Keynote - Integration of communication and clinical reasoning skills: Evolution of a medical school curriculum and reflections of a GP

Conference programme:Anna will discuss the evolution of the HYMS curriculum (including the explicit teaching of clinical reasoning, and integration of the communication and clinical reasoning curricula) and reflect on the impact of her own practice as a GP

Oral Paper SP63. Learner Centred Communication Masterclasses

Background HYMS 3rd and 4th Year MB ChB students frequently encountered communication challenges on clinical placements, despite extensive communication skills teaching in the first two (university based) years of the course. PresentationCompulsory Communication Masterclasses were introduced for 3rd and 4th year students to provide an opportunity for them to address Communication and Professionalism challenges they have encountered on clinical placement. The student-centred Masterclasses are led by Primary /Secondary Care clinicians working with experienced Simulated Patients. They provide an opportunity for students to role play Communication/Professionalism challenges and receive feedback from their peers, Simulated Patient and tutor to help identify strategies for dealing with similar challenges in their future career. Evaluation Students are required to complete an online evaluation which includes descriptive and Likert scale feedback. Students give consistently positive feedback on these sessions, and highlight appreciating the opportunity to reflect and learn from clinician tutors about real-life communication/ professionalism challenges. This student evaluation informs Staff Development Masterclasses for tutors, tutored by faculty and run similarly to the Student Communication Masterclasses. These provide an opportunity to address challenges that tutors have encountered when tutoring Masterclasses and ensure that tutors deliver a consistently high quality student-learning experience

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

Faculty Development: Equipping teachers with the skills to assist students to develop their clinical reasoning and communication skills in patient consultations - an integrated approach

This interactive and multimedia workshop will showcase an approach that integrates the teaching of communication and clinical reasoning skills, through observation and discussion.· To consider the challenges teachers/tutors (experts) might face in helping medical students (novices) develop their clinical reasoning skills· To develop awareness of the role of faculty development in helping teachers/tutors develop the skills required for both clinical reasoning and communication skills teaching in real life patient encounters.· To encourage delegates to share best practice and reflect on faculty development in their own institutions

Threshold concepts and their relevance to clinical reasoning

This interactive workshop offers you the opportunity to look at clinical reasoning with a new ‘threshold concept’ lens. Identified by Meyer and Land in 2003, ‘thresholds’ are thought to be key to achieving mastery of a subject. We will first introduce the ideas of threshold concepts, troublesome knowledge and the liminal space and encourage you to consider examples from your own experiences. You will work in groups to 1) consider which clinical reasoning concepts may be threshold or troublesome and 2) analyse student language to notice when and why students are struggling or have crossed thresholds. We will discuss how the learning from these activities could influence how you develop curricula or teach clinical reasoning in your own settings. We will also share ways you can further develop your understanding of threshold concepts

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 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

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

Clinical Reasoning in Medicine: Developing Students' meta-cognitive skills

This poster outlines the progress of the authors’ project in introducing formal Clinical Reasoning Skills sessions.This project was instituted on the basis of observations of students’ performances in live examinations in years 4 / 5 of our five year course and from feedback from students. Despite having excellent core communication skills students struggled with effective analytical thinking when faced with complex diagnostic challenges. Using research evidence a three week SSC was designed introducing concepts underpinning the clinical reasoning process. This is founded on experiential practice in practical sessions where students analyse their thought processes and hypotheticodeductive 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. Feedback from students was overwhelmingly positive: ‚These sessions were very useful and could benefit all students, particularly if they were incorporated into the curriculum at the start of the year, rather than as an optional SSC‛ ‚I have learnt a lot which I can use in future to make a more thorough and educated diagnosis‛ All students felt that sessions such as these should become a core part of the undergraduate curriculum rather than an SSC. The second year curriculum has now been altered to include two formal sessions that focus on Clinical Reasoning for all students. The SSC continues to be offered and is oversubscribed each time. We are now conducting a pilot research project recording these sessions to analyse as an initial exploration of how diagnostic reasoning and meta-cognitive skills develop in undergraduate students