Residents’ perceptions of simulation as a clinical learning approach

Background: Simulation is increasingly being integrated into medical education; however, there is little research into trainees’ perceptions of this learning modality. We elicited trainees’ perceptions of simulation-based learning, to inform how simulation is developed and applied to support training.Methods: We conducted an instrumental qualitative case study entailing 36 semi-structured one-hour interviews with 12 residents enrolled in an introductory simulation-based course. Trainees were interviewed at three time points: pre-course, post-course, and 4-6 weeks later. Interview transcripts were analyzed using a qualitative descriptive analytic approach.Results: Residents’ perceptions of simulation included: 1) simulation serves pragmatic purposes; 2) simulation provides a safe space; 3) simulation presents perils and pitfalls; and 4) optimal design for simulation: integration and tension. Key findings included residents’ markedly narrow perception of simulation’s capacity to support non-technical skills development or its use beyond introductory learning.Conclusion: Trainees’ learning expectations of simulation were restricted. Educators should critically attend to the way they present simulation to learners as, based on theories of problem-framing, trainees’ a priori perceptions may delimit the focus of their learning experiences. If they view simulation as merely a replica of real cases for the purpose of practicing basic skills, they may fail to benefit from the full scope of learning opportunities afforded by simulation.

Occupational Therapy Students’ Perceptions of OSCE: A Qualitative Descriptive Analysis

Objective Structured Clinical Examinations (OSCE) are commonly used across health professions educational programs to evaluate student clinical competencies. OSCE are multiple, brief stations representing common practice scenarios. The purpose of the study was to evaluate student perceptions of OSCE. The researchers implemented 17 OSCE stations with 40 second year occupational therapy students to assess clinical competencies prior to fieldwork. Applying a qualitative descriptive methodologic approach, researchers analyzed station rating data, Qualtrics survey Likert-type items, and Qualtrics survey open-ended responses. Number of station rating responses varied widely, due to perceived time press. Station rating responses confirmed the more robust 80% response to Qualtrics survey. Analysis of Likert-type items revealed perceptions of OSCE as comprehensive, mixed eustress and distress, confirming of competence, and supportive of growth. Four dimensions of learning emerged from analysis of open-ended items: temporal, real world, bottlenecks to learning, and being open to the process. Findings affirmed student perceptions of OSCE to be valuable as summative and formative assessment of clinical competence. Existing literature supports three of the four dimensions of learning. The researchers advocate additional research to examine bottlenecks to learning, psychometrics of OSCE, the use of OSCE in program evaluation, and longitudinal study of student performance related to OSCE

Design of an OSCE to Assess Clinical Competence of Occupational Therapy Students

Objective structured clinical examinations (OSCEs) are a series of controlled, timed stations in which students demonstrate clinical skills. OSCEs are commonly used within health professions education to demonstrate competence, prepare for clinical education, and conduct program evaluation. The body of literature addressing the use of OSCEs in occupational therapy (OT) is growing; however, there are no available guidelines for developing an OSCE specific to the profession. The purpose of this paper is to describe the design of an OSCE for OT students prior to fieldwork placement. Twelve OT practitioners participated in a modified-Delphi method to generate possible OSCE scenarios. The authors developed a blueprint, designed items, implemented an OSCE, and collected data. Quantitative analysis suggests OSCEs to be valid assessment of clinical skills. Qualitative analysis suggests students perceive OSCEs to be stressful but valuable learning experiences. The authors are conducting additional analysis of outcome data, exploring the utility of OSCEs as a strategy to assess clinical competence in OT. Stakeholders concurred with the need to investigate the experience of learning through doing. The authors believe OSCEs could address universal professional rather than program specific clinical competencies

P15. Employing students' multilingualism and language diversity in teaching and learning

Before our innovative clinical skills session ‘Interpreting in Consultations’, we conducted an annual survey of languages spoken by students on admission, in 2006, 2007 and 2008. Froma response rate of 94% we noted that 28% of students are advanced/fluent speakers of language(s) other than English and a total of 48 languages are spoken.The session, ‘Interpreting in Consultations’, involves first and second year students who speak the same language other than English, role-playing an ‘interpreted’ consultation.Feedback from tutors and students following the session shows that using different languages serves multiple, valuable purposes, highlighting:• issues encountered with interpreters• challenges of ‘medical’ language• difficulties in transmitting a patient centred approach• how linguistic and cultural sensitivities are lost in translation.Student linguistic diversity is considerable and not used to its full potential: the single clinical skills session we report suggests there is much more to be gained. The education we design and delivermay fail to recognise what patient-centred-ness means in different languages and cultures.Future research should: consider how to make best use of multiculturalism and linguistic diversity; explore how students’ awareness of, and competence in, different languages and culturescan be developed and maintained

Workshop 07. Developing approaches to professionalism in medical students

Since the inception of our medical school seven years ago we have noticed that despite undergraduate medical students having an awareness that doctors have expected professional behaviours they have not always appreciated how professional behaviour applies to medical students. Professionalism issues have arisen both within and outside the medical school. This has been particularly evident during the introduction three years ago of peer physical examination as a means for students to acquire physical examination skills.We have been able to address these issues in several ways - At an institutional level we have both been closely involved with supporting tutors and students as issues have arisen. Challenges that have arisen have informed tutor training –helping tutors to feel empowered to deal with issues themselves. Professionalism issues are addressed in staff development sessions covering acceptable behaviours and tutors are encouraged to draw on each other for advice. For example, we involved our tutors in the development of a session which involves case vignettes around appropriate behaviour in physical examination sessions. We have developed a highly effective process of peer observation within the tutor group. Existing tutors mentor new tutors. We are proud to have developed a group of experienced clinician tutors with diverse views who have collective ownership of the teaching process. On a practical level we have raised the ‘professionalism’ thread in the students’ learning experience – via lectures, written material and discussions. For example, one of the first lectures given to the first year students focuses on professionalism and its relevance to them within both clinical and non-clinical teaching sessions and also outside the medical school. One area that continues to challenge both students and tutors is that of cultural diversity and how this sits alongside expected professional behaviours

P16. Introducing Peer Physical Examination

We are a new medical school (now into our eighth year) and until the 2008/09 academic year our Year One and Two students acquiredphysical examination skills by examining healthy volunteers. The Year One cohort in 2008/09 were the first to acquire these skills using Peer Physical Examination (PPE), performing the examinations on each other, and this was rolled out to involve all Year One and Twostudents this academic year.Introducing PPE involved a culture shift within the medical school, training of existing and new tutors and revisions to our written studyguide material.Over the past eighteen months we have overcome several practical and ideological challenges during the introduction of PPE as a teaching method.Our poster explains our teaching methods, the challenges encountered and the pragmatic ways in which we have navigated a course through these challenges at both an individual and organisational level. We are now able to give much clearer guidance to students and tutors with the benefit of what we have learntover the past 18 months

Hybrid simulation compared to manikin alone in teaching pelvic examinations:a randomised control trial

INTRODUCTION: Performing a pelvic examination is a core skill for all medical undergraduates. The use of hybrid simulation, manikin with patient actress, to attain technical and communication skills competencies and to improve the quality of care we offer women, has not been compared to other teaching methods before. Outcome measures were technical skills, communication skills and confidence in completing a pelvic examination. METHODS: A cluster randomised control trial was conducted over an academic year. Forty-eight medical students who completed an 8-week obstetrics and gynaecology attachment were recruited. Clusters were randomly assigned for initial training on hybrid or manikin only models and attended an end of attachment Objective Structured Clinical Assessment. RESULTS: Outcome data were received for 43/48 students (89.5%). Following the objectively structured clinical examination, the hybrid trained cohort had higher technical scores (mean 23 (95% CI 20.1 to 25.8) vs 16.7 (CI 14.7 to 18.6); mean difference 6.3, CI 3.0 to 9.6) and communication skills scores (mean 22.6 (CI 21.2 to 23.8) vs 15.9 (CI 14.4 to 17.3); mean difference 6.7, CI 4.8 to 8.5) compared to the manikin only trained participants. Confidence in undertaking future pelvic examinations were similar in the control and intervention groups; (p=0.10, r=0.18). CONCLUSIONS: This study demonstrates the value of hybrid simulation compared to manikins alone in improving the short-term acquisition of competence in simulated pelvic examinations at an undergraduate level. Future research should focus on whether hybrid models lead to long-term acquisition of skill and comparison of these models with other innovative methods such as clinical teaching associates

Training safer surgeons: How do patients view the role of simulation in orthopaedic training?

BACKGROUND: Simulation allows training without posing risk to patient safety. It has developed in response to the demand for patient safety and the reduced training times for surgeons. Whilst there is an increasing role of simulation in orthopaedic training, the perception of patients and the general public of this novel method is yet unknown. Patients and the public were given the opportunity to perform a diagnostic knee arthroscopy on a virtual reality ARTHRO Mentor simulator. After their practice session, participants answered a validated questionnaire based on a 5-point Likert Scale assessing their opinions on arthroscopic simulation. Primary objective was observing perception of patients on orthopaedic virtual reality simulation. FINDINGS: There were a total of 159 respondents, of which 86% were of the opinion that simulators are widely used in surgical training and 94% felt that they should be compulsory. 91% would feel safer having an operation by a surgeon trained on simulators, 87% desired their surgeon to be trained on simulators and 72% believed that additional simulator training resulted in better surgeons. Moreover, none of the respondents would want their operation to be performed by a surgeon who had not trained on a simulator. Cronbach's alpha was 0.969. CONCLUSIONS: There is also a clear public consensus for this method of training to be more widely utilised and it would enhance public perception of safer training of orthopaedic surgeons. This study of public perception provides a mandate to increase investment and infrastructure in orthopaedic simulation as part of promoting clinical governance

Voluntary undergraduate technical skills training course to prepare students for clerkship assignment: tutees’ and tutors’ perspectives

BACKGROUND: Skills lab training has become a widespread tool in medical education, and nowadays, skills labs are ubiquitous among medical faculties across the world. An increasingly prevalent didactic approach in skills lab teaching is peer-assisted learning (PAL), which has been shown to be not only effective, but can be considered to be on a par with faculty staff-led training. The aim of the study is to determine whether voluntary preclinical skills teaching by peer tutors is a feasible method for preparing medical students for effective workplace learning in clerkships and to investigate both tutees’ and tutors’ attitudes towards such an intervention. METHODS: A voluntary clerkship preparation skills course was designed and delivered. N = 135 pre-clinical medical students visited the training sessions. N = 10 tutors were trained as skills-lab peer tutors. Voluntary clerkship preparation skills courses as well as tutor training were evaluated by acceptance ratings and pre-post self-assessment ratings. Furthermore, qualitative analyses of skills lab tutors’ attitudes towards the course were conducted following principles of grounded theory. RESULTS: Results show that a voluntary clerkship preparation skills course is in high demand, is highly accepted and leads to significant changes in self-assessment ratings. Regarding qualitative analysis of tutor statements, clerkship preparation skills courses were considered to be a helpful and necessary asset to preclinical medical education, which benefits from the tutors’ own clerkship experiences and a high standardization of training. Tutor training is also highly accepted and regarded as an indispensable tool for peer tutors. CONCLUSIONS: Our study shows that the demand for voluntary competence-oriented clerkship preparation is high, and a peer tutor-led skills course as well as tutor training is well accepted. The focused didactic approach for tutor training is perceived to be effective in preparing tutors for their teaching activity in this context. A prospective study design would be needed to substantiate the results objectively and confirm the effectiveness