Abstracts
Researching Medical Education
23rd November 2010
The Royal Institute of British Architects,
66 Portland Place, London
Index
Page / Title / Authors3 / Use of video taping for direct observation of case based learning: a feasible method for analyzing small group teaching / R McEwan
4-5 / Using Kirkpatrick’s levels to establish and test a conceptual modelof reflective thinking and patient safety in a cohort of medical students as they advance through a medical curriculum / L Ambrose,
K Stirling, D Murphy & JS Kerr
6 / Bedside teaching – do junior doctors and medical students make a winning team? / A Nair & S Singh
7 / The evaluation of an inter-professional multimedia musculoskeletal examination teaching resource: a qualitative study / C Griffin, C Chung,
V Tzortziou-Brown & D Morrissey
8 / Ethnicity and academic under achievement early in the medical course / M Carroll
9 / An exploration of the methodological opportunities and limitations of case studies for research on educating health professionals living with HIV in Kenya / C O’Keeffe
10 / Co-operation in a Competitive World / P Bryant
11 / Corpus analysis of problem-based learning transcripts: A new method to look into PBL / A L Da Silva &
R Dennick
12 / Gender, culture and professional identity: a qualitative enquiry into the effects of the learning and professional environment on the construction of a surgical identity / L Etheridge
13 / Unpicking issues within the osteoarthritis consultation in primary care using videotaped surgeries / Z Paskins,
AB Hassell &
PR Croft
14 / Conceptions of learning and leadership – a qualitative study of senior faculty in a research-intensive university / A Berlin
15 / From theory to data analysis: using mixed qualitative methods to explore a complex educational intervention / S Yardley
Use of video-taping for direct observation of case based learning: a feasible method for analysing small group teaching
R McEwen, L Varadhan, S Williams, A Hassell
R McEwen, Clinical teaching fellow, CEC building, City General Hospital NHS Trust, Stoke on Trent ST4 6QG
Context
As part of the new curriculum being implemented in KeeleMedicalSchool a locally developed form of Case Based Learning (CBL) was implemented in the 3rd year. CBL was performed in small groups with an expert tutor; a generic case was discussed during the opening session. Closing session was performed a week later where students presented cases they had seen relating to the generic case. Traditionally small group sessions have been assessed by questionnaire or focus group discussion, with little direct observation of sessions published in the literature.
Methodology
As part of the evaluation process a pilot study was undertaken to assess feasibility of video-taping these sessions. A selection of CBL sessions, including opening and closing, were video-taped over a two week period after gaining formal consent from tutors and students. Small DVD video recorders were left un-mannedin the rooms. No group was video-taped more than once. One major challenge was the methodology for analysing the recordings. Video-tapes were assessed for group interactions (a tool was developed and internally validated for scoring) and adherence to locally developed CBL guidelines.
Results
Video-taping was generally well accepted, apart from one tutor and one student declining consent. Nine sessions including medicine, surgery and paediatrics were video-taped. One video-tape was lost due to technical fault after recording. There was wide variation in the quantity of group interactions but all sessions were predominantly tutor driven. Inter-student interaction was minimal. Although the expected content was broadly covered, the process was widely variable.
Conclusions
Video-taping is feasible and a simple and efficient method of directly observing small group teaching, allowing evaluation of a variety of domains. These recordings could be used in staff development or CBL training for students and staff. There remains work to be done in developing the methodology for analysis of recordings.
Using Kirkpatrick’s levels to establish and test a conceptual model of reflective thinking and patient safety in a cohort of medical students as they advance through a medical curriculum.
L Ambrose, K Stirling,D Murphy, J S Ker
L Ambrose, KeeleUniversity, Clinical Education Centre, UniversityHospital of North Staffordshire, Newcastle Road, Stoke on Trent, Staffordshire, ST4 6QG
Context
Understanding how medical students learn about patient safety is a key area in medical education. A series of studies have been conducted using Kirkpatrick’s (1) levels to follow a cohort of students through the new curriculum in Dundee which has integrated patient safety activities from year 1. The initial patient safety programme in year 1 was met with a strong negative response by a sub set of students (2). This reaction was explored through qualitative data from focus groups. The analysis identified a conceptual model which was subsequently tested over time using appropriate methods aligned to Kirkpatrick’s levels to assess knowledge, attitudes and behaviours as the students ascended the curriculum.
Methods
Study 1 - Aligned to Kirkpatrick’s level 1. The aim of this study was to understand the student response to a programme of activities using patient safety tools introduced in 2006 using qualitative data.
Study 2- Aligned to Kirkpatrick’s level 2. This study tested the association between knowledge and attitudes of patient safety with reflective thinking. Students completed validated questionnaires which tested their reflective thinking and understanding and future intentions about patient safety (3, 4).
Study 3 -Aligned to Kirkpatrick’s level 3. This study used the ward simulation exercise which students undertake in year 5 as the basis for measuring safe behaviour and error. Participants completed a questionnaire to assess reflective thinking.
In studies 2 and 3 correlations coefficients were calculated to identify associations between knowledge, attitudes and behaviours with reflective thinking.
Study 3 (Year 5)
Study 2 (Year 3)
Study 1 (Year 1)
Figure 1. Diagram illustrating methodological approach
Results
The three studies were completed between 2006 and 2010. Study 1 used qualitative data to capture students’ reactions at level 1. The analysis identified a conceptual model linking reflection and patient safety which was then subsequently tested in studies 2 and 3. In study 2 significant correlations were identified between students’ knowledge and attitudes and reflective thinking. In study 3 significant correlations were identified between safe behaviour, observed errors in simulated practice and reflective thinking.
Conclusion
By using the approach described here, the initial qualitative data has been explored using methodologies appropriate to students’ knowledge and skills at different levels of the curriculum. This has enabled the conceptual model to be tested over time using Kirkpatrick’s framework.
References
1. Kirkpatrick, D L. (1959). Evaluating Training Programs, 2nd ed. San Francisco: Berrett Koehler
2. Ambrose L,Pennington G , Ker J.S Junior medical students’ perspectives on involvement in a patient safety initiative. ASME Association for the Study of Medical Education, Annual Scientific Meeting. Aberdeen 2006.
3. Kember D, Leung D, Jones A, Yuen Loke A, Mckay J, Sinclair K et al. Development of a Questionnaire to Measurethe Level of Reflective Thinking. Assessment & Evaluation in Higher Education, Vol. 25, No. 4, 2000
4. Patey R, Flin R, Cuthbertson BH, MacDonald L, Mearns K, Cleland J, Williams D. Patient safety: helping medical students understand error in healthcare Qual Saf Health Care. 2007 Aug;16(4):256-9.
Bedside teaching – do junior doctors and medical students make a winning team?
A Nair,S Singh
SSingh,10 Lancaster Avenue,WestNorwood,London, SE27 9DZ.
Objectives
Bedside teaching by junior doctors plays an important and growing role in undergraduate teaching. In our study we had three aims. We set out to assess the role junior doctors play in preparation for finals and whether there were significant differences in the expectations and limitations of bedside teaching between teachers and students. Finally we assessed the value of having a structured bedside teaching programme of up to eight weeks, as is in place in our teaching hospital.
Method
We designed a single survey that both students and teachers answered anonymously using 5 point Likert scales. The survey was sent to 149 medical students and 43 Foundation Year 1 doctors who all took part in the structured bedside teaching programme at Basildon and ThurrockUniversityHospital. Students answered the questionnaire after completing theirMBBS exams. The questions were designed using components of the Cleveland Clinical Teaching Effectiveness Instrument, separated into 10 different areas and were positively and negatively keyed to help reduce acquiescence bias. Using a single survey and non-parametric statistical methodology for both groups allowed us to highlight any differences between the groups effectively.
Results & Discussion (Results pending August 2010)
Given the increasing demand on junior doctors to teach medical students, our results will show whether final year students had confidence in their tutor. It is important that students and teachers have similar expectations of any mode of teaching. This study will highlight whether differences exist between bedside tutors and students. Addressing these discrepancies should help improve the quality of teaching and the learning experience. Bedside teaching in many hospitals is ad hoc and we asked whether a more structured approach was beneficial for teaching. We also explored other roles for such a programme including providing mentoring and support for students, work experience and developing teaching skills.
The Evaluation of an Inter-Professional Multimedia Musculoskeletal Examination Teaching Resource: A Qualitative Study
C Griffin, C Chung, V Tzortziou-Brown, D Morrissey
CGriffin, 106 White Hill, Chesham, Buckinghamshire, HP5 1AR
Background
Inter-professional education (IPE) has been used more frequently over the last thirty years to encourage collaborative teamwork within healthcare.
Objectives
The aims of this study were primarily to assess the impact of multimedia instruction on musculoskeletal clinical examination (MCE) skill acquisition. Secondly, to evaluate students’ perceptions of the value of IPE and multi disciplinary team (MDT) work.
Method
A survey was administered to a purposively sampled group of post-graduate students, comprising of medical practitioners and physiotherapists (n=26). The sample was diverse in age, speciality, and MDT and IPE experience. The intervention was four sports injury assessment DVDs made by expert clinicians modelling inter-professional team working. Post-intervention semi-structured interviews, conducted with a sample from the survey group (n=10) until data saturation occurred, were audio-recorded and analysed by thematic content analysis (TCA).
Results
The survey response rate was 85%. Responses revealed 46% of the group described their competence in MCE as ‘developing skills’ and 50% described having ‘some experience’. Attitudes towards IPE and MDT work were highly positive. The interviews revealed five main themes: a real time approach with expert instruction; multiple perspectives; diversity within the cohort; changing behaviour by improving MCE technique and enhancing interactive skills.
Conclusion
This study is the first to provide evidence for the self-perceived learning of MCE skills through an inter-professional DVD simulation amongst post-graduate students. Self-perceived learnt skills included detailed examinations, special joint testing, and biomechanical assessments. Furthermore, the DVDs improved students’ appreciation of IPE, healthcare teamwork, and awareness of other disciplines. The use of DVD simulations to teach and assist with the delivery of MCE and IPE warrants further investigation.
Key words
Inter-professional education; musculoskeletal; multimedia; learning; skills
Ethnicity and academic under-achievement early in the medical course
M Carroll
M Carroll, Centre for Medical Education, Barts and The London, London E1 2AD
Medical students and graduates from ethnic minority groups under-achieve academically at every level. We sought to identify the underlying causes in one cohort of our Year 1 medical students. We combined qualitative methods (questionnaire and focus groups) and quantitative methods (statistical analysis of examination performance at MBBS Part 1 and possible variables, both demographic and academic). Students were categorised as either ‘white’ or ‘non-white’ on the basis of self-declared ethnicity.
Relative to white students, non-white students: were significantly younger; had a significantly lower proportion of graduate entrants; scored significantly lower marks on all 4 papers at MBBS Part 1; were much more likely to fail; had closely comparable prior educational attainment (from UCAS tariff scores) and potential (in 2 out of 3 UKCAT sub-domain scores); attended PBL tutorials to the same extent. Regression analysis confirmed that the only unique significant variables contributing to examination performance were ethnicity and UCAS scores; graduate status was a contributory variable to coursework performance. Qualitative analysis suggested that the family background of non-white students influenced their work ethic in multiple ways that might impair academic achievement; however the low response rates limited reliable conclusions.
Our research indicates that non-white students arrive at our medical school with closely comparable academic attainment and potential to those of non-white students, but that their experience in Year 1 somehow undermines their academic progress. Further work is needed to: combine more cohorts to improve statistical analysis and enable differentiation of ethnic sub-groups; analyse the influence of socio-economic background; and engage non-white students more effectively in the qualitative analysis.
An exploration of the methodological opportunities and limitations of case studies for research on educating health professionals living with HIV in Kenya
C O’Keeffe
C O’Keeffe, Faculty Development Education Lead, London Deanery, 32 Russell Square, London
Understandings of professionalism held among health care workers can perpetuate perceptions that health professionals are role models who have knowledge and resources to protect themselves from infection with HIV, even though they are often subjected to similar gender and cultural norms that predispose community members more generally to infection. There is evidence from Kenya to suggest that health workers are therefore subjected to increased levels of stigma and discrimination from local communities and from within the health system, often preventing them from accessing treatment, further exacerbating the already critical shortage of human resources for health. To address this problem support groups for health workers living with HIV have been established within Ministry of Health facilities.
A qualitative case study approach within a contructivist paradigm was used to explore the nature and purpose of these support groups, the perceived effect of the groups on the personal and professional lives of their members and on their experiences of stigma and discrimination. Data was collected using narrative interviews with 22 support group members and 13 key informants. The study provided new knowledge about how support groups can help to promote learning to address HIV related stigma and discrimination within health facilities.
This paper will focus on the methodological challenges related to researching support groups for health professionals living with HIV in Kenya. The issues include: cross cultural power relations between the researcher and study participants, and challenges associated with conducting interviews on sensitive issues. The value of case study research for exploring this topic, and the nature of knowledge produced will be examined. The limitations of this approach will also be considered and suggestions made for the design of future research on this issue.
Cooperation in a Competitive World
P Bryant
P Bryant, Lecturer UEA, Faculty of Health, Level 2 MED Building, University of East Anglia, Norwich, NR4 7TJ
Context
Doctors of tomorrow are expected to learn and work effectively within multi-professional teams. (General Medical Council 2009) Group work is emphasised as important in the undergraduate medical curriculum by GMC in order to promote better team performance in the working environment.
UEAMedicalSchool runs a Problem Based Learning (PBL) curriculum in which students spend many hours a week working together in small groups. Management of the group by a facilitator is important in achieving cooperation within the group (Azar 2008) but external factors may also be influential. In 2005, it became a requirement for each medical school, to place its students into quartiles A-D, (banding) for entry to post graduate medical specialty training posts. (Foundation Programme 2010 ) Many studies have demonstrated that cooperative learning is more effective at producing individual success than competitive learning (Salvin 2008) but banding may conflict with team cooperation and learning.
Methodology
The project will be divided into 4 phases
1. In depth interviews with medical students to gain insight into the learning environment.
2. Development of a cooperative learning environment scale.
3. Statistical analysis of student’s exam results in competitive and cooperative environments.
4. Consideration of development of group reward system to promote for cooperative working / learning if this appears more effective.
Results
Phase 1. I will use qualitative data analysis for interviews and code data using grounded theory or the constant comparison method.
Main conclusions
The conclusions will be used to inform undergraduate curriculum development at UEA, other PBl medical school and those using or introducing group work.
References
Azar, Sammy A. 2008. Navigating Problem-based Learning: London : Churchill Livingstone Elsevier.
Foundation Programme. Available at ( Accessed 24. June 2010)
General Medical Council, 2009, Tomorrow's Doctors 2009. London: General Medical Council.
Slavin, Robert E. JohnsHopkinsUniversity, 1995. Research on Cooperative Learning and Achievement: What We Know, What We Need to Know.Adapted from Slavin, 1992. Available at Accessed June 2010
Corpus Analysis of Problem-Based Learning Transcripts:A new method to look into PBL
A L Da Silva, R Dennick
A L Da Silva, Medical Education Unit, MedicalSchool, University of Nottingham, NG7 2UH
Problem Based Learning (PBL) is one of the most researched areas of medical education with numerous papers and meta-analyses concerned with its overall effectiveness in comparison to traditional methods. Fewer studies, however, have looked at the processes occurring within the PBL group discussions. In particular, it is remarkable that relatively little attention has been paid to the fact that students who engage in PBL talk to each other for 3–5 hours per week, which may lead to hundreds of hours of interpersonal discourse over a complete PBL curriculum. Research has not yet capture or analyzed the cognitive activities that take place during this “talking”.