really good stuff educational research across many disciplines. The development of teaching skills forms an essential part of the foundation programme competencies expected of junior doctors.1 We developed a novel method of ensuring the sustainability of a medical student simulation training programme by cascading the facilitation training of junior doctors from one year cohort to the next, thereby ensuring the continuing professional development of both groups. What was tried? A medical student simulation programme was initially established by two junior doctors with the support of clinical teaching leads. Mapping of the undergraduate curriculum was used to create simulation scenarios that address technical and human factor skills. Weekly simulation sessions were held throughout the course of a year in the hospital’s simulation centre. The Laerdal SimMan was used. Following the annual mass rotation of junior doctors the following year, we were challenged to achieve the sustainability of the programme by recruiting new junior doctors as facilitators. Two separate facilitator training courses, each consisting of 2-hour evening sessions, were established, recruiting a total of 35 potential facilitators. They focused on debriefing skills and the role of human factors, as well as the more technical skills of operating a classic Laerdal SimMan manikin. Twenty-eight Year 3 medical students were invited to participate in the simulated management of an acutely unwell patient. Common scenario themes included upper gastrointestinal bleed, sepsis, myocardial infarction and acute asthma. Qualitative and quantitative data were collected using pre- and postcourse Likert scale-based feedback questionnaires. Medical students rated the educational value of the simulation experience at a mean of 4.7 out of 5. Mean ratings of perceived medical student confidence in managing acutely unwell patients increased from 1.8 to 3.5 out of 5 after the course. In free-text comments, students highlighted the use of the SBAR (situation, background, assessment, recommendation) protocol for effective handover, the ABCDE (airway, breathing, circulation, disability, exposure) approach for a systematic patient assessment, and the importance of the prompt escalation and prioritisation of tasks. Facilitators’ feedback indicated that 28 of the 35 certified participants voluntarily facilitated in the undergraduate simulation programme; 86% of facilitators were Foundation Year doctors and 60% of facilitators facilitated more than two sessions. In free-text comments, the junior doctors admitted that being a facilitator altered aspects of their own
clinical practice: it enhanced awareness of their own limitations, promoted interprofessional collaboration, and reinforced the use of a systematic approach in assessing an acutely unwell patient. Five of the 28 facilitators further explored their interest in medical education by undertaking research projects in medical simulation. What lessons were learned? A near-peer simulation training programme for medical students, run by newly qualified doctors, can be beneficial for both parties. For medical students, it can enhance the development of both technical and non-technical skills prior to qualification. In junior doctors, it can contribute to postgraduate professional development, provide opportunities to practise skills that may often be reserved for more senior colleagues, and possibly motivate doctors to become involved in medical education at an earlier stage in their careers. REFERENCE 1 Qureshi Z, Ross M, Maxwell S, Rodrigues M, Parisinos C, Hall HN. Developing junior doctor-delivered teaching. Clin Teach 2013;10 (2):118–23. Correspondence: Marilina Antonelou, Department of Acute Medicine, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Tel: 00 44 20 02077940500; E-mail: [email protected] doi: 10.1111/medu.12443
Faculty development of an OSCE in an internal medicine clerkship Marcelo Cruzeiro & Valdes Bollela What problems were addressed? At our institution, undergraduate internship used only a structured global assessment as a method of evaluating clinical competence. The faculty coordinators therefore proposed to implement a cognitive and competence assessment rating system to address current issues, although most faculty staff had no previous experience in performance assessment. What was tried? Faculty enablement workshops on the evaluation of clinical competence were held. These focused on the development of an objective structured clinical examination (OSCE) to give feedback to Year 5 undergraduate students of medicine. Weekly meetings were held over 7 months in which the participants discussed developing the OSCE, as well as a blueprint and the building of test stations. Our blueprint was based on a competence matrix which showed how
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really good stuff each station should be constructed. We included five stations: blood pressure measurement; a patient with an unusual headache; a patient with marked indicators of dengue; a child with dehydration, and an instance of alcohol abuse. SurveyMonkey was used to administer two surveys in our institution prior to the implementation of the OSCE. The goal was to learn how students and teachers viewed the clinical competence evaluation and the current institutional assessment model. Students recognised that assessment is part of the teaching process and encourages medical study, but they had previously experienced badly elaborated tests. Teacher responses indicated that they felt assessments prepare students better and that the evaluation of clinical competence is essential. Teachers believe that assessments are formative and summative, and suggest that the former quality is the more important. Teachers viewed the clinical competence evaluation as an assessment of skills and performance. The OSCE performance assessment was implemented and included the provision of feedback to students over five stations. It was then re-implemented with 10 stations which involved 16 teachers (11 evaluators, two observers, two actors and a coordinator) and 19 students (10 actors and nine evaluators). Each station lasted 10 minutes, of which 8 minutes were devoted to evaluation and the provision of immediate feedback to students about performance. A further SurveyMonkey exercise was conducted after the OSCE. Students’ views following this survey were that the OSCE was extremely important to their development and was fundamental to their medical course. Students felt they should be encouraged to take part in this method of evaluation, although many of them disclosed much anxiety. The OSCE with feedback met their expectations and the consensus was that this new method of clinical competence evaluation should be implemented in the medical course. What lessons were learned? The OSCE with feedback is an important tool in the evaluation of clinical competence and is able to motivate teachers and students alike. Faculty staff recognised that the OSCE with feedback is helpful in the academic and professional development of undergraduate students. Faculty staff felt motivated to work with performance assessment and planned to include it as part of the faculty development programme. Each step of the development and implementation of the OSCE provided both faculty staff and students with opportunities to reflect about the learning process, the evaluation and the overall structure of their medical course.
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Correspondence : Marcelo Cruzeiro, Department of Internal Medicine, Federal University of Juiz de Fora, Avenida Eug^enio Nascimento s/n, Juiz de Fora, Minas Gerais 3603-833, Brazil. Tel: 00 55 32 2102 3829; E-mail: [email protected] doi: 10.1111/medu.12472
Are mentors born or made? Michelle Elizov, Miriam Boillat & Peter J McLeod What problems were addressed? Mentorship has traditionally been conceptualised as a relationship wherein one person, often a more experienced and knowledgeable person (the mentor), guides another person (the mentee), by providing the instrumental and psychosocial support necessary for the achievement of the mentee’s goals.1 Mentorship can provide guidance for the introduction of new members into a group while facilitating their socialisation and providing a source of advice and emotional support. In health sciences environments, mentorship can also be a useful adjunct to other faculty development activities. During recent orientation workshops for new faculty members, we were surprised to discover that numerous participants reported having received limited or insufficient mentorship. To explore this disturbing revelation, we conducted a needs assessment with potential mentors who had expressed hesitation in taking on this role. Numerous potential mentors cited lack of time, lack of knowledge about the mentoring process, and lack of confidence in assuming the mentoring role as reasons to avoid such involvement. A prime concern was managing or dealing with ‘challenging situations’, including problems of a personal nature. What was tried? The Faculty Development Committee of the McGill Faculty of Medicine developed a workshop designed to address some of the concerns about mentoring. Workshop participants were invited to take part in a study on the impact of the workshop on their knowledge of mentoring processes, as well as their confidence in their abilities as mentors. The workshop’s plenary presentation was designed to provide basic information on the process of mentoring, and to identify its benefits, as well as the roles and responsibilities of both mentors and mentees. Following the plenary presentation, participants (n = 41) worked in small groups and, drawing from case vignettes, identified potential mentoring challenges and possible solutions or management strategies. Subsequently, participants worked in pairs to discuss their mentoring
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
clinical practice: it enhanced awareness of their own limitations, promoted interprofessional collaboration, and reinforced the use of a systematic approach in assessing an acutely unwell patient. Five of the 28 facilitators further explored their interest in medical education by undertaking research projects in medical simulation. What lessons were learned? A near-peer simulation training programme for medical students, run by newly qualified doctors, can be beneficial for both parties. For medical students, it can enhance the development of both technical and non-technical skills prior to qualification. In junior doctors, it can contribute to postgraduate professional development, provide opportunities to practise skills that may often be reserved for more senior colleagues, and possibly motivate doctors to become involved in medical education at an earlier stage in their careers. REFERENCE 1 Qureshi Z, Ross M, Maxwell S, Rodrigues M, Parisinos C, Hall HN. Developing junior doctor-delivered teaching. Clin Teach 2013;10 (2):118–23. Correspondence: Marilina Antonelou, Department of Acute Medicine, Royal Free Hospital, Pond Street, London NW3 2QG, UK. Tel: 00 44 20 02077940500; E-mail: [email protected] doi: 10.1111/medu.12443
Faculty development of an OSCE in an internal medicine clerkship Marcelo Cruzeiro & Valdes Bollela What problems were addressed? At our institution, undergraduate internship used only a structured global assessment as a method of evaluating clinical competence. The faculty coordinators therefore proposed to implement a cognitive and competence assessment rating system to address current issues, although most faculty staff had no previous experience in performance assessment. What was tried? Faculty enablement workshops on the evaluation of clinical competence were held. These focused on the development of an objective structured clinical examination (OSCE) to give feedback to Year 5 undergraduate students of medicine. Weekly meetings were held over 7 months in which the participants discussed developing the OSCE, as well as a blueprint and the building of test stations. Our blueprint was based on a competence matrix which showed how
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
545
really good stuff each station should be constructed. We included five stations: blood pressure measurement; a patient with an unusual headache; a patient with marked indicators of dengue; a child with dehydration, and an instance of alcohol abuse. SurveyMonkey was used to administer two surveys in our institution prior to the implementation of the OSCE. The goal was to learn how students and teachers viewed the clinical competence evaluation and the current institutional assessment model. Students recognised that assessment is part of the teaching process and encourages medical study, but they had previously experienced badly elaborated tests. Teacher responses indicated that they felt assessments prepare students better and that the evaluation of clinical competence is essential. Teachers believe that assessments are formative and summative, and suggest that the former quality is the more important. Teachers viewed the clinical competence evaluation as an assessment of skills and performance. The OSCE performance assessment was implemented and included the provision of feedback to students over five stations. It was then re-implemented with 10 stations which involved 16 teachers (11 evaluators, two observers, two actors and a coordinator) and 19 students (10 actors and nine evaluators). Each station lasted 10 minutes, of which 8 minutes were devoted to evaluation and the provision of immediate feedback to students about performance. A further SurveyMonkey exercise was conducted after the OSCE. Students’ views following this survey were that the OSCE was extremely important to their development and was fundamental to their medical course. Students felt they should be encouraged to take part in this method of evaluation, although many of them disclosed much anxiety. The OSCE with feedback met their expectations and the consensus was that this new method of clinical competence evaluation should be implemented in the medical course. What lessons were learned? The OSCE with feedback is an important tool in the evaluation of clinical competence and is able to motivate teachers and students alike. Faculty staff recognised that the OSCE with feedback is helpful in the academic and professional development of undergraduate students. Faculty staff felt motivated to work with performance assessment and planned to include it as part of the faculty development programme. Each step of the development and implementation of the OSCE provided both faculty staff and students with opportunities to reflect about the learning process, the evaluation and the overall structure of their medical course.
546
Correspondence : Marcelo Cruzeiro, Department of Internal Medicine, Federal University of Juiz de Fora, Avenida Eug^enio Nascimento s/n, Juiz de Fora, Minas Gerais 3603-833, Brazil. Tel: 00 55 32 2102 3829; E-mail: [email protected] doi: 10.1111/medu.12472
Are mentors born or made? Michelle Elizov, Miriam Boillat & Peter J McLeod What problems were addressed? Mentorship has traditionally been conceptualised as a relationship wherein one person, often a more experienced and knowledgeable person (the mentor), guides another person (the mentee), by providing the instrumental and psychosocial support necessary for the achievement of the mentee’s goals.1 Mentorship can provide guidance for the introduction of new members into a group while facilitating their socialisation and providing a source of advice and emotional support. In health sciences environments, mentorship can also be a useful adjunct to other faculty development activities. During recent orientation workshops for new faculty members, we were surprised to discover that numerous participants reported having received limited or insufficient mentorship. To explore this disturbing revelation, we conducted a needs assessment with potential mentors who had expressed hesitation in taking on this role. Numerous potential mentors cited lack of time, lack of knowledge about the mentoring process, and lack of confidence in assuming the mentoring role as reasons to avoid such involvement. A prime concern was managing or dealing with ‘challenging situations’, including problems of a personal nature. What was tried? The Faculty Development Committee of the McGill Faculty of Medicine developed a workshop designed to address some of the concerns about mentoring. Workshop participants were invited to take part in a study on the impact of the workshop on their knowledge of mentoring processes, as well as their confidence in their abilities as mentors. The workshop’s plenary presentation was designed to provide basic information on the process of mentoring, and to identify its benefits, as well as the roles and responsibilities of both mentors and mentees. Following the plenary presentation, participants (n = 41) worked in small groups and, drawing from case vignettes, identified potential mentoring challenges and possible solutions or management strategies. Subsequently, participants worked in pairs to discuss their mentoring
ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 522–548
