Podium Presentations
Setting up a teaching programme for surgical core trainees. Experience from the Oxford School of Surgery.
Authors
Lieske B1 & Soin B2
Institutions
1 Department of General Surgery, Royal Berkshire Hospital NHS Foundation Trust,
2 Department of General Surgery, Heatherwood and Wexham Park Hospitals NHS Foundation Trust
We report our experience of a Deanery wide monthly teaching programme for all surgical Core Trainees. Needs analysis by questionnaire to all surgical SHOs in the Oxford Deanery in 2007. Teaching blueprint mapped on the ISCP Curriculum with one themed teaching session per month. Booklist – a compilation of recommended reading material and basis of “homework” prior to teaching sessions. Session outline: Each teaching session consists of three parts, utilising different teaching modalities: 1. “donut round”, a question and answer session on a set text, enabling trainees to engage with reading material and practise thought formulation and articulation. 2. Assessment, a brief written test of recall and comprehension of their “homework”. 3. Small group teaching, discussion of topics with Senior Trainees and Consultants. Feedback after every session, enabling continuous improvement of the programme, which is now in its third year.
Quality, Not Quantity: A Collaboration of Training Opportunities to Ensure High-quality Surgical Training Despite EWTD.
Authors
Hamdan MF, Vaughan-Shaw PG & Pearson KL
Introduction: Following Calman reforms and ‘New Deal’, implementation of the EWTD is another threat to surgical training. Our institution has implemented multi-faceted collaborative training opportunities to ensure Surgical Core Trainees receive the highest quality training.
Method: A 4-pronged approach was developed: Monthly consultant-led dissection-room clinical anatomy sessions and clinical tutorials were run to improve theoretical knowledge; weekly laparoscopic-simulator training and daily bleep/registrar-free training lists at the day-surgery unit were available to increase operative experience. All sessions were advertised and bookable online.
Results: Trainees have logged on average 27 procedures over the past month at the day-surgery unit, of which 25% were trainee performed. Over 18 months, 28 laparoscopic-simulator classes were run while over 8 months, 19 tutorials and anatomy sessions were delivered with average attendance of 10 trainees. Feedback on all sessions was extremely positive.
Conclusions: Quality training is achievable despite EWTD. Meticulous organisation, coordination and consultant support are essential to success.
Abbreviations: EWTD European Working Time Directive
Medical Education in Sub-Saharan Africa
Authors
Young L & Shankar S
UK medical training programmes encourage continuing professional development. For anaesthetic practitioners in sub-Saharan Africa, formal learning opportunities are rare after completion of undergraduate training.
We participated in an anaesthetic conference in Togo, West Africa, delivering lectures and running practical workshops. Our delegates comprised 99 enthusiastic nurse anaesthetists from 23 Togolese hospitals. They were desperate to enhance knowledge of their profession, and to perfect practical skills.
This experience challenged all aspects of lecture delivery and content and “one-to-one” teaching became “two-to-one” interaction with delegates via an interpreter. Teaching in one’s first language is itself a demanding task, requiring thorough preparation, without our additional challenge of French translation.
Subsequent to our experience in Togo, we have undergone a period of intensive deliberation and reflection – it has forced us to scrutinise the way we think about delivering education, and how lucky we are to have the educational opportunities and resources that we do.
Introduction to theatre and basic surgical and anaesthetic skills. A theatre induction course for third year medical students.
Authors
Knight W & Glaysher M
Institution & contact details
Queen Alexandra Hospital
Traditionally, operating theatres are a sub-optimal educational setting for medical students. Learning objectives are not clearly defined and many students are intimidated by unfamiliar rituals and procedures. A poor induction into theatre has a negative impact on learning behaviour and patient safety.
In 2009/10 a theatre induction course was provided for 24 3rd year medical students rotating through a DGH. It was designed to give a grounding in safe theatre practise, an understanding of the surgical care pathway and to teach basic surgical and anaesthetic skills.
This presentation argues that a formal one day theatre induction course nurtures confidence and adult active learning behaviour in students, therefore maximising learning opportunities. A good understanding of theatre practise lends itself to the development of more effective and safe surgical house officers. Furthermore, the early development and practise of basic surgical skills will help lessen the impact of the EWTD on surgical training.
Posters
This enquiry set out to explore how one component of WPBA, the Consultation Observation Tool (COT), is currently integrated into teaching and learning about consultations.
Gibbons E
Research Question: In what way does the use of the Consultation Observation Tool meet a trainee’s needs for learning from a consultation?
Methodology: The findings of this enquiry are derived from interpretation of a case study of educational practice in action (action research), and are based on my own values, beliefs and experiences of education, and the use of Workplace based assessment in particular. It therefore operates in a non-positivist paradigm.
Methods: I observed and made an audio recording of a tutorial between the ST1 GP trainee in our practice and her clinical supervisor (GP trainer). During the tutorial the trainer reviewed two consultations undertaken by the trainee. A COT assessment was completed for both consultations. The observations and transcript of the tutorial were analysed to identify themes relevant to the enquiry
Results: Six themes were identified;
Theme 1: Barriers: These were apparent in a number of forms, particularly when the COT assessment was being undertaken, but were reduced once it was completed.
Theme2: Reconstruction: The skill of the trainer in reconstructing what he saw and heard during the consultations and interpreting it for the benefit of the development of the trainee was particularly apparent during the discussions after the COT form had been completed.
Theme 3: The Apprentice: There were a number of situations where the trainer drew on aspects of the consultation outside the tasks of the COT assessment specifically to promote the trainees development and understanding.
Theme 4: Consultation style: There was a particular focus on ‘Understanding the doctor/trainee’
Theme5: Trainee Confidence: Feedback was tailored to specifically address issues of trainee confidence
Theme6: The approach to the COT: The trainer in this case study saw a much greater significance in his role as a teacher as opposed to that of an assessor.
Conclusions: The COT was designed in its original form to be a task orientated, objective summative assessment used by RCGP external examiners. In reality teaching GP trainees about consultations within practice requires a more significant emphasis on the development of an apprentice rather than signing off a trainee. There is a significant amount of tacit knowledge about understanding patients, doctors and their consultations which risks being overlooked by the bureaucratic burden of workplace based assessment, and the use of an assessment tool which was originally designed for a different purpose.
Saving lives with SimMan: Our experience with FY1 Doctors.
Vaughan-Shaw PG & Pearson KL
Thousands of preventable in-hospital deaths occur annually in the UK.1 Improving simple aspects of acute-care through simulation-training could save countless lives.2 We have implemented protected simulation-training for FY1s.
FY1 doctors attended sessions chaired by experienced faculty and took turns leading simulated scenarios using Laerdal SimMan®. Scenarios included chest-pain, seizure, acute asthma, sepsis and anaphylaxis. Each scenario was followed by feedback and teaching.
To date 40 FY1s have participated. Feedback indicates these sessions are worthwhile and relevant. Participants felt more confident managing clinical emergencies and felt that simulation should become compulsory within Foundation training.
Simulation involves integration of knowledge, skills, problem-solving ability and communication1. The benefits of medical simulation have been widely reported3, 4 and we believe this programme will better prepare FY1s for treating acutely-ill patients. We aim to incorporate validated assessments3 of simulated scenarios into our Foundation curriculum while in accordance with GMC recommendations5, undergraduates will also experience simulation-training.
Human Simulators in PALS teaching – The education of all.
Aggarwal D & Jakeman N
This project aimed to bring together the age-old concept of Peer-assisted learning (PAL) with innovative Human Patient Simulators (HPS) by having a 5th year medical student teach 3rd year peers daunting Emergency Medicine topics using HPS in a non-threatening, conducive environment.
Objective analysis used 7 unvalidated MCQs, comparing the 6 HPS students to 12 similar tutorial-only students. Mean scores were 77.1% (Range 71.4-82.9%) for HPS versus 73.7% (Range 60-94.2%) for “non-HPS” students, indicating this type of teaching may standardise and improve the range of clinical experience, and therefore test scores as well as acute patient management. Subjective feedback from the HPS session were excellent, and better than a similar tutorial by the same PAL teacher.
This method of teaching appears to be beneficial to both levels of students involved, and may also provide a cost benefit to Universities and Hospital academies wishing to participate in such teaching.
The Royal Bournemouth Buddy Scheme for New Foundation Doctors
S Rees S, Honney R, Drake T, Tang E, Raza T & Vassallo M
Junior doctors can no longer rely upon the traditional team structure and the cohesion, unity and support it provided. A move from free accommodation and a change to a shift based pattern of work, in order to comply with the EWTD, has meant alternative systems are required to help with the difficult transition from medical student to doctor. Two years ago a buddying system was introduced for FY1’s starting their career as a doctor at the Royal Bournemouth Hospital (RBH), it was an informal scheme similar to the ‘Superfamily’ concept common in many medical schools. In our evaluation of the existing programme we identified a number of organisational issues and implemented a range of improvements. These changes in turn were then evaluated. It is hoped that the buddy scheme could be used as a template for other hospitals both within Wessex and further a field.
An African experience of nursing education
Ribbons T, Faurie M & Oosthuizen G
South Africa is renowned for being a divided country in the wake of apartheid. This is evident in the healthcare system. In the private sector nursing staff receive postgraduate training and go on to become specialists in their branch of nursing, much as in the UK. In the old township state hospital there is little or no postgraduate training available to nursing staff. This has led to a downward spiral of poor ward care in many state institutions, with poor working relationships between doctors and nursing staff.
I set up a weekly “in-service” training program for the surgical ward nursing staff at Edendale Hospital, Kwa-Zulu Natal – an ex-“black” township hospital. There was resistance to the program from several of the senior nursing staff. My key results were (a) improved understanding of the importance of vital signs and the need to report them, and (b)enthusiasm and participation at the teaching sessions.
Designing a ‘hernia study guide’ for medical students attached to general surgery at Southampton General Hospital using the help of the ‘TRACKER’ mnemonic.
Tzouliadis L
Title: Designing a ‘hernia study guide’ for medical students attached to general surgery at Southampton General Hospital using the help of the ‘TRACKER’ mnemonic.
Aims: Medical students often have a poor understanding of different types of abdominal wall hernias and their diagnosis and management. A study guide to aid learning was developed.
Results: By using the ‘TRACKER’ mnemonic – (targets, route of study, assessment activities, core information, key tips, educational opportunities, readable material) a study guide was developed to aid learning and understanding.
Conclusion: The ‘TRACKER’ mnemonic facilitates the design of a comprehensive study guide in a chosen area of the medical curriculum.
The impact of feedback on medical education
Najran P & Matharu G
Aims: To determine whether feedback given by medical students does improve the standard of education.
Methods: Students were given three lectures based teaching sessions on neck of femur fracture, ankle fracture and basic trauma management. They were then given a basic test and questionnaire. The feedback was noted and teaching was changed accordingly. The same test was given and the results had improved from the previous group.
Results: After the teaching sessions were delivered they were given a test comprising of ten questions in which the average result was 50%. The students suggested replacing lecture-based teaching with bedside teaching. The test results improved to 80%.
Discussion: This demonstrates the importance of feedback. Being dynamic in teaching and introducing different methods, this audit demonstrates how this can significantly improve teaching.
Conclusions: Introducing a variety of teaching methods is essential, especially when teaching surgical topics. Acting on feedback is essential, there are far too many occasions where feedback questionnaires are introduced but not acted on, this demonstrates how education can improve significantly by simply acting on feedback.
A Learner Directed Approach to Teaching Medical Students
Dulay GS
Introduction: When medical students are given control over the content of teaching sessions the educational format changes to a more learner directed approach (LDA). This approach aims to facilitate effective learning.
Aims & Objectives: To discover whether a LDA to teaching would be more effective than a traditional pre-formed lecture.
Methods: Groups of medical students were taught on topics using both a pre-formed lecture and a LDA. The latter entailed conducting a session based upon specific questions the students had about the topic from the outset. Formal feedback was subsequently sought and amendments made to the teaching.
Results: Students felt they gained more from the LDA. Furthermore, the undertaking of further independent learning was greater after LDA teaching sessions.
Conclusion: Students stated they gained greater educational value from teaching sessions that they were able to direct compared to delivery of a traditional pre-formed lecture.
Fluid balance knowledge in medical students can be improved using a multi-dimensional teaching intervention
Wilson J & Taylor MG
Background: Undergraduate experience in practical fluid prescribing is frequently reported to be sub-optimal. The aim of this project was to improve intravenous fluid prescribing by designing a final year medical student teaching programme which would: a) improve knowledge of fluid physiology, b) provide practical experience of fluid prescribing.