members’ posters abstracts Assessment Staff and Volunteer Evaluation of a Paediatric Postgraduate Clinical Examination Participant Evaluation of a Paediatric Postgraduate Clinical Examination A Chinoy, A Mathew A Chinoy, A Mathew A Chinoy, Department of Paediatrics, Worthing Hospital, Worthing, West Sussex, UK A Chinoy, Department of Paediatrics, Worthing Hospital, Worthing, West Sussex, UK Background: The MRCPCH Clinical is the final part of the Paediatric Membership exams with the Royal College of Paediatrics and Child Health (RCPCH) in the UK. This exam assesses whether candidates have reached the standard in clinical skills expected of someone entering their period of core specialist training. Hospitals are invited by the RCPCH to host these examinations, and do so with the help of suitable patients, clinical staff and volunteers. Methods: A questionnaire survey was conducted inviting all staff and volunteers who helped in the exam, qualitatively evaluating their views on various aspects of the examination day and their involvement. Participation in the survey was voluntary and completed questionnaires were anonymous. Results: Eighty-six percent of staff and volunteers completed the questionnaire (18/21). Assisting in training and education was the most popular reason for contributing in the exam (being given as a reason by 67% of responders). The opportunity to be involved in a potentially interesting day and that they were scheduled to help were other popular responses. Sixty-seven percent of staff and volunteers reported they had been ‘fully’ prepared for the day, with 33% feeling they were only ‘somewhat’ prepared. Eighty-three percent felt that their personal contribution to the running of the exams was ‘very useful’. All 18 responders agreed that the clinical exams had been ‘very’ wellorganised. Conclusions: It was pleasing to note that the staff felt their contribution to the day was ‘very useful’, an important facet to such a task where each member of the team needs to be felt valued and respected. That all 18 responders agreed that the exams were ‘very’ well-organised highlights a successful team effort and careful planning and implementation so that the day ran smoothly. As responses were anonymous, it is difficult to categorise whether those who had central roles in the running of the exam were better prepared than those involved more peripherally and as such it is important to note that a third of helpers only felt ‘somewhat’ prepared prior to the examination. This needs addressing for future examinations by more detailed briefing to further ensure smooth-running of the examination. Co-participation, by displaying appropriate intent, support and commitment from all participants, was pivotal to the success of this examination, demonstrating many of the ideals of communities of practice. Background: The MRCPCH Clinical is the final part of the Paediatric Membership exams with the Royal College of Paediatrics and Child Health (RCPCH) in the UK. This exam assesses whether candidates have reached the standard in clinical skills expected of someone entering their period of core specialist training. Hospitals are invited by the RCPCH to host these examinations, and do so with the help of suitable patients, clinical staff and volunteers. Methods: A questionnaire survey was conducted inviting all parents and children who participated in the exam, qualitatively evaluating their views on various aspects of the examination day and their involvement. Participation was voluntary and completed questionnaires were anonymous. Results: Thirty-five percent of families completed their questionnaire (42/120). Assisting in education and training was the most popular reason for participating in the exam, although 21% of participants thought that it ‘may help in getting better care’. The amount of time actually spent in the examination room by most children was thought to be ‘just right’ (88%). Hospitality issues such as the waiting areas, refreshments provided and care and consideration from staff and volunteers were rated very highly. All 42 responders reported that they would be happy to participate in these exams again. Conclusions: The limited response rate may not accurately reflect participants’ perspectives, with those less satisfied not responding, thereby skewing results. However it is encouraging that all responders expressed willingness to participate in future exams. Improvement in managing families’ expectations prior to the examination does seem necessary, but needs to be delicately balanced against deterring patients from participating. It is interesting that 21% of participants thought that involvement in these examinations ‘may help in getting better care’. This is particularly disappointing, as such exams rely on the goodwill of parents and their children, and one’s co-operation or refusal to participate does not have any implications on their future clinical care. Perhaps this needs further clarification when families are first approached to participate. Diligent preparation and efficient implementation, coupled with appropriate attention towards hospitality and information-sharing all contribute to successful clinical examinations, and is reflected when participants are willing to participate again. It is however important to ensure that parents do not feel under any obligation to participate, and the expectations of their experience on the day is appropriately managed. 86 ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts Does UKCAT Predict Performance in the First Year of an Integrated Systems Based Medical School Curriculum? K Hanlon, G Prescott, J Cleland, R KMacKenzie K Hanlon, Division of Medical and Dental Education, University of Aberdeen, Aberdeen, UK Background and Purpose: The UKCAT was introduced in 2006 as a selection tool for medical schools. UKCAT aims to predict future success as a doctor1, testing ability in the domains of Quantitative Reasoning, Verbal Reasoning, Abstract Reasoning and Decision Analysis. Previous assessment of predictive ability of the UKCAT has found it to be low2,3 but only in the context of pre-clinical curricula. Our aim was to determine if the lack of early predictive power of the UKCAT is constant across curricula by analysing performance on a traditional pre-clinical curriculum and an integrated, systemsbased clinical course in the same medical school. Methodology: Anonymised data was collected from students matriculated in 2007 and 2009. The 2007 cohort represented the traditional pre-clinical curriculum assessed by written exam only, whilst the 2009 cohort undertook a new, systems-based, clinically integrated curriculum assessed by both written and clinical OSCE exams. Spearman’s rank correlations were generated for each of the exam outcome measures. Linear regression analysis was performed using UKCAT total as predictor. Adjustment was made for the potential confounders of age, gender and previous graduate status. Results: Correlations between UKCAT scores and written exams in the traditional curriculum were very weak (between 0.2 and )0.2). This was found to be the same for the clinically integrated curriculum OSCE scores as well as written exams. Linear regression analysis demonstrated that, at best, UKCAT score explained around 5% of the variance in the traditional curriculum exam scores and 6% in the clinically integrated curriculum, even when the regression analysis model was expanded to include UKCAT domains and demographic data. Discussions and Conclusions: UKCAT domain and total scores did not predict performance in Year one on either a pre-clinical or a clinically integrated curriculum suggesting that it remains a poor predictor of success across both curricula. Given that UKCAT is intended to predict future clinical success it is interesting that it was a poor predictor of success in the clinical OSCE exam. This study is limited by the fact that all subjects attended first year at the same medical school, albeit in different year groups. It would be interesting to compare UKCAT and performance across a number of medical schools with very different curricula. Further research should aim to examine prediction of performance in later years of study. 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 the UKCAT predict Year one performance in medical school? Med Educ 2009;43(12):1203–9. 3. Yates J, James D. The value of the UK Clinical Aptitude Test in predicting pre-clinical performance: a prospective cohort study at Nottingham Medical School. BMC Med Educ 2010;10:55. Correlation among Medical Students’ Basic Communication and Physical Examination Skills Portfolios and OSCE and Written KnowledgeReasoning Exams R M Roger, L A Pérula, I Salido, I Morales, A Alba Dios, C A Taberne, F G Pasadas R M Roger, Department of Medicine, School of Medicine, Córdoba University, Córdoba, Spain Background and Purpose: Interest in the use of portfolios within graduate medical education has grown in Spain recently. This has been mainly because portfolios seems to have potential to encourage reflective practice and self-directed learning, they can be good tools for assisting formative assessment. Nevertheless medical educators highlighted the difficulties associated with the lack of standarization of their content and so their limit to be used as summative assessment. We developed a reflective portfolio as part of the student’s third year training in basic communication and physical examination skills. The aims of this study were to determine the reliability of assessment criteria (1) and to assess their correlation with other summative tests. Methodology: Portfolio was carried out by 160 students. We modified the Rees&Sheard (1) proposal for the assessment of portfolios. Those were evaluated by 2 raters (80/rater). Agreement between both raters was obtained in 30 portfolios by means of an intraclass correlation coefficient (ICC) for the total percentage and item scores and by Simple Concordance Index or Kappa Coefficient when possible, for the individual items. Spearman correlation coefficient was used to assess the correlation among the scores obtained in the portfolios and final medical written and OSCE exam. All these variables were categorized by quartils and compared 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 (9 maximum) 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 between portfolios and written exam was positive and significant: Spearman coefficient: 0.474 (P: 0.001). Quartils comparison was also significant (22.5; P: 0.007). There were no correlation between portfolios and OSCE: 0.023 (P: 0.780). Quartils comparison (9.72; P:0.37). Discussion and Conclusions: The agreement for the total scores for the assessment criteria was satisfactory, so these criteria could be used to discriminate reliably between low and high quality portfolios. Most of the students seem to have difficulties articulating a deep reflection upon their experience, but those that show these abilities also got the higher scores in written exams about knowledge and reasoning. Conversely there is no correlation among ability for reflection and practical skills scores. In this way the reflective reports of portfolio could be used as an additional tool for sumative evaluation of these domains but less for those related to practical skills. Reference: 1. Rees CE, Sheard CE. The reliability of assessment criteria for undergraduate medical students’ communication skills porfolios: the Nottingham experience. Med Educ 2004;38:138–44. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 87 members’ posters abstracts Modelling the Use of Confidence Intervals with the Borderline Regression Method for Final Year Undergraduate OSCE at the University of Southampton B 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 novel use of the confidence interval (CI) and standard error of the measurement (SEM) with the borderline regression method, in line with recommendations by PMETB/GMC,1,2 and in place of simple examiner global judgements. Methodology: Students must satisfy 2 criteria to pass the BM finals OSCE: aggregate score and minimum number of stations passed. The SEM has been equated with CI1 and applied to aggregate score3–5. We wished to introduce it into our examination, and also proposed a novel strategy to calculate the CI in the cut score for a single station. Using the standard error of the intercept and gradient we calculated the CI for these values, and used them in the regression equation to interpolate a new value of y when x is constant. We modelled these techniques to maximise the sensitivity and specificity of both criteria. Results: In a cohort of 242 students, 6 failed > 3 stations on global judgement. For 2 of them the mean grade was also below the threshold but none failed this criterion alone. Introducing borderline regression without adjustment, 23 students failed > 3 stations but none on aggregate score. Recalculating the aggregate pass mark as mean cut score plus 1.96 · SEM (upper 95%CI) considerably improved the sensitivity of the aggregate score criterion, which 6 students now failed. For individual stations, using the gradient and intercept minus 1.96 · SEM (lower 95%CI) provided an adjusted cut score for each and considerably improved the specificity of this criterion. Students failed if their actual scores were below the cut score for > 3 stations. Seven failed on this criterion. Considering both criteria 8 failed the OSCE, 5 of whom failed both criteria. Observed agreement with global assessments rose from 92.1% to 98.35% (Kappa 0.32–0.71). Discussion and Conclusions: The adjusted cut scores showed improved sensitivity and specificity for both criteria and improved agreement with global judgements. It was perceived to be fair to students, affording them the benefit of the doubt when considering individual stations, but protecting patient safety when decisions could be reliably based on 16 assessments. Since most students who failed did so on both criteria, the method was perceived to be more robust. The authors plan to remodel this on another cohort of students before considering incorporating into the exam regulations. References: 1. Postgraduate Medical Education and Training Board. Developing and maintaining an assessment system – a PMETB guide to good practice. PMETB 2007. 2. General Medical Council. Assessment in undergraduate medical education – Advice supplementary to Tomorrow’s Doctors (2009). GMC 2010. 3. Dauphinee WD., Blackmore D.E., et al. Using the Judgments of Physician Examiners in setting the Standards for a National Multicenter High Stakes OSCE. Advances in Health Sciences Education 1997; 2: 201–211. 4. Smee, S.M., Blackmore D.E. Setting standards for an objective structured clinical examination: the borderline group method gains ground on Angoff . Med Educ 2001; 35: 1009–1010. 88 5. Kilminster S., RobertsT. Standard Setting for OSCEs: Trial of Borderline Approach. Advances in Health Sciences Education 2004;9: 201–2097. Collaborating with Medical Students to Develop an Objective Structured Clinical Examination (OSCE) for Assessing Knowledge, Psychomotor and Affective Competence in Emergency Medicine J Acheson, R S Patel J Acheson, Department of Emergency Medicine, Leicester Royal Infirmary, Infirmary Square, Leicester, UK Introduction: ‘Tomorrow’s Doctors (2009)’1 outlines the General Medical Council’s expectation that graduates from UK medical schools should demonstrate competence in diagnostic and therapeutic procedures. Thirty-2 competencies are outlined and the challenge for institutions is to ensure methods for assessing these are robust and fit for purpose. The Objective Structured Clinical Examination (OSCE) is an assessment approach in which clinical competence is evaluated in a comprehensive, consistent, and structured manner2, using an examination format in which students rotate around a circuit of clinical task stations. Methods: A 10-station OSCE was piloted to assess the feasibility and utility of this form of assessment at evaluating the competence of students following an 8-week placement in the emergency department. A focus group with clinical skills staff and 10 volunteer students was conducted to inform the decision about whether a formal introduction of the OSCE into the curriculum should be recommended. Thematic analysis was used to code focus group data. Results: Students most valued the OSCE as an opportunity to participate in assessment as part of their preparations for finals. They disliked the set up in the suturing station, citing it was ‘too confusing’ and ‘encouraging bad clinical practice’. The clinical skills staff most valued the OSCE because it allowed them to contribute further to the placement, beyond their routine teaching roles. Clinical skills staff had previously used item checklists, however, and disliked the responsibility of using global rating scales. They felt uncomfortable making judgements about candidates, which could potentially affect their progression on the course. Conclusions: Valuable feedback could not have been obtained for evaluating the OSCE and facilitate a proposed introduction, without organising a pilot in collaboration with medical students. Inviting students to contribute their perceptions, and tailoring the assessment towards their needs as well as those of stakeholders, may increase it’s acceptance over the long-term. More data is required to improve reliability and validity of the OSCE before making an evidence-based judgement of it’s utility for assessing competence in emergency medicine. References: 1. General Medical Council. Tomorrow’s Doctors 2009 (www.gmcuk.org/Tomorrow_s_Doctors_2010.pdf_30373144.pdf). 2. Harden, R. M. What is an OSCE? Medical Teacher 1998; 10:19– 22. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts Does Medium Fidelity Simulation Training in a District General Hospital Improve Confidence to be a Part of the Medical Emergency Team (M.E.T): An Analysis of the Experience of Trainees Millar’s Pyramid Can be used as An Effective Guide in Assessing Authentic Performance of Consultation Skills in the Ambulatory Care Setting N Patravali, J S Ker A Leatherbarrow, W Dainty, M Cooksey, D Pandit A Leatherbarrow, Medical High Dependency Unit, Russells Hall Hospital, Dudley, West Midlands, UK Background and Purpose: Medium-fidelity simulation training is shown to improve a medical trainee’s ability to manage medical emergencies1. It is a highly effective educational tool but is also expensive and provides a sizable workload for medical educators. We have been running a simulation programme at this trust for the last 2 years with a SimMan to improve confidence of foundation year doctors to perform as part of the medical emergency team and assess emergencies at the front door. Methodology: During the 2010–2011 academic year we conducted several multi-disciplinary simulated training sessions covering the management of medical emergencies using SimMan3G. Scenarios were based in real life M.E.T. calls attended in the hospital. Hundred medical professionals were provided with questionnaires to complete following the sessions to assess their experience of simulated training. A 14 point questionnaire was utilised. Undergraduates were invited as a part of Simulation training using a video link and completed a questionnaire. An advanced nurse practitioner is involved in the sessions to initially assess the patient and then calls the candidate to assess the patient. Results: We had 81 responses. The majority of trainees had experienced < 3 simulated training sessions. Seventy-nine (98%) agreed that simulated training was beneficial to learning. Sixtythree (77%) agreed the scenarios accurately reflected acutely unwell patients. Seventy-five (94%) agreed the scenarios enhanced their ability to manage acutely unwell patients. Seventy-five (94%) agreed introducing simulated training as part of undergraduate training would be beneficial. Sixty (75%) would like simulated training used as part of the formal assessment of foundation trainees. Discussion and Conclusions: Our simulated training programme is well received by a range of medical professionals both post/ undergraduate. If offers a more realistic experience of medical emergencies in a protected non-threatening environment. It mimics the pressures of real world medicine while providing an environment where questions can be asked. Criticisms involved the inaccuracy of the scenario timescales (in relation to procedures and patient response) and that it is harder to assess the patient as they do not respond in a realistic manner. Candidates desired scenarios on reduced conscious level, arrhythmias and gastro-intestinal bleeds suggesting these are areas of trainee concern. We also utilised these sessions as a Case based discussion (CBD) to link in with trainee e-portfolios. We achieved good feedback from deanery foundation quality assurance visits and have shown better interaction between members of the M.E.T. We plan to roll out this programme to core medical trainees and also integrate this into inter-professional training (medical, nursing and physiotherapy students). References: 1. Ruesseler M et al. Simulation training improves ability to manage medical emergencies. Emerg Med J 2010 Oct;27(10): 734–8. 2. Miller MD. Simulations in medical education: a review. Med Teach 1987;9(1):35–41. N Patravali, Clinical skills Centre, University of Dundee, Dundee, UK Introduction: Millar’s Pyramid is a very useful model in explaining the levels of assessment of learning. Its phased structure allows effective assessment of students to achieve competence and performance authenticity. However it does present a challenge. Challenge to Assess Performance: ‘Performance’ is the ability to demonstrate skill in a real life situation. ‘Competence’ usually indicates what people can do in a contextual vacuum in near perfect conditions. Most undergraduate curricula for teaching and assessment of ‘competence’ for consultation skills use simulated environments reflecting the ideal context. To translate competence to performance with unequivocal results is hence a challenge. What Millar’s pyramid can perhaps be utilized for is developing a staged and 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 around basic 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, the students consolidate their knowledge going through various system-based blocks. They interact with patients using the ‘hot seat approach’. A formative assessment is carried out during the process by individual tutor feedback and peer review. It is subject to inter and intra observer variation, however through formatted teaching has achieved unequivocal results improving ‘face validity’. Proposal for assessment of Ambulatory care teaching as the next step towards ‘authentic performance’. ‘Shows how’: ‘Clinic Simulated environment’ at the end of 2nd year may allow assessing ‘Competence’. Assessment using remote videolink by trained assessors will reduce bias for ‘face validity’. Realism involved allows reliable ‘Predictive validity’ towards performance. This opportunity can be used to dictate research in performance indicators for work-based assessments as part of continuous professional development. ‘Does’: This final frontier to test ‘authentic performance’ may be assessed in students progressing to 3rd year. The designed work based assessments can be used to assess consultation skills in the real 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 achieve authentic performance in Ambulatory care setting. Its usage at the moment is inadequate to assess and convert ‘competent’ individuals to ‘performers’. The above-proposed model may facilitate this transition with complete utilization of the pyramid. This will also help overall development by improving interprofessional learning. Achieving high performers as end products can implement positive changes in the health sector improving patient 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 medical teachers. Elsevier, Churchill, Livingston. 3. Collins JP & Harden RM. 1999. The Use of Real Patients, Simulated Patients and Simulators in Clinical Examinations. AMEE Guide 13. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 89 members’ posters abstracts 4. Dent JA, Ker JS, Angell-Preece HM, Preece PE. Twelve tips for setting up an ambulatory care (ou tpatient) teaching centre. Med Teach 2001; 23: 345–350. 5. Jennet P. Chart stimulated recall: a technique to assess clinical competence and performance. Education for General Practice 1995; 6: 30–34. The Effects of Examiner Training on Self Confidence in Long Case Assessment S Atkinson, A Levy S Atkinson, University of Bristol, Centre for Medical Education, Bristol, UK Background and Purpose: Of all clinical assessment formats used in undergraduate medical education, the validity of the long case is recognised as high1. Arguments that inter-case reliability is questionable compared to OSCEs are debatable: both methods can be shown to exhibit similar reliability2, 3. To try and further improve the reliability of the assessment, a series of examiner training sessions were carried out and the effects of training on self confidence and perception of ability to make appropriate decisions assessed using a feedback tool. Methodology: In each of our clinical academies training sessions were offered to long case assessors. Three assessment tools were demonstrated: 1. Clerking proforma, with a series of aide memoires and key questions for assessors to consider. 2. Long Case Descriptors allowed assessors to grade faults on the basis of major and minor criteria, the former being omissions or misinterpretations that compromise patient safety or hinder a correct diagnosis and management. 3. Behavioural Indicators4, brief descriptors of positive or negative behavioural traits in a candidate, addressing such areas as empathy and sensitivity, communication skills and professional integrity. A series of video clips of senior students collecting the ‘History of presenting complaint’ under real test circumstances were then shown, for assessors to consider as a group. Feedback was collected after the 3 hour session. Results: Feedback identified several outcomes of assessor training: 1. The confident assessor, who as a result of training became more cautious and more questioning of the validity and reliability of the Long Case assessment; 2. The initially unsure assessor, who became more confident in their judgements after training; 3. The initially unsure assessor, whose confidence remained low or further diminished as a result of the training; 4. The confident assessor, whose confidence in their judgement was confirmed by the training. Discussion and Conclusions: In a recent GMC visit, overwhelming emphasis was placed on exam reliability over high validity. Part of the problem may be negative perceptions of the Long Case, encouraged by opinion leaders 5, 6 . We believe that qualifying in medicine without being assessed clerking real patients is anomalous. There is evidence that reliability can match that of the currently preferred OSCE format, given appropriate modification and rater training7, 8, 9, 10. Further work will quantitatively address this, but it also seems crucial to review assessor attitudes and confidence: a statistically reliable assessment must also be perceived to be so. 90 References: 1. Ponnamperuma GG, Karunathilake IM, McAleer S, Davis MH. The long case and its modifications: a literature review. Med Educ 2009; 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 findings from 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 Bulletin 31:342–344. 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 – Improvement of validity and reliability. International Journal of Osteopathic Medicine 2008; 11(4): 137–141. Basic Science Education Promising Findings for Additional Mediators of Human Melanocyte Senescence C Asher, D Bennett C Asher, Woodley, Berkshire, UK The best established familial melanoma locus CDKN2A, encodes 2 mediators of cell senescence, p16 and ARF. p16 at least is involved in the proliferative arrest of naevi (moles) – benign growths of skin melanocytes. p16 and the cell senescence barrier are lost in advanced melanoma. However this senescence is still not fully understood; it appears not to be mediated solely by p16, because although all naevi express p16, not all cells within a given naevus seem to express it. Accordingly it seems likely that there are other growth inhibitors involved. Growth inhibitors other than p16 may be additional mediators of human melanocyte senescence. My aim was to determine whether the expression of likely growth inhibitors (ARF, p27, p21, p15) rose as normal human melanocytes became senescent. These growth inhibitors were selected based on demonstration of growth arrest typical of senescence in murine studies and human fibroblasts. Subsequently, I would see whether similar tests on p16 deficient human melanocytes (which also senesce although after many extra divisions) would reveal even higher expression of the potential mediators. Normal and p16-deficient cells were grown, passaged and counted each time, until senescent. This was confirmed by using a stain for acidic b-galactosidase. The expression of potential growth inhibitors was investigated using immunostaining which was used to check the location of any inhibitor that was expressed. Results and Conclusions: These findings were the first association of ARF and p15 increase with cell senescence in normal human melanocytes. ARF was further elevated in senescent p16-deficient melanocytes, suggesting a secondary/backup role in senescence in the absence of p16. The results for p27 and p21 were relatively consistent with current evidence that suggests neither may be involved in human melanocyte senescence. This study suggests ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts novel candidates for additional mediators of human melanocyte senescence. Further research will help with the understanding of melanoma and perhaps diagnostic testing. References: 1. Hayflick L. The limited in vitro lifetime of human diploid cell strains. Exp Cell Res 1965; 37: 614–636. 2. Kong N, Fotouhi N, Wovkulich P, Roberts J. Cell cycle inhibitors for 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 human naevi. Nature 2005; 436: 720–724. 4. Gray-Schopfer VC, Cheong SC, Chow J, Moss A et al. Cellular senescence in naevi and immortalisation in melanoma: a role for p16? Br J Cancer 2006; 95: 496–505. 5. Mooi WJ, Peeper DS. Oncogene-induced cell senescence—halting 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 the primary clonal events? Pig Cell Mel Res 2007; 21(1): 27–38. 7. Bandyopadhyay D, Medrano EE. Melanin accumulation accelerates melanocyte senescence by a mechanism involving p16INK4a/CDK4/pRB and E2F1. Ann N Y Acad Sci 2000; 908: 71–84. 8. Bandyopadhyay D, Timchenko N, Suwa T, Hornsby PJ, Campisi J et al. The human melanocyte: a model system to study the complexity of cellular aging and transformation in non-fibroblastic cells. Exp Gerontol 2001; 36: 1265–1275. 9. Sviderskaya EV, Gray-Schopfer VC, Hill SP, Smit NP, EvansWhipp TJ et al. p16/cyclin-dependent kinase inhibitor 2A deficiency in human melanocyte senescence, apoptosis, and immortalization: possible implications for melanoma progression. J Nat Cancer Inst 2003; 95(10): 723–732. has produced an impressive range of online resources, ranging from granular assets, to more complex aggregations and discrete learning activities. A peer review process is underway to ensure that resources are quality assured, constructed to agreed technical standards and delivered in formats consistent with flexibility of use, technical interoperability, and accessibility. All resources are being metadata tagged and stored in an online repository accessible by the whole dental community; it is hoped this should ensure longevity. To date CLEO has delivered learning resources to underpin oral biology covering microbiology, physiology, histopathology, tooth development, and clinical procedures many of which would be of interest to medical teachers. Various resource types have been developed: interactive tutorials with built-in learning and self-assessment activities; interactive cases/virtual patients; highquality 3D animations; simulations of practical and clinical procedures; videos and histology/pathology resources based on the use of a virtual microscope. Discussion and Conclusions: The CLEO model is an example of how multi-institutional collaborative development and sharing of high-quality, peer-reviewed digital teaching and learning resources can be achieved in support of dental education. Evaluations of educational effectiveness and impact are under way. The usefulness of this approach as a model for supporting medical education should be considered. Clinical Skills Do Student Assistantships Help Achieve Practical Skills Outcomes from Tomorrow’s Doctors? S Sihota, D Blaney, A Brown Collaborative Development and Sharing of Undergraduate Digital Teaching and Learning Resources Across Scottish Dental Schools – a Model for 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 that Scotland’s 3 dental schools and the Postgraduate Dental Institute were making little use of online teaching resources and that there was a strong willingness to collaborate in their development and share the outputs. Anecdotal evidence suggests that this trend may also be apparent in related healthcare areas such as pharmacy and allied healthcare professions. The Collaborative Learning Environment Online (CLEO) project funded by NHS Education for Scotland (NES) aims to stimulate collaborative development, ensure best practice and enable sharing of new online healthcare resources. Methodology: Specific discipline and pedagogic expertise is available in Aberdeen, Dundee, Glasgow and Edinburgh dental schools. Following negotiation and agreement, all Scottish Dental Schools have agreed to work together to prioritise areas of the dental curriculum where the creation of on-line resources would have most benefit across Scotland. Each school, aided by an academic dental teacher and learning technologist is leading in the development of specific resources in line with their particular expertise to collaboratively ensure that the dental curriculum is supported and the student learning experience is enhanced. Results: CLEO is now well developed with strategic, operational and financial management structures in place. The collaboration S Sihota, Hull York Medical School (HYMS), University of York, York, UK Background: Tomorrow’s Doctors 2009 lists diagnostic and therapeutic procedures that students should achieve by graduation. It recommends final year students having at least 1 Student Assistantship (SA) where ‘assisting a junior doctor’ they undertake ‘most of the duties of an F1’ and where ‘students must use practical and clinical skills’. HYMS final year students have 3 8-week SAs in General Medicine, Surgery and General Practice where, under supervision, they manage patients and are expected to consolidate these procedures and skills through this real patient management experience. We explored HYMS students’ experience of these skills during their SAs to see whether these outcomes are achieved during these placements. Methodology: Questionnaires are being distributed to final year students asking about their practical procedure experience gained during their SAs. The list of 36 practical procedures is based on the Tomorrow’s Doctors 2009 list. A baseline questionnaire at the start of the year is being followed by repeat questionnaires after each of the 3 SAs. In addition to estimating the frequency of how many times each procedure is performed, students are also being asked to selfrate their competency. Results: The baseline skills data has been grouped into 4 categories based on the median number of times each procedure had been performed; from the least where the median = 0 to the most where the median was > 10 with skills examples given. 1. Median = 0. 20/36 skills, predominantly therapeutic skills e.g. nebuliser administration, nasogastric tube insertion, catheterisation. 2. Median > 0 and £ 5 ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 91 members’ posters abstracts 10/36 skills, a mixture of diagnostic and therapeutic skills, e.g. fingerprick glucose measurement, i.v. cannulation, instructing inhaler technique. 3. Median > 5 and £ 10 3/36 diagnostic skills: body temperature measurement, pulse oximetry, multistix urinalysis. 4. Median > 10 3/36 diagnostic skills: automated device and manual blood pressure measurement, venepuncture. Self-rating as ‘competent to perform procedure without supervision’ improved from group 1 to 4, with mean percentages for each group being 12.5%, 50%, 91% and 97% respectively. Conclusions: The results show students have limited experience of a large number of procedures on commencing the final year; these are mainly therapeutic procedure skills. As expected their selfrating of competence is lower in these. The SAs, where students are directly involved in patient care management, should therefore provide the ideal opportunity to achieve these. Subsequent questionnaire 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 Help Structure A Learner’s Personal Development Plans and Self-Directed Learning – A Pilot Study SDL around on their PDP. One Foundation trainee went further and added a reflective learning log of the learning activities and a peer/tutor feedback form. Discussion and Conclusions: Learners who want to add structure to their PDP and SDL will benefit from using this approach. However, this approach may be viewed as being overly focussed on what the learner desires to achieve in their PDP and may hinder reflective thinking and evaluation of the learning that fell outside the curriculum. We suggest that adding a reflective learning log of the learning activity will help document the quality of learning and encourage reflection. The time required to build a curriculum map depends on how detailed the curriculum items were. The curriculum map should be updated whenever the PDP of the learner change. We recommend that learners should be given guidance prior to developing their personalised curriculum maps. References: 1. The Foundation Programme Curriculum 2010, UK Foundation Programme 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 [Accessed 8 Feb 2011] URL: http://www.copdend.org.uk/download/Dental%20 Foundation % 20 Programme % 20 Curriculum.pdf. 3. Knowles M., 1975, Self-directed Learning: A Guide for Learners and Teachers. New York: Associated. 4. Tso S, Using curriculum mapping to help self-directed learners to structure their learning. Abstract presented at the 8th Asia Pacific Medical Education Conference, 2011. S H Y Tso, E C Y Tiong S H Y Tso, Academic Foundation Year 2 Trainee, Whipps Cross University Hospital NHS Trust, Leytonstone, UK Background and Purpose: UK Foundation doctor and dentist training are based upon their respective prescribed frameworks1, 2 . These newly qualified graduates are encouraged to devise their non-curricular personal development plans (PDP) and record their PDP into their learning portfolio. At the Asia Pacific Medical Education Conference 2011, we demonstrated the concept of using a learner-designed curriculum map, based on Knowles’ five step model of self-directed learning3, can be used to help learners to structure, monitor and evaluate their selfdirected learning (SDL)4. This pilot study looked at the application of this concept into portfolio learning where curriculum mapping is used as a tool to help structure SDL around the 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 on the objectives. Step 4: The curriculum map is used to map out the curriculum items (the desired learning outcomes) that would be met through carrying out the learning activity. This facilitates reflection and planning of learning. Step 5: The curriculum map profiles of individual learning activities are combined to produce a summary map. This illustrates the learning that has occurred over a period of time and facilitates monitoring and evaluation of learning. Methodology: Two Foundation trainees applied the concept of using a personalised curriculum map to structure their SDL around their PDP. Results: The Foundation trainees designed their own curriculum maps and found them helpful in structuring and evaluating their 92 Comparison of Medical Student Feedback When Taught by Pedagogical Versus Andragogical Methods A Leahy A Leahy, Respiratory Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK Background: Traditional medical teaching favours a high lecture component. This pedagogical approach is teacher dominated, and the students remain relatively passive. In contrast, andragogical teaching emphasises active and participative learning by the student. Aims: The author wanted to compare student feedback when the same topics were taught in lecture form compared with a student-centred approach, involving regular learner activities. Methods: Two lessons were prepared on pleural diseases, lasting 1 hour, covering the same topics, and involving the same teacher. Sixty third year Bristol medical students were allocated either lesson, with 30 per group. The pedagogical lesson was in lecture format with PowerPoint slides, and no student interaction. The andragogical lesson included teacher talk mixed in with various student activities including; completing request forms for pleural fluid, marking diagrams where to site drains, case studies with audience voting, and creating posters about exudates and transudates. Evaluation questionnaires were collected from students. These used rater scores (ranging from 0 = strongly dissatisfied through to 5 = strongly satisfied) and qualitative responses about the sessions’ quality, usefulness, and least useful aspects. Results: Average rating out of 5 for session quality was 4.8 for the active teaching and 3.0 for the lecture. Despite both sessions having ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts the same topics and length, students complained of feeling rushed and unable to consolidate learning during the lecture. The active learners were extremely satisfied across all evaluation aspects, with average score of 4.8, and they had no negative comments. The teacher noted that active teaching students had increased energy levels and enthusiasm for the subject. Those in the lecture group failed to stay interested and concentrate over an hour. Conclusions: The average person can concentrate on subject matter for about 5–15 minutes (Fontana, 1995). It is difficult for any student to remain focussed during a 60 minute lecture. During the interactive session, the students were fully participative, making their own decisions, and were more enthused and attentive than the lecture group. It will be interesting to compare the difference in learning between groups receiving either lesson in the future. Reference: 1. Fontana D. Psychology for Teacher. London: MacMillan and BPS Books, 1995. Curriculum Planning of a team; despite understanding the MDT approach. Heavy service-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 these conditions, we need to identify ways to be more inclusive of students within our clinical teams. References: 1. General Medical Council. Medical students: professional values and fitness to practice. Guidance from the GMC and the MSC. 2009. London. http://www.gmc-uk.org/Medical_students_2009.pdf_27494223.pdf. 2. Teunissen PW, Westerman M. Opportunity or threat: the ambiguity 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 Kingdom medical schools. BMJ 1996; 312: 885. 4. Goddard AF, Hodgson H, Newbery N. Impact of EWTD on patient:doctor ratios and working practices for junior doctors in England and Wales 2009. Clin Med 2010; 104:330–5. Positive 3-Year Outcomes of a Clinical Introductory Attachment for Second-Year Medical Students Pre-Clinical Student Perceptions and Expectations of Upcoming Clinical Placements J Wright, S Mallappa, J Thompson, A Jethwa, J Pitkin, R Soobrah V Vijayakumar, O Edafe, D Bee J Wright, Undergraduate Department, Northwick Park Hospital, Harrow, UK V Vijayakumar, Academic Unit of Medical Education, University of Sheffield, Broomhill, Sheffield, UK Aims: For over a decade, UK universities have introduced undergraduate medical students to clinical medicine during their first 2 years of study. The GMC has set out professional values and behaviour expected of students when working with multidisciplinary team (MDT) colleagues. It is necessary they respect the skills and contributions of other professionals, and develop effective communication with the MDT and patients [1]. Hospital attachments can be organised to create a supportive learning-environment and aid future transition [2]. We aimed to evaluate the 3-year outcomes of a clinical introductory attachment for second-year students, during a period of curriculum change. Methods: A total of 149 second-year medical students completed a 3-week attachment at our trust hospitals between 2008 and 2010. They attended MDT meetings, ward rounds, sessions with healthcare professionals and visited hospital departments. They also participated in small-group tutorials and skills-laboratory sessions. Students were asked to complete an end-of-attachment feedback questionnaire. Results: Fifty-seven percent of the group were male. Nearly all students (98.3%) thought the attachment was helpful or relevant to their training. Eighty-six percent rated their learning experience as ‘enjoyable’; 94.2% understood the importance of an MDT approach in patient care; 91.3% understood the roles of healthcare professionals. Throughout the 3-year period, despite curriculum change, annual trends were similar. Before starting their attachment, 15.2% felt apprehensive; this reduced to 1.0% post-attachment. However, over half (51.8%) did not feel part of a team during their attachment and 6.7% (n = 10) felt unsure they would continue their medical career. Conclusions: Early clinical introductory attachments in a medical student’s career can facilitate enjoyable and relevant learning experiences. This study illustrates consistently good feedback received from our students. Since an estimated 12% of medical students ‘drop-out’ of university [3], these clinical attachments may allow timely recognition of students who do not wish to become doctors. A significant proportion of our students did not feel part Introduction: The transition period from the preclinical phase to clinical years is a time of stress, uncertainty and difficulty amongst medical students1. Various retrospective studies have identified common themes in these groups including anxiety, lack of preparation and abrupt transition1,2. However few perspective studies have 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 the University of Sheffield. Using convenience sampling we identified 28 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 different researchers, and open questions were used to gain students’ opinions. Content analysis was used to identify common themes in each group. The recordings from the groups was independently analyse by the 4 different researches to improve the inter-rater reliability. Results: There were similar numbers of males and females in each group and we gained appropriate contributions from all individuals in the group. Through discussions, we reached consensus on clustering various themes identified into a groups. We identified workload & time, anxiety, interactions between medical professionals, management of course, lack of clinical skills and knowledge and travel & cost as issues. Conclusion: Themes that were elicited from the focus groups reinforced many already identified in the literature like anxiety and workload1, 3, 4. However we did discover new themes like travel cost and organisation of clinical placement. Although plenty of time is spent by the faculty to address these problems, we felt that more student contribution to the planning of the clinical years can help ease this transition period. References: 1. Radcliffe C, Lester H. Perceived stress during undergraduate medical training: a qualitative study. Med Educ 2003;37:32–8. 2. Moss F, McManus IC. The anxieties of new clinical students. Med Educ 1992;26:17–20. 3. Prince KJAH, Boshuizen HPA, Van Der Vleuten CPM, Scherpbier AJJA. Students’ opinions about their ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 93 members’ posters abstracts preparation for clinical practice. Medical Education 2005;39:704– 712. 4. Van Hell EA, Kuks JB, Schönrock-Adema J, Van Lohuizen MT, Cohen-Schotanus J. Transition to clinical training: influence of pre-clinical knowledge and skills, and consequences for clinical performance. Med Educ 2008;42:830–7. International Medical Education Community- and Hospital-Based Teaching in the Medical Curriculum – Examples from Cuba and the United Kingdom J K F Wong, A Wylie J K F Wong, Department of Primary Care and Public Health Sciences, King’s College London School of Medicine, London, UK Background and Purpose: Medical schools in Cuba place a strong emphasis on community-based teaching within the main curriculum. In the United Kingdom, emphasis is placed on hospital-based teaching. Cuba’s healthcare system is successful in providing good healthcare to her citizens and with good outcomes. For example, in 2006, Infant Mortality Rate per One Thousand Live Births is the same 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 care to shift from the hospital to the community2, as well as primary care-led services commissioning3. This work forms the foundation for further research into community settings in which medical students can learn. Methodology: We reviewed the advantages and disadvantages of community- and hospital-based medical teaching from the literature and from staff experiences at the Department of Primary Care and Public Health Sciences, King’s College London School of Medicine. We also compared the community component of 2 medical curricula: Latin American School of Medicine (ELAM), Havana; and King’s College London School of Medicine (KCLSOM), London. Results: We noted that 1 of the major advantages of learning in the community is the development of the Five-Star Doctor4; namely being a care provider; decision maker; communicator; community leader and manager. These qualities enable 1 to meet the fundamental values of a good healthcare system: relevance, quality, cost-effectiveness and equity. The disadvantages of learning in the community include travelling, the varied standards of teaching received and the unpredictability of the cases encountered. The percentage of the medical curriculum spent in the community is approximately 20% at the turn of the century for ELAM5, and 14% for KCLSOM6. A major difference is the greater continuity of time spent in the community at ELAM compared with KCLSOM. Discussion and Conclusions: Community-based teaching provides a useful setting to develop the Five-Star Doctor and the role for doctors as ‘managers of resources, leaders in the public understanding of difficult and contentious issues, and innovators and integrators of new knowledge’7,8. Given the increasing role of the Community context in health care provision within the NHS, opportunities to increase community based teaching should evolve. Learning in the community, with clearly defined aims and objectives, may therefore increase significantly. However the actual and perceived disadvantages will need to be addressed. References: 1. UNdata Available at: http://data.un.org/Default.aspx. Accessed 1/8/2011, 2011. 94 2. Professor the Lord Darzi of Denham KBE. High quality care for all: NHS Next Stage Review final report. 2008. 3. Secretary of State for Health. Equity and excellence: Liberating the NHS. 4. Boelen C. World Health Organisation. The five-Star Doctor: An asset 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, Duran Garcia F. MEDICC Review: Cuban Medical Education: Aiming for the 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 doctors in changing times. Challenges of Continuing Medical Education in Saudi Arabia’s Hospitals A 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 expanding rapidly. However, the country is struggling to cope with the lack of competent health professionals. Continuing Medical Education (CME) encounters some challenges that hinder learning programme from responding appropriately to professionals’ demands and needs, and to the complexity of health care. Methods: The study used a mixed methods (qualitative and quantitative) approach. Depth, semi-structured interviews were followed up with a questionnaire (sent by email) listing all CME challenges identified by the interviews, asking participants to rank them. Sampling Seven public hospitals were selected from different geographical areas (N = 7). 1. Snowball sampling targeted 33 medical education representatives 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 and divided into 5 themes: 1. Health care resources Poor 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 programme Duplicated. Not at the level of staff. Don’t reflect staff and department needs. 3. Designing of learning programme Methods of identifying needs are limited. Activities are delivered using passive methods. Lack of planning and designing policy. Lack of formal written evaluation. 4. Staff Diversity of staff’s backgrounds and educational needs. Staffs lack interest to attend meetings. Resistance to changing performance. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts 5. Decision makers Lack of knowledge about needs. Exerting influence over programmes. Developing programme for the sake of reputation. Discussion: CME budget lacks transparency that may result in heavily reliance on pharmaceutical industry subsidy for CME events as well as to sponsor medical professionals’ trips. This may affect the quality of the events or cause bias. Staff diversity was a major challenge as they came from different training and educational backgrounds; however, learning programmes lacked needs assessment, resulting in activities that may be based on desires and wishes rather than on actual needs. Conclusion The study showed a strong correlation between the stakeholders’ lack of knowledge and support, and CME limitations, this primary problem as well received the highest ranking in the study. References: 1. Grant, J. Learning needs assessment: assessing the needs. BMJ 2002; 324:156–159. 2. AL-Fouzan, K. S. Continuing education needs as reported by 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 Saudi Council 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 Saudi nurses. Eastern Mediterranean Health Journal 2001;7:1. 6. Farooq, S. Continuing professional development for psychiatrists in developing countries. Adv Psychiatric Treat 2003, 9: 161–163. 7. Towle, A. Continuing medical education: Changes in health care and continuing medical education for the 21st century. BMJ 1998; 316: 301–304. An ‘Introduction to Theatres Workshop’ as a Teaching Tool for Medical Students Results: Consultant surgeons and medical students had similar opinions on what should be included in the workshop. Competencies rated most important were principles of sterile fields/ theatres and infection control, case preparation, surgical scrub technique, and theatre etiquette – these were subsequently selected as teaching aims for the workshop. The need for the workshop was reinforced by a perceived difference in current standards in the suggested competencies between medical students and consultants (mean difference 2.25/10). On delivery, a large majority of students agreed that the workshop was useful (87% rated the workshop as ‡ 7/10) and met the learning objectives (99% ‡ 7/10). Eighty-four percent stated that they 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 before any theatre experience. Discussion and Conclusions: Initial student feedback to this ‘Introduction to Theatres Workshop’ for medical students has been very positive. Over the coming months changes will be made in response to feedback and the workshop will be delivered to theatrenaive medical students. Consultant surgeons will be sent a further questionnaire to subjectively determine whether they feel there has been an improvement in medical student learning in theatre, and assessments 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 about infection 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 to Surgery. 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 theatrebased learning? Medical Education 2007;41(10):968–974. Students as Co- Educators Using E-Learning to Standardise Undergraduate Medical Teaching C Milner-Smith, O Jagger, J Williams T G Martin, D R Clarke, D J Bowrey C Milner-Smith, Smith Centre of Medical Education, Bristol, UK T G Martin, College of Medicine, Biological Sciences and Psychology, University of Leicester, Leicester, UK Background and Purpose: Attendance in operating theatres has long been part of medical school curricula. This can be an intimidating environment for medical students (1), and a lack of understanding of basic etiquette can be problematic for theatre staff. It has been shown that medical students also have a deficit in knowledge of principles of infection control (2), and therefore there is the potential for patient safety to be compromised. Whilst there is some evidence that formal teaching relating to operating theatre etiquette does increase student confidence, as well as enhancing enthusiasm for surgery as a career (3), there is a lack of validated teaching tools to deliver this information. Our aim therefore, was to design and deliver a workshop that could be validated as an introduction to operating theatres, as part of an undergraduate surgical placement at a UK medical school. Methodology: Input from previous research (4) and questionnaires sent to consultant surgeons and medical students were used to develop a workshop teaching plan. This workshop was delivered to 2 cohorts totalling 76 University of Leicester medical students undertaking a surgical placement. Feedback from the students was collected on a 10-point Likert scale questionnaire. Background and Purpose: In year three, as medical students we have the opportunity to develop innovative online learning materials as part of the Student Selected Components Programme providing opportunities for independent study and development of new skills. Our aim was to provide a core e-learning teaching resource for ear, nose and throat (ENT) that could be accessed by our peers on the Bristol Medical School online learning website. This would provide a standardised learning resource and address the variability in teaching that students experience because they are taught in unconnected geographically-dispersed NHS-based Academies1. Methodology: Results accumulated from qualitative research in the form of questionnaires identified that medical students prefer to learn in a variety of ways. Based on this, we produced a userfriendly, problem-based, interactive and clinically relevant tutorial, which builds upon and tests students’ knowledge. We developed the tutorial combining several tools: Final Cut2 to produce examination videos, Dragster3 to produce pictorial labelling exercises, and eXe4 to combine these elements alongside core text based materials. Results: Our tutorial received approval for both its design and medical accuracy. User-testing to date has received positive ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 95 members’ posters abstracts feedback. Students commented that it is a useful resource that they will incorporate into their studies because it fills the ‘gaps’ in their teaching. The tutorial will soon be accessible online allowing us to run more extensive user-testing and draw wider conclusions. The tutorial production process has been an invaluable learning experience. We have developed a range of skills including technological skills, project management, problem solving, collaborative team working and the ability to construct information in such a way that it can be used to teach others. Discussion and Conclusions: The tutorial provides students with a standardised ENT learning resource, providing reassurance that they are all receiving the same core teaching. The skills we have developed will be applicable throughout our medical career. In particular, all doctors have an obligation to teach and producing the tutorial has developed our skills as medical educators at an early stage in our careers. Following the success of our SSC, we believe the role of students as co-educators is important and one that should be expanded. Working with both clinical and e-learning experts in this way provides an effective example of students engaging in and influencing their own curriculum5. References: 1. Mumford D.B. (2007). ‘Clinical academies: innovative schoolhealth services partnerships to deliver clinical education’. Academic Medicine 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 Higher Education Academy Engineering Subject Centre Report http:// www.heacademy.ac.uk/assets/York/documents/ourwork/studentengagement/student_engagement_project_report_engsc.pdf Does Previous Degree Matter in GEP Courses? P Marvão, J Ponte P Marvão, Depto. de Ciências Biomédicas e Medicina, University of Algarve, Faro, Portugal The Medical degree in University of Algarve was the first graduateentry course with a 4-year, PBL-based curriculum in Portugal. We have students from different backgrounds and the question arose whether there would be measurable differences in academic achievements between different groups and whether those differences, if existing, would disappear during the course. We aggregated our first cohort of students (30), now in their second year, in 5 clusters: nurses (11), health technologies (3), biological sciences (9), psychology (3) and pharmaceutical sciences (3) and compared the results obtained in 3 different types of assessment. The first was a standardized progress test organized by the International Partnership for Progress Testing; the second was an OSCE with 12 stations 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 our first cohort of students and 2 progress tests and 10 WBAs for our second cohort. We found no significant differences in academic achievement between our 2 most numerous groups in the first 96 cohort in all progress tests but one. No significant differences were found in the OSCE and WBA. In the 2 first progress tests of our second cohort the results achieved by the groups of biological sciences and health technologies were significantly lower than the results achieved by the nurse’s group. The WBAs so far performed in the second cohort of students showed no significant differences. The results from our first cohort seem to indicate that a student’s previous degree has little or no effect on the overall academic results. The progress tests of our second cohort, on the contrary, suggest that previous degree may affect academic results, at least in that component. The explanation for this observation may simply be chance, due to the small numbers studied, or it may be due to the fact that the first progress test was applied to the first cohort in January while the second cohort had its first test in October, at the start of the course. We expect that, as further data is accumulated, it will become clear to what extent academic results in our graduate entry program are influenced by the type of degree the student obtained previously. Student Conferences: Unique Opportunities for Personal and Professional Development A Lawson McLean, C Saunders, L Hryhorskyj, P Palani Velu, K Hor A Lawson McLean, Edinburgh, UK Background: A career in academic medicine requires many skills which have been identified as fundamental requirements for junior doctors. A student-led academic medicine society, ATRIUM, organised an annual conference inviting medical student delegates from across the UK to present their research in a studentfriendly and accessible environment. We outline how participation led to the development of key skills and competencies for delegates and organisers, and investigate what students believe are the main incentives and disincentives of a career in academic medicine. Methods: The conference was held successfully in November 2010. UK-wide publicity led to 241 abstract submissions which, after anonymous marking, were accepted for 6 oral and 100 poster presentations. After the conference, questionnaires were given to participating delegates and staff to address the study’s objectives. Results: Feedback from completed questionnaires (n = 92) indicated that the majority of delegates were senior medical students who had previously completed an intercalated degree. Encouragingly, 85% of delegates felt that the Conference improved their confidence in presenting at national meetings. The main incentive identified by delegates for a career in academic medicine was a desire to carry out research, while the main disincentive was competing pressures between clinical medicine and acadaemia. Discussion: Organising and presenting at the Conference led to development of skills in key domains for both organisers and delegates. These are transferable to the clinical setting and will be useful for careers both in and outwith academic medicine. Therefore, we encourage students to attend and organise studentled conferences to enhance their professional and personal development. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts Management and Administration Leadership and Management Training: Are We Hitting the Mark? S Liu, Z Haider, G Gaskin S Liu, University College London Hospital, London, UK Background: It is well recognised that effective clinical leadership is closely linked to organisational performance1. As the NHS shifts into a period of growing uncertainty, effective clinical leadership is more important than ever. Increasingly there is recognition that leadership and management training needs to been incorporated into the medical curriculum2,3. However 1 of the challenges is how do we support the next generation of clinical leaders in developing the competencies necessary for their future roles. Today’s postgraduate medical training is evolving to meet these challenges but how closely are we meeting trainees’ needs and expectations? Objectives: To assess and determine how well trainees’ needs in leadership and management training are being met. To understand what aspects of leadership and management training are significant to trainees. Method: We conducted a survey of doctors across all disciplines in training positions between Feb 2010 and May 2010 in a London teaching hospital. Eighty questionnaires were sent out and in total 59 responses from doctors at various stages of training were received. Results: Sixty-four percent had been working in the NHS for over 5 years. Despite this level of experience only 1 responder felt that current post graduate training provided adequate leadership and management development opportunities. Informal and unstructured ‘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 management, financial flows in the NHS and building effective teams. Conclusions: These findings clearly indicate there continues to be a gap in post graduate clinical leadership and management training. It supports the need to continue development of training programmes to address the needs of tomorrow’s consultant. The findings also help to inform on some of the areas that need to be addressed. References: 1. Hamilton P, Spurgeon P, Clark J, Dent J, Armit K. Engaging Doctors: Can doctors influence organisational performance? : NHS Institue 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’s Fund, 2010. Leadership and Management Training: An Executive Shadowing Programme for Trainee Doctors Z Haider, S Liu, K Holroyd, G Gaskin Z Haider, UCL Partners Darzi Fellow, University College Hospital NHS Foundation Trust, London, UK Background: There is increasingly a ‘disconnect’ between doctors and medical management1. As future clinical leaders, trainee doctors will be expected to take an active role in developing clinical services. Unfortunately, trainees’ practical experience of service management 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 Shadowing Programme for trainee doctors (funded by an award from the London Deanery) between October 2010 and January 2011 at UCLH. Method: The programme was advertised to UCLH specialist registrars and 6 participants (level ST5 and above) selected. Following a 1 day introductory workshop, they were provided with a mentor and attended a variety of committees and clinical board meetings, the selection of meetings tailored to meet their individual learning needs. The trainees were asked to consider how actions are planned, monitored and outcomes evaluated, and how the Trust responds to and resources the healthcare needs of patients. Meetings with mentors explored these issues further and stimulated additional conversations. Trainees were asked to take their learning back to their clinical team. A final meeting attended by the trainees and mentors gave the trainees an opportunity to feedback about their experiences of the programme. Results: The feedback from the trainees was overwhelmingly positive. All said that they had a clearer understanding of the role of managers and the relevance of management to their own clinical specialties. Quotes included ‘I am much more aware of trust goals, PCT demands and clinical priorities’, ‘I feel inspired to take on a leadership role’, ‘I have a clearer picture of how management fits into my clinical work’. All enjoyed the practical nature of the programme; 2 trainees had taken up audit projects with renewed vigour, understanding more clearly their relevance. Others had applied their learning to pathway redesign. Suggestions for improvement of the programme were to increase the duration to 6 months and to require each participant to undertake a project during the programme. Conclusion: This programme has provided trainee doctors with a unique and low cost opportunity to learn about management within the Trust. Similar programmes in other trusts should be encouraged to enable doctors to gain a greater understanding of the role of management, address the learning needs of tomorrow’s consultants and reduce the disconnect between doctors and management. Reference: 1. Degeling, P, Maxwell, A, Kennedy, J and Coyle, B. Medicine, management and modernization: a ‘danse macabre’? British medical journal 2003; 326: 649–652. A Clinical Approach to the Management of Unprofessional Behaviour in Medical Students H Pascoe, J West H Pascoe, Medical and Social Care Education, Leicester, Royal Infirmary, Leicester, UK Background: The management of unprofessional behaviour in medical students remains challenging for UK Medical Schools but important to recognise and document as particular patterns of behaviour can recur during postgraduate practice (Papadakis et al. 2005). The GMC document: Medical students: professional behaviour and fitness to practise 2007 states that medical schools will decide if individual students are fit to practise by the time they graduate, that thresholds for unacceptable behaviour should be defined and decisions should be taken on a case-by case basis. Leicester Medical School has taken a diagnostic approach to the management of unprofessional behaviour in undergraduate medical students utilising a standardised referral tool and a team-based ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 97 members’ posters abstracts approach to guide decisions, similar to clinical triage and assessment services used in community settings. Methodology: An iterative approach was taken to establish a diagnostic process in an academic setting following literature review. A series of case-based discussions involving senior academic staff were used to define thresholds for intervention and categorised using a traffic light coding system. Anonymised past examples of student unprofessional behaviour were reviewed by clinical academic staff to obtain a consensus opinion on the structure and content of a reporting tool. Further consultation with students, NHS and administrative staff was used to determine usability and acceptability. The Leicester Medical School professionalism reporting form (Yellow Form) was launched in 2009 at the Medical School and all clinical areas. Results: The Professional and Academic Concerns group was established in 2009 to monitor the performance of students giving cause for concern and has evaluated 430 students to December 2010. The group meets regularly to consider all yellow form submissions, assigns and reviews codes and determines outcome based on the nature, severity and frequency of the concern raised for individual students. The group operates a range of interventions from written work to promote reflection on professional attitudes, through to sanctions including referral to Fitness to Practise proceedings. Conclusion: Leicester Medical School has successfully used a diagnostic approach based on a clinical model of care to improve the documentation and categorisation of unprofessional behaviour in medical students to facilitate early intervention and active management. Reference: 1. Disciplinary Action by Medical Boards and Prior Behaviour in Medical School. Papadakis MA, Teherani A, Banach MA et al. N Engl J Med 2005; 353:2673–2682. Assessing the Usefulness of the Professionalism Concerns Form H Pascoe, J West H Pascoe, Medical and Social Care Education, Leicester, Royal Infirmary, Leicester, UK Aims and Objectives: 1. To assess whether professionalism concerns forms are a useful indicator of summative assessment results. 2. To assess the difference in concern types between academically strong and weak students. 3. To assess whether there is a link between student concern coding and summative assessment result. Introduction: It is necessary to monitor medical students’ professionalism in order to comply with GMC guidance1. A professionalism concerns form, adapted from a reporting system used at San Francisco School of Medicine2, was introduced to Leicester Medical School 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, amber or red), subsequent action to be taken, and referrals to FTP/APC as appropriate. This study was carried out to assess the validity of these forms and concerns codes in predicting students who may be at risk of not progressing on the course. Method: First and Second Year Students were selected for study and were subdivided into those who had been satisfactory (n = 265) and those who were unsatisfactory (n = 159) in their most recent summative assessments. The concerns forms were then analysed to show: total number of forms received; and category of concern. 98 The concern codings for all students prior to their most recent summative assessment were also analysed to note the number of students in each group. Results: 1. Seventeen percent of students who were unsatisfactory received concerns forms, compared to 11% of satisfactory students. A chi-square analysis found a significant link between concern forms and summative assessment results. 2. The proportion of concerns forms received for ‘diminished relationships 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 for unsatisfactory students. 3. Twenty-seven percent of unsatisfactory students were already in the PACG system compared to 7% of satisfactory students. Of the coded students, 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 academic progression. 2. Students who fail to engage with the remedial process are more likely to be unsatisfactory at summative assessments. 3. The PACG system is identifying students who are likely to be unsatisfactory in assessments. References: 1. GMC. Tomorrow’s Doctors 2010. 2. Papadakis MA. A strategy for the detection and evaluation of unprofessional behaviour in medical students. Academic Medicine 1999; 74:980–990. Developing Quality Criteria for Practices Undertaking Undergraduate Medical Teaching in Scotland S Law, K Foster, F Garton, J Hamilton, C Jackson, N Merrylees, K Millar, 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 that aimed to offer a ‘bottom up’ approach to the development of quality standards in General Practice Undergraduate Teaching. Comment was made that ‘Quality’ was very much on the NHS agenda and that this approach was likely to be very productive. The Schools of Medicine across Scotland place medical students on attachment in general practice for varying periods of time, dependent upon their own curricula. While the School of Medicine in Edinburgh tends to place most students in the local area, the other Schools use practices throughout Scotland and there is significant amount of overlap in the sites used. Using different systems and personnel to approve these practices and tutors was, we considered inappropriate and wasteful of both time and resources. Methodology: A modified Delphi technique was used to undertake this exercise2. Participants, all experienced experts in approving undergraduate practices, reviewed their own processes and the literature3, 4 in the light of existing quality criteria4.5. Initial thoughts suggested the need to develop criteria which related to the Tomorrow’s Doctors Framework4, the NES Quality Framework for Postgraduate Medical Training and which were both practical and measurable. Subsequent meetings rationalised an initial list of items to a concise and workable framework. Results: Over a series of meetings and email discussions the group developed a set of criteria that sat under the headings ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts 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 develop quality criteria for the approval of undergraduate teaching practices. The tool is now used by all Departments as they approve and revisit undergraduate training practices. We plan to undertake an evaluation 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 New Collaboration: The Scottish GP Tutor Group presented at ASME, 2009. 2. Hsu C, Sandford B The Delphi Technique: Making Sense Of Consensus Practical Assessment. Research & Evaluation 2007; 12: 10. 3. Cotton P Developing a set of quality criteria for community-based medical education in the UK. Education for Primary Care 2009; 20: 143–51. 4. Boendermaker PM, Conrad MH, Schuling J, Meyboon De Jong B, Zwiersrta RP & Metz JCM Core Characteristics of the Competent General Practice Trainer, a Delphi Study. Advances in Health Sciences Education 2003; 8: 111–116. 5. General Medical Council Tomorrows Doctors General Medical Council 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 a Small 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 deliver medical undergraduate clinical programmes. Traditionally, district generals are perceived not to have a strong teaching pedigree. The capacity to accommodate students in outpatient clinics can be harder to arrange than in large ‘teaching’ hospitals. Pressures from the clinical workload on the teacher can prevent delivery of a useful experience. Teaching clinics, where patient appointment times are extended, have been advocated as good learning experiences. They certainly encourage active learning by the student,1 but have financial implications for the provider.2 The aim of this project was to evaluate present clinic activity, and to assess the possibility of setting up teaching clinics. Methodology: A simple questionnaire was given to every consultant in the general outpatients department in 1 week. The questionnaire asked about current attendance of students, and what they felt about students attending clinics in the future. There was an opportunity to express willingness to be involved in a teaching clinic. Results: Eighty-two percent of consultants replied. Twenty-seven percent were from visiting tertiary specialities. Every consultant felt students benefited from attending their clinic. One third accepted 2 students in a clinic, with only 1 speciality, saying they were too busy to accept students. Twenty-eight percent of those clinics who currently took 1 student, felt they could not accept any students. Students were expected to clerk and present the patient in half the clinics, the rest shadowed the consultant. One third of consultants said they had last seen a student in their distant memory, and this corresponded to an expression of preferring not to have students in clinic. No consultant said they saw students more than once a month. The biggest constraint to accepting more students was unanimously time, space, and overbooked clinics. Fifty percent of consultants would be interested in a dedicated teaching clinic. The willingness to consider a teaching clinic did not reflect current clinic teaching practices. Discussion and Conclusions: In our small hospital we have consultants who are willing to teach, including being involved in teaching clinics. Currently, service commitments inhibit them from teaching students even though everyone 1 agrees experience in the outpatient environment benefits students. As an educational provider we must continually reassess what learning opportunities we can provide. This may include the introduction of regular teaching clinics with reduced patient load. This project has proven the willingness of our teachers, and we need to consider how to utilise their enthusiasm and skills, in the organisation 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 patients in ambulatory (outpatient and general practice) consultations. Med Teach 2009 Feb;31(2):e24–31. 2 Stahl J, Roberts M, Gazelle S. Optimizing Management and Financial Performance of the Teaching Ambulatory Care Clinic. J Gen Intern Med 2003; 18:266–274. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 99 members’ posters abstracts Postgraduate Education Why Do General Practice in the Second Year of Foundation 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 expose junior doctors to community medicine to develop doctors suited to deal with the increasing primary care demands of an ageing population1. As part of course evaluation we assessed Foundation 2 doctor’s perspectives on their general practice placements, within non GPVTS training practices within Northern Deanery. Methods: Fifteen FY2 doctors were invited to complete a questionnaire exploring learning opportunities during their General Practice attachments. Questions were aimed at evaluating clinical support, teaching experience, workload and influences on career choice. Participants were encouraged to add free text comments. Results: We had a 73% response rate (11/15). Six had plans to apply to and 4 were considering general practice. No doctor had to work beyond the EWTD and they were all allowed to steadily increase their workload. All respondents stated that they had teaching directed towards their learning needs, with constructive feedback and adequate clinical support. Participants agreed that they had a better idea of the roles of the primary health care providers and how to work within a multidisciplinary team. During the placements trainees had the opportunity to take part in joint visits, IT training, and 90% completed an audit. All had their referrals reviewed and 90% had their medical records evaluated. Sixty percent reported experience of DOPS with 9 different procedures described. Hundred percent enjoyed their placement and stated they would recommend this attachment. Table 1: Teaching Methods used. Discussion: The results show that a high proportion of the doctors involved in general practice placements were considering this as a career, with 5 free text comments suggesting that the rotation had a positive effect on this career choice. Results found that doctors enjoyed having an influence on their workload and found the supportive atmosphere of general practice helpful in addressing their learning needs. Graded responsibility was appropriately given. Doctors had an array of learning opportunities available, including seeing patients in their home environment and observing healthcare at a primary level. Although DOPS are harder to achieve 100 outside of the hospital environment the survey suggests that there are opportunities within the community to fulfil the foundation curriculum. Conclusion: Community placements are felt to be increasingly important within foundation rotations as pressures on primary care increase. Responses to our survey show that they offer varied and high quality learning opportunities and enable foundation doctors to address their learning needs and fulfil curriculum requirements. Reference: 1. Professor John Collins, Foundation For Excellence: An Evaluation of the Foundation Programme, Medical Education England, October 2010. Foundation Doctors and Patient Death G T Linklater G T Linklater, NHS Education for Scotland, Roxburghe House, Aberdeen, UK Background and Purpose: Patients die. Care of the dying is recognised as important by the GMC and the Scottish Government.1,2 Many of the competencies identified within the Foundation Curriculum relate to care of the dying.3 We sought to perform an educational needs assessment to inform the development of an educational intervention for Foundation doctors based in the North of Scotland deanery. Methodology: A triangulated approach was used including a literature review, questionnaire survey, analysis of expert opinion and other published curricula. The postal survey was sent to all (n = 132) year one Foundation doctors in the North of Scotland deanery 6–9 months after they had started their Foundation posts. Results: The survey confirmed that exposure to death was common and distressing for junior doctors in the North of Scotland. Communication tasks around care of the dying were perceived as more difficult than practical tasks. Lack of support (particularly from consultants) and concerns about overtreatment were significant issues. The synthesised educational outcomes resulting from the analysis of the literature review, questionnaire survey, expert opinion and other published curricula are presented as per Harden’s 3-circle, 12-outcome model.4 Discussion and Conclusions: It is interesting to note that the needs identified from the questionnaire and literature review of junior doctor experiences relate more to emotional, analytical and personal competencies rather than cognitive or technical competencies. To address these needs, a small-group, case-based teaching intervention has been introduced to the North of Scotland Foundation teaching programme. This intervention has been positively evaluated, however, ongoing concerns around educational supervision, lack of support and negative role modelling may mean that any lessons learned do not transfer well into the clinical environment. References: 1. General Medical Council. The new doctor: Recommendations on general clinical training. 2006. 2. Scottish Government. Living and dying well: A national action plan for palliative and end of life care in Scotland. 2008. 3. Academy of Medical Royal Colleges. Foundation Programme curriculum. 2007. 4. Harden RM, Cosby JR, Davis MH, Friedman M. AMEE Guide N0. 14: Outcome-based education. Part 5. From competency to metacompetency: a model for the specification of learning outcomes. Medical Teacher 1999;21:546–552. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts Aspirations for Intensive Care Training in North West England J Bannard-Smith, R Clayton, M Holland, J Rogers J Bannard-Smith, StR Anaesthesia & Intensive Care, Department of Anaesthesia & Intensive Care Medicine, University Hospitals South Manchester, Manchester, UK Background and Purpose: Intensive care medicine (ICM) is a relatively young speciality in the midst of considerable political and organisational change. National bodies are striving to unify and standardise the speciality, not least in matters surrounding training. ICM trainees originate from a parent speciality and part of their training comprises an ‘advanced year’ as a senior registrar. This study sought to evaluate the advanced year in North West England and ask: how can advanced training be improved to ensure trainees are better prepared for consultant roles? Methodology: A panel of 35 experts was recruited. The definition of an expert was ‘any clinician with intimate experience or involvement in advanced ICM training’. The panel consisted of a mixture of trainees and consultants including some heavily involved in planning and delivering advanced training. Using the Delphi method, panellists anonymously submitted suggestions on how to improve advanced ICM training (Round 1). Panellists were then shown all suggestions (Round 2) and asked to score them (1–5; 1 = poor, 5 = excellent). Finally panellists were presented with suggestions with mean scores > 4.0 and standard deviations (SD) < 1.0 and asked whether they should be considered for implementation (Round 3). An agreement level of 75% for Round 3 responses identified suggestions for the final consensus view. Results: Round 1: 34 panellists (97%) provided 350 suggestions for change to advanced training. Analysis of common themes and repetitions by an independent researcher and the lead author refined this to a common list of 171 suggestions. Round 2: 29 panellists (83%) submitted scores. One hundred and thirteen 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 of 58 suggestions from Round 2 should be considered for implementation and formed the basis of consensus opinion. Of these 39 suggestions 14 related to improving the provision of non-technical skills training relevant to critical care; another 14 concerned the promotion and logistical organisation of the advanced year. Conclusions: The Delphi technique was useful in ascertaining a consensus expert opinion on how to improve standards in advanced training with local resources and experience in mind. Particular focus areas included non-technical skills training and refining the promotion, organisation and delivery of the advanced year. Work has begun on a trainee directed checklist to address these areas. We envisage a more diverse and holistic training experience resulting in Northwest trainees being better prepared for consultant roles. Simulation before Reality. A Practical Course in Endoscopic Simulation Prior to Endoscopy in Patients C Quah, E Wood C Quah, Barts & The London School of Medicine and Dentistry, Whitechapel, UK Introduction: Often endoscopy sessions are limited and time constrained thus restricting the number and range of trainees able to learn endoscopy; or trainees have other commitments limiting attendance to sufficient sessions1. Various studies demonstrate that endoscopy simulation improves hand-to-eye co-ordination and learning curves are reduced1, 2, 3, 4. We propose all endoscopy naı̈ve trainees must complete modules using endoscopic simulation (Simbionix GI Bronch Mentor) prior to performing endoscopy with patients – initially commencing on programmes for diagnostic oesophogastroduodenoscopy (OGD). Candidates include endoscopy naı̈ve trainees who are prospective Medical Gastroenterology or Gastrointestinal Surgical trainees, wishing to train in endoscopy at Homerton University Hospital NHS Trust. Objectives: 1. Introduce endoscopy-naı̈ve trainees to endoscopy. 2. Promote patient safety by ensuring trainees have basic skills prior to performing endoscopy with patients. 3. Promote educational excellence by increasing number of trainees 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 time Trainer: review trainees’ progress after each module, provide constructive feedback before trainee proceeds to next module Methodology: An experienced endoscopist presents an introduction to endoscopy to trainees via lecture format: including endoscopic equipment, safety, patient consent and safe sedation as per Joint Advisory Group (JAG) curriculum; followed by induction to the endoscopic simulator. Trainees complete assigned modules. Each module contains 4–5 cases for the trainee to practice endoscopy, taking approximately 45–60 minutes to complete allowing for practical endoscopy time and writing of report demonstrating management. Progress is reviewed by an experienced trainer (constructive feedback to improve performance5) at the end of each module via video-replay of performance. If progress is satisfactory and the programme of modules completed, trainees receive a certificate of simulation completion, and are assigned to a consultant-supervised endoscopy session, training with patients. Trainers assess further progress via double direct observed procedural skill (DOPS) assessment of trainee after 3 months of performing endoscopy with patients – aiming to perform approximately ‡ 200 OGDs, as recommended by JAG. If performance is acceptable and safe then the trainee is signed off (e-portfolio) and advances to other endoscopy procedures if desired (e.g. therapeutic OGD, flexible sigmoidoscopy). Conclusions: This scheme was commenced in December 2010 and endoscopy naı̈ve trainees are undertaking this training programme. Feedback from the trainees will be obtained after completion assessing if they found simulation and constructive feedback useful towards their training. References: 1. Clark JA, et al. Initial experience using an endoscopic simulator to train surgical residents in flexible endoscopy in a community medical center residency program. Current Surgery 2005 Jan–Feb: 62(1):59–63. 2. Cohen J, et al. Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointestinal Endoscopy 2006: 64: 361–368. 3. Gerson LB. Can colonoscopy simulators enhance the learning curve for trainees? Gastrointestinal Endoscopy 2006: 64: 369–374. 4. Haycock A, et al. Training and transfer of colonoscopy skills: a multinational, randomized, blinded, controlled trial of simulator versus bedside training. Gastrointestinal Endoscopy 2010 Feb: 71(2): 298–307. 5. Kruglikova I, et al. The impact of constructive feedback on training in gastrointestinal endoscopy using high-fidelity virtualreality simulation: a randomised control trial. Gut 2010: 59: 181– 185. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 101 members’ posters abstracts Selection Will Rising Tuition Fees Change the Demographic of Future Doctors and Dentists: A Survey of Current Medical and Dental Students? 4. Merani S, Abdulla S, Kwong JC, Rosella L, Streiner DL, Johnson IL, Dhalla IA. Increasing tuition fees in a country with 2 different models of medical education. Med Educ 2010 Jun; 44(6):577–86. 5. Jim Reed. New medical students could ‘face £70k debt’ [updated 08:57 GMT, Friday, 10 December 2010, cited 15 Dec. 10]. Available from: http://www.bbc.co.uk/newsbeat/11960783. R H Kassamali, R Faruque, V Kokotsis, N S Lee, G Pabla, A Song, M S Spears, M P Sutcliffe R H Kassamali, Academic Foundation Year 2, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK Background and Purpose: The recent government vote to increase tuition fees to a maximum of £9000/annum, will impact young people’s decisions to enter higher education. Students who choose to study medicine or dentistry could face £45 000 of student debt in tuition fees alone and an estimated £75 000 debt overall1. In the last 5 years the government has invested significant amounts of money to give opportunities to lower socioeconomic groups, and to maintain diversity between students, however these efforts could be wasted2. Will this increase in tuition fees during a time of global recession make low income students believe that a career in medicine or dentistry is unattainable? Will doctors and dentists of tomorrow originate from a socio-economic group that is not representative of the majority of patients they will be treating? Methodology: A questionnaire was distributed among students containing questions about current students background education, socioeconomic status, opinions on the tuition fee rise and their opportunity to study medicine or dentistry had this been the situation at their time of entry. A paper copy of the questionnaire was distributed in student recreational areas and an online copy was emailed out in a student bulletin. On completion of all the questionnaires a focus group with 10 students will be completed discussing options for students hoping to fund these high fees. Results: One hundred and twenty questionnaires have been collected to date and further responses continue to come in. Eighty percent of responses are from medical students, and 20% from dental students. Preliminary results show a very small proportion of medical and dental students are from the lowest socioeconomic group. The majority of students are against the tuition fee rise, however those students who have had state funded education in the past feel that these courses would have been unattainable had the costs been this high at their time of entry. Following the focus group, options for coping with these financial burdens will be presented. Discussion and Conclusions: The preliminary results show that a rise in tuition fees will change the demographic of medical and dental students. More students will come from independent schools rather than from state funded schools. This could have implications on the quality of future patient care. Forums and advice must be provided for students who feel that these careers are unattainable due to financial constraints. The government could develop a scholarship or 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/pressrel.nsf/wlu/RWAS-8AUJJM?OpenDocument&vw=wfmms. 2. BBC News. Access to medical school ‘not widening’. [updated 16 Dec 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 Singapore. Singapore Med J 2009 May;50(5):462–7. 102 Staff Development Staff Attitudes Regarding Self-Harm: Does Training Help? K Saunders, K Hawton K Saunders, University Department of Psychiatry, Warneford Hospital, Oxford, UK Background: The attitudes held by clinical staff towards people who self-harm (SH), together with their knowledge about selfharm, are likely to be important influences on their clinical practice and hence the experiences and outcomes of those they treat1. We sought to explore whether training in this area was associated with any improvements in attitude towards this patient group. Method: We conducted a systematic review of both qualitative and quantitative studies of staff attitudes towards and knowledge about people who engage in SH where staff were involved in the provision of services to them. A comprehensive search was performed of all relevant electronic databases. Results: Of 69 studies that explored staff attitudes towards patients who self-harm 10 reported the impact of training. A variety of training models were used but all focussed on risk factors and how to conduct an assessment rather than attitudes per se. Significant improvements in self-reported attitudes and confidence were reported with training in both general hospital and psychiatric staff in the majority of studies. Attitudinal change was sustained at longer term follow-up in one UK study even though knowledge had deteriorated. The only study that failed to show improvement following training only made use of a notice board and information folder suggesting that a more formal and interactive approach is required for training to be successful in changing attitudes. Discussion and Conclusion: The results provide support for the concept that improvements in knowledge and understanding can lead to the development of more positive attitudes towards patients. Formal training of all clinical staff in the management of self-harm is a specific requirement in the NICE guideline (2004)2 however, at present there is no nationally agreed framework or curriculum for this and existing training opportunities are often poorly attended due to the low value placed on this client group. The shift towards non-medical staff carrying the responsibility for frontline psychiatry is likely to mean that assessors are less likely to be aware of the evidence base or to have received formal training in the assessment of self-harm as part of their professional training. If we are to truly understand the impact of training more meaningful forms of assessment (e.g. patient feedback) should be used particularly given how difficult attitudes are to truly quantify. References: 1. Pompili, M. & Girardi, P. (2005). Emergency staff reactions to suicidal and self-harming patients. European Journal of Emergency Medicine 12(4):169–78. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts 2. National Collaborating Centre for Mental Health. (2004). Clinical Guideline 16. Self-harm: the short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. National Institute for Clinical Excellence. Hi Fidelity, Multidisciplinary Point of Care Simulation S Burnell, L Warnock S Burnell, Department of Anaesthesia, Betsi Cadwaladr University Health Board, Ysbyty Gwynedd Hospital, Bangor, UK Introduction: There is little doubt that simulation is a useful tool in reducing risk within high-risk industries. It allows for the repeated practice of rare or dangerous events in a risk free environment and enables the real life event to be dealt with on the foundation of detailed rehearsal. In-situ simulation, where the simulated experience takes place within the familiar workplace offers many potential advantages. Here we outline a programme of in-situ, multidisciplinary team based simulation in an actual operating theatre. The objective of the simulation was to train the teams to deal with demanding situations and to help develop standard operating procedures for different adverse incidents. Methods: Our hospital is a large, 550 bedded district general hospital in North Wales, UK. We have 11 operating theatres within the main theatre suite and a number of ancillary operating theatres throughout the site. During a period of shutdown for routine theatre maintenance, we utilised a vacant theatre and an adjacent anaesthetic room to run a series of simulated critical incidents. The theatre was equipped with permanent IP cameras, attached to MetiVision, a digital audio-visual system. We utilised a wireless METI iSTAN high-fidelity mannequin in a theatre that was fully equipped with all usual surgical and anaesthetic equipment. Prior to the entry of the multidisciplinary theatre team, the mannequin was draped and prepared for surgery, in an identical fashion to an actual patient. The scenarios used were total power failure, fire in the anaesthetic room and total pipeline failure. Simultaneously, in an adjacent anaesthetic room, the remainder of the theatre personnel were able to watch a live video feed of events within the theatre. The non-participants were tasked with creating a list of problems identified during the scenario, with potential solutions. The video recorded was used as part of a focussed de-briefing for the whole theatre team, targeting strategies for dealing with the simulated emergencies. Following the de-briefing, a further, identical scenario was run with a different group of individuals comprising the theatre team. A second de-briefing then took place. Outcome: For each simulation, the strategies for dealing with the emergencies will be used to develop SOPs. The organisation also benefits from an increase in familiarity, understanding and engagement of staff with SOPs. The training was extremely well received by all participants and was perceived as less threatening and more relevant than that occurring in a simulation centre. The Process of Creating a Postgraduate Taught Programmes Teaching and Learning Training and Resource Website S Coxall, J Boyd, H Broughton, H Lister, H Pugsley, N Webb, R Williams S Coxall, School of Medicine, Cardiff University, PGT Studies Office B2-C2 Corridor, Heath Park, Cardiff, UK Background and Purpose: The School of Medicine, Cardiff University delivers 21 postgraduate taught (PGT) campus-based and distance-learning (elearning) programmes across many disciplines, to over 1600 students per year. The programmes rely on a large number of tutors and lecturers, based in Cardiff and worldwide. Programme Directors expressed an interest in the creation of an online support, training and resources area for tutors. Creating this area will allow the training of tutors to be centralised and more efficient, therefore improving the learning experience for students and allowing tutors to feel valued. A crossschool working party consisting of academics, administrators and elearning specialists explored the needs of tutors involved in the delivery of PGT programmes and how best these could be met through online support. Methodology: A meeting was held of academic leads and administrators representing programmes across the School. Through a process of small group discussion activities they identified the characteristics of an effective tutor, a list of skills tutors should develop and what resources and information they require to be effective. These were prioritised and the results were circulated to all programme leads for comment. An online needs assessment survey was then made available to all individuals involved in teaching and learning. This requested prioritisation of features identified by the programme leads, to see if the tutors’ expected and actual needs were the same. Results: The 78 responses showed many similarities between what had been identified as the tutors’ expected needs and their actual needs. Areas highlighted as important included providing feedback effectively, facilitating online, delivering small group work sessions, developing study skills in learners, general information on aims and objectives of the programme and details of students’ educational backgrounds. Seventy-seven percent of tutors responded with willingness to undertake formal education for their skills development, preferably as an online course. Discussion and Conclusions: Based on the results of the survey, a pilot website will be developed containing programme specific information and teaching and learning resources related to the areas prioritised by the teaching teams and their tutors. Sixty-one percent of the respondents to the needs assessment have agreed to be involved in further consultations about the project. The long term plan will be to develop specific teaching modules to make an accredited programme. It is anticipated that we will report the findings from the pilot project in the poster at the ASME Conference in July. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 103 members’ posters abstracts GPs’ Confidence in Diagnosing and Managing Eye Disease: A Cross-Sectional Questionnaire Study in London S Nageshwaran, V Nageshwaran, S Nageshwaran, I Khan S Nageshwaran, Camden, UK Introduction: Around ninety percent of General Practitioners (GPs) have only received undergraduate ophthalmology experience and its inadequacy has been long established. NHS reforms pressing for cost saving practices from physicians have put an important emphasis on reducing inadequate referral to secondary care. Ophthalmology represents a small proportion of presentations to primary care, but accounts for a considerably large number of referrals. Studies to assess GPs’ confidence with eye presentations and the influence of this on their referral behaviour are lacking. 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 all participants. Access to and confidence in using basic ophthalmological assessment tools, training information and opinions on training 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 using them. Emergency and urgent referrals were seen to be more frequent for those conditions clinicians were less confident diagnosing. The difference in overall mean confidence scores for diagnosing eye conditions between those with (n = 2) and without (n = 27) postgraduate experience was of borderline significance (P = 0.1). Thirty-eight percent felt they were less confident with ophthalmology than other specialties, 66% stated that ophthalmology required a high level of technical expertise and 66% had received < 4 weeks of training as an undergraduate (n = 29). Conclusion: The data suggests that most GPs have brief experience in Ophthalmology as an undergraduate, may not be confident making basic Ophthalmological investigations and consequently exhibit low levels of confidence in diagnosing certain treatable causes of blindness. Our data also suggests that postgraduate experience may not affect GPs’ confidence in eye presentations. There seems to be a clear lack of high quality training in this specialty for prospective GPs. Educator Appraisal in the North Western Deanery S 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 to have an annual appraisal, conducted by their NHS employer. The appraisal should encompass all aspects of their role, including any educational elements. As the vast majority of consultants are engaged to varying degrees in medical education, as trainers, supervisors or managers, it is expected that their educator role should be appraised in some way. Deaneries must have structures and processes to support and develop trainers.1,2 A survey was 104 designed to gather information on educator appraisal within the deanery. Methodology: A survey of all hospital consultants in the North Western Deanery (NWD) was conducted to obtain data on educator appraisal. This online survey was conducted via a self-completion questionnaire, and data collected in a secure, anonymous way. The questionnaire was designed to collect both quantitative and qualitative data. Data was analysed to provide descriptive statistics to summarise the main features of the data set. Results: There was a response rate of 20.1%. Only 17.7% had been appraised for their educator role, yet 91% of those who had not had educational appraisal had received a NHS employer appraisal. Roughly half of educational appraisals occurred during NHS Employer appraisal, predominantly by Clinical Directors. Of those having an appraisal of their educational role, most had not used the appraisal guidance or documentation recommended by the NWD at that time. Of those that did almost all found it useful in helping to decide what evidence to collect. 93.4% rated their appraisal as moderately valuable or higher with 84.2% receiving constructive feedback to develop suitable goals. Three-quarters of appraisees felt reassured they were fulfilling their educational role. Similar numbers felt the process had helped them identify personal and trust/specialty educational development plans. Some appraisers may warrant guidance on accurately conveying appraisal outcomes. Discussions and Conclusions: Formal appraisal of the educator role appears to be a valued and key component of educator development. Uptake has previously been suboptimal. The NWD has now developed a simplified and specific appraisal framework www.nwpgmd.nhs.uk/edudev/edroles.html, together with workshops for lead educators to support development of educational appraisal within Trusts and Schools. The uptake is being monitored through the NWD quality management process. References: 1. General Medical Council. Standards for Deaneries. April 2010. 2. General Medical Council. Generic standards for speciality including GP training. April 2010. Development of an Interactive Suturing Skills Resource A Baker, F Grant, R Keenan, J Mann, A Renwick, M Vella, J Ker A Baker, Clinical Skills Managed Educational Network, University of Dundee, Ninewells Hospital, Dundee, UK Background: A key concept in the development of a Clinical Skills Programme is to create practitioners with skills appropriate to the health needs of the population, rather than the needs of the practitioner or the health care system. The concept of shared fields of practice, of which suturing is an example, requires collaboration and equity among health professionals. This ensures that the impact of change is for the benefit of the patient. One of the main criteria for the development of a suturing resource was that it would be relevant to all health care practitioners who have a requirement to carry out this skill as part of their care of patients in either a secondary or primary care setting. Methodology: An interactive online resource was developed to enable health care practitioners to enhance their knowledge, skills and competence in suturing skills. A standard development process ensures that resources are evidence-based and quality assured. An initial literature review was conducted and content was developed using an iterative process. Review of the resource was by an expert panel. The resource was ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts also developed with representation from the relevant professional groups from different geographic locations within Scotland. This maximises transferability and eases implementation of the skill. Results: The theoretical online resource is interactive and theoretical knowledge is assessed. The resource is also complemented by a series of workshops followed by a period of supervised practice within the workplace. Conclusions: A social constructivist approach to learning is used which builds on theoretical and simulated practice and assessment, to enable supervised practice in the workplace. This multi-professional clinical skills resource aims to establish a standardised training for learning suturing skills for medical, nursing and relevant allied health care professions. How Useful is Peer Led Education within the Undergraduate Medical Programme? A Qualitative Study into the Learning Experiences of Second Year Medical Undergraduates in a Single Institution B Cole, J Dalgleish, B Parsons, I Colville, S J Atkinson the most appropriate teaching methods to convey information most effectively. Conclusion We aim to report whether peer led education in medical undergraduate study allows students to develop their perceived teaching skills, meeting the guidelines in Tomorrow’s Doctors, as well as what additional benefits to intra and inter personal skills have accrued. References: 1. General Medical Council. Tomorrow’s Doctors. London: General Medical Council, 2009. 2. Dandavino M, Snell L, Wiseman J. Why medical students should Learn How to Teach. Medical Teacher 29(6):558–565. 3. Knight AM, Carrese JA, Wright SM. Qualitative assessment of the long-term impact of a faculty development programme in teaching skills. 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 development program in teaching skills. J Gen Intern Med 2005;20:721– 725. 5. Busari JO, Scherpbier AJ. Why residents should teach: A literature review. J Postgrad Med 2004;50:205–210. 6. Cate OT, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Medical Teacher 2007; 29: 591–599. B Cole, Bristol University, Centre for Medical Education, Bristol, UK Background/Purpose: Tomorrow’s Doctors1 emphasises the need for teaching skills in medical graduates. Numerous studies have shown peer led education to be a vital tool for the development of these skills. One such study2 identifies how peer led education develops teaching skills in medical students. It stipulates that peer led education allows students to gain a better understanding of teaching techniques, allowing them to become more effective learners, enhancing communication skills and improving their ability to interact with medical professionals and patients. This qualitative study evaluates the expectations and experiences of medical students undertaking the Student Selected Component: Peer Led Sex Education (PLSE) in the context of future benefits to their career. Methodology: Data was collected from 19 Y2 University of Bristol medical undergraduates studying PLSE. Common pre-course goals were identified using data from initial expectations forms which outlined what students wished to gain from the programme. Postcourse data was provided by reflective accounts of student learning throughout the course. Through evaluation of these accounts we identified common themes relating to the teaching and other skills gained. These were then compared to the initial expectations, identified at the commencement of the course and conclusions were drawn regarding the effectiveness of peer led education in developing students’ teaching skills, as well as what other perceived benefits students had gained. Results: Previous studies might lead us to expect benefits to the students beyond an immediate improvement in their skills as teachers.3,4 We expect to complete our analysis in the coming month. Based on previous studies,5,6 we anticipate that students might feel more confident to discuss sensitive issues with peers, a skill of importance in their future careers when dealing with patients. We might also find that students perceive learning in small groups to be more effective than conventional lecture-based teaching. Due to the peer led nature of the course, students may find that they are able to learn more effectively as they understood the bases of teaching methods being employed and how to adapt their learning to gain the most from them. Similarly, by understanding optimal conditions for learning, they may be able to adopt Student Support Effects of Pregnancy and Parenthood on Studying Medicine K Khadjooi, P Scott, L Jones K Khadjooi, Hull York Medical School, York, UK Background: Medical training is demanding and medical students are faced with numerous course-related stressors such as role overload, numerous assessments, placements, financial difficulties and career choices. This psychological morbidity can potentially be exacerbated by responsibilities for a child. The impact of pregnancy and parenthood on progression and matriculation of medical students has not been adequately addressed and the purpose of our study was to explore this impact. Methodology: Using self-completion questionnaires, we conducted a study of medical students and newly qualified doctors (FY1) from a UK medical school to assess the impact of pregnancy and parenthood on studying medicine and explore students’ opinions, choices and attitudes. Results: Total participants were 174 with age range 18–44. Table 1 shows the demographics. 77.6% of respondents believe that the decision to have a child is influenced by studying medicine. Twentythree percent have delayed becoming a parent and 7.5% have chosen not to have children because of medical training. The most common factors considered as a barrier for a parent/pregnant medical student are: 1. Lack of time 2. Financial difficulty 3. Stressful, demanding and lengthy nature of the course 4. Difficulty striking a balance between academic and social life Among other factors, career progression, dispersed geographical nature of the course, childcare and welfare of child, lack of peer support and fear of discrimination in job applications and interviews are notable. Female students feel particularly under ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 105 members’ posters abstracts Figure 1: Demographics of study participants. Sex Year of study Current marital status Pregnant or parent students (either the student or the partner) Male F e m a le Unanswered Year 1 Year 2 Year 3 Year 4 Year 5 Newly Qualified Unanswered Single M a r r ie d Living with partner Separated Divorced Unanswered Pregnant during study 24.7% 7 4 .2 % 1.1% 17.8% 1 7 .8 % 20.7% 19% 17.2% 5.8% 1.7% 74.1% 7 .5 % 16.1% Currently have children Planning to have children in the near future 7.5% L 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 21.3% L Jawaheer, Royal Bolton Hospital, Bolton, UK 0 0.6% 1.7% 6.9% Teaching about Specific Subjects Ophthalmology Teaching in Medical Schools pressure by the burden of raising a family and many feel that taking time out may jeopardise their career and they have to choose between career and parenthood. Only 9.2% of respondents are aware of support systems available for pregnant/parent students. In our students’ opinion, studying medicine has implications on other aspects of their life: decision to marry, choice of partner and number of children they plan to have. Discussion: The impact of pregnancy and parenthood on studying medicine is undoubtedly significant and considering more and more 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/pregnant students in learning, additional or specialised support should be provided, including: 1. Flexibility in programs and placements 2. Faculty support 3. Specific psychological and academic counselling services 4. Sufficient and affordable childcare facilities 5. Providing information about available support systems and financial entitlements for parent students (e.g. childcare funding). References: 1. Guthrie EA, Black D, Shaw CM, Hamilton J, Creed FH, Tomenson B. Embarking upon a medical career: psychological morbidity in first year medical students. Med Educ 1995;29:337– 41. 2. Firth J. Levels and sources of stress in medical students. BMJ 1986;292:1177–80. 3. Malik S. Students, tutors and relationship: the ingredients of a successful student support scheme. Med Educ 2000;34:635–641. 4. www.nus.org.uk. Meet the Parents: The experience of students with children in further and higher education. National Union of Students, 2009. 106 5. Keller K, Jones W, Hoover K. Executive Summary: Nursing Education Barriers Identification Survey. Office of Nursing Workforce, Mississippi, 2003. 6. Arhin AO, Cormier E. Factors influencing decision-making regarding contraception and pregnancy among nursing students. Nurse Education Today 2008; 28/2:210–7. 7. Cujec B, Oancia T, Bohm C, Johnson. Career and parenting satisfaction among medical students, residents and physician teachers at a Canadian medical school. Canadian Medical Association Journal 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 for the delivery of undergraduate medical education. British Medical Association, 2005. Background: The place of specialty subjects within the undergraduate medical curriculum isn’t easy to define and teaching of these subjects varies widely from university to university. It is difficult to be sure of the effect of the amount and type of specialty teaching in medical schools. Purpose: This project gives some insight into the teaching of ophthalmology at undergraduate level. It looks at factors that favorably influenced levels of confidence in ophthalmic knowledge among students as well as student perception of teaching. Methods: Questionnaires were distributed in 11 hospitals in the North West deanery among Foundation doctors during the first rotation of their foundation track. Two hundred and forty-six completed questionnaires were obtained. Results: 31.6% of the respondents had been taught for at least 5 days (recommended time according to International Council of Ophthalmology guidelines1). Ophthalmic teaching was mainly delivered via lectures (76.0%) and in a clinical setting (69.5%). Factors that significantly increased levels of confidence in ophthalmic knowledge were: (1) being taught for recommended time or longer; (2) being taught in a clinical setting, i.e. by a consultant ophthalmologist or a GP; and (3) having done a special study module in ophthalmology. 28.1% of the respondents thought that the ophthalmic education they had received in medical school was adequate to prepare them for their job as a foundation doctors. Student perception of ophthalmic teaching improved with longer teaching time – 12.7% (n = 20) of those who had been taught for less than recommended time found ophthalmic teaching adequate, while 66.7% (n = 48) of those who had been taught at least for recommended time found teaching adequate. Conclusions: The results show that the students having received more teaching in ophthalmology were more confident in their ophthalmic knowledge, and were more likely to have found the teaching to be adequate. Unfortunately, the amount of ophthalmic teaching in medical schools was below international recommendations in more than two-thirds of the cases. Clinical exposure to ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts Barriers or difficulties a parent/pregnant medical student may face 100.0% 90.0% % Answered 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Time constraints Financial Studying Social Other factors Figure 2. ophthalmology seems to increase confidence in ophthalmic knowledge. Nearly 3-quarters of the respondents thought that the teaching they had received was inadequate to prepare them for their foundation jobs. Reference: Principles and Guidelines of a Curriculum for Ophthalmic Education of Medical Students. Klinische Monatsblätter für Augenheilkunde (‘Clinical Journal of Ophthalmology’) Nov 2006; 23(Suppl):S1– S19. Medical Students’ Feedback on a Comprehensive Teaching Schedule Offered in Geriatric Medicine I Natarajan, L Varadhan, K Mccarron I Natarajan, University Hospital of Staffordshire, Stroke Teams Offices, Royal Infirmary, Hartshill, Stoke on Trent, UK Background: Geriatric medicine is generally taught integrated with other clinical medicine rotations in medical schools. With an increasing number of geriatric patients in any clinical setting, it is important to offer structured, specialty specific teaching which is tailored to meet student needs and various learning styles. The aim of our study was to assess the satisfaction levels of a dedicated teaching schedule for medical students in geriatric medicine. Sampling Methods: One hundred and thirty-two medical students were posted in geriatric medicine in 6 blocks of 4 week each, with 5 sessions per week to be spent in the department. Students spend the other 5 sessions at the university. The teaching within the department was re-organized to meet the increasing learning needs of the students. A consultant-based teaching schedule was organized to offer 4 dedicated teaching sessions per week. Three different types of teaching sessions were offered: dedicated bedside teaching, seminars and small group teaching. Students rotated through 3 different clinical environments were used: acute stroke unit, geriatric ward and community hospital. Three themes were covered: stroke, falls and confusion assessment. Students filled in an anonymous intradepartmental questionnaire at the end of the block, grading the general organization and the individual types of teaching sessions, on a scale of 1–5. The students also filled in a formal feedback form for the university, which does not form a part of this assessment. Results: Eighty-eight feedback forms (67%) were received at the end 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 teaching programme. 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 and bed-side teaching. Conclusion: A dedicated and sufficiently long period of attachment to geriatric medicine, with a structured and dedicated teaching schedule offered by experts in the specialty is met with high satisfaction rates from the medical students. It also shows that an effective and satisfactory teaching schedule could be provided amidst busy clinical environment. Awareness of Radiation Doses for Common Diagnostic Radiological Procedures amongst FifthYear Medical Students R 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 diagnostic imaging studies, particularly computed tomography (CT), in all developed countries. Statistics from the UK indicate a 12-fold increase in CT usage over the past 2 decades1. It is generally acknowledged that radiation from these tests involves some risk of cancer 2 . Many studies have raised concerns about the limited awareness of these risks among medical students and referring doctors3,4. Methods: Between 2008 and 2009, ninety fifth year medical students were given an 8-item multiple choice questionnaire prior to their radiology tutorials; the questions were designed to specifically test their actual knowledge of radiation doses. The aim of this study was to assess the students’ awareness of relative radiation exposures associated with common diagnostic imaging procedures including abdominal radiographs, intravenous urograms, ventilation/perfusion scans and CT scans (chest, abdomen, head, urinary tract). Results: Only 31.5% (227/720) of the total questions were correctly answered. 44.4% (320/720) underestimated the radiation dose of all tests listed above. Detailed analysis of CT-specific questions 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. The most correctly answered question was the radiation dose equivalent of an abdominal radiograph (79%). None of the students were 100% correct on all 8 questions. Conclusion: This study shows a lack awareness of ionising radiation from diagnostic imaging among senior medical students. As future medical professionals, it is imperative that they are familiar with radiation doses associated with commonly requested radiologicial investigations. These shortcomings in medical students’ knowledge regarding important aspects of radiation protection should be considered when developing the undergraduate medical curriculum and highlight the need for improved education. References: 1. Hall EJ, Brenner DJ. Cancer risks from diagnostic radiology. Br J Radiol 2008; 81(965):362–78. 2. Berrington de Gonzalez A, Darby S. Risk of cancer from diagnostic 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 dose among health professionals in Northern Ireland. Br J Radiol 2008; 81969:725–9. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 107 members’ posters abstracts 4. Zhou GZ, Wong DD, Nguyen LK, Mendelson RM. Student and intern awareness of ionising radiation exposure from common diagnostic imaging procedures. J Med Imaging Radiat Oncol 2010; 54(1):17–23. Impact of a Well-Designed Work Experience Programme for Budding Medical Students R 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 of deciding to become a doctor and it has the potential for motivating students and enhancing their self-esteem1. All medical schools expect applicants to have undertaken some health or social care work experience, thus making it one of the most sought after attachment. Our aim was to evaluate the learning experience of students who attended a clinical work placement at a busy district general hospital. Methods: Between 2009 and 2010, sixty AS-level students (2 batches) completed a 1 week attachment at our hospital. During that period they attended lectures, visited various departments and participated in skills-laboratory sessions. While shadowing junior doctors and nurses, they witnessed their daily work routines and gained insight into the nature of these jobs. Sessions with other healthcare professionals were also organised. Students’ feedback was collected through post-attachment questionnaires. Results: The majority of students (97%) evaluated their learning experience as being ‘enjoyable’ and believed this attachment had strengthened their motivation to apply for a medical degree course. Ninety-seven percent had a good understanding of how a hospital generally functions. The main reasons for studying medicine were listed as follows – helping people (26.7%), personal/job satisfaction (21.7%), scientific interest (23.3%) and challenging career (23.3%). The second batch of students (n = 25) were asked more detailed questions. Fifty-six percent (n = 14) had done a previous clinical work experience placement. All students understood the roles and responsibilities of junior doctors and the multidisciplinary approach in patient care. Having completed the attachment, they all said they would recommend it to their peers. Conclusion Despite the changing financial remunerations associated with medical practice, students’ passion for this subject is undiminished. Interestingly, none of our respondents indicated their future earning potential influenced their decision to study medicine. An estimated 8% to 10% of medical students drop out of university2. Hence, the importance for AS-level students to attend such clinical placements to ensure that they fully comprehend the work 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 County Durham 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 ‘The Child 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% of 5 year olds1. Early detection and treatment is important to prevent 108 permanent vision loss. The International Council of Ophthalmology recommends that medical students are familiar with this condition and are competent in assessing a child for squint2. Increasing demand on undergraduate medical education has resulted in reduced exposure to certain specialities, including ophthalmology3. The use of computer based learning has gained increasing use in medical education and has shown good results in delivering core teaching to students4. Aim: To create a teaching video on which explains the principles of squint, how to assess a child for a squint and treatment options available. Target Audience: This video is aimed at medical students, foundation year doctors, general practitioners, paediatricians and allied healthcare professionals. Objectives: At the end of the module, users of this teaching tool should 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 various aspects of squints were obtained from patients attending the outpatient clinic. Informed consent was sought prior to filming. Illustrations and graphics were used to demonstrate important concepts. Outcome: A teaching tool that will equip medical students and non-ophthalmology specialist with the knowledge and understanding of squint. References: 1. Guidelines for the management of strabismus and amblyopia in childhood. Royal college of Ophthalmologists Guidelines, February 2000. 2. Parrish R.K., Tso M.O.M. Principles and guidelines of a curriculum for ophthalmology education of medical students. Kilm Monatsbl Augenheilkd 2006; 223(Suppl 5): S3–S19. 3. Quillen D.A., Harper R.A., Haik B.G. Medical student education in ophthalmology: Crisis and opportunity, 2005. Ophthalmology 2005; 112(11): 1867–1868. 4. Devitt P., Smith J.R., Palmer E. Imporved student learning in ophthalmology with computer-aided instruction. Eye 2001; 15(5): 635–639. A Theoretical Underpinning for Measurement of Professional Culture in Healthcare Training Institutions M Chandratilake, S McAleer, J Gibson M Chandratilake, Centre for Medical Education, University of Dundee, Tay Park House, Dundee, UK Background and Purpose: The importance of teaching professionalism explicitly in health professional education has been repeatedly emphasised.1 As a result, it is now recognised as a welldefined educational outcome by several healthcare training programmes2,3 and formally delivered in many pedagogical programmes using a range of instructional methods.4,5 The extent to which professionalism can also be learned informally,6 however, should not be underestimated as: social environment has a large influence on individuals’ learning7; hidden curriculum plays an important role in fostering professionalism8; and professional culture affects student motivation for learning9 and individuals’ professionalism.10 We attempted to identify a theoretical basis for ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts understanding and measuring professional culture prevailing in institutions training healthcare professions. Methodology: A literature review was conducted for the following purposes: to define the term ‘professional culture’ in relation to healthcare professions education and to identify its characteristics; to evaluate educational and sociological theories as the theoretical basis for understanding professional culture; and to propose a methodology to measure professional culture. Results: Professional culture of an institution is the cumulative behaviours of its inhabitants which result from their attitudes, values, norms and social pressures. The Theory of Reasoned Action11 and the Theory of Planned Behaviour12 seemed to be relevant to describe ‘professional cultures’. However, Theory of Planned Behaviour (TPB), which establishes the relationship between individuals’ attitudes, intentions, social norms, and capacity to operationalise desired behaviours, was found to be the more appropriate of the two. Researchers have used both qualitative and quantitative methods in studying health-related behaviours 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 occur when there is an abusive culture in ward setting), and quantitative approaches (e.g. survey) to describe a particular culture (e.g. abuse of juniors). Discussion and Conclusions: According to social learning theory and research on the hidden curriculum, not only what is delivered formally in educational programmes but also what is transmitted from the professional culture of the institution play vital roles in fostering professionalism among healthcare students. The Theory of Planned Bahaviour can be used as a theoretical basis for understanding, explaining and measuring the professional culture of institutions training healthcare professionals. Based on the TPB, measurement instruments can be developed either to describe prevailing professional cultures in targeted institutions or to predict possible outcomes of such cultures. References: 1. General Medical Council. Tomorrow’s doctors. General Medical Council London 2009; 25–29. 2. University of Dundee School of Medicine. Dundee Medical School course information. University of Dundee, 2008; 12. Goldie J. Integrating professionalism teaching into undergraduate medical education in the UK setting. Medical Teacher 2008;30:513–527. 3. Cruess RL, Cruess S. Teaching professionalism: general principles. Medical Teacher 2006;28:205–208. 4. Paice E, Heard S, Moss F. How important are role models in making good doctors. British Medical Journal 2002;325:707–710. 5. Hafferty FW. Confronting medicine’s hidden curriculum Academic Medicine 1998;73:403–407. 6. Bandura A. Social Learning Theory. New York General Learning Press; 1977. 7. Hafferty FW, Franks R. The hidden curriculum, ethics teaching and the structure of medical education. Academic Medicine 1994;69:861–871. 8. Brazeau CM, Schroeder R, Rovi S, Boyd L. Relationships between medical student burnout, empathy, and professionalism climate. Acad Med 2010;85:S33–36. 9. Moyer CA, Arnold L, Quaintance J, et al. What factors create a humanistic doctor? A nationwide survey of fourth-year medical students. Acad Med 2010;85:1800–1807. 10. Sheppard BH, Hartwick J, Warshaw PR. The theory of reasoned action: a meta-analysis of past research with recommendations for modifications and future research Journal of Consumer Research 1988;15:325–343. 11. Ajzen I. The theory of planned behaviour. Organisational Behaviour and Human Decision Processes 1991;50:179–211. Teaching and Learning Role Play-Engaging the Participants P Lockwood, S Law P Lockwood, UCME, MacKenzie Building, Kirsty Semple Way, Dundee, UK Background: Role play can be a useful method to help tutors develop practical skills such as giving feedback. One of the challenges, when using this form of teaching, is to prevent the participants from feeling threatened and disengaging with the learning opportunity. Evidence suggests that when role play is used well the outcomes are positive but it is often poorly done. Aims of the Poster: To describe a method of using a role play which provides an environment that encourages learners to take part. The poster also aims to present an evaluation of this method. What was done? A small group teaching method which used role play was developed. The participants are shown a DVD clip of a doctor consulting with a patient or a colleague. They were asked to develop phrases which would provide feedback to the doctor. The doctor is then role played using an actor. The feedback phrases are collated by the facilitator and discussed by the group. The opening feedback statements that are to be given to the actor are chosen by the group. The facilitator starts the role play process by delivering the feedback to the actor. Once the initial feedback comments have been delivered the facilitator asks the group for further guidance. The participants are then encouraged to take over the role playing process. Method for Evaluation: The participant evaluations from a similar learning session in which the participants were asked to role play giving feedback and the new session were compared. Both evaluations were questionnaire based and requested to be handed in anonymously at the end of the session. The facilitators and actor were also asked to give their evaluations of the learning session. Results of the Evaluation: A significant number of participants from the control session had indicated that they did not like the use of role play and in fact had not engaged in role play. Some of the facilitators had found that the participants rearranged the session to take out role play. Each time the new session has been run the participants have reported the role play as an enhancement to the session. The facilitators found learners fully engaged with the process in the new session. Conclusion: Using a facilitator to start the role play process with an actor improves learner engagement and seems to reduce the threat of role play. The Constipation Game N M Hamilton, A R Morrison, G T Linklater, J McDonald, A D Lobban N M Hamilton, Medical School, Polwarth Building, Foresterhill, Aberdeen, UK This poster outlines the functionality of an e-Learning application aimed at undergraduate medical students. A 68 year old man with severe COPD is admitted with an exacerbation. He is breathless at rest and not able to mobilise. He has a PMHx of steroid induced osteoporosis with associated crush fractures of 2 thoracic vertebrae. HIS bowels last moved 2 days ago. The student is asked to choose a drug, or variety of drug ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 109 members’ posters abstracts combinations, to administer on day one and upon each successive day thereafter. The e-Learning application presents this information in the style of a computer game including a sliding scoring system which reflects how well the patient is progressing in terms of bowel movements. This Adobe FLASH application was constructed using ActionScript v3.0. Transition to University: The Role Played by Emotion W J McMillan W J McMillan, Faculty of Dentistry, University of the Western Cape, South Africa Background and Purpose: The transition from school to university1 and the shift in academic challenge2 is experienced by many new university students as challenging. Non-traditional students are particularly vulnerable in this transition3,4. Theoretical frameworks have been offered to understand students’ experience of transition, including ‘resistance and persistence’5 and ‘habitus’6. Suggestions have been made to support retention and throughput by improving institutional culture,7 through facilitating teaching, curriculum and teacher development,8 and by supporting student learning.9 Most recently, theoretical insights from accounts of emotion and affect in transition to university3 and student engagement studies10 suggest the significance of an emotional dimension to learning, transition, throughput and retention.11 Understanding how students experience this transition allows institutions to put appropriate support mechanisms in place. Understanding the role of affect in higher education success has the potential to inform student support mechanisms that go beyond traditional interventions of academic development and curriculum innovation. Methodology: A qualitative approach was used to elicit the insider accounts12 required for the study. From the first year dentistry students of 2010 at a single Faculty of Dentistry (n = 80) in South Africa, 1 class of students (n = 20) was selected for inclusion in the study. Fifteen students (75%) consented to participate. Three friendship- group focus group interviews (n = 7; n = 4; n = 4) probed students’ experiences of transition to university. A semistructured interview protocol explored ‘coming to university’, ‘being a student’, and ‘being a dentist’. Interviews were audiorecorded and transcribed. Issues identified in the literature as significant to transition were used to analyse the interview data. Descriptive tags were assigned for these. This process allowed for easy retrieval and collation of data associated with a specific descriptive tag. Results: Twenty six descriptive tags were identified from the data. These were clustered into 5 themes: ‘outside support and constraints’, ‘influences’, ‘career choice’, ‘academic challenges’, and ‘agency and identity’. Further analysis indicated that 16 of the 26 tags, and tags from all 5 themes, were associated with the use of emotive words. Discussion and Conclusions: This initial analysis indicates that, for these students, there was a powerful emotional component to their transition to university. Students associated both the challenges that they experienced and any available support structures through the lens of the affect. Further, the clustering of descriptive tags clustered under the theme, ‘influences’, indicated that new students relied heavily on the emotional support of parents and friends in their transition period. Findings suggest that mechanisms to support student transition need to engage with the interface between academic support and development and the social and emotional components of learning. 110 References: 1. Christie H, Munro M, Fisher T. Leaving university early: exploring the differences between continuing and non-continuing students. Studies in Higher Education 2004; 29(5):617–636. 2. Smith K. School to university. An investigation into the experience 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 real rollercoaster of confidence and emotions’: learning to be a university student. Studies in Higher Education 2008; 335:567–581. 4. Wilcox P, Winn S, Fyvie-Gauld M. ‘It was nothing to do with the university, it was just the people’: the role of social support in the first-year experience of higher education. Studies in Higher Education 2005; 20(6):707–722. 5. Tinto V. Leaving college: Rethinking the causes and cures of student 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 compelling interest. Ensuring diversity in the health-care workforce. Washington, DC: Institute of Medicine of the National Academies, 2004. 8. Haggis T. Pedagogies of diversity: retaining critical challenge amidst fears of ‘dumbing down’, Studies in Higher Education 2006; 31(5):521–535. 8. Swail WS, Redd KE, Perna LW. Retaining minority students in higher education. A framework for success. ASHE-ERIC Higher Education 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 to university. 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 and Future Directions A 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 teaching skills at undergraduate level, and developed a teaching course designed for medical students. The course has been run in 3 different permutations, and several more are currently being organised. By comparing the courses we sought to determine which components were key to the success of a student-run teaching course. Each course aimed to enhance students’ teaching skills, allow them to practise the skills, receive extensive feedback, and be inspired to teach in the future. They began with background teaching theory, followed by microteaching sessions, where students taught a skill to a small group of peers. They then received feedback from their peers and facilitator, with the opportunity to reteach in light of the feedback. The pilot course ran in London in 2009, with 2 further courses in Cambridge and Leicester during 2010. Whilst the 3 courses had similar aims and core themes, there were also key differences between them, namely, the course length, facilitator experience, amount of background theory, and types of skills taught. London was a full-day teaching course with a morning of theory and afternoon of microteaching. Cambridge was a 2 hour workshop, and Leicester a 4 hour component of another course. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts Opinion from the London pilot course highlighted that the chance to practise teaching and gain feedback were considered to be the most important components, and these have been predominant features of the shorter courses. In our experience this should be supported by relevant and well contextualised teaching theory. London and Cambridge used expert facilitators with a background in teaching and medical education; Leicester used senior medical students. The depth and weight of feedback was perceived to be better when an expert-facilitator was present. However, much of the feedback came from peers and the delegates found the student perspective very valuable. Co-facilitation will be tried in future courses. The London course took nearly a year to develop, but subsequent courses are becoming easier to organise. Formats are increasingly being shaped by extensive evaluation from students. JASME are working with ASME to develop a network of students at each medical school to help future dissemination of the course, and other medical education events. It is possible for keen students to organise a teaching course, providing they receive the appropriate support, plan well in advance, and persevere! and reflective discussion. Thirty-nine percent of tutors had received no formal training in debriefing. Eighty-eight percent of tutors were interested in participating in a faculty development programme. The opinions of students and tutors on effective feedback were explored and analysed. These included use of structured feedback techniques and identification of barriers to effective feedback. Discussion and Conclusions: There is a wide variety in the methods and delivery of debriefing in the ACD clinical scenario. Tutors in the ACD have identified an unmet training need and have raised several issues that can be used in developing a training programme to improve the consistency of the feedback in the Acute Care Day Programme. Is Peer-Assisted Learning the Best Introduction to Clinical Skills? R Varughese, S Montgomery-Taylor, A Mathew R Varughese, Oxford University Medical School, Oxford, UK How Can the Consistency of the Feedback in the Clinical Scenario be Improved When Delivering the acute 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 to final year medical students (MB ChB 4/5) from the University of Glasgow. Included in this programme are a series of clinical scenarios where an actor simulates a patient with an acute illness. Appropriate clinical equipment is provided to simulate an acute care setting. Two experienced medical tutors supervise a small group of students managing the patient. The aim of this case study is to identify the methods currently used to debrief students during the acute clinical scenario in the ACDP, to investigate the opinions of the tutors on the most effective methods and triangulate this with that of the students. Methodology: A hypothesis generating retrospective cross sectional pilot case study using electronic and paper-based surveys to obtain quantitative and qualitative data on tutors and students of the ACDP. Tutors were contacted by email and asked to complete an on line electronic survey. The questionnaire identified which feedback techniques they used, training previously received, and elicited opinions on further training they might find useful. A written questionnaire was also circulated to 5th year Medical Students who had completed the Acute Care Day programme, during the last session as part of their feedback. The questionnaire identified and evaluated different feedback techniques. Statistical Analysis examined differences between the groups, using Chi squared or Fisher’s exact test as appropriate. Free text from the questionnaires was analysed using NVIVO coding and qualitative data analysis techniques. Common themes were identified and explored on debriefing techniques with potential to work in the ACDP scenario. Results: The response rates for the questionnaires were 87% (n = 239) from students and 56% (n = 88) from tutors. Triangulation of results identified differences in perception between the tutors and the students in frequency of use of debriefing methods. Most students thought that debriefing after uninterrupted runthrough of the whole scenario was best, followed by peer feedback Background and Purpose: The first 3 weeks of clinical training at Oxford University Medical School are spent doing a peer-assisted learning course ‘MedEd’. First year clinical students are taught in small groups by final year students to carry out history taking, clinical examination and practical procedural skills. A combination of bedside teaching and tutorials are used in order to prepare students for subsequent short placements on wards; where they are assessed by doctors and nurses. Methodology: All 133 first year clinical students who took part in MedEd were asked to participate in a questionnaire survey, to ascertain whether they found the teaching prepared them well for being on the wards and if the feedback they received on their skills was positive. Responses were presented on a 6-point Likert scale and free text comments were invited. Results: Seventy-six percent of the year group responded (102/ 133). Seventy percent of students rated their confidence on the wards highly (5/6; 6/6) after MedEd teaching as compared to 87% rating their confidence levels poorly (1/6; 2/6) before MedEd teaching. Ninety percent students rated the feedback from doctors on their clinical skills as positive (4/6; 5/6;6/6). Importantly, 98% of students determined that students were better teachers than doctors for preliminary clinical teaching. Comments from students established that the course was pitched at the right level for their stage in training both in terms of information imparted and the necessary skills required for future assessment. However, they also highlighted the necessity for regular practice of the skills, after establishing familiarity with them. Interruption with a lecture course, made resuming ward skills a daunting experience. A suggestion would be to organise a brief, intensive refresher course to remedy this. Conclusions: Overall, this survey highlights the value of utilising the first hand experience and knowledge from practised students in order to develop the skills of clinically inexperienced peers. Peer teaching is vital in developing the confidence of first-year clinical students on the wards. The use of students as teachers facilitates the imparting of relevant core knowledge to their juniors, while providing an environment conducive to questioning and reassurance. Moreover this is a mutually beneficial system as it also provides revision opportunities for final year students. Take-home message Peer-assisted learning is a successful introduction to clinical examination skills, after which continuity is essential in maintaining confident clinical practice. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 111 members’ posters abstracts Implementing a Bespoke VLE Using Moodle I 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 and Medicine, University of Aberdeen, Foresterhill, Aberdeen, UK The Medi-CAL Unit started uploading lectures onto the web in 1996. Since then, the VLE used by Medical Students at the University of Aberdeen has gone through a variety of redesigns and a regular overhaul of the services that it provides. The advent of social networking and greater availability of the internet means that students now expect more from their online experience. This paper explores the experiences of developing a VLE and outlines plans for future developments to support an ever growing variety of end-user devices, including laptops, tablet computers and smart phones. An Assessment of Student Feedback to Find the Value of Bedside Teaching during the Child Health Block P Wilson, H Pascoe, E Carter 5. Key suggestions for improvement were: better planning between teachers to avoid repetition of cases, smaller group sizes and teaching from junior doctors if the consultant had to cancel. Conclusions and Recommendations: 1. Bedside teaching in the child health block is extremely valuable. It should be continued and protected. 2. Students prefer bedside teaching to E-learning 3. Student feedback should be used to improve the teaching programme. References: 1. Kroenke et al. Bedside Teaching. Southern Medical Journal 1997; 90: 1069–1074. 2. Williams K et al. Improving bedside teaching: Findings from a focus 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’ attitudes to teaching medical students and junior doctors. Journal of Paediatrics and Child Health 2010; 46: 647–652. 5. Young L et al. Effective teaching and learning on the wards: easier said than done? Medical Education 2009;43: 808–817. P Wilson, Leicester Medical School, Leicester, UK Aims and Objectives: 1. To assess the usefulness of Bedside Teaching in the Child Health Block 2. To compare Bedside Teaching to E-learning 3. To obtain suggestions for improvement of the teaching programme. Introduction: It is well known that bedside teaching is an effective way to educate medical students,1 associated with very high levels of learner satisfaction.2 However the quantity of bedside teaching in medical courses has been declining and protected teaching time is constantly under threat from other commitments of the teacher.3,4 Furthermore there can be discordance between learner and teacher expectations in terms of what teaching should be delivered in clinical settings.5 In Leicester all students have protected bedside teaching during the child health block receiving roughly 4 sessions per week over the 7 week block. The study was carried out to assess the usefulness of this teaching programme. Usefulness, satisfaction and quantity of bedside teaching were assessed as well as whether students were observed taking histories, examining patients, and if they received immediate feedback on their performance. A direct comparison was made between bedside teaching and E-learning to ascertain what students found the best learning method to master key competencies. The students were invited to make suggestions on what they found particularly valuable and what they thought could be improved. Method: A questionnaire about bedside teaching in the Child Health 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 grouped into themes. Results: 1. The students overwhelmingly found the bedside teaching programme useful and enjoyable. 2. The amount of bedside teaching in the Child Health block was appropriate. 3. 94.8% of students were observed taking histories, 91.4% of students were observed examining patients and 96.6% of students received direct feedback about their performance. Again, overwhelmingly the students found this useful. 4. 77.6% of students preferred bedside teaching to other learning methods. 112 Do Students Learn What We Want Them to Learn? S Sadasivam, N Kumar S Sadasivam, Education Centre, University Hospital of North Durham, Durham, UK Background and Purpose: Fibromyalgia is a chronic pain syndrome associated with significant morbidity. Third year medical students based at University Hospital of North Durham received a teaching session on fibromyalgia as part of their ‘chronic illness, disability and rehabilitation’ module. The focus of the session was on patient experience, patient education, addressing ideas concerns and expectations (ICE) and considering the biopsychosocial impact of the condition. Medical aspects of fibromyalgia were also covered. The session was concluded with 2 take home points, Fibromyalgia is a real illness and distressing for patients. Remember ICE and the biopsychosocial model. Methods: At the end of the teaching sessions, students were asked to fill in an evaluation questionnaire. Forty-five students were given a questionnaire with a 100% response rate. As part of the questionnaire, free text boxes were provided to list 2 things they had learnt from the session. Simple framework analysis was used to categorise these learning points. Learning points were also subdivided into medical model of disease or holistic. Results: The most popular learning point was treatment (recorded by 62%, 28 students) followed by symptoms (40%, 18 students) and pressure points (38%, 17 students). ‘Real illness’ was only recorded by 18% (8 students), ICE by 9% (4 students) and biopsychosocial model by 4% (2 students). Eighty-two percent of responses related to the medical model of disease whereas only 18% related to a more holistic view. Discussion and Conclusions: Despite the focus of the session and the clearly expressed take home messages, the majority of students focused on the medical aspects of the teaching session which was surprising. Potential reasons for this are listed below: 1. Prior understanding of the patient experience from studying other chronic illnesses. 2. May have felt the holistic view did not constitute ‘knowledge’ in the same way as medical information. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts 3. Encouraged by the fact that there was diagnostic criteria and treatment for this distressing condition which may have taken priority over the take home messages. The evaluation exercise has provided an insight into the fact that students are not necessarily taking home the intended messages from the session. Future research should be designed to explore reasons why students recorded mostly medical learning points. This might provide insight into why there was a difference between intended and reported learning. 2. Bulte C, Betts A, Garner K, Durning S. Student teaching: views of student 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’ Course Can Increase Medical Student Knowledge, Skills and Confidence F Frame, S Hyde, M Player, A Hastings, A Newton Combining Expert and Peer Led Teaching: the Future of Undergraduate Medical Education? L Wheeler, C Reddick L Wheeler, Withington, Manchester, UK Background: Tomorrow’s doctors (1993) prompted changes to the curriculum in many UK medical schools, with a move towards selfdirected learning (1). However, these changes have not addressed all of the gaps within the curricula and dermatology remains an often overlooked specialty. The new ethos of self-directed learning has resulted in a number of student led teaching schemes in order to address these gaps. Methods: DermSoc Manchester was established to promote awareness and education of skin disease using both expert and peer-led teaching. It has organised 3 full day symposia, providing an introductory course in dermatology to 180 students. DermDays were advertised to students in their clinical years via email, the intranet and a social networking site. Feedback forms were given to all delegates and they were asked to rate 3 aspects (presenting style, usefulness and overall mark) of each component of the symposium on a 1–5 Likert scale, 1 being poor and 5 being excellent. A free text comment box was also provided. Results: The feedback generated from the 134 completed forms was analysed by SPSS 18.0 and proved overwhelmingly positive. Across all 3 symposia a score of above 4 was awarded to every aspect of the lecture series and the interactive sessions as well as the careers question and answer session. Scores for the lectures run by students and by clinicians received similar marks for presenting style, usefulness and as an overall mark. Patient sessions were awarded the highest overall mark with an average score of 4.79 out of 5. Conclusions: The DermDay events have demonstrated the effectiveness of combined near-peer and expert teaching. Delegates were as happy with peer led sessions as with expert led sessions, although successful peer-led teaching would be difficult without support from experts; highlighting the importance of a clinical cocoon. There is little research in the educational literature demonstrating the benefits of this approach and our findings suggest that further research is required to explore the potential benefits of such schemes. It is well established that peer learning is beneficial for both teachers and learners as it provides a safe environment in which to learn (2). Patient interaction affords medical students the opportunity to increase one’s knowledge base and improve crucial communication skills (3). The formulaic days run by DermSoc Manchester provide a template for other like minded students wishing to deliver an introductory course in dermatology, or any other medical specialty. References: 1. General Medical Council – Tomorrow’s Doctors. Recommendations on undergraduate medical education. 1993;7–12. F Frame, University of Leicester Medical School, Maurice Leicester, UK Introduction: GMC guidelines state that undergraduate medical students must gain experience of teaching during the clinical years1. Many students at Leicester Medical School have demonstrated an interest in this area, and as a result Leicester Medics Association of Teaching (LMAT) worked in collaboration with the Junior Association for the Study of Medical Education (JASME) to run a peer-led course. This was designed to teach, assess and reinforce the core knowledge, skills and attitudes needed to teach others. The 1-day programme was based on an established JASME education package and combined basic theories of teaching with practical workshops. Students gained experience whilst receiving extensive feedback from peer tutors and learners throughout the day. Peer Assisted Learning (PAL) provides a range of potential benefits for both student groups2 and was therefore considered an ideal approach for the course. Method: Students rated their pre- and post-day understanding of the core components of the course by completing a questionnaire. In addition, they reported their perceived confidence in relation to these components and overall enjoyment of the day. Data collection and analysis were based on an ordinal step-wise approach to a series of Likert scale responses, directly identifying pre- and postday attitudinal changes for each individual student as a result of the teaching received. Findings: The reported understanding of teaching techniques increased significantly during the course, with no deficits found. In addition, the majority of students showed an increase in perceived confidence in their ability to give a lecture, teach small groups and facilitate a clinical skills session – further replicated in the workshops. Perceived confidence in utilising small group teaching methods demonstrated the biggest attitudinal change. When asked, 83% of students indicated that the course would positively change their future practice, with many highlighting that it fuelled their motivation and enthusiasm for medical education. Discussion and Conclusions: Our findings suggest that regardless of initial understanding, a peer-led ‘teaching how to teach’ course can increase knowledge, skills and confidence in teaching others. Importantly it can provide a safe environment in which to learn and practice skills whilst receiving individualised, specific feedback. The literature confirms this, suggesting PAL can offer a unique and valuable exposure to teaching and learning for clinical practice – enhancing personal and professional development2. It is a powerful tool 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: Recommendations 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 of peer assisted learning’, BMC Medical Education 2006; 6:18. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 113 members’ posters abstracts Medical Professionalism Education and Students’ Perceptions V 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 in current medical education, although it is not easily defined. It underpins the trust society has in doctors by comprising a set of behaviours, principles and responsibilities, which must be described and explicitly taught to medical students. The assumption that professional values and attitudes will be acquired unconsciously can no longer be made. The Bute Medical School (BMS) curriculum (a 3-year pre-clinical course) encompasses several professionalism-promoting mechanisms, including role modelling, the Yellow Card Scheme, ePortfolio, reflective practice and the Bute Medical Agreement. Methods: A questionnaire investigating medical students’ views on professionalism and on the educational mechanisms promoting it was devised. All 430 students at the BMS were invited to participate, resulting in 334 responses (77.7% participation rate). Results were interpreted using Microsoft Excel and SPSS statistical software v. 17.0. Results: The data shows that participants value medical professionalism and consider it a priority at their undergraduate level. According to students’ responses, the most effective mechanism in promoting professionalism is role modelling, whilst the Yellow Card Scheme and ePortfolio reflection are deemed to be the least effective. However, if ePortfolio and professionalism were summatively assessed, students would consider them more important than they currently do. Conclusions: Students consider what is evaluated to be important; hence professionalism should not only be taught but also evaluated. Formal assessment of professional attitudes and behaviours should be developed within medical school curricula. These must not simply highlight unprofessional behaviour students must avoid; more essentially they ought to promote excellence. Defining Feedback from the Medical Student’s Perspective: Exploring Students’ Experiences at Three UK Medical Schools L M Urquhart, C E Rees, J S Ker L M Urquhart, Institute of Health Skills & Education, College of Medicine, Dentistry & Nursing, University of Dundee, Dundee, UK Background and Purpose: In medical education, feedback has been repeatedly shown to be an influential driver of learning. 1, 2 Students perceptions, however, are that they do not receive sufficient feedback3. A recent review4 of 132 articles on feedback postulated a consensus definition for feedback. However, all definitions were written by expert feedback givers. To our knowledge, there have been no studies to date that have defined feedback from the medical students’ perspective. Studies at both undergraduate and postgraduate levels have shown that there are large disparities between what the tutor feels they have given and what the student feels they have received.5, 6 The current study seeks to address this gap in the research literature by exploring medical students’ experiences of feedback at 3 schools in the UK. Methods: We are currently conducting focus groups at 3 medical schools in Scotland, asking students about their experiences of feedback to date. The focus groups will include students across all 114 5 years of the medical curriculum. The key topics that are being discussed include students’ understandings and definitions of feedback, their experience of feedback to date, where they feel feedback has been given well and badly, and what they do with feedback. These focus groups are being audio-taped and a thematic framework analysis7 identifying how and what participants say will be performed by the researchers. Results: The data collection for this study is ongoing. By the time of the conference, the preliminary thematic analysis will be complete. Although the themes themselves will be identified inductively from the data, it is likely that the presentation will include certain topics linked to the interview questions. For example: students’ understandings of feedback, their positive and negative experiences of feedback and how those experiences have impacted on their subsequent learning. This data will be used not only to redefine feedback but also to inform the second phase of the first author’s PhD study into feedback for medical students – a video ethnography study of feedback in 2 settings (simulated and medical workplace setting) in the UK. Discussion: This study will bring an authentic viewpoint about feedback through students’ understandings and experiences of feedback at 3 diverse UK medical schools. In order to solve the much talked about ‘feedback problem’ in medical schools, we must first be able to define feedback from students’ perspectives. This presentation will discuss the implications of these results, thereby informing future educational practice and future studies on feedback 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 Teacher 2006; 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 attending surgeons have different perceptions of feedback. Medical Teacher 2005; 27(5):470–2. 6. McIlwrick J. ‘How am I doing?’ Many problems but few solutions related to feedback delivery in undergraduate psychiatry education. Academic Psychiatry 2006; 30(2);130–135. 7 Richie J and Spencer L. Qualitative data analysis for applied policy research. In:. Bryman A and Burgess RG Ed. Analysing qualitative data. Routledge; 1994. Chapter.9. Delivery and Evaluation of Blended Learning Courses in a Large Medical School in the United Kingdom: A Model for Uniform Delivery and Equitable Access K Khan, K Gaunt, J Wilson, C Lumsden K Khan, Manchester Medical School and Lancashire Teaching Hospitals Foundation Trust, Preston Simulation Centre, Royal Preston Hospital, Sharoe Green Lane, Preston, UK Background and Purpose: Large medical schools are faced with challenges to achieve and maintain a degree of standardisation in the content and delivery of educational courses. Manchester Medical School has in excess of 450 medical students per year placed in 4 different clinical sectors across the Northwest of England. A wide geographical distribution and more than 20 hospital placements makes it difficult to deliver standardised, quality-assured teaching. Faced with this challenge we developed ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts a blended learning environment using a combination of elearning modules and small-group facilitated sessions to achieve uniform delivery and equity of access. Blended learning has been shown to be effective in promoting learner-centred higher education1. We hosted the e-learning packages on our Medical School e-learning environment to which both the students and tutors have access. The small groups consisted of 6–8 students and the students had 4 days to prepare for each topic in their own time before the small-group facilitated session. We managed to deliver 4 tutorials in this format for 450 medical students in a 16-week period. We present here the development, delivery and evaluation of the blended learning environment created at our medical school. Methodology: Feedback was collected using Medlea (Manchester Medical Schools’ e-learning environment) from the tutors and the students on a voluntary basis. The data was exported to excel and qualitatively analysed using the thematic analysis technique by 2 investigators. The key themes are presented in this poster. Results: All the teaching hospitals reported to us that the tutorials were delivered uniformly across the sectors with a very high attendance rate. We received 13 tutor feedback responses and 56 responses from students. Two main themes emerged from both students and tutors. 1. They found blended learning to be more effective than elearning or a small group discussion alone. 2. They identified that the small group discussions worked more effectively when all involved had prepared adequately beforehand. Minor themes included the identification of this package as a tool to deliver a standardised learning experience. Students also identified enhanced flexibility of the e-learning tool to be of importance for future development. Discussion and Conclusions: Blended learning has the advantages of flexibility, convenience and improved participation2. We conclude that this blended environment is an effective tool in the delivery of content to a large number of students, maintaining standardisation and allowing uniform access, all of which enhances the learning. References: 1. Brandt BF, Quake-Rapp C, Shanedling J, Spannaus-Martin D, Martin P, Blended Learning: emerging best practices in allied health workforce development. J Allied Health 2010 Winter; 39(4):e167–72. 2. McCown LJ. Blended courses: the best of online and traditional formats. Clin Lab Sci 2010 Fall: 23(4):205–11. Faculty Development: Specialty Trainees as Ambassadors and Providers of Medical Education K L Macleod, C Morris K L Macleod, East of England Multi-Professional Deanery, CPC1 Capital Park, Fulbourn, Cambridge, UK Background: Faculty development has traditionally centred on consultants, yet there are clear arguments for supporting doctors as medical educators early in training. Fostering a deeper understanding and appreciation of medical education could strengthen trainer/learner relationships, develop senior trainees who teach their junior colleagues, and prepare trainees as future educational and clinical supervisors. The Study The East of England Multi-Professional Deanery piloted an innovative scheme to sponsor 2 cross-specialty cohorts of 20 trainees to study a Postgraduate certificate in Medical Education at the University of Bedfordshire. Participants were selected to be ambassadors for medical education and provide regional and local teacher training post-qualification. Key elements of the learner-centred course included: 1. Participation in an online educational ‘community of practice’1; 2. Development of an individual teaching philosophy and academic and research literacy; 3. Interrogation of educational theory in the context of different specialties; 4. Experimentation with e-learning to develop a group ‘Wiki’ microsite; 5. Reflective learning, using a teaching portfolio and reflective narrative; 6. Formative feedback, including peer and tutor observations, to cultivate skills and capabilities. A range of data has been collected to evaluate this model and identify the potential benefits of a Deanery-funded scheme. Participants were surveyed midway through the course and 6 months after completion. Results: Nineteen trainees from the first cohort attained the PG Cert qualification, with 7 trainees choosing to continue their studies to Masters level qualification. All reported high levels of satisfaction and engagement with the course. Thematic analysis of feedback identified significant benefits of the programme, including; 1. The value of shared peer learning and a ‘community’ approach; 2. Significant personal and professional development of trainees as educators; 3. Self-reported improvement in the quality of teaching activities with junior colleagues; 4. Enthusiasm for cascading learning to other colleagues; Data to illustrate these points will be provided. Case studies of faculty development training events organised by the participants will illustrate horizontal and vertical sharing of learning. Discussion and Conclusions: This Deanery-sponsored scheme facilitated the professional development of committed trainees as medical educators. The postgraduate course significantly enhanced their own teaching and learning and supported them as medical education ‘champions’ able to cascade learning and development to their colleagues. Reference: 1. Lave, J and Wenger, E. Situated Learning. Legitimate Peripheral Participation. Cambridge University Press, 1991. Trauma and Emergencies in Pregnancy (TrEP): Developing a Course for Undergraduate Medical Students at the University of Leicester F 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 in pregnancy was an aspect of acute care that senior medical students at the University of Leicester had demonstrated an increased interest in. As a result, the Trauma and Acute Care Society ran a student-led course using this as a framework to teach, assess and reinforce core knowledge, skills and attitudes in this specialised area. These were based on Immediate Life Support principles. Trauma and Emergencies in Pregnancy (TrEP) was developed as a 1 day course combining a series of key lectures with practical skills stations, an OSCE and moulage. Senior clinicians with a specialist interest in obstetrics and/or anaesthetics from the University Hospitals of Leicester (UHL) provided invaluable teaching expertise in a high tutor to learner ratio. Method: Using a Likert scale questionnaire, students were asked to report their perceived satisfaction with the component parts of TrEP. In addition they commented on their overall enjoyment of ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 115 members’ posters abstracts the day and identified areas for improvement. Data were collected and evaluated to further develop and refine the structure and content of the course, in order to make future courses more responsive to the learning needs of students in clinical practice1. Findings: When asked, 100% of the students who attended the day said they would recommend it to others, showing an extremely high degree of satisfaction overall. In addition, many students reported a perceived improvement in the knowledge, skills or attitudes needed to manage trauma and emergencies in pregnancy. When the lectures were reviewed, ‘managing shock’ and ‘medical emergencies’ evaluated most well – with 82% of students giving these the highest satisfaction rating. Lectures that evaluated less well did not fully meet student learning needs, and suggestions were made for improvement. In the clinical skills components, 95% of students gave the practical skills stations the highest satisfaction rating – with the OSCE and moulage also demonstrating very high levels. Clinical relevance was acknowledged by many students. Discussion and Conclusions: Findings suggest that the course evaluated very well overall, demonstrating a perceived improvement in knowledge, skills and attitudes amongst many students. It facilitated a valuable exposure to aspects of care that could potentially be experienced in clinical practice, whilst providing a safe environment to learn and practice the necessary skills2. Responsive changes will now be made, with the aim of including TrEP within the undergraduate curriculum at the University of Leicester 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 medical education: an opportunity to learn from errors’. Medical Teacher 2005; 7(3): 193–199. Peer-Assisted Learning: Does Comfort Build Confidence? 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 facilitated by year four medical students at Salford Royal Hospital and delivers clinical teaching to year 3 peers. We facilitated PAL sessions covering clinical examination of the head and neck in preparation for OSCEs. Aims: This study aims to determine whether a teaching session delivered via PAL increases student’s confidence at attempting a relevant OSCE station. Additionally, we aim to determine the reasons behind any change in confidence. Methods: We surveyed year three students attending small group PAL sessions (n = 51). The students rated their confidence at tackling an OSCE station before and after PAL, using a scale from 1 (no confidence) to 10 (most confident). Additionally we asked students to give feedback using free text answers about the PAL session. We used thematic analysis of the feedback forms to study students’ perceptions of PAL. Results: Students’ confidence at tackling a head and neck OSCE station demonstrated a significant improvement (P < 0.001) after the PAL session. The mean confidence before the session was 5.1, increasing to 8.0 after. All students reported increased confidence after the session. Thematic analysis of the students’ free text answers revealed that the most common perception of PAL was of a comfortable, relaxed environment (47.4%). The second most 116 common perception related to students’ appreciation of the relevance of the session content to OSCE assessments (44.7%). Discussion: The most common theme students’ reported was feelings of comfort related to PAL sessions. We believe these feelings 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 peer teaching leads to increased disclosure of areas of weakness in knowledge by students. This allows peer-tutors to address these areas and teach more effectively, leading to the increased confidence experienced by students. Conclusions: We propose that enhanced disclosure is a product of a highly congruent relationship between peer-tutor and student. Congruent social roles occupied by student and peer-tutor may foster a more effective learning environment2. The lack of hierarchy between student and peer-tutor leads students to experience feelings of comfort, meaning they are more likely to expose their weaknesses, which can then be addressed, resulting in their 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 peer teaching in medical education. Med Teach 2007;29(6):546–52. Factors Influencing Stethoscope Cleanliness amongst Clinical Medical Students at a Scottish University C Saunders, J Skinner C Saunders, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK Background and Purpose: Cleanliness within clinical environments is of great importance to patient safety, with an estimated 15–30% of all healthcare-acquired infections (HAIs) being completely preventable through simple improvements in hygiene1. To date, training and awareness campaigns have focused on the role of good hand hygiene; however, despite evidence that stethoscopes can spread HAIs2, little attention has been given to this common piece of medical equipment. Daily cleaning of stethoscopes can reduce the number with bacterial contamination from over 90% to < 35%3. Despite this, many medical students still fail to clean their stethoscopes regularly and teaching in this practical skill may be lacking3. The aim of this study is to determine stethoscope hygiene habits amongst clinical medical students and correlate this with a number of factors likely to influence cleaning frequency. Methodology: The study population consisted of medical students in their clinical years from a single Scottish medical school. An anonymous study questionnaire was completed by 308 students; students were asked how often they cleaned their stethoscope on average, whether they had received teaching in stethoscope hygiene, and which factors were preventing them from cleaning as often as they would like using Likert scale questions. Results: There was no difference in cleaning frequency between males and females (P = 0.982) or year of study (P = 0.472), and students cleaned their stethoscope on average once per month. Only 9 students (2.9%) had received teaching to show them how to properly clean their stethoscope, and 86.7% felt that this topic needed more awareness in the medical curriculum. Significant correlations were found between the frequency of stethoscope cleaning and whether a student felt confident in knowing how to ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 members’ posters abstracts clean (P < 0.001), whether they witnessed others clean their stethoscope (P < 0.001), whether they thought cleaning was important (P < 0.001), and whether cleaning equipment was readily available (P = 0.001). Cleaning frequency was not correlated with whether the student felt they had enough time (P = 0.101). Discussion and Conclusions: The vast majority of students had received no formal teaching in stethoscope hygiene. By increasing students’ confidence in performing this essential practical 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 wards to promote this skill. Additionally, more equipment should be made available for stethoscope cleaning. In turn, widespread adoption of these suggestions by medical schools both nationally and internationally may help reduce HAIs, increasing patient outcomes. References: 1. House of Commons. Committee of Public Accounts. Fortysecond report: the management and control of hospital acquired infections in acute NHS Trusts in England, together with the proceedings of the Committee relating to the report, the minutes of evidence and appendices. Session 1999–2000. London: The Stationery Office. 2. Breathnach AS, Jenkins DR, Pedler S. Stethoscopes as possible vectors of infection by staphylococci. BMJ 1992; 305: 1573–1574. 3. Uneke CJ, Ogbonna A, Oyibo PG, Ekuma U. Bacteriological assessment of stethoscopes used by medical students in Nigeria: implications for nosocomial infection control. World Health Popul 2008; 10(4): 53–61. Introducing Realism and Contextualization in Ambulatory Care Teaching Enhances the Student Learning Experience N Patravali, R Jarvis, K McKelvie, J Ker N Patravali, University of Dundee, Dundee, UK Background: Ambulatory care is a challenging area for teaching at a junior undergraduate level: understanding, planning and executing patient care is a daunting task for early undergraduates. Treating more patients in the health sector in the ambulatory setting makes teaching in this context both viable and current. Translating this concept, to introduce realism whilst maintaining consistency and reliability in teaching is the challenge. Realism and contextualization includes utilization of patient information prior to seeing the patient, setting up the ‘scene’ based on that information, getting the patient from the waiting area, conducting the interview process and planning future care based on the information procured. This pilot survey was aimed at exploring students’ insight in to patient care in the consultation necessary in the ambulatory care setting, and furthermore to assess their overall learning experience of contextualization. Methodology: A structured change was introduced in the 2nd year undergraduate curriculum. The session was divided into ‘preinterview phase’, ‘interview phase’ and ‘post interview phase’, lasting for 90 minutes. All the 3 phases were based on the underpinning principles of 1. ‘Content’- What is the information? 2. ‘Process’- How is the information gathered? 3. ‘Perception’- What does the doctor think? What clinical reasoning goes on? What attitudes and biases do they have? A real outpatient area was used, using simulated patients. In the pre-consultation phase, the students were asked to plan the consultation based on the principles of content, process and perception. This was contextualized with a letter of referral or similar. Students were observed as they collected the patient from the clinic waiting area. Students were expected to gather information, plan investigations and formulate an initial management plan. Using peer review in the post consultation phase the process was critically appraised and immediate feedback was given. A structured questionnaire was given to the students to help ascertain their understanding of patient care and management in the ambulatory care setting. Results: Students reported that the 3-part process helped them to understand the consultation. Introduction of realism by collecting the patients from the clinic waiting area helped them to learn and develop necessary social skills. Student’s situational awareness, their ease with patients, their planning prior to seeing patients and the importance of formulating a management plan were all noted as learning issues by students. Students also felt more involved in the teaching, as using peer review made the session more interactive. Conclusion: The results show that using realism and contextualization helped the students acquire greater understanding of the consultation. The process helped the students to think and analyze broadly thus improving their understanding of ambulatory care. This structured and contextualized teaching improves the quality of the learning. References: 1 Barrows, H.S An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic Medicine 1993;68(6):443–453. 2 Dent JA, Ker JS, Angell-Preece, HM, Preece PE. Twelve tips for setting up an ambulatory care (outpatient) teaching centre. Med Teacher2001;23:345–50. 3 Irby DM, Wilkerson L. Teaching when time is limited. BMJ 2008;336:384–7. 4 Lipsky MS, Taylor CA, Schnuth R. Microskills for learners: twelve tips for improving learning in the ambulatory setting. Med Teacher1999;21:469–72. 5 Irby D. Teaching and learning in ambulatory settings. A thematic review of the literature. Acad Med 1995;70:898–931. 6. Teaching and Learning Communication Skills in Medicine Suzanne Kurtz, Jonathan Silverman, Juliet Draper. Radcliffe Medical Press, 2004. ª 2011 The Authors Medical Education ª 2011 Blackwell Publishing Ltd. MEDICAL EDUCATION 2011; 45 (Suppl. 2): 86–117 117