Medical Education – Orals

© 2012 Royal Australasian College of Physicians 29Internal Medicine Journal 2012; 42 (Suppl. 2): 29–31

Medical Education – Orals

SUPERVISING DIVERSE STUDENT AND TRAINEE GROUPS AT

MULTIPLE LEVELS IN HIGH VOLUME WORK ENVIRONMENTS

Brazil V1, Mudge A2, Toombes S3

1Emergency Department, Royal Brisbane Hospital, Herston, Queensland, Australia, 2Department of Internal Medicine, Royal Brisbane Hospital, Herston, Queensland, Australia, 3Department of Medicine, Toowoomba Hospital, Toowoomba, Queensland, Australia

Description: This session focuses on one of the most challenging aspects of supervision: How to teach groups of trainees/medical students/OTPs who are at various levels of competence while working in environments focused on meeting service commitments. This interactive session provides practical tips on how to do an on the spot assessment of the level of learning of students/trainees, plan for learning in clinics and on ward rounds and incorporate useful teaching strategies to improve skill development into busy schedules. Participants will be asked to analyse and discuss a series of teaching conun-drums, and critique facilitators’ performance in simulated scenarios. The session is chaired by Victoria Brazil and co-facilitated by two experienced supervisors who share their knowledge and personal experience in meeting such challenges.

Background: The increasing infl ux of medical graduates entering into the specialist training programmes has created several challenges in medical education. One of the major challenges for consultants is to supervise diverse trainee groups such as residents, registrars, senior registrars and overseas-trained specialist working at multiple levels. Trainees at different levels of practice have different training needs, and therefore need differential supervi-sion (Kilminster et al., 2002). Supervision in complex environments should be planned in terms of structure and content. Cottrell (1999) suggests that this should include setting up ground rules, timing, fl exibility, learning objec-tives, record-keeping and formal meetings with the training supervisor. The content of supervision should cover aspects related to the clinical manage-ment, teaching, research, management and administration and personal and career guidance and support.

Aims: To share lessons from literature and personal experience related to teaching multiple levels of trainee and student groups in healthcare settings

To practice teaching skills

Methodology: This interactive session will provide opportunities for fellows and trainees to practice skills related to teaching multiple levels in complex healthcare environments.

SUPPORTING PHYSICIANS’ PROFESSIONALISM AND

PERFORMANCE (SPPP)

Dalton S1, Phelps G2

1Emergency Department, The Children’s Hospital At Westmead, Westmead, New South Wales, Australia, 2Clinical Lead – Clinical Engagement Program, Department Of Health, Victoria, Australia

Description: This session is based on the Supporting Physicians’ Profes-sionalism and Performance (SPPP) Guide. Facilitated by Dr Grant Phelps and Dr Sarah Dalton, Co-Chairs of the SPPP Executive, the practical appli-cations of the SPPP Guide and its usefulness as a self-refl ection tool will be explored.

The session will provide an opportunity for Fellows and trainees to develop a greater understanding of the SPPP Guide, the benefi ts of utilising the SPPP framework and the ongoing evolution of SPPP project.

Background: The medical landscape is changing and the College recognises that physicians have an increasing need for transparency and accountability in demonstrating high standards of performance to their patients, colleagues, the organisations they work with, and to society at large.

The SPPP Guide, approved by the Board in October 2011, presents a framework that has adapted the Professional Qualities Curriculum domains to describe a range of behaviours against which physicians can measure their own performance.

The SPPP Guide is primarily a self-refl ection tool that encourages physicians to develop a strong sense of their individual strengths and weaknesses and

identify opportunities for personal learning and thus professional improvement.

Aims: The session will:• Provide information on how to use the SPPP Guide• Present feedback from the SPPP pilot study (conducted in February 2012)

Methodology: The session will present accounts from the pilot study par-ticipants on how they utilised the SPPP Guide. The session will also provide an interactive discussion on how to use the SPPP and how the SPPP Guide can benefi t Fellows and trainees.

LEARNING THROUGH NARRATIVE: MEDICAL STUDENTS REFLECT

ON THEIR VISIT TO PATIENTS IN A HOSPICE

Donnelly S1,2, McKinlay E2

1Wellington Regional Hospital, Wellington, Aotearoa New Zealand, 2Otago Medical School, Wellington, Aotearoa New Zealand

Background: Medical students learn effectively about end-of-life by talking to patients and using appropriate pedagogical tools to synthesise this experi-ence. Fourth (and fi rst clinical) year medical students in pairs visit a patient at the end-of-life.

Aim: To examine how students use narrative to process this experience and express what they have learnt.

Method: Eighty-one students opted to have their narrative essays retained for research after the academic year was completed. Twenty-nine were chosen as representative for our dataset. Charmaz’s constructivist grounded theory methodology was adopted with theoretical sensitivity used to test categories and theoretical concepts of emerging theory.

Findings: Narrative articulates a learning moment co-created by the medical student, teacher and dying patient. A theory of ‘learning through narrative’ is put forward with the categories of tension, challenge and growth being identifi able in the students’ essays.

Conclusion: In the context of learning about end-of-life care, narrative writing assists students to understand both the patient and themselves. They integrate past experience and articulate transformational learning to teachers who in turn are able to monitor the safety of learning. Narrative writing humanises what for most students is a challenging experience and enables them to resolve initial tension, gain insights and skills as well as grow person-ally and professionally.

THE INTERN EXPERIENCE IN GENERAL MEDICINE: AN INTERN

‘LOG BOOK’ TO IDENTIFY AND MONITOR TRAINING NEEDS

Gardiner B, Pierce D, Yeh P, O’Callaghan C

Department of General Medicine, Austin Health, Melbourne, Victoria, Australia

Background: General registration by the Medical Board of Australia requires medical graduates to complete an ‘internship’ where ‘structured experiences’ consolidate and extend theoretical knowledge and technical skills. Each intern post is accredited by the Post Graduate Medical Council of Victoria. However, determining if individuals appointed to those posts achieve the goals stipulated by the PMCV is not usually assessed.

Methods: Survey questions were determined by consultation with general physicians who have responsibility for intern supervision. Interns self-reported into a Microsoft Excel spreadsheet each week of their General Medicine rotation. Responses were collated via email. Validation of intern responses was determined by separately surveying other members of the General Medicine workforce.

Results: Logbooks were completed by 50 of 50 interns (100%) rostered to General Medicine posts over a 12-month period. Data reported by interns were consistent with reports of activities by other medical staff. Interns performed an average of 13.5 admissions (range 4 to 30) per rotation. There was a signifi cant difference between the number of admissions performed by each unit, ranging from Med 5 (0.91/week) to Med 4 (2.20/week). The logbook identifi ed that substantial time was expended by interns on database entry and modifi cation to the computing programme was associated with a reduction in this time (26.93–11.17 minutes/week).

Conclusions: Internship experiences can be reliably monitored by self-report. This can provide a mechanism for determining the suitability of

Abstracts for the RACP Future Directions in Health Congress 2012

30 © 2012 Royal Australasian College of Physicians Internal Medicine Journal 2012; 42 (Suppl. 2): 29–31

experience during internship and for developing initiatives to improve the education value of internship.

HANDS-ON HANDS-OFF – A MODEL OF EFFECTIVE SUPERVISION

Iedema R1, Hu W2

1Centre for Health Communication, University of Technology Sydney, Sydney, New South Wales, Australia, 2School of Medicine, University of Western Sydney, New South Wales, Australia

Description: This session shares fi ndings from two research studies. One was conducted by Rick Iedema, Professor of Communication in the Faculty of Arts and Social Sciences at the University of Technology Sydney, and the other is currently being conducted by Wendy Hu, Associate Professor, School of Medicine, University of Western Sydney. The studies focus on a key chal-lenge which faces supervisors: how to effectively assess trainees’ level of competence and provide them with learning opportunities that harbour appropriate degrees of independence and support whilst meeting quality standards of patient care.

The workshop session addresses these issues using visual (video and photo) case studies. The data highlight the unique challenges of communicating with trainees and students in real life clinical settings, and assessing students in those settings. The data will be used to guide discussions about how to make best use of communication in the clinical learning environment to improve trainees’ skills and performance, and about what we can learn as supervisors about our own teaching assumptions and approaches.

Background: Professor Rick Iedema and his colleagues explored the issue of autonomy versus direct supervision by examining junior doctors’ perspec-tives on supervisory relationships and interactions at a rural healthcare facil-ity (Iedema et al. 2010). Based on the data, the authors proposed that supervision should navigate between ‘hands-on’ or ‘active’ forms wherein supervisors can provide direct support to facilitate a trainees’ skill develop-ment, and ‘hands-off ’ or ‘passive’ supervision which encompasses fl exible supervisory support when a trainee is acting independently. Associate Profes-sor Wendy Hu and colleagues from medicine, nursing, occupational therapy and physiotherapy at the University of Western Sydney are conducting a video study of supervisors engaging in actual formative assessments of the clinical competence of students in hospital, outpatient and private practice settings. Results from this study will be used to examine and illustrate the hands-on-hands-off supervision model.

Aims• Share fi ndings from research studies exploring the hand-on hands-off supervision model• Review video and photo case studies of supervision• Explore the implications of research outcomes for effective supervision

Methodology: The session will provide a framework for effective supervision and examine its practical implications.

PROFESSIONALISM ISSUES IDENTIFIED THROUGH WORKPLACE

BASED ASSESSMENT PREDICTS POOR PERFORMANCE

OF MEDICAL STUDENTS IN FORMAL WRITTEN AND

CLINICAL EXAMINATIONS

Jones P, Rigby B, Le Duc C

Bond University, Gold Coast, Queensland, Australia

Background: Professionalism in Medical curricula is often narrowly defi ned as clinical ethics and student behaviour monitored via the equivalent of a Personal and Professional Development (PPD) committee. In 2010 Clini-cians expressed concern that the Bond Medical School did not appear to act on poorly performing students. The assessment was complex and workplace based performance contributed to half of the 10 marks allotted to the PPD theme. This system allowed students to compensate for poor workplace performance and academically progress.

Aims/objectives: In 2011 the Medical School aimed to improve the work-place performance of its students in the clinical rotations by improving the rigor of the In Training Assessment (ITA) of the rotations and broadened Professionalism to allow it to be assessed as a workplace based outcome.

Methods: In 2011 the assessment for year 4 was divided into graded and ungraded assessment and both components had to be passed. This made success in the ITA mandatory. The ITA includes 10 measures: fi ve on clinical

performance and fi ve relating to professionalism. Crucial to the successful implementation of this strategy was having a meeting of the clinicians from each teaching site and each discipline at the end of each 8 week rotation.

Findings and Conclusions: Five of 73 students (7%) failed a clinical rota-tion because of an adverse ITA in 2011. All of these students were in the bottom 20% of the class in their graded assessments. Individual student performance was monitored across the full year. The clinicians’ meeting provided a vehicle for communication between each other. Clinicians dem-onstrated the capacity to make robust assessment decisions that correlated with poor academic performance. Workplace based assessment is a robust tool but requires an assessment system which values Professionalism as an academic outcome and engages with Clinicians to support their student assessments.

PRACTICAL SKILLS FOR SUPERVISORS

Lake F1, Cole A2

1School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia, 2Rehabilitation Unit, St George Hospital, Kogarah, New South Wales, Australia

Description: This session is based on the highly successful Teaching on the Run model of supervisor training. Facilitated by Professor Fiona Lake Uni-versity of Western Australia and A/Professor Andrew Cole, Chair of the RACP Physician Educators Expert Advisory Group, the session focuses on practical advice for supervisors about how to give effective feedback to train-ees – particularly dealing with trainees in diffi culty.

Background: Medical Educators in Australia and overseas emphasise the importance of the process of giving feedback to medical students. According to Professor Fiona Lake, medical students and junior medical offi cers report that feedback from their educators/supervisors doesn’t occur frequently enough and that it is not always conveyed effectively. She emphasises that feedback should encourage self-refl ection, raise self-awareness and help stu-dents plan for future learning and practice. (Vickery & Lake, 2005).

Evidence collected from Fellows, Trainees and Supervisors in the PREP Consultation conducted by the RACP in 2011, revealed that ‘There was strong support for taking time to ensure refl ection leads to better professional practice’ (RACP, 2011, P.96), with the ‘value of refl ection . . . understood as helping trainees think more broadly about their practice, rather than merely describing the clinical aspect of events’.

Aims: To assist supervisors to:• Describe the educational pu r pose of assessment, feedback and evaluation• Enhance learning through assessment and feedback• Facilitate effective teaching and learning opportunities

Methodology: The session will be interactive and provides opportunities for supervisors to practice these skills. The session will conclude with an evalu-ation on the effectiveness of this workshop for local delivery as part of the College’s supervisor training strategy.

CONTINUING PROFESSIONAL DEVELOPMENT (CPD) IN PRACTICE

Leighton M1, McCay H2

1Captial Coast DHB, Wellington, New Zealand, 2Department of Paediatrics, Waikato DHB, Hamilton, New Zealand

Description: Facilitated by Dr Marion Leighton and Dr Hamish McCay, members of RACP Continuing Professional Development (CPD) Expert Advisory Group, the session focuses on practical advice for Fellows and others required to complete CPD and how to build it into your everyday practice. The session will touch on the principles of the College’s MyCPD programme, the Australian Medical Board & New Zealand Medical Coun-cils’ regulatory requirements for CPD, and the College resources available to assist Fellows in meeting these.

Background: The Medical Board of Australia and the Medical Council of New Zealand are increasingly regulating participation in CPD by medical practitioners. CPD is now mandatory in both countries and a re-certifi cation process has begun in New Zealand.

One of the RACP’s roles is to support its Fellows in completing CPD requirements set by the regulators. The online MyCPD programme, launched in 2007, assists Fellows in adequately recording their CPD activities. The

Medical Education – Orals

© 2012 Royal Australasian College of Physicians 31Internal Medicine Journal 2012; 42 (Suppl. 2): 29–31

MyResources Gateway, launched in 2011, houses RACP online resources for Fellows use in their ongoing learning and development.

Aims: To assist Fellows and other MyCPD users in knowing:• How to make the most out of the MyCPD programme• What is appropriate to record as CPD, and under which category• What the current requirements are of the medical regulators in completing CPD are• What the future of CPD and recertifi cation is likely to look like

Methodology: The session will be interactive and will provide opportunities for Fellows to ask questions and feedback on the MyCPD programme and College CPD resources. The session will conclude with an evaluation on the effectiveness of this workshop for local delivery.

WHAT DOES IT TAKE TO MAKE EDUCATION CHANGE HAPPEN IN

YOUR HEALTH SERVICE?

McCahon E

Children’s Hospital Westmead, Westmead, New South Wales, Australia

Description: This interactive workshop will focus on the role of DPEs and supervisors as leaders of educational change within health care settings. It will focus on leadership, infl uencing skills and practical strategies to bring about effective change. The session is facilitated by Emma McCahon, Pae-diatrician at the Children’s Hospital at Westmead, Chair NSW State Paedi-atric Training Council and Clinical Chair Leadership Development Programs for the NSW Clinical Education and Training Institute. In addition, during this session, three DPEs and supervisors share stories of challenges and solu-tions to the complexities of leading educational change in their work.

Background: Traditionally doctors have been trained as expert clinicians. As they gain promotions in their organisations increasingly they need to grapple with a myriad of new challenges outside their fi eld of clinical exper-tise: leading teams, negotiating with multidisciplinary teams, advocating for resources for their department and individual patient groups, implementing system-wide change including within medical education and practice improvements. The skill sets required to develop expertise in such areas of practice broadly relate to the fi elds of leadership and management: emotional intelligence, infl uencing skills and change management. The purpose of this session is to assist supervisors and DPEs to develop such skills particularly within the context of managing education change within their healthcare settings.

Aims: To assist supervisors and DPEs to:1. Lead educational change in their health services2. Develop their infl uencing skills3. Gain practical strategies to implement and sustain change

Methodology: The workshop is designed to integrate evidence/theory, hands on exercises, application to RACP education programmes as well as drawing on experience from leaders/change agents.a. Theory – drawing on evidence from health, education and other

industriesb. Exercises – are an opportunity to put into practise the key skills identifi ed

in the change theoriesc. Application to PREP – will focus on taking the workshop learning and

identifying opportunities to use in the participants workplaced. Open Microphone – brief interview with ‘change champion’ – to learn

from their stories of the complexities of leading educational change in their work environment; the challenges and solutions.

THE SENSE AND NONSENSE OF WORKPLACE-BASED

ASSESSMENT

Schuwirth L1, Stokes M-L2

1School of Medicine, Flinders University, Adelaide, South Australia, Australia, 2Education Services, Royal Australasian College of Physicians, Sydney, New South Wales, Australia

Description: This session commences with a presentation led by the world renowned Medical Education researcher, Professor Lambert Schuwirth,

Flinders University, Adelaide who will unpick the ‘Sense and Nonsense of Workplace-based Assessment’. The presentation will be followed by a pres-entation from Dr Marie-Louise Stokes, Director of Education, RACP, who will outline the College’s approach to medical education in 2012 and beyond.

Background: Workplace-based assessment methods such as 360-degree feedback and mini-CEX are becoming increasingly popular. This, however, should mean that they can be seen as a panacea for all workplace-based assessment problems. Quite the contrary, incorrect use will only lead to unwanted effects and frustration. In this presentation Professor Schuwirth highlights some of the supporting educational research outcomes and what they mean for an effective, effi cient and sustainable use of these assessment methods and their application in the workplace.

This presentation provides the backdrop for addressing how the College is planning to adopt effective, effi cient and sustainable options to the design and implementation of changes to its training programmes. The presentation draws on the fi ndings of the Physician Readiness for Expert Practice Consultation conducted in 2011 to outline some of the complexities in bringing about effective change in physician education from the perspective of Fellows and trainees. It proposes a model to facilitate educational change in physician training, new formative assessment tools, a supervisor strategy, online learning developments and plans to work with jurisdictions to improve infrastructure in hospital settings including protected time and increased administrative support.

Aims:• To highlight supporting educational research outcomes on work place-based assessment• Explore the implications of research outcomes for effi cient and sustainable application of workplace-based assessment• Outline the RACP approach to medical education in 2012 and beyond

Methodology: The session will comprise two papers each followed by a 15-minute question and answer forum.

A NOVEL METHOD OF DELIVERING PROFESSIONAL QUALITIES

CURRICULUM IN BASIC PREP TRAINING

Eisemann R1, Toumpas C1, Menkens M1, Levitt D1,2, Suresh S1,2

1Mater Children’s Hospital, South Brisbane, Queensland, Australia, 2School of Medicine, University of Queensland, Brisbane, Queensland, Australia

Background: The College has revamped the basic training curriculum and a structured, trainee centred programme, Physician Readiness for Expert Practice (PREP), has been introduced recently. There are component cur-ricula for both adult and paediatric medicine, as well as a professional quali-ties curriculum (PQC) that encapsulates the essential core professional skills needed by both trainees and practicing physicians. However, there is limited information available on delivering the PQC in the training environment.

Aims/objectives: To assess the feasibility of delivery of PQC in a weekly training programme for basic trainees.

Methods: Following a weekly journal club presentation, a trainee randomly selects one of the 26 PQC themes. Given the all-pervasiveness of the PQC component, the trainee is encouraged to refl ect on the chosen topic and explore its relevance to their practice. To extend their understanding of the topic, there is then a group discussion with other trainees and a facilitator. To increase trainee exposure to the PQC refl ection, all domains are to be discussed twice per year.

Findings: After initial trepidation, all trainees embraced the new activity with vigour. They have discussed relevant aspects of PQC in their formative assessments and supervisor feedback meetings. The trainees also have shown keen interest in keeping in their portfolios a copy of the professional qualities refl ection. Feedback obtained from the trainees at the end of year demon-strates that they have gained signifi cantly by trailing this novel method of refl ection.

Conclusions: This study demonstrates that PQC teaching and learning can be integrated seamlessly into the basic trainees’ workplace environment. Further qualitative and quantitative studies are planned for 2012 to deter-mine the impact of this training method.