Anna Ryan

Game of Hospitals

Systems of health care is a key learning area in medical curricula. An understanding of the health care system with regards to reducing medical errors, improving efficiency in the provision of care and cost containment is recognised as being difficult to teach.

Tensions in post-examination feedback: information for learning versus potential for harm

Self‐regulation is recognised as being a requisite skill for professional practice This study is part of a programme of research designed to explore efficient methods of feedback that improve medical students’ ability to self‐regulate their learning. Our aim was to clarify how students respond to different forms and content of written feedback and to explore the impact on study behaviour and knowledge acquisition.

Benchmarking in Australia using the International Foundations of Medicine Clinical Science Examination

emonstration of consistent standards in medical Deducation is an important response to the increasingmobility of theworkforce and the propagation of new medical schools around the world. Five Australian medical schools (at the universities of Adelaide, Melbourne, Sydney, Queensland and Western Australia) collaborated to perform a comparison across the subdisciplines included on the 2014 International Foundations of Medicine Clinical Science Examination (IFOM CSE).

Demographics and study practices of psychiatry trainees sitting the RANZCP written examinations.

Objectives: This study explored trainee preparation for the Royal Australian and New Zealand College of Psychiatrists (RANZCP) written examinations. We examined the relationship between candidates’ prior psychiatry experience, preparation techniques and expenses, perceptions of the exam and a pass result. We also examined perceptions of well-being. Method: A web-based survey was sent to RANZCP trainees. The association between responses and exam outcome was analysed using SPSS Statistics 23. Results: A total of 23% (n = 38) of the cohort responded to the survey. Respondents studied for an average of 7.8 months for the essay-style exam and 4.4 months for the multiple-choice questions. The mean months of total psychiatry experience prior to sitting was 36.1 months. Every additional 50 hours of study increased odds of passing by 23%. Respondents who believed that exam preparation would affect outcome had an almost 4-fold higher odds of passing than those who did not. Ratings of well-being before release of results were also positively associated with passing. Conclusions Trainees are sitting the written exams with clinical experience commensurate with RANZCP recommendations. Total study hours and favourable perceptions of exam processes appear to be predictors of success.

Managing student anxiety during curriculum change.

within the context of modern medical practice. This theory is the guiding principle which underlies the recent introduction of a new professionalism tutorial at Cardiff University School of Medicine, UK, replacing previous didactic teaching. The session, based on the idea of medical ‘‘heroes and anti-heroes’’, encouraged students to design and deliver short presentations on recent obituaries or fitness to practice cases. In turn, these presentations generated discussions amongst other students in the tutorial. We used evaluation forms to gain feedback from students on their perspective of this new style of professionalism teaching. Of 81 responses, 73% of the students felt that this interactive method of learning was more effective than a lecture-based approach, and 95% of the students found the session to be at least fairly effective in teaching the duties of a doctor. Sixty-five percent of the students felt that the session was effective or very effective in teaching what constitutes unprofessional behaviour by medical professionals. One criticism we found, however, was that the students felt unprepared for the session, due to the fact that no structured learning outcomes were provided. Despite this, students commented that this facilitated engaging discussions, as a wide range of presentations were produced. From this research, it is clear that the theories drawn together by the Birden et al. article can be realistically translated into improved medical teaching for undergraduates. Professionalism is a key aspect of medical training, as highlighted by the General Medical Council’s document ‘‘Tomorrow’s Doctors’’ (General Medical Council 2009). It is our hope that through better professionalism education, many of the ethical pitfalls encountered by doctors further into their careers can be prevented.

Practice interviews for final-year medical students.

involved in the course design and implementation. Educational outcomes and expected standards were agreed by both faculty members in line with each undergraduate curriculum. Reusable lesson plans and scenarios were developed to enable future implementation. What lessons were learned? All students attended a focus group following the pilot programme. The programme was well received, with students finding it ‘helpful’ [MS1] and ‘worthwhile’ [NS1]. The simulation session was perceived to be of great educational benefit, both for the group undertaking the simulation and for the group observing. The formative nature of the sessions and provision of feedback helped to alleviate the potentially stressful nature of the simulation. One student commented: ‘. . .the more mistakes you do, the more you can be aware of what to do.’ The interprofessional nature of the programme was welcomed and strong desires for further realistic interprofessional experiences were expressed. Students described previously being aware of ‘tension between the two professions’ [MS2], and feelings of ‘a hierarchy’ [NS3]. They also felt that the two groups work in ‘different system[s]’ [MS2], resulting in communication difficulties. It was suggested that interprofessional education throughout undergraduate training might eliminate these problems, and help professionals ‘all know what each other are doing’ [MS2]. Overall, the pilot programme was felt to be a success by all involved, and has shown that not only is it feasible to provide undergraduate IPSE in a DGH, but that it is greatly appreciated by students.

Encouraging peer review in long case tutorials.

Context and setting The long case examination is a complex examination that assesses communication skills, clinical examination skills, and the application of clinical knowledge of undergraduate medical students and postgraduate medical trainees. It has been demonstrated to provide a useful assessment of the candidate’s overall approach to the patient. Why the idea was necessary A review of examiner marking sheets for the semester 9 (Year 5) long case examinations in 2009 revealed themes of deficits in student skills, specifically in the synthesis of information, ability to connect related issues, correlation of historical and examination information, and interpretation. These seemed to be areas that could be targeted by careful tutorial design. Typically, the format of long case examination tutorials requires one student to present while the tutor and other students listen. The active participation of all students (and thus student engagement) in the group is often neither required nor encouraged. What was done The tutor designed a 50-minute long case tutorial that gave non-presenting students a structured examiner role. The tutorials were conducted in groups of eight students and each student was given a card outlining his or her role during that tutorial. One student presented a long case, and the other seven students were assigned roles as examiners of: history of the presenting complaint; past medical and surgical history; medications; psycho-social and social aspects; examination findings; issues; and overall presentation. Each student was asked to evaluate the entire case presentation from the perspective of his or her area of assessment. For example, the medications examiner listened to the whole long case from the perspective of medications, considering which medications the patient should commence based on that history of presenting complaint; whether the patient’s usual medications were explained by his or her past medical and surgical history, and whether the examination findings suggested complications from any long-term medications, etc. These tutorials were provided for two groups of students in semester 9 in 2010. They were introduced with a brief outline of the review of examiner mark sheets, and a discussion about the value of engagement in learning. Subsequent tutorials then involved students presenting cases and providing feedback as outlined. Evaluation of results and impact Both groups of students rated the overall learning experience of the tutorials highly (9.5 and 10 out of 10, respectively). Comments related to the format (‘a good system’), interactivity (‘encouraging participation’ and ‘interactive’) and the feedback provided (‘great’). Although only a small number of students (n = 16) were involved in the tutorials, the marks achieved in the subsequent end-of-semester long case examination were also encouraging: 75% of the long case tutorial students achieved a ‘Good’ or ‘Excellent’ result in the examination compared with 60% of the 83 students who did not take these tutorials within the same clinical school environment. This experience suggests that students value peer feedback and find it useful within a semi-structured long case tutorial environment. More research needs to be undertaken to determine if this format actually has a significant impact on student marks, but initial results (within a small sample size) suggest this may be the case.