it one of the most sought after attachment.Our aim was to evaluate the learning experience of students whoattended a clinical work placement at a busy district general hospital.Methods: Between 2009 and 2010, sixty AS-level students (2batches) completed a 1 week attachment at our hospital. Duringthat period they attended lectures, visited various departments andparticipated in skills-laboratory sessions. While shadowing juniordoctors and nurses, they witnessed their daily work routines andgained insight into the nature of these jobs. Sessions with otherhealthcare professionals were also organised. Students’ feedbackwas collected through post-attachment questionnaires.Results: The majority of students (97%) evaluated their learningexperience as being ‘enjoyable’ and believed this attachment hadstrengthened their motivation to apply for a medical degree course.Ninety-seven percent had a good understanding of how a hospitalgenerally functions. The main reasons for studying medicine werelisted as follows – helping people (26.7%), personal/job satisfac-tion (21.7%), scientific interest (23.3%) and challenging career(23.3%). The second batch of students (n = 25) were asked moredetailed questions. Fifty-six percent (n = 14) had done a previousclinical work experience placement. All students understood theroles and responsibilities of junior doctors and the multidisciplin-ary approach in patient care. Having completed the attachment,they all said they would recommend it to their peers.Conclusion Despite the changing financial remunerations associ-ated with medical practice, students’ passion for this subject isundiminished. Interestingly, none of our respondents indicatedtheir future earning potential influenced their decision to studymedicine. An estimated 8% to 10% of medical students drop out ofuniversity2. Hence, the importance for AS-level students to attendsuch clinical placements to ensure that they fully comprehend thework environment and demands encountered in a medical career.References:1. Pearce SJ. Raising aspirations for medicine and other health

care science careers – a role for the Trust. Darlington and CountyDurham Medical Journal 2007; 1(2):45–53.

2. Hughes P. Can we improve on how we select medical students?J R Soc Med 2002;95:18–22.

An Educational Multimedia Teaching Tool on ‘TheChild Presenting with a ‘Turned Eye’M Sikuade, C Williams, G Woodruff, C O’Callaghan

M Sikuade, Department of Medical and Social care Education,University of Leicester, Leicester, UK

Background: Squint is a common condition affecting about 5% of5 year olds1. Early detection and treatment is important to prevent

permanent vision loss. The International Council of Ophthalmol-ogy recommends that medical students are familiar with thiscondition and are competent in assessing a child for squint2.Increasing demand on undergraduate medical education hasresulted in reduced exposure to certain specialities, includingophthalmology3. The use of computer based learning has gainedincreasing use in medical education and has shown good results indelivering core teaching to students4.Aim: To create a teaching video on which explains the principlesof squint, how to assess a child for a squint and treatment optionsavailable.Target Audience: This video is aimed at medical students, foun-dation year doctors, general practitioners, paediatricians and alliedhealthcare professionals.Objectives: At the end of the module, users of this teaching toolshould be able to:

1. Define the term Squint.2. Use appropriate terminology to describe squint.3. Describe binocular vision and understand how a squint may

lead to Amblyopia.4. Describe how to test for a squint in a young child including.5. Discuss the treatment options available for squint.

Methods: Video footage and still images demonstrating variousaspects of squints were obtained from patients attending theoutpatient clinic. Informed consent was sought prior to filming.Illustrations and graphics were used to demonstrate importantconcepts.Outcome: A teaching tool that will equip medical students andnon-ophthalmology specialist with the knowledge and under-standing of squint.References:1. Guidelines for the management of strabismus and amblyopia inchildhood. Royal college of Ophthalmologists Guidelines, February2000.2. Parrish R.K., Tso M.O.M. Principles and guidelines of acurriculum for ophthalmology education of medical students. KilmMonatsbl Augenheilkd 2006; 223(Suppl 5): S3–S19.3. Quillen D.A., Harper R.A., Haik B.G. Medical student educationin ophthalmology: Crisis and opportunity, 2005. Ophthalmology2005; 112(11): 1867–1868.4. Devitt P., Smith J.R., Palmer E. Imporved student learning inophthalmology with computer-aided instruction. Eye 2001; 15(5):635–639.

A Theoretical Underpinning for Measurement ofProfessional Culture in Healthcare TrainingInstitutionsM Chandratilake, S McAleer, J Gibson

M Chandratilake, Centre for Medical Education, University ofDundee, Tay Park House, Dundee, UK

Background and Purpose: The importance of teaching profes-sionalism explicitly in health professional education has beenrepeatedly emphasised.1 As a result, it is now recognised as a well-defined educational outcome by several healthcare trainingprogrammes2,3 and formally delivered in many pedagogical pro-grammes using a range of instructional methods.4,5 The extent towhich professionalism can also be learned informally,6 however,should not be underestimated as: social environment has a largeinfluence on individuals’ learning7; hidden curriculum plays animportant role in fostering professionalism8; and professionalculture affects student motivation for learning9 and individuals’professionalism.10 We attempted to identify a theoretical basis for



understanding and measuring professional culture prevailing ininstitutions training healthcare professions.Methodology: A literature review was conducted for the followingpurposes: to define the term ‘professional culture’ in relation tohealthcare professions education and to identify its characteristics;to evaluate educational and sociological theories as the theoreticalbasis for understanding professional culture; and to propose amethodology to measure professional culture.Results: Professional culture of an institution is the cumulativebehaviours of its inhabitants which result from their attitudes,values, norms and social pressures. The Theory of ReasonedAction11 and the Theory of Planned Behaviour12 seemed to berelevant to describe ‘professional cultures’. However, Theory ofPlanned Behaviour (TPB), which establishes the relationshipbetween individuals’ attitudes, intentions, social norms, andcapacity to operationalise desired behaviours, was found to be themore appropriate of the two. Researchers have used both quali-tative and quantitative methods in studying health-related behav-iours based on TPB. They have used qualitative approaches (e.g.direct observation) to establish the relationship between the‘culture’ and its potential outcomes (e.g. medical errors occurwhen there is an abusive culture in ward setting), and quantitativeapproaches (e.g. survey) to describe a particular culture (e.g. abuseof juniors).Discussion and Conclusions: According to social learning theoryand research on the hidden curriculum, not only what is deliveredformally in educational programmes but also what is transmittedfrom the professional culture of the institution play vital roles infostering professionalism among healthcare students. The Theoryof Planned Bahaviour can be used as a theoretical basis forunderstanding, explaining and measuring the professional cultureof institutions training healthcare professionals. Based on the TPB,measurement instruments can be developed either to describeprevailing professional cultures in targeted institutions or topredict possible outcomes of such cultures.References:1. General Medical Council. Tomorrow’s doctors. General MedicalCouncil London 2009; 25–29.2. University of Dundee School of Medicine. Dundee MedicalSchool course information. University of Dundee, 2008; 12. GoldieJ. Integrating professionalism teaching into undergraduate medicaleducation in the UK setting. Medical Teacher 2008;30:513–527.3. Cruess RL, Cruess S. Teaching professionalism: general princi-ples. Medical Teacher 2006;28:205–208.4. Paice E, Heard S, Moss F. How important are role models inmaking good doctors. British Medical Journal 2002;325:707–710.5. Hafferty FW. Confronting medicine’s hidden curriculum Aca-demic Medicine 1998;73:403–407.6. Bandura A. Social Learning Theory. New York General LearningPress; 1977.7. Hafferty FW, Franks R. The hidden curriculum, ethics teachingand the structure of medical education. Academic Medicine1994;69:861–871.8. Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationships betweenmedical student burnout, empathy, and professionalism climate.Acad Med 2010;85:S33–36.9. Moyer CA, Arnold L, Quaintance J, et al. What factors create ahumanistic doctor? A nationwide survey of fourth-year medicalstudents. Acad Med 2010;85:1800–1807.10. Sheppard BH, Hartwick J, Warshaw PR. The theory of reasonedaction: a meta-analysis of past research with recommendations formodifications and future research Journal of Consumer Research1988;15:325–343.11. Ajzen I. The theory of planned behaviour. OrganisationalBehaviour and Human Decision Processes 1991;50:179–211.

Teaching and Learning

Role Play-Engaging the ParticipantsP Lockwood, S Law

P Lockwood, UCME, MacKenzie Building, Kirsty Semple Way,Dundee, UK

Background: Role play can be a useful method to help tutorsdevelop practical skills such as giving feedback. One of thechallenges, when using this form of teaching, is to prevent theparticipants from feeling threatened and disengaging with thelearning opportunity. Evidence suggests that when role play is usedwell the outcomes are positive but it is often poorly done.Aims of the Poster: To describe a method of using a role playwhich provides an environment that encourages learners to takepart. The poster also aims to present an evaluation of this method.What was done? A small group teaching method which used roleplay was developed. The participants are shown a DVD clip of adoctor consulting with a patient or a colleague. They were asked todevelop phrases which would provide feedback to the doctor. Thedoctor is then role played using an actor. The feedback phrases arecollated by the facilitator and discussed by the group. The openingfeedback statements that are to be given to the actor are chosen bythe group. The facilitator starts the role play process by deliveringthe feedback to the actor. Once the initial feedback comments havebeen delivered the facilitator asks the group for further guidance.The participants are then encouraged to take over the role playingprocess.Method for Evaluation: The participant evaluations from a similarlearning session in which the participants were asked to role playgiving feedback and the new session were compared. Bothevaluations were questionnaire based and requested to be handedin anonymously at the end of the session. The facilitators and actorwere also asked to give their evaluations of the learning session.Results of the Evaluation: A significant number of participantsfrom the control session had indicated that they did not like theuse of role play and in fact had not engaged in role play. Some ofthe facilitators had found that the participants rearranged thesession to take out role play. Each time the new session has beenrun the participants have reported the role play as an enhancementto the session. The facilitators found learners fully engaged with theprocess in the new session.Conclusion: Using a facilitator to start the role play process with anactor improves learner engagement and seems to reduce the threatof role play.

The Constipation GameN M Hamilton, A R Morrison, G T Linklater, J McDonald, A DLobban

N M Hamilton, Medical School, Polwarth Building, Foresterhill,Aberdeen, UK

This poster outlines the functionality of an e-Learning applicationaimed at undergraduate medical students.A 68 year old man with severe COPD is admitted with anexacerbation. He is breathless at rest and not able to mobilise. Hehas a PMHx of steroid induced osteoporosis with associated crushfractures of 2 thoracic vertebrae. HIS bowels last moved 2 days ago.The student is asked to choose a drug, or variety of drug



combinations, to administer on day one and upon each successiveday thereafter.The e-Learning application presents this information in the style ofa computer game including a sliding scoring system which reflectshow well the patient is progressing in terms of bowel movements.This Adobe FLASH application was constructed using ActionScriptv3.0.

Transition to University: The Role Played byEmotionW J McMillan

W J McMillan, Faculty of Dentistry, University of the Western Cape,South Africa

Background and Purpose: The transition from school to univer-sity1 and the shift in academic challenge2 is experienced by manynew university students as challenging. Non-traditional students areparticularly vulnerable in this transition3,4. Theoretical frameworkshave been offered to understand students’ experience of transition,including ‘resistance and persistence’5 and ‘habitus’6. Suggestionshave been made to support retention and throughput by improvinginstitutional culture,7 through facilitating teaching, curriculum andteacher development,8 and by supporting student learning.9 Mostrecently, theoretical insights from accounts of emotion and affectin transition to university3 and student engagement studies10

suggest the significance of an emotional dimension to learning,transition, throughput and retention.11 Understanding how stu-dents experience this transition allows institutions to put appro-priate support mechanisms in place. Understanding the role ofaffect in higher education success has the potential to informstudent support mechanisms that go beyond traditional interven-tions of academic development and curriculum innovation.Methodology: A qualitative approach was used to elicit the insideraccounts12 required for the study. From the first year dentistrystudents of 2010 at a single Faculty of Dentistry (n = 80) in SouthAfrica, 1 class of students (n = 20) was selected for inclusion in thestudy. Fifteen students (75%) consented to participate. Threefriendship- group focus group interviews (n = 7; n = 4; n = 4)probed students’ experiences of transition to university. A semi-structured interview protocol explored ‘coming to university’,‘being a student’, and ‘being a dentist’. Interviews were audio-recorded and transcribed. Issues identified in the literature assignificant to transition were used to analyse the interview data.Descriptive tags were assigned for these. This process allowed foreasy retrieval and collation of data associated with a specificdescriptive tag.Results: Twenty six descriptive tags were identified from the data.These were clustered into 5 themes: ‘outside support andconstraints’, ‘influences’, ‘career choice’, ‘academic challenges’,and ‘agency and identity’. Further analysis indicated that 16 of the26 tags, and tags from all 5 themes, were associated with the use ofemotive words.Discussion and Conclusions: This initial analysis indicates that, forthese students, there was a powerful emotional component to theirtransition to university. Students associated both the challengesthat they experienced and any available support structures throughthe lens of the affect. Further, the clustering of descriptive tagsclustered under the theme, ‘influences’, indicated that newstudents relied heavily on the emotional support of parents andfriends in their transition period. Findings suggest that mecha-nisms to support student transition need to engage with theinterface between academic support and development and thesocial and emotional components of learning.

References:1. Christie H, Munro M, Fisher T. Leaving university early:exploring the differences between continuing and non-continuingstudents. Studies in Higher Education 2004; 29(5):617–636.2. Smith K. School to university. An investigation into theexperience of first-year students of English at British universities.Arts and Humanities in Higher Education 2004;3:81–93.3. Christie H, Tett L, Cree VE., Hounsell, J. & McCune, V. ‘A realrollercoaster of confidence and emotions’: learning to be auniversity student. Studies in Higher Education 2008; 335:567–581.4. Wilcox P, Winn S, Fyvie-Gauld M. ‘It was nothing to do with theuniversity, it was just the people’: the role of social support in thefirst-year experience of higher education. Studies in Higher Education2005; 20(6):707–722.5. Tinto V. Leaving college: Rethinking the causes and cures ofstudent attrition research. Chicago: Chicago University Press, 1993.6. Bourdieu P, Wacquant L. An invitation to reflexive sociology.Chicago: Chicago University Press, 1992.7. Smedley BD, Butler AS, Bristow LR. In the nation’s compellinginterest. Ensuring diversity in the health-care workforce. Washing-ton, DC: Institute of Medicine of the National Academies, 2004.8. Haggis T. Pedagogies of diversity: retaining critical challengeamidst fears of ‘dumbing down’, Studies in Higher Education 2006;31(5):521–535.8. Swail WS, Redd KE, Perna LW. Retaining minority students inhigher education. A framework for success. ASHE-ERIC HigherEducation report, 30(2). New Jersey: Wiley Periodicals, 2003.9. Krause K, Coates H. Students’ engagement in first-year university.Assessment & Evaluation in Higher Education 2008; 335:493–505.10. Christie H. Emotional journeys: young people and transitions touniversity. British Journal of Sociology of Education 2009; 30(2):123–136.11. Mason J. Qualitative researching. London: Sage, 2003.

The JASME Teaching Toolkit for Medical Students:Perspectives on Our Student Run Workshops andFuture DirectionsA Newton, L Wright, J Abraham, H Watson, H Fry, E Bate

A Newton, Intercalating Medical Student, Liverpool, UK

JASME (Junior Association for the Study of Medical Education)wholeheartedly believe that students should begin to gain teachingskills at undergraduate level, and developed a teaching coursedesigned for medical students. The course has been run in 3different permutations, and several more are currently beingorganised. By comparing the courses we sought to determine whichcomponents were key to the success of a student-run teachingcourse.Each course aimed to enhance students’ teaching skills, allow themto practise the skills, receive extensive feedback, and be inspired toteach in the future. They began with background teaching theory,followed by microteaching sessions, where students taught a skill toa small group of peers. They then received feedback from theirpeers and facilitator, with the opportunity to reteach in light of thefeedback. The pilot course ran in London in 2009, with 2 furthercourses in Cambridge and Leicester during 2010.Whilst the 3 courses had similar aims and core themes, there werealso key differences between them, namely, the course length,facilitator experience, amount of background theory, and types ofskills taught. London was a full-day teaching course with a morningof theory and afternoon of microteaching. Cambridge was a 2 hourworkshop, and Leicester a 4 hour component of another course.



Opinion from the London pilot course highlighted that the chanceto practise teaching and gain feedback were considered to be themost important components, and these have been predominantfeatures of the shorter courses. In our experience this should besupported by relevant and well contextualised teaching theory.London and Cambridge used expert facilitators with a backgroundin teaching and medical education; Leicester used senior medicalstudents. The depth and weight of feedback was perceived to bebetter when an expert-facilitator was present. However, much of thefeedback came from peers and the delegates found the studentperspective very valuable. Co-facilitation will be tried in futurecourses.The London course took nearly a year to develop, but subsequentcourses are becoming easier to organise. Formats are increasinglybeing shaped by extensive evaluation from students. JASME areworking with ASME to develop a network of students at eachmedical school to help future dissemination of the course, andother medical education events. It is possible for keen students toorganise a teaching course, providing they receive the appropriatesupport, plan well in advance, and persevere!

How Can the Consistency of the Feedback in theClinical Scenario be Improved When Delivering theacute Care Day Programme?C Gilhooly, P Evans

C Gilhooly, University of Glasgow, Glasgow Royal Infirmary,Glasgow, UK

Background and Purpose: The Acute Care Day programme(ACDP) provides key clinical, practical and communication skills tofinal year medical students (MB ChB 4/5) from the University ofGlasgow. Included in this programme are a series of clinicalscenarios where an actor simulates a patient with an acute illness.Appropriate clinical equipment is provided to simulate an acutecare setting. Two experienced medical tutors supervise a smallgroup of students managing the patient. The aim of this case studyis to identify the methods currently used to debrief students duringthe acute clinical scenario in the ACDP, to investigate the opinionsof the tutors on the most effective methods and triangulate thiswith that of the students.Methodology: A hypothesis generating retrospective cross sectionalpilot case study using electronic and paper-based surveys to obtainquantitative and qualitative data on tutors and students of theACDP. Tutors were contacted by email and asked to complete anon line electronic survey. The questionnaire identified whichfeedback techniques they used, training previously received, andelicited opinions on further training they might find useful. Awritten questionnaire was also circulated to 5th year MedicalStudents who had completed the Acute Care Day programme,during the last session as part of their feedback. The questionnaireidentified and evaluated different feedback techniques. StatisticalAnalysis examined differences between the groups, using Chisquared or Fisher’s exact test as appropriate. Free text from thequestionnaires was analysed using NVIVO coding and qualitativedata analysis techniques. Common themes were identified andexplored on debriefing techniques with potential to work in theACDP scenario.Results: The response rates for the questionnaires were 87%(n = 239) from students and 56% (n = 88) from tutors. Triangu-lation of results identified differences in perception between thetutors and the students in frequency of use of debriefing methods.Most students thought that debriefing after uninterrupted run-through of the whole scenario was best, followed by peer feedback

and reflective discussion. Thirty-nine percent of tutors had receivedno formal training in debriefing. Eighty-eight percent of tutorswere interested in participating in a faculty development pro-gramme. The opinions of students and tutors on effective feedbackwere explored and analysed. These included use of structuredfeedback techniques and identification of barriers to effectivefeedback.Discussion and Conclusions: There is a wide variety in the methodsand delivery of debriefing in the ACD clinical scenario. Tutors inthe ACD have identified an unmet training need and have raisedseveral issues that can be used in developing a training programmeto improve the consistency of the feedback in the Acute Care DayProgramme.

Is Peer-Assisted Learning the Best Introduction toClinical Skills?R Varughese, S Montgomery-Taylor, A Mathew

R Varughese, Oxford University Medical School, Oxford, UK

Background and Purpose: The first 3 weeks of clinical training atOxford University Medical School are spent doing a peer-assistedlearning course ‘MedEd’. First year clinical students are taught insmall groups by final year students to carry out history taking,clinical examination and practical procedural skills. A combinationof bedside teaching and tutorials are used in order to preparestudents for subsequent short placements on wards; where they areassessed by doctors and nurses.Methodology: All 133 first year clinical students who took part inMedEd were asked to participate in a questionnaire survey, toascertain whether they found the teaching prepared them well forbeing on the wards and if the feedback they received on their skillswas positive. Responses were presented on a 6-point Likert scaleand free text comments were invited.Results: Seventy-six percent of the year group responded (102/133). Seventy percent of students rated their confidence on thewards highly (5/6; 6/6) after MedEd teaching as compared to 87%rating their confidence levels poorly (1/6; 2/6) before MedEdteaching. Ninety percent students rated the feedback from doctorson their clinical skills as positive (4/6; 5/6;6/6). Importantly, 98%of students determined that students were better teachers thandoctors for preliminary clinical teaching. Comments from studentsestablished that the course was pitched at the right level for theirstage in training both in terms of information imparted and thenecessary skills required for future assessment. However, they alsohighlighted the necessity for regular practice of the skills, afterestablishing familiarity with them. Interruption with a lecturecourse, made resuming ward skills a daunting experience. Asuggestion would be to organise a brief, intensive refresher courseto remedy this.Conclusions: Overall, this survey highlights the value of utilisingthe first hand experience and knowledge from practised studentsin order to develop the skills of clinically inexperienced peers.Peer teaching is vital in developing the confidence of first-yearclinical students on the wards. The use of students as teachersfacilitates the imparting of relevant core knowledge to theirjuniors, while providing an environment conducive to question-ing and reassurance. Moreover this is a mutually beneficialsystem as it also provides revision opportunities for final yearstudents.Take-home message Peer-assisted learning is a successful intro-duction to clinical examination skills, after which continuity isessential in maintaining confident clinical practice.



Implementing a Bespoke VLE Using MoodleI J Robotham, A D Lobban, A R Morrison, D L Cheseldine,J McDonald, N M Hamilton

I J Robotham, Medi-CAL Unit, College of Life Sciences andMedicine, University of Aberdeen, Foresterhill, Aberdeen, UK

The Medi-CAL Unit started uploading lectures onto the web in1996. Since then, the VLE used by Medical Students at theUniversity of Aberdeen has gone through a variety of redesigns anda regular overhaul of the services that it provides. The advent ofsocial networking and greater availability of the internet means thatstudents now expect more from their online experience.This paper explores the experiences of developing a VLE andoutlines plans for future developments to support an ever growingvariety of end-user devices, including laptops, tablet computers andsmart phones.

An Assessment of Student Feedback to Find theValue of Bedside Teaching during the Child HealthBlockP Wilson, H Pascoe, E Carter

P Wilson, Leicester Medical School, Leicester, UK

Aims and Objectives: 1. To assess the usefulness of BedsideTeaching in the Child Health Block2. To compare Bedside Teaching to E-learning3. To obtain suggestions for improvement of the teachingprogramme.Introduction: It is well known that bedside teaching is an effectiveway to educate medical students,1 associated with very high levels oflearner satisfaction.2 However the quantity of bedside teaching inmedical courses has been declining and protected teaching time isconstantly under threat from other commitments of the teacher.3,4

Furthermore there can be discordance between learner andteacher expectations in terms of what teaching should be deliveredin clinical settings.5 In Leicester all students have protected bedsideteaching during the child health block receiving roughly 4 sessionsper week over the 7 week block. The study was carried out to assessthe usefulness of this teaching programme. Usefulness, satisfactionand quantity of bedside teaching were assessed as well as whetherstudents were observed taking histories, examining patients, and ifthey received immediate feedback on their performance. A directcomparison was made between bedside teaching and E-learning toascertain what students found the best learning method to masterkey competencies. The students were invited to make suggestionson what they found particularly valuable and what they thoughtcould be improved.Method: A questionnaire about bedside teaching in the ChildHealth block was completed by final year medical students, n = 58.The questionnaire provided both quantitative and qualitative data.The data was analysed and the qualitative comments was groupedinto themes.Results: 1. The students overwhelmingly found the bedsideteaching programme useful and enjoyable.2. The amount of bedside teaching in the Child Health block wasappropriate.3. 94.8% of students were observed taking histories, 91.4% ofstudents were observed examining patients and 96.6% of studentsreceived direct feedback about their performance. Again, over-whelmingly the students found this useful.4. 77.6% of students preferred bedside teaching to other learningmethods.

5. Key suggestions for improvement were: better planning betweenteachers to avoid repetition of cases, smaller group sizes andteaching from junior doctors if the consultant had to cancel.Conclusions and Recommendations: 1. Bedside teaching in thechild health block is extremely valuable. It should be continuedand protected.2. Students prefer bedside teaching to E-learning3. Student feedback should be used to improve the teachingprogramme.References:1. Kroenke et al. Bedside Teaching. Southern Medical Journal 1997;90: 1069–1074.2. Williams K et al. Improving bedside teaching: Findings from afocus group of study learners. Academic Medicine 2008; 83: 257–264.3. Amer et al. Bedside Teaching in the Emergency Department.Academic Emergency Medicine 2006;13: 860–866.4. Peadon E et al. ‘I enjoy teaching but….’: Paediatricians’ attitudesto teaching medical students and junior doctors. Journal ofPaediatrics and Child Health 2010; 46: 647–652.5. Young L et al. Effective teaching and learning on thewards: easier said than done? Medical Education 2009;43:808–817.

Do Students Learn What We Want Them to Learn?S Sadasivam, N Kumar

S Sadasivam, Education Centre, University Hospital of NorthDurham, Durham, UK

Background and Purpose: Fibromyalgia is a chronic pain syn-drome associated with significant morbidity. Third year medicalstudents based at University Hospital of North Durham received ateaching session on fibromyalgia as part of their ‘chronic illness,disability and rehabilitation’ module. The focus of the session wason patient experience, patient education, addressing ideas con-cerns and expectations (ICE) and considering the biopsychosocialimpact of the condition. Medical aspects of fibromyalgia were alsocovered. The session was concluded with 2 take home points,Fibromyalgia is a real illness and distressing for patients. RememberICE and the biopsychosocial model.Methods: At the end of the teaching sessions, students were askedto fill in an evaluation questionnaire. Forty-five students were givena questionnaire with a 100% response rate. As part of thequestionnaire, free text boxes were provided to list 2 things theyhad learnt from the session. Simple framework analysis was used tocategorise these learning points. Learning points were also subdi-vided into medical model of disease or holistic.Results: The most popular learning point was treatment (recordedby 62%, 28 students) followed by symptoms (40%, 18 students) andpressure points (38%, 17 students). ‘Real illness’ was only recordedby 18% (8 students), ICE by 9% (4 students) and biopsychosocialmodel by 4% (2 students). Eighty-two percent of responses relatedto the medical model of disease whereas only 18% related to amore holistic view.Discussion and Conclusions: Despite the focus of the session andthe clearly expressed take home messages, the majority of studentsfocused on the medical aspects of the teaching session which wassurprising.Potential reasons for this are listed below: 1. Prior understandingof the patient experience from studying other chronic illnesses.2. May have felt the holistic view did not constitute ‘knowledge’ inthe same way as medical information.



3. Encouraged by the fact that there was diagnostic criteria andtreatment for this distressing condition which may have takenpriority over the take home messages.The evaluation exercise has provided an insight into the fact thatstudents are not necessarily taking home the intended messagesfrom the session.Future research should be designed to explore reasons whystudents recorded mostly medical learning points. This mightprovide insight into why there was a difference between intendedand reported learning.

Combining Expert and Peer Led Teaching: theFuture of Undergraduate Medical Education?L Wheeler, C Reddick

L Wheeler, Withington, Manchester, UK

Background: Tomorrow’s doctors (1993) prompted changes to thecurriculum in many UK medical schools, with a move towards self-directed learning (1). However, these changes have not addressedall of the gaps within the curricula and dermatology remains anoften overlooked specialty. The new ethos of self-directed learninghas resulted in a number of student led teaching schemes in orderto address these gaps.Methods: DermSoc Manchester was established to promoteawareness and education of skin disease using both expert andpeer-led teaching. It has organised 3 full day symposia, providingan introductory course in dermatology to 180 students. DermDayswere advertised to students in their clinical years via email, theintranet and a social networking site. Feedback forms were given toall delegates and they were asked to rate 3 aspects (presenting style,usefulness and overall mark) of each component of the symposiumon a 1–5 Likert scale, 1 being poor and 5 being excellent. A freetext comment box was also provided.Results: The feedback generated from the 134 completed formswas analysed by SPSS 18.0 and proved overwhelmingly positive.Across all 3 symposia a score of above 4 was awarded to every aspectof the lecture series and the interactive sessions as well as thecareers question and answer session. Scores for the lectures run bystudents and by clinicians received similar marks for presentingstyle, usefulness and as an overall mark. Patient sessions wereawarded the highest overall mark with an average score of 4.79 outof 5.Conclusions: The DermDay events have demonstrated the effec-tiveness of combined near-peer and expert teaching. Delegateswere as happy with peer led sessions as with expert led sessions,although successful peer-led teaching would be difficult withoutsupport from experts; highlighting the importance of a clinicalcocoon. There is little research in the educational literaturedemonstrating the benefits of this approach and our findingssuggest that further research is required to explore the potentialbenefits of such schemes. It is well established that peer learning isbeneficial for both teachers and learners as it provides a safeenvironment in which to learn (2). Patient interaction affordsmedical students the opportunity to increase one’s knowledge baseand improve crucial communication skills (3). The formulaic daysrun by DermSoc Manchester provide a template for other likeminded students wishing to deliver an introductory course indermatology, or any other medical specialty.References:1. General Medical Council – Tomorrow’s Doctors. Recommenda-tions on undergraduate medical education. 1993;7–12.

2. Bulte C, Betts A, Garner K, Durning S. Student teaching: views ofstudent near-peer teachers and learners. Med Teach 2007 Sep;29(6): 583–90.3. British Medical Association: Medical Education Subcommittee.Role of the patient in medical education. 2008; 2–3.

How a Peer-Led ‘Teaching How to Teach’ CourseCan Increase Medical Student Knowledge, Skillsand ConfidenceF Frame, S Hyde, M Player, A Hastings, A Newton

F Frame, University of Leicester Medical School, Maurice Leicester,UK

Introduction: GMC guidelines state that undergraduate medicalstudents must gain experience of teaching during the clinicalyears1. Many students at Leicester Medical School have demon-strated an interest in this area, and as a result Leicester MedicsAssociation of Teaching (LMAT) worked in collaboration with theJunior Association for the Study of Medical Education (JASME) torun a peer-led course. This was designed to teach, assess andreinforce the core knowledge, skills and attitudes needed to teachothers. The 1-day programme was based on an established JASMEeducation package and combined basic theories of teaching withpractical workshops. Students gained experience whilst receivingextensive feedback from peer tutors and learners throughout theday. Peer Assisted Learning (PAL) provides a range of potentialbenefits for both student groups2 and was therefore considered anideal approach for the course.Method: Students rated their pre- and post-day understanding ofthe core components of the course by completing a questionnaire.In addition, they reported their perceived confidence in relation tothese components and overall enjoyment of the day. Data collec-tion and analysis were based on an ordinal step-wise approach to aseries of Likert scale responses, directly identifying pre- and post-day attitudinal changes for each individual student as a result of theteaching received.Findings: The reported understanding of teaching techniquesincreased significantly during the course, with no deficits found.In addition, the majority of students showed an increase inperceived confidence in their ability to give a lecture, teach smallgroups and facilitate a clinical skills session – further replicatedin the workshops. Perceived confidence in utilising small groupteaching methods demonstrated the biggest attitudinal change.When asked, 83% of students indicated that the course wouldpositively change their future practice, with many highlightingthat it fuelled their motivation and enthusiasm for medicaleducation.Discussion and Conclusions: Our findings suggest that regardlessof initial understanding, a peer-led ‘teaching how to teach’ coursecan increase knowledge, skills and confidence in teaching others.Importantly it can provide a safe environment in which to learn andpractice skills whilst receiving individualised, specific feedback. Theliterature confirms this, suggesting PAL can offer a unique andvaluable exposure to teaching and learning for clinical practice –enhancing personal and professional development2. It is a powerfultool that is mutually beneficial to both peer tutors and learners.With adequate support it has a bright and promising future.References:1. General Medical Council. ‘Tomorrow’s Doctors: Recommenda-tions on Undergraduate Education’ London: GMC, 2002.2. Glynn, L.G., MacFarlane, A., Kelly, M., Cantillon, P & Murphy,A.W., 2006, ‘Helping each other to learn – a process evaluation ofpeer assisted learning’, BMC Medical Education 2006; 6:18.



Medical Professionalism Education and Students’PerceptionsV H Fialho Lopes, R Cruickshank, A H Laidlaw

V H Fialho Lopes, School of Medicine, University of St Andrews,St Andrews, Fife, UK

Background: Medical professionalism is an essential concept incurrent medical education, although it is not easily defined. Itunderpins the trust society has in doctors by comprising a set ofbehaviours, principles and responsibilities, which must be de-scribed and explicitly taught to medical students. The assumptionthat professional values and attitudes will be acquired uncon-sciously can no longer be made. The Bute Medical School (BMS)curriculum (a 3-year pre-clinical course) encompasses severalprofessionalism-promoting mechanisms, including role modelling,the Yellow Card Scheme, ePortfolio, reflective practice and theBute Medical Agreement.Methods: A questionnaire investigating medical students’ views onprofessionalism and on the educational mechanisms promoting itwas devised. All 430 students at the BMS were invited to participate,resulting in 334 responses (77.7% participation rate). Results wereinterpreted using Microsoft Excel and SPSS statistical software v.17.0.Results: The data shows that participants value medical profes-sionalism and consider it a priority at their undergraduate level.According to students’ responses, the most effective mechanism inpromoting professionalism is role modelling, whilst the YellowCard Scheme and ePortfolio reflection are deemed to be the leasteffective. However, if ePortfolio and professionalism were summa-tively assessed, students would consider them more important thanthey currently do.Conclusions: Students consider what is evaluated to be important;hence professionalism should not only be taught but alsoevaluated. Formal assessment of professional attitudes and behav-iours should be developed within medical school curricula. Thesemust not simply highlight unprofessional behaviour students mustavoid; more essentially they ought to promote excellence.

Defining Feedback from the Medical Student’sPerspective: Exploring Students’ Experiences atThree UK Medical SchoolsL M Urquhart, C E Rees, J S Ker

L M Urquhart, Institute of Health Skills & Education, College ofMedicine, Dentistry & Nursing, University of Dundee, Dundee, UK

Background and Purpose: In medical education, feedback hasbeen repeatedly shown to be an influential driver of learning. 1, 2

Students perceptions, however, are that they do not receivesufficient feedback3. A recent review4 of 132 articles on feedbackpostulated a consensus definition for feedback. However, alldefinitions were written by expert feedback givers. To ourknowledge, there have been no studies to date that have definedfeedback from the medical students’ perspective. Studies at bothundergraduate and postgraduate levels have shown that there arelarge disparities between what the tutor feels they have given andwhat the student feels they have received.5, 6 The current studyseeks to address this gap in the research literature by exploringmedical students’ experiences of feedback at 3 schools in theUK.Methods: We are currently conducting focus groups at 3 medicalschools in Scotland, asking students about their experiences offeedback to date. The focus groups will include students across all

5 years of the medical curriculum. The key topics that are beingdiscussed include students’ understandings and definitions offeedback, their experience of feedback to date, where they feelfeedback has been given well and badly, and what they do withfeedback. These focus groups are being audio-taped and a thematicframework analysis7 identifying how and what participants say willbe performed by the researchers.Results: The data collection for this study is ongoing. By the timeof the conference, the preliminary thematic analysis will becomplete. Although the themes themselves will be identifiedinductively from the data, it is likely that the presentation willinclude certain topics linked to the interview questions. Forexample: students’ understandings of feedback, their positive andnegative experiences of feedback and how those experiences haveimpacted on their subsequent learning. This data will be used notonly to redefine feedback but also to inform the second phase ofthe first author’s PhD study into feedback for medical students – avideo ethnography study of feedback in 2 settings (simulated andmedical workplace setting) in the UK.Discussion: This study will bring an authentic viewpoint aboutfeedback through students’ understandings and experiences offeedback at 3 diverse UK medical schools. In order to solve themuch talked about ‘feedback problem’ in medical schools, we mustfirst be able to define feedback from students’ perspectives. Thispresentation will discuss the implications of these results, therebyinforming future educational practice and future studies onfeedback for medical students.References:1 Norcini J. The power of feedback. Medical Education 2010;44:16–17.2 Veloski J et al. Systematic review of the literature on assessment,feedback and physician’s clinical performance. Medical Teacher2006; 28(2):117–28.3. National Student Survey. Http://unistats.direct.gov.uk.4. Van de Ridder J et al. What is feedback in clinical education?Medical Education 2008;42:189–197.5. Sender Liberman A et al. Surgery residents and attendingsurgeons have different perceptions of feedback. Medical Teacher2005; 27(5):470–2.6. McIlwrick J. ‘How am I doing?’ Many problems but few solutionsrelated to feedback delivery in undergraduate psychiatry education.Academic Psychiatry 2006; 30(2);130–135.7 Richie J and Spencer L. Qualitative data analysis for appliedpolicy research. In:. Bryman A and Burgess RG Ed. Analysingqualitative data. Routledge; 1994. Chapter.9.

Delivery and Evaluation of Blended LearningCourses in a Large Medical School in the UnitedKingdom: A Model for Uniform Delivery andEquitable AccessK Khan, K Gaunt, J Wilson, C Lumsden

K Khan, Manchester Medical School and Lancashire TeachingHospitals Foundation Trust, Preston Simulation Centre, RoyalPreston Hospital, Sharoe Green Lane, Preston, UK

Background and Purpose: Large medical schools are faced withchallenges to achieve and maintain a degree of standardisationin the content and delivery of educational courses. ManchesterMedical School has in excess of 450 medical students per yearplaced in 4 different clinical sectors across the Northwest ofEngland. A wide geographical distribution and more than 20hospital placements makes it difficult to deliver standardised,quality-assured teaching. Faced with this challenge we developed



a blended learning environment using a combination of e-learning modules and small-group facilitated sessions to achieveuniform delivery and equity of access. Blended learning has beenshown to be effective in promoting learner-centred highereducation1. We hosted the e-learning packages on our MedicalSchool e-learning environment to which both the students andtutors have access. The small groups consisted of 6–8 studentsand the students had 4 days to prepare for each topic in theirown time before the small-group facilitated session. We managedto deliver 4 tutorials in this format for 450 medical students in a16-week period. We present here the development, delivery andevaluation of the blended learning environment created at ourmedical school.Methodology: Feedback was collected using Medlea (ManchesterMedical Schools’ e-learning environment) from the tutors and thestudents on a voluntary basis. The data was exported to excel andqualitatively analysed using the thematic analysis technique by 2investigators. The key themes are presented in this poster.Results: All the teaching hospitals reported to us that the tutorialswere delivered uniformly across the sectors with a very highattendance rate. We received 13 tutor feedback responses and 56responses from students.Two main themes emerged from both students and tutors.1. They found blended learning to be more effective than e-learning or a small group discussion alone.2. They identified that the small group discussions worked moreeffectively when all involved had prepared adequately beforehand.Minor themes included the identification of this package as a toolto deliver a standardised learning experience. Students alsoidentified enhanced flexibility of the e-learning tool to be ofimportance for future development.Discussion and Conclusions: Blended learning has the advantagesof flexibility, convenience and improved participation2. We con-clude that this blended environment is an effective tool in thedelivery of content to a large number of students, maintainingstandardisation and allowing uniform access, all of which enhancesthe learning.References:1. Brandt BF, Quake-Rapp C, Shanedling J, Spannaus-Martin D,Martin P, Blended Learning: emerging best practices in alliedhealth workforce development. J Allied Health 2010 Winter;39(4):e167–72.2. McCown LJ. Blended courses: the best of online and traditionalformats. Clin Lab Sci 2010 Fall: 23(4):205–11.

Faculty Development: Specialty Trainees asAmbassadors and Providers of Medical EducationK L Macleod, C Morris

K L Macleod, East of England Multi-Professional Deanery, CPC1Capital Park, Fulbourn, Cambridge, UK

Background: Faculty development has traditionally centred onconsultants, yet there are clear arguments for supporting doctors asmedical educators early in training. Fostering a deeper under-standing and appreciation of medical education could strengthentrainer/learner relationships, develop senior trainees who teachtheir junior colleagues, and prepare trainees as future educationaland clinical supervisors.The Study The East of England Multi-Professional Deanery pilotedan innovative scheme to sponsor 2 cross-specialty cohorts of 20trainees to study a Postgraduate certificate in Medical Education atthe University of Bedfordshire. Participants were selected to beambassadors for medical education and provide regional and localteacher training post-qualification.

Key elements of the learner-centred course included: 1. Participa-tion in an online educational ‘community of practice’1;2. Development of an individual teaching philosophy and academicand research literacy;3. Interrogation of educational theory in the context of differentspecialties;4. Experimentation with e-learning to develop a group ‘Wiki’microsite;5. Reflective learning, using a teaching portfolio and reflectivenarrative;6. Formative feedback, including peer and tutor observations, tocultivate skills and capabilities.A range of data has been collected to evaluate this model andidentify the potential benefits of a Deanery-funded scheme.Participants were surveyed midway through the course and6 months after completion.Results: Nineteen trainees from the first cohort attained the PGCert qualification, with 7 trainees choosing to continue theirstudies to Masters level qualification. All reported high levels ofsatisfaction and engagement with the course.Thematic analysis of feedback identified significant benefits of theprogramme, including;1. The value of shared peer learning and a ‘community’ approach;2. Significant personal and professional development of trainees aseducators;3. Self-reported improvement in the quality of teaching activitieswith junior colleagues;4. Enthusiasm for cascading learning to other colleagues;Data to illustrate these points will be provided. Case studies offaculty development training events organised by the participantswill illustrate horizontal and vertical sharing of learning.Discussion and Conclusions: This Deanery-sponsored schemefacilitated the professional development of committed trainees asmedical educators. The postgraduate course significantly enhancedtheir own teaching and learning and supported them as medicaleducation ‘champions’ able to cascade learning and developmentto their colleagues.Reference: 1. Lave, J and Wenger, E. Situated Learning. Legiti-mate Peripheral Participation. Cambridge University Press, 1991.

Trauma and Emergencies in Pregnancy (TrEP):Developing a Course for Undergraduate MedicalStudents at the University of LeicesterF Frame, S Francis, K Hammond, A Brewer, C Oppenheimer

F Frame, University of Leicester Medical School, Leicester, UK

Introduction: The management of trauma and emergencies inpregnancy was an aspect of acute care that senior medicalstudents at the University of Leicester had demonstrated anincreased interest in. As a result, the Trauma and Acute CareSociety ran a student-led course using this as a framework toteach, assess and reinforce core knowledge, skills and attitudes inthis specialised area. These were based on Immediate LifeSupport principles. Trauma and Emergencies in Pregnancy(TrEP) was developed as a 1 day course combining a series of keylectures with practical skills stations, an OSCE and moulage.Senior clinicians with a specialist interest in obstetrics and/oranaesthetics from the University Hospitals of Leicester (UHL)provided invaluable teaching expertise in a high tutor to learnerratio.Method: Using a Likert scale questionnaire, students were askedto report their perceived satisfaction with the component parts ofTrEP. In addition they commented on their overall enjoyment of



the day and identified areas for improvement. Data werecollected and evaluated to further develop and refine thestructure and content of the course, in order to make futurecourses more responsive to the learning needs of students inclinical practice1.Findings: When asked, 100% of the students who attended the daysaid they would recommend it to others, showing an extremelyhigh degree of satisfaction overall. In addition, many studentsreported a perceived improvement in the knowledge, skills orattitudes needed to manage trauma and emergencies in pregnancy.When the lectures were reviewed, ‘managing shock’ and ‘medicalemergencies’ evaluated most well – with 82% of students givingthese the highest satisfaction rating. Lectures that evaluated lesswell did not fully meet student learning needs, and suggestionswere made for improvement. In the clinical skills components, 95%of students gave the practical skills stations the highest satisfactionrating – with the OSCE and moulage also demonstrating very highlevels. Clinical relevance was acknowledged by many students.Discussion and Conclusions: Findings suggest that the courseevaluated very well overall, demonstrating a perceived improve-ment in knowledge, skills and attitudes amongst many students. Itfacilitated a valuable exposure to aspects of care that couldpotentially be experienced in clinical practice, whilst providing asafe environment to learn and practice the necessary skills2.Responsive changes will now be made, with the aim of includingTrEP within the undergraduate curriculum at the University ofLeicester in the future.References:1. Wilkes M. & Bligh J. ‘Evaluating educational interventions’.British Medical Journal 1999;18:1269–1272.2. Ziv A., Ben-David S. & Ziv M. ‘Simulation based medicaleducation: an opportunity to learn from errors’. Medical Teacher2005; 7(3): 193–199.

Peer-Assisted Learning: Does Comfort BuildConfidence?E Maile, J Farikullah, L Magee

E Maile, Salford Royal NHS Foundation Trust, Stott Lane, Salford,UK

Introduction: The Peer-Assisted Learning (PAL) scheme is facili-tated by year four medical students at Salford Royal Hospital anddelivers clinical teaching to year 3 peers. We facilitated PALsessions covering clinical examination of the head and neck inpreparation for OSCEs.Aims: This study aims to determine whether a teaching sessiondelivered via PAL increases student’s confidence at attempting arelevant OSCE station. Additionally, we aim to determine thereasons behind any change in confidence.Methods: We surveyed year three students attending small groupPAL sessions (n = 51). The students rated their confidence attackling an OSCE station before and after PAL, using a scale from 1(no confidence) to 10 (most confident). Additionally we askedstudents to give feedback using free text answers about the PALsession. We used thematic analysis of the feedback forms to studystudents’ perceptions of PAL.Results: Students’ confidence at tackling a head and neck OSCEstation demonstrated a significant improvement (P < 0.001) afterthe PAL session. The mean confidence before the session was 5.1,increasing to 8.0 after. All students reported increased confidenceafter the session. Thematic analysis of the students’ free textanswers revealed that the most common perception of PAL was of acomfortable, relaxed environment (47.4%). The second most

common perception related to students’ appreciation of therelevance of the session content to OSCE assessments (44.7%).Discussion: The most common theme students’ reported wasfeelings of comfort related to PAL sessions. We believe thesefeelings of comfort foster a more productive learning environment,therefore leading to significantly increased levels of confidence.To explain this we refer to Topping1, who theorised that peerteaching leads to increased disclosure of areas of weakness inknowledge by students. This allows peer-tutors to address theseareas and teach more effectively, leading to the increasedconfidence experienced by students.Conclusions: We propose that enhanced disclosure is a product ofa highly congruent relationship between peer-tutor and student.Congruent social roles occupied by student and peer-tutor mayfoster a more effective learning environment2. The lack ofhierarchy between student and peer-tutor leads students toexperience feelings of comfort, meaning they are more likely toexpose their weaknesses, which can then be addressed, resulting intheir improved confidence.References:1. Topping K. Trends in peer learning. Educ Psych 2005;25:631–45.2. Ten Cate O, Durning S. Dimensions and psychology of peerteaching in medical education. Med Teach 2007;29(6):546–52.

Factors Influencing Stethoscope Cleanlinessamongst Clinical Medical Students at a ScottishUniversityC Saunders, J Skinner

C Saunders, College of Medicine and Veterinary Medicine,University of Edinburgh, Edinburgh, UK

Background and Purpose: Cleanliness within clinical environ-ments is of great importance to patient safety, with an estimated15–30% of all healthcare-acquired infections (HAIs) being com-pletely preventable through simple improvements in hygiene1. Todate, training and awareness campaigns have focused on the roleof good hand hygiene; however, despite evidence that stetho-scopes can spread HAIs2, little attention has been given to thiscommon piece of medical equipment. Daily cleaning of stetho-scopes can reduce the number with bacterial contamination fromover 90% to < 35%3. Despite this, many medical students still failto clean their stethoscopes regularly and teaching in this practicalskill may be lacking3. The aim of this study is to determinestethoscope hygiene habits amongst clinical medical students andcorrelate this with a number of factors likely to influence cleaningfrequency.Methodology: The study population consisted of medical stu-dents in their clinical years from a single Scottish medical school.An anonymous study questionnaire was completed by 308students; students were asked how often they cleaned theirstethoscope on average, whether they had received teaching instethoscope hygiene, and which factors were preventing themfrom cleaning as often as they would like using Likert scalequestions.Results: There was no difference in cleaning frequency betweenmales and females (P = 0.982) or year of study (P = 0.472), andstudents cleaned their stethoscope on average once per month.Only 9 students (2.9%) had received teaching to show them howto properly clean their stethoscope, and 86.7% felt that this topicneeded more awareness in the medical curriculum. Significantcorrelations were found between the frequency of stethoscopecleaning and whether a student felt confident in knowing how to



clean (P < 0.001), whether they witnessed others clean theirstethoscope (P < 0.001), whether they thought cleaning wasimportant (P < 0.001), and whether cleaning equipment wasreadily available (P = 0.001). Cleaning frequency was not corre-lated with whether the student felt they had enough time(P = 0.101).Discussion and Conclusions: The vast majority of students hadreceived no formal teaching in stethoscope hygiene. Byincreasing students’ confidence in performing this essentialpractical skill, it is likely that stethoscope hygiene will increase.This could be done through formal clinical skills sessions,awareness campaigns, and encouraging clinical tutors on wardsto promote this skill. Additionally, more equipment should bemade available for stethoscope cleaning. In turn, widespreadadoption of these suggestions by medical schools both nationallyand internationally may help reduce HAIs, increasing patientoutcomes.References:1. House of Commons. Committee of Public Accounts. Forty-second report: the management and control of hospital acquiredinfections in acute NHS Trusts in England, together with theproceedings of the Committee relating to the report, the minutesof evidence and appendices. Session 1999–2000. London: TheStationery Office.2. Breathnach AS, Jenkins DR, Pedler S. Stethoscopes aspossible vectors of infection by staphylococci. BMJ 1992; 305:1573–1574.3. Uneke CJ, Ogbonna A, Oyibo PG, Ekuma U. Bacteriologicalassessment of stethoscopes used by medical students in Nigeria:implications for nosocomial infection control. World Health Popul2008; 10(4): 53–61.

Introducing Realism and Contextualization inAmbulatory Care Teaching Enhances the StudentLearning ExperienceN Patravali, R Jarvis, K McKelvie, J Ker

N Patravali, University of Dundee, Dundee, UK

Background: Ambulatory care is a challenging area for teaching ata junior undergraduate level: understanding, planning and exe-cuting patient care is a daunting task for early undergraduates.Treating more patients in the health sector in the ambulatorysetting makes teaching in this context both viable and current.Translating this concept, to introduce realism whilst maintainingconsistency and reliability in teaching is the challenge. Realism andcontextualization includes utilization of patient information priorto seeing the patient, setting up the ‘scene’ based on thatinformation, getting the patient from the waiting area, conductingthe interview process and planning future care based on theinformation procured. This pilot survey was aimed at exploringstudents’ insight in to patient care in the consultation necessary inthe ambulatory care setting, and furthermore to assess their overalllearning experience of contextualization.

Methodology: A structured change was introduced in the 2nd yearundergraduate curriculum. The session was divided into ‘pre-interview phase’, ‘interview phase’ and ‘post interview phase’,lasting for 90 minutes.All the 3 phases were based on the underpinning principles of1. ‘Content’- What is the information?2. ‘Process’- How is the information gathered?3. ‘Perception’- What does the doctor think? What clinicalreasoning goes on? What attitudes and biases do they have?A real outpatient area was used, using simulated patients. In thepre-consultation phase, the students were asked to plan theconsultation based on the principles of content, process andperception. This was contextualized with a letter of referral orsimilar. Students were observed as they collected the patient fromthe clinic waiting area. Students were expected to gather informa-tion, plan investigations and formulate an initial management plan.Using peer review in the post consultation phase the process wascritically appraised and immediate feedback was given. A structuredquestionnaire was given to the students to help ascertain theirunderstanding of patient care and management in the ambulatorycare setting.Results: Students reported that the 3-part process helped them tounderstand the consultation. Introduction of realism by collectingthe patients from the clinic waiting area helped them to learn anddevelop necessary social skills. Student’s situational awareness, theirease with patients, their planning prior to seeing patients and theimportance of formulating a management plan were all noted aslearning issues by students. Students also felt more involved in theteaching, as using peer review made the session more interactive.Conclusion: The results show that using realism and contextual-ization helped the students acquire greater understanding of theconsultation. The process helped the students to think and analyzebroadly thus improving their understanding of ambulatory care.This structured and contextualized teaching improves the qualityof the learning.References:1 Barrows, H.S An overview of the uses of standardized patients forteaching and evaluating clinical skills. Academic Medicine1993;68(6):443–453.2 Dent JA, Ker JS, Angell-Preece, HM, Preece PE. Twelve tips forsetting up an ambulatory care (outpatient) teaching centre. MedTeacher2001;23:345–50.3 Irby DM, Wilkerson L. Teaching when time is limited. BMJ2008;336:384–7.4 Lipsky MS, Taylor CA, Schnuth R. Microskills for learners: twelvetips for improving learning in the ambulatory setting. MedTeacher1999;21:469–72.5 Irby D. Teaching and learning in ambulatory settings. A thematicreview of the literature. Acad Med 1995;70:898–931.6. Teaching and Learning Communication Skills in MedicineSuzanne Kurtz, Jonathan Silverman, Juliet Draper. Radcliffe Med-ical Press, 2004.



Impact of a Well-Designed Work Experience Programme for Budding Medical Students

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