Formative process evaluation of the army social work care manager program

The U.S. Army has undergone extreme transformation to meet new national security needs of the nation due to the Global War on Terror (GWOT). In order to meet the needs of Soldiers and families exposed to increased stressors, the Army behavioral health system has undergone much transformation as well. The Army Social Work Care Manger Program (CMP) is one program recently developed to enhance Army behavioral health services to this population. It provides care for Soldiers and their families who experience psychological or interpersonal difficulties throughout the deployment cycle. This study investigates the ability of this new program to create effective services throughout several locations across the Army. More specifically, the study evaluates the extent to which the CMP has been implemented as intended, reaches the target population and accomplishes the intended tasks. Soldier survey data, multiple Care Manager (CM) activity reports, interviews and focus groups were analyzed in a triangulated methodology. CMPs studied were found to reach the target population and address target issues across installations; however, senior enlisted as well as white male Soldiers appeared to be exposed to trauma at higher rates than they received treatment. Burnout, lowered health benefits, overtasking, and recommendations for program formalization through manuals were identified as areas of program development.Social Wor

Oral Paper S26 - What are students frightened of?

Background Despite extensive consistent integrated early clinical experience at HYMS, students have often been noted to struggle in making the transition from the largely University-based Phase I (2 years) to immersion in the clinically-based Phase II. Tutors report student difficulties in adopting an appropriate attitude to learning in this environment; some are noted to respond to this by minimising the time spent on the wards with obvious consequences for their experience and education. Presentation A new “Core Clinical Skills and Professional Expectations” course, lasting 2 weeks was introduced in August 2014 for students making this transition. This block aimed to address many areas which students have been noted to struggle with, including professionalism and development of clinical diagnostic reasoning and skills for independent learning. Evaluation Students were asked to identify their own fears and anxieties about moving into the clinical environment. All students completed a brief survey at both the beginning and the end of this two week period which included identification of their own sources of anxiety in approaching immersion in the clinical environment. Results of this survey are presented and discussed with implications for clinical teaching

P33. Optimising student experience: an innovative and integrated tutor support and development programme

Background The curriculum of the five year MBBS course at HYMS is integrated and student–centred with regular clinical skills sessions throughout the first two years. The clinical skills tutors are practising clinicians who deliver their teaching role alongside everyday clinical practice. The essential features of our successful support system have evolved during our first eight years, creating a vibrant integrated and innovative Community of Practice. Our support system includes:• Peer observation • Regular online student-tutor feedback • Regular tutor training sessions • Regular Action Learning Sets • New tutor mentoring • Annual Performance Review 65 • Tutor commitment to completing a Postgraduate Certificate in Medical Education • Core staff in key roles facilitating inclusion of tutors in all aspects of the medical school. • Involvement in student assessment.Our tutors benefit and learn from each other’s experiences whilst developing professionally as educators embedded within medical school life. The Community of Practice ensures that tutors deliver consistently high quality student learning experience. The evaluation includes:• Students complete online, anonymous evaluation of tutors • We performed an evaluation of one session by observing all tutors • Informal evaluation that problems are now frequently managed by the tutor group rather than by faculty

Workshop 13. Clinical Diagnostic Reasoning: Equipping students with peer instruction skills to work together in developing their diagnostic reasoning

Workshop Format An introductory presentation covering best evidence in current medical education literature regarding development of diagnostic clinical reasoning skills for undergraduate students Small group work focusing on clinical tutor- identified real case scenarios to enable delegates to identify teaching and learning approaches to help undergraduate students to develop diagnostic reasoning skills. This will include consideration of facilitation of peer-peer approaches for development of clinical reasoning skills A closing plenary will include • DVD demonstrating the authors’ approach to facilitation of skills development in this area • Further discussion about the student-led approach • Reflection on incorporating novel approaches in delegates` own curriculum and teaching sessions • Presentation of the authors student “pocket guide” hand-out • Questions/Answers/Sharing best practice. Workshop Submissions Objectives To consider clinical tutor-identified, specific, student cognitive-processing difficulties in clinical diagnostic reasoning in contemporary systems based curricula. o consider specific challenges for students in developing their own clinical reasoning skills, following a transition from university to clinical teaching environments. To aid development of students` ability to consider their own clinical reasoning skills and facilitate development of these skills in their colleagues To share best practice with colleagues To discuss the authors` example of curricular innovation in this area Intended audience Tutors responsible for delivering clinical skills/ clinical reasoning teaching in undergraduate training

P06. Clinical Reasoning in Medicine: Developing Students' metacognitive skills

This poster outlines the introduction of formal Clinical Reasoning Skills sessions - initially a Student Selected Component (SSC) - as compulsory sessions in the core second year curriculum. Observations of 4th and 5th Year students’ performances in live examinations and student feedback indicated that, despite having excellent core communication skills, students struggled with the skills needed for effective analytical thinking when faced with complex diagnostic challenges.A three week SSC was designed around current research introducing students to the concepts underpinning the process of clinical reasoning. This SSC is founded on experiential practice where students analyse their thought processes and hypothetico-deductive reasoning governing the choices and conclusions reached whilst interviewing patients. All sessions are conducted in small interactive groups with experienced simulated patients and academic clinician tutors. Student feedback was extremely positive; all students felt these sessions must become part of the core undergraduate curriculum. The iterative processes required for developing higher order thinking skills in students are described

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

Workshop 08. Professional Delivery of Clinical Reasoning in Medicine

Objectives To consider the specific challenges for students in developing clinical reasoning skills in contemporary systems-based curricula. To consider case vignettes portraying specific student cognitive-processing difficulties in diagnostic reasoning and design a teaching approach to address these difficulties. To share best practice with colleagues. To watch and discuss one example of teaching and learning practice demonstrated in the authors’ DVD recording of an innovative teaching session .Workshop Summary A brief presentation will explore recent evidence in current literature regarding clinical teaching in this area. The delegates will work in small groups on real case vignettes bringing these specific student cognitive difficulties to life. This will enable delegates, in collaboration, to generate suitable teaching and learning approaches for consideration by the whole group. Watching the authors’ own demonstration DVD depicting an innovative teaching approach will stimulate further discussion and reflection on incorporating novel approaches in delegates` own teaching. There will be time for Questions/Answers and sharing best practice with other delegates

Roundtable RT06. Clinical Reasoning skills: Something that can be taught or just a matter of seeing lots of patients?

There is considerable literature regarding the complex nature of clinical reasoning for clinicians. Norman (2005) stated “there is no such thing as clinical reasoning - there is no best way through a problem. The more one studies the clinical expert, the more one marvels at the complex and multidimensional components of knowledge and skill that he brings to bear on the problem, and the amazing adaptability he must possess to achieve the goals of effective care”.For novices to become experts they need extensive deliberate practice to facilitate the availability of conceptual knowledge and add to their storehouse of already solved problems (Norman 2005).The authors are aware that previously students learnt how to reason clinically by clerking lots of patients and constructing lists of likely differential diagnoses. Students were repeatedly interrogated by doctors to justify their differential diagnoses. Changes in working time directives and increased shift working mean that students are less likely to have to justify their thinking on several occasions to the same doctor who then helps them develop their reasoning skills.Today’s students face further challenges, as modern medical curricula generally focus on delivering clinical experience in system-specific rotations leaving students unable to organise information effectively when patients present with complex, multisystem illnesses. A limitation of systems based curricula is that it does not encourage the development of clinical reasoning skills.There is now extensive literature regarding the need to explicitly teach clinical reasoning skills to students in addition to them having lots of practice in clerking patients and then constructing lists of the most likely differential diagnoses.Delegates at this round table discussion will be encouraged to debate whether they believe that students can be explicitly taught clinical reasoning skills or whether it is just a case of ‘seeing lots of patients’

Workshop: Helping undergraduate medical students to improve their clinical reasoning in the direct patient encounter - skills for tutors

Workshop Description: This workshop demonstrates how clinical consultations can be used in a structured way to facilitate student understanding of their own clinical reasoning. Participants will actively explore, analyse and practise some of the skills needed for facilitating students’ learning of clinical reasoning.Workshop Objectives: Following the workshop participants will be able to: • Recognise opportunities to strengthen the teaching of clinical reasoning within their environment • Evaluate students’ individual clinical reasoning learning needs • Identify new opportunities for patient participation in clinical reasoning teaching • Discuss current opinion about teaching and learning clinical reasoning • Reflect on their personal experience of learning and teaching clinical reasoning

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