Oral 13. Unconscious Bias Training for our Simulated Patients: Showcasing a new and innovative workshop

Oral Presentation objectives1) To develop awareness of our innovative workshop delivered to our Simulated Patients to increase their understanding of unconscious biases, how these might impact their work as Simulated Patients in our teaching and assessments and to equip them with skills to challenge and interrogate their automatic thinking. 2) To consider Simulated patient feedback and reflections and my own critical reflections on the Workshop.3) To share best practice with delegates regarding their own experiences of developing Unconscious Bias training to Simulated Patients / other groups in their own institutions

Workshop 47. The Future of consulting: Impact of changing practice on our cognitive load as experts and educators & insights into the novice perspective

Objectives1) To consider current & future impact of remote consulting & the covid pandemic on our cognitive load as clinical reasoning ‘experts’ 2) To consider & reflect on the insights this has provided us as clinicians & educators into the student perspective (clinical reasoning ‘novices’) & their clinical reasoning development 3) To analyse delegates’ own experiences where this & similar transformative learning experiences could be deployed to drive effective learning 4) To recognise & describe the impact on traditional curricula structures

Workshop 21. Faculty Development - Equipping clinical tutors with the skills to assist students to develop their clinical reasoning in patient consultations

Workshop ObjectivesTo consider the particular challenges for clinical tutors (experts) in helping medical students (novices) develop their clinical reasoning skills.To develop awareness of innovative approaches to faculty development to help tutors develop their skills in facilitating students development of their clinical reasoning skills in patient encounters.To encourage delegates to share best practice and reflect on faculty development in their own institutions

Experiences and mentoring needs of novice nurse educators at a public nursing college in the Eastern Cape

The nurse educator role is challenging to novice nurse educators and even more so when mentorship is lacking or ineffective. Novice nurse educators who enter the academic world are expected to demonstrate knowledge of both the clinical and classroom environment. Such an expectation creates role strain, stress and frustration. Mentorship has proved to make this entry easier. There appears to be a lack of mentorship for newly-appointed nurse educators in most schools and/or departments of nursing at higher education institutions in South Africa. This phenomenon prompted the researcher to investigate the experiences and mentoring needs of novice nurse educators with the goal of making recommendations on the mentorship of novice nurse educators. A qualitative, exploratory, descriptive, contextual design and phenomenological approach was used to explore and describe the experiences and mentoring needs of novice nurse educators at a public nursing college in the Eastern Cape. Purposive sampling of nurse educators with less than five years’ experience at a public nursing college in the Eastern Cape, South Africa and with no experience, or less than one year’s previous experience as a nurse educator at any other nursing education institution (NEI) was used. Data was collected using face-to-face, semi-structured individual interviews and unstructured observations. Sixteen in-depth, semistructured interviews that were digitally recorded provided saturated data that was then transcribed verbatim. To ensure that the study was trustworthy, the researcher used Guba and Lincoln’s criteria, namely: credibility, confirmability, dependability and transferability. Ethical standards were maintained throughout the study as the researcher complied with the ethical principles: respect for persons, beneficence and justice. Tesch’s method of thematic analysis was used by the researcher and the independent coder to analyse data and to draw meaning from the content. The five themes that emerged from the data were: novice nurse educators experience challenges related to theoretical mentoring; novice nurse educators experience challenges related to clinical mentoring; novice nurse educators experience a lack of orientation; novice nurse educators experience a lack of resources and novice nurse educators provide recommendations in order to optimise the experience and performance of the novice nurse educators in their first year of teaching at a nursing college. The results of the study reveal that novice nurse educators have reservations about their experiences. Their insights on how their mentoring needs could have been realized were incorporated into recommendations for the mentoring of novice nurse educators. These recommendations can be adopted at local, provincial, and national levels

Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace

Focuses on promising strategies and opportunities for retaining experienced nurses, one of many approaches the authors recommend to alleviate the current nurse shortage crisis

Playing the game: a grounded theory study of the integration of internationally qualified nurses in the Australian healthcare system

Background Twenty-nine per cent of registered nurses in Australia received their first nursing qualification in a country other than Australia. Therefore, understanding the process of successfully transitioning internationally qualified nurses into a foreign healthcare system is vital to ensure the provision of safe, quality nursing care for all Australians. Aim The aim of this study was to explore how internationally qualified registered nurses and Australian qualified registered nurses adapt to working together in the Australian healthcare system and develop a theory that explains this process. Research question What is the process by which internationally qualified registered nurses are integrated into the Australian healthcare system? Methodology Grounded theory methodology was used in this study. Concurrent data collection/generation and analysis of online survey data (n = 186) and individual participant interviews (n = 15) was undertaken. Storyline was used as a technique of advanced analysis to integrate and present the theory. Two focus groups (n = 9 and n = 7) were held to evaluate and validate the theory. Findings International and Australian nurses work together to enable the successful integration of international nurses into practice. Four phases underpin professional socialisation, enculturation and adaption to the cultural norms of the workplace: (i) joining the game: adapting to context—observing and learning the cultural norms; (ii) learning the game: becoming socialised—receiving support; (iii) playing by the rules: aligning scope— communicating for quality care; and (iv) the end game—integration. These phases interconnect to form the final theory of 'playing the game'—a grounded theory of the integration of international nurses in the Australian healthcare system. Discussion Nurse migration trends to Australia have seen an increase in international nurses from developing countries. Context of the work milieu as the dynamic playing field is instrumental in understanding how authentic leadership and positive work environments support integration processes. Consequences for unsuccessful integration are significant and result in: negative work environments; patient dissatisfaction; adverse events; damaged reputations of registered nurses, organisations and the profession; and loss of skilled and experienced registered nurses from the profession. Conclusion The findings of the research are significant for the nursing workforce in Australia in relation to the recruitment, retention and integration of experienced registered nurses. Promotion of cultural responsiveness education and integration strategies prevents the attrition of experienced registered nurses. Recommendations are made to inform policies and practices for sustaining a workforce that will provide quality nursing care for all Australian citizens, regardless of the place of origin of the nurse or where they obtained their initial nursing qualification

WS19. From pedagogy to practice: implementing transformative learning in clinical reasoning

BackgroundHealthcare professionals must provide high quality care that is both efficient and safe. Underpinning this requirement is a presumption that individuals are able to make accurate clinical decisions. Knowledge is not sufficient: judgment and reasoning are required to translate clinical information into accurate decisions to produce effective care. Clinical reasoning skills need to be developed in healthcare professionals in a way that produces change in behaviour. This is aplies to the spectrum of healthcare education: from undergraduate to postgraduate to lifelong practice. Though much is understood about clinical decision-making theory, direction for systematic implementation of teaching in both undergraduate and postgraduate medical education programmes is lacking. In particular, evidence describing transformative teaching methods is limited. This workshop will explore how to design effective spiral curricula in clinical reasoning, compare and contrast experiences from three medical schools in the UK, discuss challenges in implementation, share a variety of teaching methods, provide hands on demonstration of technological resources that have produced changes in learner behaviour and support attendees to adapt methodology to their programmes.Structure of workshopWe will briefly review current knowledge on clinical decision-making learning before sharing experiences from three UK medical schools.Attendees will participate in discussions supported by interactive exercises to explore each subtopic. These exercises will include role play, video and trial of electronic teaching tools used in our current practice. The session will conclude with a reflection on principles and ideas shared during the event

The Use of Prototypes to Engage Stakeholders in Low- and Middle-Income Countries During the Early Phases of Design

Human-centered design processes have been leveraged to help advance solutions to the world’s most pressing problems. Early and frequent engagement with stakeholders is a key activity of early-stage human-centered design processes that leads to better alignment of product requirements with the needs of stakeholders and the context of the artifact. There are many tools to support early stakeholder engagement. A subset of methods includes the use of prototypes – tangible manifestations of design ideas. However, prototypes are underutilized in early design activities to engage stakeholders, notably during cross-cultural design in Low and Middle-Income Countries (LMICs). In such contexts, prototypes have the potential to bridge contextual and cultural differences, which is especially critical when designing for LMICs where many proposed solutions have failed to meet people’s needs. To investigate the roles of prototypes to engage stakeholders in LMICs, I used both qualitative and quantitative research methods emphasizing both engineering design and economics theory and methods. Specifically, I conducted an interview-based study with industry practitioners and investigated two prototype-based stakeholder engagement methods in practice in LMICs. I conducted semi-structured interviews focused on the use of prototypes to engage stakeholders in early design stages with 24 medical device design practitioners from multinational and global health companies. Practitioners described the types of stakeholders, prototypes, and settings leveraged during front-end design and the associations of engagement strategies, stakeholders, prototypes, and/or settings. I further studied the practices of global health design practitioners working on medical devices for use in LMICs and described their approaches to tackle stakeholder remoteness, explore the environment of use, bridge cultural gaps, adjust the engagement activities to stakeholders, and work with limited resources. My analysis of requirements elicitation interviews with 36 healthcare practitioners from two hospitals in Ghana revealed participant preferences when viewing three, one, or no prototypes. The findings indicate that stakeholders preferred interviews with prototypes and in the absence of a prototype, stakeholders referenced existing or imaginative devices as a frame of reference. I investigated the preferences for, willingness to pay for, and usage of a novel tool for electronic-waste recycling with 105 workers in North-Eastern Thailand. Workers were assigned to one of two conjoint experiments that leveraged different prototype forms. Workers further completed baseline and endline surveys and participated in a Becker-Degroot-Marschak auction experiment. The results showed that the prototype form used in the conjoint experiment affected the valuation of product features. One-month evaluation of usage revealed that participants who received the new tool decreased their injury rates and increased productivity. This research provides new insights into the practices and teachings of prototype usage for stakeholder engagement during early design stages, contributes to the developing body of literature that recognizes the unique design constraints associated with designing for LMICs, and advances approaches for promoting more inclusive design practices. The description of the types of stakeholders, prototypes, settings, and strategies leveraged by industry practitioners when engaging stakeholders in LMICs are potentially transferable to, and can have a broader impact on, other contexts in which prototypes are used to engage stakeholders. Furthermore, both applied studies illustrate the effect of using different numbers of prototypes and different prototype forms on the outcomes of the two commonly used stakeholder engagement methods – interviewing and conjoint analysis. The applied studies provide examples of stakeholder engagement methods with prototypes in LMIC settings in practice.PHDDesign ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/162996/1/mjcoul_1.pd

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture